Following backlash from patients with chronic pain and people in the disability community, Sen. Kirsten Gillibrand (D-N.Y.) on Wednesday found herself backpedaling on her recently introduced legislation to put a time limit on opioid prescriptions.
The 2020 presidential contender sought to help “end the opioid epidemic” with legislation she introduced with Sen. Cory Gardner (R-Colo.) to limit opioid prescriptions for acute pain to seven days.
But many in the disabled community, as well as chronic pain patients, said they feel such legislation could make it harder for people with chronic pain to get the treatment they need.
While the legislation’s text hasn’t been submitted to Congress’ website yet, Gillibrand’s news release specified that the prescription limit was not meant for patients with chronic pain but for those with acute pain, “such as a wisdom tooth removal or a broken bone.”
But disability rights advocates ― many who responded to Gillibrand on Twitter ― noted that the line between acute and chronic pain was not always simple to determine and that acute and chronic pain often overlapped.
“The distinction between chronic pain and acute pain isn’t nearly as neat and tidy as the Gillibrand and Gardner press release indicates,” Matthew Cortland, a disabled, chronically ill disability rights lawyer, told HuffPost. “The patient community knows that for many living with pain, it can take months or years to get a correct diagnosis of chronic pain.”
Gillibrand acknowledged the criticism Wednesday in a Medium post, saying she wanted to “get this right.”
“I believe that we can have legislation to help combat the opioid epidemic and the over-prescription of these powerful drugs without affecting treatment for those who need this medication,” the senator wrote. “To the patients and disability advocates who have raised concerns: Thank you for sharing your stories. I am listening.”
Noting she’d be “happy to meet” with advocates, she said that she wanted to ensure the bill “does what it was originally intended to do without harming patients” and that she was “open to improving the bill.”
Medical experts HuffPost spoke to said that, though Gillibrand’s legislation may have been well-intentioned, federal-level legislation was too broad an approach to addressing overprescription.
“There are excellent reasons for doctors to change medical practice and provide just a few days’ opioids or none for acute short-term problems,” said Dr. Stefan Kertesz, an addiction scholar and professor of medicine at the University of Alabama at Birmingham.
However, he added, “federal laws are a very blunt tool, and they take away our ability to address individual human situations that are not easy for the Congress to anticipate or micromanage.”
Gillibrand’s bill was meant to address the real and serious problem of opioid abuse in the U.S. Drug overdoses continue to rise, particularly from opioids, according to the U.S. Centers for Disease Control and Prevention. From 1999 to 2017, almost 400,000 people died of an opioid overdose, including prescription and illicit drugs ― and in 2017, an average of 130 Americans died every day of opioid overdoses.
Although the rate of opioid prescriptions peaked around 2010 to 2012, according to the CDC, it has since dropped significantly year over year, suggesting that “healthcare providers have become more cautious in their opioid prescribing practices,” the agency said.
Gillibrand’s bill is “modeled” on existing laws in more than a dozen states, including New York, which already set limits for initial opioid prescriptions for acute pain, according to her team’s news release.
Her bill sets a limit at seven days for a prescription for acute pain ― but one recent study of over 200,000 patients found that the “optimal” length for opioid prescriptions after common surgeries was up to nine days for general surgery procedures, up to 13 days for “women’s health” procedures and up to 15 days for “musculoskeletal” procedures.
Earlier this month, more than 300 medical experts signed a letter to the CDC saying its 2016 guidelines urging caution in prescribing opioids to patients with chronic pain may have actually ended up causing harm to some patients with severe pain. The experts said the guidelines were being used by doctors to refuse treatment to patients, reported The New York Times, and patients were then suffering and going into withdrawal. Some have even died by suicide.
“While the intention is good, the diagnosis is ultimately the doctor’s to make, acute or chronic, as there are no standardized tests to measure pain,” said Dr. Indra Cidambi, an expert in addiction medicine and medical director at the Center for Network Therapy in New Jersey.
“Doctors will become more cautious about prescribing opiate pain medications,” she added.
Cidambi warned that patients who are unable to get adequate prescriptions for pain from their medical provider may end up buying them illegally on the street, with some even turning to harder drugs, such as heroin, which can be cheaper to obtain.
“It’s clearly a well-intentioned bill, but anyone who is living this can tell you how quickly it can fall apart in practice.”
“It’s clearly a well-intentioned bill, but anyone who is living this can tell you how quickly it can fall apart in practice,” said Julia Bascom, executive director of the Autistic Self-Advocacy Network, who is autistic and lives with chronic pain. “We believe that whenever disability is discussed, disabled people need to be at the table ― this bill is a good example of why.”
Cortland noted the unequal treatment of patients from marginalized groups when it comes to pain, with research showing that black patients were less likely to be believed than white ones when reporting their pain, resulting in their being undertreated.
He said that lawmakers should instead focus their efforts to address the opioid crisis on public health interventions, such as funding safe consumption sites or increasing access to treatment instead of incarceration for people who use drugs.
“If politicians want to make an impact on substance abuse, they should look at societal drivers of addiction,” Bascom echoed. “Not prescriptions, [but] things like poverty and lack of access to mental health supports.”