Are CDC Opioid Guidelines Causing More Suicides?

By Pat Anson, Editor

A recent report by the Centers for Disease Control and Prevention documented a disturbing trend in suicides in the United States. Suicides increased by 24 percent from 1999 to 2014, and are now the 10th leading cause of death in the country.   

In 2014, nearly 43,000 Americans committed suicide, over twice the number of deaths that have been linked to opioid overdoses. Most often suicides are blamed on depression, mental illness, financial problems, or drug and alcohol abuse. Untreated chronic pain is rarely even mentioned.

But in recent months there have been a growing number of anecdotal reports of pain patients killing themselves because they can no longer get pain medication or find doctors willing to treat them.

Donald Alan Beyer of Bovill, Idaho was one of them.

After years of suffering from chronic back pain, the disabled logger went into his backyard on May 8 – his 47th birthday --- and shot himself in the head.

“He was in so much pain he could barely get out of bed to go to the bathroom. I guess he felt suicide was his only chance for relief,” says Beyer’s son, Garrett.

“I have witnessed my Dad in more pain than any one person should deal with every day of his adult life due to degenerative disc disease that was made so much worse by an accident on the job that broke his back. This and the eventual hole in the healthcare system focused on ignoring people with chronic pain led to his suicide this month.”

That hole in the healthcare system turned into an abyss when Beyer’s doctor retired last year. Beyer searched frantically for a new doctor, according to his son, but was unable to find anyone willing to take a new patient with chronic pain.

After months without pain medication, Beyer reached his breaking point.

DONALD BEYER

“My dad was a great man and worked through the pain every day as a logger to support his family,” says his son. “Even in his suicide all he thought about was his family. He worked up the strength to go outside before he shot himself in the head specifically so he could leave his house to my little brother. If that isn't the model of what we should all be then I don't know what is.”

Garrett Beyer is sharing the painful memory of his father’s death because he wants government officials, politicians and anti-opioid activists to recognize that efforts to discourage opioid prescribing are having devastating consequences for pain patients and their families across the country. 

“I use such painfully vivid expressions in hopes that the people in the CDC and DEA and everywhere can maybe experience for a second what a person with chronic pain and their families live with every day,” said Garrett, who suffers from many of the same back problems his father did.

“I have inherited his genetic spine problems, and after a car accident when I was 19 crushed 2 of my already flawed lumbar discs leading to my first spine surgery, I suddenly plummeted quite literally into my Dad's painful shoes. I am now terrified that I will also follow in his devastating footsteps.”

Garrett is 27, married and has two children, but says he is “constantly plagued” by the feeling that his wife and kids deserve better.

“I have now had 2 spine surgeries in the past 5 years, which included 3 discectomies and laminectomies, leaving me completely disabled and preparing for yet more surgeries in hopes that one day I can be normal,” Garrett said. “But until the day that medical technology can simply cure chronic pain, we could use all the compassion we can get, rather than the exact opposite that we are getting now.”

Impact of CDC Guidelines

In mid-March, the CDC released controversial guidelines that discourage doctors from prescribing opioids for chronic pain. The guidelines are voluntary and were only meant for primary care physicians, but many other doctors appear to be adopting them, even pain management specialists. Two pain clinics in Tennessee recently said they would stop prescribing opioids to patients “in response to changing regulations.”

Pain News Network has been contacted by dozens of pain patients in recent months who say their physicians are weaning them off opioids or abruptly cutting them off completely.

Others say they are being dismissed by their longtime doctors – often with the excuse of a failed urine drug test. Still others say they are contemplating suicide, rather than face a life of intractable pain.

A 67-year old Florida woman who has suffered from migraines since the age of five wrote to us, saying she was having trouble finding a doctor.

“I finally have an appointment with a doctor in two months who will then refer me to a pain clinic which no doubt will take another two months. At this point I have to live in pain. I may become one of the suicide statistics,” said Lana.

“I was told by several people including a cousin that I should just check into a nursing home. All I need is medicine for pain. I'm not ready to be written off. A cab driver told me that a lot of retirees with pain issues are resorting to buying heroin on the street because it's easier to get and cheaper! Is that what we want for people who led productive lives and are now in pain?”

Another woman, who suffers from chronic back and abdominal pain, is worried that her physician will stop prescribing pain medication.

“My pain management doctor constantly makes comments that he's going to stop all meds. No reason or plan.  If this happens I will be forced to go on disability, I will lose my job, insurance benefits, and means of caring for myself and family,” she wrote. “I rarely speak to avoid upsetting him. This doctor has full control of my life with a swipe of his pen.”

“I’ve been on Percocet and Vicodin for 15 years passed every test,” said a 51- year old Massachusetts woman with chronic back pain who failed a drug test last month and was dismissed by her doctor.

“I was discharged. Told me I was positive for morphine, methadone, cocaine, Klonopin and no Percocet in my system. I have never ever done those drugs ever. I told doctors wouldn't all that kill me? Oh and positive too for Suboxone. I'm in shock. What went wrong?”

What went wrong is that her doctor is not following the CDC’s guidelines, which urge physicians not to dismiss patients for a failed drug test because it “could constitute patient abandonment and could have adverse consequences for patient safety.”

Unintended Consequences

“I'm a chronic pain sufferer affected by the new law to curb addiction,” Jeannette Poulson wrote to us. “I suffer severe pain disorders and no longer have access to my previously working medications. I've never had a history of abusing my medications, and the quality of my life has been greatly diminished.”

Poulson has a question for CDC director Tom Frieden, who said the guidelines couldn’t wait because “so many people are dying” from overdoses.

“Then I ask you, are you willing to deal with a new epidemic of increased suicide rates, as many are dying of a result of unintended suffering?” said Poulson.

We'll never know just how many patients kill themselves because their pain was untreated or under-treated. Experts believe many suicides go unreported or are misclassified as accidental, often covered up by grieving family members or accommodating medical examiners.

In some cases, as we learned with Sherri Little (see “Sherri’s Story: A Final Plea for Help”), it takes months or even years for someone to acknowledge that a loved one died at their own hands.

The fallout from the CDC’s guidelines – which were released a little over two months ago – was in many ways predictable. In our survey of over 2,200 pain patients last fall, many predicted there would be unintended consequences if the guidelines were adopted.

• 90% thought more people will suffer than be helped by the guidelines
• 78% thought there would be more suicides
• 76% thought doctors would prescribe opioids less often or not at all
• 60% thought pain patients would get opioids through other sources or off the street
• 70% thought use of heroin and other illegal drugs would increase

It didn’t take long for drug dealers to begin targeting pain patients as potential customers. Counterfeit pain medication made with illicit fentanyl -- disguised as Norco, oxycodone and other medications -- have recently appeared in several states. The so-called “death pills” are blamed for at least 14 deaths in California and 9 in Florida.

Rhode Island has reported a “significant increase” in fentanyl-related overdoses since March, with a whopping 60% of the fatal overdoses in that state now attributed to fentanyl. Rhode Island health officials say the shift began when “more focused efforts were undertaken nationally to reduce the supply of prescription drugs.”  

We’re still in just the early stages. How have the CDC guidelines affected you and your family?

Leave a comment below or send me an email at editor@painnewsnetwork.org.