Biases and Barriers

Illustration by Scott Laumann
Illustration by Scott Laumann

By Lee Anna Sherman

Bi-Mart seems an unlikely springboard for social change. Yet tucked away in a corner of a store on the edge of Springfield, pharmacist Kathy Hahn is waging a militant campaign against pain.

“I’m kind of an activist,” she says, leaning close to her listener and whispering the word “activist” as if confiding a dark secret. “When I see something that’s wrong all day every day, I’m the type that says, ‘I’m going to do everything in my power to change that.’”

What she’s changing is the way chronic pain is managed in Oregon. In her 20 years as Bi-Mart pharmacy manager, she has seen legions of patients — combat veterans, fibromyalgia sufferers, accident victims, people with auto-immune disorders and degenerative diseases — who suffer needlessly because their pain is poorly controlled. The twin fears of patient addiction and illegal drug trafficking scare doctors away from prescribing opium-based medications for many of the 76 million Americans living with chronic pain, Hahn explains. And pharmacists often behave judgmentally when patients come to the counter with high-dose prescriptions for opioids.

“Many pharmacists think people who use Vicodin or Percocet are all potential addicts, and they treat them horribly — horribly! — whispering to the technician, looking at the patient with suspicion,” she says. “A pharmacy that does not understand pain management can be the biggest barrier in the health-care chain.”

Far from being content with just filling “scrips,” Hahn teaches in OSU’s College of Pharmacy as an affiliate faculty member, chairs the Oregon Pain Management Commission (the first of its kind in the United States) and serves as Oregon co-leader for the American Pain Foundation. She also is active in Death with Dignity, Oregon’s first-in-the-nation assisted suicide law.

Listening to Patients

From a curtained consultation room overlooking the Bi-Mart pharmacy counter, Hahn keeps a sharp eye out for patients who might need her expertise or just a cheerful “hello.” When Vietnam vet Richard Ketter shuffles up, bent low over a shopping cart, his hat decorated with buttons and pins — including a purple heart — Hahn calls out to him.

“Hi, Mr. Ketter, how are you today?”

“Good. Gettin’ ready to go prospectin’ for gold out in Arizona.”

The news is nothing short of miraculous. Injuries suffered during a helicopter crash in Vietnam left the 65-year-old Ketter with a painfully damaged leg. Unable to get the meds he needed through Veteran’s Affairs, he searched online for a new doctor and was steered to Hahn. She in turn referred him to Dr. Martin Klos, who accepts patients like Ketter whom “no one else will touch.”

“Kathy and Dr. Klos saved my life,” says Ketter, who admits to nearly giving up on life before finding help. “They’re the only people who seem to care.”

Passing the Torch

As the chair of the 17-member Oregon Pain Management Commission, Hahn helps set policies and guidelines to improve the lives of patients. One controversial issue is medical marijuana.

“The commission understands that marijuana can have tremendous medical value,” she says. “It is a travesty that more money has not gone into investigating and developing it. I believe that its niche is going to be neuropathic pain, and neuropathic pain — if you look at the whole spectrum of pain — is the monster. It is the one that is most difficult to treat.”

As a teacher and mentor, Hahn is passing the torch to a new generation of pharmacists, raising awareness and providing guidance during students’ six-week rotations at Bi-Mart. “What the students have to learn is that it takes a village to take care of a pain patient,” she says. “I want them to do a paradigm shift before they leave here. I want them to become advocates.”

— Lee Sherman

To support OSU pharmaceutical research, contact the OSU Foundation, 800-354-7281.

The Fibromyalgia Challenge: Q&A with Kathy Hahn

Fibromyalgia: Fibromyalgia makes you feel tired and causes muscle pain and “tender points.” Tender points are places on the neck, shoulders, back, hips, arms or legs that hurt when touched. People with fibromyalgia may have other symptoms, such as trouble sleeping, morning stiffness, headaches, and problems with thinking and memory, sometimes called “fibro fog.” (National Institutes of Health)

Terra: Who are some of the most vulnerable patients dealing with chronic pain?

Kathy Hahn: Probably my best examples are middle-aged women with fibromyalgia. I try to champion these women, because there are still so many people who still don’t believe that fibromyalgia exists. There are so many things we don’t know about the disorder and how to treat it. We have some patients who are on some pretty heavy medication, and they often are discriminated against.

Terra: In what ways are they discriminated against?

Hahn: I had one patient in her 40s who had been going to another pharmacy that was being very judgmental. They weren’t keeping her medication in stock, not doing any of the things they needed to do to facilitate a smooth treatment and make sure she didn’t run out. A pharmacy can either be a help or a hindrance. For example, if you’ve got a patient saying, “My insurance company won’t pay for this medication,” the pharmacy can jump through the right hoops, work with the doctor and be a facilitator in getting the medication through the insurance process. The pharmacy has to be a big partner in helping patients with chronic pain. They are the gatekeepers of the medications. If they become judgmental, everything falls apart.

Terra: Part of your mission is to encourage patients to advocate strongly for what they need, right?

Hahn: Yes, and that can be very difficult, especially for the fibromyalgia patient who is isolated and alone. You get these women who’ve had more and more trouble and pain and can’t get out of bed, and they lose everything – they lose their job, they lose their spouse, they lose their family, they lose their home – and trying to teach them how to advocate for themselves is tough. You’re trying to pull them back in. You’re trying to teach them: “You’re not alone. You are not alone!” We teach them how to access resources, encourage them to get a computer and find online communities for discussion and information. We have to stop them from every day just curling up on the couch and thinking, “Should I continue breathing today, or not?”