People living with chronic pain and the doctors who treat them have become victims of new policies in Florida intended to deal with the out-of-control prescription drug abuse crisis. While quick to prematurely declare victory in the war on drugs, policymakers have run roughshod over millions who deserve better: disabled, elderly and chronically ill people who live with pain.
Unquestionably, the abuse of prescription medications is a huge problem, and Florida has become a breeding ground for unscrupulous drug dealers masquerading as physicians, pharmacists and "patients." Their pervasiveness has led to suspicion of all prescribers as dealers and all patients as addicts. In an ill-conceived effort to right the wrongs brought by this scourge of prescription drug abuse, Florida policymakers have unintentionally stopped good pain care in its tracks.
Dramatically increased scrutiny from regulators and law enforcement means legitimate physicians and pharmacists fear being put out of business and even arrested for prescribing or dispensing medications to a drug dealer posing as a patient. Federal and local law enforcement agencies simultaneously have pressed to deliver results by taking the most direct and overly simplistic route: cutting off pain medication supplies. In this atmosphere of fearful providers and artificially short supplies of medications, people with pain who benefit from these medications are sometimes forced to drive hundreds of miles to find a doctor and visit dozens of pharmacies to get medication that will loosen the unrelenting grip of pain.
Last year, the Institute of Medicine issued the groundbreaking report "Relieving Pain in America: A Blueprint for Transforming Pain Prevention, Care, Education and Research." The report estimated that more than 100 million American adults live with chronic pain, translating to more than 5.5 million people in Florida. These are our neighbors who can't mow their lawn anymore; our co-workers who show up to work but miss deadlines and important meetings; our relatives who opt out of family events.
"Relieving Pain in America" details how our current treatment model for pain, a biomedical approach focused on medications, nerve blocks and steroid injections, has largely failed. The IOM report calls for a "cultural transformation" in the way pain is perceived, judged and treated. It defines the undertreatment of pain as a national challenge and asserts that there is a "moral imperative" to address it. "Relieving Pain in America" calls on governmental agencies, health care providers, professional organizations and patient advocacy groups to take the lead in this transformation.
The report calls for a new approach to pain management — a "biopsychosocial approach" — one that may include medications and interventionalist approaches but may also include diet, exercise, physical therapy, counseling, chiropractic care and other treatments. It acknowledges, too, that clinicians have not been taught how to manage chronic pain and that patients have been conditioned to expect a pill to "fix" everything.
Relieving pain and suffering is a fundamental duty of all those in the healing professions. State legislators, regulators and law enforcement agents are obligated to create and enforce fair and equitable policies and laws that protect the rights of their citizens and promote the well-being of all, especially the most vulnerable. While medical professionals and officials worry about protecting their reputations and livelihoods, patients have been shrugged off as an inconvenient afterthought that will sort itself out in time.
Left to live with physical and emotional anguish, their undue suffering has been chalked up to an "unintended consequence" of knee-jerk policy decisions based on heated emotion — not fact. Recent efforts to address prescription drug abuse have created an environment in which health care providers are being encouraged to walk away from their moral imperative to treat pain. How are policymakers fulfilling their obligation to reflect the interests of all of their constituents, including the millions who live with unrelenting daily pain?
There has never been a better time to work together to transform the way that we care for each other. "Relieving Pain in America" provides a unique road map and opportunity for all of those who are a part of the pain community — policymakers, patients, providers, pharmacists, insurance companies and others — to consider. Chronic pain patients should not be punished for the behavior of criminals. They should not become "collateral damage" in the war on drugs.
Lennie Duensing, far left, is executive director of the American Academy of Pain Management. Bob Twillman is director of policy and advocacy for the American Academy of Pain Management.