For them, drugs are the answer

Brushing teeth or applying makeup can feel like a game of Russian roulette to Jo Hewitt. Hewitt, founder of the Vacaville-Sacramento area Reflex Sympathetic Dystrophy Syndrome Association, a chronic pain support group, suffers from trigeminal neuralgia, or TN, which is sometimes referred to as the “suicide disease.” That’s because of the searing agony that can be triggered from the lightest of touches.

According to the Mayo Clinic, TN affects the trigeminal nerve, which carries sensations from a person’s face to their brain. Mild stimulation of the face, even from a breeze, can shoot lightning into the brain.

As a longtime pain patient, Hewitt says she’s proven capable of transitioning between marijuana and opioids to manage her discomfort. But because America’s opioid epidemic is threatening an unprecedented drop in mortality rates for the third straight year, Hewitt says she was denied an opioid prescription for a condition that can strike at any time.

“I’m your typical chronic pain patient,” Hewitt said. “For years I was on and off pain prescriptions. I transitioned over to pot and then later broke my hand and got diagnosed with [TN]—and when I asked to go back on pain meds, I was denied. I could barely get a Tylenol from the doctor.”

On September 18, roughly four dozen people sympathetic to Hewitt’s plight or experiencing similar challenges gathered outside the state Capitol to protest federal prescribing guidelines that they say have panicked doctors into sitting on their prescription pads. Rallied by Don’t Punish Pain, a national organization, it was a rare public defense of opioids amid an epidemic.

At the rally, Oroville resident Charlotte Elmore expressed her discontent with doctors’ flip-flopping attitudes toward powerful analgesics.

“Years ago, I tried to tell my doctor I didn’t want my dosage to be so high and he told me he thought I’m good right where I’m at,” Elmore said. “Now, I’m physically dependent on them, and the guidelines are making my doctor lower my dosage to a level that’s too low.”

Some studies show that the federal government may be overcorrecting when it comes to regulating pain patients’ access to medication. In an April 2018 study, Pain Medicine, a multidisciplinary journal dedicated to pain professionals, found that “many current assumptions about opioid analgesics are ill-founded. Illicit fentanyl and heroin, not opioid prescribing, now fuel the current opioid overdose epidemic.”

But other studies show that prescription drugs, which are still responsible for a number of deaths and addictions, are the Pandora’s box that often lead directly to the abuse of fentanyl and heroin. According to the Center for Behavioral Health Statistics and Quality, between 8 and 12 percent of opioid users develop a disorder; about 80 percent of people who use heroin first misused prescription opioids.

Dr. Jason Busse, a clinical epidemiology professor at McMaster University in Ontario, says that although some pain patients with a legitimate need for medication may fall through the cracks, legislation regulating opioid prescriptions was overdue. Busse said governments need to find a middle ground between the overprescribing of the late 1990s and 2000s, and the disinclination to prescribe he sees today and foresees for the future.

“The pendulum tends to swing from one end to the other,” Busse said. “For years, there was fairly generous prescribing, often at very high doses, in the U.S. and Canada. Now, we’re seeing regulations on dosages and some prescribers choosing not to prescribe opioids altogether.

“I think we need to find that middle ground, a balance where we do a better job recognizing what kinds of individuals are unlikely to experience greater benefits than harm from prescription opioids.”

California state lawmakers considered at least 20 opioid-related bills during the recent session. Senate Bill 1109, authored by Sen. Pat Bates, expands opioid education for physicians and surgeons, and Assembly Bill 2760, authored by Assemblyman Jim Wood, requires doctors to provide overdose-reversing medications when prescribing opioids. Both were signed last month by Gov. Jerry Brown.

Pain patients want more. Lawrence Favero, a spokesperson for Don’t Punish Pain, said his organization is looking to amend California’s Pain Patients Bill of Rights. Favero says that although the bill guarantees opioids as an option for chronic pain, it gives doctors too much discretion and doesn’t go far enough in protecting patients.

“Though it seems to provide some protection for chronic pain patients, it is too vague and has been largely ignored,” Favero said in a written statement to SN&R. “We have proposed changes that would provide more specific protections for patients, physicians and pharmacists. Focusing the responsibility for treatment on the physician and patient instead of government agencies and insurance companies.”

Favero hopes that legislation strengthening the bill will be introduced during the next legislative session.

It’s a balmy summer morning, even under a low-slung awning on the porch of a North Sacramento house. The big family that’s crowded under its brim is discussing the origins and local ripples of America’s drug epidemic when the sister who resides here shares her own brush with a public health crisis that is erasing scores of lives.

Patricia Lester tells her siblings she only recently learned that a medication her doctor had prescribed her for three years was an opioid pain killer commonly administered to dogs and cats. The drug is called Tramadol. Some hard-up addicts snap their pets’ limbs to score from veterinarians’ offices. For Lester, who says she turned down her doctor’s offer of Norco explicitly because she feared the addictive lure of opioids, the discovery explained why she had been sidelined with extreme lethargy the past few years.

“It was like I was dying in my own [body],” she said. “And it was like the spirit just said, ‘Quit taking them damn pills!’ And I became a human again.”

One of Lester’s sisters waits a comedic beat before chiming in.

“Do you have any more?” she asked, prompting peels of laughter.

Lester lets out a full-throated roar.

”Hell no,” she retorted. “Look, I told the man I don’t want none of that shit.”

But many still do. In 2016 alone, more than 42,000 people died from opioids in the United States, according to the U.S. Centers for Disease Control and Prevention. That’s more than the number of people who live in Fair Oaks. Fifty-five of those deaths occurred in Sacramento County.

In recent years, Washington D.C. has made the opioid epidemic a top public health priority. The U.S. Surgeon General’s Office identified doctors’ overprescribing habits since the late 1990s as a key factor in the misuse of opioids. In 2016, the CDC released prescribing guidelines aimed at cutting into a legal supply blamed for starting scores of Americans on the path to addiction. The guidelines recommend nonopioid therapy, the lowest possible opioid dosage effective, and reducing the risk of over-prescribing through urine drug testing and prescription drug monitoring programs. A patient’s medical history should also be considered before prescribing for pain, the CDC recommended.

By 2017, the prescribing rate dipped to under 59 opioid prescriptions dispensed per 100 persons, the lowest since 2006. In total, 191 million opioid prescriptions were dispensed in the country.

According to a drug monitoring surveillance report issued to county supervisors last year, local opioid prescriptions peaked in 2013 and have started to inch down since then. More than 1 million opioid prescriptions were dispensed in Sacramento County in 2015, according to local data, most of that for hydrocodone. That equates to about two prescriptions for every three residents, the county says.

But that doesn’t reflect the true toll of addiction. That same year, the number of reported prescriptions for buprenorphine, a common opioid dependency drug, marked a 247 percent increase over 2008. Some of that has to do with what happens outside of the county.

While the rate is 50 opioid prescriptions per 100 people in Sacramento County, the prescription rate starts to redline in the foothills and spikes off the charts in the lesser-populated upper reaches of the state. Placer and El Dorado counties are well over 60 prescriptions per persons, while Amador and Tuolumne counties peak past 112, CDC data shows.

In Sacramento County, opioids are the primary drug of choice among homeless people as well as residents of the Land Park, Meadowview and Pocket communities, the county’s Health and Human Services Department reported earlier this year.

Back in North Sacramento, Lester and her family reflect on the toll that drugs have had since the crack cocaine epidemic of the 1980s targeted communities of color like theirs.

“So now it’s meth and ‘surp and pills, fentanyl and norcos,” said Monique Smith, Lester’s niece. “I drive Uber. So I get all kinds of people in my car.”

Smith says she’ll take fares to the Roseville suburbs where mostly young, mostly white women hooked on smack and other substances ask her to pray for them.

Smith tells them that she will. Outside of divine intervention, she knows these women feel like they have few options left.

“One girl was pregnant,” Smith said. “Twenty-three years old and pregnant. She was on meth. Her parents don’t know that she’s on those drugs. And it’s such a sad thing because it’s not a black thing. It’s a universal thing.”