Et tu, John Oliver?

Maybe you will recall an article in the New York Times this year about the ER at St. Joseph’s Regional Medical Center in Paterson, New Jersey, deciding to use opioids only as a “last resort” to treat pain:

Dear NY Times: You Suck

Here’s a recent article praising the virtues of these new programs to treat pain from the American Hospital Association:

http://www.hhnmag.com/articles/7653-overthrowing-todays-pain-paradigm

When leaders set out to create a more uniform approach to emergency pain treatment, the original goal was to run an “opioid-free ED.” However, Rosenberg says they soon realized that this was unrealistic and, instead, have fostered a culture in which physicians have a broader range of resources. Opioids are now the last line of defense.The medical center’s Alternatives to Opioids program was launched in January for patients who present with one of five acute pain diagnoses — headache, long bone fractures, kidney stones, back pain and other musculoskeletal pain…

Since January, St. Joe’s already has cut the number of opioids prescribed in its ED by 38 percent…

The opioid war loves to tell us how much the supply of opioids has been decreasing. How wonderful. But this one statistic doesn’t tell us much. Why don’t we visit Paterson, NJ, and see how it’s doing?

http://www.nj.com/passaic-county/index.ssf/2016/10/7_drug_overdoses_reported_over_1-day_period_in_pat.html

Seven people overdosed on drugs in a 24-hour period Thursday in Paterson – four of them in a one-hour period in a park on Ward Street, authorities said Friday…  All seven victims survived after receiving medical treatment, police said…

“Fentanyl and carafentinal are increasingly apparent and becoming a national problem,” Speziale said Friday. “Many toxicology reports come back with what is categorized as polypharm, which means there’s a combination of heroin, fentanyl and other opiods.” …

http://www.recordonline.com/article/20160109/NEWS/160109447

In fact, law enforcement intelligence points to Paterson and Newark, N.J., as the sources for much of the heroin that’s plaguing the lower Hudson Valley, northern New Jersey and the Tri-State area where Port Jervis sits.

“For western Orange County, Paterson is the connection,” said Orange County District Attorney David Hoovler. Why Paterson? Heroin there is cheap and accessible…

The treatment courts are full. The narcotics unit is running full bore. Meanwhile, overdoses are worsening…

Back to the article by the American Hospital Association:

The massive Veterans Health Administration — with more than 1,700 care sites treating nearly 9 million patients annually — recently rolled out a systemwide effort to better address the complex pain from which returning vets often suffer. Dubbed the Opioid Safety Initiative, it targets individuals on high-dose prescriptions, and helps them to treat their pain through education, a mobile app called Pain Coach, and such alternative treatments as acupuncture. At the initial implementation sites, the VA reduced high-dose opioid use by more than 50 percent, with no rise in pain scores…

With no rise in pain scores? (I’m sorry, but if you believe that, I want to sell you some bitcoins.) Even with those patients who didn’t see a rise in their pain scores after being forced off of opioids, that just means their pain scores didn’t change and are still high.

Rollin Gallagher, M.D., the deputy national program director for pain management at the VA, believes these results can be duplicated easily at any hospital…

Groups like the American Hospital Association urged the Centers for Medicare & Medicaid Services to remove pain-related questions from patient satisfaction surveys and, in July, CMS agreed to do so…

From a graphic in the article:

The U.S. has experienced a 300 percent surge in prescription opioids dispensing since 1999, with no corresponding drop in the amount of pain reported by Americans.

I don’t know where they got this information, and I’m not sure what it’s supposed to be telling us. Opioids help manage pain, they don’t get rid of it, so why would there be a drop in the amount of pain reported? Using this questionable information, we could also say that there hasn’t been an increase in the amount of pain reported by Americans. And that would be a good thing, but we’re not allowed to give any credit to opioids.

http://www.painnewsnetwork.org/stories/2016/10/20/fewer-pain-meds-but-more-overdoses-in-massachusetts

The CDC said it will “take time” before overdoses start to decline.

“Reducing the level of opioid prescribing is a long term strategy to limit exposure to these drugs. Mortality outcomes would not be expected to change for several years after implementation, and impact would be complicated by the increasing supply of illicit opioids,” Courtney Lenard, a CDC spokesperson, said in an email to Pain News Network…

The actions of the DEA, CDC, and VA have actually increased the size of the underground drug market. They have created this demand. They are the reason that people are overdosing on unsafe, illegal drugs. But you see, these government agencies have decided that they’re okay with that. This is a “long term strategy,” and they know that some people will be lost. They think they’re saving lives in the future, which for some reason, is more important than saving lives in the present.

The thing is, everything may be getting even worse for pain patients. Because, allegedly, corporate power has been hampering the DEA’s efforts to get at suppliers and distributors, at least according to recent articles in the Washington Post. Even if Big Pharma just keeps getting a slap on the wrist, that doesn’t mean they’re still operating in the same way. They don’t want to pay more fines and they’re spending millions to develop new and “safe” painkillers (which will be expensive, probably less effective, and out of reach for many patients). And there are millions of corporate dollars funding the opioid war, matched by our tax dollars.

http://www.washingtonpost.com/investigations/the-dea-slowed-enforcement-while-the-opioid-epidemic-grew-out-of-control/2016/10/22/aea2bf8e-7f71-11e6-8d13-d7c704ef9fd9_story.html

Before Reeves’s arrival, Geldhof said, investigators had to demonstrate that they had amassed “a preponderance of evidence” before moving forward with enforcement cases, which are administrative, not criminal. Under Reeves, Geldhof said, investigators had to establish that their evidence was “beyond a reasonable doubt,” a much higher standard used in criminal ­cases…

You can label a case as “administrative,” but it still involves drugs and crime, so why shouldn’t the agency be required to prove the higher standard? It appears that the DEA has been stripped of some of its abusive power — and they want it back. So, they’re blaming corporate power for the slowdown in cases. Will Congress give this power back to the DEA? Perhaps I should say, when Congress gives this power back to the DEA, things will get worse for pain patients.

To top it all off, the latest episode of John Oliver is about the opioid “crisis.” I don’t think he added any new information about the opioid war, but he appeared to be on the side of the CDC. He mentioned that opioids were only previously prescribed for acute pain. He included a video from PFROP. He made one slight mention of patients who need these medications, but he mostly blamed the whole thing on Big Pharma, singling out Purdue. He mentions how insurance needs to cover alternative treatments, without including the fact that alternative treatments only work for a small percentage of patients.

For me — who finds humor in just about anything (even Trump) — I didn’t find anything funny in John Oliver’s take on the opioid “crisis.” For the first time, I’m disappointed in Mr. Oliver. I’m sad that so many intelligent people cannot see the whole picture of the opioid war. Cannot see the millions of chronic pain patients who are suffering. And why doesn’t the media ever mention the epidemic of suicide in this country? It’s as if those deaths have nothing to do with pain and the opioid war.

Today I’m very sad that there is not one person with any power who is willing to stand up for pain patients. As if we are unimportant and mean absolutely nothing. As if science means absolutely nothing.

Thanks for reading. Sorry if I bummed you out. Blame John Oliver and Trump. 🙂