Treating cancer patients like criminals won't solve the opioid crisis

I am a 45-year-old woman who's always been in fairly good health. I practice yoga, run nine miles a week, lo...

Posted: Sep 5, 2018 6:28 PM
Updated: Sep 5, 2018 6:28 PM

I am a 45-year-old woman who's always been in fairly good health. I practice yoga, run nine miles a week, love kale, avoid red meat, generally get enough sleep and don't smoke cigarettes. I also have stage 3 colon cancer -- I was diagnosed a mere two months after the government's colonoscopy screening age recommendation was lowered from 50 to 45. I was surprised as anyone to find myself among the alarming recent rise in patients under 50 being diagnosed with colon cancer.

I got this diagnosis in western Pennsylvania, one of the epicenters of the opioid crisis raging in this country. The state ranks fourth-highest in the nation for drug overdose deaths (with two-thirds of the nationwide toll from prescription opioids fentanyl and oxycontin and from heroin). A new study from the University of Pittsburgh also finds this state to be the highest in the nation in unreported opioid deaths, meaning the statistics may be even higher than previously thought.

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Fighting an epidemic on this scale is, obviously, incredibly important. But it is also creating a terrifying new reality for patients facing painful medical procedures. When I woke up from laparoscopic surgery at Monroeville, Pennsylvania's Forbes Hospital to remove 6 inches of my colon and a pingpong ball-size tumor from my body, I entered into a medical system so frightened of the specter of addiction (and, I imagine, potential ensuing lawsuits) that treating what I know to be my legitimate pain during recovery became a distant afterthought.

Germophobe that I am, I walked into the hospital aspiring to leave the place as soon as humanly possible. When I asked nurses to take my catheter out after two days -- it was uncomfortable and complicated the multiple daily walks the surgeon had recommended -- they immediately also took away the dilaudid pain pump and saline IV I'd been administered post-surgery and put me on a low, 5 milligram-dose of the opioid Percocet instead. I soon found myself sobbing in bed, unable to walk and clutching my husband's hand, the pills not nearly strong enough to counter the crippling pain in my abdomen.

The hospital released me two days later with half the dosage of Percocet my nurse told me -- quietly, when no doctors were around -- was reasonable to treat a colon resection. I got into an argument (embarrassingly involving more tears, thanks to the pain) with the hospital doctor who wrote me the prescription. He shrugged and said they were pretty sure I wouldn't abuse the drugs but couldn't be totally sure.

He was -- in the most insulting way possible -- enforcing the new anti-opioid mandate from the Centers for Disease Control and Prevention: On March 15, 2016, the CDC introduced new limiting guidelines on the prescribing of opioids, designed to target primary care physicians who gave them out too carelessly and for too long to patients with chronic pain (defined as "pain lasting longer than three months or past the time of normal tissue healing"). The ensuing media hype around the guidelines, though, has turned "opioid" into a dirty word no matter what its context.

The guidelines do not include active cancer treatment, but what they meant for me, as someone who had been treated not (yet) by an oncologist but a surgeon, was this: I spent the next two weeks curled in a fetal position on my couch at home, my endlessly patient husband taking care of everything from keeping up our house to trying to get me to eat to responding constantly to emails, texts and calls from my anxious friends and family. When my husband and I asked -- no, let's be honest, begged -- the doctor's office to refill my prescription, I was subjected to multiple interrogations by nurses at the surgeon's office about my pain level.

In the language of pain management, it's all about the number on a scale from 1 to 10, which no one bothered to clarify to me beyond the illustrations on a chart displayed in the doctor's office of a face going from happy to miserable. It hardly seemed like enough of a precise diagnosis for what I was feeling. They reluctantly agreed to give me 15 more pills, which amounted to a few more days of treatment, running counter to their prediction that I would need two to six weeks of recovery time at home.

I know all about the dangers of opioids; it's hard to miss hearing about them in this part of the world. We have seen opioid addicts stumbling around our small town like the walking dead. We have heard the warnings about the rash of deaths from overdoses, about the way opioid addiction can lead people to turn to cheaper and deadlier heroin.

As for me, I took the pills they gave me only when needed -- and can't wait for the day I can get back to being able to walk more than a couple of blocks at a time. I am desperate to return to my job as a journalist. But to do so, I need my post-surgical pain to be treated adequately. When I'm seriously hurting, I cannot walk or eat, two of the main building blocks for recovery.

I'm not an addict; I'm a cancer patient. And I am shell-shocked from my experience with the current state of medical pain management thus far. (I have since begun chemotherapy, which will entail longer-term treatment but with less outright pain.) A couple of Advil or Tylenol is not enough to treat post-abdominal surgery pain in the first weeks afterward despite what my doctor's office blithely told me. When I met with my surgeon and his team for my two-week follow-up, I repeatedly mentioned I had been in a lot of pain and that over-the-counter medication was not helping. No one did anything other than shrug and move on to the next subject. (There is, relatedly, a mounting public outcry about women being systematically under-treated for pain and/or written off as neurotic hypochondriacs, but that is a rant for another time.)

Eventually, I was advised by an oncology therapist that I ought to contact a pain management clinic immediately. I did, and within two days had a prescription for the less-addictive painkiller Tramadol as well as a couple of other non-opioid meds. I think it bears asking why nobody at my surgeon's office told me about the existence of pain management clinics, or Tramadol. I am nothing if not tenacious (thanks, journalism background) -- and am lucky enough to have a wide network of well-connected friends who doggedly help me find what I need, treatment-wise. What about everyone out there who doesn't have these advantages? What are they going through, if they don't know the right questions to ask?

I am getting off relatively easy, with a prognosis that should have me up and around within months; it's patients who struggle with chronic and lifelong pain who are suffering the most. "Chronic pain patients and the groups that represent them say the escalating government response to opioid addiction ignores their need for the painkillers and doctors who will prescribe them, leaving some out of work, bedridden and even suicidal," USA Today reported in a recent story.

Out here, and I imagine in many other places around the country, the new treatment mantra for the gravely ill seems to be "Suck it up and put an ice pack on it." One editorial in an Allentown, Pennsylvania, newspaper quoted Dr. John Gallagher, chair of the Pennsylvania Medical Society's opioid task force, as icily saying that "any decrease in prescribing is to be celebrated." Regardless of the huge potential for needless suffering, the CDC continues to demonize opioid prescription across the board. As one addiction psychiatrist put it in Politico, "The myth (is) that the epidemic is driven by patients becoming addicted to doctor-prescribed opioids, or painkillers like hydrocodone (e.g., Vicodin) and oxycodone (e.g., Percocet)," when in reality, the problem is that "as more prescribed pills are diverted, opportunities arise for nonpatients to obtain them, abuse them, get addicted to them and die." The psychiatrist pointed out that, according to the Substance Abuse and Mental Health Services Administration, "among people who misused prescription pain relievers in 2013 and 2014, about half said that they obtained those pain relievers from a friend or relative, while only 22 percent said they received the drugs from their doctor."

As of right now, there's no end in sight to the current backlash against the humane treatment of pain that exceeds the reach of aspirin or Advil. So please, I urge everyone in your 40s and over, get a preventative colonoscopy. There's never been a good time to get colon cancer, but now might be one of the bleakest.

Mississippi Coronavirus Cases

Data is updated nightly.

Cases: 307836

Reported Deaths: 7119
CountyCasesDeaths
DeSoto20784248
Hinds19894408
Harrison17493302
Rankin13316275
Jackson13099243
Madison9896210
Lee9859169
Jones8293160
Forrest7523146
Lauderdale7189237
Lowndes6265144
Lamar610784
Lafayette6028117
Washington5280132
Bolivar4770129
Oktibbeha455297
Panola4442103
Pearl River4420139
Warren4281118
Marshall4273100
Pontotoc416472
Monroe4057132
Union403775
Neshoba3988176
Lincoln3871108
Hancock372185
Leflore3468124
Sunflower329389
Tate322781
Pike3181104
Scott310572
Yazoo304368
Alcorn297764
Itawamba296876
Copiah293065
Coahoma289677
Simpson287484
Tippah284868
Prentiss275659
Marion265979
Wayne261341
Leake261173
Grenada254982
Covington254580
Adams245982
Newton244859
George237847
Winston225981
Tishomingo222067
Jasper219748
Attala213373
Chickasaw204857
Holmes186471
Clay182454
Stone179131
Clarke176876
Tallahatchie175540
Calhoun163230
Yalobusha158836
Smith158634
Walthall130543
Greene129433
Lawrence126323
Noxubee125933
Montgomery125542
Perry125138
Carroll120826
Amite120141
Webster113432
Jefferson Davis105432
Tunica102525
Claiborne101330
Benton97225
Kemper95226
Humphreys94332
Franklin81923
Quitman78916
Choctaw72817
Jefferson64828
Wilkinson64727
Sharkey49617
Issaquena1686
Unassigned00

Alabama Coronavirus Cases

Cases: 519071

Reported Deaths: 10712
CountyCasesDeaths
Jefferson754131487
Mobile37774798
Madison33868494
Tuscaloosa25283443
Montgomery23969565
Shelby23112238
Baldwin20638300
Lee15524165
Calhoun14286311
Morgan14140268
Etowah13664345
Marshall11957219
Houston10383278
Elmore9994200
Limestone9814147
Cullman9475188
St. Clair9429234
Lauderdale9218227
DeKalb8747181
Talladega8060171
Walker7092275
Jackson6755110
Autauga6727103
Blount6488135
Colbert6205130
Coffee5401112
Dale4768110
Russell428938
Franklin419982
Chilton4083109
Covington4053114
Tallapoosa3893146
Escambia388074
Dallas3527149
Chambers3500122
Clarke346360
Marion3066100
Pike305875
Lawrence295395
Winston272372
Bibb256458
Marengo248661
Geneva245875
Pickens232959
Barbour224955
Hale218775
Butler212366
Fayette208960
Henry187844
Cherokee182044
Randolph176941
Monroe171540
Washington164038
Macon154848
Clay149454
Crenshaw149357
Cleburne146041
Lamar139334
Lowndes136453
Wilcox124327
Bullock121340
Conecuh109028
Perry107926
Sumter102932
Coosa99328
Greene90734
Choctaw58724
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