Friday , January 15 2021

As doctors shrink or prescribe extreme opioid preparations, many patients go to despair, suicide



This is the first of the three-week series of the nation's struggle to tackle the saponifying opioid crisis and the unwanted victims left behind.

This happened slowly. The pain caused by a 1980 fracture as a result of a trailer-trailer accident was more and more mutilated by Jay Lawrence's body and spirit.

By 2006, the hands and feet of the Tennesian veterans and Navy veterans became numb. The pain that tortured him lowered him to tears. Numerous operations, chiropractic corrections and physiotherapy have failed.

Finally, he found comfort in prescription painkillers – 120 milligrams a day of morphine. A high dose, but it suppresses the pain enough to be able to walk with her wife, shop for groceries, even take a few movies.

Last February, the pain killer reported violent news: "It reduced Laurence's daily dose, first 90 milligrams, then in short phases, to 30 milligrams." The doctor said the reduced dose was in response to the recommendations for prescribing the Centers for Disease Control. Control and Prevention of Diseases (CDC), published in 2016 as part of a national anti-opioid boost, according to Laurence Meredith's wife.

"The doctor said," You know that these guidelines will ultimately become a law. So we decided as a group that we would remove all our patients, "she told Fox News in an interview.

Laurence's pain returned with revenge. He could not move or sleep. He dirty his pants, unable to make the bath on time, Meredith said.

"I feel that every nerve in my body is fiery," he told his wife.

Meredith said she and her husband went to their primary care physician and asked for a referral to another hospital clinic. They told them it would take at least six weeks.

It was too much for Lawrence. In March, on the day of his next medical appointment, when his dose of painkillers had to be reduced again, he instead went to the neighboring park with his wife. And just at the point where they renewed their wedding vows only two years earlier, they held their hands.

He lifted a gun in his chest and killed himself.

Jay and Meredith Lawrence

Jay and Meredith Lawrence
(Photo by Savannah Dean)

Lawrence, aged 58, has become an indefinite number among the 20 million people suffering from chronic pain who chose suicide after being rejected or denied prescriptions for opioids. Suicides have motivated many of those who continue to suffer from pain – and family members and advocates of those who have lived their lives – call for a reassessment of the hurry to reduce opioid doses to those who have the most need them.

"We have a terrible problem: we have people who commit suicide for a reason other than being forced to stop opioids, pain medications, chronic pain," says Thomas Klein, a family doctor in North Carolina and former administrator of the medical school program in Harvard.

"It's mass hysteria, witch hunt. This is one of the worst health crises in our history, "said Klein, who has 26,000 followers on Twitter, and a website where he publishes the names of those he said he had committed suicide after their opioids were removed or eliminated. "There are five to seven million people who are tortured for their intended purpose."

CDC does not count on those who commit suicide after they have ceased their treatment with pain. But most doctors who spoke to Fox News reported that they knew that between one and six patients who had survived their lives after having lost access to opioid treatment and had given up on other doctors who now see painkillers for a prescription as a hassle.

Several prominent physicians and patient advocacy organizations said they had heard of hundreds of people who said they were still in painful pain and considered suicide. The issue set earlier this year was in the hands of Human Rights Watch, which began an investigation.

"It is clear that now there are patients who feel like life is not worth living if they return to live in pain," said Dideric Lohan, director of Human Rights Watch's Health and Human Rights. "Many of the patients we talked to are very law-abiding and would commit suicide before going to the street to get illegal drugs." The government has an obligation to react to the overdose crisis but to do it in a way, people who have a legitimate medical problem are a human rights problem. "

We have a terrible problem, we have people committing suicide, for no other reason than to be forced to stop opioids, pain medications, chronic pain. This is mass hysteria, a witch hunt. This is one of the worst health crises in our history. There are 5 to 7 million people who are tortured for their intended purpose.

– Dr. Thomas Klein, a former administrator of the Harvard Medical School Program, and a list of sick patients who died of suicide.

Many patients say they understand the urgent need for political leaders and government agencies to fight the overdose epidemic. But targeting millions who are legally suffering from chronic pain benefits from a solution that does not apply to the majority of illicit drugs, they say – or the degree of overdose caused by them.

The CDC has published a November 30 report that shows that, despite the fall in prescriptions for painkillers over the years, drug overdose has continued to grow as growth has shifted from illegal opioid fentanyl and its cousins. This is a trend that has been taking place for several years.

"People with pain should not suffer because people without pain abuse opioids," said Cynthia Tusant, a former California ballerina with complex regional pain syndrome (CRPS) who left her bed on the bed for 10 years. talks about five. "Sick patients do not want to take opioids more than cancer patients want to use chemotherapy, but many people with pain need opioids to function physically and to pursue the happy aspects of life."

At a recent meeting of the American Medical Association (AMA), group president Dr Barbara McKenney talked about how an advanced prostate cancer patient tried to commit suicide after being denied opioids by an insurer. "The pendulum exceeded too much when the pain was identified as a vital sign and we are now in danger of going back so far that the patients are hurt," she said in a report published.

PROBLEMS WITH THE GUIDELINES OF THE CDC

Federal representatives said the CDC guidelines are not intended to disrupt the proper prescribing and use of opioids. "We do not tell any doctor that they can not make a legitimate recipe," then the US. General Prosecutor Jeff Sessions told Fox News in an interview before leaving office. "Maybe some doctors become too cautious. We do not know.

The sessions acknowledge that "prescribing opiates may be essential to humans" and said, "It is very clear that people with serious pain problems need a really meaningful relief of pain and sometimes [opioids] are the only thing that will provide relief and it is absolutely legitimate to prescribe it. "

We've heard about suicide … It's tragic that everyone takes their lives for some reason, including the fact that their opiates are unilaterally stopped.

– Dr. Debbie Dowell, lead author of the 2016 "CDC guidelines for prescribing opioids for chronic pain"

CDC officials added that they are also aware that those suffering from chronic pain have committed suicide in their struggle to cope with fewer or no opioids.

"We've heard of suicide," said Dr. Debbie Doyle, Senior Medical Advisor at the CDC and lead author of the Opioid Prescribing Guidelines. – We heard the reports. It is tragic that everybody takes their lives for whatever reason, including the fact that their opioids have ended unilaterally. "

Dowell said the suicide range caused by insufficient treatment for chronic pain "is not something easy to measure." We looked at how we can measure that, sometimes patients or their families do not report it.

The CDC guidelines are focused on primary care physicians and recommends extreme caution when prescribing opioids. He also proposed a maximum daily dose of 90 milligrams morphin milligram for patients with first-degree pain.

But the guidelines have also warned that they will not divert or abruptly remove those suffering from severe pain who have taken opioids responsibly, noting that a drastic change may lead to withdrawal and serious illness.

The untreated pain, according to many health experts, may lead to hypertension, more severe pain conditions and other problems. Health practitioners say that this is a serious condition that can affect every person – all that is needed is slipping, falling or bad surgery that can lead to intense and perhaps prolonged pain.

Dowell said patients should be prescribed on a case-by-case basis.

"We believe everyone deserves effective pain management," she said. "The CDC guidelines are not a regulation or a law – this is a guide for suppliers."

"She has never made a recommendation to pull untreated people involuntarily or to shrink involuntarily," she said. "It aims to provide up-to-date information on the benefits and risks of opioids for chronic pain so that the patient and the patient – together – can make decisions.

The guidelines become implementation tools

The announcement by the CDC is clearly lost among the leading titles of the stunning number of deaths due to opioids. Political leaders and government officials often have not noticed bulk – at least 60%, according to the US Department of Health and Human Services, the overdose epidemic is caused by illicit drugs rather than prescription painkillers.

And when employees deal with part of the deaths due to prescriptions, say advocates of the safe use of opioids, they often associate ill patients and addicts who illegally receive some other opioids. This resulted in a perfect storm that formed the basis for killing solid state and federal policies, including the Trump government, promising to cut prescriptions by 30 percent over the next three years.

Or, in response to the CDC guidelines or as a proactive measure to tackle the opioid crisis alone, at least 33 countries have adopted some kind of legislation on limitation periods, according to the National Conference of State Legislators. Healthcare providers and pain patients who have Medicare prescribing plans are preparing for January when the federal insurance program will give insurers and pharmacists the power to reject prescriptions that deviate from the recommended dosage of the CDC.

"The CDC's guidelines were directed at primary care physicians but they were also abducted and weapons as an excuse for draconian legislation," said Michael Shatman, clinical psychologist and director of research and development at Boston Pain Care, a multidisciplinary hospital clinic. Editor-in-Chief of the Journal of Pain Research. "Illegal opioids, not prescription opioids, cause the death of an overdose."

The CDC guidelines … were abducted and weapons as an excuse for draconian legislation.

– Michael Shatman, editor-in-chief of the Journal of Pain

The disproportionate focus on prescription painkillers from overdose epidemics, healthcare professionals and researchers is largely the cause of drug-related deaths continuing to rise as legal opioids become more severe, less accessible to patients with pain.

"We are targeting the most vulnerable and sickest people who have used opioids for a long time," said Dr. Stephan Kertes, an addictive and professor at the University of Alabama at the Birmingham Medical School. "Insurers issue rules stating that we will not cover long-term opioids for individuals over 90 milligrams.How, five per cent of people who receive opioids account for 60 per cent of the prescribed milligrams.With so many milligrams that go to a small group by many sick people, if you can knock a few people out of these opioids, you can show a large numerical decrease.

"What we are really doing is disposing of the dose for people with disabilities," said Kertes, who sits in several state opioid safety committees. "Recipe control seems an easy response to the epidemic, but that does not stop addiction."

BOOK FOR HELP AND PROVISION

In social media, comments in news sections and emails to Fox News, numerous sufferers say they have suicidal plans because their healthcare provider has forcibly lowered their dose to an insufficient level or cut them off altogether. They talk about being treated as drug addicts, undergoing frequent urine and pill studies.

Jay and Meredith Lawrence

Jay and Meredith Lawrence
(With the courtesy of Meredith Lawrence)

"Since 2006, I have been working on pain management," said a Tampa person in a Facebook release. "You have a crippling disease that has no cure and can no longer get the medications I need." A few months ago, I was studying death with dignity and other suicide if I could not get the help I needed.

Some have posted comments about a loved one who died of suicide after losing access to long-term pain treatment and believes it is unacceptable to continue suffering. Others claim that their husband's suffering, along with a feeling of dissatisfaction and suffering that they have been diverted or forged by doctors, is the reason for them to come around to accept a suicide plan for their relatives.

In her new home in Georgia, her walls, covered with pictures of her late husband, Meredith Lawrence recalled the helplessness she felt by watching him suffer as the pain worsened and the drugs shrank.

"He said," I have three choices, "recalls Meredith." He said, "I could do illegal drugs, I could survive the pain for the rest of my life, or I could finish my life. two.

Lawrence's doctor did not respond to email and phone requests to comment on this story.

At the same time, Twitter hashtags such as # SuicideDue2Pain, #DontPunishPain, #PatientsNotAddicts are becoming commonplace.

People with pain should not suffer because people without pain abuse opioids.

– Cynthia Tussant, patient pain

"I think of suicide every day," said Down Anderson, a former Indiana nurse whose doctor cut off his opioid dose after his office was invaded by DEA.

"I recently wrote a suicide note for my family," said Anderson, a diabetic whose legs were amputated under the knee. "They've seen everything I've been through, I want to live, but not so.

53-year-old Anderson thinks it's too painful to deal with dentures because she says it's pain and is restricted to a wheelchair.

"Pain feels like an electric shock that happens every 30 seconds in some parts of my body," she said, "and in the back is pain that pierces like hot poker that is left and never goes out. , which I endure daily, accepts my will to live. "

Anderson's doctor did not respond to requests for comment.

Ana Fukua, a former nurse in Alabama, who suffers from chronic pain itself, has recorded 167 suicide records since 2014 claiming to be the direct result of patients whose opioids were cut or cut off and suffered from uncontrolled pain.

Fukua said she was in the midst of checking the more suicides she had been told.

Clay Cresta, a 26-year-old from Massachusetts, has a rare disease, a tight-willed syndrome that causes muscle spasms and rapid convulsions that break down her bones and often leave her unnatural for days. Тя е имала това състояние, откакто е на 19 години.

"Страхувате се, че Вашият лекар ще каже, че следващата Ви рецепта е последната ви", каза Креста, като добави, че когато тя има "лош ден", това означава "спирам да бъда майка, жена, дъщеря".

Прекратяването на болката, като завърши всичко, изглежда, понякога е като изход.

Д-р Стефан Кертес

КАНДИДАТСТВАНЕ НА ПОВИШАВАЩИ АНТИОПИОИДНИ ПОЛИТИКИ

Не всеки се съгласява, че проблемът е намаляването на законовите опиоидни предписания.

Д-р Андрю Колодни, който ръководи опиоидните проучвания в Хелърското училище за социална политика и мениджмънт в Хелър, вярва, че правителствените политики по отношение на опиоидите трябва да бъдат още по-строги.

Колоди, който също е изпълнителен директор на лекарите за отговорно опиоидно предписване и един от най-гласните критици на опиоидите в страната, прекъсва алармата, отекваща за намаляващата доставка на болкоуспокояващи с рецепта.

"Ефектите на хидрокодон и оксикодон, произвеждани в мозъка, са неразличими от ефекта, предизвикан от хероина", каза Колодни. – Значи моето мнение е, че когато говорим за лекарства за опиоидна болка, ние по същество говорим за хапчета за хероин.

Колоди заяви, че опиоидите играят важна роля – в ограничени случаи – като прекратяване на страданието "в края на живота на някои пациенти" и "за няколко дни след голяма хирургия".

Когато говорим за лекарства за опиоидна болка, ние по същество говорим за хапчета за хероин.

– д-р Андрю Колодни, директор на изследването за опиоидите в Heller School for Social Policy and Management на университета Brandeis

Много експерти по болка и пациенти обвиняват Колодни за това, че настояват федералните агенции, особено CDC, да лекуват опиоидите, сякаш това е хероин, и болката на пациентите като хора, които са едни от опиоидите далеч от пристрастените.

Колдни каза, че това не е вярно.

– Нямаше никаква роля – нямаше нищо – каза той. "PROP беше една от многото организации, поискани от CDC да им предостави обратна информация относно насоките. Нашето писмо е обществено достояние. CDC не направи промените, които поискахме.

За Колодни: "Това е произведен спор … Ще кажат с моя опиоид, поне мога да се изправя от леглото. За потребител на хероин това е същото нещо за тях. Казват, че се чувстват ужасно, не могат да направят нищо или да действат, докато не вземат първата си доза хероин сутрин.

Бившият генерален прокурор на САЩ Джеф Сесион

Бившият генерален прокурор на САЩ Джеф Сесион
(Ройтерс)

FEDS казва, че те са на война

Сесиите изглежда разглеждаха проблема като война, която трябва да се води, с пълна скорост напред.

"Това е най-големият риск за здравето, който сме имали", каза той за фатални свръхдози. "Нека просто да кажа това на проблема със самоубийството и други проблеми: Те произтичат от зависимостта от тези лекарства", каза той. "Хората не знаят колко мощни са тези зависимости. Така че хората се намират в ситуация, в която не могат да продължат да приемат наркотиците, а някои от тях може да заключат, че не могат да живеят без тях. "

– Трябва да пречупим този цикъл – каза Сесиънс. "Правим напредък в него, но все още предписваме много повече болкоуспокояващи, отколкото в която и да е страна по света … ние като нация трябва да се изправим пред този факт."

Федералните и държавните служители в агенциите в челните редици на борбата с опиоидите – включително Агенцията за борба с наркотиците (DEA) – бяха твърдо затруднени да предоставят подробности на Fox News за това колко смъртни случаи от свръхдоза засягат легитимно предписаните опиоиди. Докладът на Министерството на здравеопазването в Масачузетс, цитиран от много експерти по болка, посочва, че сред 477 души, чиито смъртни случаи са свързани с опиоиди през 2018 г., 90% или 423 от тях са положителни за фентанил – използвате.

Експерти по болкоуспокояването заявиха, че споделят загрижеността и тревогата за ужасно високия процент на свръхдози наркотици.

"Споделям загрижеността на нацията, че повече от 100 души на ден умират от свръхдоза. Но пациентът ми почти умря от недостатъчна доза ", каза Макенени, президентът на AMA.

"Моят пациент страда отчасти заради репресиите срещу опиоидите … Когато посетих пациента в болницата, докато се възстановяваше от опита му за самоубийство, се извиних, че не знаех, че лекарството му е отказано", каза Макенени. го е провалил.

Ако мислите за самоубийство, сте притеснени за приятел или любим човек или искате емоционална подкрепа, Националната мрежа за превенция на суицидите е достъпна 24 часа в денонощието, 7 дни в седмицата, в САЩ. Lifeline е достъпна за всички, е безплатна и поверителна – 1-800-273-TALK (8255)

Глухите и неприятните слухове могат да се свържат с Lifeline чрез TTY на 1-800-799-4889. Nacional de Prevención del Suicidio – 1-888-628-9454


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