When it comes to curbing opioid addiction, the cure can be worse than the condition.
A researcher at the University of Virginia says she believes many patients with chronic conditions are needlessly suffering with pain because of measures aimed at reducing the risk of opioid addiction.
Virginia LeBaron, an assistant professor at UVa’s School of Nursing, has received a $40,000 grant from the UVa Cancer Center to study what she calls the “concurrent epidemics” of opioid abuse and chronic pain caused by terminal illnesses or severe injuries.
LeBaron said she became interested in the problem while working as an oncology nurse.
“As a clinician, I had many patients suffering in pain in part because they couldn’t obtain the medicine they needed,” she said.
But care providers who prescribe these medications also have to worry about contributing to the epidemic of opioid abuse. Last year, prescription drugs accounted for nearly two-thirds of Virginia’s 882 opiate overdose deaths, according to the state Office of the Chief Medical Examiner.
New guidelines at the state and federal levels were written to combat the abuse of prescription drugs such as fentanyl and oxycodone. In March, the Centers for Disease Control and Prevention issued guidelines advising health care providers to minimize — and, if possible, avoid — prescribing these drugs and to perform urine tests on patients to ensure the drugs are being used properly.
In April, the Virginia Hospital and Healthcare Association issued its own guidelines for the use of such drugs in emergency rooms.
But some patient advocates worry the slew of guidelines could hurt patients. It is not yet clear how Virginia has been affected, but patients in other states are reporting problems.
Media reports in Montana draw attention to the plight of so-called “pain refugees” — hundreds of patients with chronic conditions who regularly fly to California to get pain relief medications since the state tightened restrictions on prescribing opioids. Patients in Massachusetts have complained their doctors have been more hesitant to prescribe medications they’ve received for years after the CDC released its guidelines.
The guidelines are not backed by any laws, but they’ve had a chilling effect on health care providers, said Aaron Gilson, who works at the Pain and Policy Studies Group at the University of Wisconsin-Madison. Many of these providers are taking a very strict interpretation of the guidelines out of fear of lawsuits or medical malpractice charges, Gilson said. They’re playing it safe, but in some cases, they could be subjecting their patients needlessly to pain.
“Medical practice is very patient specific — what works with one patient may not work with another,” Gilson said. “The way it’s perceived, practitioners are interpreting this guideline as a hard line dosage that can’t be passed.”
LeBaron’s project will examine the impact of these policies by looking at two different sets of data: markers of access to opioids — including the number of prescriptions written in a given area and the number of providers allowed to prescribe the drugs — and markers of opioid abuse, including emergency room admissions and overdose deaths.
LeBaron said she wants to know whether there’s any evidence the guidelines have cut down on the number of opioid deaths and overdoses, and whether there’s evidence that they have cut off access for patients who may need them. She said she’s particularly interested in rural Southwest Virginia, which has high rates of cancer deaths, opioid prescriptions and opioid abuse.
“Policies really need to be informed by data,” she said.
The final product, which LeBaron hopes to have ready by this spring, will be an interactive map showing how these problems affect different parts of the state.
The project has captured the attention of Dr. William A. Hazel, Virginia’s secretary of health and human services. Opioid addiction is a high priority for Hazel’s office, which is studying the problem in depth and looking for ways to cut down on the number of overdose deaths.
Hazel said he believes the inquiry will dig up evidence of both undertreatment and overprescription. He said he doesn’t know which is more common, but has seen anecdotal evidence that many of these drugs are going unused.
“I can tell you there are too many free pills floating around in the world,” Hazel said. “If there are pills for sale in a black market — which there are — there are too many pills out there.”
Hazel, an orthopedic physician by training, said a cultural shift may be in order. Providers should look more closely at alternative treatments that carry less risk, he said, or use a multidisciplinary approach that combines rehabilitative treatment with lower dosages.
“I’m not trying to say there’s no place for it,” he said. “But I do think we’ve got to look at the whole issue of pain and suffering in a different way.”