B.C. medical shift is necessary but painful

People on high doses of opioid prescriptions are being weaned down as the B.C. medical field responds to research revealing harms.

It's an agonizing journey for those caught in the middle of the medication crackdown in B.C.

It's an agonizing journey for those caught in the middle of the medication crackdown in B.C.

The torturous pain refuses to ease, and Craig Koehl says he can hardly cope with life, let alone get anything done.

The torment makes it impossible to sleep and the pain has been constant and agonizing for more than a month, ever since his doctor started decreasing his medication.

The Terrace resident says he has been on strong painkillers ever since an accident  nearly 12 years ago. Koehl says he was walking across the street when he a car slammed into him, launching him into the air and down on his back.

The accident left him with severe neck and back pain, and he has been on medication ever since.

But several months ago his medication started being decreased, prompted by a provincial shift in the medical field when new regulations were issued by the College of Physicians and Surgeons of British Columbia last June.

The college’s professional standards and guidelines are legally enforceable and meant to limit the prescriptions of strong painkillers known as opioids. They were issued in response to research identifying alarmingly high amounts of opioids being prescribed in B.C. and increasing misuse of those medications.

In tandem with the new regulations, new doctors have moved to Terrace and are reviewing patient files, required now to take careful stock of medication use.

Doctors cannot continue prescribing medications simply on the basis of a past prescription, read the college regulations.

It adds that long-term opioid treatment has only modest benefits and significant risk for treating chronic non-cancer pain.

With an exception for people with cancer or in palliative or end-of-life care, and those on methadone, the standards define a reasonable dose as below 50 mg morphine equivalents (50 MME).

“Doses greater than 50 MME per day warrant careful reassessment and documentation. Doses above 90 MME per day warrant substantive evidence of exceptional need and benefit,” the regulations state.

For Koehl, those regulation has meant his medication has been decreased from a 60 MME daily dose (two 30 mg pills of morphine), down to a 40 MME dose over the last number of months.

At one point, the dose he was getting went as low as 30 MME, but the doctor increased it a week later when Koehl explained his misery.

It has been an up and down journey over the last 12 years for Koehl, who started at a 48 MME dose (three pills of 4 mg of hydromorphone).

But his tolerance grew over time, worsening his pain and requiring a higher dose.

“I was on them for quite a while… but then I got immune to them,” Koehl explained.

Over the last number of years, his dose has climbed and bounced around, and Koehl says his pain has been manageable, though never fully gone.

Up until a few months ago he has been able to work, but that changed when he started being weaned off his medication. With his new dose, Koehl says he struggles with pain daily and can barely work or cope.

“It’s just not cutting it… He gives me 28 pills, but they don’t even last me three days. They don’t work. There’s not enough power in them,” Koehl said. “I’m in excruciating pain all the time… I get in so much pain sometimes I just feel like doing myself in.”

Another resident who has been struggling under the changes is Mandy (not her real name).

Involved in an accident in 2002, she has suffered with chronic back pain ever since. For nearly 13 years, Mandy was on Tylenol 3 Codeine (T3s) without much investigation into the source of her pain, she said.

She has a bulging disk in her back and finally a year ago she was diagnosed with degenerative disc disease, which was later deemed by a specialist in Vancouver to have no real treatment.

“There is no surgical solution for this category of patients,” reads a report from the specialist who reviewed Mandy’s case.

In March this year, Mandy started taking a 30 MME dose of M-Eslon (or morphine sustained release). It helped with the pain for a while, but her dose had to gradually increase as her tolerance grew. Over time, in order for her to carry on her part-time job, her dose climbed to 90 MME and then as high as 120 MME, hydromorphone and then M-Eslon.

Then came the shift.

Her doctor retired early this fall and her new doctor started reviewing her files. After a few weeks, concerned about the substantially high dose of opioids she was on, her doctor started decreasing her medication.

For several weeks she could scarcely function, barely able to even take a shower because of the pain that shot through her when she tried to bend.

When she asked her doctor about a plan for dealing with her disease, Mandy said she was told to wait and see.

“He just said, ‘we’ll see once you are off this medication.’”

Mandy noted that it was especially frightening because she has a degenerative disease which would only get worse over time.

Mandy felt like she was being treated like an addict, even though she had never misused her medication and had always followed doctors’ instructions.

“I’m not abusing the medication… I want to work and if this medication is helping me get through work, then why not?” she asked. For a number of weeks, she endured the agonizing pain while her body adjusted, at times battling thoughts of suicide.

“Living with chronic pain is not easy,” she said. “It’s not fun and just the thought of it… I can’t… I won’t…

“If I’m off this medication, I don’t know… I just know that I’m not going to live like that… I can’t live with this pain every day,” she said.

Mandy says things have been improving now as her doctor gets to know her. He has slowed her medication decrease, so she can cope a bit more easily, she said.

But the journey is not over.

Though it is a necessary adjustment for overall health, it will be a daily battle for many people while their bodies adjust to lower amounts of medication.

Just Posted

Grads at Riverside Park in Vanderhoof, B.C. (Aman Parhar/Omineca Express)
Vanderhoof celebrates 2021 graduates

NVSS grads got together at Riverside Park on Friday, June 11 in… Continue reading

Singing and drumming was heard in downtown Vanderhoof on Monday, June 14. (Aman Parhar/Omineca Express)
Photos: Honour Walk held in Vanderhoof

An honour walk was held Monday June 14 in Vanderhoof, remembering the… Continue reading

Emergency crews responded to the scene of a suspicious fire at the southeast corner of the OK Café in Vanderhoof Friday, June 11. The historic building is 101-years-old. (BC RCMP photo)
OK Café in Vanderhoof alright after suspicious fire

Damage kept to a minimum by firefighters

The border crossing on Highway 11 in Abbotsford heading south (file)
VIDEO: Western premiers call for clarity, timelines on international travel, reopening rules

Trudeau has called Thursday meeting, premiers say they expect to leave that meeting with a plan

People line up to get their COVID-19 vaccine at a vaccination centre, Thursday, June 10, 2021 in Montreal. THE CANADIAN PRESS/Ryan Remiorz
Vaccines, low COVID case counts increase Father’s Day hope, but risk is still there

Expert says people will have to do their own risk calculus before popping in on Papa

B.C. Premier John Horgan listens as Finance Minister Selina Robinson presents the province’s latest budget, April 20, 2021. The budget projects $19 billion in deficits over three years. (Hansard TV)
B.C. government budget balloons, beyond COVID-19 response

Provincial payroll up 104,000 positions, $10 billion since 2017

Ocean debris is shown on Long Beach in Tofino, B.C. on April, 18, 2012. THE CANADIAN PRESS/Jonathan Hayward
Shoreline cleanup finds COVID-related trash increased during height of the pandemic

Great Canadian Shoreline Cleanup reports litter from single-use food packaging nearly doubled

Doctor David Vallejo and his fiancee Doctor Mavelin Bonilla hold photos of themselves working, as they kiss at their home in Quito, Ecuador, Wednesday, June 9, 2021. Doctor Vallejo and Doctor Bonilla suspended their wedding in order to tend to COVID-19 patients and in the process Vallejo got sick himself with the disease, ending up in an ICU for several days. (AP Photo/Dolores Ochoa)
Love, sacrifice and surviving COVID-19: one couple’s story

COVID hits Ecuadorian doctors who delayed wedding to treat sick

St. Joseph's Mission site is located about six kilometres from Williams Lake First Nation. (Photo submitted)
Williams Lake First Nation to search residential school site for unmarked graves

St. Joseph’s Mission Indian Residential School operated from 1886 to 1981

Tuesday’s Lotto Max draw went unclaimed. (Photo courtesy of BCLC)
Tuesday’s Lotto Max draw went unclaimed. (Photo courtesy of BCLC)
Lotto Max jackpot goes unclaimed again

42 of the 64 Maxmillion prizes of $1 million were won, the majority were sold in Ontario

FILE - This July 6, 2017 file photo shows prescription drugs in a glass flask at the state crime lab in Taylorsville, Utah. (AP Photo/Rick Bowmer, File)
Contaminants in generic drugs may cause long-term harm to DNA: B.C. researcher

Scientist says findings suggest high volume overseas facilities require strict regulation

Restaurant patrons enjoy the weather on a patio in Vancouver, B.C., on April 5, 2021. THE CANADIAN PRESS/Jonathan Hayward
Labour shortages, closed borders major obstacles to B.C. restaurant, tourism restarts

Industry expert says it won’t start to recover until international travellers can visit

Most Read