“Comfortably Dumb”
I am a middle-aged man, newly retired Special Education teacher, husband to a beautiful woman and mother, father to an incredible teenager — and I have cancer. Some people call me a “survivor”, but I do not see it because my doctors have not actually cured it, or even gotten it into remission. It is still there, and it still grows, and we just count down the months until it is too big to ignore. When I feel ironic, I call myself a “cancer warrior”. But as much as I try to laugh it off, the tumor has taken its toll. I am proud of my modest achievements, but I also know I could have achieved a hell of a lot more had I not had to fight off this damned thing for the past twenty years. Besides my own petty legacy, however, is the physical toll, leaving me in pathetically desperate need of constant support, often inevitably withheld, whether accidental and/or, by design.
The tumor that grows in my lower back has completely destroyed my spine and left me unable to walk and in horrible sciatic pain. After four surgeries, I live in intense constant pain and now in a wheelchair. I am forced to take significantly strong prescription drugs — opioids — to control this pain. I have been forced to take this medication daily for close to three years now. Yes, I say forced because I take them against my will; people like me don’t use opioids by choice. Anyway, at this point, it’s safest to assume that I am an addict, and due to all these new and ever-changing regulations from politicians and insurance companies, I have to beg my doctor month after month to send in a prescription for thirty day refills. Therefore, the opioid addiction debate is of singular importance to me.
A lot is said to blame pharmaceutical companies for the current opioid addiction epidemic sweeping through our country, and while they did do their part in hurrying it along, not enough is brought up about health insurance companies, politicians, and to a lesser extent, even pharmacies, with their subjective and arbitrary rules, regulation, policies, restrictions, all designed to ration opioids. For example, just last week, my doctor sent an opioid prescription to my local pharmacist, who then called to inform me that it had been rejected but he didn’t know the details. I called my insurance agent, who explained that the company will only refill an opioid prescription twice within a fifty-five day period. Typically, my doctor had sent in a thirty day prescription, but since, for whatever reason, my doctor had written may last prescription for only a twenty day supply, it fell within that period (thirty day refill in October + twenty day refill in November = fifty days, i.e., refill denied). After I begged an appeal, the agent so gratuitously approved a five day emergency ration that I can only receive once every 365 days. The next week, my doctor sent in the prescription again. Thankfully, the insurance company approved the prescription this time, but now my pharmacy was out of stock, and every nearby same pharmacy was, too! To top it off, my pharmacist also informed me the earliest they could have it back in stock was one week. Seven days?
This is the kind of medical limbo within we sufferers of chronic pain live. I try to ration my medication as much as possible. I admit I occasionally take a little more in a day than the script orders, but I also often take less. Either way, though, this pain is constant. I’m going to need that refill every thirty days; this pain is not moved by restrictions, or policies, or even inventory shortages. And it’s tense because once that medication is cut off, I have about twelve hours before this pain really starts to turn on, and now, along with that, after about another twelve hours more, I first notice the beginnings of the sickness start to settle in. It’s not long after this when any available option that’s going to control these symptoms is going to seem perfectly acceptable, so long as it’s simply available. Sadly, this is just one example of some of the hassles and issues I’ve had to overcome just to live comfortably, and I’m not alone. I’ve spoken with so many people from all over the country, who also suffer from chronic pain. Many, like myself, have been forced to use opioids for years. We all have similar stories to tell. How can it be any wonder, considering all this, how these arbitrary, ever-changing rules and regulations, alongside the failures of the pharmaceutical companies, are driving our current opioid crisis?
When I mentioned to my insurance agent that the company never informed me about this fifty-five day restriction on opioids, he told me it was written in the packet of company information that I received when I first became a member. I did find it there — eventually — in tiny print, somewhere in the middle, written with far more legal mumbo-jumbo than the agent let on, rendering it almost unidentifiable if one’s not looking specifically for it. Yes, they had indeed “informed” me, and I’ll not bother to appeal on grounds that no one read such things, for as realistic as that may be, it’s simply not a sincerely acceptable argument. However, it would be acceptable to say that such an arbitrary fifty-five day timeframe for opioid prescriptions puts patients at serious risk, first by increasing levels of physical pain, and second by the eventual symptoms of opioid withdrawal, both of which could potentially put the patient’s life in danger — in danger not because of the original illness, but because of the vast bureaucracy of health insurance regulation. Surely, we all must agree that these restrictions and regulations on needed medication is not the solution to our opioid crisis. Hell! I say they’re precisely the cause of it! It seems pretty obvious to me that rationing out a highly addictive medication and forcing patients to wait days for a refill can only lead to them looking to other, far more dangerous options.
Now while we’re on the topic of options, some suggest we look for alternatives. Okay, but where? When it comes to prescription drugs, what other medication can a doctor truly prescribe for severe chronic pain? What about acetaminophen? That stuff’s probably more dangerous than opioids. Cannabis? Yeah, I’ve been trying that. It’s helpful, not as powerful as opioids, but it would be acceptable, If it weren’t so hard to get. Even with a medical marijuana card, I just can’t afford to pay the easily thousands, even tens of thousands, of dollars a year needed to completely replace opioids. Besides, when opioids are practically being given away after insurance pays (a $10 copay can potentially get me hundreds of opioid pills depending on how the script is written), what sane person, except the most purity-minded among us… or wealthiest, would even entertain the notion of switching?
Last but certainly not the least at all, we need to hear what patients have to say. We’re letting corporate and political bureaucrats dictate policies that will define a very large part of how we be forced to live our lives, and no one wants to hear from the people who will most be affected by it — those with severe chronic pain, those who follow their prescriptions and don’t abuse the drug, those who lack the conviction to appeal a denial; those are the ones whose suffering will be compounded. And adding injury to insult, many of these bureaucrats haven’t even the least clue about opioids! Politicians come into power, declaring sweeping reforms, yet they often don’t know anything about legitimate healthcare, let alone pharmaceuticals. Doctors ought to have a greater voice in this debate than these politicians and businessmen, and patients — who haven’t ever even had a voice at all within this entire debate — severely, chronically, painfully… deserve a chance to be heard.
