Mon December 2, 2013
'I Just Want To Manage My Life': Painkiller Law Leaves Some Patients Behind
Theresa Young, a cancer survivor, could watch the birds outside her Renton apartment for hours. It brings her peace, she says.
The birds line up, one at a time, for their turn to duck into a hole to feed from an amazingly squirrel-proof trough.
Young was diagnosed with cancer in 1997. She had reconstructive surgery, but it was unsuccessful and left her with severe, neuropathic pain from nerve damage.
She took opiates to manage the pain and developed a tolerance to the drugs. For more than a decade, she took increasing doses of opiates.
Then, a surprise. By email, her doctor said the pain management clinic was dropping her. She and five other patients would have to find a new doctor.
“And that was that,” Young said.
Elsewhere in Washington state, thousands of pain patients, many on Medicaid, were getting the same message from their doctors. The state had implemented what remains the nation’s most strict law on prescribing pain meds, a response to a staggering statistic: In 2010, the number of people who died of prescription opiate overdoses outpaced car deaths in state.
It’s been a nearly year since the law was implemented, and prescribing is down, as are overdose deaths. Other states are following Washington’s lead. Indiana, New Jersey, Oklahoma, Tennessee and Ohio are considering or have passed similar dosing guidelines on prescribing opiates.
But the law has left patients scrambling for new providers, and doctors who treat chronic pain have been inundated with new patients.
Young said she called 30 doctors before finding one who would accept her as a patient.
Dr. Patty Read-Williams, who works at the UW Neighborhood Clinic in Issaquah, said the uptick in new patients has strained resources.
“We had people when it first started who came from Aberdeen, Wenatchee, Ellensburg – all over the state,” she said. Read-Williams, a family physician for 26 years, said they had to restrict access.
“We only take care of patients whose counties actually touch King County, in order to actually be able to take care of all those patients,” she said.
Read-Williams said the law has empowered some physicians to work with patients to come up with other ways to deal with their chronic pain, like yoga, acupuncture and massage. She said some of these alternative medicines make a big difference for patients simply by giving them more hands-on therapy.
“And we actually have a physician who does acupuncture at our Factoria clinic,” she said. “I think he’s been filled since the day he got there. But we can’t use him for Medicaid patients.”
That leaves Medicaid patients like Young with few options.
Dr. Dan Lesser, the chief health care officer at the Washington State Health Care Authority, said the pain management law was a good first step, but more could have been done to serve patients.
“We need to undertake additional efforts to improve how we manage the care of people with chronic pain,” he said.
Lessler believes that providing good pain care involves a multidimensional approach.
At Read-Williams’ clinic, they recently ran a pilot program for some of the clinic’s toughest pain management cases.
Between appointments, a nurse followed up with patients by phone. According to Read-Williams, they asked: “What kind of goals have you set for yourself? Are you out walking around? Did you go to the pool this week? How are we doing with lowering that medication?”
The patients also worked with a psychologist.
It made a difference. Some patients were more willing to lower their dosage and try other medications. They reported they were thinking more clearly and felt more in control.
Read-Williams said it also revealed that many chronic pain patients are isolated and face hidden barriers. A patient might not want to go for a walk, for example, because going out meant suffering down three flights of stairs.
But the pilot proved expensive and time consuming and ultimately wasn’t adopted.
Back at her Renton apartment, Theresa Young said pain specialists have suggested she undergo surgery to implant a spinal cord stimulator to help control her pain. But her first experience left her leery of more surgery.
On some days, she takes more medication than she’s supposed to, leaving her short at the end of the month.
She said she vacillates between feeling like a criminal and a victim.
“I don’t expect myself, and I don’t think most chronic pain patients expect to be completely out of pain,” she said. “That’s not what I’m looking for. I just want to manage my life, take care of myself and be independent.”
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