CDC Opioid Guidelines Put More Pressure On Montana Specialist MDs
Doctors in Montana are cutting down on the amount of painkillers they’re prescribing in response to the nationwide epidemic of opioid abuse, and that’s having some unintended consequences.
Sixteen months ago, the federal Centers for Disease Control and Prevention issued new guidelines for doctors, aimed at helping them prescribe more responsibly, and dial back use of highly addictive opioid painkillers.
Those guidelines are having a direct impact on people like Kate Lamport.
Lamport lives in a busy house outside Helena, which she shares with some extended family and a few small dogs.
One morning this winter, Lamport sat on her living room couch wearing a baggy black sweat shirt and drinking a cup tea while her four kids were at school. She’s been taking what the CDC classifies as a high dose of opioids for the last 4 years for her back pain.
She says the new guidelines scare her and chronic pain patients like her.
“There is a lot of fear," Lamport says. "I don’t think there is one pain patient in the United States that isn’t afraid every day.”
Lamport and other pain patients say that one effect of the CDC guidelines is that primary care doctors are a lot more reluctant to prescribe opioids than they used to be. Some are declining to treat chronic pain altogether.
“We’re all afraid," Lamport says, "because any minute they could say ‘sorry, no one is getting pain medication.’”
Lamport says she gets most of her treatment out of state. When she looks for care closer to home, it’s getting harder find a doctors willing to help.
Doctor Andrew Kolodny is the director of the national advocacy group Physicians for Responsible Opioid Prescribing. He says that while there isn’t good data reflecting what Lamport says about doctors stopping, or cutting down on prescribing opioids because of the CDC guidelines, he thinks it’s true.
“Many primary care doctors are only too happy to opt out, and to say, 'I knew this was wrong all along and I’m glad I don’t have to keep doing this,'" Kolodny says. "And so I do think that many of the patients are now being referred to pain management doctors.”
Kolodney says many patients fear they can’t live without opioids because they’ve become dependent on them, and there needs to be a focus on compassionate care for that population as pills are taken away.
Flathead Valley Doctor Camden Kneeland says that since the CDC’s guidelines came out, there’s been a surge in demand for appointments with pain specialists at his clinic.
“Oh, it’s grown dramatically” says Kneeland, who is the Medical Director of the Montana Center for Wellness and Pain Management in Kalispell.
“We are currently averaging between 30 and 40 new patient referrals a week," Kneeland says. "We are having a very difficult time keeping up with patient demand. We are recruiting another, actually two other providers here to try to manage that increased workload.”
Kneeland says the CDC guidelines are good for the vast majority of patients, but there is a small group of patients that do well on high doses of opioids. He says the state doesn’t need more pain specialists, it needs primary care physicians who feel comfortable, and have the tools, to treat pain.
Kneeland says that demand has tapered off somewhat since this winter, but his clinic still has a significant waiting list to get in for a initial appointment.
According to the Montana Medical Association there are just over a dozen doctors trained in pain medicine in Montana, nearly all located in larger cities.
Montana has long had a shortage of all kinds of specialist physicians. So if the CDC opioid guidelines are causing people with chronic pain to seek care outside of primary care clinics, it could be a problem, says the Medical Association’s Doctor Marc Mentel.
“We just do not have enough pain management people here in in the state who can take care of the population, so we need to be aware of those scarce resources," Mentel says. "We need to take on the responsibility as primary care providers and learn how to do this better.”
In the meantime, Mentel says, "some patients have been taken off some of these medicines and led down to lower doses or taken off completely based on these guidelines and it wasn’t intended to be harmful, but it may have been harmful to some of these patients. I truly think if we follow the process of individualized care for certain individuals I think we can hit the right stride.”
Helena resident Kate Lamport is one of those individuals hoping Montana doctors can hit the right stride.
“There is not enough doctors to care for us," Lamport says. "We don’t have any options.”
She says she takes naturopathic remedies, gets vitamin C infusions, meditates, and writes in a journal to keep her mind off the pain.
“I would love nothing more than for all of my alternative stuff to be all I need. But it’s not enough. I have no quality of life," she says.
Lamport says opioid painkillers, while not a miracle drug, help keep her living.
"It’s truly just sometimes that’s all we need to get us back out there working or taking care of our families or to keep us from committing suicide. There is only so much your mind and your body can take from pain before it just gives up," she says.
In part two of this story, we’ll hear more about how Montana Doctors are trying to achieve a balance between compassionate care for people with chronic pain, and their responsibility to help turn the tide of the national epidemic of addiction to opioid painkillers.