The crackdown on opioid prescriptions is leaving chronic pain patients in limbo
Jenny Rellick was born with spinal muscular atrophy, a degenerative disease that causes muscles to waste away. Eight years ago, she was facing pain so severe that her doctors put her on a high-dosage regimen of two different kinds of opioids. One is a long-acting, time-released opioid called Kadian that delivers 100 milligrams of morphine or its equivalent (MME) throughout the day. The other is a short-acting dose of oxycodone, which she takes in 15 MME increments as needed. Today Rellick, 46, takes anywhere from 175 to 190 MME of these painkillers daily.
“Opioids give [her] the ability to think about something other than pain,’” said Ashley Carr, Rellick’s caregiver. (Rellick had a tracheotomy, which makes it difficult for her to speak, and Carr often helps translate for her.) “But that does not mean she is pain-free. Even on opioids, she is constantly in pain, but opioids reduce it enough that it’s not a constant thought.”
But Rellick, who lives in Alexandria, Virginia, may no longer be able to get the medication she’s become dependent on. Recently, her primary care physician decided she would only write one-time prescriptions for opioids for up to 30 days. Other pain specialists Rellick has seen have said they would cut her daily dose in half.
“If I have to cut down 50 percent, it won’t help my pain enough to warrant the side effects,” Rellick told me in an email.
Increasingly, chronic pain patients like Rellick who take high doses of opioids daily are confronting new restrictions on the strength of opioids or length of prescriptions that doctors can give. The aim of these new measures being implemented throughout the health care system is to curb the epidemic of opioid addiction and overdoses. (More than 22,000 overdose deaths in 2015 involved prescription opioids.)
But they’re creating a new conundrum: what to do about patients like Rellick who could be hurt by big cuts in their dosage.
“People have been on these high [opioid] doses for years, and [if] all of a sudden they’re reduced within a day, the potential unintended consequences are huge,” said Chinazo Cunningham, a professor of internal medicine at Albert Einstein College of Medicine who helped review the 2016 Centers for Disease Control and Prevention guidelines on opioid prescriptions.