Montana's 'Pain Refugees' Find Relief in California

They call themselves pain refugees.

Every 90 days, three patients from Montana fly to California to get a prescription for opioids.

As the U.S. faces an epidemic of overdose deaths from prescription painkillers, some patients with chronic pain say doctors are less likely to prescribe them opioids. Some Montana patients say the only way they can get the treatment they need is to fly out of state.

On a mid-afternoon flight out of Missoula, Montana, Gary Snook pauses in the aisle in front of seat 17B. He stretches with a slight wince and sits down.

“My pain, it is all from my waist down. It’s like being boiled in oil 24-hours a day,” Snook said.

He has been in severe pain since he had surgery on his spine for a ruptured disk 14 years ago.

Snook says he's done all kinds of things to try to get better. “I got a surgery, epidural steroid injections, acupuncture, anti-inflammatories, physical therapy, pool exercises,” he said. “I’ve tried everything that anyone has ever suggested me to try.”

He says the only thing that works is opioids. But when he tries to get them in Montana, he says the doctors treat him like a criminal.

“I just want humanitarian care," Snook says. “And I get that in California.”

In the last 15 years, the rate of overdose deaths from opioids has quadrupled in the U.S.

The Centers for Disease Control and Prevention recently released guidelines to curb the overprescribing of opioids for chronic pain, and the Drug Enforcement Administration increased oversight and sanctions for doctors who overprescribe the drugs.

Some Montana doctors say these federal actions are scaring them away from taking on new pain patients.

“A lot of the chronic pain doctors are dropping out of the business, says Charles Farmer with the state’s medical board. "One of the reasons is because they don't want the DEA following them around.”

The Montana medical board suspended the license of physician Mark Ibsen this year for overprescribing.

“We as physicians are terrified that we are going to go to prison or lose our license over prescribing pain pills to patients,” Ibsen said.

He denies he was overprescribing and is appealing the suspension of his license. But he shut down his practice in Helena anyway.

Pain management has always been hard, Ibsen says, and all the oversight is interfering with the doctor-patient relationship.

“The thing is there is no objective measurement of pain. If you don’t take people at their word that they are in pain, and you are suspicious of them, you can’t have a therapeutic relationship,” Ibsen says. “No miracles happen between you and me -- as a patient and a doctor -- if I suspect that you’re a scumbag.”

The Montana Board of Medical Examiners Executive Director Ian Marquand says he couldn’t say whether the board’s disciplinary actions have had an impact on patients’ access to opioids.

“The door is open in Montana for any qualified, competent physician to come in and practice,” Marquand said.

For some Montana pain patients, like Gary Snook, relief is only found at a strip mall clinic in suburban Los Angeles.

His doctor is Forest Tennant, a former army physician who opened his first pain clinic in 1975. Today, He has about 150 patients –- half of them are Californians and half are from out-of-state.

“The last week or two has just been unbearable," Tennant says. "We hardly want to (answer) the phones, the number of people calling that want to come here."

He says California has laws that Montana and other states don’t, including the Pain Patient’s Bill of Rights. It allows a patient to request or reject the use of any technique in order to relieve their pain.

Tennant says that’s coupled with intensive physician training in all the other ways to treat pain before turning to opioids.

“They are the last resort, when there is no other option. You don’t use them until everything else has failed,” Tennant said.

He says opioids shouldn’t be stigmatized, they should be used responsibly.

A recent CDC report shows that California has the second lowest prescribing rate for opioid pain relievers.

Tennant is now helping pain patients in Montana lobby lawmakers to guarantee more access to opioids in their home state, so people like Gary Snook don’t need to travel so far for a prescription.

“I mean, it’s life and death in that bottle. At least it’s my life,” Snook said.

He says he just wants to visit a doctor near his home and be seen as patient, not a criminal.