Al Driggers remembers the day when he was diagnosed with leukemia: Dec. 12, 2006. He remembers the date of his bone marrow transplant in 2007. Now he has another date to add to his calendar: the one in September when his fentanyl prescription will run out.
“Yes, I have become an addict, because I don’t want more pain,” he says. “This little bitty, teeny tiny patch right here is making me a drug addict. They’re trying to fix that on the streets, but they’re messing with me.”
Driggers, 66, is one of an untold number of people who use doctor-monitored opioids to manage chronic pain. His neuropathy, a side effect of chemotherapy, is incurable and leaves him with a searing pain in his feet that feels, he says, like “walking on burning needles, or hot coals that are sharp.”
But new state regulations that went into effect in March to combat the opioid epidemic are lowering the number of painkiller prescriptions filled in Virginia pharmacies, says the state Board of Medicine. And its members hope that additional changes that go into effect on July 1, which require prescribers to refer to a patient database for any opioid prescription longer than seven days, will lower that number even more.
Stemming the flow of medication to patients, though, is putting people such as Driggers on the front line of the complex, national opioid epidemic.
Driggers and his wife Lydia, 69, moved to Mechanicsville from Southwest Virginia in order to get Driggers better cancer treatment at Virginia Commonwealth University Medical Center.
For his pain, Driggers tried lidocaine patches, electrodes and acupuncture, among other alternative treatments. One doctor prescribed the opioid Dilaudid, and when it didn’t work at first, another told him to increase the dosage to four pills every four hours. “It builds up and builds up,” says Lydia Driggers. “I had to end up taking him to the hospital. He didn’t even know hardly where he was.” Al Driggers detoxed there for a week.
It took years to find the sweet spot in his pain management, he says: 600 milligrams a day of a nerve pain medication and fentanyl patches that administer about 50 micrograms per hour. “If I try to get any more pain gone, I become an unfunctional bull. I just sit or sleep all day,” he says. “And if we do anything less, I have severe, severe pain.
“I’m not abusing anything,” he adds.
The new rules and doctors’ newfound aversion to prescribing opioids are dumbfounding to the Driggers. This month, they were given one last three-month prescription and referred to a pain management program at the VCU Health Neuroscience, Orthopedic and Wellness Center. The doctors there said Driggers’ condition did not align with their expertise.
The current crisis began in the mid-’90s, says Peter Cunningham, a professor in the department of health behavior and policy at VCU, when doctors sought more aggressive pain treatments and pharmaceutical companies marketed new opioids as relatively safe and nonaddictive.
Some drug companies eventually were prosecuted for misleading doctors and the public about the safety of certain opioids. And Attorney General Mark Herring announced this month that Virginia is part of a multistate coalition of attorneys general investigating whether drug manufacturers have engaged in unlawful practices in the marketing and sale of opioids.
On the doctor-patient level, there’s a cultural shift in how pain is treated and managed. “The biggest challenge is the expectation of patients,” Cunningham says. “They’ve become accustomed to the idea that there’s this relatively easy fix to acute or chronic pain. They don’t really care about this history or culture. They only care about their pain — rightly so.”
But Cunningham says there’s not a strong consensus what should replace opioid prescriptions, especially for chronic pain, which is a common problem for cancer survivors.
“The thing is that, for all the problems they’ve caused, opioids have worked, in terms of easing people’s pain,” he says.
And taking a chronic pain patient off opioids has its risks, too. Recent studies report that nearly 80 percent of heroin users started off using prescription opioids.
It’s a crisis that has struck Richmond. Overdoses rose sharply in recent years, as heroin laced with fentanyl circulates on the streets. Chip Decker, head of the Richmond Ambulance Authority, says that first responders saw 173 overdoses in the city between January and May. Thirteen of those people died.
Driggers understands the crisis, but he also worries about people losing their doctor-prescribed opioid medications. To make things worse, he says, insurance companies are unwilling to fund sleep aids after a patient turns 65.
“Can you imagine being in pain because they don’t want to give you any pain medicines, and then being wide awake all the time, because they don’t want you to sleep?” he says. “I can predict, if it stays like it is, the senior citizen suicide rate is going to go through the roof.”
Sebastian Tong, a doctor and assistant professor of family medicine at the VCU School of Medicine, says that while the regulations are intended to decrease opioid prescriptions, there are always exceptions.
“I think it’s going to affect more [a situation where] if I show up in an ER complaining about pain, I’m less likely to get an opioid,” he says.
He sees the risk of cases like Driggers’, though. “Each physician is interpreting the guidelines,” Tong says. “No doctor wants his license taken away for one patient.”
Opioids should be a last resort, he says, even when someone has a long doctor-patient relationship and there’s trust.
Driggers hopes for admission into some sort of clinical trial and is curious about medical marijuana as a pain-management option. Pharmaceutical companies have lobbied against marijuana legalization precisely for this reason, but some political leaders now support a plan to decriminalize it, partly as a way to combat the opioid crisis.
“I never thought I’d see 60,” Driggers says. “But now that I’ve got some longevity, I sort of want to keep it. I like hanging around.
“But you don’t want to be old and hurt. I deserve not to hurt much more.” S