Stewart is 49 years old. He has long silver hair and an eighth-grade education. For the past four years, he has taken large amounts of prescription opioids, ever since a surgery to replace his left hip, ruined by decades of trucking, left him with nerve damage. In the time since, his life buckled. First he lost his job. Then his house, forcing a move across the state to this trailer park. Then began a monthly drive of 367 miles, back to his old pain clinic, for an opioid prescription that no doctor nearby would write.
“It’s 10 after,” reminded Tyra Mauch, his partner of 27 years, watching him limp over to her.
“Got to go,” he said, nodding.
He hugged her for a long moment, outside the bathroom with the missing door, head full of anxiety. He knew what awaited him on the other side of the drive. Another impossibly difficult conversation with his provider, who, scared by the rising number of opioid prescribers facing criminal prosecution, would soon close the pain clinic. Another cut in his dosage in preparation for that day. More thoughts of the Glock.
The story of prescription opioids in America today is not only one of addiction, overdoses and the crimes they have wrought, but also the story of pain patients like Kenyon Stewart and their increasingly desperate struggles to secure the medication. After decades of explosive growth, the annual volume of prescription opioids shrank 29 percent between 2011 and 2017, even as the number of overdose deaths has climbed ever higher, according to the IQVIA Institute for Human Data Science, which collects data for federal agencies. The drop in prescriptions has been greater still for patients receiving high doses, most of whom have chronic pain.
The correction has been so rapid, and so excruciating for some patients, that a growing number of doctors, health experts and patient advocates are expressing alarm that the race to end one crisis may be inadvertently creating another.
“I am seeing many people who are being harmed by these sometimes draconian actions amid this headstrong rush into finding a simple solution to this incredibly complicated problem,” said Sean Mackey, the chief of Stanford University’s Division of Pain Medicine. “I do worry about the unintended consequences.”
Chronic pain patients, such as Stewart, are driving extraordinary distances to find or continue seeing doctors. They are flying across the country to fill prescriptions. Some have turned to unregulated alternatives such as kratom, which the Drug Enforcement Administration warns could cause dependence and psychotic symptoms. And yet others are threatening suicide on social media, and have even followed through, as doctors taper pain medication in a massive undertaking that Stefan Kertesz, a professor at the University of Alabama at Birmingham who studies addiction and opioids, described as “having no precedent in the history of medicine.”