Brought to you by SAMHSA

3/3/2015, Managing Chronic Pain & Medication Misuse

After being arrested for forging a prescription, he spent nine years “doctor shopping” for pills, losing jobs, and suffering overdoses and suicide attempts. After nine years, he made it through rehab and he has been sober since 2007…  Mr. Loffert’s trajectory is a common one.

Common?  Really?  Maybe for those who suffer from addiction, but not for chronic pain patients.

According to SAMHSA’s Treatment Improvement Protocol (TIP) 54, “Managing Chronic Pain in Adults with or in Recovery from Substance Use Disorders,” almost one third of chronic pain patients may have substance use disorders…

May have?  Let’s see, that’s 30% of about 45 million (to 100 million) people who suffer from chronic pain in this country.  That’s 13.5 million people.  Wow, SAMHSA, way to earn your budget.

Dangerous interactions can also occur with medications used to treat mental illnesses such as depression, which is common among pain patients.

Depression is common?  No, it’s sadness that’s common among pain patients, not depression. And when you add sadness to constant pain, anxiety, and stress, you might just be diagnosed with Major Depressive Disorder — especially if your pain is under-treated.

Non-opioid pain treatments or other services, such as physical therapy or acupuncture, are better options for those who may need ongoing treatment for pain, particularly since there is little evidence for effectiveness of opioids in the long-term treatment of chronic pain…

There is “little evidence” because the research hasn’t been done, not because opioids are ineffective for long-term treatment.  And tell me, SAMHSA, where is the evidence that expensive physical therapy or acupuncture are effective long-term treatments for chronic pain?  Because if there’s evidence, maybe then insurance companies would cover those treatments.

…continue to offer waiver training for physicians interested in providing office-based treatment of opioid use disorders with buprenorphine under the Drug Addiction Treatment Act of 2000.

So, what is the difference in the abuse rates between bupe and other opioids?  It seems like bupe is abused in about the same percentage of patients as hydrocodone and other opioids, but since the government is heavily invested in bupe, SAMHSA gets to advocate for one drug over another.

Click to access TIP54.pdf

A Treatment Improvement Protocol

Managing Chronic Pain in Adults With or in Recovery From Substance Use Disorders

Current Opioid Misuse Measure (Page 58)

How often have you been in an argument?

How often have you gotten angry with people?

Symptoms and signs of opioid withdrawal are as follows. (Page 61)

Symptoms include:
• Abdominal cramps, nausea, vomiting, diarrhea
• Bone and muscle pain
• Anxiety
• Insomnia
• Increased pain sensitivity in the original painful site

Gee, I could suffer from all those symptoms just from being in constant pain, without taking any drugs at all.  Watch out, if you have a stressful job and food poisoning or the flu, you could be assessed as a drug addict.

To SAMHSA, every chronic pain patient either has, or will develop, a drug addiction.  Of course, chronic pain patients are like a whole new toy for SAMHSA — how many other patient groups can they claim suffer from addiction?  I wonder how many people who work at SAMHSA suffer from addiction themselves?  Maybe they’re all graduates of an AA program.

Because SAMHSA is an agency centered around drug abuse and addiction, I guess they have a rather narrow focus on drug issues.  After all, SAMHSA is a big part of the drug war.  They’ve been around so long, yet our drug abuse problems keep escalating… it appears they’re not very good at their job.  Why would anyone listen to them?

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