Column: Opioids treat real pain; don’t limit doctors
‘Please help me!” The panicked pleas of my wife (then girlfriend) ripped through the air as she implored the doctor. We had been dating only a few months when I received a text that she was heading to the emergency room.
I knew that she suffered from chronic pain, but nothing prepared me for the scene I encountered. Her body slightly swayed on the bed as she laid on her side. She continued clutching her knees to her chest in an attempt to mitigate the abdominal pain.
In the other corner of the room stood the doctor. He stared away from the bed at a monitor in silence, his face expressionless as my wife’s pleas continued.
It was as if she wasn’t in the room.
My appearance in the doorway startled him. He looked up and introduced himself. He explained that my wife was “complaining” about pain, and they would “try” to address it. Then, in a surprisingly blunt sequitur, he mentioned that addicts often come to the emergency room looking for opioids.
I knew enough about my wife’s condition to recognize something had gone wrong with the nerve block procedure she received earlier. A skiing accident roughly 15 years ago had resulted in a damaged nerve. She tried everything to treat her chronic pain, including visiting the Mayo Clinic, Cleveland Clinic and University of Michigan. After attempting over 40 medications and multiple procedures, the only effective regimen was a complicated treatment plan that, unfortunately, included opioids.
So we sat in the emergency room for hours, both of us pleading for sufficient medications to abate the pain. The doctor finally agreed to increase the dosage of opioids. It was still a fraction of her usual regimen, but it was enough to get her home until her pain doctor’s office opened on Monday.
I was shocked by the experience. But perhaps I shouldn’t have been. Every day we see headlines describing the opioid epidemic sweeping our nation. The articles are filled with stories of accidental overdoses, corrupt doctors and addicts caught in a vicious cycle of abuse.
But what about the millions of Americans for whom opioids are medically necessary after all other treatments fail and who do not exhibit signs of abuse?
It’s as if they aren’t in the room.
We aren’t listening to their pleas. For example, a bill was recently introduced in the Michigan House of Representatives, HB 4601, that would put absolute limits on the dosages chronic pain patients may receive. The patient’s medical history, condition or absence of evidence of addiction is all irrelevant. Instead, the government would mandate that no doctor may prescribe opioids to a chronic pain patient exceeding 100 morphine milligram equivalents per day. No matter what.
Dosages can affect people differently. For example, if HB 4601 was law, my wife would be immobilized due to her severe abdominal pain.
I am proud to say that the Oakland County Board of Commissioners has taken a stand against this draconian proposal.
The board unanimously passed a resolution finding that HB 4601 “infringes on a doctor’s ability to care for patients by substituting the Legislature’s opinion for the opinion of individual medical professionals.” The board further advocated a balanced approach “that specifically targets addiction and abuse while protecting the rights of patients for whom these prescriptions are medically necessary.”
Government can and must take a role combatting the opioid epidemic. Too many are dying from the abuse of painkillers. But we don’t have to sacrifice one group to save another. We can protect lives without swinging the pendulum of thoughtless regulation.
Balance is hard. It’s why we often resort to the tired wars of “big government” versus “small government.” But if we started focusing more on “smart government,” we wouldn’t get legislation such as HB 4601. We would start tailoring laws to address societal harm and avoid legislative dragnets that sound good in headlines but bring collateral damage to too many citizens.
Wholesale slashing of dosages without effective alternative treatments is cruel. It is government at its worst. We can do better for chronic pain patients who rely on opioids after all other options have failed.
They are in the room. And we must start listening.
Adam Kochenderfer is an Oakland County commissioner and attorney.