The Federal TGA opioid prescribing policy changes in 2018, and more recently in 2020
Kevin’s thoughts and experiences surrounding this controversial topic.
Kevin waited eight years within the public system before attending his first pain clinic in 2017. Given the recent conversations we as a community have been sharing, he finds other member’s experiences in many ways mimic that of his own, and many other chronic pain patients he speaks with online. The following comments have been provided from these conversations he has shared.
In talking to many other chronic pain patients, who are using legally prescribed opioids safely and responsibly, I have noticed many GP's are just not trained in chronic pain management. They do not know how to differentiate between the observable, destructive addiction 'behaviours' displayed by those unfortunate people with substance abuse disorder and the normal, rational requests of a chronic pain patient requiring his/her usual stable dose of pain-relieving opioids.
This issue is magnified many times over IF a chronic pain patient has to explain their condition to a new doctor, or worse still, is required to present to a Hospital Emergency Department due to an acute flare up of a chronic condition. During such occasions the patients must outline their often complex symptoms to a doctor or nurse who does not know their history, who then often incorrectly assumes the patient has addiction issues -because they are requesting temporary or additional opioid treatment to get through an acute phase.
I understand in this type of emergency environment [having been a Registered Nurse before medically retiring some years ago] but it is not possible to know everything about the patient in such a short space of time when decisions must be made promptly. However, the situation is not helped when the terms of psychological ‘addiction’ and physical ‘dependence’ cannot even be agreed upon by the world's experts and International peak bodies.
In my personal experience [as with so many other chronic pain patients], having to front up to my GP every four weeks and ask for Schedule 8 opioid pain relief brings with it a kind of anxiety associated with being able to continue on my normal dose long term. Furthermore, having to justify why I need it every four weeks can be rather stressful, especially if you get told “you know you must taper off these medications one day!”
Why, I ask?
If a chronic pain patient is stable, their quality of life and mobility has improved AND the current pain medication used [as part of an overall pain management plan] is beneficial, why do we need to change the protocol for ALL patients - just because a minority of unfortunate people may have addiction issues? Most reputable large-scale International studies indicate that the addiction risk in chronic pain patients, who DO NOT have a history of substance abuse disorder, is far less than 1% (Fishbain, D. A. Cole, B. Lewis, J. Rosomoff, H. L. Rosomoff, R. S. (2008).
Perhaps people and the media need to be reminded and re-educated when they use the word ‘addiction,’ if they are talking about legally prescribed opioid pain medications. Chronic pain patients never asked for their condition in the first place and it is my opinion that the vast ‘silent majority’ manage to cope to the best of their ability, using all reasonable treatment options available to them within their pain toolbox - which includes pain medication, where warranted.
The illicit and/or recreational drug trade [especially synthetic Fentanyl, which is largely responsible for the high opioid overdose rates in America] is an entirely different 'law enforcement' debate. However, there is increasing and undeniable evidence that many desperate, chronic pain patients who have been forcibly tapered or stopped 'cold turkey' are turning to the black market to source their drug of choice for pain control. This is not an ideal outcome.
It seems the American medical industry [specifically the Centre for Disease Control or, CDC and their 2016 'Guidelines For Prescribing Opioids'] has turned their back on chronic pain patients over there and in many cases no legal or viable options remain for this forgotten demographic. Surely we DO NOT want the same ‘one-size-fits-all’ approach to health care, where pain relief is denied to vulnerable chronic pain patients to come to our Australian shores.
References:
Fishbain, D. A. Cole, B. Lewis, J. Rosomoff, H. L. Rosomoff, R. S. (2008). What percentage of chronic nonmalignant pain patients exposed to chronic opioid analgesic therapy develop abuse/addiction and/or aberrant drug-related behaviors? A structured evidence-based review. Available at: https://pubmed.ncbi.nlm.nih.gov/18489635/
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