Michael Needham is a Vietnam veteran who served in the Navy before being discharged as a result of his ankylosing spondylitis (AS). In order to live with the pain of his AS, Needham relies on prescription narcotics.
“Hydrocodone in the morning when I get up,” he says, “because it’s fast acting. I give it a couple hours [then] take my morphine” before following it up with more hydrocodone later in the day.
Needham’s use of opioids to treat his ankylosing spondylitis pain is not uncommon, nor is it illegal.
Like many vets with AS, he got started on the drugs with a prescription from his doctor. But now, Needham has relocated to North Dakota and sees a new doctor at the local VA…and he might have a hard time continuing to get his medication.
On October 6, 2014, hydrocodone was reclassified as a Schedule III drug to Schedule II. According to the DEA, Schedule III drugs have “a moderate to low potential for physical and psychological dependence” whereas Schedule II drugs present “a high potential for abuse” and “are also considered dangerous.”
Michele Leonhart, an administrator with the DEA, said
“almost seven million Americans abuse controlled-substance prescription medications, including opioid painkillers, resulting in more deaths from prescription drug overdoses than auto accidents.”
Partially because of that “risk to the public through diversion” (that is, the distribution of prescription narcotics to those without a prescription via friends and family) the Department of Veterans Affairs also issued new protocols in 2014.
VHA Directive 1005 explicitly states that anyone receivingnarcotics for long-term pain management will be monitored by their provider.
The directive states, “This may include checking how often you refill and renew your prescription, counting pills, asking you about your symptoms, and testing your urine, saliva, and blood.”
The VA insists the policy goes beyond monitoring diversion. Dr. Breton Weintraub, Chief of Staff at the VA that Mr. Needham now goes to, says the drug screen is “to allow the provider to know when the situation is riskier and to take that into account.”
Mr. Needham, however, views the drug screen as an infringement of his constitutional rights. “My whole family is going, ‘Why don’t you just go pee?’ It’s because I’m not going to be forced to,” he says.
But Dr. Weintraub does have a point:
Beyond the risk of overdose, drugs like morphine and hydrocodone have also been linked to increased risks for heart attack and respiratory depression (which reduces the amount of oxygen a person is getting).
Furthermore, a review by the Annals of Internal Medicine (published in January 2015) indicated that no studies have adequately assessed the long-term efficacy or safety of opioid use for chronic pain.
