KASPER, Pain, and Prejudice

KASPER is now the law of the land in the state of Kentucky. According to the Kentucky Cabinet for Health and Family Services (KCHFS) this law is intended to prevent abuse of prescription drugs by creating a database that has to be checked by any prescriber before they give patients any of the controlled drugs on the mandated list. Their intent was to keep reckless and perhaps even corrupt physicians from writing too many prescriptions for controlled drugs, however the end results may be quite unintended. In fact, the KCHFS makes it clear on their website that the KASPER law is not intended to prevent people who need medication from getting treatment. But that is exactly what has happened. After the very public arrest of several doctors in the state, and the subsequent media attention that garnered, doctors must have felt a cold finger of fear settle across their hearts.

Some stopped writing for any of the controlled medications, opting out of the program and presenting patients with statements that they do not treat pain for any reason. Others still require patients to sign contracts that prevent them from seeking pain treatment elsewhere. So a patient who gets pain medication in an ER will then be in violation of the contract with their oncologist (cancer doctor) and may be denied pain treatment from then on. The law has also had the effect of requiring patients be seen in person before refills of controlled medications can be refilled, but with short limits on the time a prescription of this sort is written for, the result are patients who have to see their doctors monthly for insomnia medication, or ADHD meds for their children.

The sad thing about the KASPER law has been the unnecessary suffering so many people have had to endure to protect addicts from themselves. Rather than focusing on identification and treatment of drug addiction, the state of Kentucky has chosen to focus on criminalizing certain medications and their prescribers. So a patient with a truly justifiable pain cannot get treated for fear they may be an addict, or that the doctor may be arrested for giving too many controlled prescriptions. It means that doctors focus on the use of anti-inflammatories, which are notoriously damaging to the body; increasing cardiovascular risk factors and taxing the liver and kidneys. Studies have shown a mild narcotic is much safer for the elderly, or those with kidney damage, than NSAIDS, yet again, the law has precluded the rights of patients to safe and appropriate care.

People are suffering; mothers with breast cancer, fathers with brain tumors, and children with broken limbs are all being denied adequate pain control. Despite the fact that the World Health Organization has identified adequate pain management as a fundamental human right. Despite the fact that people in actual pain are very unlikely to become addicted to pain medications, or that people who are addicts can just as easily access illegal drugs to meet their needs, or that pain can lead to suicide, disability, and enormous financial loss in society; despite all these things lawmakers have chosen to take the step to make the new law of the land based on not one bit of research based evidence. They have denied that addiction is a disease and needs treatment, and have chosen instead to harm the innocent rather than help the addicted.

Remember this the next time you are in the emergency room and in agony, that they have to obtain your prescription history from KASPER before giving you pain medications. Remember this the next time your dying parent begs for relief, but the doctor doesn't do that in their office. Remember that when a person addicted to prescription medications dies from heroin overdose. Remember, and let the Kentucky Cabinet for Health and Family Services know how this new law has harmed you and your loved ones.

Take these lemons and shove it.

It has been a long time since I posted to this blog. So much has happened, it is impossible to write it all down and not make everyone reading want to jab sharp objects into their eyes. Life has handed me some seriouslybitter lemons in the last twelve months. I could make lemonade as some suggest, but really I want to throw them at someone or something. Anything to vent the rage at what has been taken and suffered this year. Could it be worse? Well, yes of course it could. Should I look on the bright side of life? Well, yes I could. Should I be grateful that I survived? Well, yes I am.

But really, it was bad enough that worse would be pretty damn hard to find. The bright side of life is currently escaping my notice. In fact, I think it left on vacation a while ago. I am glad I survived. But I am filled with rage and disappointment that I had to survive this at all. People say I was so lucky they found the clots, so lucky I had such an amazing surgeon, so lucky I didn't die. They don't say how unlucky it was to have those two enormous clots in my heart, sitting side by side, biding their time, killing me by their sheer presence. Or how the surgeon who put the port in that caused the clots should never have put the line into my heart. Or that it took being near death for them to even look at me as anything other than just a chronically ill person who just got sicker. No one says what I hear in my heart, which is that I could have, would have, should have died but for asking for the one test that saved me.

The truth is that I am a disabled woman. I am overweight. I do not work. My value is low in our society. That extends to attitudes in health care. These are not specious assertions, they are supported in plenty of medical research. So yes, I am happy I didn't die, but so sad that I was dying, and would have been allowed to die by the medical community I rely upon. I look at the ragged scar on my chest, the one that transects my sternum, the one that was left to remind me that I cannot trust my care to anyone ever again. It is to remind me how close I came to being killed by apathy and disregard.

So for all the people out there with chronic disease, remember you are a human being with value. Be your own advocate. Ask for that test before it becomes too late. Demand that treatment before they forget you even exist. And know that you are something wonderful, a living breathing part of the universe, a person who loves and is loved, and never let the world forget it. Never let them give you lemons, and tell you that is the best you can get. Demand the whole damned lemon-meringue pie.