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| Hank Skinner and his wife, Carol, are no strangers to pain, having collectively experienced multiple illnesses and surgeries. Hank relies on a fentanyl patch but is now being forced to lower his dosage. (Salwan Georges/The Washington Post) |
By Joel Achenbach
Carol and Hank Skinner of Alexandria, Va., can talk about pain all day long.
Carol,
77, once had so much pain in her right hip and so little satisfaction
with medical treatment she vowed to stay in bed until she died.
Hank,
79, has had seven shoulder surgeries, lung cancer, open-heart surgery, a
blown-out knee and lifelong complications from a clubfoot. He has a
fentanyl patch on his belly to treat his chronic shoulder pain. He
replaces the patch every three days, supplementing the slow-release
fentanyl with pills containing hydrocodone.
But
to the Skinners’ dismay, Hank is now going through what is known as a
forced taper. That’s when a chronic pain patient has to switch to a
lower dosage of medication. His doctor, Hank says, has cut his fentanyl
dosage by 50 percent — and Hank’s not happy about it. He already
struggles to sleep through the night, as Carol can attest.
“He’s moaning, he’s groaning, he’s yelling out in pain,” Carol says.
“Why am I being singled out? I took it as prescribed. I didn’t abuse it,” Hank says.
He
is part of a sweeping change in chronic pain management — the tapering
of millions of patients who have been relying, in many case for years,
on high doses of opioids. With close to 70,000 people in the U.S. dying
every year from drug overdoses, and prescription opioids blamed for helping ignite this national catastrophe, the medical community has grown wary about the use of these painkillers.
Chronic
pain patients form a vast constituency in America and millions of them
take opioids for relief. Changes in medical guidance covering opioids
have left many of them frustrated, confused and sometimes howling mad.
They feel demonized and yanked around.
Hank Skinner has been tapered gradually over the
course of the year. The situation is worse for people forced to cut back
their medication too quickly. Even medical experts who advocate a major
reduction in the use of opioids for chronic pain have warned that
rapid, involuntary tapering could harm patients who are dependent on
these drugs.
There is little doubt among medical experts that opioids
have been prescribed at unsound and dangerous levels, particularly in
their misuse for chronic pain. But at this point there’s no easy way to
dial those dosages back. Long-term use of opioids creates dependency. Tapering can cause extreme pain from drug withdrawal, regardless of the underlying ailment.
The
United States is now in the midst of a “national experiment” as
misguided as the one it conducted 20 years ago, when doctors put
millions of patients on opioids with little understanding of the
consequences, says Tami Mark, senior director of behavioral health
financing and quality measurement for RTI International, a North
Carolina think tank. She has conducted one of the few formal studies of
“forced tapering” of opioid patients.
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