KELLY MCEVERS, HOST:
The rate of overdose deaths involving opioids has quadrupled in the United States in the last 15 years. That includes heroin and prescription painkillers. As the crisis grows, some pain patients say doctors are less likely to prescribe them opioids, and they're having a hard time. Montana Public Radio's Corin Cates-Carney reports.
CORIN CATES-CARNEY, BYLINE: They call themselves pain refugees.
UNIDENTIFIED WOMAN: To operate your seatbelt, insert the metal clip into the buckle.
CATES-CARNEY: Every 90 days, a group of three Montanans fly to California to get prescriptions for opioids. They say that finding a doctor willing to help them in Montana is almost impossible, and the only way they can get the treatment and relief they need is to fly out of state.
GARY SNOOK: My pain - it's all from my waist down, and it's like being boiled in oil 24 hours a day.
CATES-CARNEY: Pain has turned Gary Snook into a spectator. He spends a lot of time lying down, isolated. Sometimes he talks about his life like it was something he had once then lost. Snook has been in severe pain and on opioids since he had surgery on his spine for a ruptured disc 14 years ago. He says he's done all kinds of things to get better.
SNOOK: I got a surgery, epidural steroid injections, acupuncture, anti-inflammatories.
CATES-CARNEY: Snook is desperate like an addict, which he says he's not. He says the culture around the drugs prevent him from having a normal relationship with a doctor near his home. He feels like some doctors treat him like a criminal.
SNOOK: Pain control is a fundamental human right - or at least an attempt at pain control. And to deny someone like me access to pain medications is the worst form of cruelty.
CATES-CARNEY: It's dark outside when Snook, his wife and the two other patients arrive in Los Angeles. This whole trip has become routine. Montana is a tough state to find many options for medical care. It's rural, and the people often have to travel long distances or out of state for specialty care.
In the past several years, Montana's medical board has taken on several cases of doctors they consider to be overprescribing opioids. At least two doctors have had their licenses suspended, says Ian Marquand. He's with the Montana Board of Medical Examiners.
IAN MARQUAND: The board doesn't play favorites. The board does not encourage particular kinds of doctors. It does not discourage particular kinds of doctors. The door is open in Montana for any qualified, competent physician to come in and practice.
CATES-CARNEY: But there is fear in Montana's medical community around prescription painkillers. Dr. Marc Mentel is with the Montana Medical Association.
MARC MENTEL: The perfect medicine that would take away a person's pain and allow them to function normally does not yet exist, so we're trying to use any tool, any means we can to help lessen the severity of their pain.
CATES-CARNEY: And he does hear of doctors being more wary of prescribing opioids. Mentel, who started practicing in the 1990s, says medical education when he was training didn't include anything about treating long-term pain.
MENTEL: We need to recognize that this is usually going to be a chronic disease state. They may be in pain for the rest of their life. So how do we address that? How do we treat them without actually harming them?
CATES-CARNEY: Mentel says opioids do help some patients, but he hopes his generation of doctors will learn more about pain and understanding better ways to treat it beyond opioids.
But for some people like Gary Snook, relief is found in a small strip-mall clinic in suburban Los Angeles. Their doctor is Forest Tennant. He opened his first pain clinic in 1975. He's a longtime political advocate for insuring opioids remain an accessible option for patients. He has about 150 patients - half Californians, half out-of-staters. Snook was referred to Tennant by another out-of-state doctor. To an untrained physician, Tennant says addicts and pain patients can look similar.
FOREST TENNANT: Doctors can get conned and get the wrong patient. So I think that it is true that we've had a lot of opioids that have been out on the street, and people get them. Opioid addicts are going to go get opioids, whether it's heroin or whether it's a prescription opioid. And they're going to go where they can get them.
CATES-CARNEY: He says there does need to be more education.
TENNANT: They are the last resort when there is no other option. You don't use them until everything else has failed.
CATES-CARNEY: But Tennant is lobbying Montana law to guarantee more access to opioids for pain patients so people like Gary Snook don't need to travel so far for a signed prescription.
SNOOK: Had I stayed in Montana, I would have killed myself. I just want humanitarian care, and I get that in California.
CATES-CARNEY: He says he just wants to visit a doctor near his home and be seen as a patient, not a criminal. For NPR News, I'm Corin Cates-Carney in Helena.
MCEVERS: This story is part of a reporting partnership of NPR, Montana Public Radio and Kaiser Health News.
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