Should We Believe Patients With Pain?

NOVEMBER 20, 2018
Cmdr John Burke
I recently came across an article about the symptoms that patients with fibromyalgia suffer and the likelihood of their committing suicide.

The rate of suicide is potentially very high, and the prospect of someone we know and love suffering from this disease and considering this drastic action seems plausible. I have a very close family member and a good friend who both suffer from this disease. The associated pain has been described as excruciating, and they pray that the symptoms pass quickly, meaning in a few days, not hours.

Years ago, I suffered from cluster headaches, which have been described as “suicide headaches” because their intensity is incredible, and the pain I felt far outweighed any other that I have ever experienced. Fortunately, these cluster headaches stopped when I was in my 50s, but some are besieged by these headaches multiple times a day for weeks on end. I cannot say that if my cluster headaches had continued that I would not have been tempted to take drastic action.

This brings me to my mother-in-law, who passed away several years ago after experiencing 70-plus years of chronic pain. She had moved in with us, and I found out that her former physician, who had died several decades prior, told her never to take anything stronger than aspirin, or she would become addicted. So, trusting her doctor, she never did take anything stronger or even ask a practitioner for pain medication. This lady had her legs fused together when she was in her 20s and later refused to allow physicians to amputate them, even though the pain had become almost unbearable.

Once I found this out, we sent her to a doctor who I thought would prescribe an opioid to give her a chance to live a somewhat normal life. Unfortunately, that physician lied to my mother-in-law, saying she could not prescribe pain medication. Eventually, we found a doctor specializing in pain who prescribed fentanyl patches that gave my mother-in-law almost 5 years of far less pain than she had endured for decades.

It is true that an opioid crisis has engulfed much of America, including my home state of Ohio. I spent many years in charge of drug units to fight this scourge on our society, and we were able to make dents in the activity of drug cartels, which were only replaced by other drug kingpins.

In the meantime, prescription drugs came to be viewed as the reason for the heroin and synthetic fentanyl epidemics. These drugs and the companies that manufactured and distributed them became easy targets for politicians, some of whom piled on by suing these companies with the goal of gaining votes, while an uninformed public applauded their efforts and continued to reelect them.

This has also led to government agencies’ deciding that prescribers have overprescribed opioids. Overprescription by criminal practitioners has been going on for decades. I have overseen law enforcement units that have pursued, charged, and successfully prosecuted dozens of them. This is nothing new, and it is the responsibility of law enforcement to deal with the outliers without negatively affecting the overwhelming number of legitimate prescribers who are trying to treat patients with pain.

So, should we believe patients who say they are suffering from pain? Have they been targeted by prescribers and dispensers of prescription drugs in the past few years who have refused to write or fill their prescriptions? Of course, there are drug seekers who are not legitimate patients seeking treatment for pain, and sometimes these folks are difficult to root out. They are partly responsible for patients with pain not receiving needed medications, but their actions should not make prescribers, dispensers, and even law enforcement wary of everybody claiming to be in pain. 

Let’s get back to dealing with each person claiming to be in legitimate pain and believe them until we have solid evidence that they are scamming the system. If they are, then let’s pursue them through vigorous prosecution, but let’s not punish the majority of people receiving opioids who are legitimate patients with pain.
 
Cmdr. John Burke is a 40-year veteran of law enforcement, the past president of the National Association of Drug Diversion Investigators, and the president and cofounder of the International Health Facility Diversion Association. He can be reached by email at burke@rxdiversion.com or via rxdiversion.com.


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