Effort to curb opioids alarms pain patients

Since Chereese Ferreira’s pain medications were cut by 70 percent over the past few years she says her ability to walk, work and function normally has been significantly diminished.

She is among the chronic pain patients caught in the middle of a nationwide effort to reduce prescription opioids in the community as health officials seek to curb drug overdoses, the leading cause of injury-related deaths in Hawaii.

“I lost 45 pounds. I don’t sleep. I don’t eat right. (There’s) pain, lots of pain,” since her medications were tapered down by her physician following 2016 guidelines by the Centers for Disease Control and Prevention limiting opioid prescriptions, she said. She said she’s lived with complex regional pain syndrome, scoliosis and other issues since 2001. “They treat you like criminals. They treat us like drug addicts.”

Ferreira, who uses a wheelchair, joined a half dozen others this week at a rally at the state Capitol, one of 80 similar “Don’t Punish Pain” events across the nation.

Opioid prescriptions have decreased significantly between 2014 and 2015. There were about 717,000 opioid prescriptions in Hawaii in 2014, compared with 646,000 in 2015, a decrease of about 71,000, according to CDC data.

It’s the law

Hawaii law limits chronic pain patients to a 30-days-at-a-time prescription limit, while guidelines by the CDC for primary care physicians limit the dosage to no more than 90 morphine milligram equivalents.

The limits on prescription drugs are resulting in situations where many say their pain is not being controlled.

“They’re making chronic pain patients have to go to the black market to get medication. That’s when they’re running into the people making tablets out of fentanyl from China,” said Carmen Mitsuyasu-Gapero, who’s been on opioids since 2005 for severe back pain and osteoarthritis in her hands, knees and feet. “The doctors can’t prescribe what patients really need so it’s forcing them to either commit suicide or go to the black market and then you have no idea what they’re going to get and then that’s increasing the overdose rate.”

Mitsuyasu-Gapero said through the years she has lost weight, exercised and tried to live a healthier lifestyle but “opiates are part of my routine.”

“It allows me to function. That’s what it is — quality of life,” she said. “It allows us to get up and do our laundry, do our grocery shopping. It might take us all week to do it but it still lets us to function a somewhat normal life.”

No power

Some doctors say they no longer have the power to prescribe what patients need because insurance companies and pharmacies, citing the guidelines, restrict the practice of medicine.

“They came up with arbitrary numbers that says you should not go above this level. The insurance companies look at the guidelines and say we’re not going to pay for anything that exceeds these doses,” said Honolulu pain specialist Dr. Jeffrey Wang, adding that the perception that doctors are overprescribing pain medication and “that must be the reason why there’s more deaths” is misplaced.

“I’ve had patients who have been on the same dose of narcotics for 10 years functioning at work with no problem. I get letters every day from insurance companies and pharmacies saying that these are exceeding (the guidelines), you have to watch this. Basically you’re punishing pain patients for a lot of illegal use.”

He argues that “quality of life is worse” for his patients whose “pain is going up” as more pressure is put on drug companies and the health care industry to limit the distribution of highly addictive opioids.

National drug cuts

The U.S. Department of Justice and U.S. Drug Enforcement Administration are seeking to reduce the amount of narcotics produced in 2019 as part of President Donald Trump’s plan to “cut nationwide opioid prescription fills by one-third within three years.” The plan decreases by about 10 percent production of the most frequently misused opioids — including oxycodone, hydrocodone, oxymorphone, hydromorphone, morphine and fentanyl.

“So now it’s getting harder to even find the medications. Some patients have actually gone to six, seven pharmacies to fill their prescriptions because there’s not enough supply … and still they’re unable to find it sometimes,” said Wang, who has about 1,000 patients in his practice. “It also doesn’t help when the Legislature starts making laws about how much you can prescribe and how much you cannot prescribe. Even this past hurricane Gov. David Ige was on television telling everybody to get two extra weeks of emergency medicine. That’s fine for non-narcotic medicine but what do you do when they limit narcotics to 30 days at a time?”

Eddie Mersereau, chief of the state Health Department’s Alcohol and Drug Abuse Division and part of Ige’s opioid task force, said the state needs balanced policies to address the “opioid crisis.”

“People become addicted pretty easily to opioids,” Mersereau said. “But on the flip side, we have to be balanced in our perspective. Chronic pain is a very real issue. Personally I don’t believe in demonizing or pedestalizing any substance. We need to look at how we’re going to address the risk of addiction and overdose and not penalize people who validly can and should be on medication.”