06/02/2023
"Pain Patients Abandoned"
West End News
June 2, 2023
-by Kelly Merrill
"When Dr. Merideth Norris was indicted by the DOJ’s New England Prescription Opioid Strike Force in late October of 2022, her pain patients were abandoned to a hostile regulatory and prosecutorial climate. Physicians are fearful about prescribing opioid pain medications and medical professionals are increasingly refusing treatment, rescinding care, and forcing rapid downward tapers that ignore FDA warnings and CDC clarifications that such methods of treatment are dangerous and have serious consequences, including su***de.
"Seven months after the Norris indictment, the situation is dire. Pain patients with rare, disabling illnesses and other conditions causing severe, persistent, life-limiting pain, say they cannot find adequate continuing medical care. Further, they have been given no alternative but to drastically reduce or discontinue the use of opioid pain medications that allowed them to function.
"The results have been disastrous for those still struggling to find care. I sat down with seventeen legacy pain patients who have been displaced by the DOJ actions. Legacy patients are people who have tried and failed numerous treatments for pain. They have relied on opioid analgesics for many years to manage symptoms.
[photo of two pain patients in obvious emotional distress, supporting one another. Pain patients Diane Nason and Elaine Pepin - Diane Nason (left) was with Dr. Norris for 12 years. She has complex comorbidities and has been treated under the palliative care exemption since 2018. Elaine Pepin (right), with degenerative disc disease, was a patient of Dr. Norris for at least 10 years. Norris helped her to reduce her daily medications, including opioid pain relievers, to find a regimen that worked.]
"Who is Merideth Norris?
"Dr. Norris is a Board-Certified Addiction Medicine Specialist. Dr. Norris has been a leading voice in opioid policy and a fierce advocate of treatment options and access for people with substance use disorder. In 2015, Norris was appointed by the then Governor to the Treatment Task Force for the Maine Op**te Collaborative. She was an early-adopter and advocate of harm reduction, offering treatment access to the uninsured.
"Norris’s expertise around addiction medicine and the Opioid Epidemic extends to the pain community, as well. She has been an outspoken critic about rigid policy prescribing limits adopted by the state in 2017, which followed soon after the publication of the 2016 CDC Guideline for Prescribing Opioids for Chronic Pain. She then foretold the unintended consequences for both physicians and patients.
"Norris Indictment
"Last October, Norris was indicted for illegal distribution of opioids by the DOJ. While people being medically treated for substance use disorder were able to find doctors, disabled pain patients with complex comorbidities could not find care.
"The NEPO Strike Force specifically claims to address what they call one of the root causes of the epidemic, “unlawful prescription and diversion of opioids.” They single out doctors and other medical professionals by using the state’s Prescription Monitoring Program. Norris was a top prescriber in private practice; she is the Strike Force’s first target.
"As someone who is an expert in the field of opioid policy, who was treating patients with pain-generating illnesses, as well as patients with substance use disorder, it is logical that Norris would be a top prescriber of opioid medications. Further, she was the only doctor who would take on such patients when three doctors from Southern Maine retired during the pandemic, said an anonymous prescriber who contacted me from a restricted number.
"If convicted, Norris faces up to twenty years in federal prison.
"The Impact of Public Policy
"This issue has been ramping up for years. Public outcry over lethal, unintended patient harm, resulting from the 2016 CDC Guidelines, lead to strong actions from agencies tasked with protecting public health. In 2019, the FDA issued a Safety Communication, warning about abruptly discontinuing and rapidly reducing dosages due to precipitated withdrawal, psychological distress, and su***de. And in a rare move, at the end of 2022, CDC finally clarified their stance due to widespread misapplication of the guidelines. But the damage was already done. Six years later, the guidelines, originally intended as recommendations for primary care physicians, were adopted into law. Thirty-eight states have imposed hard prescribing limits.
"The CDC’s Guidelines and Maine’s prescribing limits, formed in the early years of the fentanyl crisis, have done nothing to mitigate overdose deaths, which have set records for the past three consecutive years. The restrictions have, however, had a chilling effect on the pain community, resulting in a 40% reduction in opioid prescribing. This seismic shift has left many patients in the state without options.
"Devastating Consequences
“'Since the limits on prescribing took effect in January of 2017, it has been more difficult for patients with chronic pain to find prescribers willing to use the appropriate and lawful palliative care exemptions in the statute that were designed to assist them,' said Gordon Smith, Director of Opioid Response for the current Governor. Smith was involved in drafting of the 2016 legislation while he served as Executive Vice President for the Maine Medical Association. 'The recent enforcement action by the federal government has had an additional chilling effect,' he added.
"Physicians are too afraid to go on the record and speak publicly in support of Norris or treat her patients. “They’re hunting us,” said an anonymous prescriber. “They’ve weaponized the Prescription Monitoring Program and there’s always going to be a top prescriber.” When asked about using the palliative care exemption, multiple prescribers have expressed extreme discomfort and an unwillingness to use it because of the current climate.
"When Norris was indicted, patients were blindsided. Emergency rooms bridged care by writing prescriptions for five to seven days. Meanwhile, patients scrambled to find practitioners to treat them. Mike Albaum, Chief Medical Officer at Southern Maine Health Care, explained the rocky process of trying to accommodate patients in the aftermath of the Norris indictment. He said he consulted with the Schmidt Institute in Bangor. They set up a plan to reduce and taper patients off their medications or transfer them to another provider for what he calls longitudinal care. He does not plan to use the palliative care exemption that was passed in 2018 because he says they are unclear. That taper clinic is scheduled to close this month.
"Pain Patients Speak
"The pain patients interviewed had been taking pain medications safely and responsibly for six years to two decades. After the DOJ action, they report dangerous dose reductions that have caused extreme harm and bodily injury, leaving them deeply disabled and unable to function. Of those patients, several who were in recovery from alcohol and drugs for many years have lost their sobriety as they self-medicate. Another is now housebound. Two reported precipitated withdrawals, one experienced multiple seizures, and another’s new medication regimen causes constant vomiting. Several have reported dangerous spikes in blood pressure.
"Ms. Snyder
"Ms. Snyder, who asked that we not use her first name, is a 48-year-old patient with degenerative disc disease. She said that during her first visit to her new provider, they cut short-term opioid pain relievers by 25%. They continued with an aggressive tapering schedule and eliminated the medication entirely in just three weeks. At the same time, they cut her benzodiazepine Xanax by 25 – 75% per week, eliminating the anxiety medication entirely over just a five-week period. According to revised CDC Guidelines, patients who have been using opioids and benzodiazepines long-term should not have medications reduced by more than 10% per month. Snyder went into precipitated withdrawal, resulting in five bad falls within four weeks. The last one split her forehead open on a windowsill, giving her a bloody nose and two black eyes.
"At one point, Snyder reports calling the provider thirteen times, and says they never called back. She then contacted Norris, who prescribed medication for the severe withdrawal she was experiencing.
'Until the DOJ targeted my doctor, I had been on stable doses of opioid analgesics and other medications for twelve years. Now, my eleven-year recovery from alcohol is in jeopardy, my mental health has deteriorated, and I can barely make it to my psychotherapy appointments,' she said. 'I am barely hanging on. I can’t move around; I can’t make my bed. These are medications that allowed me to function when nothing else has been effective.'
"Elaine Pepin
"Elaine Pepin, who has been through years of interventional therapies and medication management, is seeking a neurosurgeon who will do her spinal fusion. She detailed over a decade of care that she received from Norris, as well as what she has endured subsequent to Norris’s arrest.
"'When I first came to Norris years ago, she helped me reduce my intake of opioid and other medications, and we found a regimen that was still effective,' she said. 'In my subsequent visits to the hospital, I’ve been treated like a criminal. I’ve been told, ‘You know, that’s like heroin.’ ‘We don’t do opioids here.’”'Pepin wearily explained, 'I wouldn’t be taking these medications if I didn’t need them. It’s demeaning, and it’s insulting.'
"Pain Advocacy Alliance
"Their stories are too numerous to detail. After being turned away from doctor after doctor, some patients fear they won’t survive this and that su***de may be their only answer. Others are actively pursuing legal remedies through litigation against institutions for patient abandonment, refusal to treat, and dangerous, inhumane medical practices.
"In the ten weeks following this story, patients’ health continues to deteriorate.
"If you or someone you know has been impacted by forced downward tapers or the inability to obtain pain management or you are a prescriber who wants to talk about the current climate, please contact Pain Advocacy Alliance at [email protected].
Kelly Merrill is a long-time contributor to The West End News and the Executive Director of the Pain Advocacy Alliance. They are a community organizer, activist, and journalist.
When Dr. Merideth Norris was indicted by DOJ’s New England Prescription Opioid Strike Force in October 2022, her pain patients were abandoned.
