Monday, July 4, 2011

The Drug Stigma

According to the Institute of Medicine (IOM), approximately 116 million people in the United States suffers from chronic pain.  The report acknowledges that,  "For many people, however, pain prevention, assessment, and treatment are inadequate." This is a subject S and I are intimately familiar with.

Because of the stimga attached to narcotics, it is virtually impossible for some people to get access to the pain relief that they desperately need.  S uses a narcotic pain patch and oral narcotics for breakthrough pain.  Due to medication interactions and his bipolar disorder, narcotics are the only effective pain medication he can take without a risk of extreme mania.

However, whenever he sees a new doctor or takes a trip to the emergency, he is almost seen as a drug seeker.  Even if he is there for something other than the pain and never once asks for his medication.

Case in point, I recently had to take S to the emergency room.  He was "falling asleep" without warning, no matter what he was doing.  It came on suddenly and scared both of us rather badly.  We called his insurance company's nurse line and the nurse suggested that it might be extremely low blood pressure.  We tried most of the day to raise his blood pressure, but the episodes continued.  It was a Friday afternoon and there was no way we were going to be able to see his regular doctor and I was frightened that his blood pressure would drop low enough to due permanent damage or kill him.

To their credit, the ER doctors actually did do every test that they could to rule out a stroke, heart or lung problems or an infection.  But, I could hear the doctors and nurses talking and they automatically assumed drug addiction.  As test after test came back negative, there was more and more talk of addiction and rehab at the nurses station.

After 4 hours, I asked that he be given his regular medication dose because I had left in a hurry and forgot to bring a dose from home.  My request was outright denied.  He was even denied his psychiatric drugs, even though it was well past his time to take them.  He was forced to lie there in excruciating pain for another four hours.

Once, while S was passed out, the doctor came to suggest taking him off all of his medication, including his psychiatric drugs.  I just kind of looked at him like he was insane and said "no, thank you.  He is on these medications for a reason."

After 8 hours,  S was released with the helpful answer of "reduce the levels of your pain medication."  By that time I wanted to punch the doctor in the face, but I managed to smile, nod and get S dressed and out the door without any yelling or violence.  I was pretty darn proud of myself!

Fast forward a couple of days to S's regularly scheduled therapy session.  He told his psychologist what was going on, and she knew exactly what happened.  The stress from fighting with his disability insurance company combined with his barely managed pain levels were causing him to experience blackouts.  He wasn't falling asleep.  His blood pressure was not low.  His body was just shutting down.

Had the doctor taken him off his medications, he would have probably experienced them more frequently.  Not to mention the fact that his bipolar disorder would be completely unmanaged and he would not be able to walk or function on his own due to extreme pain. 

I have been reading The Truth About Chronic Pain: Patients And Professionals On How To Face It, Understand It, Overcome It by Arthur Rosenfeld which discusses in detail, the stigma of narcotics and the problems people have with getting adequate pain relief.  Over the next couple of days, I will share my thoughts and feelings about this book.  I recommend it to anyone living with a chronic pain condition.

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