Doctors drop patients on painkillers amid federal opioid scrutiny, experts say
Kristin Kirell, of Commack, who has had severe spine-related pain for nearly two decades, said she was “dumped” by her pain-management doctor in 2022. Credit: Rick Kopstein
Patients on opioid medication for pain relief are being "abandoned" by doctors as government scrutiny of prescriptions is leading an increasing number of physicians to stop prescribing opioids, medical and legal experts say.
Fear of being flagged by the Drug Enforcement Administration, which can revoke its approval to prescribe controlled substances and refer cases of suspected illicit prescribing for prosecution, is a key reason, doctors and attorneys say.
Patients dropped by doctors, physician assistants and nurse practitioners say they’re collateral damage in crackdowns aimed at reducing opioid overdoses and addiction, enduring severe pain while they look for other health care providers.
“We are being tossed aside because of the crisis,” said Steve Dlag, 62, of Calverton, who has severe back pain and has spent most of his time immobile since he was abandoned in 2020. “We are looked at as drug-seekers, pill-seekers … . We have track records. In my case it’s well over 20 years of no issues and living a life on opioids as opposed to having no life and being bedridden.”
An estimated 2.3 million people had prescription opioid use disorder, or addiction, in 2020, federal data shows. Opioid prescriptions fell 46% between 2012 and 2021, according to the American Medical Association, as tens of thousands of Americans continue to die every year of opioid overdoses, although most deaths are from synthetic opioids that include illegally manufactured fentanyl, not from prescription drugs.
Experts agree that abandoning opioid patients can cause serious harm, but disagree whether opioids are appropriate for people with newly diagnosed chronic pain.
The 2022 Centers for Disease Control and Prevention opioid prescribing guidelines warn against abandoning patients, abruptly cutting them off opioids or rapidly reducing dosages.
But Claudia Merandi, executive director of The Doctor Patient Forum, which advocates for pain patients who use opioids, said the problem is widespread.
“We receive about 600 messages a month from patients who have been abandoned,” said Merandi, of East Providence, Rhode Island.
Don Peterson, 66, of Hicksville, who has spinal disc degeneration, severe spinal stenosis, severe arthritis and diabetic neuropathy, has been taking opioids for more than 20 years.
Starting in 2020, he said, the medical practice he went to repeatedly lowered his dosage of oxycodone. In 2021, after his doctor left the practice, a physician assistant “told me to go find another doctor,” even though the practice had other physicians.
“He said, ‘We’re not going to prescribe opioids anymore here,’ ” Peterson recalled.
Peterson said he found another doctor, who tried various injections and other non-opioid therapies, but they didn’t work beyond a few hours. The doctor declined to increase his oxycodone dosage to previous levels.
With the full dosage, “I was able to move around, I was able to do things around the house, I could cook, take out the garbage and do a little yard work, be social. I could go out,” Peterson said. “Now because of the pain, I’m spending a minimum half the day lying down because I can’t do anything.”
The sharp drop in opioid prescriptions is occurring amid a backdrop of disagreement among medical experts over the role of opioids in relief of chronic pain.
The CDC’s 2022 nonbinding opioid guidelines were a revision of those from 2016 that were criticized by many health professionals as overly restrictive, and that led some clinicians to stop prescribing opioids to avoid problems with state or federal authorities, said Dr. Kevin Zacharoff, course director of pain and addiction and clinical assistant professor at Stony Brook University’s Renaissance School of Medicine.
The 2022 document “softens” the guidelines, but “it’s a very difficult thing to undo," and many health professionals are influenced by the old recommendations, Zacharoff said.
The 2022 CDC guidelines say that although “opioids can be essential medications for the management of pain,” a review of studies found there is “insufficient evidence to demonstrate long-term benefits of prescription opioid treatment for chronic pain,” and long-term use carries a risk of misuse and overdose.
The CDC says clinicians should continue opioid treatment if benefits outweigh risks, although they also should try non-opioid therapies.
Dr. Charles Argoff, president-elect of the American Academy of Pain Medicine and a professor of neurology at Albany Medical College, said if opioids are helping people, they should be continued, and they should be prescribed to some new chronic-pain patients.
“If people are benefiting from opioid therapy, and you can show for that person it’s being done safely, why would you take somebody off it?” he asked.
Argoff, co-author of a study published last year in the journal Pain that found opioids are “a viable option” for some chronic-pain patients, said, “A clear subset of people with chronic pain, not a majority, do benefit from chronic opioid therapy for non-cancer pain, but the data also support that many people do not. The challenge is to find what works best for your patients.”
Dr. Andrew Kolodny, president of Health Care Professionals for Responsible Opioid Prescribing, which supports more “cautious” prescribing of opioids, and medical director of the Opioid Policy Research Collaborative at Brandeis University in Massachusetts, said new chronic-pain patients should not be prescribed opioids.
“We still prescribe too many opioids,” he said.
A 2021 Congressional Research report found that, despite the drop in prescribing, the United States still has the highest opioid prescription rate in the world.
But, Kolodny said, “Abandonment is a very serious issue,” and some doctors may not understand how difficult it can be to taper people off opioids.
“Nobody wants these patients,” he said. “They’ve become like hot potatoes. They’ve been put on drugs that are extremely hard to come off. Many of these people may never be able to come off opioids.”
He sees them as “victims of very aggressive overprescribing” that began in the 1990s, when opioid manufacturers exaggerated the benefits of opioids and deceived doctors about risks.
Kolodny attributed the abandonment of patients to fear of legal liability of harm from opioids rather than concern about the DEA.
Argoff said people cut off of opioids may become desperate to regain the pain relief they found with the medications.
"People have turned to street drugs and/or committed suicide," he said.
Multiple studies show an increased risk of suicide, suicidal thoughts and overdoses in patients whose opioid treatment was stopped.
Zacharoff said street drugs are especially dangerous today, when they may be laced with fentanyl, which is lethal even in small quantities.
“Any drug that is obtained through an illicit channel in 2023 has to be considered potentially tainted with fentanyl, and pose a significant risk of unintentional overdose," he said.
Kristin Kirell, 43, of Commack, who has had severe spine-related pain for nearly two decades, said she was “dumped” by her pain-management doctor last year.
Kirell hasn’t found a new provider.
One reason, she said, is she also is prescribed benzodiazepines, another controlled substance, by two separate doctors, one for epilepsy seizures, the other for anxiety and depression. That, she said, makes some doctors wary.
Kirell said she has tried many alternatives to opioids, including other medications and multiple types of injections. But nothing provides the pain relief that opioids do, she said.
“You have a whole bunch of people who are suffering, and no one seems to care,” she said.
Dr. Edward Rubin, a pain management specialist with offices in Garden City and Lake Success, said the DEA contacted him several years ago when he was flagged as a high opioid prescriber. After investigating, “They’re like, ‘Look, we don’t think you’re doing anything wrong here,’ ” but they warned him about the quantity of opioid prescriptions he was writing, he said.
“Obviously, I was pretty spooked,” he said.
Rubin now scrutinizes patients more intensely and typically only accepts opioid patients if they’re from doctors he knows and with whom he can review patients’ records.
“I can’t take every person who needs meds, partly because of the logistics of the availability in my practice and partly because I can only handle so much med writing without me having to worry about the DEA,” he said.
The DEA did not respond to questions on how it determines when to flag a health care provider for potential excessive or illegal prescribing, and to whether it keeps statistics on how many providers are flagged or have had their controlled-substance registrations revoked for alleged opioid-related offenses.
Dlag said his doctor cut him off hydrocodone without explanation in 2020.
“Without the medication, I was in excruciating pain, thoughts of suicide, not being able to do anything,” he said.
The Calverton resident said he finally found another doctor last year, who first tried other options that didn’t work and then prescribed him half his previous hydrocodone dosage, which helps, but “it is not giving me the pain relief I know is possible.”
Dlag spends most of the day sitting in a chair or in bed, but he is worried about asking for a higher dosage.
“I don’t want to cause any grief where he says I’m not going to treat you anymore,” he said.
Patients on opioid medication for pain relief are being "abandoned" by doctors as government scrutiny of prescriptions is leading an increasing number of physicians to stop prescribing opioids, medical and legal experts say.
Fear of being flagged by the Drug Enforcement Administration, which can revoke its approval to prescribe controlled substances and refer cases of suspected illicit prescribing for prosecution, is a key reason, doctors and attorneys say.
Patients dropped by doctors, physician assistants and nurse practitioners say they’re collateral damage in crackdowns aimed at reducing opioid overdoses and addiction, enduring severe pain while they look for other health care providers.
“We are being tossed aside because of the crisis,” said Steve Dlag, 62, of Calverton, who has severe back pain and has spent most of his time immobile since he was abandoned in 2020. “We are looked at as drug-seekers, pill-seekers … . We have track records. In my case it’s well over 20 years of no issues and living a life on opioids as opposed to having no life and being bedridden.”
WHAT TO KNOW
- An increasing number of health care providers are “abandoning” patients who use opioids for pain relief because of a fear of government scrutiny amid efforts to reduce opioid overdoses and abuse, medical and legal experts say.
- Patients say they endure severe pain, and their quality of life plummets, after they are “dumped” by doctors or when their opioid dosages are significantly reduced.
- Federal guidelines prohibit abandoning patients, abruptly taking them off opioids or rapidly reducing dosages. But patient advocates said the practice is common.
An estimated 2.3 million people had prescription opioid use disorder, or addiction, in 2020, federal data shows. Opioid prescriptions fell 46% between 2012 and 2021, according to the American Medical Association, as tens of thousands of Americans continue to die every year of opioid overdoses, although most deaths are from synthetic opioids that include illegally manufactured fentanyl, not from prescription drugs.
Experts agree that abandoning opioid patients can cause serious harm, but disagree whether opioids are appropriate for people with newly diagnosed chronic pain.
The 2022 Centers for Disease Control and Prevention opioid prescribing guidelines warn against abandoning patients, abruptly cutting them off opioids or rapidly reducing dosages.
But Claudia Merandi, executive director of The Doctor Patient Forum, which advocates for pain patients who use opioids, said the problem is widespread.
“We receive about 600 messages a month from patients who have been abandoned,” said Merandi, of East Providence, Rhode Island.
'Half the day lying down,' Hicksville patient says
Don Peterson, 66, of Hicksville, who has spinal disc degeneration, severe spinal stenosis, severe arthritis and diabetic neuropathy, has been taking opioids for more than 20 years.
Starting in 2020, he said, the medical practice he went to repeatedly lowered his dosage of oxycodone. In 2021, after his doctor left the practice, a physician assistant “told me to go find another doctor,” even though the practice had other physicians.
“He said, ‘We’re not going to prescribe opioids anymore here,’ ” Peterson recalled.
After multiple surgeries, Don Peterson of Hicksville required presciption opioids for pain, but has had difficulty finding doctors to prescribe them. Credit: Newsday / Thomas A. Ferrara
Peterson said he found another doctor, who tried various injections and other non-opioid therapies, but they didn’t work beyond a few hours. The doctor declined to increase his oxycodone dosage to previous levels.
With the full dosage, “I was able to move around, I was able to do things around the house, I could cook, take out the garbage and do a little yard work, be social. I could go out,” Peterson said. “Now because of the pain, I’m spending a minimum half the day lying down because I can’t do anything.”
The sharp drop in opioid prescriptions is occurring amid a backdrop of disagreement among medical experts over the role of opioids in relief of chronic pain.
The CDC’s 2022 nonbinding opioid guidelines were a revision of those from 2016 that were criticized by many health professionals as overly restrictive, and that led some clinicians to stop prescribing opioids to avoid problems with state or federal authorities, said Dr. Kevin Zacharoff, course director of pain and addiction and clinical assistant professor at Stony Brook University’s Renaissance School of Medicine.
The 2022 document “softens” the guidelines, but “it’s a very difficult thing to undo," and many health professionals are influenced by the old recommendations, Zacharoff said.
The 2022 CDC guidelines say that although “opioids can be essential medications for the management of pain,” a review of studies found there is “insufficient evidence to demonstrate long-term benefits of prescription opioid treatment for chronic pain,” and long-term use carries a risk of misuse and overdose.
The CDC says clinicians should continue opioid treatment if benefits outweigh risks, although they also should try non-opioid therapies.
Dr. Charles Argoff, president-elect of the American Academy of Pain Medicine and a professor of neurology at Albany Medical College, said if opioids are helping people, they should be continued, and they should be prescribed to some new chronic-pain patients.
“If people are benefiting from opioid therapy, and you can show for that person it’s being done safely, why would you take somebody off it?” he asked.
Argoff, co-author of a study published last year in the journal Pain that found opioids are “a viable option” for some chronic-pain patients, said, “A clear subset of people with chronic pain, not a majority, do benefit from chronic opioid therapy for non-cancer pain, but the data also support that many people do not. The challenge is to find what works best for your patients.”
Case for cautious approach
Dr. Andrew Kolodny, president of Health Care Professionals for Responsible Opioid Prescribing, which supports more “cautious” prescribing of opioids, and medical director of the Opioid Policy Research Collaborative at Brandeis University in Massachusetts, said new chronic-pain patients should not be prescribed opioids.
“We still prescribe too many opioids,” he said.
A 2021 Congressional Research report found that, despite the drop in prescribing, the United States still has the highest opioid prescription rate in the world.
But, Kolodny said, “Abandonment is a very serious issue,” and some doctors may not understand how difficult it can be to taper people off opioids.
“Nobody wants these patients,” he said. “They’ve become like hot potatoes. They’ve been put on drugs that are extremely hard to come off. Many of these people may never be able to come off opioids.”
He sees them as “victims of very aggressive overprescribing” that began in the 1990s, when opioid manufacturers exaggerated the benefits of opioids and deceived doctors about risks.
Kolodny attributed the abandonment of patients to fear of legal liability of harm from opioids rather than concern about the DEA.
Argoff said people cut off of opioids may become desperate to regain the pain relief they found with the medications.
"People have turned to street drugs and/or committed suicide," he said.
Multiple studies show an increased risk of suicide, suicidal thoughts and overdoses in patients whose opioid treatment was stopped.
Zacharoff said street drugs are especially dangerous today, when they may be laced with fentanyl, which is lethal even in small quantities.
“Any drug that is obtained through an illicit channel in 2023 has to be considered potentially tainted with fentanyl, and pose a significant risk of unintentional overdose," he said.
'Dumped' by pain-management doctor
Kristin Kirell, 43, of Commack, who has had severe spine-related pain for nearly two decades, said she was “dumped” by her pain-management doctor last year.
Kirell hasn’t found a new provider.
One reason, she said, is she also is prescribed benzodiazepines, another controlled substance, by two separate doctors, one for epilepsy seizures, the other for anxiety and depression. That, she said, makes some doctors wary.
Kirell said she has tried many alternatives to opioids, including other medications and multiple types of injections. But nothing provides the pain relief that opioids do, she said.
“You have a whole bunch of people who are suffering, and no one seems to care,” she said.
Long Island pain doctor 'spooked'
Dr. Edward Rubin, a pain management specialist with offices in Garden City and Lake Success, said the DEA contacted him several years ago when he was flagged as a high opioid prescriber. After investigating, “They’re like, ‘Look, we don’t think you’re doing anything wrong here,’ ” but they warned him about the quantity of opioid prescriptions he was writing, he said.
“Obviously, I was pretty spooked,” he said.
Rubin now scrutinizes patients more intensely and typically only accepts opioid patients if they’re from doctors he knows and with whom he can review patients’ records.
“I can’t take every person who needs meds, partly because of the logistics of the availability in my practice and partly because I can only handle so much med writing without me having to worry about the DEA,” he said.
The DEA did not respond to questions on how it determines when to flag a health care provider for potential excessive or illegal prescribing, and to whether it keeps statistics on how many providers are flagged or have had their controlled-substance registrations revoked for alleged opioid-related offenses.
Dlag said his doctor cut him off hydrocodone without explanation in 2020.
“Without the medication, I was in excruciating pain, thoughts of suicide, not being able to do anything,” he said.
The Calverton resident said he finally found another doctor last year, who first tried other options that didn’t work and then prescribed him half his previous hydrocodone dosage, which helps, but “it is not giving me the pain relief I know is possible.”
Dlag spends most of the day sitting in a chair or in bed, but he is worried about asking for a higher dosage.
“I don’t want to cause any grief where he says I’m not going to treat you anymore,” he said.
David Olson covers health care. He has worked at Newsday since 2015 and previously covered immigration, multicultural issues and religion at The Press-Enterprise in Southern California.
Updated now Newsday travel writer Scott Vogel took the ferry over to Block Island for a weekend of fun.
Updated now Newsday travel writer Scott Vogel took the ferry over to Block Island for a weekend of fun.
