A Rock and a Hard Place: Pain Patients Suffer from Heroin Laws Fallout

See also: An Open Letter to Dr. Kolodny, The Truth About the Opioid Crisis, and Strangulation on Medicine

Good, law-abiding people are suffering severely in the fallout from recent state and federal laws. Designed to curb heroin addiction, these laws and prevailing societal views all begin with the false assumption that prescription pain pills like Vicodin and oxycodone are entirely to blame for rising heroin and fentanyl abuse rates.

Chronic pain patients, including many elderly and disabled citizens, often feel treated like criminals. What follows is a personal account of what chronic pain patients have to go through to obtain legitimate prescriptions from legitimate, experienced doctors, that enable them to participate more fully in life.

disabled
“Disabled,” Photo credit: User afri.on Flickr.com

A woman, perhaps in her late sixties, wears a tan sweatshirt with the simple, humorously ironic message, “Sarcasm Society: Like we need your membership.” She sits next to her older friend, a frail, bent woman in a wheelchair with a quilted coat draped over it. The “sarcasm” lady unfolds a newsletter, leans close to her friend, and reads. The older woman smiles as she listens.

Nearby, another couple sits; a tall, middle-aged man in military fatigues plays a game on his smartphone while his mother jokes and tells him the family news. He chuckles good-naturedly, but never takes his eyes off his phone.

At the other end of the room sits an older daughter with bushy red-orange hair in a large ponytail, and her thin, elderly father who tries to sit straight and tall with the help of his cane. He wears a black leather jacket and ball cap, and mutters something quietly. “Don’t talk like that!” his daughter admonishes. Then more gently, she says, “You’re over-thinking again…”

This long, narrow waiting room is stuffed with people. People in pain. People like me. At 33, I am perhaps the youngest person in the room. A single TV is mounted above my head, showing President Obama’s last question and answer session with reporters. A lanky black man in a golden velvet pantsuit sits near me. He stares at the floor and listens to the interview. There are many others. Some busy themselves with cell phones; some lay their heads back against the blue wall and close their eyes; one lady reads a colorful, worn-out magazine. Everyone is tired. No one wants to be here.


Once again today, I fight a rising panic that this time my surgery pain will not be treated. This time I will be told about yet another hoop I have to jump through, yet another bill I will have to fight with my insurance over. My husband points out a new sign in the office, “As of June 1, 2016, all self-pay patients will have an increased payment from $85 to $100 per visit.”

My stomach begins to hurt, and I feel like pacing. I watch the enormous clock on the wall beside me, the only decoration in the low-lit room. My appointment was scheduled for 2:45pm, we arrived at 2:35pm, it is now 3:20pm. The cushioned seats smell of stale smoke, and my husband complains of a headache. I shift in my chair but can’t get comfortable.

New laws require these appointments every month, as opposed to the previous 3-6 months, for those prescribed opiates, but every appointment is a real burden on those called chronic pain patients (*pain lasting longer than 3 months). Cost and rising insurance deductibles notwithstanding, most of these patients have to find rides and a helper to get in and out of vehicles, and in and out of the doctor’s office. These patients are physically weak, and have to juggle exhaustion, pain, and a variety of medical devices like canes, walkers, braces, and wheelchairs, not to mention purses, coats, and something to occupy the time.

Helpers and/or drivers have busy lives too, and most of them work full time. These appointments can take hours, and do not include additional appointments for physical therapy, regular doctor appointments, specialized doctor appointments (there may even be 2-3 different doctors), lab work, hospital visits for x-rays, MRIs, and CT scans, dentist appointments, and more. All of these appointments require driving and walking assistance. My husband has taken a half-day vacation today. He has been warned by his boss he has taken too much company time.

The nurses and doctors and office staff all work remarkably fast. They are used to this rush of slow-moving people and have a system. I am so deeply thankful for this place of last resort. Recent laws have prevented surgeons from treating surgery pain past three months, even for major surgeries in which recovery can take a full year or more, like my spinal fusion. Although I had referrals from both my doctor and surgeon, after calling over a dozen pain clinics in my area, this is the only one that would take me in. I was told several times the office I’d called did not work with surgery patients. Only a few local clinics are staffed by actual pain doctors. The rest are headed by anesthesiologists, who do not seem to understand the needs of post-surgery patients, or feel prevented by federal and state laws from prescribing opiates.

Due to a major uptick in DEA arrests, license revoking, and heavy fines, regular doctors refuse to prescribe opiates anymore.

The majority of pain clinics likewise either outright refuse to prescribe opiates, or resort to “prescription hopping”, changing a patient’s medication every month to avoid meeting quotas that will likely arouse government suspicion*. This results in potential side effects for patients, some of which can be very serious, as well as expensive medication bills.


I squirm in my chair, realizing I need to go to the bathroom, but I have to wait in order to take the drug test. The drug test that cost my insurance $3500 per test. The drug test which has to be sent to an outside lab for rigorous analysis. The drug test I had to have at every visit at my previous pain clinic to prove I was not abusing my medicine or taking street drugs along with it. Though my medical record and scars should prove my case, at my last visit, my doctor told me the drug screening was also to prove I was the one taking my medicine, and that I was in fact taking it. Although the legal, societal, and medical pressure is immense to be off opiates, I could be kicked out of the pain clinic for not taking my medicine exactly as prescribed, even if I wasn’t taking it, or needed it less often: “Every 4 to 6 hours, no more than 2 max/day.”

I’ve been dropped from a pain clinic before. No test ever came back positive for abuse, and no stated reason was given. My appointment for that week was canceled meaning no prescription for the next 30 days, and no referral, no information, no medication to wean and thereby prevent or reduce withdrawal symptoms was given. The month prior, they had put me on an ER (extended release) hydrocodone that I didn’t want to be on; I was very slowly getting better and wanted to begin lessening my dosage. I needed to get active and strengthen my body, but moving more than a few steps was acutely painful and exhausting. Without pain management, physical therapy was out of the question: I couldn’t even ride in a car more than 5 minutes without tears.

Still, the extended release medications, lasting 12-24 hours, and meant to curb addiction, made addiction more likely as I couldn’t wean off and my body became used to having the medicine around the clock. I called addiction clinics for advise on what to expect, I searched the internet for help in deciding my next steps. No one seemed to know what to do. After several days of highly unpleasant symptoms (including psychological ones such as suicidal thoughts), and being tossed back and forth between my doctors’ offices like a dirty ball that no one wants, I was advised to go to the ER for complications of opiate withdrawal. The doctor there heard my story and sighed deeply. She shook her head, “Everyone is so afraid of these medications now, people like you are getting caught in the cross-fire.”


Back in my current doctor’s office, the testing bathroom is curious. It has no lock on the door, no water to wash with at the sink, and large signs stating that you are not to flush. That job is left to nurses, after they have examined the contents of the toilet. It has always been very difficult for me to give a sample. My back was terribly swollen for months, and bending at all was out of the question for half a year. No other helper could attend you during testing, but a certain amount of urine is still required.


My name is called, I talk with my doctor. I am very proud of the progress I’ve made in healing since my last appointment. I can now handle long car rides, I finally got to visit
family who live 6 hours away for Christmas, I even did a little yard work during a warm spell last week. I haven’t been able to do these things since a year before my surgery last December, and I am so thrilled. I am getting better! To all this, my doctor merely gives a stiff warning not to overdo things, that she cannot increase my medication, and that if I still need medication by my next appointment (regardless of progress in healing), I will have to undergo other procedures or lose my place at the clinic. We have talked about these procedures before. They are very expensive, invasive, painful, and have mixed results, but legally, doctors are not allowed to continue medication alone, even when there is evidence it is helping. If my body does not heal according to a timeline unknown to me, I and my doctors will be forced into this procedure.

I walk down the winding hallway of exam rooms towards the exit, make another appointment, and sit down once more in the waiting room for my prescriptions. 3:45pm. My last month’s prescription cost over $40 with insurance. My oldest daughter needs new clothing. My husband needs new glasses. My son’s class is taking a field trip next week and the fee is due tomorrow. 3:55pm. I’m so thankful my dad lives nearby and is a willing and able babysitter for my three children. 4:05pm. “Mrs. Lawrence,” I walk over and check my scripts, thank the nurse, and turn around to gather my things. I glance around once more at the still-full room. Unlike me, most of these people will not get better. Unlike me, most of these people have serious and/or multiple medical conditions.

This is compassion? This is freedom? This is the state of modern medicine.


Additional Resources:

A ‘civil war’ over painkillers rips apart the medical community — and leaves patients in fear

http://america.aljazeera.com/opinions/2015/12/dea-crackdown-on-pain-meds.html

*Photo by, https://www.flickr.com/photos/cacis/

https://llawrenceauthor.wordpress.com/2016/03/13/on-opioids-one-year-after-dea-reforms-part-1-of-2/

https://llawrenceauthor.wordpress.com/2015/04/06/wackydruglaws/

Bringing Back Child Labor?

beakerboys
Breaker Boys of PA Coal Co., 1911

An international friend brought a horrifying article to my attention over the weekend. It did not involve terrorism, Syria, the Standing Rock fiasco, or even Harambe. It was far more subtle a subject, far more insidious, and based on many misconceptions and quiet propaganda. The article was originally called, Bring Back Child Labor, until the author, Joseph Sunde, received such backlash he changed it to, Work is a Gift Our Kids can Handle.

Posted on the Acton Institute Power Blog, I detected some hints of conservative Christian homeschooling rhetoric I remembered from a few years ago, when I was involved in that movement with/for my small children. The Acton Institute’s stated mission is, “to promote a free and virtuous society characterized by individual liberty and sustained by religious principles.” While the rest of the About page seeks to portray an ecumenical, almost secular and educated feel (nowhere is the word “Christian” mentioned), a quick look through Acton’s bookshop* proves their exclusively Christian underpinnings.

Betsy DeVos, Trump’s current pick for Secretary of Education, who recently made headlines with her trademark support of charter schools and school vouchers, is also a supporter of the Acton Institute, among others. This, in conjunction with the article in question, has deeply concerned many onlookers about the possible future of public education in America, but the rabbit hole goes deeper still.


And Now a Word from our Sponsors…

For at least the past 10 years, the Homeschool Legal Defense Fund (HSLDA) has made it their mission to reduce state laws pertaining to child labor. In the states of Missouri and South Dakota, they have successfully overturned previous child labor laws in the name of homeschool anti-discrimination. They have been working on a federal bill to the same end nationwide since 2006*. The HSLDA represents the welfare and rights of not just homeschoolers, but ultra-conservative Evangelical Christian homeschoolers in particular (more on HSLDA in another post).

It is the position of the HSLDA, that children as young as 12 should be allowed to work, if their parents view such work as beneficial to the child’s education.

“…a 12-year-old homeschooler in Illinois was manning the cash register for his family’s business after his morning schoolwork was done. He enjoyed the opportunity to earn a little money, and his parents knew that it helped him hone his math skills. Unfortunately, a customer did not feel the same way. She turned the family in to the Illinois Labor Department. After looking into the matter, the department prohibited the boy from working during school hours.” –Source

The article claims many of the child labor laws enacted by states in throughout the 1800s were necessary for their time, but are “outdated”, and suggests that all federal laws regarding child labor restrictions were and are superfluous (no question where this organization stands on states’ rights!). The article continues by outlining general laws pertaining to working children at different ages. A few key laws include:

  • No child under 16 may work during school hours, which are defined as public school hours (typically 8:30 a.m.-3:00 p.m., depending on the state).
  • The child is limited to 3 hours of work per day during a school week, or 18 hours a week.
  • He may not work before 7:00 a.m. or after 7:00 p.m. except from June 1 to Labor Day, when evening hours are extended to 9:00 p.m.
  • Children may perform agricultural jobs for employers who have filed a waiver with the federal secretary of labor for exemption from the work hours and minimum age requirements for those particular jobs.
  • A child may only work during school hours if he is not getting paid. An example of such a situation is a school “work study” program, in which children gain work experience for educational purposes. –Source

The question remains: Why should some Christians seek to overturn these child labor laws?


Look how “Happy (Doc and Dopey)” are the “children” working in the mines! They exemplify proper economics and virtue!

Why would Sunde (getting back to the original article in question) feel encouraged to blithely insist the Washington Post’s recent photo montage of dirty, poorly clothed child laborers from the early 1900s, was over-the-top for (rightly) calling the pictures “haunting”. Several of those kids were smoking for crying out loud! Or does Sunde think being filthy, poor, abused, and developing lung cancer are signs of virtuous character?

He seems to ignore those details, opting to focus on a favorite conservative fantasy that these children were using their “creative talents” to “build enterprises and cities, using their gifts to serve their communities, and setting the foundation of a flourishing nation.”

Sunde quotes heavily and with admiration, one Jeffrey Tucker from the Foundation for Economic Education. Tucker’s article titled, Let the Kids Work, is a perfect example of someone who is disconnected from reality. He calls the Washington Post’s photos, “beautiful”, and proceeds to imagine what the children in the pictures must have experienced:

“They are working in the adult world, surrounded by cool bustling things and new technology. They are on the streets, in the factories, in the mines, with adults and with peers, learning and doing. They are being valued for what they do, which is to say being valued as people. They are earning money. Whatever else you want to say about this, it’s an exciting life.”

Tucker pretends to believe the whopper that, “it was the market, not the government that reduced and nearly eliminated full-time grueling child labor.” Didn’t he just say those abused children were actually having the time of their lives? Didn’t he then proceed to make fun of those who might protest on the children’s behalf with, “Oh, look how exploitative it is!”

While Sunde insists in a new disclaimer, “I do NOT endorse replacing education with paid labor…nor do I support getting rid of mandatory education at elementary and middle-school ages.” Yet his own essay quotes Tucker’s insane words, “If kids were allowed to work and compulsory school attendance was abolished, the jobs of choice would be at Chick-Fil-A and WalMart.” (emphasis added by me)

Sunde goes on to say,

“In our schools and educational systems, what if we stopped prioritizing “intellectual” work to the detriment of practical knowledge and physical labor, paving new paths to a more holistic approach to character formation? In our policy and governing institutions, what if we put power back in the hands of parents and kids, dismantling the range of excessive legal restrictions, minimum wage fixings, and regulations that lead our children to work less and work later?”


Our forefathers’ greatest mission was free and public education for all American citizens, so Americans would not be subject to oppression! Washington and Franklin and the others are spinning in their graves to hear such blasphemies from so-called modern educated (Christian) men.

The reality of working children due to the continued and inexcusable lack of oversight of homeschooled kids is already a current problem:

“In some cases, educational neglect may occur when a homeschooled child is expected to work rather than study. In some cases…homeschooled children may be treated as servants and expected to do childcare and housecleaning rather than completing homeschool lessons. In other cases, homeschooled children’s education may cease at age 12 or 14 as they are expected to work full time, often in family businesses or doing various manual labor. “By 11, he was working full time with his dad who did construction,” writes Miranda of her homeschool graduate husband. “By 14, he was in the woods logging, carrying the full weight of a grown man’s job, helping bring home income for his parents.” These children are frequently not paid for their labor, and are thus both deprived of an education and exploited…These children often reach adulthood limited by their lack of education, their career path chosen by their parents through their failure to educate.” –Source

It’s even more of a problem for some homeschooled girls, whose educations are often devalued as they are raised to be “keepers at home”. The Coalition for Responsible Home Education quotes from Christian leader RC Sproul Jr., ““She [a nine-year-old homeschooled girl] doesn’t know how to read, but every morning she gets up and gets ready for the day. Then takes care of her three youngest siblings. She takes them to the potty, she cleans and dresses them, makes their breakfasts, brushes their teeth, clears their dishes, and makes their beds.” Now I [Sproul] saw her rightly, as an overachiever.”

Though it hasn’t been updated in 3 years, Sunde’s blog, Remnant Culture, features a telling who’s-who* of Evangelical and Catholic leaders and organizations whose mission is to instill pure capitalism (free market/free enterprise) in order to bring back the individual freedoms of religion and democracy they believe they have lost.

It is rather shocking that the very people who give the most lip service to education, America’s Founding Fathers, the value of children, and Christian morals, are the same ones advocating for elimination of compulsory education laws, a reduction of child labor laws, and the idolization of one form of human (i.e. fallible) government. In their minds, free enterprise is next to godliness (more on that in a later post). Make no mistake, the Industrial Revolution, America’s purest age of capitalism sans legal restrictions, saw the exploitation of everyone that possibly could be exploited. It was no less than the Northern form of slavery, without the personal investment of human chattel.

*Note: the shop link on the About page appears broken.

** When I first read Sunde’s essay on 11/27/16, he had included a statement about ending compulsory education at 8th grade. You will not find this quote in his current essay, it has since been deleted. The following comment references this quote, and there may be others: http://disq.us/p/1dx5k74.

*If you liked this post, please consider subscribing to my blog for just $1.50/month.


Resources

The Coalition for Responsible Homeschooling

Responsible Homeschooling, “Abuse in Homeschooling Environments”

Reuters, “India Children Labour”

Homeschool Federation, “Child Labor: What’s Going On?”


Cited Sources

http://blog.acton.org/archives/89837-bring-back-child-labor-work-is-a-gift-our-kids-can-handle.html

http://blog.acton.org/archives/author/jsunde

http://blog.acton.org/

http://blog.acton.org/about

http://shop.acton.org/

https://www.washingtonpost.com/news/acts-of-faith/wp/2016/11/23/betsy-devos-trumps-education-pick-is-a-billionaire-philanthropist-with-deep-ties-to-the-reformed-christian-community/

https://www.hslda.org/hs/state/sd/201403240.asp

http://www.hslda.org/cms/?q=bill/hb-1132-changes-child-labor-laws-make-them-homeschool-friendly

http://nche.hslda.org/courtreport/V22N3/V22N303.asp

http://nche.hslda.org/courtreport/V22N3/V22N303.asp

http://www.responsiblehomeschooling.org/policy-issues/abuse-and-neglect/educational-neglect/

https://www.washingtonpost.com/news/in-sight/wp/2016/10/31/20-haunting-portraits-of-child-laborers-in-1900s-america/

https://fee.org

https://fee.org/articles/let-the-kids-work/

http://remnantculture.com/

http://www.naspaa.org/jpaemessenger/Article/VOL20-1/06_Cook%20Klay.pdf

http://www.responsiblehomeschooling.org/policy-issues/abuse-and-neglect/educational-neglect/

http://disq.us/p/1dx5k74