Until the summer of 2017, Haller said, her husband's pain was managed through a combination of extended-release Opana -- a prescription opioid painkiller -- and generic oxymorphone, another opioid. The medicines helped him manage a diagnosis of fibromyalgia and searing pain in his side that started four years after a kidney surgery in 1997.
"He said it's like taking a lightbulb that's been on and shoving it inside of you," Haller said. "That's how bad the burning is."
The medication, taken under the supervision of a pain management specialist, allowed him to retain a relatively normal quality of life. But in July, the
Haller said that her husband was then switched to methadone, one of the only opioids that
If her husband's doctor agreed to prescribe more than that amount, the couple would need to pay the difference out of pocket, something Haller estimated would cost around
Her husband, already reeling from the earlier reductions, now faces the prospect of taking more than four times less medication than his doctor originally recommended. And Haller, a part-time professional caregiver, has worries of her own.
In an effort to dull his pain, she said, her husband has started to self-medicate with alcohol when he's alone at the house. He's also gone from working 60 hours a week to 25 or fewer, a shortfall that her own salary won't cover.
"If they're cutting him back all the way to this, he's not going to be able to function," Haller said. "We're going to lose the house that we've been in for 20 years. Everything that we worked hard for. I want to yell at the insurance company and say, 'Why don't you go ahead and give me the money for his cremation?' Because with these pain patients, they're cutting them back so bad that they're going to want to kill themselves."
NEW LIMITS ON OPIOIDS
Amid the panic surrounding the opioid crisis in America, Haller and her husband are part of what they feel is an underrepresented community -- chronic pain patients whose treatment is increasingly affected by new regulations on prescription painkillers.
Leading the charge are insurance companies, pharmacies and the
The effects of the new guidelines were far-reaching. In
A seven-day supply for new prescriptions, as well as limits on daily dosage, are now the industry standard for many major pharmacies and private health insurance companies. CVS,
Even the state of
Corporations largely frame the new policies as a matter of safety, shaped by
All four companies pointed out the need to prevent medication abuse among customers.
"We recognize that there are patients with a legitimate need for pain medication, and our approach is carefully designed to ensure that those patients can access their medication in an appropriate manner," said CVS spokeswoman
But for many
Her prescription is electronic -- which many pharmacies and insurers now require for easier opioid monitoring -- and can't be transferred to other stores or branches. So, Walker, who doesn't use a car, took public transit all the way to her doctor's office in
Later that day, many pharmacies refused to tell her over the phone whether they had the medication in stock. A pharmacist at a local Wal-Mart said that doing so would be against the company's policy. Walker said she heard the same thing from a nearby
A Giant pharmacy in
All in all, Walker said, she visited more than half a dozen different pharmacies in an effort to fill her prescription.
"And when you're handicapped, trying to get in and out of a car and walk in everywhere because they won't tell you over the phone -- that's a huge problem for me," Walker said. "When you can hardly walk and you're in and out of 10 different places."
Walker also struggled at the beginning of the year when her insurance company told her it would require prior authorization before covering a new prescription. She applied for the approval, but the company also refused to cover a seven-day emergency supply while she waited.
Luckily, Walker said, she was able to pay for the drugs out of pocket. But her recent experiences have made her fearful that restrictions on opioid painkillers will continue to grow tighter.
She relies on the medication after a traumatic car crash in 2015, which stripped the skin from her lower left leg and fractured her back in five places. Even with the help of pharmaceuticals, Walker said, there's never a moment of the day when she isn't in pain. Without the drugs, her experience is unbearable.
"I wouldn't wish this pain on anyone," Walker said. "Compared to what I feel now, having a baby is a walk on the beach. And I'm afraid of the amount of pain I could feel, because I know what it's like when I don't take anything at all."
A lack of empathy on the part of federal health officials is driving a growing fear within the chronic pain community, added
A former ambassador for the
When access to those opioids is restricted, Boettcher said, it has a crippling effect on patients whose symptoms aren't relieved by alternative treatments. Her own prescription has already been cut down from a 60-day supply to a 20-day supply, and her own health has suffered as a result.
"I've had less pain relief because I'm trying to take less medication to make it last longer," she said. "To get through to the next time when I can get a refill. I've already had to give up a lot of things because of this pain. And I just think that if it got to the point where I couldn't get my medicine -- I don't know. I probably wouldn't be able to do much at all."
IMPACT ON THE INDUSTRY
Recent restrictions on opioid medications have also affected physicians. Many primary care doctors have grown increasingly leery of prescribing the medications, pushing more patients into the hands of specialists.
"A lot of patients have been relying on medication through their primary care for years, and now they're impacted because those doctors can't do any pain management," said
"I think there is somewhat of a misperception surrounding that," he said over the phone. "Certainly, among my pain patients, most are not even using opioids. And the ones who are have failed at other therapies and would otherwise have a low quality of life and high levels of pain."
The problem, Christo said, is that long-term pain management patients are not among those who are likely to abuse narcotic painkillers. Most have extremely high levels of discomfort and are too worried about being cut off from their medication to abuse or divert it.
The vast majority of pain management centers also subject their patients to various control methods, including urinalysis and scrutiny through the state's prescription drug monitoring program.
"I can see why they're putting these regulations in place," Christo said. "But at the same time, for those who need it, it's a major inconvenience. It also sort of undermines the trust that would exist between me and a patient and my own clinical judgment. What if I understand, based off my own training, that a month's worth of opioids are appropriate? Well, I wouldn't be able to prescribe that because of the regulations. And those regulations are fairly impersonal."
Umbrella policies on the part of insurance companies can also place more of the burden on pharmacies, said
Shorter prescription times also require patients to go to the doctor more frequently and think ahead to make sure their medication doesn't run out, Merritt added.
"What happens if they can't get a doctor's appointment, or life happens and they just can't get in to see them that month?" Merritt said. "What if the pharmacy doesn't have that medication in stock on the day a patient needs them? We end up as the ones who have to explain those requirements. It's making us be the enforcers of the policy, which is kind of difficult to do when our bottom line is to treat the patients and give them access to the medication they need."
(c)2018 The Frederick News-Post (Frederick, Md.)
Visit The Frederick News-Post (Frederick, Md.) at www.fredericknewspost.com
Distributed by Tribune Content Agency, LLC.