Stricter Opioid Laws Criminalize Sick Children

By Jonita Davis 11/29/17

Delaware forced its youngest and sickest patients to pee in a cup and submit to questioning like parolees before getting their medicine.

Qualified doctor or specialist having some doubts
One size doesn't fit all

The face of the opioid epidemic is that of a white man or woman displayed like a limp wet noodle in the front seat of a car while a baby cries in the back seat. Their drug of choice is also the one that many seek out for relief, as the first and most effective tool for pain management. In fact, the beginning of an opioid addiction can frequently be traced to the misuse of prescription pain medication such as oxycodone, hydrocodone, fentanyl, and similar opioid-based drugs.

How does one stop such a highly addictive drug from getting into the wrong hands without criminalizing those living with chronic pain?

States all across the U.S. have come up with a solution. About half the states in the union enacted laws in 2017 to solve this dilemma of prescription pain medicine diversion. Unfortunately, the laws and restrictions that have been implemented to address the opioid crisis are designed for adults. There has been little to no talk about the effects of the epidemic, the policies, and research on children with chronic illnesses who also use opioid-based medications to manage pain. 

Dr. Elissa Miller, Director of Palliative Care at Nemours Hospital, is one of the doctors on the ground witnessing the fallout of the new opioid policy. Her patients are children who are already living with painful chronic illnesses. Some are adolescents who have been coming in for medication for a decade or longer. However, all of that changed abruptly on April 1, 2017. On March 31st, patients could come in with their parents and leave with a prescription for their usual opioid painkiller, along with the rest of their necessary prescriptions. On April 1, things took a sharp turn for the worse. 

According to Dr. Miller, patients were suddenly required to sign a two-page informed consent document, answer a lengthy questionnaire about their medication routines and prescription intake, and give a urine sample that was tested for opioid levels. The state of Delaware (where Nemours is located) was forcing its youngest and sickest patients to pee in a cup and submit to questioning in a manner similar to the treatment of parolees. They would then get a limited supply of the pain medication, forcing them to submit to the process in as little as a week later. These are just a few of the new restrictions.

“It leaves the patients questioning their trust in their care,” Dr. Miller said, and that’s just one of several concerns she has about the rule change. Many of her patients were low-income people of color who already mistrust the doctors and the care they were receiving. After the new rule was enacted, Dr. Miller had to answer questions and try to restore the trust of her patients. She had to assure them that they didn’t do anything wrong and the policy was indeed forced upon her and subsequently them by the state of Delaware. Not all of the talks ended well. 

“Some of the patients have chosen not to see my team. And that’s their right to do so.” These patients would later find that the new policies were unavoidable no matter where they went. 

The trust issue aside, the act of urinating under supervision into a specimen cup, which is then tested for opioids, is the exact same treatment that people receive when they are newly freed from prison. To maintain their freedom, ex-prisoners are required to see their parole officer on a regular basis. At the visits, they are questioned about their drug habits and tested under the watchful eye of the parole officer. The urine sample is analyzed and if it is clean, the ex-prisoner is permitted to have his limited freedom for another period of time—a week or a month. At the end of that time period, the process repeats itself. It continues until the parolee serves out his sentence and is granted his full freedom by the courts.

The children who see Dr. Miller come to her with chronic illnesses that are accompanied by constant pain—pain that Dr. Miller’s department treats with the most effective medication available: opioids. Under the current policy, these kids are criminalized and are not free to live their lives how they want to. They are chained to hospitals like Nemours and doctors like Miller because they have no other alternatives for treatment. These are frequently illnesses with no cures. These children see Dr. Miller just as often as a parolee sees their parole officer and they undergo many of the same procedures. But while the parolee can look forward to an end to the regulations and oversight, the kids are never free of their sentence. They remain shackled to this process for their lifetimes. 

The stronger regulation of opioids has resulted in criminalizing chronically ill children; an effect that no one expected, and yet everyone seems to be turning a deaf ear to it. The already overburdened families now have one more hardship to endure if they want their kids to receive the medicine they need to ease their pain. The kids are treated as untrustworthy, as if they had committed some crime and deserve punishment. Dr. Miller has gone from being a caregiver to the person who oversees the punishing process, a transformation that jettisons any strides she has made with patient relationships. 

The state of Delaware’s press release on the new restrictions claims to have been the result of “input from medical professionals, public health experts, the Attorney General, and other stakeholders.” However, the criminal treatment of the youngest victims of these laws begs the question of how much input the public health and medical professionals actually had. 

The problems with opioid regulations and addiction policy will continue in Delaware and other states (about 17 states enacted stricter policies for opiate distribution around the time Delaware did) until government leaders and lawmakers start listening to the doctors who are studying addiction medicine and are screaming for addiction to be treated as a healthcare issue and not a crime. As long as opiates remain highly restricted and hard-to-obtain, sick children will be criminalized for the very act of needing the drugs to alleviate conditions they have no control over. It is difficult to fight an epidemic caused by a drug that is also so essential to chronic patient care. However, researchers and experts have been proving for quite some time now that the key to ending opioid addiction is to treat it like a medical condition and to ease restrictions on the drug rather than strengthen them. Why our leaders insist on doing otherwise is baffling.

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Jonita Davis is a writer, avid reader, and writing instructor based on the southern shores of Lake Michigan. Her work has appeared in Washington Post, Creative Nonfiction, Redbook, and Romper. Follow her on Twitter at @SurviTeensNtots or check out her website