Opioids did NOT cause the current increase in heroin use

Posted yesterday on Pharmacist Steve’s website:

The pharmaceutical companies that manufacture and market OxyContin, Vicodin, and other highly addictive opioid painkillers — drugs that have fueled the epidemic of overdoses and heroin addiction…

http://samquinones.com/reporters-blog/2015/11/18/the-dayton-heroin-bust/

This writer, Sam Quinones, put out a book entitled “Dreamland (The True Tale of America’s Opiate Epidemic)” last year. Of course, the book is based on a bunch of drug war theories that mostly apply to rich, white people — just like the heroin “epidemic” — and don’t have much to do with the real opioid war or its victims.

I made a comment three days ago, but it was never posted. What’s the matter, Mr. Quinones, are you afraid of the truth? Or won’t the truth help you sell more books?

“…new market that exists in the U.S., created by the overprescribing of narcotic pain pills nationwide…”

As a 30-year intractable pain patient, I’ve lived through the drug war, and I don’t agree with you. I believe the heroin market was created by the under-treatment of pain, and doctors abandoning pain patients and those who suffer from addiction, forcing them into to the unregulated, underground drug market. And you can see that the problems have only gotten worse since the DEA began jailing and convicting doctors and patients in the opioid war.

Oxy is an easy drug to blame, isn’t it? But doctors aren’t stupid. They knew that Oxy was an opioid and that opioids can be addictive. But even with all this alleged increase in drug abuse, the percentage of people who suffer from addiction has stayed about the same. No, Oxy isn’t to blame, and neither are opioids, pain patients, or doctors. Drugs don’t cause addiction — I think you know that. If one drug becomes unavailable, those who suffer from addiction will just try another. And because of the increasing restrictions on opioids, at the current time, many are choosing heroin.

The fact is that the opioid war is what has caused a drug overdose epidemic in the rich, white population, which is why it’s getting so much media attention. Tell me, do any poor, disabled people buy your book?

CDC Help Desk

Mon, Dec 28, 2015 4:40 am

Re: Proposed 2016 Guideline for Prescribing Opioids for Chronic Pain
From: painkills2@aol.com
To: regulations@erulemakinghelpdesk.com

Re: Docket ID: CDC-2015-0112

Please inform me of the process for tracking my comments, only one of which has been approved, and how to find out why they have been censored by the CDC.

Thank you,
Johnna Stahl
painkills2@aol.com

https://painkills2.wordpress.com/2015/12/26/was-your-comment-censored-by-the-cdc/

https://painkills2.wordpress.com/2015/12/26/this-is-war/

This Is War

(In the future, any additional comments I make to the CDC will be added to this post.)

Your Comment Tracking Number: 1jz-8n0y-9e3t

Isn’t it odd how the comments cannot be put in date order, even though there’s an option for that? And isn’t it funny how the pro-CDC comments almost always appear at the top of the thread, even though they’re out of date order? Are the comments out of date order so the CDC can bury certain comments that it is forced to post?

And wouldn’t it be nice to know why the CDC is banning certain comments? The only rules appear to be: “those containing private or proprietary information, inappropriate language, or duplicate/near duplicate examples of a mass-mail campaign.” I’ve read hundreds of comments approved by the CDC, many of which have information that could be considered private and/or proprietary.

You know, pain patients are smarter than your average person — it’s a matter of survival. We’ve been fooled and tricked too many times to fall for the bias and discrimination exhibited by the CDC in this process. In other words, I’m not the only pain patient who believes that the CDC has already approved the guidelines and the only reason for allowing comments at this point is for the sake of appearance.

Your Comment Tracking Number: 1jz-8n0y-cuca

Are guns the answer for pain patients? I was just wondering if the CDC has found a correlation between the creation of its opioid guidelines and the increase in gun sales. Because I’m thinking that some pain patients have already given up on having their pain adequately treated and have chosen the only other alternative. After all, it’s both cheaper and easier to buy a gun than it is to access pain medications.

Your Comment Tracking Number: 1jz-8n13-p39u

The ghosts of Robin Williams, Amy Winehouse, Whitney Houston, and Scott Weiland want to remind the CDC that their deaths had nothing to do with the treatment of chronic pain. (See, even the dead can tell the difference between drug addiction and chronic pain.)

Your Comment Tracking Number: 1jz-8n2b-w4cw

For the last year, I’ve been collecting the stories of pain patients (including cancer patients) and posting them on my blog (All Things Chronic) under the category “Voices of Pain Patients.” Most of these stories weren’t found in media articles, but in comment sections from all over the internet. (The latest one is entitled “ER Horror Story,” and it will put the fear of god into an atheist.) If the CDC is really serious about creating the most effective guidelines, it will take the time to read these stories.

Today is 12/28/2015, and as of this date, only one of my comments has been approved for posting at the CDC website. Makes you wonder how many other comments have been banned. And it looks like I need to stop using my name when making these comments — perhaps my comments would have a better chance of being posted if they are made anonymously.

https://painkills2.wordpress.com/2016/01/01/and-the-cdc-saga-continues/

January 3, 2015

http://www.regulations.gov/#!docketDetail;D=CDC-2015-0112

Your Comment Tracking Number: 1k0-8n6u-4je0

Who will the CDC listen to, grieving parents of overdose victims or chronic pain patients? Which group will be allowed to have their pain treated? Will the CDC enact regulations that will satisfy a grieving parent’s need for revenge, or a pain patient’s right to have access to all treatment options?

Your Comment Tracking Number: 1k0-8n6u-6eyc

It’s easy to see the two major groups commenting on the CDC’s regulations:  pain patients and those grieving the loss of a loved one who suffered from drug addiction. Am I the only one confused as to which group these regulations are really aimed at? Is the CDC attempting to standardize the treatment of drug addiction or the treatment of chronic pain? Or has this agency decided that these two conditions are one and the same and should be treated the same?

January 7, 2016

Your Comment Tracking Number: 1k0-8n9g-elns

This Is What Desperation Looks Like:

Yes, this is my wrist, scarred by pain and desperation. These scars represent days when my pain was at a level 10, not attempts at suicide. See, I’ve read that cutting releases endorphins, and those endorphins can decrease pain. (I also saw it on an episode of House, one of my favorite TV shows.) And as I’ve tried almost every other way to manage my pain, I thought it was a good idea to try this one. I mean, if I’m willing to try treatments like hypnosis, why not something like this?

Of course it didn’t work. The cutting just left scars, which I used to be embarrassed about, but now I rarely even notice. These scars are like my stretch marks from pregnancy — they show what this old body has been through. They are like… badges of courage.

Today is a bad pain day for me, and I confess that I’ve thought about trying to release some of that pain by causing myself more pain — attempt to distract myself from the pain in my head by causing pain in another part of my body. In theory, it should work. But in practice, it doesn’t help — nothing could distract me from this level of pain. I know that, but sometimes, desperation doesn’t make any sense…

https://painkills2.wordpress.com/2015/04/06/this-is-what-desperation-looks-like/

Was your comment censored by the CDC?

https://painkills2.wordpress.com/2015/12/23/dear-power-brokers-at-the-cdc/

https://painkills2.wordpress.com/2015/12/23/hey-cdc-can-you-hear-us-now/

https://painkills2.wordpress.com/2015/12/24/censorship-by-the-cdc/

This is an invitation to anyone (like me) whose comment was censored by the CDC:  If you can find my WordPress blog, I will be happy to post your comment, or you can email it to me at painkills2@aol.com. (Censorship is for countries like Russia and North Korea, not the good ‘ol U. S. of A.)

Your Comment Tracking Number: 1jz-8n0v-eywi

Censorship by the CDC

https://painkills2.wordpress.com/2015/12/23/dear-power-brokers-at-the-cdc/

http://www.regulations.gov/#!docketBrowser;rpp=25;po=0;s=johnna%252Bstahl;dct=PS;D=CDC-2015-0112

Perhaps I should not be surprised that only one of my comments was approved for posting on the CDC website.  Looks like I’m gonna have to make more comments, maybe even some with bad words. 🙂

Hey, CDC, what are you so afraid of? The truth?

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.

NEJM and censorship

Before you click  to post a comment on a website like the New England Journal of Medicine, I suggest that you copy, paste, and save it in a draft email. Because there’s a good possibility that your comment will never show up.

I posted the comment below on Tuesday of this week, which is still awaiting a moderator’s approval. What do you think, is there something offensive in my comment? Something to fear? How many other pain patients are silenced in the comment sections?

http://www.nejm.org/doi/full/10.1056/NEJMp1507136#t=comments

I think it’s tragic that more doctors won’t stand up for pain patients — and for medical science, which not only says that 16,000 overdoses out of tens of millions of opioid users is not an epidemic, but also that opioids are only dangerous to an extremely small patient population. In fact, chemotherapy drugs (and many others) are dangerous to a larger percentage of patients than pain medications.

As a 30-year intractable pain survivor, I thank my lucky stars, every single day, that I was able to overcome my addiction to the medical industry. (Not that I had much of a choice.) Having to depend on doctors to help me manage the constant pain was a waste of both time and money. What do doctors really know about pain, unless they’ve experienced it themselves? And even then, with the opioid war, what treatments can they offer? Pain patients have had their fill of antidepressants and other off-label medications.

I think the medical industry should thank PFROP for helping to destroy its reputation and causing patients to distrust doctors, and vice versa. And I want to thank Mother Nature for providing an alternative to being treated like a drug addict and criminal.