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: 468498

Reported Deaths: 9100
CountyCasesDeaths
Harrison31907468
Hinds30552569
DeSoto29532342
Jackson22868335
Rankin21016355
Lee14393214
Madison13961263
Jones13053215
Forrest12879231
Lauderdale11244292
Lowndes10148171
Lamar9972122
Pearl River8569208
Lafayette8008136
Hancock7110107
Oktibbeha6764117
Washington6756146
Neshoba6350200
Monroe6304156
Warren6267159
Panola6036122
Pontotoc599292
Bolivar5960143
Marshall5917115
Union558885
Pike5424133
Lincoln5192127
Alcorn509388
George454766
Scott447392
Leflore4377138
Tippah431780
Itawamba429192
Prentiss429074
Copiah423883
Simpson4238108
Wayne419663
Tate418999
Adams4174109
Yazoo411486
Sunflower4057104
Covington404891
Marion399699
Leake389784
Coahoma385996
Newton360273
Grenada3489100
Stone342657
Tishomingo320987
Attala318285
Jasper308261
Winston298191
Clay282672
Chickasaw277464
Clarke271784
Holmes257685
Calhoun256939
Smith241546
Yalobusha215447
Tallahatchie213849
Walthall203457
Lawrence202431
Greene202045
Perry195053
Amite191251
Webster191141
Noxubee173437
Montgomery168652
Jefferson Davis164041
Carroll158936
Tunica146533
Benton137531
Kemper136538
Claiborne124134
Choctaw123824
Humphreys122036
Franklin114127
Quitman100925
Wilkinson98335
Jefferson85832
Sharkey61620
Issaquena1916
Unassigned00

Alabama Coronavirus Cases

Cases: 757893

Reported Deaths: 12784
CountyCasesDeaths
Jefferson1082301712
Mobile694251158
Madison47738562
Baldwin35347420
Shelby34758281
Tuscaloosa32576495
Montgomery32249645
Lee21576200
Calhoun19621363
Morgan19061307
Etowah18363413
Marshall17028252
Houston15881337
St. Clair14724270
Limestone13908178
Elmore13812239
Cullman13756228
Lauderdale12909263
Talladega12124200
DeKalb11705220
Walker10047303
Autauga9371119
Blount9272146
Jackson8970132
Coffee8550150
Colbert8229160
Dale8162142
Escambia632298
Tallapoosa6255165
Covington6214153
Chilton6152128
Russell586753
Franklin558292
Chambers5155127
Dallas4569173
Marion4490114
Clarke447070
Pike439188
Geneva415999
Lawrence4002101
Winston399982
Bibb388975
Barbour334667
Marengo317778
Monroe306844
Butler305878
Pickens296166
Henry288550
Randolph288255
Hale282981
Cherokee275649
Fayette268569
Washington241844
Crenshaw226962
Clay219260
Macon211154
Cleburne205746
Lamar184638
Conecuh173337
Lowndes167856
Coosa160031
Wilcox153033
Bullock145642
Perry132430
Sumter122635
Greene117941
Choctaw71925
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Columbus
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The combo of a no named front and former tropical system Nicholas' leftovers will continue leave us with some pretty decent chances for some showers and thunderstorms over the next several days.
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