Gregory Dennis, Between the Lines: When the opioid crisis hits closer to home
It’s one thing to hear about the crisis in drug use and the damage it’s doing to individuals and families in Vermont.
It’s quite another thing to realize that the state of Vermont thinks you personally might be a drug addict.
Here’s how that happened to me.
I occasionally take hydrocodone (also known as Vicodin) for back pain. I mean very occasionally. A prescription of 10 pills can last me a year.
Even that tiny amount, however, means that under a new Vermont law, people like me have to sign a contract with a physician — a “Controlled Substance Agreement” — to get a prescription or renewal for an opioid. The same law now requires these individuals to meet every three months with their physician to have access to even a low dose of the medication. It limits the amount that can be prescribed based on four different categories of pain.
In my case I sometimes resort to a hydrocodone pill when low-grade, chronic back pain flares up after strenuous exercise such as skiing or basketball. Or, come spring, pain from prepping the garden for yet another season of armed combat against woodchucks and weeds.
Our state is not alone in its efforts to stop the overprescribing of opioids. It’s one of 22 that passed or toughened such laws last year. Vermont’s new law went into effect on July 1.
Did the state need to do more about limiting access to drugs such as oxycodone, hydrocodone and tramadol?
Key decision makers certainly thought so. Then-Gov. Peter Shumlin made a national reputation for himself when he devoted his 2014 State of the State address to opioids and the related explosion in abuse of opiates such as heroin.
He called it “a crisis bubbling just beneath the surface that may be invisible to many, but is already highly visible to law enforcement, medical personnel, social service and addiction treatment providers, and too many Vermont families.”
He added later, “In 2015, enough painkillers were handed out in Vermont to give every man, woman and child a bottle of 100 pills.”
That is what you call a scary statistic, if accurate.
The new rules, he averred, would help “ensure that fewer Vermonters are sent home with enough painkillers to set off a lifetime of horrible addiction.”
Which was a not-so-subtle swipe at the state’s doctors. But there was a consensus that something had to be done to dial back prescription patterns.
Some years ago the prevailing wisdom was that pain was widely undertreated. Doctors responded by prescribing greater pain control. Drug companies developed more effective medications — and then fraudulently marketed them as nonaddictive.
Now the pendulum is swinging the other way.
The state’s overtaxed system is having to deal both with overuse of opioids — drugs manufactured in the lab that are prescribed to manage pain — and opiates like morphine and heroin.
The frightening impacts of opiate usage are becoming increasingly clear. In Brattleboro, for example, first responders treated seven cases of heroin overdose over the July 4 holiday alone.
Part of the problem arises from past overuse of opioids to kill pain. When people who have relied on opioids can’t acquire them legally, they turn to buying them on the street. Or they buy a dangerous and illegal drug such as heroin to ease their pain.
State officials are emphasizing the value of reaching patients. “Among the most critical pieces is patient education because they don’t necessarily know (the risks of overusing opioids),” said David Englander, the legal adviser to the Vermont Department of Health.
Count me as one patient who has now been educated.
The Controlled Substance Agreement I recently signed has 23 clauses and is nearly two pages long.
It requires me not to drink alcohol if I’m taking hydrocodone “as serious harm could result if I do.” I have to “safeguard my controlled substances from loss or theft.” (Note to would-be thieves: My prescription has run out.)
I’ve acknowledged that my past prescriptions are being tracked through the Vermont Prescription Monitoring System. I’m supposed to bring “all unused medicine to office visits when requested by the provider or his/her staff for a pill count.”
Long-term use of opioids, it says, “will lead to dependence. If my provider identifies any abuse or misuse, then weaning off of the medication and/or recommendation to substance abuse facility will occur.”
Moreover, the contract requires that to get any more hydrocodone, I must be seen in the doctor’s office every three months “and at any other intervals my provider deems appropriate.”
A friend recently came back from Colorado with an over-the-counter bottle of “extra strength relieving body creme.” It contains arnica, peppermint, juniper — and cannabis.
He gave the creme to me to alleviate my back pain. It smells real nice. But otherwise it’s not much good.
At this point I’ve decided it will probably be simpler to treat my back pain with a heating pad, lidocaine patch and ibuprofen.
Which is probably what the state wants me to do. If so, well, then, mission accomplished.
Gregory Dennis’s column appears here almost every other Thursday and is archived on his blog at www.gregdennis.wordpress.com. Email: email@example.com. Twitter: @greengregdennis.
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