'I've Been a Nurse for 30 Years. Opioids Saved My Patients' Lives'

As a registered nurse, I have been very familiar with opioids for years. Opioids are lifesaving and life-restoring medications. In acute care, they are essential for health, wellness, and recovery—both in short-term and long-term use.

I have witnessed patients in excruciating pain find relief by taking opioids, allowing them to eat, sit up, walk, and engage in physical therapy. Throughout my career, I have consistently seen the beneficial use of opioid therapy.

I moved to Boston 41 years ago. I was excited to be working in some of the larger medical centers and teaching hospitals. I worked in critical care for roughly eight years before starting my own healthcare company in 1986.

My goal was to provide quality care to patients, including children who were sick. I eventually sold my company in 1992 and took 15 years off to raise my children before returning to nursing in 2004.

Since 2016, there has been a significant change in the way opioids are prescribed, ordered, and delivered. In my opinion, the prescriptive rights of physicians have been usurped over the past five to seven years. I noticed some of these changes earlier, but I couldn't have predicted the outcome of what is happening now.

I have witnessed doctors becoming more reluctant to prescribe pain medication, which has been an issue in hospice care for a long time. It's not uncommon to encounter doctors who do not believe in hospice care, and that's to be expected.

However, over the past twelve years in Massachusetts, we have seen regulations change, such as requiring prescribers for opioids to be from contiguous states. This requirement varies from state to state.

I know of someone who had to visit six pharmacies and two Walmarts before finding one that would fill their prescription, even though they had been on opioids for quite some time.

Some pharmacists are now refusing to fill prescriptions if they believe the quantity is too high, and while I respect their expertise, in reality, pharmacists are not part of the care team. They can provide information on drug interactions and other related concerns, but they do not have the right to usurp a physician's order. But we are now witnessing such instances.

Most patients turn to opioids after trying everything else. It's not the first option—it's generally the last resort. Opioids are effective if prescribed appropriately. But now, many patients are still suffering from their pain.

I work with Claudia Merandi of The Doctor-Patient Forum and the Don't Punish Pain Rally Organization. We see a lot of supply cuts because the Drug Enforcement Administration (DEA) controls the supply.

In some cases, there may be only a few doctors or prescribers in a state like Rhode Island, and if that person decides to stop prescribing, it can leave the entire state without any prescribing options.

This has led to a push for alternative medications like Suboxone or other adjunctive options, but what people fail to understand is that there are limited alternatives available.

I have seen doctors argue with pharmacists about doses, and typically, the pharmacist wins because they have the authority. That's why people go from one pharmacy to another. If a pharmacist doesn't feel comfortable with a written prescription, they may refuse to fill it, and it's difficult to win against them.

Just last week, I witnessed somebody walk out of their doctor's office in agony because their dosage of opioids was tapered. But from the physician's point of view, the DEA has been cracking down on physicians and even arresting them.

Doctors have been wrongly vilified as the source of the opioid crisis, when in fact it's illegal and illicit drugs that are responsible for opioid overdoses. Physicians don't get arrested for prescribing insulin dosages to 2,000 diabetics as endocrinologists, but if they have 2,000 pain patients, then it must be considered a problem.

But that's not always true. These drugs are ripe for abuse, but the patients I know in Rhode Island haven't experienced a single overdose in the last couple of years. However, the state does have a high overdose problem. So what's happening?

I believe people are getting these drugs off the street. The pain patients aren't overdosing. They follow, especially now, exactly what they're supposed to do.

During COVID, patients with addiction issues were allowed to have telehealth visits. I feel terrible for patients who struggle with addiction, but pain patients, on the other hand, still had to go to the clinic every month and provide a urine sample that cannot be flushed, or their hands washed, until after being tested.

Pain patients must be seen every month, and they've only been prescribed enough medication for that month. Their pain scripts can be counted at any time, which affects their vacation plans, travel, and other commitments.

Moreover, with the DEA cutting back the supply of opioids, pain patients are unsure if they will have access to their medication at the pharmacy. There are millions of pain patients in the U.S., and millions suffer from chronic daily intractable pain. What are they going to do?

I have never witnessed a patient who takes pain medication that has been appropriately prescribed by a physician have more than a few, if any, side effects. I also don't see hyperalgesia, a term that states opioids make your pain worse. I'm not hearing that from anyone, and I'm not seeing that from anyone.

The one side effect of opioids that I see is constipation. However, some patients with invisible pain also have irritable bowel associated with it. So sometimes the opioids can almost correct that if, in fact, you happen to have irregularities in your bowels.

I'm not a prescriber. But I have seen many patients going back and forth about dosing with other colleagues, prescribers, and with family members. In general, I can honestly tell you that, as with most drugs, when they're taken as prescribed, opioids are safe and effective, and they should always be stored responsibly. I believe that adults can do that.

We recently encountered a young chronic pain patient who was facing yet another forced taper. This phenomenon of forced tapering is concerning. The doctor reviewed the patient's dose, and while the patient was slightly above the recommended limit, they were comfortable. However, the decision was made to cut them down anyway.

As a result, the patient experienced increased pain after the tapering. This happened to two younger individuals I know, and a couple, where the husband was forcibly tapered and subsequently took his own life. His wife also committed suicide after his second tapering. This case is well-known in the pain community.

If a patient's pain is so severe that they're considering suicide, what does it matter how much opioids they take, as long as it's under a physician's order and the physician is monitoring it?

Why do we care if they're taking "too much" and why would we dial that back to a point where the patient is so miserable that they might end up taking their own life? What were we trying to protect them from?

I also came across another case where a patient I knew was hospitalized because she threatened to end her life due to uncontrollable pain. Patients are also not always seen in a timely manner, which further complicates the situation.

For instance, I recently worked with a girl at a local hospital whose pain medication was inconsistently administered despite her having a kidney infection with stones. She was hysterical and struggled for two days to get appropriate pain relief.

Another heartbreaking example was a gentleman who had jackknifed his truck in an effort to save a van. As a result, he suffered severe skeletal injuries and was later forcibly tapered as well. He had very significant ongoing long-term pain as a result of his accident. He took opioids, and it was enough that he could get out of his chair, maybe do a little shopping with his wife, and enjoy a meal.

As a registered nurse who graduated from a Catholic college, it is my calling to take care of those who suffer. I never thought I would see the day when we would deny people pain relief and they would resort to suicide because they couldn't get a prescription signed by a prescriber, and filled at the pharmacy.

Elizabeth G. Dost is a registered nurse with over 30 years of experience in the healthcare sector. She is also a senior healthcare executive consultant and advisor. Elizabeth just released her new book, Deadly Business, a medical thriller. It is available on Amazon/Kindle and in bookstores. You can find out more about her here.

All views expressed in this article are the author's own.

As told to Newsweek associate editor, Carine Harb.

With thanks to The Doctor Patient Forum.

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