Letters for Monday, March 19, 2012

• Airport un-aloha • Chronic pain on Kaua‘i

Airport un-aloha

I would like to add to all the letters to the Forum about all the un-aloha curbside security men at Lihu‘e Airport.

I was welcoming my family from Utah to Kaua‘i for their first visit to this beautiful island. We were all loading lots of luggage into my car and trunk. We were all laughing and enjoying seeing each other while packing when the very rude and mean security person told us we had to move the car now.  We were still putting the luggage into the car.

I asked him if we could please finish loading, and he barked back at us to move the car now. We were not in a red zone. So I got in the car and took it around the airport and came right back to the same spot in front of my puzzled family, standing there with the last of the luggage.

And still, the rude man told us to move the car. Well, we had to throw the luggage in as fast as we could and drove off. This was the worst way for my family to see and  hear this first impression of our island. I was very embarrassed and amazed that we had to go through that.

I take it from all the other letters that this is a real problem. Can’t someone do something about this? Do they send these people to an un-aloha school or what? How many other people out there have had to deal with this and just not written a letter?

Barbara Stevens, Kapa‘a

Chronic pain on Kaua‘i

I write to thank our community for the email responses to Makepeace (makepeacenow@live.com) in regard to my letter printed in this Forum (Letters: Feb. 22).

These responses from others dealing with chronic and/or acute pain mostly reflect our own experiences trying to find a doctor on Kaua‘i who will help with effective pain management.

When making honest, legitimate and desperate appeals for pain medication, they are treated as drug addicts, as if they are children and the doctors the adults, and as if the doctors are somehow the lords of the medications that have been created and developed for all of us, when we are in real need.

We find instructive a letter to Neurology Now magazine (Nov. 12, 2009) from a more enlightened doctor that reads: “I am amazed at how many people — physicians included — do not know the difference between ‘addiction’ and ‘physical dependency’ in reference to the use of pain relieving medications. In my opinion, the whole class of drugs containing opioids has been given a bad name, and too many doctors label and stigmatize chronic pain patients as ‘drug seekers’ without evidence. They fear misuse to the extent that many patients suffer from acute and/or chronic pain without appropriate intervention.”

I have more than once seen my husband actually dying of heart attacks (which were eventually found to be oh so very real) in emergency rooms, while physicians delayed the administration of the drugs that would save his life, because they feared he might be there for a “free high.”

I’ve sat next to him and heard two of our otherwise most excellent young and honest doctors tell him that if he needs anything stronger than the weakest of the prescription medications approved for pain (hydrocodone/Vicodin), then he would have to “buy it on the street.”

I’ve seen him prescribed Suboxone as the only pain medication allowed him, and he screamed and writhed in indescribable pain, before he was carried by neighbors down the stairs to where I could drive him, still screaming and writhing, to the emergency room, because once he’d taken the Suboxone, he could not take the opiates we had at hand, because it is an opiate antagonist. And then he was told again that Suboxone is the only pain medication that he will get. This is for a man who has had four major back surgeries and has never been addicted to anything more powerful than nicotine and refined carbohydrates.

Relevant is the stated policy of Kaua‘i Medical Clinic in regard to pain medication in the Feb. 11 issue of The Garden Island newspaper (page 5A), which reads,” Staff at Kaua‘i Medical Clinic … said … that the doctor only prescribes non-opioid Suboxone for long-term pain management rather than opioid-based drugs like oxycodone.” Compare this to the Wilcox Hospital pamphlet titled  “Managing Your Pain,” which reads, “Taking care of pain is an important part of taking care of your health,” and, “You are the only one who knows how much pain you feel and what makes it feel better.”

 And how hard can it be to understand that if the doctor isn’t going to trust the patient, then the patient is going to find it very difficult to trust the doctor.

The doctors on Kaua‘i seem to be more concerned with addictions there is no evidence of, than in the care of serious medical conditions. So how can I remain silent?

A confusing aspect of this issue is that, although any pharmacist will confirm that Suboxone is FDA-approved not for pain but for symptoms of withdrawal (detox), evidently it can be effective to some degree or other with certain patients under certain conditions as an “off label” prescription for some kinds of pain.

But when prescribing “off label,” any doctor is morally and ethically bound to obtain the patient’s informed and uncoerced consent and agreement to do this, and almost always only after all other approved medications have been employed and proved ineffective.

Kaua‘i Medical Clinic’s blanket prohibition of all opiates in favor of Suboxone is simply wrong, unfair and utterly inhumane, and Makepeace and others will, must, continue to write and to work to correct this injustice as long as the completely unnecessary suffering continues.

Sandra Coppola, Kapa‘a

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