Page 8 - Sonoma County Gazette April 2019

OPINION: Millions Denied Pain Relief?
Are Millions of Chronic Pain Patients Being Denied By John Lewallen Essential Opioid Pain Relief?
By Elizabeth McCarthy, Sebastopol
According to early results of the March 5 special election, voters in the Palm
As politicians are trying to outdo each other in a fervor to attack the “opioid crisis,” I can no longer remain silent about the crisis in my peer group, oldsters who are reliant on a steady, modest supply of opioids to spend our “golden years” without suffering from extreme chronic pain.
Drive Health Care District resoundingly passed Measure A. It is important to be clear on what precisely voters approved. In the District’s haste to call the special election, I am afraid the process was bungled, resulting in widespread confusion about what was being voted on - whether Resolution 18-10, passed unanimously by the District Board on December 7, or Resolution 19-01, adopted on a 4-1 vote of the District Board on February 4.
It seems every day brings a new spate of federal, state, hospital and clinic restrictions on the opioids needed by millions of chronic pain patients to be functional human beings. Some are seeing their doses cut back. Others are cut off completely.
To resolve this confusion, we need to look at the source documents for the election. Copies of these are attached:
1. The text of Measure A and County Counsel’s Impartial Analysis of Measure
Even people of all ages recovering from surgery are being denied opioids, the only drug truly effective against acute short-term pain.
All factual statements and quotes in this commentary are from Avoiding Opioid Abuse While Managing Pain by Lynn R. Webster and Beth Dove (Sunrise River Press, 2007) a book for pain management doctors by two leading experts in both opioid addiction and chronic pain management.
A, from the Sonoma County Voter Information Guide, page 6.
2. Election Information for Measure A, including Board Resolution 18-10, filed
Opioids are the most effective pain relievers discovered so far. When used responsibly, they can enable life for many people without serious side effects.
by the District with the Sonoma County Registrar of Voters on Dec. 7, 2018, accompanied by two ballot arguments and proof of publication, submitted on Dec. 18, 2018, and the official calendar for the March 5, 2019 Special Election.
Professionals categorize opioid users as:
Even researching with the trained eye of a former city attorney, I was befuddled by the seemingly moving target of what we (voters) were being asked to approve. As my previously published letters indicate, I found serious flaws in the terms of the lease-sale contained in Resolution 19-01.
But Resolution 19-01 was never on the ballot. It couldn’t be - since it was not adopted until after the deadline for submitting ballot information to the Registrar of Voters. (See the official calendar for the special election, at page 6 of the attached election information.)
• “chronic-pain patients,” whose lives are improved by opioid use and who use opioids as prescribed;
• “abusers,” who use opioids for anything except prescribed pain relief for the person they are issued to;
• “addicts,” who suffer from the disease of addiction, which is, to quote Webster and Dove: “A primary chronic neurobiologic disease influenced by genetic, psychosocial and environmental factors. It is characterized by impaired control over drug use, compulsive drug use, and continued drug use despite harm and because of craving.”
Although much attention has been paid to Resolution 19-01 since its adoption on February 4, it is nowhere to be found either in the text of Measure A or the Voter Information Guide. On the other hand, Measure A explicitly refers to Resolution 18-10. As stated in the Impartial Analysis of Measure A by County Counsel:
There is nothing mystical about opioid withdrawal. Simply stated, people naturally produce endorphins, literally “internal morphine,” which intervene when the nervous system sends pain signals to the brain to take the edge off the pain. Opioids supplement, then eventually overwhelm, endorphins, which the body eventually stops producing. When opioids are discontinued, it takes several days for natural endorphins to recover.
District has had preliminary discussions and negotiations with American [American Advanced Management Group, Inc. or AAMG] with respect to such a lease/option to purchase District’s assets. If voters approve Measure A, District will negotiate a sales agreement with American, with the price based upon an appraisal by an independent third party. The Board will review and approve both the appraisal and any definitive transfer agreement at a duly noticed pubic meeting. (Emphasis added.)
Whether happy patient or desperate addict, long-term users who suddenly quit opioids get “a syndrome characterized by symptoms that include sweating, tremor, vomiting, anxiety, insomnia, and muscle pain. It can be avoided by carefully tapering the opioid dosage.”
The opioid crisis is not going to be solved by terrorizing
Thus, now that voters have approved Measure A, the District has the
green light to negotiate with AAMG for a lease/option agreement on terms that conform to state law (i.e., requiring an appraisal of market value by an independent third party), and to present both the appraisal and any definitive agreement for public scrutiny at a duly noticed public meeting, prior to their review and approval.
doctors into denying people effective pain relief.
As Webster and Dove wrote, “about 70 million people live with chronic pain in America today. In a world with few alternatives, opioids remain the best treatment available for many chronic pain conditions and are the first choice of therapy for acute and postoperative pain.”
Are we becoming a sadistic society, forcing millions to
suffer unendurable pain because of fear and ignorance about
opioids?
It is unclear why the District Board even considered Resolution 19-01 on February 4, before securing passage of Measure A. In any event, Resolution 19-01 fails to comply with the terms of Measure A, because it is the product of a series of closed session meetings held prior to the passage of Measure
A, and the appraisal and lease/option agreement it contains have never been presented for review at a duly noticed public meeting. That falls short of what the law requires to approve the sale of substantially all the assets of the District.
“People who live with chronic pain,” wrote Webster and Dove, “live with pervasive stress, and their lives are forever changed. Pain is physically stressful. It interrupts sleep and disrupts hormone levels. Unremitting pain is also psychologically stressful. It causes low self-esteem and may result in loss of job or social standing. Financial worries may be overwhelming. Independence, mobility, and family relationships are compromised. There appears to be no escape from the merry-go-round of life lived in hospital emergency rooms.
During the month of voting in the March 5 special election (voting by mail opened on February 4), voters understandably were seeking information about Measure A. However, town hall meetings, social media posts, online and published comments to the press, chats between neighbors, etc. are not official sources and do not have the weight of the formal decision making process - which is what the passage of Measure A now requires of the District. If the Board majority would like to ask the voters and taxpayers of the District to consider the terms contained in Resolution 19-01, they need to present it at a duly noticed public meeting.
The chronic-pain patient is forever called on to justify his or her experience and to explain what is unexplainable. The possibility always looms that whatever pain relief is available will be snatched away because if the fear, misinformation, or apathy of the latest caregiver....
“Oblivion can seem an attractive alternative to consciousness. People living with chronic pain have high rates of attempted and completed suicides.”
Also, I understand that serious questions, about whether or not the appraisal relied on in Resolution 19-01 satisfies the statutory requirements for a fair price to the District, have not received the dignity of a response from District officials. But all this can be aired once the District holds duly noticed public meeting(s) on the terms of the proposed lease-sale option.
8 - www.sonomacountygazette.com - 4/19
OPED: MEASURE A cont’d on page 9
OPINION: Measure A: What Voters Actually Approved & What’s Needed
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