A Drug Addiction Risk Algorithm And Its Toll On People With Chronic Pain

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Because Crohn’s flare-ups alone can cause severe pain, Schechtman already had a prescription for oral opioids, but she went to the hospital that day in 2017 because she was so nauseous from the pain that ‘she couldn’t keep them or anything. . Like Kathryn, she also took benzodiazepines for an anxiety disorder.

This combination, both appreciated by drug addicts and considered a risk factor for overdose, made the hospitalist in charge of Schechtman’s care suspect. Without even introducing himself, he asked why she was taking the drugs. She therefore explained that she suffered from PTSD, expecting this disclosure to be sufficient. Nonetheless, he urged her on the cause of the trauma, so she revealed that she had been sexually abused as a child.

After that, says Schechtman, the doctor got even more blunt. “Because of this, I can’t give you intravenous pain relievers,” she recalls saying. When asked why, she said he claimed that intravenous drug use and child sexual abuse changes the brain. “You will thank me someday, because because of what you went through as a child, you have a much higher risk of becoming addicted, and I cannot participate,” she says.

Schechtman says she felt the doctor blamed her for being mistreated. She was also puzzled.

She had been taking opioids intermittently for about 20 years and had never become addicted. Wasn’t that relevant? And how could it be ethical to deny pain relief on the basis of theoretical risk of abuse? She wasn’t asking for drugs to take home; she just wanted to be treated in the hospital, as she had been before, without a problem.

As will happen later with Kathryn, the experience took Schechtman to the Internet. “I just became obsessed with researching it all,” says Schechtman. “I would ask members of these online groups, ‘Have any of you been refused opioids because of a history of sexual abuse? And the women stepped forward.

Schechtman eventually joined a advocacy group called the Don’t Punish Pain Rally. Along with other activists in the group, she discovered that the question about the history of sexual abuse in the ORT unfairly targeted women, but not men. (An updated version of Webster’s tool now excludes the gender difference, but the older version appears to survive in some electronic medical record systems.)

She also found many pain patients who reported having problems with NarxCare. Strangely enough, even people who receive the gold standard drug treatment can be incorrectly flagged by NarxCare and then denied the same treatment by pharmacists.

Buprenorphine, better known by the brand name Suboxone, is one of two drugs that have been shown to reduce the death rate from opioid use disorders by 50% or more, primarily by preventing overdoses. But because it is an opioid itself, buprenorphine is among the substances that can elevate the NarxCare score, although it is usually listed in a separate section of a NarxCare report to indicate that the person is undergoing treatment. This separation, however, does not necessarily prevent a pharmacist from looking at a patient’s high score and refusing to offer prescriptions.

Ryan Ward, a Florida-based recovery advocate, has been taking buprenorphine for almost a decade. He also has a history of severe back pain and associated surgeries. In 2018, when his pharmacy stopped offering buprenorphine, he tried to fill his prescription at a Walmart and was turned away. Then he visited two CVS and three Walgreens, and was similarly blocked.

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