By Robin Huebner on Aug 24, 2015 at 8:21 a.m.
FARGO, N.D. –When Kent Heneman had an outpatient procedure to treat his chronic back pain recently, he assumed he’d get a prescription drug for the residual pain expected afterward. But he says he was refused medication because his medical record stated, erroneously, that he had violated an opioid treatment agreement with the facility.
It was part of a tussle Heneman is having with Essentia Health over handling of his pain management agreement–a document that aims for accountability in patients who take opioid medications and doctors who manage them.
Known previously as pain “contracts,” pain management agreements came about as a way of curbing the growing problem of drug diversion–when drugs legally prescribed for medical purposes are diverted into illegal channels.
“There are people out there that come to us for the wrong reasons,” said Dr. Manuel Colon, a pain management specialist and anesthesiologist at Sanford Health in Fargo.
“Like it or not, these drugs do have street value,” Colon said.
Under a pain agreement, the patient signs a list of conditions, promising to never give or sell their opioid medications to anyone else and to get the medicines from one health care provider and one pharmacy only. It can also require them to take drug tests.
Breaking a rule constitutes violation of the contract, meaning the patient can no longer receive opioid medicines from the doctor or anyone else in that health care system.
Colon says while it’s a doctor’s job to ensure that patients who need opioids for pain relief get them, they must also do their part in keeping them out of the wrong hands.
He cites statistics that indicate Americans, making up less than 5 percent of the world’s population, consume 80 percent of the global opioid supply and 99 percent of the global hydrocodone supply.
“It really is a big problem,” said Colon. “It keeps me up at night, to be honest.”
Pain management agreements common
Many healthcare systems require written agreements for their patients who are taking opioid or narcotic painkillers.
Colon said they use a local document specific to Fargo and satellite clinics in the region, but Sanford is currently crafting a universal agreement to be implemented system-wide, spelling out the flow to occur between its pain clinics and primary care physicians.
Kent Heneman says he has no problem with pain contracts in general and didn’t hesitate to sign one with Essentia, but doesn’t like how it was managed.
He thinks a primary care doctor should oversee a patient’s opioid treatment because they have better knowledge of the patient’s condition. Instead, Heneman was assigned a separate pain management provider who he claims mismanaged his pain meds.
Heneman said with what his pharmacy told him was an aggressive ramp-up to a higher dose of one medication, he had extreme fatigue, numbness in his arms and legs and slurred speech.
When he complained of the symptoms, he said he was switched abruptly to other medications, causing him to experience worsening back pain and drug withdrawal.
“My skin was kind of crawly–my mind, it was like it wasn’t working. I couldn’t concentrate on things,” said Heneman.
While Heneman said he requested the pain agreement be voided, his medical record showed that he, in fact, had violated it. He’s trying to get that changed in the system and meantime, has sought treatment at an independent pain center in Fargo.
A spokesperson at Essentia Health said the facility cannot comment on any individual patient’s case due to privacy regulations and declined comment on its opioid treatment agreement, as well.
An imperfect tool
Heneman said it’s hard for him to understand why anyone would abuse prescription painkillers.
He said at the proper dosage, the drugs usually don’t have much of an effect on him, mentally.
“It hasn’t brought me out of the pain and it hasn’t taken me into la-la land,” said Heneman.
When he once stopped hydrocodone on doctor’s orders, he said he had no trouble quitting.
That’s not the case, however, for the millions taking opioids legally and illegally who become desperately addicted to them.
Colon said a big part of the problem is that insurance companies often won’t cover non-opioid painkillers, but don’t hesitate to cover the far cheaper narcotic ones.
He cited a recent case of a patient who got complete relief from a non-narcotic patch he prescribed for nerve pain in her hands, but she couldn’t continue using it.
“She can’t afford $150 for the patch, but guess what? Insurance will cover unlimited amounts of hydrocodone,” said Colon.
According to the U.S. Centers for Disease Control and Prevention, the amount of prescription painkillers dispensed in the country has quadrupled since 1999, while deaths from prescription painkillers have also quadrupled.
Colon said there’s no direct data to show that pain management agreements help keep the drugs from being used illegally and he acknowledged it’s not a perfect system–something Heneman experienced firsthand.
However, it is one tool available to attempt to reverse the trend toward a population that’s increasingly addicted to prescription drugs.
Colon says opioids can give the right pain patient his or her life back.
“At the same time, we can’t ignore the societal issues that come with this medication,” he said.