Repealing opioids when there are no replacements is ignorant and barbaric

http://www.centralmaine.com/2017/01/21/central-maine-patients-fear-medication-weaning-as-they-struggle-with-chronic-pain/

(January 21, 2017) Central Maine patients fear weaning off opioids as they struggle with chronic pain

And while patients concerned about medication limits may be able to qualify for exceptions, two of the people interviewed weren’t aware of exceptions and already were being tapered off their medications by doctors. Another said there’s scant information available about how to apply and qualify…

New patients are limited to a dosage amount of less than 100 morphine milligram equivalents, or MME, of opiates, and those already taking medications above the limit must taper to less than 100 MME by July 1…

About 16,000 patients in Maine are prescribed more than 100 morphine milligram equivalents, according to Gordon Smith, executive vice president of the Maine Medical Association. About 1,300 Maine patients are prescribed more than 300 MME.

“Even at 200 morphine milligram equivalents, you have a 1 in 32 chance of dying within the next two-and-a-half years,” Smith said. “That’s a mortality rate that’s very, very high.” …

This sounds like something drummed up by statistics, which the medical industry is relying on more and more. I’m always amazed at how easy it is to bend statistics to your own belief system. Thing is, patients are not statistics, and to think of us that way is a huge mistake.

“I hate having medicine legislated,” said Steve Diaz, chief medical officer for MaineGeneral Medical Center in Augusta. “I believe as a profession we physicians should be policing ourselves and have the wherewithal to provide guidelines. But I think the issue here is the opioid epidemic was getting worse, and there was no national or state medical response to rein it in.”

No national or state medical response? Like, the opioid war? Where the fuck have you been, Mr. Diaz?

Smith, of the Maine Medical Association, said that “help is coming” for those who are tapering off. Nurse practitioners and physician assistants can prescribe suboxone, a narcotic that is used to treat addiction to pain relievers, beginning in February. The Maine Department of Health and Human Services also announced $2.4 million in funding used to create 359 additional medication-assisted treatment slots across the state that began Jan. 1…

Here you see the government’s answer to the epidemic of chronic pain — treat us all like drug addicts. (The stock price for the maker of Suboxone is currently up 13 points. How many of those involved in advocating for the opioid war own stocks in addiction treatments?)

While the use of opioid medication for chronic pain may be common, it’s not necessarily the best form of treatment. A growing body of evidence shows that long-term opioid use actually worsens chronic pain, as well as depression, ability to function and overall quality of life, said Dr. Stephen Hull, director of medical pain management at the Mercy Pain Center in Portland.

“They work very well for dampening down activity of the nervous system in relationship to pain,” Hull said. But the drugs also activate the immune system within the brain and spinal cord, making the brain more sensitive to pain. So although opioid patients experience short-term pain relief, the activation of the immune system results in even higher pain levels as the drug leaves the bloodstream. At the same time, as patients build up tolerance to the drugs, they require higher and higher dosages to feel the positive effects and stave off the heightened pain levels that come with withdrawal…

Dear Dr. Stephen Hull: You’re a dickhead who makes no sense. Are you a graduate of Trump University?

“What we’ve seen at the Mercy Pain Center is that those folks who are willing to come off these medicines succeed at high rates and report not only that their pain is better but that their cognitive functioning is much better,” Hull said. “We’ve come to feel that not only is it appropriate to get under that 100 milligram equivalents of morphine, we are telling our patients that it’s appropriate to get them off opioids altogether.”

Are we in a doctor’s office or a church? Are you a doctor, a priest, or a judge? I feel sorry for your patients, Mr. Hull. How many have left your practice?

Physicians can prescribe opioid medication above the new legal limit for pain related to cancer treatment, end-of-life care, treatment for substance abuse and palliative care. Palliative care, as defined by state law, is patient-centered care that aims to optimize quality of life by anticipating and treating “suffering caused by a medical illness or physical injury or condition.” …

Well, this is new. An exception for the treatment of substance abuse. Is that a nice term for addiction or does the government now consider every chronic pain patient on opioids to be suffering from substance abuse? Does that also mean that every chronic pain patient is also entitled to palliative care? I’ve never been to a palliative doctor, but I’ve heard they exist.

My comment:

Isn’t it funny how doctors say one thing, then patients come along to prove them wrong? After about 10 years on prescription medications to treat intractable pain, I was forced into a cold-turkey detox. That was over 5 years ago. Tell me, Dr. Hull, when will my pain get “better”? Because I’m still waiting.

Since you claim to be an expert in treating intractable pain, your clinic must be having a hard time keeping up with demand. Tell us, Dr. Hull, how many patients have you lost or abandoned since you decided that opioids are not appropriate to treat chronic pain? What’s the annual suicide rate for your patients and how much has it increased within the last 5 years?

Just like it’s stupid and cruel (willfully causing pain or suffering to others) to repeal Obamacare without an adequate replacement, it’s likewise ignorant and barbaric to repeal the use of opioids to treat chronic pain without having adequate replacements. Of course, there’s always a gun, which is now easier to buy than pain medication.

Might as well use the opioid war to start the conversation on the right to die. If doctors refuse to treat my pain, I should have the right to humanely end my suffering. Animals get that right, so should humans.

Celebrating the anniversary of Roe v. Wade

“In New York and cities across the country, women marched.”

This is a quote from “Makers: Women Who Make America,” a 3-part documentary that I just watched on YouTube. I highly recommend it. The quote is from the 1970s.

Let’s look at how long the battle for women’s right has been going on, shall we?

On October 11, 1972, Sarah Weddington, a 26-year-old lawyer from Texas with very little experience, argued Roe v. Wade before the Supreme Court. At that time, the Supreme Court was made up of nine white men.

Forty-four years ago today, on January 22, 1973, Roe v. Wade was decided. I celebrate that day.

The Equal Rights Amendment was first proposed in 1923. It wasn’t until 1972 that it passed both houses of Congress. But in the end, the states wouldn’t ratify the ERA, partially due to the advocacy work of white, religious women. It was a backlash against Roe v. Wade and the women’s movement. And then Reagan was elected president. Reagan used his high-profile, government position to advocate against abortion, helping to stop the women’s movement in its tracks.

I don’t know why anyone would think that the potential life of a fetus is more important than the life of the mother. That’s like saying that the woman’s life doesn’t matter. That she’s not allowed to make her own health care decisions. That her body is not her own. That the most important purpose of a woman’s body is reproduction.

I wonder how men would feel if we treated their bodies in the exact same way. Where every single sperm was considered potential life, and men had to constantly fight for the right to control their reproductive health care.

There is nothing more important for a woman than to have control over her own body. Men have total control over their reproductive organs, and so should women. And when I talk about control, I’m not just talking about reproductive rights. I’m talking about all kinds of health care.

Male or female, as adults, we should have complete control over our own bodies, including the choice of medical treatments. Our own health care decisions should not be taken away from us by the government, insurance companies, or doctors.

I should not have to experiment with one drug just because it’s cheaper, when more successful drugs are available. My access to certain drugs should not be restricted just because I see one doctor over another. Just because one doctor believes that certain reproductive health care options (or treatments for pain or addiction) are sinful and against their beliefs. That’s not practicing medicine. That’s forcing your beliefs on your patients.

One of the reasons I watched this documentary was in the hope of finding some clues on how pain patients can fight for their rights. Media attention was important back then, just as important as it is today. It appears that pain patients have lost the media war. But I was just wondering… Have we already lost the opioid war?

There’s nothing wrong or sinful about feeling good

I believe we should have access to any and all treatments for pain, including cannabis. But I don’t want pain patients to think that if they switch to cannabis, it will be the only drug or treatment they’ll need to manage their pain. (Any drug is just one part of an overall pain management program.)

I’ve been very lucky to have access to a quality strain of cannabis in the last couple of months — one of those strains that are very hard to find. I’ve wondered if daily use of a good strain would be enough to manage my high pain levels (averaging about a 7 out of 10), but I think that’s about false hope. Cannabis is great, but it’s not a wonder drug. Of course, everyone’s experience will be different, but I think I’ve had enough experience throughout the past 3+ years to reach some conclusions.

If I had a choice (which I do not), I would probably choose a combination of cannabis and a painkiller to treat my pain. The addition of a painkiller would allow me to smoke less cannabis, and the cannabis would allow me to keep my painkiller usage to a minimum. I might even add a muscle relaxer at night, because the muscles in my face deserve more rest than I’m able to provide.

If I was able to add a painkiller to my pain management program, I might be able to take a walk every other day, instead of once or twice a week. I might be able to lose some weight. With a little extra pain relief, I might not think about death so much. I might think that I have some kind of survivable future. There’s even a possibility that I’d be able to regularly clean my toilet. (Okay, maybe not.)

When I was taking a bucket full of prescription medications, I relied on them to manage my pain. Maybe I relied on them too much, but that’s only because, out of all the treatments I’ve tried, prescription medications worked the best. I think that’s true for most people. I think it’s true that a lot of acute and chronic pain is best controlled with painkillers. (Patients aren’t given high doses of antidepressants before surgery.) Maybe the opioid war advocates would agree with me on that, but would disagree about how long we should be allowed to use opioids to manage pain. After all, according to the other side, anyone who swallows a pain pill has a high risk of becoming a drug addict. (And what’s worse than being a drug addict? Maybe a murderer?)

I read an article recently about how cannabis affects the part of the brain that deals with your sense of time. I’ve been thinking about that…

I know that being in constant pain makes time go by very slowly. Twenty-four hours feels like a week, not one day. And then I thought about the occasions that I’ve felt “high” from a drug. You know, the shameful high that almost all pain patients deny they experience with painkillers. The high that drug addicts chase on a daily basis. The high that makes you feel good artificially because it’s from a drug. The feel-good high that is really what the drug war is all about.

Within that high — a possible side effect of some drugs — is a distortion of time. That relief allows time to float, almost fly by, as if you lost 10 pounds and your feet had wings. As if a heavy burden had been lifted just a little, allowing a tiny taste of freedom inside your prison of pain. (Everyone’s prison of pain is different, caused by mental and/or physical pain.)

Does it feel good to get high? You betchya. However, it’s not like that good feeling lasts very long. But it can last long enough to, say, take a walk (or scrub your toilet). Or the high can work as an incentive — a reward for doing the painful thing that you really don’t want to do.

I suppose it’s all about what you do with the high. Those who suffer from addiction will always be chasing the high, and because of the drug war, will always be shamed and criminalized. Looked down on for suffering from a medical condition that most people think is a choice.

Those who suffer from constant pain will always be chasing after relief, and because of the drug war, we are now treated like those who suffer from addiction.

I’d just like to point out that the high I’ve been talking about gives relief to both pain patients and drug addicts. Look down on that high if you will, but it serves a purpose. The pleasure centers in our brains are there for a reason. They’re activated not only by drugs (including caffeine and chocolate), but also by things like friendship, caring, sex, love, risk, and winning.

Good feelings are part of being human. Unfortunately, so is pain. But just like humans are not meant to feel constant pleasure, we’re also not meant to be in constant pain. We’re not meant to feel depressed every single day, and if we do, that means our brains are out of balance. We’re not meant to feel constant fear and anxiety, and if we do, that means our brains need help.

Being human means we have to suffer, but when pain reaches a level where death is preferable to life, then our brains need help. Not help for a couple of weeks or months, but constant help. The pain is constant. The help has to be constant, too.

Sometimes the help we need will include the high from drugs. Let’s stop looking down on the high. There’s nothing wrong or sinful about feeling good.

To cut costs, Medicare adopts CDC’s regulations

I think you’d be surprised at how many federal and state government agencies are a part of the opioid war. As predicted, the CDC’s opioid guidelines are being treated more like regulations than simple guidelines. With the backing of the CDC’s false theories, these agencies are deciding which treatments for pain will be available to patients — and which will label you a criminal. If you’re a pain patient with Medicare, this information will affect you.

http://www.painnewsnetwork.org/stories/2017/1/12/medicare-takes-big-brother-approach-to-opioid-abuse

A new strategy being developed by Medicare to combat the abuse of opioid pain medication will encourage pharmacists to report physicians who may be prescribing opioids inappropriately. Patients that a pharmacist believes are abusing opioids could also be referred for investigation.

The strategy, which has yet to be finalized, was outlined by the Centers for Medicare & Medicaid Services (CMS) last week in a 30-page report on the agency’s “Opioid Misuse Strategy.” It has not been widely publicized by CMS or reported in the news media…

I read a story the other day about a pain patient who was reported to his doctor by the pharmacist for buying alcohol with his prescription drugs. But I don’t think it’s news that doctors and pharmacists have also become an extension of the DEA in the opioid war, just like other government agencies.

Here are some excerpts from CMS’s “Opioid Misuse Strategy” report:

http://www.cms.gov/Outreach-and-Education/Outreach/Partnerships/Downloads/CMS-Opioid-Misuse-Strategy-2016.pdf

Increase the use of evidence-based practices for acute and chronic pain management. Evidence-based practice is an integral part of all of CMS’s priority areas, but expanding the evidence base of effective and alternative treatments for acute and chronic pain is especially vital. CMS stated this priority area specifically to emphasize the need to address the limitations of research that is currently available.

By January 1, 2019, CMS will enforce requirements that the vast majority of prescribers who write prescriptions for Medicare Part D beneficiaries must be enrolled in Medicare or be validly opted out in order for the beneficiaries’ drugs to be covered. This enrollment requirement will allow Medicare to have better oversight of prescriber behaviors and revoke enrollment of providers proven to demonstrate inappropriate behaviors.

The Medicare Part D Opioid Prescriber Summary File, which will build on this Medicare prescriber enrollment requirement, presents information on the individual opioid prescribing rates (for new prescriptions as well as refills) of prescribers of Part D drugs. This public data set will provide information on the number and percentage of prescription claims for opioid drugs, as well as each provider’s name, specialty, state, and zip code. The file can be used to explore the impact of prescribing practices of controlled substances on vulnerable populations.

Finally, through CMS’s Overutilization Monitoring System (OMS), Part D sponsors are provided quarterly reports on high risk beneficiaries and provide CMS with the outcome of their review of each case. Since 2011, the OMS helped sponsors reduce the number of potential opioid overutilizers by 47 percent among Medicare Part D beneficiaries.

Additionally, CMS is addressing the issue of drug diversion by identifying consistent thresholds across programs to flag providers as “high prescribers” and patients as “high utilizers” who may require additional scrutiny.

CMS is in the exploratory phase of identifying metrics to quantify and track progress in each priority area. For priority area 1, metrics are currently under consideration in the following areas:

For prescribers enrolled in Medicare who prescribe Part D drugs:

Percentage of opioid prescriptions:
o Exceeding CDC guideline of 90 morphine milligram equivalents (MME) per day
o Exceeding 7 days of treatment
o Written for extended release/long-acting opioids

Percentage with beneficiaries receiving an opioid prescription without other supportive therapies/treatments

Research would also increase the focus on identifying methods for migrating the significant number of chronic pain patients with long standing opioid use to other medications along with alternative modalities. Without initiating other medications at the same time as alternative therapies, these patients may vigorously resist reducing or giving up the opioids that for many years have allowed them to manage their pain at tolerable levels and lead functional lives. The benefit of tolerable pain levels and functional lives may outweigh the risk of opioid use for these patients.

Recognizing its critical role in promoting and reinforcing appropriate treatment approaches, Medicare, Medicaid, and Marketplace plans would cover therapies that are consistent with CMS’s evidentiary standards.

CMS has a number of initiatives underway to increase the use of recommended evidence-based practices for pain management. CMS provides outreach regarding best practices and technical assistance through the Transforming Clinical Practice Initiative’s Practice Transformation Networks. CMS has distributed publications on evidence-based prescribing practices to providers, often in coordination with other HHS agencies, including the Office of the Surgeon General.

CMS is also playing a part in expanding the evidence base to identify and support effective nonpharmacologic therapies and additional non-opioid pharmaceuticals. The agency’s key role is to identify services that need more evidence to support coverage by Medicare and other health plans. CMS then collaborates with research-focused HHS agencies, such as NIH, who can concentrate research on these need areas.

The focus of CMS’s immediate efforts under this priority area is twofold. First, identify non-covered treatments that already have sufficient evidence in order to quickly expand coverage of those therapies; for example, for certain common pain conditions, such as chronic lower back pain, CMS is exploring ways to streamline coverage of evidence-supported alternative therapies.

Secondly, educate providers and beneficiaries in order to improve provider utilization of evidence-based treatments and adjust patient expectations appropriately.

CMS’s long term priorities focus on broadening coverage and increasing utilization of therapies that are [might be] proven to be effective. This approach will accelerate identification and implementation of effective alternative treatments for pain.

What happens when access to the only adequate treatments for pain are reduced and removed before other “effective” therapies are found? Like, what happens when Republicans repeal Obamacare before having something comparable to replace it with? I think the term “chaos” fits.

http://www.blog.cms.gov/2017/01/05/addressing-the-opioid-epidemic/

“The opioid epidemic is one of the most pressing public health issues in the United States today.” – Health and Human Services (HHS) Secretary Sylvia Mathews Burwell

Really? If more people suffer from untreated chronic pain than suffer from addiction, which is the epidemic? If more people die from suicide than from drug overdoses, which is the epidemic?

Many Medicare and Medicaid beneficiaries and their families have been affected by the consequences of opioid misuse and opioid use disorder, commonly referred to as addiction. Given the growing body of evidence on the risks of misuse, highlighted by the Centers for Disease Control’s (CDC) new guidelines for prescribing opioids that was released earlier this year, and the Administration’s commitment to combatting the opioid epidemic, CMS is outlining our agency’s strategy and the array of actions underway to address the national opioid misuse epidemic. The actions outlined here do not include CMS’s vision for the treatment of cancer and hospice patients.

See, those who suffer from cancer, or are under hospice care, deserve to have their pain treated, while everyone else can just suffer. Thanks, CDC.

Comments are closed.

Of course comments are closed. They don’t want anyone to invade their bubble. But Medicare is on Facebook, along with the agency that oversees it, HHS:

http://www.facebook.com/HHS/

http://www.facebook.com/medicare/

My comment posted today on Medicare’s Facebook page:

The CDC’s opioid regulations, and Medicare’s adoption of them, are forcing tens of millions of Americans to find alternative treatments for pain, like marijuana and kratom. How much savings does that amount to for Medicare?

What happens when you reduce and remove access to the only successfully proven treatment for pain before equally successful alternative treatments are available? How smart is it to repeal before you replace?

Many pain patients are unable to find safe and adequate replacements for opioids. Some will be forced into the underground drug market. Some will choose suicide. Most will survive, but their lives won’t be worth living. Many will just hunker down, suffer quietly, and wait to die — shamed by the opioid war into believing they deserve to suffer.

Has Medicare/CMS identified metrics to quantify and track the destruction being caused by it and the CDC? Like the increase in addiction rates, poisonings, and suicides. The increase in the use of alcohol, cigarettes, acetaminophen and NSAIDs, sugar, and other legal, over-the-counter drugs and supplements. The increase in domestic violence, family break-ups, obesity, kidney and liver disease, disability claims, and homelessness. The increase in anxiety, depression, and PTSD.

Once the government cures addiction (with money and good intentions), what is it going to do about the epidemic of intractable pain? The epidemic of suicides and gun violence? The epidemic of Americans being unable to trust even one government agency in this country?

Is chronic kidney disease painless?

This “expert” thinks so:

http://www.medpagetoday.com/PainManagement/PainManagement/62462?isalert=1&uun=g875301d5423R7051790u&xid=NL_breakingnews_2017-01-11

How Much Are Docs Responsible for Patients’ Opioid Abuse?
F. Perry Wilson, MD, looks at the data on how patients get hooked

I’m a nephrologist. I specialize in chronic kidney disease – a completely painless condition. But there has been a coordinated and I think well-intentioned campaign to increase physicians’ awareness of patient pain. Some have argued that the adoption of pain as the “fifth vital sign” has led to an increased rate of opioid prescription, addiction, and overdose…

The major unknown here is the rate of transition from licit to illicit opioid use. And that data is harder to find than, well, street fentanyl nowadays. We also need to know the reason for that initial opioid prescription. It is a very different thing to receive oxycodone after you have your wisdom teeth removed and to receive it for chronic low back pain, and the risk of transition to opioid use disorder is much higher in the latter…

Do you suffer from back pain? The opioid war has now labeled you a faker and potential drug addict.

If you complain of back pain to a doctor, expect your pain to be disregarded and dismissed. After all, back pain can’t be a symptom of a more serious condition (like kidney disease), right? If your doctor isn’t concerned about your back pain, why should you worry about it? I’m sure you’ll be just fine.

How do you feel about spanking?

http://www.today.com/parents/france-just-made-spanking-your-kid-illegal-t106715

Studies have shown that spanking basically doesn’t work: It can not only impair a child’s IQ and their overall ability to learn, but it can also lead to low self esteem, aggressive behaviors and substance abuse and addiction problems in later years.

According to a June 2016 study that appeared in the Journal of Family Psychology, more than five decades of research revealed that children who were spanked were more likely to encounter mental health and cognitive difficulties and obstacles, become anti-social and introverted, and were more likely to defy their parents.

Reports have revealed that, since 1986, the practice of spanking children has decreased among women. However, parents across the U.S. say they still approve of spanking as a form of discipline…

I’m very thankful that spanking was not a part of my upbringing. If you hit a stranger, it’s considered criminal battery. Why not the same for your own child? What can a child learn when violence is used as a reinforcement? Spanking is about bullying, not about teaching. It’s about who has the most power in a parent/child relationship.

Don’t hit your kids. Don’t hit your pets. Spanking is not an educational tool. It creates anger and resentment, and just makes the victim want to hit you back. And if they can’t hit you back, they’ll take it out on someone else.

Pain patients have no support from media

http://abcnews.go.com/US/fentanyl-deaths-spiked-us-sign-slowing/story?id=44554601

My comment:

I find it odd that the media doesn’t connect the dramatic increase in fentanyl deaths to the federal government’s opioid war. It’s not surprising that deaths in Florida are up 70%, as the DEA began its increased crackdown on pill mills in that state. As the DEA took its opioid war from state to state, those who suffer from drug addiction have had even fewer safe choices. It’s almost like, because prohibition was so long ago, the government has forgotten the lessons learned from that huge mistake.

When the CDC passed new opioid guidelines this year, the agency knew that one of the effects would be an increase in drug overdoses and suicides. Andrew Kolodny from PFROP (the addiction industry group that worked with the CDC on the guidelines) admitted as much. They believe that it’s more important to save people from a potential future addiction than it is to save the people who are now dying. Since the guidelines only went into effect this year, overdose deaths will keep increasing.

Those who suffer from addiction are not the only people who have been and will be adversely affected by the government’s opioid war. If you suffer from any kind of pain, you will also be affected — if not now, then sometime in the future.

A recent poll showed that over 60% of doctors don’t believe that painkillers work for chronic pain. Many doctors have stopped prescribing painkillers altogether. You may think this is a great idea — until your doctor refuses to treat your pain. And you may be surprised to learn that, just because you have a serious medical condition like cancer, that doesn’t mean you’ll have access to painkillers. Also be ready for a lecture from your doctor about the horrors of addiction whenever a painkiller is prescribed, regardless of whether you’re part of the 10% of people who may suffer from addiction.

Everyone agrees that the drug war has been a huge and expensive failure (except the DEA). Isn’t it time we had a war against pain instead of the drugs that can treat it?

For every story about someone who suffers from addiction, if the media wanted to, it could find 20 stories of people suffering from chronic pain. I wonder if someone could tell me why the media refuses to report on the millions of chronic pain patients who are the latest victims in the drug war.

#DearCDC

Posted today on the CDC’s Facebook page:

http://www.facebook.com/CDC

#DearCDC: Why is being in agonizing pain better than being addicted?

#DearCDC: Has the CDC considered waging a war against intractable pain?

The Collapse of the Health Care Insurance Industry

WASHINGTON, DC (Rueters) — In December, 2016, the Kaiser Family Foundation reported that more than 11 million people had purchased private health insurance plans through the Affordable Care Act exchanges. Now, three plus years after President Trump took office, Kaiser is reporting that 30 million people have lost their insurance. What happened?

One of the first moves of the Republican Congress was to get rid of the ACA requirement that insurers provide certain benefits such as mental-health services and maternity care, saying those requirements drove up premiums.

Since the crash of the health care insurance industry, premiums are no longer a problem.

Studies have shown that since the ACA was gutted by a male president and mostly-male congress, women have suffered the most from its loss. There’s been a sharp increase in abortions, and the U.S. — already one of the international leaders in infant mortality — is now number one on that list.

There’s been an increase in deaths from certain types of cancer that mostly affect women, like breast and uterine cancer. By the time women seek treatment, it’s already too late. Planned Parenthood has been made to close an alarmingly large amount of clinics, both before and after Trump took office. The corresponding explosion of sexually-transmitted diseases, including AIDS, is unsurprising and was expected by most experts.

Mental health clinics, already poorly funded, have also been closing left and right since Trump’s inauguration. The suicide rate has mostly increased every year, but since 2017, it has skyrocketed, finally forcing the CDC to consider suicide as a threat to public health. Rates for depression, addiction, and crime have also increased. After 8 years of an unemployment rate that only went down, it started creeping back up again in the early part of 2018, and is still increasing.

Another idea supported by the Republican Congress was health savings accounts, but it didn’t take long for HSAs to fall out of favor after China Bank & Trust was found guilty of bankrupting around a million of these accounts held by Americans. The Russian Gold Bank was found to have only bankrupted about 1,000 American health savings accounts. The Consumer Financial Protection Bureau discovered these criminal actions before Republicans closed it down, the information only coming to light this year through anonymous internet sources.

Almost everyone (with the exception of state insurance commissioners) thought that selling health care insurance across state lines would be beneficial to consumers, but a recent study by Harvard University showed that the majority of consumers were actually harmed by the proliferation of fly-by-night insurance companies created by this new market. Customers often bought insurance from companies that only existed on the internet, and many people were dumped as soon as they filed a claim.

The health care insurance industry was able to withstand these changes, only falling apart in 2018 after Republicans cut the taxes which funded the ACA. Doctors began to only accept insurance from well-known companies, leaving millions of people unable to find a doctor, even with insurance. Then the largest corporations stopped selling health care insurance altogether.

After the collapse of the health care insurance industry in early 2019, medical costs have started to decline. When it’s too expensive to go to the doctor, you just don’t go. Doctors are now advertising on Craig’s List and Tinder, many offering free introductory visits. After a slew of busy years for hospitals and mergers, three years after Trump became President, there are now 40% fewer hospitals in the U.S.

After President Trump ended the drug war last month, experts have predicted a similar collapse of the medical industry. Only time will tell.

Maybe I should become a conspiracy theorist

For every story about someone who suffers from addiction, if the media wanted to, it could find 20 stories of people suffering from chronic pain. It’s inequities like this that make one start to believe in conspiracy theories. I’ve seen addiction articles recently in the Los Angeles Times and now the Washington Post:

http://www.washingtonpost.com/national/health-science/no-longer-mayberry-a-small-ohio-city-fights-an-epidemic-of-self-destruction/2016/12/29/a95076f2-9a01-11e6-b3c9-f662adaa0048_story.html?utm_term=.826e5a2ffb86

As I predicted, pretty soon, there will be an addiction clinic next to every place that does surgery. Because I’m not aware of any kind of surgery that would not include the use of some kind of painkiller.

She told him the truth: More than a year earlier, she had hurt her back lifting a patient at work, where she was a nursing assistant. A doctor gave her a prescription for 120 Percocets with two automatic refills. That was 360 pills. After those ran out, he gave her a scrip for 60 more and warned her about addiction. Too late. She had no problem finding pills on the street.

I don’t know what to think about this story. What kind of doctor would prescribe Percocet right off the bat for a hurt back? I would think that most doctors would at least start with codeine.

This happened fairly recently, so what kind of doctor would give an automatic refill for a painkiller (without worrying about the DEA)? And then within a span of months, this patient went from taking Percocet for her back to finding pills on the street? Is her story supposed to be representative of… something?

Am I supposed to believe this:

“Now you can get heroin quicker in these communities than you can get a pizza,” said Teri Minney, head of the Ross County Heroin Partnership Project.

I don’t know what to believe anymore, but I do know that only one side of this war is being told. And I don’t understand why.

Thinking of you, Carrie Fisher

Thank you for being a firecracker.

http://www.bloomberg.com/news/articles/2016-12-27/daughter-actress-and-author-carrie-fisher-dies-at-age-60

Little was off-limits in the show. She discussed the scandal that engulfed her superstar parents, Debbie Reynolds and Eddie Fisher (he ran off with Elizabeth Taylor); her brief marriage to singer Paul Simon; the time the father of her daughter left her for a man; and the day she woke up next to the dead body of a platonic friend who had overdosed in her bed.

“I’m a product of Hollywood inbreeding. When two celebrities mate, something like me is the result,” she said in the show. At another point, she cracked: “I don’t have a problem with drugs so much as I have a problem with sobriety.”

“She was funnier&smarter than anyone had the right to be,” Whoopi Goldberg wrote on Twitter Tuesday. “Sail On Silver Girl. Condolences Debbie & Billie.”

“Hail Hail! A genius has vacated this realm-RIP Carrie Fisher,” Roseanne Barr posted on the site.

Chocoholic

Wikipedia:  A chocoholic is a person who craves or compulsively consumes chocolate. There is some medical evidence to support the existence of actual addiction to chocolate. However, the term is mostly used loosely or humorously to describe a person who is inordinately fond of chocolate… Even scientists who doubt the existence of true addiction agree that chocolate craving is real. Women are especially affected.

Hi, my name is Johnna and I’m a chocoholic. And I blame it all on my female genes. 🙂

Bridges

It’s important to build bridges.

I’ve tried to build bridges between pain patients and those who suffer from addiction, with little, if any, success.

I’ve tried to build bridges between pain patients and the cannabis industry, spreading the truth about using pot to treat pain.

I find it difficult to build bridges between atheists and religious people. I don’t understand the worship of some supernatural being, and I don’t understand why religious people follow my atheist blog.

Because I visit everyone who visits me, I found myself reading about the sin of masturbation today. Did you know that if you masturbate, it proves you have no self control? Please.

Humans are able to pleasure themselves in a myriad of ways, including with food, sex, and drugs. Just like with the drug war, religious people have a problem with the notion of pleasure. Ironically, researchers have shown that prayer can elicit the very same pleasure responses in the brain as sex and drugs.

Some people on the internet think we should build bridges between Democrats and Republicans. That’s a given. But, build bridges with white-pride Nazis? No, I don’t think so.

Build bridges with people like this?

I watched this video, and I’m like, isn’t anyone going to stand up to this bully?

Here’s a warning to bullies: Don’t pull this shit when I’m standing there. I can also cuss like a sailor and I’m not afraid of you.

Criminalizing pain

http://www.kevinmd.com/blog/2016/12/need-speed-acceptance-opioid-guidelines.html

(12/17/2016) We need to speed up our acceptance of the opioid guidelines

My comment:

I’ve predicted that pain clinics and addiction clinics would eventually become one and the same. I suppose addiction clinics will soon be cropping up next to dentist offices and places that treat cancer, too. I guess these places will help the very small percentage of pain patients who also suffer from addiction, but pain patients are extremely tired of being treated like drug addicts.

Yes, the medical industry should pull together and speed up its acceptance of the CDC’s opioid guidelines, even though a basic principle of medical ethics says that when you have an intervention that works, you don’t introduce alternatives unless there are significant advantages. After all, doctors have so many different and successful alternative treatments to manage pain that I’m sure no one will miss painkillers.

Yes, doctors should treat every patient who complains of pain as a potential drug addict. That sounds like a wonderful idea. Let’s see how that attitude will help those who suffer from addiction, along with 90% of the rest of the population.

People refusing to see a doctor when they’re in pain. People in pain automatically going to the underground drug market, where there’s a better chance of finding some kind of relief. What good is a doctor who will not only minimize your pain, but ignore it? How many serious medical conditions will be missed because a doctor ignores a patient’s pain?

Yes, we’ve done such a good job of criminalizing addiction, let’s criminalize pain, too. Another wonderful idea from the medical industry.

Goodbye, Vicodin

http://www.publicintegrity.org/2016/12/15/20544/drugmakers-push-profitable-unproven-opioid-solution

“…crucial efforts to steer physicians away from prescription opioids — addictive pain medications involved in the deaths of more than 165,000 Americans since 2000.”

How much more effort will it take? How much more fear can be instilled in doctors and patients?

Pain medications are not addictive for the majority of people who take them, so to describe them as such is just pure ignorance. Let’s see the number for the amount of Americans who have taken pain medications since 2000 without becoming addicted. Because believe it or not, opioids provide benefits to tens of millions of Americans. And while it’s easy to throw around huge numbers like 165,000 (within a 16-year period), the truth is that the percentage of Americans who suffer from an opioid addiction is very low (0.6% of the population).

“An estimated 78 Americans die from heroin and prescription opioid overdoses every day.”

For comparison, according to the CDC, in 2013 there were 113 suicides every day.

The CDC also says that “firearms are the most commonly used method of suicide among males (56.9%).” When will the government force gun manufacturers to make an abuse-deterrent gun? When will they force gun owners to buy a more expensive, abuse-deterrent model?

“The FDA already has begun moving in the direction suggested by companies, mapping out a process for removing older opioids from the market when newer versions are shown to be more effective at thwarting abuse.”

How many other drugs are considered effective only because they’ve been shown to thwart abuse? Is that the purpose of these medications, or is their purpose to treat pain? Has the FDA determined that it’s not important to show how effective the abuse-deterrent opioids are at treating pain? Because as a 30-year intractable pain survivor who’s taken almost every prescription opioid, I find it hard to believe that these new formulations work better, or even as well as, ubiquitous painkillers such as Vicodin and Percocet.

http://www.publicintegrity.org/2016/12/15/20549/drugmakers-set-gain-taxpayers-foot-new-opioid-costs

Some drugmakers aim to replace ubiquitous painkillers such as Vicodin and Percocet with harder-to-abuse formulations that are patent-protected and command higher prices — a plan that could cost government-funded health programs hundreds of millions of dollars in higher medication expenses…

http://www.facebook.com/CDC

#DearCDC: A basic principle of medical ethics says that when you have an intervention that works, you don’t introduce alternatives unless there are significant advantages. Please share with the public which alternative treatments for chronic pain show significant advantages over opioids for a majority of patients. In other words, prove that the CDC’s guidelines are in compliance with the basic principles of medical ethics.