Last year during a visit to New England my wife slipped on ice and dislocated her shoulder, leaving her in excruciating pain. It wasn’t the first time it had happened. Since suffering a bad skiing accident in the 1990s, Kate’s left shoulder has been increasingly unstable and prone to pop out at the slightest provocation.
It hadn’t happened in a while, but having been through this ritual at least four times in as many states, she thought she knew what to expect: A trip to the emergency room where a doctor would greet her with a stiff shot of morphine and then pop the errant ball joint back into its socket. Simple as that, she assured me.
Despite her moans of pain and dangling arm, it took three attendants–one of them a physician–nearly 40 minutes to authorize and administer a single dose of the synthetic painkiller Fentanyl that was so weak it barely took the edge off. It took me another 20 to convince the nurse she needed another one, but by then it was too late. She was fixed up and on her way out, having experienced more pain for a longer amount of time than any of her previous visits to the E.R.
Welcome to pain management in the 21st century.
My wife is lucky. The pain of a dislocated shoulder is fleeting and mostly gone once the joint has been properly reset. But for millions of Americans who suffer from chronic pain, getting properly medicated means navigating an austere maze of restrictions that is designed to ensure they’re not gaming the system, but more often leaves them feeling stigmatized and alone.
In Pennsylvania, their predicament may be about to get even worse. Republican lawmakers in Harrisburg are advancing a plan to tackle prescription drug abuse in the state by invading the privacy of thousands of patients and creating yet another obstacle between sick people and their medicine.
This week, Rep. Matthew Baker of Tioga County introduced legislation that would expand the commonwealth’s prescription monitoring system by establishing a database listing all prescriptions of habit-forming medications and the identities of the citizens who receive them. The plan has the support of Gov. Corbett who called for an expanded prescription drug registry to “reduce the criminal diversion of prescription drugs” when he announced his “Healthy Pennsylvania” initiative earlier this month.
According to the American Civil Liberties Union, which is working to block the bill’s passage, the proposed Pharmaceutical Accountability Monitoring System will track dozens of drugs under the federal Controlled Substance Act–ranging from painkillers like hydrocodone, oxycodone and morphine, to anti-anxiety medications such as Xanax and Ativan, sleep aides like Ambien, and drugs like Ritalin that are used to treat childhood ADHD.
Under the legislation, law enforcement agencies could request information relating to Schedule II drugs–which include opiates like Oxycontin and Percocet, and amphetamines like Adderall–without a warrant. Doctors, pharmacists, dentists and others licensed to dispense medication would be authorized to query the database for patient or prescription information.
In other words, the same party that has been holding up a bill to establish universal background checks for people buying guns–and has fought tooth and nail against a public registry of gun owners because it unfairly singles out law-abiding citizens–thinks it’s okay for the government to collect, store and monitor the private medical information of every patient in the state whose doctor believes their health or quality of life requires a drug that has the potential for abuse.
There are, of course, legitimate concerns the bill seeks to address. Pharmaceutical overdoses are responsible for hundreds of thousands of emergency room visits a year; and, according to data from the Centers for Disease Control, prescription drugs led to the deaths of more than 16,000 people in 2010–the last year for which data is available.
Some would call that an epidemic, and I’m inclined to agree. But just to put those numbers into perspective, that’s still half the number of people who die each year at the business end of a firearm, but you won’t find a Republican legislator in Harrisburg–or anywhere else I suspect–that would suggest we begin tracking gun owners. I point this out not because I support a universal gun registry; quite frankly, I vacillate on that issue, and at the moment I am inclined toward opposing such a scheme. Rather, it’s a glaring example of hypocrisy from a party that claims to value personal freedom above social utility –but only means it when it involves protecting a base constituency. Unfortunately there are millions of Pennsylvanians who don’t fall under that rubric who now stand to pay the price for that hypocrisy.
A 2011 report from the Institutes of Medicine (IOM) determined that 116 million Americans suffer from chronic pain, while another 25 million experience acute pain as a result of injury or surgery. Add to that the roughly 12 million Americans living with cancer (approximately 80 percent of whom report attendant pain), and the potential number of affected individuals becomes staggering. The World Health Organization has long held that restrictions on the legal use and availability of opioid analgesics like morphine and Oxycontin are an impediment to adequate pain care; and, according to a 2009 report by Human Rights Watch–which has called access to pain meds a fundamental human right–burdensome restrictions on pain management have a ripple effect that leads doctors to withhold medication out of fear of prosecution or censure.
“It’s extraordinary how many patients describe themselves as feeling like collateral damage in the war on drugs because of extraordinarily burdensome [requirements to get opioid medications],” said Melanie Thernstrom, an author of the IOM report. “Many pain patients, in fact, are paying the price for a policy not designed for their benefit.”
In a previous column, I detailed some of the myths about prescription pain management that feed the media hype about prescription drug abuse and lead to widespread support for legislation like the current monitoring bill—such as the myth that dependence equals addiction, or that patients on extremely high doses of opioid medication have negligent doctors. I encourage you to read it.
Creating and monitoring a database that singles out legitimately sick people with prescriptions for the drugs they need will further stigmatize patients and add an additional burden to a system already rife with them. If registries are an invasion of privacy for citizens who voluntarily choose to buy a gun, surely they are for those who have no choice but to be sick.