Editor’s note: Patient abandonment is a serious and growing problem in the pain community. Thousands of patients have been discharged by doctors who have grown fearful of treating chronic pain and losing their medical licenses for prescribing opioid medication. We were recently contacted by a nurse practitioner, who offered her perspective on this disturbing trend. The author asked to remain anonymous.)
I am a nurse practitioner who has been in the field of pain management for the past 4 years. Prior to that, I spent years as an intensive care unit nurse and in primary care as an advanced registered nurse practitioner (ARNP).
Working with chronic pain patients has been the highlight of my professional career. I absolutely love my job and about 99% of my patients. I have had two complaints about me made to the Washington State Department of Health, both of which accused me of prescribing too much opioid medication to my patients. Both complaints were investigated by the state and I was found to be practicing within the standards of care — and essentially told to continue. Which I did.
Then the Seattle Pain Centers closed in 2016, leaving thousands of untreated pain patients in the Puget Sound area. I inherited some of their patients. I felt like I had been “vetted” by the state, and believed that if I continued to do everything according to the law, I would be safe from any legal action.
In my practice, we fight ALL THE TIME for our patients, against the state, insurance companies, pharmacies and even the patient’s families sometimes (when they don’t understand). I’m not afraid of a good fight, because I have seen patients’ lives turned around when they are finally given the correct amount of opioids. I believe in opioid therapy.
Of course, all the tools in the box should be used, and I refer routinely to physical therapy, interventional pain specialists, surgeons, acupuncturists, chiropractors and others, in addition to prescribing opioids for pain.
Now I find how naive I have been. I have been to national conferences to learn more about pain management, and have heard the top doctors and researchers talk. One of these giants, Dr. Forest Tennant, was recently raided by the DEA. With Jeff Sessions as Attorney General, there is apparently more money being allotted to these raids and more are promised in the future. I also went to a website called “Doctors of Courage” and learned more about the DEA.
My interpretation of the facts is that it doesn’t matter if I practice legally anymore. The DEA will look at my prescribing patterns, and tell me that I MUST have known that the ONLY reason any patient would get that much medication is if they are selling it on the street. And therefore, I am a “drug trafficking organization.” The Justice Department takes over the case and the provider is prosecuted.
If convicted, which seems to be the case recently, the provider becomes a felon and serves a prison term. Medical license is lost, time is served and because it is a “drug crime,” asset forfeiture law may be used to confiscate everything I own.
‘My Fear Is Very Real’
I am married, with a daughter still at home. I cannot do this to my family. So I am joining the legions of others who are closing their pain practices. I have just begun to tell my patients, and have had many, many tears, thoughts of both suicide and homicide, and one very special patient who told me that she will no longer be able to keep her service dog because she will be unable to care for him.
This whole thing is making me literally sick to my stomach. I’ve cried a million tears for my patients already, and I’m just beginning. I will be carefully weaning them all down to 90 MED per day over the next 6 months, or arranging transfer of care to anywhere the patient would like. What a joke that is — there is no one else prescribing effective doses of opioids for chronic pain patients. If I am to be thrown in prison, it should be for that — not for keeping them on therapy that enriches their lives.
I keep asking my husband to tell me that I am overreacting, but as wonderful and encouraging as he has always been, he is scared too.
Please tell all patients that what may have started merely as a provider being paranoid about his or her license has recently morphed into something truly dangerous for us. I will be absolutely no good to anyone, once locked up. If I can stay clear of the DEA’s witch hunt, perhaps I can remain a voice of advocacy for pain patients. God help us all.
Please don’t use my name if you post this. I can tell you, my fear is VERY real, and I don’t want to call any attention to my practice right now. Thank you for understanding.