If we cannot help how to get: Help for Complex Pain and/or SUDs
HELP FOR PATIENTS
There is serious shortage of effective help for patients with complex chronic pain and substance use disorders (addictions). Patients who benefit or not from pain pills often lack access to effective medical care. There is an epidemic of opiate misuse. It could be argued that opiate related problems are one of America's primary public health concerns. What to do?
The first step most often involves getting help for yourself or a loved one. Afterwards, one can attempt to help others and the community at large.
Dr. Rotchford wrote a book in 2018 entitled Opioids In Chronic Pain Management - A Guide for Patients There is an entire chapter on how to talk with physicians about your pain management needs.
The Washington State Department of Health has published a flyer to help patients out: Opioid Patient Resources provides links to helpful resources including suicide hot lines.
Recently we published a handout: What to do when your medical needs are not being met? It is primarily for established patients but it has a lot of helpful information for patients at large.
HELP FOR YOURSELF OR A LOVED ONE
1. Obtain a formal pain management or addiction medicine consult. These are unfortunately difficult to come by. Ask your primary care provider for suggestions or referrals. If they say they don't know ask them to find out or help you find someone who does know.
For SUD related issues one can call the confidential Washington approved hotline: 1-866-789-1511
The website is: Washington Recovery Helpline. To get a referral for evaluation for a substance use disorder is often indicated if not already done. Unfortunately most physicians are ill prepared to do a formal substance use disorder assessment. Conversely, most state authorized/licensed chemical dependency services are ill prepared to address co-morbid pain management or mental health problems. Given the importance of Medication Assisted Treatment (MAT) in all patients with opioid use disorders, and the proven value of same in other substance use disorders, medical support can be essential for the best outcomes with substance use disorders. A formal diagnosis of a substance use disorder changes what constitutes the best care. Hence, to have a substance use disorder formally ruled out is indicated for most patients with chronic pain management issues. If a substance use disorder is present referral for care can also be obtained. If an opioid use disorder can be established it paradoxically it often better enables a patient to get adequate opioids for their pain management needs.
There are many ways a pain management or an addiction medicine specialist helps patients: they can at least work with other prescribers to assure that a patient is prescribed the safest and most effective medical regimens. Not all patients do well tapered off of their opioids!
Addiction specialists and other "waived providers" can provide FDA approved medical care for addictions. Buprenorphine is commonly used when comorbid pain and OUDs exist. Naltrexone is another FDA approved medication that can be helpful for treating opiate addiction and alcohol use disorders. It may also useful in some cases of chronic pain but this can be problematic.
There are non-pharmacological ways to manage pain and addictions. Since the early 1980s Dr. Rotchford has provided medical acupuncture. He is skilled as well in other non-pharmacoligical ways to treat pain. There are several options that might be applicable and do not include addictive substances. A host of medications, supplements, and behaviors that promote healthy pain management and brain function are now available. The best care is individualized. Please go to the handout tab on this page to get a menu of possiblilities for pain management.
2. Seek help whether through us or others
OPAS Introductory Memo regarding access to OPAS specialized services by J.Kimber Rotchford, M.D. This is our "master" handout regarding access to specialized services on the Olympic Peninsula.
List of providers - Worth checking out. But I am afraid many patients struggle to find qualified providers particularly if they are insured by Washington State plan. Help us if you can keep this list updated.
Methadone/Buprenorphine Clinics in Puget Sound Area - These are the default care providers for patients who are opiate dependent. Access is challenging, sometimes expensive, and makes it difficult to hold down a job if one lives or works far from one. Nonetheless, when one has a life threatening disease, such as opiate addiction, a move to a community which has a methadone clinic warrants serious consideration.
Special information for patients with Washington State Insurance plans including DSHS, Apple Health, Basic Health, L&I. See Memo.
3. Community-wide action steps and support material:
Some recent books Dr. Rotchford has published provide some valuable background information and references. Opidemic - A Public Health Epidemic and Opioids in Chronic Pain Management are valuable resources for patients and professionals. His most recent book: Medical Cannabis - Initial Medical Consultation formally addresses the use of cannabinoid products in managing chronic pain.
MEMO Regarding: Medicaid (DSHS) covered patients or those with L&I, Basic Health, and other Washington government managed insurance plans. J.K. Rotchford, M.D.
A Case Report - Published in the Pain Practitioner – Winter 2013. J.K. Rotchford, M.D. This article spells out some of the dangers of not recognizing opioid use disorders in pain patients who have been prescribed opioids.
Failure to Diagnose Opioid Addiction in Chronic Pain Patients – J.K. Rotchford, M.D. This is an academic article submitted for publication. It makes the point that a good percentage of pain patients, particularly high risk patients, are at risk for having a formal opioid use disorder if they have been prescribed opioids over an extended time. The lack of appreciation for this is significant within the medical community.
The Inhumane and Dangerous Game of Forced Opioid Reduction – This is an editorial by a respected pain specialist that lays out some of the issues that have come up with the current opioid phobia and untoward effects of regulatory efforts to curb opiate use. While risks are significant without proper patient selection and oversight, there remains an unequivocal place for the proper chronic use of opiates in medicine.
Our local Hospital Board/Commission meetings might be a place to clamor for access to effective medical care for pain and addiction.
Please let us know other ways you have found helpful in finding effective medical care for your condition(s). We support interested family members, parents, friends, and others to come together to help create a political force that would encourage state policy makers to effectively address the medical needs of patients with complex chronic pain or substance use disorders. If you are interested in such a group our office has started to put together a list of interested persons. Without grass root's political pressure it is unlikely the lack of access will effectively change.
I hope that patients along with their friends and loved ones become politically active in promoting access to needed medical care for patients with complex pain, addictions, and other central nervous system disorders. As a starter I suggest you write your state senator and representatives. The following is a suggested letter to a legislator. It could be readily amended to sent to other state officials and legislators.
Dear Senator /Representative ,
I am writing you regarding my or “---) not having access to specialized medical care in complex pain or addiction. I have struggled to find effective medical care for my conditions. It is apparent that I am not the only one and I am concerned that current state policies and regulations have aggravated the problem. It is hoped that you will do all you can to review DSHS and other State policies and actions to better assure access to essential medical services.
Perhaps some personal stories about your struggles to find help, or the consequences of not finding it, may help?
Online, at drrotchford.com we have a tab related to getting access to care. There is information and resources designed to encourage and empower you to take action.
Please let us know if you have other ideas or resources in view of mobilizing a response that could promote our meeting these unmet needs, whether for our local communities or across the country.
There is a text messaging app which identifies all of your legislators and even lets you send messages to the governor. Online it is at https://resist.bot/
But to simply get started: Text RESIST to 50409 and they’ll help you contact your officials and you can readily shoot off some comments.
There are a number of groups who are advocating for patient rights, particularly those with pain management needs. One in Washington is at: https://www.facebook.com/groups/WASHPAG/ Through them you can find other advocacy groups.
Nationally, there are several groups. One of the leaders is the U.S. Pain Foundation. https://uspainfoundation.org/
Washington Patients in Intractable Pain (WashPIP) Contact information is 206/406-6336 and firstname.lastname@example.org