Overcoming Opioids Cures Act

This Tuesday, Aug. 15, 2017 photo shows an arrangement of pills of the opioid oxycodone-acetaminophen in New York. 

BOSTON — Rebecca West suffers from endometriosis, a debilitating stomach illness that causes bleeding, blood clots and crippling pelvic pain.

Over the years, she's tried everything to treat her pain -- from surgery to physical therapy, yoga and acupuncture -- but opioid medications were the only thing that gave her relief.

"The pain at times is so excruciating that I can't even get out of bed," said West, 29, of Quincy. "Opioids helped me to live a fuller, more functional life."

But as the state cracks down on opioid prescribing to address the wave of addiction that has claimed thousands of lives, West said she’s been cut off from her medication.

Skeptical doctors won't give her a prescription for the drugs, even if they'll see her. When she finds a physician willing to prescribe the medication, many pharmacies no longer stock OxyContin and other opioids, or have run out of supplies.

West said she’s even been flagged on the state's prescriber list as a potential substance abuser.

"As soon as someone hears you have chronic pain, their whole attitude changes," she said. "They instantly assume that you're a drug addict."

In Massachusetts and elsewhere, doctors and other health care providers are being urged limit use of painkillers, in part by offering alternatives for pain management.

Three years ago, Gov. Charlie Baker and lawmakers pushed through a raft of rules aimed at curbing over-prescribing of opioids. Those included setting a seven-day limit on new opioid prescriptions; mandating emergency room evaluations of anyone treated for an overdose; and requiring doctors to consult the prescription monitoring database each time they prescribe an opioid.

Meanwhile, states, counties and individual cities have filed more than 1,000 opioid-related lawsuits against pharmaceutical companies in state and federal courts.

There are active investigations into the opioid crisis nationwide, including several initiated by Massachusetts Attorney General Maura Healey and U.S. Attorney for Massachusetts Andrew Lelling.

Supporters of the tougher restrictions argue that most heroin addicts first become hooked on pain medications that were either prescribed or obtained illegally.

Lawsuits against Purdue Pharma and other opioid makers accuse them of putting profits over patients by aggressively marketing the addictive drugs.

The pressure seems to have produced results. Data released by state health officials show opioid prescriptions in Massachusetts have declined 39% in the past four years.

But as doctors cut back on opioid prescribing, and state and federal governments step up efforts to prevent and treat addiction, patients who suffer from chronic pain are struggling to get their medication, according to Cindy Steinberg, chairwoman of the policy council with the Massachusetts Pain Initiative, an advocacy group.

"People in pain are being deprived of their medication," said Steinberg. "They can't even get care now because doctors don't want to treat people with opioids."

What's more, patients seeking pain treatment alternatives find that insurers won’t foot the bill or are forcing them to jump through hoops to get coverage, she said.

Steinberg said while the opioid epidemic may have its roots in prescription drugs, the data show the epidemic is being driven primarily by illegal — not medical — abuse of pills.

On Beacon Hill, much of the focus, money and resources is being devoted to dealing with substance abuse with little regard to the impact on pain patients, according to Steinberg.

She cited a proposed tax on opioid manufacturers being weighed by legislative leaders — a cost she said would likely be passed onto consumers.

Baker, a former health care executive, is proposing a 15 percent tax on the overall sales of opioid manufacturers to help cover the state's drug treatment costs and "pay for some of the carnage they have created." It wouldn't apply to opioid distributors, and inpatient treatment and medication-assisted treatment would be exempt.

Opioid-related deaths are continuing to decline in Massachusetts, falling about 4% from 2016 to 2018, according to the state Department of Public Health.

Despite that decline, health officials say there were 497 confirmed and estimated opioid-related overdose deaths in the first three months of 2019 — a rate of more than five deaths per day.

The percentage of opioid-related overdose deaths where prescription drugs are present fell from 2014 through 2016 and has since remained stable, according to the agency.

In the final three months of 2018, about 13% of cases of fatal, opioid-related overdoses involved prescription drugs.

Physicians say they're doing their part to curb opioid misuse while seeing to the medical needs of patients.

"This is a public health crisis that concerns all of us," said Dr. Maryanne Bombaugh, the Massachusetts Medical Society's newly elected president. "Physicians don't want to be a part of the problem. They're trying to find the right balance between judicious prescribing and caring for our patients."

In recent years, the society has trained thousands of prescribers on how to manage pain without overusing opioids; how to screen for substance abuse; and alternative therapies to opioids.

West said she wants state officials to understand that people with legitimate pain issues should not be punished because others become addicted to street-level drugs.

"The problem is we're only talking about one side of the coin -- people who are abusing these medications," she said. "We're not talking about the people who need them."

Christian Wade covers the Massachusetts Statehouse for the North of Boston Media Group's newspapers and websites. Reach him at cwade@cnhi.com.

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