Chronic pain sufferers fear they could become casualties in the war on Ohio's opioid overdose epidemic.
They say recent moves by Gov. John Kasich to fight the plague by restricting how many painkillers can be prescribed will add to their anguish — and could force them to go underground to find the relief they need to make it through a day.
"We are being punished for being in pain," said Amy Monahan-Curtis, 44, who has been living in agony since 1993 due to condition called cervical dystonia that causes her neck muscles to contract involuntarily.
Monahan-Curtis, who lives in Cincinnati, said limiting painkiller prescriptions for adults to just seven days at a time, as Ohio now does, means "an additional financial burden is being placed on the pain patient if a primary doctor will write a prescription to pay for multiple scripts."
"What these regulations are doing is forcing pain patients out of terror and extreme pain to the street, to find something to control their pain," she said. "Legislators are making the drug problem much worse."
Monahan-Curtis said she already follows strict rules laid out in the "narcotic contract" she signed when she enrolled in a pain management clinic, including having to submit to random urine samples.
"I can be called into the office at any time in between my monthly appointments, asked to bring in my narcotics bottle for a count to see if I have an appropriate amount left and am not selling them or taking too many," she said.
And if her meds are lost or stolen, Monahan-Curtis said, "they will not be replaced."
Kasich, when he made his announcement last week, said the new rules don't apply to patients who already take painkillers for things like cancer or to treat dying patients receiving hospice care.
"We have tried to make it as clear as possible that this is not aimed at chronic pain sufferers," said Cameron McNamee at Ohio's state Board of Pharmacy.
A guide put out by Kasich's administration clearly states that "the limits only apply to the treatment of acute pain."
"I suspect what may have caused some confusion is that two pieces of legislation that do address chronic pain dropped a day before Gov. Kasich made his announcement," McNamee said. "I can tell you with 100 percent certainty that the rules proposed by the governor are not aimed at persons who suffer from chronic pain. Those individuals will still be able to get their appropriate medications."
Monahan-Curtis said she doesn't believe it. She said the online message boards for chronic pain sufferers lit up after Kasich unveiled the restrictions.
"Doctors are already feeling this pressure not to prescribe pain medications," she said. "What I am hearing is people are already being turned away. They are not getting medications. They are not even being seen. "
Ashley Marie MacDonald, who has been living in constant pain since a falling bookcase crushed her foot in 2011, echoed those concerns.
"I understand that there is a drug epidemic, but by doing this it is affecting people like me," said MacDonald, 28, of Cincinnati.
MacDonald suffers from a malady called complex regional pain syndrome, that she says makes her feel "like I've been lit on fire and have barbed wire around my skin." Workers' compensation pays for her visit with a pain management specialist every 28 days.
But under Kasich's order, MacDonald fears patients like her will have to make more frequent visits and pay $150 out of pocket every time. She said she's got barely enough money now to survive. But the alternative is a horror she knows all too well.
"I had to recently go to court to fight for my medicine because workers comp got some doctor who never met me and said I don't need my medicine," she said. "So I went without for several days."
What happened? "I could not get off the couch because the pain was unimaginable," she said.
MacDonald said even before Kasich's order pain patients were treated like criminals.
"You're looked at suspiciously all the time," she said. "You feel as if you are being treated like an addict. I don't know how treating people like us like criminals will help stop the opioid epidemic. I'm not taking meds to get high, I am taking them to survive."
"I do not believe that making it harder for people is going to solve this opiate crisis," added 29-year-old Christa Whighstel of Columbus, Ohio, who suffers from the same syndrome as MacDonald.
Whighstel said the unintended consequence of Kasich's rule is likely to be pain patients "jumping ship and getting addicted to the illegal stuff."
"It will force people to go over to the other side," she said. "They just want to live their lives without pain."
While the deadly scourge of fentanyl-laced heroin cutting through Rust Belt states like Ohio has made headlines of late, the number of fatal overdoses from opioids that can be purchased with a prescription like oxycodone, hydrocodone, and methadone "have more than quadrupled since 1999," according to the federal Centers for Disease Control and Prevention.
During that same time period, the amount of prescription opioids sold in the U.S. also quadrupled, according to the CDC.
In 2013 alone a quarter billion prescriptions were written, which equates to "enough for every American to have their own bottle of pills," the agency reported.
Even if used correctly the CDC reported, "anyone who takes prescription opioids can become addicted to them."
"In fact, as many as one in four patients receiving long-term opioid therapy in a primary care setting struggles with opioid addiction," according to the CDC. "Once addicted, it can be hard to stop. In 2014, nearly two million Americans either abused or were dependent on prescription opioid pain relievers."
Even before Kasich made his announcement, Ohio in January 2016 released new prescription painkiller guidelines recommending that people suffering short-term pain from surgery or injuries should be given alternatives whenever possible.
Among the alternatives suggested by Dr. Mary DiOrio, medical director for the state Department of Health, were ice, heat, wraps, stretching, massage therapy, acupuncture, physical therapy and non-addictive medicines like ibuprofen.
"Nobody wants to punish people with chronic pain," Dr. Michael Kelley of the Ohio Health hospital system told NBC News. "But at the same time we don't want to develop more addicts."
Asked why the chronic pain community isn't getting the message that they are not being targeted, Kelley said, "I don't know for sure."
"From the very start we were clear that doctors should responsibly treat people with chronic pain," Kelley said. "But some doctors are starting to feel a little bit paranoid about the different laws. I think, sometimes, they're over-concerned."
Coming as early as September, Ohio will be able to offer chronic pain patients another alternative — medical marijuana.
"There is some evidence it works for chronic pain," said Kelley. "There is also some evidence it may be a way to treat people who are addicted to opiates."