America is fighting a massive epidemic of prescription drug abuse.
More Americans die from drug overdoses than in car crashes, mostly from opioids, a class of drugs that includes heroin and prescription painkillers like OxyContin and Vicodin.
At the same time, the data show more than 116 million Americans experience chronic pain. And their pain is not being alleviated in many cases, according to the National Institutes of Health, which launched a sweeping review of the role of opioids in the treatment of chronic pain in 2011.
In El Paso, the number of deaths involving opioids remains low but has been increasing. There were 30 deaths involving opioids in 2011 and 55 in 2015, according to data collected by the Office of the Medical Examiner.
The national epidemic of prescription drug abuse, along with new federal and state laws aimed at reining in the problem, have changed the way doctors are treating pain in El Paso, as it has nationwide.
Today, your doctor is more likely to refer you to a pain specialist if you are suffering from pain, local doctors say. The result is that pain specialists in El Paso have become very busy, and some local doctors’ groups have been working to expand. As of the last count in 2014, there were five board certified pain specialists in El Paso, according to Texas Medical Society data.
Today, doctors are also more cautious about prescribing opioids to treat pain, and if they do prescribe them, monitor patients more closely, requiring that patients sign treatment agreements. By doing so, patients typically agree to submit to random pill counts and urine drug tests, local doctors say.
The treatment agreements also typically direct patients to fill their prescription at one pharmacy. They direct patients not to “doctor shop,” share drugs, sell them or abuse them. In El Paso, that can include not getting pharmaceuticals in Juárez, a short trip south of the border.
“The truth is other physicians can prescribe exactly what we are doing,” says Dr. Eduardo Vasquez, a local pain specialist. “But because of the risks, (primary care physicians) are really trying to narrow their scope.”
Vasquez, an El Paso native who attended El Paso High School, founded El Paso Pain Center with other doctors in 2009. The group recently opened a second location in Far East El Paso.
“People typically have a misconception about what we do,” Vasquez said.
All doctors work to alleviate pain. That, and extending life, is almost the job description. But for some patients, the pain never goes away. It becomes its own disease.
“It’s a very traumatic thing to be labeled a chronic pain patient,” Vasquez said. “It’s a scarlet letter for many of these patients.”
Chronic pain can be debilitating and isolating. Those who have chronic pain may no longer be able to work. Vasquez said he’s seen patients struggle with insomnia, anger and depression. Studies have also shown that the risk of suicide is higher among chronic pain patients.
“There’s a lot of notoriety, obviously, with the growing epidemic of opioid abuse and things of that nature. And to some degree, the public has assessed us as licensed drug dealers,” Vasquez said. “That’s harsh, because we really do serve a purpose.”
The annual U.S. expenditures related to pain, including medical expenses and missed work days, are higher than those for cancer, heart disease and diabetes combined – between $560 billion and $630 billion per year, according to the National Institutes of Health.
And “the evidence indicates that 40 to 70 percent of people with chronic pain are not receiving proper medical treatment,” wrote the authors of a 2014 NIH report.
El Paso Orthopaedic Surgery Group recently expanded its pain management specialist team, hiring a new interventional spine and pain management physician, Dr. Janet Lee. She specializes in using non-surgical options such as physical therapy to help alleviate patients’ pain.
Dr. Carlos Viesca, a pain specialist who has worked at the surgery group for 12 years, said they struggled for years to expand, hiring several people who ultimately decided they didn’t want to stay in El Paso. The region has long suffered from a doctor shortage and local hospitals and clinics have struggled to recruit doctors to the region.
“It’s really sad to see somebody who was receiving the right amount of medication, for the right reasons, that now has to wait longer to come see us, because we are overwhelmed,” Viesca said. “As pain physicians we have many patients knocking on our door.”
Some patients wait four to six weeks to see a pain specialist in El Paso, he said.
“All of this opioid prescribing is what put us where we are at,” Viesca said.
A commercial during the Super Bowl advertising a drug to treat opioid-induced constipation introduced many Americans to how widespread opioid use has become.
But Viesca said new laws “are helping us curb some of the problems that were happening before.”
In Texas, laws passed last legislative session have made it harder to “doctor shop” by strengthening the state’s prescription monitoring database, said Dr. C.M. Schade, past president of the Texas Pain Society, a non-profit that represents pain doctors and helped craft the new rules. The database allows doctors and others to see patients’ prescription drug history.
Last September, the Texas Department of Public Safety handed oversight of the program to the Texas State Board of Pharmacy, which has proposed a number of improvements, including push notifications. The notifications will alert physicians and pharmacies when a patient fills a prescription for a controlled substance from more than one doctor, Schade said.
Another bill passed last legislative session expanded access to naloxone, a drug that counteracts the effects of opioid overdose, Schade said.
Email El Paso Inc. reporter Robert Gray at email@example.com or call (915) 534-4422 ext. 105. Twitter: @ReporterRobby.