美国国家公共电台 NPR Patients With Chronic Pain Feel Caught In An Opioid Prescribing Debate

 

MICHEL MARTIN, HOST:

One more health story.

To fight the opioid crisis, states are limiting the number of opioid pills that doctors can prescribe. But that's led to fears of another kind of health crisis with legitimate¹ patients caught in the middle of it. Will Stone of member station KJZZ in Phoenix² reports.

WILL STONE, BYLINE³: It started with a rolled ankle during a routine training exercise. Shannon Hubbard never imagined it was the prologue⁴ to one of the most debilitating⁵ chronic⁶ pain conditions called complex regional pain syndrome⁷.

SHANNON HUBBARD: Basically makes my leg feel like it's on fire pretty much all the time. It spreads to different parts of your body.

STONE: The 47-year-old military veteran who lives outside Phoenix props⁸ up her swollen⁹ leg, careful not to graze it against the kitchen table. It's still scarred from an ulcer¹⁰ that landed her in the hospital a few months ago.

HUBBARD: That started in as a little blister¹¹, and four days later, it was, like, the size of a baseball.

STONE: Hubbard's disease causes the nervous system to go haywire, creating pain disproportionate to the actual injury. There's no cure. All you can do is treat the pain, an elusive¹² search that's left Hubbard with a bag of discarded pill bottles.

HUBBARD: And here is a sample of some of the drugs that I've tried over the last three years.

STONE: More than 60. But eventually, Hubbard did find one thing that helped, a combination of long- and short-acting opioids. She took that for nine months, until recently, when she was told her pain doctor was lowering the dose.

HUBBARD: They didn't indicate that there was any medical reason for cutting me back. It was simply the pressure because of the opioid rules going into effect.

STONE: Hubbard knew about those rules, part of Arizona's new opioid law, which limits the maximum dose most doctors can prescribe. But it wasn't supposed to affect her, an existing patient with chronic pain. She pushed back but with no success.

HUBBARD: The only thing that helps is the one thing they won't give you. So it's just frustrating¹³.

STONE: Hubbard's situation is not unique. Faced with skyrocketing drug overdoses, states are cracking down on opioid prescribing.

Arizona's Republican governor, Doug Ducey, declared the opioid crisis a public health emergency, and earlier this year, pushed through a broad law. At its signing, flanked by Democrats¹⁴ and Republicans, Ducey pledged...

(SOUNDBITE OF ARCHIVED RECORDING)

DOUG DUCEY: We will maintain access for chronic pain sufferers and others who rely on these drugs.

STONE: But doctors like Julian Grove¹⁵ say that's not how it's playing out.

JULIAN GROVE: Unfortunately, I've seen - I've heard from my colleagues - that there are patients who are not doing well.

STONE: Grove's a pain specialist and head of the Arizona Pain Society.

GROVE: Were finding a portion of patients have exceedingly difficult time who have been on decades on a stable pain management regimen and now been reduced.

STONE: He understands Arizona's law wasn't intended to force legitimate doctors to dial back opioids for legitimate patients. But there was already a lot of pressure. He says the new state rules only compounded that.

GROVE: The environment was changing at such a rapid pace - whether it was the federal government, Medicare guidelines, separate commercial guidelines - that the reduction of opioids - it made that more fast and furious.

STONE: In fact, the rate of opioid prescribing nationally is at its lowest in years. These days, more people are dying from illicit¹⁶ drugs like heroin¹⁷ and fentanyl than prescription¹⁸ opioids. In Arizona, only about one-third of overdoses in the past year involved just a prescription painkiller¹⁹.

Dr. Sally Satel, a psychiatrist²⁰ and fellow at the American Enterprise Institute, says the crackdown on prescribing has created fear. We spoke²¹ via Skype.

SALLY SATEL: It's a very, very unhealthy, deeply chilled environment in which doctors and patients who have chronic pain can no longer work together.

STONE: She worries the rush to stop prescribing will turn more people to illegal drugs.

GERALD HARRIS II: I've seen it already.

STONE: Dr. Gerald Harris II is a physician outside Phoenix who specializes in addiction²². He's getting more and more requests to evaluate pain patients for addiction. Many doctors don't want the risk of treating a patient on high doses of opioids, he says.

HARRIS: On the provider's side, I don't want to lose my livelihood²³. And on the patient's side is I don't want to lose the medicines that has been keeping me functional²⁴ for the last 10 years.

STONE: The head of Arizona's Health Department says doctors are still learning the rules but that patients should not be losing access to medicine. That isn't the case for Shannon Hubbard, though, now at a lower dose. Her pain is back.

HUBBARD: It just hurts. I don't want to walk. I don't want to - you know, pretty much don't want to do anything.

STONE: Except hold out hope for a change and try to wait out the pain.

For NPR News, I'm Will Stone in Phoenix.

1 legitimate   

adj.合法的，合理的，合乎逻辑的；v.使合法

参考例句：

• Sickness is a legitimate reason for asking for leave.生病是请假的一个正当的理由。
• That's a perfectly legitimate fear.怀有这种恐惧完全在情理之中。

2 phoenix   

n.凤凰，长生(不死)鸟；引申为重生

参考例句：

• The airline rose like a phoenix from the ashes.这家航空公司又起死回生了。
• The phoenix worship of China is fetish worship not totem adoration.中国凤崇拜是灵物崇拜而非图腾崇拜。

3 byline   

n.署名；v.署名

参考例句：

• His byline was absent as well.他的署名也不见了。
• We wish to thank the author of this article which carries no byline.我们要感谢这篇文章的那位没有署名的作者。

4 prologue   

n.开场白，序言；开端，序幕

参考例句：

• A poor wedding is a prologue to misery.不幸的婚姻是痛苦的开始。
• The prologue to the novel is written in the form of a newspaper account.这本小说的序言是以报纸报道的形式写的。

5 debilitating   

a.使衰弱的

参考例句：

• The debilitating disease made him too weak to work. 这个令他衰弱的病，使他弱到没有办法工作。
• You may soon leave one debilitating condition or relationship forever. 你即将永远地和这段霉运说拜拜了。

6 chronic   

adj.(疾病)长期未愈的，慢性的；极坏的

参考例句：

• Famine differs from chronic malnutrition.饥荒不同于慢性营养不良。
• Chronic poisoning may lead to death from inanition.慢性中毒也可能由虚弱导致死亡。

7 syndrome   

n.综合病症；并存特性

参考例句：

• The Institute says that an unidentified virus is to blame for the syndrome. 该研究所表示,引起这种综合症的是一种尚未确认的病毒。
• Results indicated that 11 fetuses had Down syndrome. 结果表明有11个胎儿患有唐氏综合征。

8 props   

小道具； 支柱( prop的名词复数 )； 支持者； 道具； （橄榄球中的）支柱前锋

参考例句：

• Rescuers used props to stop the roof of the tunnel collapsing. 救援人员用支柱防止隧道顶塌陷。
• The government props up the prices of farm products to support farmers' incomes. 政府保持农产品价格不变以保障农民们的收入。

9 swollen   

adj.肿大的，水涨的；v.使变大，肿胀

参考例句：

• Her legs had got swollen from standing up all day.因为整天站着，她的双腿已经肿了。
• A mosquito had bitten her and her arm had swollen up.蚊子叮了她，她的手臂肿起来了。

10 ulcer   

n.溃疡，腐坏物

参考例句：

• She had an ulcer in her mouth.她口腔出现溃疡。
• A bacterium is identified as the cause for his duodenal ulcer.一种细菌被断定为造成他十二指肠溃疡的根源。

11 blister   

n.水疱；(油漆等的)气泡；v.(使)起泡

参考例句：

• I got a huge blister on my foot and I couldn't run any farther.我脚上长了一个大水泡，没办法继续跑。
• I have a blister on my heel because my shoe is too tight.鞋子太紧了，我脚后跟起了个泡。

12 elusive   

adj.难以表达(捉摸)的；令人困惑的；逃避的

参考例句：

• Try to catch the elusive charm of the original in translation.翻译时设法把握住原文中难以捉摸的风韵。
• Interpol have searched all the corners of the earth for the elusive hijackers.国际刑警组织已在世界各地搜查在逃的飞机劫持者。

13 frustrating   

adj.产生挫折的，使人沮丧的，令人泄气的v.使不成功( frustrate的现在分词 )；挫败；使受挫折；令人沮丧

参考例句：

• It's frustrating to have to wait so long. 要等这么长时间，真令人懊恼。
• It was a demeaning and ultimately frustrating experience. 那是一次有失颜面并且令人沮丧至极的经历。 来自《简明英汉词典》

14 democrats   

n.民主主义者，民主人士( democrat的名词复数 )

参考例句：

• The Democrats held a pep rally on Capitol Hill yesterday. 民主党昨天在国会山召开了竞选誓师大会。
• The democrats organize a filibuster in the senate. 民主党党员组织了阻挠议事。 来自《简明英汉词典》

15 grove   

n.林子，小树林，园林

参考例句：

• On top of the hill was a grove of tall trees.山顶上一片高大的树林。
• The scent of lemons filled the grove.柠檬香味充满了小树林。

16 illicit   

adj.非法的，禁止的，不正当的

参考例句：

• He had an illicit association with Jane.他和简曾有过不正当关系。
• Seizures of illicit drugs have increased by 30% this year.今年违禁药品的扣押增长了30%。

17 heroin   

n.海洛因

参考例句：

• Customs have made their biggest ever seizure of heroin.海关查获了有史以来最大的一批海洛因。
• Heroin has been smuggled out by sea.海洛因已从海上偷运出境。

18 prescription   

n.处方，开药；指示，规定

参考例句：

• The physician made a prescription against sea- sickness for him.医生给他开了个治晕船的药方。
• The drug is available on prescription only.这种药只能凭处方购买。

19 painkiller   

n.止痛药

参考例句：

• I shall persuade him to take the painkiller.我将说服他把药吃下去。
• The painkiller only provides him a short respite from his pain.止痛药仅仅让他在疼痛中有短暂的疏解。

20 psychiatrist   

n.精神病专家；精神病医师

参考例句：

• He went to a psychiatrist about his compulsive gambling.他去看精神科医生治疗不能自拔的赌瘾。
• The psychiatrist corrected him gently.精神病医师彬彬有礼地纠正他。

21 spoke   

n.（车轮的）辐条；轮辐；破坏某人的计划；阻挠某人的行动 v.讲，谈（speak的过去式）；说；演说；从某种观点来说

参考例句：

• They sourced the spoke nuts from our company.他们的轮辐螺帽是从我们公司获得的。
• The spokes of a wheel are the bars that connect the outer ring to the centre.辐条是轮子上连接外圈与中心的条棒。

22 addiction   

n.上瘾入迷，嗜好

参考例句：

• He stole money from his parents to feed his addiction.他从父母那儿偷钱以满足自己的嗜好。
• Areas of drug dealing are hellholes of addiction,poverty and murder.贩卖毒品的地区往往是吸毒上瘾、贫困和发生谋杀的地方。

23 livelihood   

n.生计，谋生之道

参考例句：

• Appropriate arrangements will be made for their work and livelihood.他们的工作和生活会得到妥善安排。
• My father gained a bare livelihood of family by his own hands.父亲靠自己的双手勉强维持家计。

24 functional   

adj.为实用而设计的，具备功能的，起作用的

参考例句：

• The telephone was out of order,but is functional now.电话刚才坏了，但现在可以用了。
• The furniture is not fancy,just functional.这些家具不是摆着好看的，只是为了实用。