Chronic pain on YouTube

What does YouTube have to say about chronic pain? My search uncovered the following videos:

I found an interesting and informative talk by a Professor of Anesthesiology at the University of Michigan to actual pain patients (2013):

I think this doctor is trying to change the wording of how we talk about subjective pain, referring to conditions like fibromyalgia as “brain pain,” as opposed to peripheral pain. He’s saying that, yes, the pain is all in your head, but there’s a reason for that, and it’s not because you’re imagining it.

As a pain patient, that’s the message I got; but if you work for an insurance company, the only message you’d hear is that fibromyalgia pain isn’t really real. The pain is an amplification of reality — it’s only your perception of the pain that makes it severe, and your perception has now been deemed overactive. And even though your DNA is partly to blame, your sensitivity to pain is nothing that can really harm you or your body, so your treatment options are restricted and limited.

This doctor says opioids don’t work for brain pain problems, and that they won’t help any patient who’s suffering from a central pain “syndrome” (which he goes on to describe). As far as I can tell, anyone with the label of “chronic pain” is suffering from a central pain syndrome, even though he mostly uses fibromyalgia as an example (along with IBS and TMJ).

And if I’m not mistaken, this doctor believes that fibromyalgia is a case of hyperalgesia, just not always caused by opioids. But he also says that opioids are making chronic pain patients worse, actually causing fibromyalgia and central pain syndromes.

I’ll tell you what, this doctor is very convincing. If not for my own experiences, I might have believed him. But the real proof of whether hyperalgesia exists is in the discontinuance of the opioid therapy.

Now that I’m off all the pills, how come I’m not one of these alleged patients who got better? How many patients really do get better when opioids are terminated? If opioids are causing hyperalgesia in some patients, what about the other patients who don’t have that problem? From the stories I’ve read from pain patients, the only thing that happens when opioid treatment is withdrawn is more pain, so I’m not the only one.

While I found this talk interesting, my take away from the video was that anyone who suffers from chronic pain also suffers from a central pain syndrome — and that means pain medications are not for you.

How will your doctor tell you that he’s refusing to prescribe any more opioids? For this biased re-enactment, we’ll need an example of a pain patient who’s abusing his medications (the patient portrayed in the video has been monitored by the PDMP, which shows he’s received multiple prescriptions for Lortab from different doctors):

In real life, this patient would be behind bars after this visit, especially since he refused the doctor’s suggested treatment (Suboxone or bupe). And just to show you how inaccurate the portrayal of the pain patient is, this guy keeps asking for stronger pain medication — I don’t know any pain patient who would do that, knowing they would be risking whatever limited access they still have.

And I’ll just add that most of the stories I’ve read about patients forced to discontinue opioids involve doctors notifying patients by letter, or just abandoning them altogether by refusing to see or talk to them.

Here’s a sarcastic take on a patient’s first visit with pain management:

Under comments:

petmom ful 10 months ago
I signed the contract and did everything right. They still treated me like a criminal. I hated the whole thing. It was a terrible experience. The drugs made me sick, yet they pushed more and more on me. They would not listen to anything I said. The dr. told me I was a fail and had shut myself off from further treatment. I could not bear any more injections. PT made me so bad that I could not even get on the table after 7 weeks. I told him that would happen but he did not listen. He treated me like a degenerate and yelled at me. They would not even take the time to look at the PT report that had been faxed to them. I made my husband go into the room with me, so maybe they would treat me with a little more respect. I sat across the room so they could not grab my head and jack it right and left to check my range of motion. The drugs made me sick, angry, and upset, then they labeled me a nut. Every appt. I made was screwed up! They give you just enough meds to last to your next appt, then they screw up your appt. and you reschedule. Now you don’t have enough meds to last! Too bad! If you decide you can’t take it, and change doctors, you are now a dr. shopper. It is hopeless. No more pain management for me! I realize not everyone can do without it, but I am managing and I don’t plan on going back.

Finally, here’s our own Payne Hertz’s take on a pain patient’s ER adventure:

Hey, CDC, can you hear us now?

At this point, there are 486 comments on the CDC’s new opioid guidelines. And while I didn’t read every single one, I think it’s extremely important for the voices of pain patients to be heard — which is why I copied and pasted some of the comments (mostly excerpts) here on my blog. Now these comments can be found by a simple Google search, instead of being buried on the CDC website (for however long).

I think it’s also important for patients to know which doctors agree with the CDC (you know, so you can avoid them). (See comments under “Doctor” heading.)

Just like I want my story to be read, other pain patients want the same thing, so please take a little time to read a few of these comments. You can find my story here:

https://painkills2.wordpress.com/2014/11/15/medical-cannabis/

In my overall review of the comments, I’d say that 95% of them are from patients and are against the CDC.  I also noticed that there were a significant number of comments from patients with CPRS, EDS, Arachnoiditis, Interstitial Cystitis, and Fibromyalgia.

I’d also like to mention the defensiveness and fear within all the comments from patients. Many comments include lengthy descriptions of medical conditions, along with adamant protestations of innocence for abusing medications, such as:

“I take my medication exactly as my dr has prescribed it.”

“BUT, I DO NOT ABUSE MY PAIN MEDICATION AND I’M NOT A ADDICT”!!!

I hate to break it to pain patients, but I don’t think that matters to the CDC. See, in this agency’s view, almost EVERY non-cancer pain patient on opioids is taking too high of a dosage. In fact, the CDC believes chronic pain patients shouldn’t be taking opioids at all, so it doesn’t matter if you’re taking your medications as prescribed.

I also noticed that too many commenters posted under “Anonymous,” obviously afraid to use their real names.

Lastly, I noticed that many pain patients are rooting for doctors, saying these decisions are between doctors and patients. Until your doctor abandons you, I suppose you might still have faith in him or her… Yeah, good luck with that.

Because if you believe that the medical industry is on the side of pain patients, I’m afraid you’re in for a rude awakening. If you believe your current doctor will never abandon you, I don’t see how you’ll be prepared for the eventuality. And as a pain patient, if you have to find another doctor for any reason, you’ll be up shit creek (right next to suicide alley).

In fact, many doctors are taking advantage of the opioid war by taking advantage of pain patients — overcharging and other abuses (including sexual abuse) against patients are not reported, but believe me, the medical industry is rife with abuse against patients. Ya’ll be careful out there…

PAIN PATIENTS:

Comment from Anonymous

It is very frustrating to have my orthopedic Dr. be with a group that has passed a policy to not give out pain meds after a certain number of months post surgery, then sends me to a pain clinic who won’t prescribe narcotics either…

Comment from Emily Valtreaux

Why are your “professional panels” made up of people that will greatly benefit by throwing us all in detox I wonder? Why do you cry “hyperalgesia” (apparently the new fear mongerer word favorite) even when an individual is still in pain, just to the point that is tolerable? …

Comment from S S

Announcing this with no notice and over the holiday season keeps the PATIENTS (the citizens who need these medicines) from having any input on the topic…

Comment from Jaymie Reed

One of the biggest problems we face is that the very people who are suffering are the ones that need to speak out but won’t because of fear of reprisal from the DEA. They won’t sign petitions or comment on public forums such as this, because they are afraid that they won’t even be able to fight to get the pain medication they need that it will simply be taken from them completely… The number of heroin deaths are increasing and it isn’t because the chronic pain patient who is being treated for their pain. It is because of the chronic pain patient that is no longer receiving treatment for their pain. They turn to the streets and buy a drug they have no idea how to use and end up overdosing…

Comment from Rebecca

In Colorado they had me try medical marijuana and that also helped but I had to move back to West Virginia and the medical marijuana is not legal here so I haven’t had any real relief in over a year. I need help…

Comment from John Bocchicchio

A colleague of mine who had a similar condition and had been battling out the pain management paradox, I.e. You are treated like a drug seaker until further proven. He dealt with the suspicions, urine tests, and intense scrutiny as he was fighting for his life with the pain that sought to kill him. Unfortunately, the pain won. Faced with disability battles, and struggles obtaining relief from chronic pain that is constantly screaming at you to give up, he took his own life in 2009 rather face another day of pain and frustration. I don’t want to end up being like my colleague…

Comment from Shelley Anderson

Do you know what it’s like to feel split open from the waist down, have red ants dumped on you, and be eaten alive from the inside out…. YEAH… THAT’S HOW I FEEL EVERY SINGLE DAY… and yet – the answer I get from our local clinic is…just go to the ER to get some pain relief. REALLY? For Gods sake – I DESERVE TO LIVE A SOMEWHAT NORMAL LIFE…I feel like a begging junkie every single month when I have to pick up my “piece of paper”….how gross to live like this. It’s just so damn frustrating. Today…I’d be better off dead. What a sad and pathetic way to try and get my point across. So so so sad. No one should have to live like this. No one.

Comment from Kevin Howerton

I have a degree in neuroscience… Likewise “they aren’t terminal” seems like a very poor argument for denying someone treatment that has the potential to drastically improve their quality of life. I’d rather a short and painful life to a long and painful one.

Some of the more “serious” arguments seem to revolve around the idea that opiate use increases exponentially. “Opiates require an infinite increase to quench an ever increasing tolerance”. You’d be surprised but this idea is preposterous. You have a finite number of receptor sites in your brain; your head occupies a finite amount of space … how could you expect an infinite amount of tolerance. Tolerance does increase with chronic opiate use though it is far from infinite. Having to titrate up a patient to a useful therapeutic dose as their treatment and disease progresses is not something physicians have to uniquely do with opiates … rather this is the nature of all drugs…

Comment from Dana Spencer

I will never get better. I will only get worse.

Comment from Anonymous

SHAME ON YOU

Comment from Anonymous

I just notice the comment I submitted 12/20 was not listed. In fact, comments between 12/19-20 were missing. [This was not the only mention of disappearing comments.]

Comment from Lori Mahloch

I am appalled that the CDC thinks that the only people who deserve to be treated humanely are people with Cancer. I have Reflex Sympathetic Dystrophy, This rates the HIGHEST on the McGill pain scale for pain. Yet I am unable to get treatment by physicians because of CDC guidelines. Walking into a doctors office for a first visit and the first words out of a doctors mouth should NOT be we don’t give pills here. Because of the audacity of the CDC many doctors will not see, nor treat anyone who has a chronic pain disease. I have not been able to see a doctor for a year because of these guidelines. I have lost friends to suicide , due to not being able to get pain meds for their pain…

Comment from Rebecca Scarbrough

Do you think regulations that label sick people as drug addicts or dealers helps with the personal anxiety and depression that almost always accompanies chronic pain? Why add to this? I wonder how many lives were lost when a pharmacist stare and judgement was the final straw. Have you ever thought of that? …

Comment from George Gregorich

I no longer respect or trust doctors…

Comment from Rhonda Barth

You all should be ashamed! My husband is 100% service connected disabled Veterans who is being made to suffer in agony now because you have made it to where the VA is taking away his pain medication. He is now bedridden and has no quality of life, he does not want to be here anymore…

Comment from Theresa Schramm

After 32 years of dealing with temporomandibular joint pain and dysfunction, I had both of my jaw joints replaced and all of my remaining natural teeth pulled earlier this year. The TMJ dysfunction has improved, and is still improving as I slowly get used to dentures, but the headaches and myofascial pain have not. The surgeon was very clear in warning me up front that the pain might not improve with this surgery, and he was right. It seems that the 32 years I spent trying to find ways to treat this has left me with incurable scar tissue all around my jaw joints on both sides. This scar tissue affects every move I make with my face, from simple carrying on a conversation all the way up to eating. My mouth will never open as wide as it should, nor will it move from side to side. I experience pain on a daily basis, sometimes in my jaw joint areas and more often all over my head. It hurts to talk on the phone for more than 15 minutes. Singing causes such pain I have almost completely given it up…

Comment from George Gregorich

I can’t wait for the day when I watch the news and see you people being arrested for crimes against humanity. You are just as bad as chronic pain , you don’t know when to quit…

Comment from Richard Osband

Opiates (of one form or another) have been the sovereign analgesics for centuries. The CDC’s efforts to essentially criminalize them when no other really effective alternative to their use exists is simply sadistic. While there are many ways to treat addiction there are no other ways to treat intractable pain. The proposed guidelines seem to make pain management a matter of morality rather than of proper clinical practice…

Comment from Anonymous

I have lived with Severe pain since I was 14 years old. There is no doubt what the cause is behind the pain. I have had 13 brain surgeries since then and 4 spine surgeries. If I did not have access to my daily dose of Morphine, and Hydrocodone I would not be able to get out of bed because of Hydrocephalus, and a spine disorder called Arachnoiditis. Please stop the madness surrounding to restrict access to much needed life-improving medications. Doctors have all said to me, I may not have cancer but its clear from my vital signs, my labwork and scan results I am living in constant severe pain, and need to be treated adequately before it kills me. It’s proven that chronic pain can put a strain on your heart and other vital signs if not treated appropriately patients can die prematurely.I am fearful that the government wants to do is kill off all chronic pain patients rather than helping us have a better quality of life. The pain we are in isn’t psychological.

Comment from Paul Clay

I work in emergency medicine and critical care. Here’s what happened to opiod abusers. They couldn’t get prescription pills easily enough so the abuser went to heroin,which resulted in more overdose deaths in a few months more than i had seen in my 20 yrs. . If your goal was to kill off the abuser and make it more difficult for true needs patients then congratulations you have succeeded…

Comment from barbara williams

I was nave in thinking that when people are in pain that going to a pain clinic would fix everything. Going to the pain clinic did nothing. Tramadol took a bit of the edge off, but ganglion blocks, injections, trial l with spinal chord stimulator did nothing. We then tried alternative methods of chiropractor care acupuncture, calmare scrambler, ozone injections, dry needling and biofeedback to the tune of $10,000…

Comment from Arianne Grand-Gassaway

Relief from pain should not be a crime…

Comment from Angela Farthing

I am a victim of the 2012 Fungal Meningitis outbreak. I was injected with a contaminated vial of methylprednisone acetate to treat sciatic pain. Shortly thereafter I was diagnosed with fungal meningitis, suffered a stroke, a brain aneurysm, an intradural abscess, and ultimately adhesive arachnoidits. The arachnoiditis left me in horrific pain, pain that literally made me wish I never survived the meningitis (which I almost didn’t). When I initially told my doctors about the pain that left me crying on the floor, my plea for pain relief began…  I now take Low Dose Naltrexone and am completely opioid and synthetic opioid free…

https://edsinfo.wordpress.com/2015/12/22/one-pitfall-of-chronic-oral-low-dose-naltrexone/

DOCTORS:

Comment from Stephen Pew, Ph.D.

My own Mother ended her own life by starving herself because her chronic pain was mismanaged and the doctor would not allow her IV morphine to be administered even in the hospital because “she might get addicted”… I myself ended up in the emergency room with a kidney stone. I was shuffled around for over two hours in terrible pain because the ER was hesitant to administer care for pain. After an hour I was finally given an IV for pain and it was explained to me by the doctor that new regulations limited their ability to treat efficiently. No follow up opioid medication for pain was allowed…

Comment from Elayne Baumgart, Ph.D.

It would be one thing to remove opiates if you had something with which to replace them. Something that would effectively manage pain. But, you don’t…

Comment from Kathryn Rosenberg

I am a Family Physician with 33 years experience in the field. I began to see a pain specialist for back pain about 3 years ago mainly to prevent any questions about my use of opiates. Since then I have started Lyrica and ymbalta for pain control. I have found Tylenol to be of little use… I simply do not see how I could go on living if opiates were not available to me.

Comment from Paul McCurry

As an anesthesiologist, pain physician and addictionologist [made-up term], I applaud the CDC’s efforts to assist in curbing the current opioid addiction epidemic our country is experiencing… All of these adverse consequences are due to continued prescribing of drugs that have NO LONG TERM PROVEN EFFICACY…

Comment from Nathan Hitzeman

These recommendations look reasonable… As a primary care doc losing the war on chronic pain, I applaud the CDC for coming up with these guidelines!

Comment from Blaise Vitale

I am a family physician who regularly sees that chronic narcotics are simply ineffective for chronic pain. I know there are a lot of people who are addicted who think their lives will be ruined by stopping narcotics, but they simply can’t see how the narcotics are harming them. These guidelines may not go far enough to discourage opioids for chronic non-cancer pain. In particular, any patient who has any history of addiction to substances like tobacco or alcohol should never be prescribed these medications chronically. [This is what discrimination looks like.]

Comment from Adrian Bartoli

As a physician specializing in chronic pain management for the past 20 years, double board certified in Anesthesiology and Pain Management, involved in clinical research and the pharmaceutical industry, I strongly and unequivocally SUPPORT the CDC recommended guidelines for restrictions on opioid prescriptions…

Comment from Dr. Edwin Cabassa, DNP, FNP, BC

Unfortunately, there is a significant abuse for opiods in all socio-economic communities. Doctors and Nurse practioners are a major source for those seeking illegal use of such asnd ssimilar substances. My experience is such I will not prescribe opioids unless there is a definitive diagnosis indicating its use. From my panel of patients, I’ve been able to isolate my patients to just 3 who require opiods…

Comment from Maryn Sloane

As an MD board certified in addiction medicine with a sub specialty in the hopefully growing field of effectively treating opiate dependent chronic pain pts… [Someone is seeing lots of dollar signs…]

2. ANYONE on an opiate >30 days will develop opioid induced hyperalgesia… [Liar, liar, pants on fire.]

Opiates ARE NOT INDICATED EVER for neuropathic pain. They WORSEN IT. [Maybe in some patients, but not all.]

Man up docs! – JUST SAY NO!

it takes the simple writing of a prescription to create a substance dependent patient… [Speak for yourself, not everyone else.]

Chronic opiate users should be registered

detoxes should be offered for any pt on opiates for >1y

SUBOXONE MUST BE STANDARD OF CARE

Comment from Richard Webb, MD, Addiction Psychiatry

The use of opiates should be used with extreme caution in anyone with a personal or family history of addiction. [How many Americans don’t have a personal or family history of addiction?]

Comment from Maxwell Stepanuk

I am an orthopedic surgeon and the abuse of opioids is appalling… The problem, as I see it, is with the GPs. [Doctors turning against each other?]

Comment from Barry Saver

As a family physician who has spent my career working in the health care… I would say I have seen some patients genuinely helped by chronic opioid therapy for pain – but far more harm, including addiction, overdose, and diversion… Based on conversations with colleagues, at least 99% would happily accept a time limitation for how long they could prescribe opioids to an individual patient (with exceptions for oncology and palliative care)…

Too bad there aren’t many doctors who commented that still believe in medical science. (Still think doctors are on your side?)

Maybe you’re wondering if I made a comment? No, and I’m not sure I will. However, considering I am currently without bud and in a really bad mood, I might just change my mind. And since I don’t see a rule about how many comments one person can make, I’m sure I could wrangle some fun out of the experience. 🙂

Note:  Comments are due by January 13, 2016.

Dr. Shame

If you’re not a chronic pain patient, this post won’t interest you…

And it’s really (really) long, because the linked article is full of lies, hypocrisy, and voices of “experts” who aren’t really experts. In other words, there’s a bad word (or two) in this post, as I really (really) dislike liars. Don’t say I didn’t warn you…

You’re still reading? Seriously, since this is my blog, I get to rant, but you don’t have to read it. 🙂

http://www.mailtribune.com/article/20151108/NEWS/151109770

Patient reactions are ranging from dismay to newfound hope as doctors cut back on narcotic painkiller prescriptions for chronic pain in an effort to combat addiction.

Newfound hope?  Ummm, okay, this should be interesting…

And just so we get this straight:  Doctors are reducing or stopping medications to combat addiction, not treat pain. So, really, what doctors are doing is treating about 90% of pain patients for addiction — a condition they don’t have — while also refusing to adequately treat their pain.

Linda Stotts, who lives in the town of Rogue River, said she has tried almost every available painkiller since rupturing disks in her back while trying to lift a desk in 1987. She has taken methadone for four years to ease her pain, but has been told she must taper off the drug until she is methadone-free in two months.

As she reduces her dose and her pain worsens, Stotts said she is contemplating suicide… Stotts, 69, said she fears she no longer will be able to care for herself and will have to move to a nursing home. She said she has been classified as a drug addict because of her painkiller use…

Dr. Jim Shames, medical director for Jackson County Health and Human Services, has been spearheading the local effort to curb use of addictive opioid painkillers…

And so enters the black knight in tarnished armor…

“These drugs are powerful, addictive and dangerous,” Shames said. “But at the same time, people are in pain and we’re bringing their doses down. They’re in a tough place and I recognize that. The trick is how to compassionately put them in a safer place and give them better tools to manage pain. Nationwide, there are millions of legacy patients on high doses. No one is trying to be cruel.” …

“Legacy” patients — what an interesting term. I looked up the definition of that word, but I’m still not sure what this Dr. Shame (I mean, Dr. Shames) is referring to. One of the ways Google defines legacy is:

“denoting software or hardware that has been superseded but is difficult to replace because of its wide use”

If you’re a pain patient currently on opioid treatment, what do you think your chances are of being one of these legacy patients, allowed to continue on opioid therapy?

I read about another anti-drug doctor who suggested that doctors wait for legacy patients to die out, but not create any new ones. I think he said this would take a couple of decades. Isn’t it comforting to know that the medical industry is waiting for current pain patients to die out? Doctors don’t have to feel guilty about not treating us because we’re terminal.

Wait a minute…  If we’re terminal, are we now “legitimate” pain patients?

Shames said the pharmaceutical industry oversold the benefits of opioid painkillers. New research shows they are only about 30 percent effective in treating chronic, long-term pain.

Did Big Pharma oversell the benefits of opioids or did doctors just hear what they wanted to hear? And why would doctors trust their local pharma rep over their own experiences? Did you know that oxycodone has been in clinical use since 1916? (Per Wikipedia.)

Funny how easy it is for doctors to scoff at medication that’s 30% effective, although there’s no reference or link to the research, so I’m not exactly sure what Dr. Shame is talking about. Is he saying that opioids give a patient 30% relief from the pain? Or that 30% of pain patients show increased function with opioids?

Exercise, physical therapy, adequate sleep and cognitive behavioral therapy can yield better results, he said.

If doctors won’t tell you the truth, then I will:  Do you know what treatment yields the best results?  By itself, that would be opioids. But if you have enough money and time to include all these other treatments along with opioids, then the combination of treatments would provide the best results.

Some researchers have reported long-term use of opioids can leave patients hyper-sensitive to pain. Shower spray can feel like needles driving into the skin, for example.

Gosh, I really hate to nitpick (obviously not), but I haven’t read about too many patients who actually suffer from hyperalgesia. But I’m wondering, if you stop taking opioids and your pain doesn’t magically decrease or disappear, would Dr. Shame then allow you to access opioids again? Somehow I doubt it, which makes this doctor a freaking hypocrite.

Because of opioids’ addictive nature, patients become physically dependent on them. Without the medications, patients can suffer withdrawal symptoms such as nausea, vomiting, diarrhea, muscle pain, sweating, chills, insomnia, anxiety, irritability and low energy.

So, how about we don’t take these medications away from patients? Instead, increase efforts at educating (not scaring) patients about the drugs they’re taking. There, problem solved.

Touchstone Interventional Pain Center in Medford is among local medical groups working to transition patients to safer doses or off opioids altogether. A few months ago, the center sent a letter to 1,500 patients saying changes in the field of pain management likely will cause adjustments to pain medication prescriptions. The high risk of overdose death, coupled with studies showing many patients with chronic pain failed to show substantial improvements in pain, have caused a shift in policy about prescriptions, the letter said. Patients on high doses were told they would need to taper down to safer levels within three to six months…

I can’t imagine receiving one of these letters…  I’m sure the thoughts of many of these patients turned to suicide. Lucky for them, they live in Oregon, which is one of a very few states that have a right-to-die law.

“For the majority of patients, this transition can be done slowly and in a way that is tolerable,” the letter said. “Many patients may even notice an improvement in their pain as several studies suggest that pain medication over time may actually worsen pain.”

Let me translate:  I’m the doctor. I know what’s best. I paid hundreds of thousands of dollars for those fancy degrees on my wall. And I’ve decided that you should suffer. But hey, don’t worry about it, you could be part of a very small percentage of patients who actually feel BETTER after they stop taking medication to treat their pain. Anyway, there’s nothing you can do about it, so you can either agree, or… fuck off.

Dr. Shawn Sills, a pain expert with Touchstone, said most patients have been understanding about the changes. 

Most? Ah, Mr. Sills, just another liar and hypocrite…

He battled opioid addiction himself several years ago and was the subject of an Oregon Medical Board investigation. After undergoing treatment, Sills opened Touchstone in 2012 with firsthand knowledge of the addictive power of opioids. He is also the medical director for Addiction Recovery Center and Rogue Valley Fresh Start Detox in Medford.

Oh. My. God. Another ex-addict turns his personal experiences into a profit-making machine…

“If opioids worked, we would be happy to continue prescribing them,” he said. “But the majority of patients develop tolerance. Doses go up, they get tolerant, the dose escalates, and then they’re at risk of dying — even when they’re not abusing and they’re taking their medication as prescribed.”

If doctors admitted that opioids actually do work, your business would suffer, right Mr. Sills? And I have to wonder if your clinic prescribes bupe or methadone. (You hypocrite.) Or do you just over-prescribe antidepressants and anti-psychotics? (Still a hypocrite.)

The truth is that the majority of pain patients are not abusing their medications; they work just fine. And if patients are taking their meds as prescribed (including being careful of interactions), they’re not at risk for dying. Wow, they’ll let anyone be an “expert” these days, won’t they?

“As they cut down on medications, they experience withdrawal. It’s really hard for our patients, and not all of them understand why they’re being cut down,” he said. “They say, ‘I’ve been taking these for years and I haven’t died.’

Yeah, but tomorrow, you could become a drug addict.

We try to discuss research with them that opioids can make pain worse. If we slow down the taper and educate them, most understand. About 10 to 15 percent are really struggling and may need to be kept on those higher doses.”

Well, there you go. About 10 to 15 percent of current pain patients will be allowed to become “legacy” patients. Talk about death panels…

Continued opioid use may be appropriate for patients who experience pain relief and improvements in their ability to function.

What a thin line patients walk when trying to prove they deserve pain medications:  If you don’t show enough improvement, the meds are taken away. But if you show too much improvement, doctors will say you’re cured… and then the meds are taken away.

Some older patients also may be kept on their medication because they are less likely to escalate their dosages compared to younger patients, Sills said.

Another wow, because this doctor is basically (and publicly) discriminating against young people.  Especially when the age group allegedly abusing their meds is the older one. I wonder how he feels about women and black people?

Many insurance companies are now covering other pain treatment methods, including physical therapy and counseling. There are also procedures that can target pain generators, such as radiofrequency ablation, in which a current targets nerve tissue, Sills said.

I’m sure these treatments help some pain patients, but tell me Mr. Sills, if you burn nerve tissue and it makes the pain worse, how are doctors going to treat the resulting (and new) pain?

I think it’s important for patients to realize that if a treatment is unsuccessful, treating the new (and old) pain with opioids will not be an option (at least for very long). I assume that goes for surgery, too. If your pain levels haven’t been reduced within a couple of weeks or months after surgery, you won’t have access to pain meds.

I know a pain patient in the U.K. who was told at her last doctor appointment that from now on, opioids will only be prescribed for cancer patients. And even though she’s a cancer survivor, she’s technically in remission, so no opioids for her.

Sills is also using the new Senza spinal cord stimulation system, which was approved in May by the federal Food and Drug Administration as a method to combat pain…

Before you have an implant, be sure to check for recent FDA and international recalls.

While attending pain resiliency group sessions, Eshoo said she learned opioids can be appropriate to treat short-term acute pain from injuries such as a broken bone, but they can do more harm than good for chronic pain…

Brainwashing or placebo effect?

She learned relaxation, moving, breathing and stretching techniques, and how to manage the negative emotions and thoughts that come with chronic pain. Her quality of life has improved and she lost 70 pounds…

Okay, I’m gonna guess that this patient is an exception, not the rule.

Statewide, prescription opioid overdose deaths skyrocketed from 48 in 2000 to 239 in 2006, when deaths peaked. Deaths have been trending downward to 150 in 2013…

https://olis.leg.state.or.us/liz/2015R1/Downloads/CommitteeMeetingDocument/58819

Total number of suicides in Oregon (2013):  698

I think the use of the word “skyrocketed” says a lot. Funny, no one talks that way about the increased suicide rate. 😦

Yeah, that’s me.  Fighting hypocrisy.  (With my keyboard.)  Every. Single. Day. 🙂

In Heroin Crisis, White Families Seek Gentler War on Drugs

When you think about the New York Times, you usually think about some kind of quality reporting. Maybe even some fact-checking. I think of the NYT’s coverage of the drug war to be more of a mouthpiece for corporate and political America than real investigative reporting. But it’s always nice to know what the rich and influential are thinking:

http://www.nytimes.com/2015/10/31/us/heroin-war-on-drugs-parents.html

While heroin use has climbed among all demographic groups, it has skyrocketed among whites; nearly 90 percent of those who tried heroin for the first time in the last decade were white…

The Times states this as if it were fact, when it’s only based on “self-administered surveys to gather retrospective data on past drug use patterns among patients entering substance abuse treatment programs.”  I can’t imagine that too many people are honest about their past drug use, let alone those who suffer from addiction. And I imagine that the racial make-up of addiction treatment programs is unlike the racial make-up of America’s prison system. Like a lot of (psychiatric) research studies, this one doesn’t prove anything.

I don’t know what percentage of first-time heroin users have been white in the last decade, but heroin has always been a drug used more by white people than blacks (even if the media in the past portrayed it differently). It’s usually not good to generalize, but people use certain drugs because they have access to them — a $400/day heroin habit is not something most black people would have access to. (Another reason why pain patients, usually poor and disabled, aren’t really a part of this heroin “epidemic.” Even though the DEA says heroin is cheaper than pills, if you need to spend $400/day for the drug to be effective, that’s a choice most pain patients don’t have.)

And the growing army of families of those lost to heroin — many of them in the suburbs and small towns — are now using their influence, anger and grief to cushion the country’s approach to drugs, from altering the language around addiction to prodding government to treat it not as a crime, but as a disease.

“Because the demographic of people affected are more white, more middle class, these are parents who are empowered,” said Michael Botticelli, director of the White House Office of National Drug Control Policy, better known as the nation’s drug czar. “They know how to call a legislator, they know how to get angry with their insurance company, they know how to advocate. They have been so instrumental in changing the conversation.”

Mr. Botticelli, a recovering alcoholic who has been sober for 26 years, speaks to some of these parents regularly.

Their efforts also include lobbying statehouses, holding rallies and starting nonprofit organizations, making these mothers and fathers part of a growing backlash against the harsh tactics of traditional drug enforcement…

These mothers and fathers are also part of the backlash against opioids. So, even though they’ve changed their thinking on how to treat addiction (no jail time for their families), that doesn’t mean they want to end the drug war. Far from it.

Heroin’s spread into the suburbs and small towns grew out of an earlier wave of addiction to prescription painkillers; together the two trends are ravaging the country…

I’d say the suicide epidemic is the trend ravaging our country, but then maybe my opinion differs from those over at the Times. But I get very tired of the media saying that prescription painkillers started this whole heroin epidemic, because that’s not true. Maybe in the media’s little white bubble, painkillers are to blame because that’s all they see — because white people are the ones with the most access to painkillers (and heroin).

This is what pain patients are up against — grieving, middle-class white people, with the time and money to make our lives miserable. Grieving parents writing anti-drug curriculum for schools, opening addiction “clinics,” and yelling in the ears of politicians and those with influence (like Michael Botticelli, director of the White House Office of National Drug Control Policy). Do you think Mr. Botticelli would make time to talk to pain patients (who are disabled and poor)? Do you think an ex-alcoholic could even understand our position?

While it’s great that more (white) people are finally recognizing addiction as a disease, the problem remains:  What’s the best way to treat it? Obviously, what we’re doing isn’t working, and these parents know it because their family members usually spent time in rehab. So, we’re gonna send millions of new patients into treatment and treat them with… what? Bupe and Suboxone? Antidepressants? AA? Talk therapy? An addiction clinic on every corner?

It’s like creating a war against opioids, but not being prepared for the consequences. The plan to substitute alternative therapies for opioids isn’t working — as if there was even a small chance that it would. Now everyone wants to treat addiction with treatments that only work for a small number of people.

We know the results of the failed (white people’s) drug war.  What will be the consequences of the white people’s war against addiction and opioids?

Bupe approved as a Schedule III opioid

http://inp.medpagetoday.com/butrans/what_does_ciii_mean_for_you_and_your_patients-79/What_does_CIII_mean_for_you_and_your_patients-412?isalert=1&uun=g875301d4621R7051790u&xid=NL_salesalert_2015-10-29

Did you know that Butrans® (buprenorphine) Transdermal System is the only available Schedule III extended-release opioid?

https://painkills2.wordpress.com/2015/07/12/buprenorphine-for-chronic-pain/

Will doctors become obsolete?

MedPage Today is written and read by doctors, which is why I think it’s important for patients to have a voice in that forum. Unfortunately, the website wouldn’t allow me to post a comment to this article, so I’ve got to post it here.

http://www.medpagetoday.com/Psychiatry/Addictions/54186?xid=nl_mpt_DHE_2015-10-21&eun=g875301d0r

“Nelson noted that most chronic pain does not respond optimally to opioids, and many patients can use better alternatives for chronic pain. ‘We have learned this the hard way over the past 20 years,’ he said.”

It appears that pain patients and doctors have learned completely different things over the past 20 years. With the experience of suffering from intractable pain for the last 30 years, I certainly don’t agree with this doctor’s opinion. (How many other pain patients would also disagree? And whose opinion is more important?)

In fact, I’d like to know which treatment options this doctor believes are “better” alternatives for the treatment of chronic pain. Better in what way? Better for each individual patient, insurance companies, the alternative medicine and addiction industries, or the DEA? (Breaking news: Walgreens and CVS employ addiction “counselors” at every pharmacy. Just $20 for an initial visit. Bupe prescriptions available. Thanks, President Obama!)

What does successful treatment for pain look like? If a pain patient doesn’t develop addiction, doctors consider that a success. Are doctors trying to treat pain or the mental illness of addiction? And how many pain patients really suffer from both?

Maybe I missed the research that proves any of these alternative treatments actually help a significant percentage of pain patients (like opioids do). But I haven’t missed the complaints by patients that show the amount of harm caused by the non-opioid treatments which are being forced upon them.

Which is more harmful, treatments like steroid injections and antidepressants or opioids? What about the pain patient who’s been spending an enormous amount of money on painful chiropractic adjustments for the last 5 years and hasn’t seen any improvement? There are many different levels of harm caused by non-opioid treatments (including financial), and yet doctors still use them because of the opioid war. When there are about 400,000 patients who die every year from medical mistakes, why should doctors (and law enforcement) decide which treatment options should be available to patients? Who are the experts here?

What pain patients have learned during the past few decades — while the drug war invaded their health care — is that trusting doctors and medical science is a big mistake. Research by survey is now considered evidence and used to shame and discriminate against patients. Long-term evidence doesn’t exist for most drugs, not just opioids, because no one wants to pay for it. Anecdotal evidence is the only thing left that doesn’t always include conflicts of interest.

“Study authors and the editorialists reported no relevant financial interests.”

Everyone knows that financial interests — whether deemed relevant or not — are not the only conflicts of interest that exist within these industries.

“‘There is virtually no data for safety or efficacy in chronic non-end-of-life pain, but patients are convinced that they need [opiate medications],’ Nelson added.”

Funny thing about medications that work — patients learn to ask for them. (And because of the drug war, drugs that work are worth more money in the underground market, so diversion will always happen.)

No one can deny that opioids work, and just like all other legal and illegal drugs, that means opioids come with side effects. Let’s see, which is more harmful in the long-term, chemotherapy or opioid therapy? Surgery or opioid therapy? Dulling chronic pain with alcohol or opioid therapy? Medical cannabis or opioid therapy? Instead of discriminating against one drug or another, why not utilize a combination so as to reduce the harm of a single one? C’mon, this isn’t rocket science.

With doctors like Lewis Nelson (practicing in New York, just like Kolodny from PFROP), who needs enemies? And when did patients become more knowledgeable than doctors? Within the last 20 years? I admit, I enjoy seeing doctors make fools of themselves because of the drug war. It allows me to imagine a day when doctors become obsolete, just like cars you have to drive yourself.

Pharmacies not accepting new Suboxone patients

http://www.suboxforum.com/pharmacy-isn-taking-new-patients-t11133.html

jrhea0095
Mon Dec 22, 2014 6:51 pm

I just changed my suboxone doctor and switched to a new doctor closer to home. After I left the doctors office I drove to my pharmacy to fill it and where I have filed all my perscription including from my previous doctor just a month ago and my pharmacy refused to fill it. They told me they were not accepting new patients. What does this mean not accepting new patients? I am an existing patient of Suboxone and they just filled my prescription a month ago so why are they refusing to fill my prescription now? I didn’t really think too much about it so I went to other pharmacies and then called around to others neat my home and no one would fill my prescription because they said they were not accepting new patients of Suboxone. So at this time I have called over 20 places today trying to find someone who will fill my prescription and they have all told me they do not accept new patients. So what am I supposed to do? I just paid $375 today for my new patient monthly fee and now I can’t even find a place to fill my prescription…

http://wjhl.com/2015/07/29/tonight-6pm-treating-addiction-with-prescription/

Kylie: “there WAS an investigation into Watauga Recovery Center for going over the 100 patient limit. And you really stood behind, “We felt like we couldn’t turn those patients away.’ Anything else you want to say about that now, since at one point you all were seeing over 100 patients yourselves.”

Dr. Reach: “Well, what we did is worked with the DEA and provided them with a plan of action where we were going to get in compliance with the law. That included removing patients from our list that were not compliant with their therapy…

http://www.addictionsurvivors.org/vbulletin/showthread.php?t=29921

Redtail
Junior Member

Below is the letter I sent to Wounded Warrior Project and all of my State Senators and Congressman and still no help. I am 100% disabled veteran suffering from Chronic pain, PTSD and Traumatic Brain Injury. They lied to me and said if I gave up my benzos I could get in their Suboxone/subutex program then denied me again. I asked for my benzos back and was denied them. I have no meds for my PTSD. I will die from complications from this dependence/addiction. The one sub Dr. nearby told me to take my money to the street as he new of no pharmacy that would fill it. I called every one nearby and was told they would not fill it. My Pain Mgt Dr dropped me last month for being 2 pills short. Now i must depend solely on the street. I can not do this.

I am 100% disabled Navy Veteran (PTSD). I have been on Oxycodone for over ten years for chronic pain in my joints prescribed by civilian Drs. About three years ago it became clear to me that it was no longer helping my pain but I had become dependent on it and needed to stop. The Drs. had me on the maximum dose and could go no higher. But I could not function at all with out it. I made several attempts to get help from the Mountain Home VA (30) miles and was turned away and told I was not a candidate for help. One time I went there for help begging for opioid replacement therapy but was put on the psyc ward for seven days suffering from withdrawal then sent home. I was able to stop the Oxycodone by going to a methadone clinic in NC every day which cost me over $900.00 a month. I quit after 3 months as I could not afford it. I once again tried to get the help I needed at Mtn Home by contacting my Congressman but was turned away again. I plan to start at a subutex/suboxone clinic nearby soon. It will cost me $400.00 a month for each visit and also the cost of the medication and it is also very expensive. I have Hep C and I have researched this and found suboxone has a second ingredient that is not good for any one with Hep C so I will have to have subutex. Subutex is in the VA formulary. I guess this is a complaint and a request as I would like to come to the Salem VA (150 miles) to get this help. I was told the last time at the Mtn Home ER that I would never get it at this hospital were their words and told me to go to Salem. It is a shame that I have to spend this kind of money (my VA Compensation check) for the help I need when my local VA could but will not help.

Snyder Drugs refuses to fill bupe prescriptions for men

http://suboxonetalkzone.com/double-standard-for-buprenorphine-at-pharmacies/

People knowledgeable about buprenorphine and Suboxone know that Suboxone and buprenorphine are virtually the same medication. People who inject both drugs in studies will give higher average ‘liking scores’ for buprenorphine, but there is considerable overlap between the two medications. Patients in my practice who admit to injecting Suboxone or buprenorphine (to make it last longer) before they could find a certified doctor claim that they found no difference between the two medications. I’ve described other reasons why adding naloxone to buprenorphine is more of a marketing ploy than a deterrent to diversion. For example, naloxone lasts about an hour in the bloodstream, whereas buprenorphine lasts for days, and the high-affinity binding of buprenorphine is not significantly impacted by the comparatively-weaker drug, naloxone.

The standard narrative, that holds that Suboxone is ‘safer’ than buprenorphine, relies on false assumptions. Many people who should know better believe that naloxone provides some measure of safety in people who don’t inject the medication— that the naloxone ‘blocks euphoria’ or that the naloxone ‘provides the ceiling effect.’ This is, off course, hogwash (do they use that term outside of the Midwest?).

The importance of naloxone is so low that the standard of care in pregnant women is to prescribe ONLY buprenorphine based on the argument that it makes no sense to expose a fetus to an extra medication (naloxone), when that medication doesn’t do anything. The natural question is ‘why expose ANYONE to an extra medication, when that medication doesn’t do anything?’

Opioid dependence is a potentially-fatal condition. People trying to rebuild their lives, after active addiction, frequently begin from a position of unemployment and poverty— and no health insurance. If lucky enough to find a physician who prescribes Suboxone or buprenorphine, their access is severely impacted by the cost of the medication. If their doctor prescribes Suboxone film, they will pay over $500 per month out of pocket. If their doctor instead prescribes buprenorphine, the cost drops to $135—saving almost 75%. But if that patient lives in remote Michigan and wanders into Snyder Drugs, the cost for the same amount of buprenorphine is over $450. I assume that Snyder Drugs has access to US Mail, UPS, FedEx, and all the other delivery methods available in Wisconsin (i.e. they do not rely on bobsleds). We often hear of criminal charges against people who gouge prices for generators during storms. Given that the current epidemic of opioid dependence has killed for more people than the typical hurricane, is it reasonable for a drugstore to mark up life-saving medications by 200%?

It gets worse. Snyder Drugs has a policy that forbids filling prescriptions for men for buprenorphine, but allows filling of the same prescriptions for women—pregnant or not—based on their conviction that men are more likely to divert buprenorphine than women. Men prescribed buprenorphine must drive hours to find a pharmacy that will fill their legal, legitimate prescription; several hours to avoid gouging altogether…

UNM Project ECHO bites the dust

http://www.pharmaciststeve.com/?p=11648

Just six weeks after New Mexico announced that the overdose death rate had unexpectedly climbed, the state received a federal grant to target opioid overdoses with big data, better monitoring and more education. The New Mexico Department of Health said it received an $850,000-a-year grant for the next four years to enhance prescription drug overdose prevention. If renewed each year, the grant would provide $3.4 million for five more staffers working on overdose prevention initiatives.

“This funding allows the New Mexico Department of Health to develop new partnerships with the Board of Pharmacy and the Workers Compensation Administration. It will increase our capacity to reach communities with a high overdose burden,” Health Secretary Retta Ward said in a statement.

After two years of decline, the number of people in New Mexico who died from a drug overdose in 2014 hit 536, a jump of 20 percent over 2013. Officials say 265 of those deaths were the result of prescription opioids. The statewide rate of 26.4 overdose deaths per 100,000 population stands at one of the worst in the United States, along with West Virginia and Kentucky.

A major focus of the grant will be to better coordinate a Board of Pharmacy registry that is to be used by medical professionals who prescribe pain medication — an online tool called the Prescription Monitoring Program. The information is meant to help monitor patients who misuse pain prescriptions by shopping for several different providers around the state to write scripts.

But because there are seven medical occupations that can prescribe — from medical doctors to dentists — there are inconsistencies in how the database is used, as each reports to a different regulatory board where enforcement varies.

“Sometimes people get introduced to opioids in different ways. They’ll get injured and go see a medical provider and they’ll prescribe opioids. In cases, that person can then get addicted and overdose can result,” said Dr. Michael Landen, an epidemiologist with the state Health Department. “This whole pathway starts with that initial prescription and ensuring that prescription is appropriate is important.”

The grant will not only allow the state to capture more data from prescription writers, but also to deploy caseworkers into areas where they see “prescription hot spots” for drugs such as oxycodone, fentanyl, methadone, hydrocodone and buprenorphine.

“We’ll be able to use the data to work with individual doctor’s offices to improve prescribing in those offices,” Landen said.

Between 2001 and 2011, for instance, oxycodone sales in the state tripled, according to the Health Department.

Another emphasis for how the money is used will be to coordinate education efforts with the state Workers Compensation Administration, which has data on prescriptions for workers who were injured on the job — such as those with back ailments from heavy machine work or long-distance driving.

Landen said Washington state had success reducing overdoses in this population, which might come from a background where they haven’t seen addiction and don’t recognize it.

“We’d be able to analyze the data and make decisions on how to improve prescribing through their program,” he said.

Which means they will be seeking out any doctors prescribing over the maximum morphine-equivalent level and “educating” them about reducing dosages (and abandoning patients).

Some states, for instance, have looked at a “lock in” requirement, in which workers filling pain prescriptions have to use one medical provider and one pharmacy to better monitor usage.

Now only used in Medicaid, but soon coming to Medicare.

New Mexico is one of 16 states that successfully competed for the four-year grant from the U.S. Centers for Disease Control and Prevention. The grant is from a new program called Prescription Drug Overdose: Prevention for States that helps states address the ongoing prescription drug overdose epidemic.

How did the state successfully complete the grant if the programs didn’t work?

The Health Department also will collaborate with the Human Services Department to increase public awareness of potential harm from prescription opioid medications.

Landen said the grant also will pay for an evaluator who can assess the state’s effort on overdose prevention and determine what approach is working.

For a state with a medical cannabis program that’s about 8 years old, it’s surprising that overdoses keep rising. Other states’ programs have reduced overdose deaths by about 25%, yet not here in New Mexico. Perhaps it’s not surprising after all, considering the sad condition of New Mexico’s medical cannabis program.  Without a program that provides adequate access for all, there are few public benefits to be had.

And New Mexico is one of the poorest states in the country, so poverty plays a big role in overdose deaths and suicides.

Targeting opioids doesn’t seem like a very thorough plan. It leaves out so many drugs that contribute to overdoses, like alcohol, anti-anxiety drugs, muscle relaxers, and anti-depressants. And it leaves out one of the most important issues of all:  suicide.  (Way to honor National Suicide Day, Department of Health.) And what’s the deal with the Department of Health working with the Worker’s Compensation Administration? Easy to pick on the disabled, right?

Ironically, in January of this year, the University of New Mexico was announcing it might have found the “holy grail” of stopping opiate abuse (mostly centered around education):

https://painkills2.wordpress.com/2015/01/26/has-university-of-nm-found-the-holy-grail-of-stopping-opiate-abuse/

New Mexico’s Project ECHO is all about reducing opioid usage in chronic pain patients, and last I heard, is working with the Veteran’s Administration. UNM calls it a program for pain patients — I call it a program to treat addiction. The fact that the program doesn’t work just confirms my opinion that addiction in the chronic pain population is not the huge problem it’s made out to be. If you can’t find and don’t treat enough chronic pain patients that suffer from drug addiction, the program won’t work.

Ironic that the federal government is spending so much more money on programs that aren’t working, but I would say that most of the funding is really for the PDMPs, the blacklist for pain patients. And PDMPs are popular with the DEA, insurance industry, government agencies, and now the medical industry.

It’s also ironic that in October, 2013, Dr. Katzman authored a study about the epidemic of chronic pain. From someone who’s recognized the problem, all the way to today with Project ECHO, this doctor has taken a mighty long fall in a really short time. Here are my posts about the director of the program, Dr. Katzman:

https://painkills2.wordpress.com/?s=katzman

The U.S. Needs More Treatment Options for Opiate Addiction

http://www.huffingtonpost.com/hyun-namkoong/flooded-with-drugs-but-fa_b_8072240.html

“When you wake up [from naloxone], you’re extremely dope sick,” said Caitlyn Phillips, a resident of Asheville who used intravenous heroin for several years. “It’s the most painful way to wake up.”

There’s been a lot of media attention on naloxone and how it saves lives.  But I’ve been waiting to hear from an actual user of naloxone, and Ms. Phillips has confirmed my thoughts on how users are affected by this drug.  And yet, as painful as the after-effects of this drug are, the experience doesn’t stop drug addicts from using again.

Because I’ve read about how this drug works on the brain, I have to wonder:  Does naloxone interfere with the pain receptors to a degree that would affect how the patient perceives pain in the future? Or how the patient reacts to pain medication used for, say, surgery? Does the use of naloxone create a potential for a chronic pain condition?

Moses Lake Professional Pharmacy recalls

https://www.consumeraffairs.com/recalls/moses-lake-professional-pharmacy-recalls-sterile-human-and-veterinary-compounded-drugs-072715.html

If there is contamination in products intended to be sterile, patients are at risk of serious infections which may be life threatening. The company has not received any reports of product contamination or adverse events to date.

The recalled products were made from July 21, 2014, through July 21, 2015, and dispensed to patients or distributed to physicians for further administering to patients [in] Arizona, Idaho, Florida, Oregon, Texas and Washington. All recalled products have a label that includes the pharmacy name and the name of the compounded drug product.

The following unexpired lots of sterile compounded products are being recalled…

BUPRENORPHINE MULTIDOSE VIAL 0.3MG/ML INJ SOLN

For some, opioids are necessary

http://blogs.denverpost.com/eletters/2015/07/21/for-some-opioids-are-necessary/38511/

Re: “Stopping the epidemic of opioid addiction,” July 15 guest commentary.

Opioids are a valuable tool for treating legitimate pain issues. But the actions of state and federal governments concerning opioid abuse are adversely affecting the ability of people with chronic pain to get the medicine they need.

In conversations with my chronic pain support group and doctors, I’ve learned: some doctors won’t even discuss opioid prescriptions; many doctors have stopped prescribing opioids for any reason; and doctors are very cautious about accepting new patients with chronic pain. The doctors are concerned about being investigated and find it simpler to just avoid the issue. This makes it more difficult for people who properly need opioids to get the help they need. The doctors are caught in the middle. The legitimate patient suffers.

This dilemma must be resolved to allow doctors to practice medicine as they should so those with chronic pain can be treated as they should.

Wayne Buehrer, Littleton

This letter was published in the July 22 edition.

http://www.denverpost.com/opinion/ci_28483017/guest-commentary-stopping-epidemic-opioid-addiction

(7/14/2015) Guest Commentary: Stopping the epidemic of opioid addiction
By Sylvia Burwell and John Hickenlooper

On Thursday, we’ll join members of the Colorado Cabinet, the Colorado Consortium for Prescription Drug Abuse Prevention and others to discuss this commitment, share the ways in which we can best tackle this crisis, and discuss specific, targeted and tangible recommendations to curb overdose deaths and reduce the rate of opioid addiction in Colorado and nationwide…

We must begin by ensuring powerful opioid medications are prescribed appropriately. Nationally, we are developing opioid prescribing guidelines and supporting training and tools for providers to make informed prescribing decisions. In Colorado, the Hickenlooper Administration and the Colorado Consortium for Prescription Drug Abuse Prevention have brought together a wide range of partners to help health care providers connect through a Provider and Prescriber Education Workgroup. Colorado now has one of the 10 lowest opioid prescription rates in the nation.

We can do even more with the power of electronic prescription tracking programs. Programs like Colorado’s prescription drug monitoring program allow pharmacists and other health providers to share information and can help identify those at risk for dependence, addiction and overdose. At the federal level, we are increasing investments for these types of programs to expand the scale of their impact…

For those Americans who have fallen into opioid addiction and dependency, we can make the greatest impact by helping them move into recovery. One way we can do this is by expanding access to medication-assisted treatment, which is the use of medication in combination with counseling and behavioral therapies…

“Fallen into opioid addiction and dependency…”?  What is that supposed to mean?  Sounds like they’re talking about fallen angels, full of sin (opioids) and now living in the hell of dependency… because opioids are now considered more harmful than human suffering.

Does anyone ever “fall” into addiction?  Does anyone ever “fall” into cancer, chronic pain, or diabetes?  Or do these conditions come with someone or something pushing people into “falling”?  Where are the DNA police when we need them?  And where’s the attorney who’s going to file a class action lawsuit against surgeons who maim, creating chronic pain patients in their wake?

You’ll notice that “medication” in recovery does not include opioids.  (Because if you’re addicted to them, they’re no longer medicine.)  Or so they want you to believe.  But medications like buprenorphine are not sugar candy.  It’s not a placebo effect.  The same harms that can befall patients taking opioids also occur in those taking medications approved for the treatment of addiction.  But, what the addiction industry calls “harm reduction services,” I call management of a chronic condition.  And the patients that use these medications to manage their addictions usually do a lot better than those who choose abstinence.

When we find strategies and ideas that work, we should share them broadly and quickly. Governor Hickenlooper recently co-chaired the National Governor’s Association Policy Academy for Reducing Prescription Drug Abuse, bringing together state leaders on this issue. And the Consortium serves as a stellar example of how health providers, state leadership and top universities can look at the epidemic in new ways and quickly implement the solutions with the power to make the biggest impact.

Ending the opioid crisis will protect our families, our businesses and our communities. It will save lives. For too many Coloradans, a medicine intended to ease pain results in abuse, addiction and, too often, death. We know that by working together and with our partners at all levels of government and across the country, we can take important steps toward ending the opioid crisis.

Sylvia M. Burwell is secretary of the U.S. Department of Health and Human Services. John Hickenlooper is governor of Colorado. The longer version of this essay is at denverpost.com/opinion.

Lots and lots of anti-drug groups.  The drug war is well-represented here. (A representation that we’re all paying for.)  And so is the drug-war rhetoric.  When you lie to the public about things like the scope of an “epidemic” or “crisis,” it usually backfires on you.  I’m not sure when the government will learn that lesson.

But do you see a group representing pain patients?  Any government announcements about groups working on viable treatments for chronic pain?  Because focusing on drug addiction is so much easier than trying to do something about the real epidemics of chronic pain and suicide.

Now, it’s time for some chocolate (and hopefully, a better internet connection).  Thanks for reading my ramblings. (These ramblings also brought to you by Verizon Sucks.)

Pitfalls of Point-of-Care Urinary Drug Screening for Pain Management

http://www.pharmaciststeve.com/?p=11105

https://www.aacc.org/publications/cln/articles/2015/july/ask-the-expert#.Va_FdVvu1sU.linkedin

What are the clinical needs for drug testing in pain management clinics? Can these needs be met by POC urinary drug screen testing?

Drug testing in pain management clinics is used to determine: (1) whether the patient is taking the pain medication as prescribed versus diverting it; and (2) whether the patient is abusing other substances.

To address the above needs, a POC urinary drug screen test must be able to detect the pain medication of interest and accurately identify any drugs of abuse.

Unfortunately, POC urinary drug screen testing has a limited ability to do these things. It is a screening tool only, and can produce false-positive or false-negative results due to the testing methodology. The cutoff concentration may also be too high in some cases for pain management use. Thus, any screening result that does not match the patient’s prescribed medication must be confirmed by mass spectrometry before the patient can be accused of non-compliance. However, many providers do not understand the presumptive nature of these test results and want to act on them immediately.

In addition, the drug of interest may not be screened by the POC test. For example, most opiate screens on the market primarily detect morphine and codeine. Depending on the assay used, hydrocodone and oxycodone may or may not be included. Some opioids, such as fentanyl, buprenorphine, tapentadol, and tramadol, are also not routinely detected by POC urine tests. However, this is not common knowledge to most providers. To many, if the opiate screen is negative, it means the patient is not taking the pain medication. Sadly, I have encountered cases in which patients were wrongfully dismissed from pain management programs because a test result was misinterpreted…

https://www.aacc.org/about-aacc

AACC is a global scientific and medical professional organization dedicated to clinical laboratory science and its application to healthcare…

Buprenorphine For Chronic Pain?

I found this in my Search Terms:  “2015 more doctors using buprenorphine for chronic pain”

Yes, it’s true, bupe (and Suboxone) are being used to treat chronic pain, although it’s mostly with the transdermal system, not in pill form.  There are different side effects with this type of delivery system, as explained by patients here:

http://www.drugs.com/comments/buprenorphine/for-chronic-pain.html

It’s difficult to gauge the effectiveness of a pain medication when used in a placebo-controlled trial, even though that’s one of the only ways to obtain proof through “scientific evidence.” Seems almost cruel to make pain patients go without any type of pain medication throughout a research study.  This is one of the many reasons there isn’t any long-term studies on treating chronic pain with opioid therapy.

http://www.clinicaltherapeutics.com/article/0149-2918(04)80345-X/abstract

(2004) Transdermal buprenorphine in the treatment of chronic pain

Patients’ assessments of pain intensity and pain relief suggested better analgesia with buprenorphine TES than with placebo, although the differences did not reach statistical significance…

http://www.clinicaltherapeutics.com/article/S0149-2918(03)90019-1/fulltext?mobileUi=0

(2002) Analgesic efficacy and tolerability of transdermal buprenorphine in patients with inadequately controlled chronic pain related to cancer and other disorders

A total of 43.5% of patients treated with buprenorphine TDS reported good or complete pain relief compared with 32.4% in the placebo group…

http://www.spine-health.com/forum/treatment/pain-medications/suboxone-pain-mgmt

Sat, 09/13/2008 – 7:38am #1
Anonymous (not verified)

Suboxone for Pain Mgmt
Anyone else taking Suboxone for pain?

My Pain Mgmt Dr. just started me on Suboxone on Monday afternoon for pain relief from DDD, Stenosis and sciatic flareup.

Is anyone else currently prescribed Suboxone for their pain? I was curious as to the level of pain relief you are having and also what if any side effects are troublesome?

At first I had some dizziness and general feeling of being “Out of it”. Hard to focus. That is getting better each day. However, I still have a feeling of being high. Pain relief is very good….better than Vicodin.

Richard J.
Chicago

Sun, 09/28/2008 – 11:07pm #6
pgcrswll

Oh there are most definately withdrawals from it they are just more subtle than with straight opiates. A lot of people at my rehab had trouble with getting off suboxone with no opiates being taken for months. For me yes it did help a bit with pain but I was going through hellish opiate withdrawals which is what its made to combat. Honestly though yes im sure it helps with pain maybe on the level of tramadol

https://painkills2.wordpress.com/2015/01/04/3252014-does-suboxone-buprenorphine-treat-pain/

https://painkills2.wordpress.com/2014/12/13/suboxone-and-toothaches/