Opioid Conundrum: A painless addiction versus a painful existence
The moral battle facing physicians and their patients

Dr. Steven Galper, a pain doctor in Prescott, speaks with his patient Rachel Turet about pain she experiences from her arthritis and fibromyalgia. (Max Efrein/Courier)

Dr. Steven Galper, a pain doctor in Prescott, speaks with his patient Rachel Turet about pain she experiences from her arthritis and fibromyalgia. (Max Efrein/Courier)

Rachel Turet had crippling pain until she tried morphine.

“For the first time in my entire life, I was getting a good night’s sleep, I was doing well,” the 72-year-old Prescott resident said.

She was introduced to the prescription pain killer 17 years ago during a bout with breast cancer. While undergoing chemotherapy, she was placed on a heavy pain therapy treatment of 105 milligrams of morphine a day.

“I used a lot less than what the doctors gave me,” she said. “I rarely took more than 75 milligrams.”

Though she was concerned about growing physically dependent and possibly addicted to opioids, the drug worked all too well. Even after chemotherapy, she continued to use morphine to manage ongoing pain she has experienced from arthritis and fibromyalgia.

About 15 months ago, however, the drug was swiftly stripped away from her. The Phoenix rheumatologist who she received her prescriptions from had changed practices and could no longer write her the scripts.

“He handed me my last prescription, and I was like ‘What am I supposed to do now?’” she said. “He kind of shrugged and said, ‘Well, you’ll have to find a pain doctor.’”

NEW LIMITS ON PRESCRIBING

The sort of sudden shift in policy regarding prescriptions Turet experienced is something patients and physicians are both having to adjust to as restrictions on prescriptions are gradually increasing in Arizona and many other states.

“For many years, [physicians] were told they should treat their patients’ pain, and now with the restrictions placed on prescribing, they’re feeling a little bit like they’re leaving some people who have legitimate chronic pain without the pain management that they need,” said Leslie Horton, director of Yavapai County Community Health Services.

Nowadays, before a controlled substance can be prescribed to someone in Arizona, a doctor is required to lookup what medications that person has been prescribed in the past using a prescription monitoring program and then log whatever is being prescribed during the visit. This is meant to keep physicians accountable for their prescribing practices and prevent medication abusers from loading up on drugs through doctor shopping.

Additionally, regular physicians can no longer prescribe large supplies of opioids. “Whereas they used to be able to prescribe a 30-day supply of Oxycodone or another opioid, now they have to cut it down to a three-to-five day supply,” Horton said.

And if a doctor wants to prescribe more than 90 milligrams of morphine equivalent a day (a significant dose), that script has to be approved by a pain doctor — someone who is board certified in pain medicine.

These regulations have led many doctors to simply stop offering opioid prescriptions entirely, said Dr. Steven Galper, a pain doctor in Prescott.

“Because of the laws that were recently passed, it’s a hassle to give people the medicine,” Galper said. “It’s a lot easier to say no than yes.”

MANAGING THE PAIN

These changes have forced patients like Turet to reconsider how they manage their pain.

After being turned away from one pain doctor in the Quad Cities for being a “long-term opiate user,” she found Dr. Galper, whose practice is designed to reduce patients’ dependencies on certain medications.

“If you’re on 150 milligrams of morphine, that’s where you’re going to start in my clinic, but you’re gonna go down,” Galper said.

In just three months of seeing Galper, Turet was completely opioid free, and has been for the last year.

“I was physically addicted because my body demanded its morphine, but I was never emotionally addicted,” Turet said.

She’s the first to admit, however, that while the pain management plan she is currently on gets her through the day, it’s not ideal.

“It does help, but I’m certainly not at the degree of comfort that I was when I was taking morphine,” she said.

Dr. Galper understands this, but believes it is just part of the gig these days.

“Any pain doctor that says they’re going to make all of your pain go away is lying to you,” Galper said. “I constantly remind [my patients] this is about management; it’s not about curing.”

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