Repealing opioids when there are no replacements is ignorant and barbaric

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

My comment:

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

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

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

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

Will exercise decrease your pain?

I recently looked up POTS, a medical condition that I’m unfamiliar with:

Wikipedia: Postural orthostatic tachycardia syndrome (POTS, also known as postural tachycardia syndrome) is a condition in which a change from the supine position to an upright position causes an abnormally large increase in heart rate, called tachycardia… A variety of treatments, including exercise and medications, can improve symptoms for the majority of people with POTS…

Okay, so while your heart is doing jumping jacks in your chest, it’s time to exercise? It seems like doctors suggest exercise for almost every medical condition. And it’s true, we don’t get enough exercise, but…

http://www.painnewsnetwork.org/stories/2017/1/22/even-a-little-exercise-is-better-than-none

They measured the physical activity of 1,600 adults with osteoarthritis in their hips, knees or feet; and found that just 45 minutes of moderate physical activity a week improved their function and reduced pain…

Osteoarthritis is a specific medical condition that can cause varying levels of pain and disability, but I don’t think that every chronic pain condition will respond the same to light physical activity.

In a study of 131 older adults who have osteoarthritis, participants attended 45-minute chair yoga sessions twice a week for 8 weeks.

Researchers measured their pain, pain interference (how it affects one’s life), balance, gait speed, fatigue and functional ability; before, during and after the sessions.

Compared to a control group enrolled in a health education program, the chair yoga group showed a greater reduction in pain, pain interference and fatigue during the sessions, as well as an improved gait. The reduction in pain interference lasted for about three months after the chair yoga program was completed…

When I lived in Houston, it was too hot and humid to take walks. I only started taking walks after I moved to New Mexico (and got a camera). At first, I lost some weight, which was a good thing. But the weight didn’t stay off. Part of the reason for that was my inability to find and afford quality medical cannabis. I’ve gone through periods of stability that have lasted for months — both in the legal and underground markets — but they always come to an end, interrupting any progress I might make.

Since I moved here over 3 years ago, I’ve been more physically active than I have been in the past. I’ve also taken up baking (which includes more cleaning), and that’s also increased my physical activity levels.

So, has all this increased physical activity helped to decrease my overall pain levels? It seems logical that it would. Maybe in a group of patients who suffer from osteoarthritis, you would see the majority of them achieving benefits from exercise, including a decrease in pain levels. Would the same be true of a group of patients who suffer from TMJ or Trigeminal Neuralgia?

I hate to go against logic, but as I sit here thinking about the connection between my level of physical activity and my pain levels, I can’t say that the increased physical activity has made any difference in my pain levels. Sure, sometimes a walk can increase my pain levels, but usually, my level of physical activity doesn’t appear to be related to my pain levels. I know that doesn’t make sense, but there you have it.

Celebrating the anniversary of Roe v. Wade

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

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

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

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

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

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

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

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

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

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

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

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

There’s nothing wrong or sinful about feeling good

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

To cut costs, Medicare adopts CDC’s regulations

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

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

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

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

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

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

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

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

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

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

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

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

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

For prescribers enrolled in Medicare who prescribe Part D drugs:

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Comments are closed.

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

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

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

My comment posted today on Medicare’s Facebook page:

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

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

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

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

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

Is chronic kidney disease painless?

This “expert” thinks so:

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

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

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

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

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

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