By DEBBIE BURKE AND DR. ANN BUKACEK
Parts 1 and 2 in this series reviewed recent laws and regulations on prescription drugs that deprive seniors of needed pain control. Names have been changed to protect identities.
Robert H., 76, worked for more than 30 years in retail sales, standing on his feet all day, despite congenital back problems. Since retirement, he’s lived in a low-income senior apartment in Kalispell.
When osteoporosis caused a disabling lumbar fracture, he was put into a nursing facility and not expected to live independently again. But he was determined to go home and worked hard in physical therapy.
After four months, he returned to his apartment.
Because Robert no longer drives, he depends on public transportation. A trip to the pharmacy is a major project. To reach the city bus stop, he must walk a mile using his rolling walker. In winter, he risks falling on snow and ice. Dial-A-Ride offers door-to-door transportation, but demand has increased so much that reservations must be made seven days in advance.
Lack of transportation leads to additional challenges when refills are restricted to short time periods.
Unfair Burden For Seniors
Under federal law, “Schedule II prescriptions must be presented to the pharmacy in written form and signed by the prescriber.” For mail order pharmacies, the prescription must be mailed, causing the patient to wait days for pain relief.
In Dr. Anne Bukacek’s experience, seniors like Robert tend to conserve pain meds until really needed, saving them for sleep or to prepare for pain-triggering activities like physical therapy. Additionally, many are on fixed incomes and try to stretch prescriptions to last, because they can’t afford regular refills.
If patients do not refill prescriptions for a controlled substance within 90 days, under Montana law HB 86, those patients are then classified as “opiate-naïve,” a term applied to individuals who don’t take daily doses for managing chronic pain. It may be used to refer to people starting narcotics for the first time, but also, as in Montana, may refer to any patient who hasn’t filled a prescription within 90 days.
Many who don’t fill within 90 days are not truly opiate naïve, because they continue taking narcotics they have taken for years but have simply cut back on the dose to make it last longer.
According to Dr. Bukacek, these are two separate patient populations who should be treated differently.
In her primary care practice, she says the imposition of the opiate naïve classification results in hassles for patients who are not truly opiate naïve. Many are subject to unnecessary regulation based on such an inaccurate designation.
The bottom Line
In Montana, prescriptions for patients defined as opiate naïve under HB 86 are limited to seven days. Then the patient has to see the doctor again in a week to get a 30-day prescription. This restriction requires more doctor visits, trips to the pharmacy, and increased costs to already cash-strapped seniors. Additionally, they must pay higher prices for pain pills, because seven-day prescriptions cost more than 30-day or longer prescriptions.
When seniors try to save money by using fewer pills, they are penalized.
Some states have passed even stricter laws, allowing refills for only five days at a time, not taking into account that patients run out on weekends and holidays when pharmacies are closed. For people using mail order pharmacies, timely refills become nearly impossible.
Should seniors and veterans be left suffering because of mail delays?
Legislatures appear to assume all people on prescribed narcotics are abusers and must be treated like addicts.
Pain Shaming
Arliss T., 66, became disabled by a work-related injury. She is not a drug abuser and resents that she is made to feel guilty and ashamed for using narcotics.
“I’m a responsible opioid user on very low doses,” she said. “Yet, I was told by a physician assistant recently at my disability evaluation that pain pills are the Devil in a bottle. That demeaning attitude has become common among health care providers toward legitimate pain patients. After 3-½ years of constant pain, these medications have restored enough function that I am able to enjoy life again, though I’m still not fully functional. I can clean my house, play with my grandchildren, and enjoy hobbies.”
Do Strict Regulations Work?
According to research, overdose deaths dropped less than 5 percent as a result of restrictions on physicians’ ability to prescribe.
Dr. Bukacek cautioned, “Any small benefit must be balanced by the understanding that regulation of legitimate physician prescribing can lead to more use of illegal substances and more suicides as legal outlets are limited.”
How Can Seniors Protect Themselves?
Regulations are adopted and laws passed to respond to a social crises that may be real or perceived as real. Despite good intentions, such actions lead to unexpected, unintended consequences that can prove more harmful than the original crisis they addressed.
Seniors often feel overlooked, cast aside, and less capable than they once were. Even though politicians court the youth vote, we seniors not only register to vote, we take the time and trouble to cast our votes.
Perhaps it’s time to use this voting power to protect ourselves from further unnecessary, debilitating pain that has been thrust upon us. ISI
Ann Bukacek, MD, practices internal medicine in Kalispell and was awarded the 2019 American College of Physicians Laureate for Montana. She serves on the Flathead City-County Board of Health. Debbie Burke lives in Kalispell and writes mystery/suspense novels as well as articles. Her recent thriller, Stalking Midas, addresses elder fraud. debbieburkewriter.com
