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

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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...

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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.