Winter Wonderland

“You can’t get too much winter in the winter.”  Robert Frost


02DSC08792 (2)

03DSC08666 (5)

“I think the story of ‘Alice in Wonderland’ in a way is a reminder that life is frightening, it can shift on you at any moment.”  Michael Sheen

04DSC08670 (4)


06DSC08687 (2)

“We’re not in Wonderland anymore Alice.”  Charles Manson

07DSC08681 (2)

08DSC08804 (2)

09DSC08668 (3)

(Photos taken 12/13/2015.)

Mistaken heroism

This is an interesting article from 2013, but it’s very odd that it doesn’t mention chronic pain in connection with suicide. In fact, in this very long article, the word “pain” (or a form of it) is only mentioned 7 times. It’s like chronic pain patients don’t even exist…

But suicide is not an economic problem or a generational tic. It’s not a secondary concern, a sideline that will solve itself with new jobs, less access to guns, or a more tolerant society, although all would be welcome. It’s a problem with a broad base and terrible momentum, a result of seismic changes in the way we live and a corresponding shift in the way we die—not only in America but around the world.

We know, thanks to a growing body of research on suicide and the conditions that accompany it, that more and more of us are living through a time of seamless black: a period of mounting clinical depression, blossoming thoughts of oblivion and an abiding wish to get there by the nonscenic route. Every year since 1999, more Americans have killed themselves than the year before, making suicide the nation’s greatest untamed cause of death…

There are as many intentional ways to die as there are people to imagine them, and we saw more of all of them: an almost 20 percent rise in the annual suicide rate, a 30 percent jump in the sheer number of people who died, at least 400,000 casualties in a decade—about the same toll as World War II and Korea combined…

This year, America is likely to reach a grim milestone: the 40,000th death by suicide, the highest annual total on record, and one reached years ahead of what would be expected by population growth alone. We blew past an even bigger milestone revealed in November, when a study lead by Ian Rockett, an epidemiologist at West Virginia University, showed that suicide had become the leading cause of “injury death” in America…

This development evades simple explanation. The shift in suicides began long before the recession, for example, and although the changes accelerated after 2007, when the unemployment rate began to rise, no more than a quarter of those new suicides have been tied to joblessness, according to researchers…

Throughout the developed world, for example, self-harm is now the leading cause of death for people 15 to 49, surpassing all cancers and heart disease. That’s a dizzying change, a milestone that shows just how effective we are at fighting disease, and just how haunted we remain at the same time. Around the world, in 2010 self-harm took more lives than war, murder, and natural disasters combined, stealing more than 36 million years of healthy life across all ages…

And this assumes we can even rely on the official data. Many researchers believe it’s a dramatic undercount, a function of fewer autopsies and more deaths by poison and pills, where intention is hard to detect. Ian Rockett of West Virginia University thinks the true rate is at least 30 percent higher, which would make suicide three times more common than murder. Last fall the World Health Organization estimated that “global rates” of suicide are up 60 percent since World War II. And none of this includes the pestilence of suicidal behavior, the thoughts and plans that slowly eat away at people, the corrosive social cost of 25 attempts for every one official death…

We’re a gregarious species, but also a gallant one, so fond of playing the savior that we’d rather die than switch roles with the saved. In this way suicide isn’t the ultimate act of selfishness or a bid for revenge, two of the more common cultural barbs. It’s closer to mistaken heroism.

If suicide has an evolutionary component, as Joiner believes it might, this is where it manifests itself. Humans are not the only animals that commit suicide. Bumblebees kill themselves as a defense against parasites, abandoning the nest to save it. Pea aphids do something similar. They use a kind of suicide bomb that maims ladybugs, their biggest predator, to save their own kind. Higher up in the animal kingdom, male lions sacrifice themselves on the savannas: they expose their throats to attacking clans in an effort to give other family members a chance to escape. A similar instinct may still linger in our DNA, colliding uncomfortably with the frailties and banalities of modern life…

In this way, suicide isn’t about cowardice. It’s not painless or easy, like pulling the fire alarm to get out of math class. It takes “a kind of courage,” says Joiner, “a fearless endurance” that’s not laudable, but certainly not weak or impulsive. On the contrary, he says, suicide takes a slow habituation to pain, a numbness to violence. He points to that heightened suicide risk shared by athletes, doctors, prostitutes, and bulimics, among others—anybody with a history of tamping down the body’s instinct to scream, which goes a long way to unlocking the riddle of military suicides…

Smart clinicians can do it, but it’s not easy to get people into treatment. There’s the cost, for one thing, but more than that, there’s the shame and the stigma. Suicide is the rare killer that fails to inspire celebrity PSAs, 5K fun runs, and shiny new university centers for study and treatment…

The opioid war began long before 2013, and yet in this macro view of suicide, it doesn’t even warrant a mention?

Title fight: Big Pharma vs. The Feds

But industry-funded groups like the U.S. Pain Foundation and the American Academy of Pain Management warn that the CDC guidelines could block patient access to medications if adopted by state health systems, insurers and hospitals. Such organizations often look to the federal government for health care policies.

“Could block patient access”?  When will everyone else join pain patients in the real world? Patient access has already been blocked, patients have been abandoned by doctors, and these groups are still saying this “could” happen?

Which is better, groups funded by industry or those funded by the federal government? What about all of the people who don’t have the funds to pay for representation?

The CDC decision to delay its guidelines followed months of lobbying by physician and patient groups aligned with the pharmaceutical industry, who have almost always had a seat at the table in federal discussions on painkillers. As a result, they have had far more influence over federal policy than addiction activists, according to experts.

I can report that there are millions and millions of pain patients who are not “aligned” with anyone; do not have a seat at any table for discussions on painkillers; and have absolutely no influence whatsoever over federal policy. I can also report that there are thousands of drug addicts who similarly have no voice in this fight.

“They’re very well-funded and they have a lot of pharma money behind them,” said Dr. Lewis Nelson of New York University, an FDA adviser who is also advising the CDC on its guidelines. “And then you have the anti-addiction groups on the other side, which is clearly much less funded and organized.”

It’s funny how some people — usually those sitting in a seat of privilege — live in a bubble of their own made-up reality. Since Big Pharma funds both sides of this issue, and the federal government only funds the anti-drug side, which side is clearly better funded? And which side does the media report on?

CDC’s Frieden says more Americans are “primed” for heroin use because of their exposure to painkillers.

I call bullshit. There are hundreds of millions of Americans who have been exposed to painkillers with no problems whatsoever.

The CDC had not publicly disclosed the panel’s membership, but Twillman and other pain advocates identified several members, including two who are leaders with Physicians for Responsible Opioid Prescribing, a group working to reduce painkiller prescribing. That group is backed by Phoenix House, a network of rehabilitation clinics.

Also backed by the federal government, along with anonymous, right-wing, private donors (like ALEC  and the prison industry).

My comment:

I want to thank the AP for not describing Mr. Kolodny from PFROP as some kind of expert on pain management (as many other media outlets have done). Unfortunately, I can’t thank the AP for its biased reporting on these issues.

As a 30-year intractable pain survivor, I’m sad to say that my voice isn’t a part of the media’s reporting on the opioid war. But what’s really tragic are the millions of pain patients who also have no voice (or a seat at any table), silently suffering and fueling a suicide epidemic that everyone refuses to talk about. Because when up to three times as many people die by suicide every day than by drug overdose — and all the CDC (and the media) can talk about is how doctors are over-treating pain — then something is terribly wrong. Maybe one day, someone will figure out how to report on the difference between tens of millions of pain patients, and the thousands of patients who suffer from drug addiction. (And maybe one day, the word “epidemic” will have meaning again.)

Since I was able to recover from my addiction to the medical industry, I can only hope that other pain patients are able to do the same. I was very lucky to survive this addiction, but there will be many who do not. While almost everyone blames suicide on the victim, my own experiences have shown me that the blame doesn’t belong there. In fact, agencies like the CDC and DEA should be held accountable for every pain patient who chooses suicide as a last resort to manage their pain, and for every pain patient who ends up in jail for being forced to turn to the underground drug market.

At The Park

“Wearing underwear on the outside of your clothes can turn a tedious trip to the store for a forgotten carton of milk into an amusement park romp.” Patch Adams

“On my first day in New York a guy asked me if I knew where Central Park was. When I told him I didn’t he said, ‘Do you mind if I mug you here?’.” Paul Merton

(Photo taken 12/14/2015.)

This Is What People In Your State Googled Most In 2015


Pluto (the dwarf planet)
Ronda Rousey (MMA fighter)
Holly Holm (MMA fighter)
Animas River (site of a massive 2015 spill of water containing toxic heavy metals)
Wiz Khalifa (rapper)

Obviously, New Mexico is the coolest state, but I thought it was also interesting to see the popular search terms in other states:

Massachusetts:  Opioid addiction and dependence

New Hampshire:  Heroin

You Can Buy Insulin Without A Prescription, But Should You?

As anyone with diabetes can tell you, managing the disease with insulin usually means regular checkups at the doctor’s office to fine-tune the dosage, monitor blood-sugar levels and check for complications.

But here’s a little known fact: Some forms of insulin can be bought without a prescription.

Carmen Smith did that for six years when she didn’t have health insurance and didn’t have a primary care doctor. She bought her insulin without a prescription at Wal-Mart…

Burke says he took his concerns to the American Medical Association. But the national doctor’s association told him there are no data showing that the drug’s over-the counter availability is a public health hazard. In fact, the AMA’s board noted, getting insulin without a doctor’s prescription may be an important way for some insulin-dependent patients to get access to the medicine they need

We could say the same about allergy medicine, along with medical cannabis. The added expense of getting a doctor’s approval for access to treat chronic medical conditions is over-burdensome and keeps millions of patients from getting the medications they need.


Wikipedia:  Quackery is the promotion of fraudulent or ignorant medical practices. A quack is a “fraudulent or ignorant pretender to medical skill” or “a person who pretends, professionally or publicly, to have skill, knowledge, or qualifications he or she does not possess; a charlatan”.

Mark Sullivan, MD, PhD, outlines steps for opioid tapering

We really need to look at whether patients consider their lives improved as a result of opioid treatment. My University of Washington colleague Jane Ballantyne, MD, and I recently published a commentary in the New England Journal of Medicine…

Many patients struggle with insomnia and anxiety as they taper opioids. It’s important that prescribers don’t add medications such as sedatives, benzodiazepines, or muscle relaxants that can increase risk of opioid overdose in unpredictable ways. Tricyclic antidepressants, like nortriptyline, can provide a safer alternative treatment for anxiety and insomnia.

Since antidepressants only work for (maybe) up to 30% of patients (and that’s for treatment of depression, not chronic pain, where the percentage is significantly lower), what other “safer” treatments do you suggest for anxiety and insomnia? And how do you treat symptoms like anxiety and insomnia that have arisen from the chronic pain itself? Oh, that’s right, doctors are refusing to treat pain, so now they can only “treat” the comorbid conditions — when they’re actually treating the pain with antidepressants…

Perhaps most “experts” don’t know this, but the use of antidepressants to treat chronic pain is actually off-label, except for a very few, specific, chronic pain conditions. Off-label use of medications (not approved by the FDA) has been under a lot of scrutiny lately and the results don’t look good (at least for the patients). So, what does it say about an “expert” who is advocating for off-label use of prescription medications? (Has the FDA approved the use of antidepressants for anxiety and insomnia?)

I have found that many patients in the subgroup taking high doses of opioids have untreated or undertreated psychiatric disorders, such as depression or post-traumatic stress disorder, which need to be monitored carefully. Opioids can mask symptoms of these disorders, so that when a patient comes off opioids these symptoms may reappear or worsen.

Opioids “mask” these symptoms, just like they “mask” pain? And when these drugs are taken away, the symptoms reappear or get worse? Dude, are you trying to say that opioids are actually treating PTSD and depression? And because of the opioid war, doctors have to take away these successful treatments? Replacing them with… antidepressants?

As I predicted, the only drugs doctors are going to prescribe for pain (anxiety, depression, PTSD, etc.) are antidepressants. Broke your leg? Here, have some Effexor. Dental pain? Here, have some Paxil.

My blood pressure increases every time I read one of these articles, but the scary part is that this quackery is becoming mainstream.