PORT ORCHARD — When Marty Mioni’s horrific back pain from a litany of ruptured discs and surgeries has subsided enough, the 63-year-old woman is able to care for her husband — nearly bedridden with Stage 5 renal disease — in their Port Orchard home.
But Mioni herself is nearly confined to a bed with wracking, chronic pain tempered over the years by a regulated dose of prescribed opiates. Now, though, an opioid epidemic across the nation has prompted the federal government, as well as state governments, to issue new restrictions to physicians who prescribe these powerful, addictive medications.
For her and many other chronic-pain patients, they are left with a previously unthinkable alternative to a life of intense pain: to end their life.
Is that an option Mioni might elect to take someday?
“Oh, I think about it all the time,” she said. “But I don’t think I’d ever do it. The thing is, [her husband] is basically keeping me alive, because I’ve got to take care of him.”
Mioni contends that people with chronic pain who have made that awful decision are an overlooked statistic among all suicides.
“Suicide is not just a mental health issue,” Mioni said. “But it’s also physical.”
Kim Hendrickson agrees it’s a significant issue. The manager of the Behavioral Health Outreach program with the City of Poulsbo said although her behavioral health “navigators” almost exclusively counsel individuals with mental health issues, she said it is easy to overlook the chronic-pain patient subset of those contemplating suicide.
“The people you’re talking about wouldn’t generally be utilizing a program like ours because police officers haven’t referred them to us as individuals looking for connections to mental health care.”
As it stands, Hendrickson and others say these people are increasingly falling through the cracks of the state health care system.
“Pain management is absolutely critical for people that have terminal conditions like cancer,” she said. “They aren’t getting their medications [to stem the pain], in my opinion. It’s a very sad situation.”
Mioni and others who deal daily with chronic pain are caught in a Catch-22 situation that’s not of their making. Opiate medications are the most effective drug to combat severe pain, but the increased use of opioids, legally and illegally, feeds the growth of addicts who are filling hospitals and treatment clinics.
The Centers for Disease Control recently issued a ruling called “90 MME” that restricts physicians to prescribe no more than 90 milligrams daily of an opioid to each patient — regardless of the intensity of their chronic pain. Some doctors have stopped prescribing opiates altogether and are referring their patients with chronic pain to specialty clinics.
That’s what happened to Mioni, whose physician had prescribed 165 milligrams daily to treat her pain for many years, she said. Her primary care provider now refuses to issue any prescription for an opiate; instead, he referred her to a pain clinic. As is the case with similar clinics in the region, there’s a long waiting list. Mioni waited one year to get into Peninsula Pain Clinic and will soon be part of a trial study using a pain pump.
She’s become something of an expert on treating chronic pain. While acknowledging there’s been an increase in opioid use, she’s wary of the statistics the state and federal governments are using.
“What they are doing is lumping all the chronic pain patients together with addicts,” Mioni said. “We sign a pain contract every year. We pass urine tests and go to the same pharmacy. According to my doctor, I’m a model patient, but, still, he says his hands are tied.
“As a patient, you are stigmatized,” Mioni said.
A few years ago, the Seattle Times reported on the death of a 58-year-old former patient of the Seattle Pain Centers who committed suicide after claiming there no longer was any help available for his chronic pain. The chain of Washington state clinics had closed shortly before his death. The man, Denny Peck, tried to find a new primary care provider, as state health officials advise patients, but because of the new restrictions, he said doctors were unwilling to risk losing their license to help.
After rationing his remaining pills, Peck soon ran out. And then he ran out of hope. Police say the desperate man was found in bed at his mobile-home park outside Yelm. Two guns in his lap, Peck had taken them to both sides of his head, then pulled the triggers.
Dr. Kathy Lofy, Washington state health officer, told the newspaper that, “We know that many people struggle with pain, both physical and emotional. We want people to know that it can get better and that there are people and resources that can help.
“If anyone feels helpless or desperate, we hope they will reach out for help and that people surrounding them will take action.”
But exactly what kind of help chronic pain patients can now expect is their uncertain reality.