Legislators Consider Unintended Effects of Forced Tapering of Opioid Prescriptions

OKLAHOMA CITY – A House committee heard Monday about the effects of restrictions on prescribed pain medication within Oklahoma after rapid reduction policies took effect in 2018.

The study was requested by Rep. John Talley, R-Stillwater, Rep. Ty Burns, R-Pawnee, and Rep. Preston Stinson, R-Edmond.

“We understand that opioid addiction is a problem across the United States that needs to be addressed, but it shouldn’t be addressed at the expense of individuals who need these medications to maintain a good quality of life,” Burns said. “In Oklahoma, we’re working to try to find a balance between addressing this crisis and making sure that Oklahomans have access to medications they need.”

In an opening statement, Talley told the House Alcohol, Tobacco and Controlled Substances Committee a constituent first brought the topic to his attention.

“This has been a very eye-opening experience hearing from people across the United States who suffer unbelievably and we’ve made some knee-jerk reactions,” he said. “We don’t want people to die from opioid problems, but we have also punished many people who need opioids.”

Tamera Stewart, policy director with P3 Alliance, spoke about her experience with opioids and the unanticipated side effects of restricting prescriptions.

“I am the pain patient that ended up being left kind of in the dark whenever the knee jerk reactions happened,” Stewart told the committee. “All of the supply side interventions, trying to limit opioid prescriptions—of course they were done with absolute best of intentions. It seemed logical at the time. And then it trickled down to kind of the wrong side and it [ended] up harming the patients that did take them every day and not changing anything on the outside.”

Dr. Beth Darnall, director of the Stanford Pain Relief Innovations Lab, investigates behavioral medicine for acute and chronic pain through clinical trials funded by National Institutes of Health and Patient-Centered Outcomes Research Institute.

Darnall said one in three individuals is living with ongoing pain of some type, which has tremendous consequences to families and economies. She said as recently as 2016, up to 11 million U.S. adults were taking daily prescription opioids to manage chronic pain.

“While we can recognize, as Tamera mentioned, that this was a good faith effort intended to help patients, there has been massive fallout,” Darnall said.

In 2016, the U.S. Center for Disease Control released guidelines for prescribing opioids. Darnall said while the intention was to help slow new opioid prescriptions, people who had been taking opioids for years or even decades saw their prescription caps lowered to below what they needed to live their daily lives. This has resulted in iatrogenic consequences, when new health risks are caused by the medical intervention itself.

“In the effort to deprescribe, we have failed to implement patient-centered care and take into account the needs of the individuals,” Darnall said. “We have applied one-size-fits-all approaches that necessarily are exposing a fraction of our patients to new harms. So we need flexible policies that attend to the individual needs of the patient and recognize that opioid reduction is not right for everybody.”

Zach Rhoads, an educational consultant with lived experience overcoming heroin, told the committee about his experience with and research on addiction.

“My research indicates that drug-focused policies are missing the mark at best but have detrimental consequences at worst,” Rhoads said. “In the last decade, we as a nation have responded to drug fatalities by reducing the number of prescriptions, the idea being that if we eliminate the drug we eliminate the problems. And it doesn’t work that way.”

Rhoads cited data from the United Nations Office on Drugs and Crime that most people who use drugs don’t become addicted.

“They take them a few times and discontinue use, or they use them with some consistency but without impairment and distress, i.e. addiction, in their lives,” Rhoads said. “They pay their bills, they work, they take care of their families, they’re productive citizens, and they have a balanced life.”

Haskell County Sheriff Tim Turner, who previously spent 11 years on a drug task force, said since 2018, there’s been a decrease in overdose deaths from pharmaceutical drugs but deaths from illegal substances has risen. He told the committee that people in pain who cannot get a prescription for opioids are acquiring illegal opioids and counterfeits on the street to treat their pain. This has led to an increase in overdoses caused by illegal substances.

Turner also said that by and large, people using opioid prescriptions to treat pain are not the ones with addiction issues.

Dr. Steven Drabeck, a family medicine and palliative care specialist, said that current statute actually allows doctors a variety of pain treatment options, but most doctors are unaware and intimidated by potential consequences.

“The problem that has emerged is the lack of education in the medical community,” Drabek said. “We don’t get educated on how to treat pain.”

Dr. Vanila Singh, a clinical associate professor of anesthesiology, pain, and perioperative medicine at Stanford University, told the committee she believes policymakers have become calloused to the suffering of pain patients and that culture as a whole needs to regain empathy for them.

The committee heard from several pain patients about their experiences with forced tapering. Daniel Byard was hit by a drunk driver 12 years ago and suffered severe damage to his knee, neck and back, as well as a concussion and consistent migraines. He is also a caregiver to his wife, who was hit by a drunk driver 16 years ago and has had 19 surgeries since.

“Opioids helped her function,” Byard said. “Once she got on a stable dose with a good pain management doctor, like Dr. Darnall stated earlier, she was immediately cut in half.”

Byard said this sent her into a seizure at their daughter’s third birthday party, and he had to catch her from falling on the floor while seizing.

Byard told the committee how his wife’s quality of life decreased following the forced tapering from her opioid prescription: “She no longer works. She was a physical therapy assistant. We used to go to date night Friday night, daughter’s soccer game Saturday, church on Sunday, everything was great. She had about two to three really bad pain days a month when she was on a dose of medication that was appropriate for her pain level. Now we’re lucky to have two to three decent days per month.”

“The hardest part is there is a solution to help my wife and give her her life back, but because of certain policies that are in place, she can’t get that,” Byard concluded.

The study can be viewed here.