11/21/2014, Treating Pain Patients Like Addicts

http://jamespmurphymd.com/2014/11/21/treating-pain-patients-like-addicts/

If not addiction, then what is this complex neuroadaptation to long-term exposure to opioids? In a 2012 commentary article from JAMA Internal Medicine, Doctors Ballantyne, Sullivan, and Kolodny referred to it as “complex persistent opioid dependence” (JAMA Internal Medicine September 24, 2012, Vol 172, No. 17):

Dependence on opioid pain treatment is not, as we once believed, easily reversible; it is a complex physical and psychological state that may require therapy similar to addiction treatment, consisting of structure, monitoring, and counseling, and possibly continued prescription of opioid agonists.

But I am suggesting, as do Doctors Ballantyne, Sullivan, and Kolodny, that the better therapeutic approach may be to view their care through the lens of Addiction Medicine in addition to that of Pain Medicine.

_____

And so you can see, the Pied Piper of Addiction Medicine (not a real medical specialty), Andrew Kolodny, has hypnotized other doctors into believing that pain patients should be treated as addicts — because there is an awful lot of money in a whole new patient population.

I found this link on a the Kentucky Pill Mill facebook page, and it appears they follow Dr. Murphy and agree with his writings.  And if I were to guess, it’s because Dr. Kolodny has created a new condition for pain patients — complex persistent opioid dependent patients (“CPOD”) — which consists of “possible” treatment with continued opioids.  Of course the condition is is not “easily reversible,” and includes long-term (expensive) treatment.

Heck, most pain patients don’t care what you call it, they just want adequate treatment.  You want to say I have CPOD and will treat me with opioids?  Instead of treating my pain with opioids?  Sure, fine, whatever.

I have no doubt that there are some pain patients on opioid therapy who might benefit from being treated for addiction or “CPOD,” but it’s a very small percentage.  Nah, this won’t help most pain patients — it only labels them — for life.

Addiction Medicine is not a recognized specialty

http://disruptedphysician.com/2014/08/15/robin-williams-melancholy-suicide-hopelessness-helplessness-and-defeat/

“The American Board of Medical Specialties (ABMS)  recognizes 24 medical specialties and subspecialties. Addiction Medicine is not one of them. The only ABMS recognized subspecialty is Addiction Psychiatry and it requires a four-year psychiatric-residency program followed by a 1-year Fellowship focusing on addiction in an accredited training program.

In contrast, ABAM certification requires only a medical degree, a valid license to practice medicine, and completion of residency training in ANY specialty.”

Qualifying Conditions for NM Medical Cannabis Program (2014)

http://nmhealth.org/about/mcp/svcs/

Amyotrophic Lateral Sclerosis (Lou Gehrig’s disease)
Cancer
Cervical Dystonia
Crohn’s disease
Damage to the nervous tissue of the spinal cord with intractable spasticity
Epilepsy
Glaucoma
Hepatitis C infection currently receiving antiviral treatment
HIV/AIDS
Hospice patients
Huntington’s Disease
Inflammatory autoimmune‐mediated arthritis
Intractable nausea/vomiting
Multiple sclerosis
Painful peripheral neuropathy
Parkinson’s Disease
Post‐traumatic Stress Disorder
Severe anorexia/cachexia
Severe chronic pain
Ulcerative Colitis

“Adequate supply”

New Mexico Register / Volume XXI, Number 24 / December 30, 2010
7.34.2 NMAC 1
TITLE 7 HEALTH
CHAPTER 34 MEDICAL USE OF CANNABIS
PART 2 ADVISORY BOARD RESPONSIBILITIES AND DUTIES

“Adequate supply” means an amount of cannabis, derived solely from an intrastate source and
in a form approved by the department, possessed by a qualified patient or collectively possessed by a qualified patient and the qualified patient’s primary caregiver, that is determined by the department to be no more than reasonably necessary to ensure the uninterrupted availability of cannabis for a period of three (3) months. An adequate supply shall not exceed six (6) ounces of useable cannabis, and with a personal production license only, four (4) mature plants and twelve (12) seedlings, or a three (3) month supply of topical treatment. An amount greater than six (6) ounces of useable cannabis may be allowed, at the department’s discretion, upon proof of special need as evidenced by a practitioner letter explaining why a larger dose is indicated. Any such allowance shall be reviewed for approval by a medical director designated by the department, who shall consider standards for exceptions to the adequate supply requirements that are approved by the advisory board. A qualified patient and primary caregiver may also possess cannabis seeds.

ADVISORY BOARD

The Board consists of nine members: six physician members, one physician assistant member and two members representing the public. All members are appointed by the Governor.

Advisory board membership term. Each member of the advisory board shall serve a term of two (2) years from the date of appointment by the secretary.

It is the responsibility of the Advisory Board to recommend quantities of cannabis necessary to constitute an adequate supply.

Members of NM Medical Board

NEW MEXICO MEDICAL BOARD
Third Quarter Meeting
August 15-16, 2013
MINUTES

Members Present:
Steve Weiner, M.D., Chair
Steven Jenkusky, M.D., Vice Chair
Paul Kovnat, M.D., Secretary /Treasurer
Roger Miller, M.D.
Sam Kankanala, M.D.
Steven Komadina, M.D.
Albert Bourbon, PA-C
Jennifer Anderson, Esquire, Public Member
Rick Wallace, FACHE, Public Member

Members Absent: None

Others Present:
Lynn Hart, Executive Director
Grant La Farge, M.D., Medical Director
Andrea Buzzard, Assistant Attorney General
Dan Rubin, Administrative Prosecutor
Gayle Mascarenas, CFO/HR
Jackie Holmes, Compliance Manager! PlO
Amanda Quintana, Licensing Manager
Debbie Dieterich, Investigations Manager
Amanda Chavez, Investigator
Leann Lovato, Investigator
Samantha Breen, Administrative Assistant

**From presentation of 1/16/14 of Jennison’s
Current Members (2013):

• Richard Adams, MD, Obstetrics / Gynecology
• Laura Brown, MD, Family Medicine / Addiction Medicine

NM State Medical Board

NEW MEXICO MEDICAL BOARD
First Quarter Meeting
February 7-8, 2013
(Relevant parts of the) MINUTES

The Council’s job is to make recommendations to the Governor on the proper use of controlled substances for the treatment of pain.

Representatives, including the medical board, met with staff members of the Governor’s office and discussed a legislative option that would give the Council the authority to create prescription limits for opiates and other controlled drugs; including the duration of treatment and doses. Representatives at the meeting voiced concern about this approach. Limits will remain an option, however, as our state battles prescription drug overdose.

I. Investigation Department

-Attorney General’s Task Force on Prescription Drug Abuse in NM

The Attorney General’s task force has asked the medical board to give a presentation at their awareness summit, which is to be scheduled in April.

*****

I communicated recently via email with the Executive Director of New Mexico’s State Medical Board, and here’s most of her response:

“I have forwarded your emails to the Governor’s Council on Drug Overdose Prevention and to several board members. I do not have the ear of the Governor nor to Legislators who have all been telling the boards who license prescribers of controlled substances to pass rules to sway the tide of over prescribing; prescribing that has resulted in NM being #1 or #2 in the country in prescription drug overdose. I will keep the board informed, but the board is not setting this policy direction on its own. Are you also writing to your elected officials? I hope so.”

In a message like this, you don’t even need to read between the lines. I mean, I’ve been told to f*** off before, but this is rather blatant. And in case you’re bored, here was my reply:

I didn’t expect you to help me, Ms. Hart. (Is it “Ms.”?) And I suppose it wasn’t very nice of me to shame you into responding to my email. I don’t know what I was thinking… I can barely help myself, why did I think I could help others? And what made me think that you would help me do that? I feel rather silly about it, after the fact.

I know there’s nothing I can do to change the minds of people who blame certain drugs for abuse and addiction, instead of facing the actual reasons for these problems. After all, it’s a lot easier to pretend that the actions of State Medical Boards, along with the DEA, are actually making a difference. And if trying to help one small group of people — those who suffer from addiction — causes harm to a much larger group of people — millions of chronic pain patients — well, I guess them’s the breaks. Can’t please everyone, right?

I mean, pain isn’t a tumor, like cancer, that can kill you. Sure, suffering can kill you, but it takes awhile, so most pain patients aren’t in danger of dying, like, right now. More under-treated pain means even more people on disability, and for longer periods of time; but that’s economically beneficial for doctors, so no worries there. It also means more people in poverty, but that’s not the Board’s problem.

I completely understand your position.

NIDA

http://www.tokeofthetown.com/2010/01/feds_wont_study_pots_benefits_only_negative_conseq.php

2010: “As the National Institute on Drug Abuse, our focus is primarily on the negative consequences of marijuana use,” NIDA spokeswoman Shirley Simson told the Times.

NIDA exercises a near-stranglehold on the research of illegal drugs, overseeing an estimated 85 percent of the world’s research on controlled substances.

http://www.washingtonpost.com/blogs/in-the-loop/wp/2014/05/06/with-demand-for-research-marijuana-high-federal-government-agrees-to-grow-more/

5/6/14: A NIDA official said the agency has broadened its definition of marijuana research to include components of the marijuana plant, such as cannabinoids. Currently its funding “well over 100 grants” for marijuana studies. Most of them still focus on the negative impacts of the drug, but as of this year NIDA has funded some 30 studies related to the “therapeutic uses of marijuana.”

http://www.medicalcannabis.com/cannabis-science/

The National Institute of Drug Abuse (NIDA) has been responsible for funding most of the studies conducted in the US and many other studies conducted in other countries. In order to receive grant funding and supplies of cannabis, researchers needed to submit study proposals that were designed to discover only its negative or harmful effects. A close review of some of the early studies will show that any positive results were buried or failed to get published and many of the negative reports were based on faulty designs or extreme doses.

3/14/14: National Geographic article

http://news.nationalgeographic.com/news/2014/03/140304-marijuana-legalized-medical-marijuana-thc-francis-collins-nora-volkow–science/

5/8/14: More cannabis from NIDA not all it seems

http://www.safeaccessnow.org/more_cannabis_from_nida_not_all_it_seems

9/3/2014, Mental Health Care System Is Failing At Suicide Prevention

http://www.huffingtonpost.com/2014/09/03/suicide-prevention_n_5736316.html

Nearly 40,000 people die from suicide in the U.S. every year — a number that has climbed recently.

A federal task force on suicide recommended in 2012 that all mental health professionals “should be trained on how to address suicidal thoughts and behaviors.” One year later, a study conducted at the University of Washington found that a mere 50 percent of psychologists, 25 percent of social workers, and 6 percent of counselors had received training in suicide risk assessment.

One major challenge for mental health professionals in assessing suicide risk accurately is getting patients to open up. The fear of being involuntarily committed to a hospital can deter patients from being honest about their mental health.

“Many men have prayed for death, but no man ever prayed for pain.”

Quotes

By Ambrose Bierce, American journalist (1842 – 1914)

Abstainer: a weak person who yields to the temptation of denying himself a pleasure.

Sabbath – a weekly festival having its origin in the fact that God made the world in six days and was arrested on the seventh.

Photograph: a picture painted by the sun without instruction in art.

Brought to you by BrainyQuote.com

9/1/2014, Prescription painkiller crackdown (Florida)

http://www.tampabay.com/news/health/prescription-painkiller-crackdown-has-gone-way-too-far-some-doctors-believe/2195678#comments

In Clearwater, Arlene Hoffer, a 52-year-old retiree, had undergone spinal injections and nerve blocks to control pain. It was, however, “impossible for her to get pain medications,” according to her sister, Cheri Hoffer, 56.  On Jan. 16, 2012, Arlene Hoffer parked her Mini Cooper at the top of the Sunshine Skyway Bridge and jumped. “My sister was terrified of pain and suffering and certainly took her life to stem that rising tide,” her sister said.