Ontario Joins War on Pain Patients: Opioids, Stigma, and Human Rights




I used to start the day crying in the shower. The pain was so great that waking up and beginning to move was torture. So I sat in the shower, salty tears mixing with the fresh water. Every day.

And then my doctor gave me a prescription for opioids and the pain subsided. No longer did I start the day by dissolving in tears. Instead, I hummed in the shower, looking forward to my day.

I have used opioids for 12 years now and at no point have I been addicted or stoned. I take these medications for strong pain, which means they have something to do other than make me high. Namely control the pain so I can get on with my life. Because of these and other medications, I am able to be an active part of my family, nurture my friendships, volunteer in my community, and do the kind of work that enables me to pay taxes and feel that I am a productive member of society.

I’m not alone. For thousands of people who live with chronic pain, opioids are a literal lifesaver. Without them, they would not be able to live their lives, instead drowning in pain. Many would be suicidal.

The many ways of stigmatizing pain patients
And we are increasingly stigmatized. It is assumed that we are addicted. In a Toronto Star article about an opioid abuse survivor cycling across Canada to raise awareness, the reporter used the term opioid user in a context where they should have written opioid abuser or opioid addict. At best, it is lazy journalism. At worst it is an indication of how profound the stigma has become.

The doctors who prescribe these medications are viewed with suspicion and regulated so tightly that they have limited options for treating their patients. And the medication that controls our pain is becoming ever more restricted.

Case in point: in six months, the Ontario Drug Program will stop paying for certain high-dose opioids, in an attempt to reduce accidental overdoses and addiction. According to statements made by Ministry representatives, this will deal with the problem of “overprescribing” that contributes to addiction. 

Many of the articles about this piece of news included comments from the Ministry of Health, as well as addiction specialists. Only the Globe and Mail included a quick quote from a palliative care specialists, and followed up with a more in-depth article about the impact of this news on people who live with the kind of pain that warrants these kinds of medications. None of the others included the point of view of people who use these medications legitimately (Toronto Star, CBC, I’m looking at you. The Toronto Sun gets smacked, too, for belittling the concerns and needs of people who have chronic pain or receive palliative care).

Lazy journalism that colludes in creating stigma.


Real facts about opioid addiction potential
The fact that opioids inevitably cause addiction has become a truism. But guess what: it's not inevitable. One meta-study showed that when prescribed and taken correctly, opioids result in addiction in one quarter of one percent of cases (1). Another (Canadian) meta-study showed that when the sample included people who had previously been addicted — the biggest risk factor for addiction — rates rose to a whopping 3.3 percent (2).

In other words, when these medications are used correctly by physicians and patients, 97 percent or more do not become addicted.

And that’s the crux of the matter here. Correct usage. Prescribed correctly. Quotes from doctors and Ministry officials indicate that this policy change is designed to limit overprescribing by doctors, a legitimate problem.

The Ministry of Health had two options. One was to educate doctors so they know when and how it is appropriate to prescribe opioids, and so they can educate their patients on how to avoid overdose and addiction. The second option was to remove access to these medications for people who live with high levels of pain, or who may be receiving palliative care — the populations also more likely to require the Ontario Drug Plan.

Not surprisingly, they went for option two.

The Ontario Minister of Health calls it an “important first step” by Ontario’s Minister of Health. Clearly more changes will follow that further restrict access to the kinds of painkillers that have a potential for addiction, but also a great potential for enabling people who have high levels of pain to function, even enjoy their lives.

One such change could be the adoption of an opioid prescribing policy, such as thone much lauded one recently developed by British Columbia, which is based on the national prescribing policy in the US. These policies urge doctors to focus on non-medication treatment of pain and if stronger medication is required, to start on a low dose and only give patients a few days` supply.

Again — and really, do I have to say this? — the realities of living with high levels of pain are not considered at all. If you have the kind of health conditions that cause this kind of pain, non-medication treatment may be part of what you are doing for pain, but it does not take the place of medication. As well, coming back to your doctor after a couple of days is next to impossible. And, quite frankly, unreasonable. Likewise if you are taking opioids for palliative care.

Pain patients and human rights
And I could go on. In story after story after story, pain patients are ignored, excluded, and their needs dismissed. This level of repeated and concerted stigmatization of a group of people who have done absolutely nothing to deserve it is heinous. Restricting access to treatment results in those of us who live with these kinds of medical conditions being exposed to the kind of pain that can only be called torture. The kind of pain that make people take their own lives.

The Declaration of Montréal bit found that “pain management is inadequate in most of the world.” It declared that access to pain management is a fundamental human right.

Opioid addiction is a problem that needs to be addressed with a great deal of thought and understanding of the issues involved. Not by bulldozing across it, in the process trampling on the rights of people in pain to have that pain treated in the best possible way, a way that may include high doses of opioids.


References:
     (1)    M. Noble, et al., “Long-term opioid management for chronic noncancer pain,” Cochrane Database of Systematic Reviews 1 (January 20, 2010): CD006605.
     (2)   The National Opioid Use Guideline Group, Canadian Guideline for Safe and Effective Use of Opioids for Chronic Non-Cancer Pain (2010): 10.

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Comments

Rick said…
we are but one more group and reason to kick down the street. We have a difficult opioid issue in US, but I can almost guarantee it is not caused by people with Chronic Pain. Unfortunately, we are bearing the brunt of the issue and as far as I am concerned for no good reason.
This truly is shameful. Thank you for writing so eloquently about it. I am a hospice volunteer, and have had many clients on pain prescriptions. They must educate the doctors, not punish patients.
Anonymous said…
I believe that it is the doctors who should be responsible and accountable for properly prescribing a patient's pain management plan and medications that allow them to enjoy daily life in a way the rest of us take for granted. Is there anything we as individuals can do to stop this stigmatism and ensure doctor's maintain the ability to prescribe opiates based on their individual patients needs?