Tuesday, September 10, 2019

Opioid crackdown forces pain patients to taper off drugs they say they need

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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