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

BC Ferries has announced the welcoming back onboard of recreational travellers on June 15 after the provincial travel restrictions were lifted. (Courtesy of BC Ferries)
BC Ferries welcomes back recreational passengers

The ferries corp will relax mask-wearing in outdoor spaces

Nic Pirillo received $1,000 Youth WORK Apprenticeship Award presented to him by Erik Brooke and Catlin Chandler of Broadwater Industries, in front of the boat Pirillo built in his free time using newly acquired skills. (Photo: supplied)
Learning and earning with apprenticeship

Nic Pirillo graduated in 2020 and was awarded the Youth WORK Trades award

According to the BC Centre of Disease Control epidemiology mapping from May 30 to June 5, there was an increase of one case in the Prince Rupert area after a three-week stability of no new cases. (Image: supplied BC CDC)
Prince Rupert second dose vaccination clinic to run from June 14 to July 9

Volunteers needed for P.R. immunization clinic, recipients must register and cases back up to one

Capt. Portugal was getting into the festive spirit out working for the City of Prince Rupert and celebrating Seafest 2021, on June 12. During regular business hours Capt. Portugal is known as David Costa. (Photo: K-J Millar/The Northern View)
Searching out fun in the sun for Seafest 44

Families and friends can participate in weekend COVID-19 friendly activities

Seafest is underway with a sunfest theme from June 11 to 13 in Prince Rupert. Alex Hoogendorn vice president of Prince Rupert Special Events is creating sunny times making feature for the decorating contest with his son Caleb Hoogendorn on June 4. (K-J Millar/The Northern View)
Seafest 44 plans a sunfest June 11 to 13 in Prince Rupert

All events in festival are COVID-19 safe, social distancing and health protocols approved by N.H.A.

Canadian Prime Minister Justin Trudeau participates in a plenary session at the G7 Summit in Carbis Bay, England on Friday June 11, 2021. THE CANADIAN PRESS/Adrian Wyld
Canada donating 13M surplus COVID-19 vaccine doses to poor countries

Trudeau says the government will pay for 87 million shots to be distributed to poor countries

Montreal Canadiens goaltender Carey Price (31) is scored on by Vegas Golden Knights defenseman Alec Martinez, not pictured, during the second period in Game 1 of an NHL hockey Stanley Cup semifinal playoff series Monday, June 14, 2021, in Las Vegas. (AP Photo/John Locher)
Habs fall 4-1 to Vegas Golden Knights in Game 1 of NHL semifinal series

Match was Montreal’s first game outside of Canada in 2021

Kelowna-Lake Country MLA Norm Letnick, assistant deputy speaker at the B.C. legislature, presides over committee discussions. The legislature is completing its delayed spring session this week, with most MLAs participating by video conference. (Hansard TV)
B.C.’s daily COVID-19 infections dip below 100 over weekend

Only 68 new cases recorded Monday, four additional deaths

The BC Ferries website went down for a short while Monday morning following a provincial announcement that recreational travel between health authorities can resume Tuesday. (Black Press Media file photo)
BC Ferries’ website crashes in wake of provincial reopening announcement

Website back up now, recreational travel between health regions to resume as of Tuesday

The Kamloops Indian Residential School is photographed using a drone in Kamloops, B.C., Monday, June, 14, 2021. The remains of 215 children were discovered buried near the former school earlier this month. THE CANADIAN PRESS/Jonathan Hayward
Communities grapple with what to do with former residential and day schools

Some tear them down as a tool to help healing, others repurpose them as tools for moving forward

FILE – Provincial health officer Dr. Bonnie Henry talks about B.C.’s plan to restart the province during a press conference at Legislature in Victoria, Tuesday, May 25, 2021. THE CANADIAN PRESS/Chad Hipolito
B.C. watching U.K.’s COVID struggles but don’t think province will see similar pitfalls

Studies show that one dose of vaccine is only 33 per cent effective in preventing B.1.617.2 spread

RCMP Const. Shelby Patton is shown in this undated handout photo. RCMP say that Patton was hit by an allegedly stolen truck that he had pulled over on Saturday morning in Wolseley, east of Regina. THE CANADIAN PRESS/HO, RCMP
Pair charged in Saskatchewan Mountie’s death make first court appearance

Const. Shelby Patton was hit by an allegedly stolen truck that he had pulled over Saturday morning

David and Collet Stephan leave for a break during an appeal hearing in Calgary on Thursday, March 9, 2017. THE CANADIAN PRESS/Todd Korol
Appeal Court rejects stay for Alberta couple facing third trial in son’s death

Pair accused in their earlier trials of not seeking medical attention for their son sooner

Highway notices like this come down effective June 14. Public health restrictions on non-essential travel and commercial operation have hit local businesses in every corner of B.C. (B.C. government)
Province-wide travel back on in B.C.’s COVID-19 restart plan

Gathering changes include up to 50 people for outdoor events

Most Read