“Of course they turn to street drugs.”
By Madeleine Janz
CORRECTION: The original version of this story suggested that Jozelle Hoodenpyle attended a support group for those using opioids, when in fact the support group was for patients experiencing chronic pain. This mistake has been corrected.
This is the third in a three-part series. Read the introduction to “The Life of a Crisis” here, the first part here, and the second part here.
After many surgeries and life adjustments, Hoodenpyle has now moved to a new city and still works to manage her pain. Now, she focuses on her own pain management but before she moved, she assisted PeaceHealth, a Northwestern Regional Hospital in Washington, Oregon and Alaska, by advising the rewriting of the hospital’s pain contract. Hoodenpyle says, “As a patient, if you get a prescription you need to have one doctor as a point of contact, you need to be available for random drug testing and you are not allowed to use alcohol or marijuana during this time.”
This pain contract is an attempt at preventing patient addiction and creating a more trusting relationship between doctors and their patients. In “Pills a Potent Problem,” written by Marissa Harshman, journalist at the Columbian, Bob Djergaian the director of physical medicine and rehabilitation at PeaceHealth speaks about medical anxiety. He says, “The misunderstanding [of prescription liability] has also prompted some physicians to stop seeing pain patients.” In the wake of this fear, Amanda Lefkowitz, a nurse practitioner and care provider at Urban Recovery in Brooklyn, NY remarks that doctors didn’t have the proper training to get their patients off opioids.
Doctors “knew how to get patients on [opioids, but] they don’t know how to get them off.” — Amanda Lefkowitz
Lefkowitz sees patients both in inpatient and outpatient who received prescriptions after an injury or surgery but were given no information about addiction risk or how to detox. She cites the use of detox drugs such as Suboxone and Naltrexone as important to her work in medically assisting her patients through their withdrawal from opioids.
In this third wave of the crisis, medication-assisted recovery and pain contracts are attempting to close the gap between doctors, that are often working to reach a quota, and patients, like Hoodenpyle, that are struggling with lasting pain. As Hoodenpyle puts it, pain contracts are “a way for doctors to understand what a patient is going through. It’s not that patients want to take opioids, it’s that what is the alternative?”
Hoodenpyle has tried plenty of alternatives, and worries that these treatments are out of reach for many patients because of poverty or lack of information.
She says, “those alternative therapies of massage therapy, physical therapy, and turmeric anti-inflammatory supplements can easily cost around 1,300 dollars a month” as compared to a $40 bottle of pain medication, if insurance covers it.
Dr. Graff, who has 40 years of experience working in assessing patient pain to prescribe opioids worries about pain monitors like the 1–10 scale as he says “from a doctor’s perspective, pain is something that is really hard to determine because it’s entirely subjective.” To combat this concern, Hoodenpyle, and many others who have experienced the role of patient advocate and self-advocate use documented pain to mean MRI’s, X-rays, and history of degenerative disease that prove a patient is in pain. She says in the wake of all the federal trials and general opioid stigma
“Doctors are so hesitant to prescribe because of the liability.” — Jozelle Hoodenpyle
So where does this leave those that cannot afford alternative therapy and cannot complete even everyday tasks because of their pain?
Hoodenpyle says its about finding spaces in which there is more support for people in pain like PeaceHealth. While she was helping rewrite the contract she attended a support group for people experiencing chronic pain. She says, “By the end of the eight week course there were only three of us left. Some people see the benefits but frankly are in too much pain to get out of their house and do something like that.”
A study on treatment of chronic pain done by the U.S. National Library of Medicine found that between 30 and 60 million Americans suffer from chronic pain. Hoodenpyle knows the daily stress of this pain and attempting to keep an opioid prescription in the third wave of the crisis. She uses alternative therapies when she can and remains aware of the fact that poverty could easily make someone unable to manage their pain without a prescription. The fallout from the federal trials still in process and the impending liability of prescribing opioids leaves her and many others in what seems to be an impossible situation. Many turn to drugs sold on the street such as heroin and fentanyl; others suffer debt trying to pay for alternative treatment.
Hoodenpyle says “Having moved to a new city trying to get a physician to continue my prescription, my odds are probably 50/50. I even have letters from my physician, surgeon, and chiropractor saying I have been an active participant in taking the pain medication responsibly. Think about just the general person without all this, of course they turn to street drugs.”
Legislation is years behind the current stage of the opioid crisis but it still affects patients living in pain today. Many, like Hoodenpyle, fear being cut off from their prescriptions that provide necessary relief and others, unable to pay for alternative treatment, rely on illegal and deadly painkillers like fentanyl. Pain contracts and medication-assisted recovery help those already entangled in the medical system but real nationwide policies have to be enacted for the crisis to stop taking new victims.
