BY MARY BETH FOGLIA: For More Info, Go Here…
After the release of federal guidelines to curb opioid misuse, a patient is unable to obtain effective pain treatment and dies from complications.
The opioid crisis caused my sister to die prematurely, but not in the way one might suppose. She died not from indiscriminate prescribing or an overdose, but from the unintended effects of policy and practices aimed at ameliorating the opioid epidemic. She died because US policy created conditions in which clinicians felt they had few options but to deny her the very medicine that she believed had enabled her to live a life that was good enough.
Before my sister became sick, she was a force of nature. She had been an artist and creative director at a national greeting card company; she was insatiably curious about people; and she was known to orchestrate interior design projects on a shoestring, for friends and family alike. Then the setbacks be-gan: She was diagnosed with renal dis-ease, spent well over a decade on dialysis and overcame at least two bouts of sepsis and a failed kidney transplant. She also had later-stage osteoporosis and often experienced debilitating pain. She relied on long-term opioids—which her primary care clinician had prescribed—to live her life reasonably well, even with the relentless assault of chronic illness.
Then, in March 2016, the Centers for Disease Control and Prevention (CDC)published its voluntary Guideline for Prescribing Opioids for Chronic Pain. The recommendations were intended to assist primary care clinicians who were prescribing opioids for the management of chronic noncancer pain and to reduce opioid prescriptions and subsequent dependence, misuse, or other adverse events.
Though the guideline was well-intentioned and necessary, its implementation process was insufficient, accelerating and justifying actions on the part of clinicians, health systems, insurers, state legislators, law enforcement officials, and others that discouraged clinical flexibility and patient-centeredness and resulted in avoidable harm to some chronic pain patients. My sister was caught in this web. The primary care clinician who had initially prescribed opioids to her refused to refill her prescriptions, insisting that instead, she sought an appointment and ongoing care from a massively overwhelmed pain clinic.
My sister died at age fifty-five in September 2018, following complications from emergency surgery for a perforated colon. According to her surgeon, her condition was the result, in part, of taking over-the-counter nonsteroidal anti-inflammatory drugs (NSAIDs). When she could no longer obtain an opioid prescription, she increased her use of NSAIDs to try to lessen the crescendo of pain that left her virtually a prisoner in her home and sometimes bed. NSAIDs are known to carry an increased risk of adverse events such as gastrointestinal bleeding, ulceration, and perforation of the stomach or intestines, which can be fatal. The last two weeks of her life (and of my time with her) were spent in a surgical intensive care unit—a twilight zone of machines, alarms, harsh lights, and an unceasing parade of caregivers, which was the most uninhabitable and inhospitable place to die. But the care was unimpeachable, the nurses and doctors were kind, and her pain was competently managed.
