When Bob Mason decided to end his life with a self-inflicted gunshot, his pain helped him pull the trigger.
Mason died in January. He was 67 years old. His daughter, Shane Mieski, says her father had been without pain-killing drugs for about a week when he died.
"For the last couple weeks up until Bob passed away, there were a lot of tears everyday on the phone," Mieski said, "between the pain and really just the sadness of not being able to walk his dog, which, I’m sure it was more than that. There would be tears, then he would joke," she said, "then he’d call back an hour later and be teary and in pain again.”
One of Mason’s doctors was Mark Ibsen in Helena. Ibsen shut his practice last winter, after being investigated by the Montana Board of Medical Examiners for over-prescribing the powerful and addictive painkillers known as opioids.
That meant Bob Mason lost his access to the painkillers he needed to make his life bearable. Mieski says she remembers her dad talking about seeing another doctor in Butte to get relief. But he was in too much pain to make the trip from his home in Helena.
“An hour down and an hour back, it was too painful," Mieski said. "He would wince every time he sat down, and cringe, and I swear I could hear his back creaking every time he stood up.”
In March a group of chronic pain patients in Montana presented what they call a "pain patient's bill of rights" to the state legislature’s Health and Human Services Committee. Terri Anderson from Hamilton was one of them.
“On behalf of all those who suffer pain, and Robert Mason, who took his own life because of uncontrolled pain," Anderson said to the committee. "We are a diverse group of patients," she said. "We come from all walks of life, and we believe the treatment of our chronic intractable pain is a fundamental human right.”
Anderson says the pain patient's bill of rights is based on similar legislation in California. Lawmakers there found that the state has a right and duty to control the illegal use of opioid drugs. They also found that for some patients, inadequate treatment of acute and chronic pain is a significant health problem.
California’s pain patient’s bill of rights allows a patient to request or reject the use of any or all techniques in order to relieve their pain.
According to The Montana Medical Association, prescription drugs contributed to more than 300 deaths in Montana between 2011 and 2013. The Association says kids in Montana have the third highest prescription drug abuse rate in the country.
“Opioids were given out like jelly beans," Pain Patient Advocate Terri Anderson acknowledges. "People did become addicted, and [there were] too many deaths from these prescribing habits. But the pendulum has swung, and the legitimate pain patients cannot get their medications. Especially in Montana."
California’s first version of the pain patient's bill of rights became law in 1997.
Los Angeles area doctor Forest Tennant advocated for it. He now treats patients who come from states all over the country - including Montana - who can’t find effective pain treatment at home.
“The last week or two has just been unbearable," he said. "We hardly want to take the phones, [because of] the number of people calling that want to come here."
"A lot of it is, doctors in other states don’t want to treat anybody," Tennant says.
"We’ve been at this since World War II, when we had a lot of sailors and soldiers settle here. And so, in California, believe it or not, we have the lowest per-capita prescribing of schedule-2 opioids. That’s because we’ve been at training and programs for decades.”
To an untrained doctor, Tennant says, addicts and pain patients can look similar. He says education in the medical community about pain management and opioids is almost nonexistent.
“Here is the thing the public doesn’t get," he says. "The government doesn’t get it, the universities don't get it, and I don’t know why this is so hard to understand.
"The CDC has got these guidelines. All they do is reiterate what is standard care anyway," Tennant says. "In other words, you have standard care. That’s non-pharmacological medication, physical therapy, injections, surgery, topical medications, psychotherapy - and all of those things have to be tried before a patient can come here. Opioids are not an option; they are the last resort when there is no other option. You don’t use them until everything else has failed. Big myth. Big misunderstanding.”
Doctor Marc Mentel chairs a Montana Medical Association committee on prescription drug abuse.
“I know nationally there is a big move to regulate these medicines, and have tighter regulations, and right now legislation is being considered," Metel says. "A lot of us are proposing [that] education is really what we need to do. The opioid problem is a big problem in the U.S. and we have to face it and take it head-on. But at the same point in time, as we take that on, we don’t want to throw out patients who also suffer from chronic pain and may benefit from these medicines. And some of them leave with actually better quality of life with them being available.”
Mentel testified at the Montana legislative committee hearing on the pain patient's bill of rights in March.
“Right now the exact means and ability to know what is the best way to manage chronic pain, what are the tools available, what is available out there? We are still developing the science," Mentel told the committee.
"A pain patient's bill of rights - although I agree with everything that is on there that they are talking about today, I agree with them wholeheartedly, it is actually in my oath I took as a physician to treat everyone as if I would want to be treated myself. I’m just fearful that a bill of rights, or some mandates for physicians to practice in a certain way, could get legislation ahead of the science.”
“What I think is important is that we have the discussion," says state Senator Mary Caferro, "and if I as a legislator can in anyway assist with that, I’m going to do it.”
The Helena Democrat says she’ll put in a bill draft request for the 2017 legislative session, but she isn’t sure yet if she’ll be a formal sponsor for a pain patient's bill of rights.
“Drug addiction is a problem, it is a very serious problem," Caferro says. "What I don’t want to see happen, and what has been identified as a problem, is that people who really need access to medication get swept up in the drug addiction. They are two separate issues. You have drug addiction, and you have people who need medicine for their pain management. Those are two separate issues.”
Bob Mason, the pain patient from Helena who committed suicide, moved to Montana to try to get relief in 2012. He got a spinal cord stimulator implant, but afterwards, still needed opioids.
His daughter, Shane Mieski, said he didn’t like the drugs, but there were no other options.
“The opioids, they cause other issues," Mieski says. "Your body starts to feel slow and a little overwhelmed, as he would mention. You don’t feel super sharp and on top of your game. At a certain point, there was nothing more that doctors could do for his type of pain. So, as a 67-year-old person, I think that you should try to enjoy any quality of life you get. And if that means taking medication to function, give them what they need.”
Opium-derived drugs are a two-headed beast. One clenches its jaws around addicts, whose lives it can crush. The other offers relief that can make life worth living, at least for long enough to allow a man like Bob Mason to feel like he can walk his dog.
The American Academy of Pain Medicine says a hundred million Americans suffer with chronic pain. That’s more than the number of people with diabetes, heart disease, and cancer combined.
Read the first part of this series on pain patients' access to opioid painkillers in Montana.
This story was made possible, in part, by a grant from the Montana Health Care Foundation.