(6/12/2015) As VA cuts narcotic prescriptions, veterans with chronic pain cry foul


For nearly four decades, the Department of Veterans Affairs had prescribed James Andrews narcotic painkillers for back pain. But last year, the VA sent the Vietnam veteran a terse letter informing him that it had canceled his prescription for hydrocodone.

His doctor told him he’d tested negative for opioids — a sign that patients might be hoarding and selling their pills — but Andrews said he had no hydrocodone in his system because he took the medication only when his pain was unbearable.

“I was extremely upset. You can’t do that to somebody, especially someone with a failed spinal fusion,” he said. “Ask me how I’m taking them rather than cutting me off and assuming I’m doing something illegal, because I’m not.” …

The complaints have grown so loud that Disabled American Veterans, an influential advocacy group, has called for more “humane” pain management treatment as the VA seeks a balance between giving the painkillers to those who need them to function and reducing or discontinuing them for those who don’t.

The VA’s new guidelines and policies on opioids look good on paper. They call for exploration of alternative therapies and gradual tapering of veterans on long-term painkillers to avoid painful withdrawal symptoms. They call for conversations with veterans about options such as acupuncture and spinal cord stimulators before doctors discontinue narcotics. And they call for reducing the amount of narcotic painkillers given to individual veterans to safer levels…

Replacing opioids with acupuncture and spinal cord stimulators?  Do these “treatments” have a better success rate than opioids?  How many pain patients does acupuncture help — something like 10%, if that?  How many VA doctors know anything about acupuncture? It’s not even a recognized medical specialty.  And how many patients are harmed by stimulators?

At the heart of many complaints is a more robust painkiller contract, known as an informed consent agreement, that the VA requires veterans to sign, pledging to take their opioids as prescribed and to avoid alcohol and recreational drugs…

One of those patients was San Marcos resident Ezekiel Enriquez, 68, a Marine veteran who fought in Vietnam. The VA had prescribed him opioids, including hydrocodone, off and on for nearly a decade for herniated discs.

Like Andrews, Enriquez tested negative for opioids late last year and was abruptly cut off of his painkillers. Enriquez says flare-ups and dental pain caused him to sometimes finish his prescription early, meaning the medications were out of his system by the time he went to the Austin VA clinic to see his doctor. “They said, ‘We can’t give it to you any more, you broke the contract,'” he said…

While Central Texas officials have introduced such alternatives as aquatic therapy and chiropractic care, Enriquez said his doctor didn’t discuss such treatments with him, and suggested in a meeting that he might be selling his pills.

Replacing opioids with aquatic therapy and chiropractic care?  How’s that working for you, VA?

Eventually another VA doctor put him on Tramadol, a less powerful painkiller that he says doesn’t relieve his pain as well as hydrocodone and makes him drowsy.

Some pain medicine experts warn against using urine drug tests as evidence that a patient isn’t taking painkillers because synthetic opioids such as hydrocodone stay in the bloodstream for only a couple of days.

“Testing the urine does not tell you if the patient took the medicine,” said pain specialist Dr. C.M. Schade, director emeritus of the Texas Pain Society. And urine tests are especially poor tools for detecting opioids in a patient taking painkillers on an as-needed basis, which many doctors recommend for chronic conditions.

Cutting patients off of painkillers cold turkey “is unsafe medicine,” Schade said…

But several patients say they weren’t given a Plan B. Bill Williams, a 62-year-old Vietnam veteran from Brackettville, had his longtime hydrocodone prescription canceled earlier this year after he tested positive for marijuana. But he said his doctor didn’t discuss the situation with him as spelled out in the guidelines.

“I would have thought they would give me the courtesy of a phone call rather than shoot me a letter,” he said. “I thought we had a little better relationship than that.”

And Enriquez said he learned of his doctor’s decision when he called the VA to ask why he hadn’t received his monthly prescription…

“We are in our last years already, where you don’t know if you are going wake up or not,” he said. “If we take the medications responsibly and it’s helping, why do you take it away from us?

Not only, why do you take away something that works, but what the hell are you going to replace it with?  Cruelty and suffering?

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