Opioid limits are hurting some, who say they need the drugs 

Pain mismanagement

click to enlarge Frank Michalski’s knee was mangled. - J. ADRIAN STANLEY
  • J. Adrian Stanley
  • Frank Michalski’s knee was mangled.
In 1997, Frank Michalski took his young son out for a dirt bike ride near their California, home.

The boy, usually called “Skeeter,” wanted to try his dad’s bike. Michalski allowed the boy to steer, but climbed on the back of the bike so he could guide him. Suddenly, his son downshifted the bike, bucking them both off.

“The front end came up and you just heard [my knee] snap,” he says.

Michalski, who is now 52 and lives in Fremont County, says his injuries, which were compounded by a life-threatening infection, kept him in the hospital for 105 days and forced him to undergo 12 surgeries. That left him disabled.

Over the years, his mangled leg continued to cause problems. He’s had a hip replacement, which will likely need another surgery because it grinds, causing immense pain. His back is degenerating, and he’s undergone fusion for the bones in his neck to combat intense headaches. Even worse, his son and only child died a decade ago at age 19.

A few weeks ago, Michalski’s life became more difficult when his doctor reduced his opioid prescription medication. He says he was told that taking a pill prescribed by one of his doctors years ago had led him to fail a drug test he undergoes as an opioid patient, and the doctor had also detected alcohol left in his system from the beers he used to enjoy while watching sports games on TV. But the main reason for the reduction, he says, was new guidelines for opioid medications — his prescriptions were well above the limit.
Dennis DelPizzo, spokesperson for the Denver office of the Centers for Medicare & Medicaid Services (CMS), explains that in response to the opioid epidemic, CMS has attempted to identify opioid over-users in its system (with the exception of cancer and hospice patients). That’s possibly how Michalski was pinpointed by his doctor. CMS will adopt parts of the Centers for Disease Control and Prevention’s (CDC) new opioid prescription guidelines next year, which will further curtail the drugs, and set a limit on doses.

But even now, many doctors are using the CDC guidelines to inform their practices, says Dr. Robin Johnson, medical officer for clinical and community partnerships at El Paso County Public Health. Johnson is leading up the physician education component of the Coalition for Prevention, Addiction Education and Recovery, headed by Community Health Partnership, meaning she informs doctors about the opioid epidemic and CDC guidelines.
Johnson says the need to reduce the medications is clear, but it can be difficult for long-term heavy opioid users like Michalski, who have developed a high tolerance for the drugs. How to help such patients while reducing their prescriptions, she says, “is a really important question that we are attempting to address.” Among the alternatives are cognitive behavioral therapy, music therapy, acupuncture, physical therapy, nerve blocks and alternative medications. She also says that many doctors try to “step down” patients’ opioid medications to ease suffering.

But there’s no magic pill to replace opioids, and history tells us that drugs like this tend to lead to addiction. Still, Michalski says since his medication was reduced he’s usually unable to do even the small tasks he once enjoyed, like taking his dog for a walk or mowing his lawn. He says he’s lost 65 pounds and is largely bedridden.

Michalski is incredibly thin, his body covered in scars, and he walks awkwardly with a cane. After our interview, he nearly falls while trying to get into his car. “I just get pain all over,” he says.
He adds, “If you’re hurt, the doctor should take care of you.”

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