The opioid war wins again

http://www.pharmaciststeve.com/?p=15623

The CMS has responded to calls to eliminate patient satisfaction on pain management from Medicare’s value-based purchasing program…

The AHA was among several prominent healthcare associations that had called on the Obama administration to stop incorporating patients’ responses to pain-management questions in the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) in the value-based purchasing program. HCAHPS results are a significant factor in how hospitals fare under value-based purchasing, and providers have complained the program gives them a financial incentive to over-prescribe painkillers to keep patients happy.

The survey asks patients if they needed medicine for pain, how often their pain was well controlled and—of most concern to the healthcare industry—if the hospital staff did everything they could to help with the pain.

“Some stakeholders believe that the linkage of the pain management dimension questions to the Hospital VBP program payment incentives creates pressure on hospital staff to prescribe more opioids,” the CMS said in the proposed rule. The agency said removing the questions from the survey would “mitigate even the perception that there is financial pressure to overprescribe opioids.” …

If you were a doctor, which would you be more afraid of, CMS or the DEA? In other words, the opioid war has pretty much removed all financial “pressure” to overprescribe opioids. The pressures doctors are under now when it comes to opioid prescribing are from the DEA and insurance companies, not patient surveys.

To me, patient surveys are not important, because it doesn’t matter what I say on a patient survey, doctors aren’t going to treat my pain anyway. But with this amazing amount of pressure brought to bare against CMS for patient surveys — specifically regarding the treatment of pain — I wonder if I’m wrong. If maybe sometime in the future, chronic pain patients will be kicking themselves because they didn’t fight against this change. Who knows?

“I can find no scientific evidence to support this statement.”

I’m tired of refuting all the lies published by the New York Times. And I have to say that the once-revered profession of journalism has certainly fallen on very hard times.

http://www.nytimes.com/2016/06/07/health/opioid-limits-older-patients-pain.html

Under comments:

John, Burlington, VT, June 8, 2016
“Older adults don’t metabolize drugs as well as a 30- or 50-year old, so the medication stays in a person’s system longer,” Dr. Reid said.

I can find no scientific evidence to support this statement.

David X, new haven, ct, June 6, 2016
As an older person who was totally healthy until a cardiologist pushed a statin drug on me, this article is doubly infuriating. At age 69, I carried 30 opioid pills to Nepal, trekking in the mountains, just in case of injury. I returned with all 30 pills.

At age 70, after 7 months on low-dose statin, I was in constant pain and couldn’t walk around the block. Now I do need pain relief. Ironic? Maybe, but not uncommon.

1/4 of Americans over 40 are on statins. 1/4 of this number (about 8 million Americans) complain of muscle pain.

No one knows about causality, since there would be no profit from knowing, but the growth in statin use exactly parallels the growth in opioid use. No one seems to know or want to know if those on statins take more opioids than the general population.

There are lots of medications that American doctors need to prescribe less, statins at the top of the list. Statinvictims.com

catrunning, pasadena, ca, June 7, 2016
Wow – this is real sadism, intentional or not, on the part of the government and medical providers masquerading as “preventative medicine”. Do those bright minds who are denying elderly pain patients a modicum of relief really believe that they are stopping all those recreational drug users in their tracks? Are they refusing to acknowledge that the recreational people have already transitioned to heroin, which is actually considerably cheaper and much easier to acquire than pills anyway.

If I sound bitter, it is because I just lost a good friend to suicide due to untreated pain. She could no longer stand the agony from a rare auto immune, degenerative disease that has no cure nor remission. After she was cut off opiates by her pain clinic because they had no CDC or whatever agency published guidelines for prescribing them in connection with her very rare disease, her life was reduced to just enduring endless agony. I even offered to get her heroin to try, but she wouldn’t let me take the risk. In retrospect, I wished I had forced the issue.

How the government creates criminals

http://www.thedailybeast.com/articles/2016/04/15/feds-pill-crackdown-drives-pain-patients-to-heroin.html

The Centers for Disease Control and Prevention issued a broad set of recommendations in March for physicians and treatment facilities that dispense opiate medications. The same week Massachusetts Gov. Charlie Baker signed into law some of the most restrictive regulations ever governing the therapeutic use of narcotic drugs—including limiting first-time prescriptions for opioid pain medication to seven days worth of pills. At least six states have passed similar measures restricting the amount and potency of narcotic medications doctors can prescribe…

[Christopher] Baltz was in his third year of treatment for chronic pain resulting from a severe motorcycle accident and was being prescribed a high dose of oxycodone when Florida Gov. Rick Scott declared war on the state’s robust pain management industry in 2011…

Scott’s crackdown led to the closure of some 400 pain management clinics almost overnight, while a coordinated effort by the Drug Enforcement Administration targeted pharmacies suspected of over-dispensing controlled substances.

This took the form of more aggressive enforcement of a decades-old federal mandate known as “corresponding responsibility” that holds pharmacies legally accountable for ensuring the drugs they dispense are being used for a “legitimate medical purpose.”

In theory, the policy is designed to add another check in the process of preventing drug abuse and diversion. In practice, it places pharmacists in the unwarranted position of policing doctors, and discriminating against patients on the basis of often arbitrary red flags (for instance, paying for their prescriptions in cash).

The net effect of the crackdown in Florida was profound and acute. Prescription drug deaths dropped precipitously within the first year-—but heroin deaths rose 39 percent, as patients cut off from legal opioids turned to illegal drugs for relief…

In spring 2013—two days after receiving a courtesy call confirming his monthly appointment—Baltz showed up at his pain management clinic only to find it had been closed down. Within weeks he was making regular trips to Miami to buy heroin.

“The government wants to prevent people abusing pain medication, but there’s no exit strategy,” said Baltz. “I never even saw heroin until this happened.” …

According to the United Nations, 5.5 billion people around the world already suffer from inadequate pain treatment. This includes roughly a third of all cancer patients in the U.S.

Dr. Webster is one of hundreds of doctors and pharmacies that have been investigated by the DEA since it launched its OxyContin Action Plan in 2001. The plan signaled a shift in federal enforcement tactics away from a focus on illicit street drugs and toward preventing controlled pharmaceuticals from falling into the wrong hands. Over the next 13 years the DEA added more than 1,500 personnel and more than doubled its budget. It also significantly ramped up administrative audits of registrants authorized to dispense controlled substances. (As The Daily Beast reported last year, over the same period the DEA was increasing its quotas of Schedule II pharmaceuticals approved for commercial sale).

During one year alone (2009-2010) the number of regulatory investigations conducted by the DEA’s Office of Diversion Control (responsible for policing prescription drugs) more than tripled, according to the Government Accountability Office…

Federal law requires that all prescriptions for controlled substances be for a “legitimate medical purpose,” but it doesn’t define the term…

Ironically, there is evidence that restricting patient access to pain medicine could actually lead to more overdoses, not fewer. Medical examiners are already unsure of how many deaths attributed to “unintentional overdose” are actually suicides. Chronic pain patients frequently suffer from ancillary mental health problems—including depression, anxiety and insomnia—and are at least twice as likely to commit suicide.

In 2013, when the Department of Veterans Affairs responded to a runaway painkiller problem with a new Opioid Safety Initiative, reports surfaced of patients being cut off their medication without proper dose reductions. Within months the agency came under fire for its new policy when a 52-year-old Navy veteran shot himself in the head in front of an outpatient clinic in Virginia after he was forced off his pain meds.

“The medications were the only thing that was helping him, and when they took that away from him, his life just went downhill,” a friend of the dead man told a local paper…

Meanwhile, there is evidence that the majority of prescription opioids that are diverted for illicit use come from the acute care setting, not the treatment of chronic pain.

I’m not sure that makes sense, if this is also true:

From the New York Times:  “And so although emergency physicians write not quite 5 percent of opioid prescriptions, E.R.s have been identified as a starting point on a patient’s path to opioid and even heroin addiction…”

But perhaps it just shows how small the diversion problem really is, even though we’ve spent so much money (and ruined so many lives) in the effort to combat it.

Dr. Daniel del Portal, who teaches emergency medicine at Temple University’s Lewis Katz School of Medicine, says the modern health care system often incentivizes doctors in acute care settings to find a quick fix for patient complaints. “The pressure is on physicians to make patients happy at any costs,” he told The Daily Beast…

Really? How many doctors have you known that made an effort to make you happy? I don’t ever recall feeling happy after leaving the doctor’s office.

Finally, doctors say there is little use in recommending alternative treatments for patients if they can’t afford them. Pain pills are cheap, and usually fully covered by insurance; physical therapy, chiropractic care, and yoga are expensive, and almost always include co-pays (if they are covered at all)…

Sure, the only reason pain patients don’t use alternative treatments is because of the cost. That really flies in the face of how many pain patients pay out-of-pocket for these alternative treatments, as many are forced to do before they are even given access to opioids.

The fact is that alternative treatments have not proven to be very successful, and their gains are extremely short-lived. This is about treating constant, daily pain, not an injury that will improve over time. For instance, I’m sure there are plenty of pain patients who would welcome a daily massage (if they could afford it), but I would need painkillers before I agreed to let someone work on my body. It would be a treatment that caused more pain, just like so many others I’ve tried. Seems to me that most of the treatments which cause more pain don’t provide as much benefit as their practitioners would have you believe. “No pain, no gain” doesn’t really work when we’re talking about chronic pain.

Another problem is that many of these alternative treatments can be practiced at home, but unless you’re being seen by a doctor, disability insurance companies will question if you’re really suffering from chronic pain. And what’s the point of paying for a doctor if all she can prescribe are these alternative treatments? Because you really don’t need a prescription for yoga, meditation, stretching and exercise, and many other alternative treatments. (Doctors suck.)

Two Insurers To Stop Treating Pot Users As Smokers

http://www.420magazine.com/forums/international-cannabis-news/278701-two-insurers-stop-treating-pot-users-smokers-marijuana-increasingly-accepted.html

In a sign of marijuana’s growing normalization in Canada, two major life insurance companies have decided to treat cannabis users as non-smokers, reversing a long-standing policy and offering many of them far cheaper premiums.

Like their competitors, Sun Life and BMO Insurance have for years classified anyone who disclosed using marijuana – either recreationally or for medical purposes – as a smoker, saddling them with charges that could be triple those of non-smokers.

But in memos released over the last week, the companies say the latest research on the drug’s health impacts convinced them to change that approach…

Who can afford life insurance these days? And when will Medicare start covering medical cannabis? Before or after I’m dead?

Drugs are a treatment, not a cure

Current Survey on MedPageToday.com:

A group of medical organizations has written to the Joint Commission, urging it to drop pain as a 5th vital sign in the wake of the opioid abuse epidemic. Is it time to get rid of pain as a 5th vital sign?

Under comments:

numa turner
Apr 16, 2016
The problem as I saw it was it was totally subjective. We don’t ask people what their blood pressure is. Granted that there is no objective way to measure pain, treating it as a vital sign can cause confusion for doctors and patients. I worked for the VA and our performance was often based on this “fifth vital sign ” and how we responded. I often saw patients on large doses of opioids who still claimed 8 out of 10 on the pain scale. What do you do with that?

This is all about money, not patients. Medicare is trying out different programs to reduce healthcare costs, and performance-based pay is one of them. How to determine if a doctor is doing his job? Ask the doctor or the patients? But PFROP is using the media- and government-hyped opioid “epidemic” to cozy up to all the doctors who hate patient reviews, especially if it’s costing them money. It’s a lesson on how to gain power and influence by increasing the number of people who support anything close to your agenda.

It’s like doctors think the only reason for a patient to give them a low score is because the doctor wouldn’t prescribe painkillers. Of course, the 400,000 patients who die every year due to the mistakes of doctors don’t get a chance to fill out a performance review. I’m guessing that many more doctors will be getting low scores because they will refuse to adequately treat both acute and chronic pain. And don’t you think they know that? This isn’t about patients, this is about money. And ideology.

Just think, if every tooth in your mouth constantly ached and throbbed, what would your pain levels be? My current pain levels average about a 7 on the 1-10 scale, but that hasn’t always been the case. I’m talking about the progression of an intractable pain condition over a 30-year period. How do you track that on a 1-10 scale? Even when I was on opioid therapy, my pain levels progressed, albeit more slowly than during the times when the pain was (and is) under-treated or untreated.

I also estimated that I received, on average, a 25% reduction in pain with opioid therapy. Did that change my average pain levels? Did my pain levels go from a 7 to a 5.25? No, that’s not what happened. The prescription drugs mostly kept me stable at a 7 (and away from a 10 and thoughts of suicide). After all, drugs are a treatment for pain, not a cure.

Let’s also acknowledge that rating pain on a scale of 1-10 is a very basic and inadequate measure of pain. Many things can affect how you rate your pain, like fear, anxiety, depression, insomnia, and anger. And also things like age, gender, and DNA.

“I often saw patients on large doses of opioids who still claimed 8 out of 10 on the pain scale. What do you do with that?”

As a doctor, you should try to understand all of these nuances, and that the pain scale is not an x-ray or blood test (none of which are 100% accurate). And as a doctor, stop putting so much pressure on pain patients to improve — why are you expecting miracles from drugs? Do you think drugs can stop the aging and degenerative processes? Do you expect all of your patients to improve from one treatment option? What kind of improvements are you demanding from your patients?

Patients are afraid to report any improvement in their pain levels. How are doctors going to change that dynamic? I’m guessing that doctors are now understanding how dentists feel, since most patients hate and fear going to the dentist. And do you know why? Because it’s freaking painful, that’s why.

The VA Isn’t Broken, Yet

http://www.washingtonmonthly.com/magazine/marchaprilmay_2016/

features/the_va_isnt_broken_yet059847.php

The long arc of the VA’s place in American life shows that the agency has always struggled against ideological enemies and against commercial health care providers who would stand to gain business from its being privatized. The only hope is that Americans will wake up in time to save the VA from those who are trying to kill it…

For example, in 2003 the prestigious New England Journal of Medicine published a study that used eleven measures of quality to compare veterans’ health facilities with fee-for-service Medicare. In all eleven measures, the quality of care in veterans’ facilities proved to be “significantly better” than private-sector health care paid for by Medicare…

In 2007, the prestigious British medical journal BMJ noted that while “long derided as a US example of failed Soviet-style central planning,” the VA “has recently emerged as a widely recognized leader in quality improvement and information technology. At present, the Veterans Health Administration offers more equitable care, of higher quality, at comparable or lower cost than private-sector alternatives.” …

And because the VA is a large, integrated system, it has the ability to coordinate care among specialists, so that patients are treated as whole persons rather than as collections of failing body parts. Though no one used the term at the time, Kizer transformed the VA into what health care policy wonks today describe as an “accountable care organization,” or ACO, in which the well-being of patients and providers are actually aligned…

“I know the veterans who are here are going to be proud to hear that the Veterans Administration is on the leading edge of change,” Bush explained, without showing any evident discomfort with praising the largest actual example of socialized medicine in the United States…

The Bush administration also reversed the liberal eligibility standards that the Clinton administration had established. No longer were all honorably discharged veterans welcomed at VA hospitals; instead, to qualify for care veterans would have to prove that they were either indigent or suffering from a service-related disability. This gave rise to much more time-consuming and bureaucratic processes, as VA employees had to determine, for example, whether a veteran’s Parkinson’s disease was due to exposure to Agent Orange in Vietnam or to some other combination of environmental and genetic factors…

Under Shinseki, the VA also fully integrated mental health professionals and substance abuse specialists into its medical home teams. This practice of treating body and mind together is virtually unknown outside of the VA because insurers, including Medicare and Medicaid managed care organizations, won’t pay for it. But the innovation was crucial in treating the VA’s patient population, 25 percent of whom suffer from chronic mental illness and 16 percent of whom struggle with addiction…

By late 2013, Hegseth and the CVA were making the case that the VA needed “market-based” reform that provided vets with more “choice” to receive care from private doctors and hospitals (though they were careful not to use unpopular words like “vouchers” or “privatize”). They were also signaling their sympathy for another abiding cause of the Koch brothers: crushing the power of unions…

The ultimate fate of the VA will likely be determined in the coming months. The Commission on Care, which has been holding hearings throughout the winter of 2016—hearings that have received no attention in the mainstream press—is scheduled to announce its recommendations in June…

Take out your heating pad

http://well.blogs.nytimes.com/2016/03/25/seeking-painkillers-in-the-emergency-room/

(3/25/2016) Seeking Painkillers in the Emergency Room, by Helen Ouyang, M.D.

Helen Ouyang is an emergency physician at NewYork-Presbyterian Hospital and an assistant professor of medicine at Columbia University.

Physicians need to know that if they don’t prescribe a narcotic because it’s not clinically indicated, or worse yet, because the patient already has an addiction problem, that they have the backing of administrators at every level, from their own department to the head of the hospital all the way up to state officials. If patients are seeking narcotics and have a documented history of doing so — and become combative or refuse to leave after discharge — they may need to be escorted out of the emergency room by security and their treatment terminated to avoid interrupting the care of other patients…

I’m guessing that every patient who has been diagnosed with — and given the label of –“chronic pain,” has a “documented history” of “seeking narcotics.” When someone is in enough pain to seek medical attention, what do you think they’re looking for? A heating pad?

Will this include any patient who asks for painkillers any time in their lives? If you ask your dentist for some Vicodin after you have a cavity filled, will he write that in your electronic health record? “Patient was seeking narcotics.”

This is what I want pain patients to know: If you go to the emergency room for any reason, keep in mind that you will no longer be able to complain about doctors refusing to treat your pain. No one in the administration of the hospital will help you (unless you have connections).

For those patients who don’t suffer from chronic pain, you will face the same problems. A doctor refuses to treat your pain? Too bad. A doctor refuses to treat your pain for hours and hours, so that she can determine your addiction potential before giving you an opiate? Well, the pain didn’t kill you, did it? Shall we depend on our legal system to put a price on your suffering?

Under comments:

Joe Snyder, Houston
Cartilage in both knees are gone from jogging in early ’70s. Synvisc (hyaluronic acid) injections had limited effectiveness in quelling pain, and less so, as time went by. I have high pain tolerance (I.e., hobbled about with ruptured Achilles’ tendon for several weeks before diagnosis). I was able to tolerate knee pain during the day at work, but at bedtime I became more conscious of the pain and had trouble sleeping. All I required was a small, occasional dose (1-2 times a week….maybe) to allow a semblance of proper sleep time. The two “pain management” docs I saw were glade to take my personal info and charge Medicare (>$600) for a single office visit; and, then deny further “treatment”. Frustrated and sensing few options I had Total Knee Replacement a year ago. Not much improvement. I feel that if I was prescribed a small quantity of (in my case hydrocodone/ acetaminophen) I could have avoided a very risky surgery. I am a 75 years old semi-retired pharmacist.

Mary DeForest, New Mexico
I guess this is a Prebyterian problem. I can’t get anything for pain for obvious trauma, like being attacked by dogs. I had part of my nose-including bone-removed, a section of my lip, and tissue between those 2 places removed. I was in agony, and I had nothing for the pain. Presbyterian is cruel. I’m told that it is because I’m a senior citizen and they don’t want me addicted at this age. I don’t even take NSAIDs because of stomach problems and gastroentology keeps telling other doctors to tell 60+ patients to take NSAIDs, because of internal bleeding.

rebecca
Sometimes those of us in chronic pain end up in the ER because our pain spikes and the meds we *have* are no longer sufficient to keep it under control. Chronic pain isn’t a steady state, it has peaks and valleys. Sometimes my migraines are worse than others. Sometimes I can get rid of them with the meds I have, sometimes it gets bad enough that I need stronger medication, and the only place for that is the ER. I do get meds from my pain specialist, but he tells me to go to the ER when those stop working, so what should I do?

Your doctor tells you to go to the ER because he doesn’t want you calling him when you’re in a flare. Because he won’t help you, just like the ER will no longer help you. You asked what you should do, when the answer is obvious to me:  All these “experts” are telling you to suffer. And to stop asking for help, because they refuse to give it.

Samer, Illinois
Government agencies played a huge role in creating the problem during my medical school years and residency “pain is the fifth vital” was pounded in…

Many doctors blame the fifth-vital-sign procedure for drug abuse and addiction, as if that makes any sense at all. And, pray tell, what’s the alternative? Doctors should stop asking patients to rate their pain? Just like Medicare should stop asking patients to rate their doctors, right?

Health Nut, Minnesota
Working in the medical field, I disagree that the fault of opioid abuse falls into the hands of physicians. I remember our hospital being “written up” by the insurance companies for not providing total pain care of our patients as our ER physicians said this was going to happen if we complied with federal government in management of pain. We offered non narcotic pain relief and counseling instead. But the government forced our hand on this issue. We are, once again, acknowledged for our low patient satisfaction scores for our decreased opioid use in our ER. Its been a lose-lose situation for us, and I can imagine, most hospitals!

An insurance company writing up a hospital for not following federal guidelines for the management of pain? Huh? I’m too tired to look up the specifics of these guidelines, but as far as I know, it’s mostly about doctors rating patients’ pain as the fifth vital sign. But that’s not only a requirement of the federal government, it’s also followed by international organizations, too.

I’m sure there are a small percentage of ER patients who are just looking for drugs to treat an addiction, but the majority of people who are forced to go to the ER are not drug addicts. People use everything they can to manage pain, including over-the-counter drugs, ice, heat, etc., before they even get to the ER. So, an ER offering only “non-narcotic pain relief and counseling” is the stupidest thing I’ve ever heard.

And then, when you place blame on low patient satisfaction scores, you’re basically just blaming the patients for not agreeing with your anti-drug ideology. You mean patients in pain are not satisfied with anti-inflammatories and counseling? Gee, who would have thunk it?

Briam, usa
The heroin dealer around the corner won’t say no

Honeybee, Dallas
Then let them go to the heroin dealer.
But remember that 9 out of 10 won’t to a heroin dealer.
Instead, they will go through withdrawal and get their lives back.

Yes, it’s probably true that 9 out of 10 patients denied treatment for pain won’t go to a heroin dealer — it’s not like they’re easy to find. But suggesting that most patients who go through withdrawal will then get their lives back is utter nonsense. In fact, when it comes to the treatment of addiction, the opposite is usually true — those who experience the torture of withdrawal are usually even more motivated to relapse.

Let’s see what else Honeybee has to say, shall we?

Honeybee, Dallas
To be fair, it doesn’t sound like any legitimate user is going to be denied any drug.
I don’t see the problem. Yes, there will be a few more hoops, but nothing ridiculously unreasonable. Huge mistakes were made with alcohol and tobacco; I’m glad the govt and the doctors are trying to prevent a similar disaster with opioids/opiates.

I suppose there will be a lot of people who refuse to see the problem — that is, until they experience the problem for themselves. And it’s unreasonable to compare alcohol and tobacco to opioids, just like it’s unreasonable to compare opioids to cannabis, especially when we’re specifically talking about the potential for addiction. This is a person who obviously believes the drug war has been a success.

Honeybee, Dallas
Note how many of the chronic-pain claimants have a host of other health issues and constant problems abiding by the simple 30-day refill policies (“I got sick” or “I went out of town” or “The pharmacy charged too much”). This is textbook addict behavior and addicts want their drugs on demand with no questions asked, no hoops presented.

So should the doctors enable the addict or cause them to suffer withdrawal? Objective observers will say to step the addicts down gently but firmly. Yes, they will suffer. Yes, their pain will feel worse. But they will survive. Cutting them off is necessary, but we also need to help them withdraw.

Hillary Clinton, is that you?

familydoc, brooklyn, NY
I reach for narcotics rarely now and haven’t found my patients to be in more pain. It may sound lame to hear doctors recommend therapy, heat and a variety of complementary approaches to pain but I’ve found it returns patients to functionality faster than masking the pain with narcotics…

Perhaps your patients stopped complaining to you about their pain, or maybe they see a different doctor when they’re in pain. Perhaps your patients have learned to find their pain relief elsewhere, instead of from their doctor.

What sounds lame is to pay a doctor to tell you to plug in your heating pad. Too bad you can’t take a heating pad wherever you go, right? You went to medical school for that? I’m paying you to refer me to a heating pad and a therapist?

(It’s like these doctors have never heard of the internet, where advice is plentiful and free.)

I think it’s hilarious that doctors have created their own downfall, making themselves obsolete. Just freaking hilarious. 🙂

Good luck, England

http://www.bloomberg.com/news/articles/2016-03-21/u-k-tory-turmoil-worsens-as-ex-minister-questions-deficit-focus

Duncan Smith said Sunday he was no longer able to support the cuts to disability benefits while taxes for higher earners and companies are being lowered. He denied his decision to quit late Friday as work and pensions secretary had anything to do with his support for leaving the EU in the June 23 referendum, a position in opposition to the prime minister and chancellor…

While Osborne’s Budget initially drew a positive reaction from Tory lawmakers, criticism soon began to surface about the impact of disability-benefit changes, intended to save about 4.4 billion pounds ($6.3 billion) over five years. The government signaled on Friday, before Duncan Smith quit, that it was looking again at the details…

http://www.ft.com/cms/s/0/85a8b894-eecc-11e5-9f20-c3a047354386.html#axzz43cEHLGXT

The former Conservative leader quit dramatically on Friday, claiming he had been forced by George Osborne, the chancellor of the exchequer, to implement £4bn of cuts to disability benefits against his will...

https://www.benefitsandwork.co.uk/news/3024-suicides-at-10-year-high-and-linked-to-benefits

Figures released today by the Office for National Statistics show that suicide rates, which had fallen consistently since 1981, have been climbing since 2007 and are now at their highest in over a decade…

The link between benefits issues and increased suicide risk is being highlighted by charities such as Mind. Speaking to the Guardian, Tom Pollard, policy and campaigns manager at Mind, said:

“Pressurising people by threatening to stop their benefits causes a great deal of financial problems and emotional distress, with some people attempting to take their own lives as a result.” …

http://www.mirror.co.uk/news/uk-news/more-80-suicide-cases-directly-5634404

(5/4/2015) More than 80 suicide cases directly linked to Coalition cuts claim disability campaigners

When pain patients attack each other (and the CDC)

You’ll have to be patient with me, as it appears I’m not quite done ranting against the CDC…

http://www.buzzfeed.com/danvergano/cdc-opioids-guidelines

“We know of no other drug prescribed so frequently that kills so many patients,” said CDC Director Thomas Frieden, at a briefing for reporters.

Statements like this are so generic that they could be true, but that would depend on a lot of things, including the CDC’s definition of “drug” — which doesn’t appear to include alcohol or cigarettes, as these drugs are not prescribed by doctors. (Alcohol and cigarettes are drugs that are mainly used by poor people to self-medicate, although the recreational market for these two drugs is obviously very large.)

And to put it into context, MRSA infections kill about as many people as opioid-related deaths. Is the CDC panicking and holding press conferences about MRSA? (Freaking hypocrites.)

While hardly any of the media adds the “related” part to “opioid-related” when talking about overdoses, that is the correct term. And because the CDC includes both legal and illegal opioids in their statistics, it inflates the problem even more — yet the numbers still don’t rise to the description of an “epidemic.” And if they do, then the CDC needs to post a list of epidemics in this country, and let’s see where opioid-related deaths are listed in the overall picture.

https://painkills2.wordpress.com/2015/06/30/which-is-an-epidemic/

I think that opioids, by themselves, probably kill more people who are actually committing suicide than unintentionally overdosing, but no one can know for sure. However, since more people die from suicide than from opioid-related causes, why hasn’t the CDC declared suicide as an epidemic? (Freaking hypocrites, that’s why.)

Considering the media blitz on the opioid war, the CDC has had plenty of opportunities to talk about suicides, especially in connection with opioids and chronic pain.

Dawn Anewday · Magnolia High
What is the suicide rate in chronic pain patients now?

Hey, CDC, why don’t you answer this commenter’s question? (Because even if you did, you would be wrong. No one knows the answer to this very important question.)

“Almost all opioids on the market are just as addictive as heroin,” the CDC director said.

I guess the director is excluding opioids like methadone and bupe, as they’re used to treat addiction. (Hypocrite, hypocrite, hypocrite.)

This is just a bald-faced lie. If you’re talking about the population of the U.S. — at 318 million — then for over 90% of us, this is not true. Because about 90% of us will never suffer from an opioid addiction, so these drugs are perfectly safe to use. (Unless you have an allergy or suffer from intolerable side effects.)

If that was true, then many patients who’ve been given opioids in the hospital would have later turned to heroin. How many women are given opioids during labor and delivery? How come the majority of mothers don’t turn into heroin addicts?

There are only 47 comments on this article right now, which partially illustrates how the CDC (and FDA) have been able to join the opioid war — there are more people fighting on the drug-war side, and they have much more money and influence. The voices of pain patients are too little and very easily overlooked. And it looks like a lot of pain patients are just giving up, not even bothering to comment anymore.

Sure, the media pretends that patients have a voice through advocacy groups, but there are only a handful that do good work — and they all have their own agenda. Currently, there is no lobby for pain patients. Now, compare that to the anti-drug lobby that includes the federal government (and now Big Pharma). Seriously, we never had a chance.

Pain patients who commented on this article are very angry (and you can use swear words on BuzzFeed). I get that. But it’s no excuse to attack other pain patients:

Susan Carnes · Western Illinois University
Hydrocodone for BOWLING TOURNAMENTS? Are you kidding me? Your doctor is one of the reasons legit chronic pain patients have to fight for their medicine. I don’t think I could even pick up a bowling ball.

No, the doctor is not to blame for the opioid war. You’re obviously believing what certain media sites are telling you (which are just regurgitating the government’s view). And there’s no reason to compare each other’s pain levels — as if we should be judging who deserves adequate treatment. (In other words, stop being a dickhead.)

Maggie Karabel Christy · Indiana University Northwest
Why are you taking opiods for migraines?

Why are you asking this question? Let’s learn more about Ms. Christy, shall we?

Maggie Karabel Christy · Indiana University Northwest
I understand people are mad about this. I have chronic migraines and neck and shoulder pain because of a genetic fluke in my skeletal system. I was addicted to painkillers for 7 years. Having come out of the other side, I understand this.
Painkillers cause rebound pain. You go to the doctor and ask why they aren’t working. He or she ups the dose. It still doesn’t work. You switch medications. The new pill works for a while and then the same thing happens. I almost died of an accidental overdose so I had a medical withdrawal and went to rehab. It’s a shock to find out how much the pills that you think help you get through the day are ruining your life.
I get the Harvard Botox Migraine Treatment once a year now (you start doing it once every three months) and aside from maybe a month of slightly droopy brows each time I get it, I have no complaints. It’s funny, they use roughly the same amount of Botox recommended for each smile line, but there are 32 places on the head and neck where you get tiny amounts. Creepy to think about how much of that a woman can legally get injected with.
I had two surgeries and although half of my shoulder pain remains, physical therapy and massage help me deal.
These pills are SO DANGEROUS. I’m 8 years sober and still recovering from Seratonin Syndrome. Synthetic opiods can make your brain lazy and stop it from knowing how to make seratonin. It’s hell and I’m still on medication to help. That’s just one example of what they do to you.
GO TO A PAIN SPECIALIST. A doctor (legally) has to give you pain medication (not kidding) when you complain of pain. Pain specialists want you to try everything under the sun along with small monitored doses of painkillers.
There is always something else to try. Try it.

For one thing, obviously a doctor is not legally bound to give you pain medication when you complain of pain. (Not kidding.) In fact, this article is all about how the CDC is giving doctors support (and a legal defense) so that they can refuse to prescribe pain medication. (Duh.) (As if fear of the DEA was not enough.)

Along with hyperalgesia, serotonin syndrome is used as part of the rhetoric in the opioid war to scare the public. But doctors often put a label on medical conditions before they understand them, which I think is the case with these two conditions. Caused by over-use of opioids? Could be, at least in some patients. Perhaps in those who build up a sensitivity to opioids, or perhaps it has to do with changing hormone levels or a mental illness.

Ms. Christy is also putting forth the argument that opioids can “make your brain lazy and stop it from knowing how to make serotonin.” Actually, I think chronic pain patients have a lack of serotonin — the constant pain either sucks it all up, stops it from being created, or both. And opioids also treat that part of chronic pain, affecting serotonin levels. But just like antidepressants have negative effects for many patients, opioids can also have negative effects on some patients.

And really, is injecting a poison like Botox better than opioids? Perhaps, at least if it works for you. (And you can afford it.)

Maggie Karabel Christy · Indiana University Northwest
How often do you go to physical therapy?
Chronic pain sufferer and former prescription drug addict here. Long term use of painkillers causes rebound pain. Your back probably wouldn’t hurt as much if you STOPPED the drugs. You’d still be in pain for sure. But you’d be motivated to try other methods that aren’t causing brain damage and stopping you from producing seratonin naturally.
You have options. Hopefully you won’t almost die of an accidental overdose like I did before you figure it out.
I have been in your shoes. Life seems impossible without the pills and I feel your anger. I remember it. I hope it stops.
Please don’t take this as condescension, if you feel I was rude I apologize.

Some pain patients advocate to stop all drugs, claiming that pain levels will decrease after doing so. I’m sure this happens, but it’s rare. And then there are the patients who stop taking prescription medications, preferring to suffer rather than jump through hoops and be treated like a drug addict again. Some will switch to alcohol or bud (if they can find and afford it), some will choose stoicism, and some will distract themselves from the pain with gambling, sex, and/or food. Other patients will give up on life and just stop eating, and some will engage in risky behavior to hasten death, including suicide.

Pushing patients into a desperate state so that they’ll “try other methods” is one way to treat pain (which the CDC has chosen). I don’t know if these patients didn’t try other options first (before opioids), because they obviously don’t understand that most pain patients have already tried all the other options, paying for them out of their own pockets. Health insurance doesn’t cover much for the treatment of pain, and the CDC has now been instrumental in the removal of one of the most successful treatment options.

I believe that affordable access to all options is the solution, and even the CDC agrees that pain is best treated with a combination of therapies. But when you take away the pain relief that allows patients to participate in a lot of these other treatment options (if they can afford it), you’ve basically taken away just about everything.

After the CDC guidelines…

http://www.huffingtonpost.com/tom-frieden-md-mph/do-no-harm-cdc-guideline_b_9471168.html

Jett Ward · Troy, Ohio
I had three wisdom teeth pulled and the dentist would not give me anything. Told me to take some Tylenol…

People already avoid the dentist, mostly because of cost, but what do you think will happen when more people realize that dentists are refusing to treat the pain from dental work? Surgeons refusing to treat pain after a certain number of days after surgery? All the healthcare insurance coverage in the world will not provide better outcomes for a large population who refuses to even seek treatment.

Whatever good Obamacare has brought is now destroyed by the CDC (and FDA).

Carole Dunn · SUNY Empire State
I have to look at this from the perspective of people who are in horrific pain. For two years I had nothing but bone on bone in my left hip. I was prescribed opioids that barely took the edge off the pain. I had days where I couldn’t walk at all, but I was never able to get the amount of medicine I actually needed. I had thoughts of suicide a lot. I was finally able to get my hip replaced after doctors repeatedly told me the pain was coming from my back. After the operation the pain meds were so inadequate I couldn’t do the physical therapy. The physical therapists realized I was not adequately medicated and they convinced the pain management specialist to give me adequate meds so I could do the necessary exercises. They said it was a common problem with patients who were in terrible pain and were so inadequately medicated they couldn’t participate.

They talk about people overdosing, but no one talks about the suicides of people who are denied the help they need because of the drug laws and doctors using a one size fits all approach. One of my neighbors killed himself by using his electric drill on his head…

Et tu, Guardian?

I’m surprised The Guardian published such a one-sided article. It’s like Kolodny from PFROP wrote it himself.

http://www.theguardian.com/us-news/2016/mar/17/cdc-guidelines-against-prescribing-opioids

Under comments:

hang3xc fortetoo 2d ago

They have stopped paying for pain meds too. Everyone I know has had problems since the first of the year. My insurance company (BCBS) had been paying for my pain meds since I got hurt in 1992. Jan 1st 2016 they denied payment. My doctor called and gave them everything they wanted yet they still denied me. Again, this is something I have been stuck with for 24 years, but NOW it is a problem? … As it is, my monthly prescription, which cost $20-$30 per month NOW costs me $250…

Future Visit to Serenity Mesa Addiction Clinic

https://painkills2.wordpress.com/2016/01/22/dear-new-york-times/

Fri, Jan 29, 2016 12:17 am

Johnna,

I have “enjoyed” reading your continual posts about me and my advocacy work and your “opinions” about me give me a good laugh now and then. You question my ability to fact check and to be labeled as an “expert” in addiction but maybe you should do your own fact checking. Numerous entries in your blog are incorrect. Your most recent blog post listed several quotes that you said I made (see below). I never made these quotes and have no idea who did. Maybe there is another Jennifer Weiss in Albuquerque or someone made those comments in my name but I absolutely did NOT make those comments.

You can talk about me, my deceased son, my advocacy work all you want but please do not start posting false information about me and making up things that I did not say. I also do not receive endless amounts of funding from the state as we are up in Santa Fe right now fighting for the little funding we do get. Maybe you should do your own fact checking before you publish inaccurate information with my name attached to it.

And, as it appears that you have an excessive amount of time on your hands, maybe you should come visit Serenity Mesa and I will give you a personalized tour showing you all of the evidence-based therapy we provide our young residents who suffer from heroin and meth addiction. Maybe if you saw the services we provide and the work we are doing you wouldn’t be so quick to judge. It’s obvious you have never been an addict, loved and addict or lost an addict so maybe you should try a little more empathy and a little less judgement for something you know nothing about.

Once again, the comments below were not made by me:

Jennifer Weiss · Top Commenter · Albuquerque, New Mexico

And one more thing. Since it looks like you hate cops, how many times has APD arrested your dumb butt for just being a jackass or slapping around your p*nis because no hooker in their right mind would ever touch you. So how many times have you been locked up?

Jennifer Weiss · Top Commenter · Albuquerque, New Mexico

Loretta Baca obviously you think your s*it doesn’t stink because you think violence begets violence. Wow, you’re more into death and destruction for your own gratification because your life is so boring and lacking of what is truly important. And you know what, I actually feel sorry for you. You are a pitiful excuse for a human.

Jennifer Weiss-Burke
Executive Director
Healing Addiction in Our Community &
Serenity Mesa Youth Recovery Center
jenweiss24@msn.com
(505) 363-9684

—————–

Tue, Feb 23, 2016 4:36 am

Dear Jennifer:

I’m sorry it took me so long to respond to your email, but if you follow my blog, then maybe you can understand the lateness of my reply. (Being disabled, poor, and powerless is no fun, believe me.) And if you’ve read my blog, then no doubt you are prepared for the type of response you would receive. (At least, I hope so.)

You may not believe this, but it was nice to hear from you. And it’s nice to know that I could give you a good laugh, even if it was at my expense. After all, I’ve heard that laughter is the best medicine. 🙂

We’ll have to disagree about the Facebook comments you’re now disclaiming, because I think they were, in fact, made by you. However, there have been plenty of times when I’ve responded in anger and said things I didn’t mean, so let’s just forget about those comments for now.

It’s funny what some people use to claim the title of “expert” these days, especially in the addiction industry. Considering your background, you can’t be surprised that anyone would question your credentials. Maybe that doesn’t happen in the addiction and political industries? Or is this the very first time? Being rich and white is something I’ve never experienced, but I’m guessing the combination has been really helpful for you.

Maybe you can tell me why you think your experience — specifically in pain management — qualifies you for things like this:

https://painkills2.wordpress.com/2014/12/25/prescription-drug-misuse-and-overdose-prevention-advisory-council/

“The council shall meet at least quarterly to review the current status of prescription drug misuse and overdose prevention and current pain management practices in New Mexico and national prescription drug misuse and overdose prevention and pain management standards and educational efforts for both consumers and professionals. The council shall also recommend pain management and clinical guidelines.”

https://painkills2.wordpress.com/2015/02/02/because-grieving-parents-make-great-medical-experts/

“We will have a discussion on how opiates affect the brain, their addictive qualities and how prevention is a far better option than treatment. We will also offer ideas on how the dental community can help be part of the solution to an epidemic affecting so many people in NM.”

I can’t help but wonder if these are paid positions, and if so, which part of your work experience has qualified you for these positions? Maybe all you need is a college degree, like doctors who become addiction “specialists”?

You say you’re now fighting for more government funding (an endless task, right?), but you didn’t mention the funds you’ve already received:

https://painkills2.wordpress.com/2014/12/25/1172014-healing-addiction-in-our-community/

https://painkills2.wordpress.com/2015/02/02/nonprofit-501c-organizations-albuquerque-nm-87187/

And remember when you advocated to deny the approval of Zohydro?

https://painkills2.wordpress.com/2014/12/31/reconsider-approval-of-dangerous-new-opioid-zohydro/

I also have to wonder, what is your experience with Zohydro? Do you think that treating pain and drug addiction are the same thing? Do you also advocate to deny patients access to opioids like Suboxone, Methadone, and bupe?

And why doesn’t your addiction clinic accept Medicare/Medicaid?

With all your advocacy work on pain management and addiction, you must be aware of the crisis that millions of pain patients are experiencing. You must also be aware that even if your work helps thousands of drug addicts, at the same time, it is also part of terrorizing tens of millions of pain patients. So, with this knowledge, I assume that you also understand why I have felt compelled to publicly point out all the hypocrisy.

We might be fighting on opposite sides of the opioid war, Jennifer, but as a 30-year intractable pain survivor, at least I can say that I’ve tried very hard to understand your side. Can you say the same? Not in my opinion.

For all these reasons, I would be happy to accept your offer for a visit to Serenity Mesa. However, I don’t think it should be a scheduled visit, or include a tour given by the owner of the facility. And because of my current financial difficulties, as well as my disabilities, I don’t know when I’ll be able to plan this visit.

But rest assured, I plan on visiting Serenity Mesa in the future. And just like any stranger off the street who may have questions about your facility (and the treatments offered therein), I hope my visit will help me better understand addiction. After all, I advocate for access to all treatment options for all patients, not just for those suffering from chronic pain.

Now, Jennifer, what are you going to do to learn more about chronic pain?

Johnna Stahl
Executive Director of My Own Blog
The Disabled Community
painkills2@aol.com
No phone

Honeysuckle Haven

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I dream of a future where pain patients come together and create their own pain clinic. The one pictured in my mind is called Honeysuckle Haven.

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Since it will be totally self-sufficient, health insurance will not be required for admittance.

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Honeysuckle Haven is not like the Mayo Clinic’s Pain Rehabilitation Center — housed in a building made of concrete and steel, with doctors and tests to monitor your every move — or any other pain programs that currently exist.

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And in my future, the drug war will be over, so the Haven will offer all available treatment options.

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It will be a sprawling commune, nestled in fields of honeysuckle and bluebonnets, with large trees standing guard nearby. (The land will be a gift from the federal government as reparation for its cruel torture of pain patients in the opioid war, and in memory of those who didn’t survive.)

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Each building will offer different treatments, like water therapy and massage. There will be a building for patients who want to fight their pain with vitamins, a farm for those who are currently choosing cannabis, and patches of land for garden therapy.

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There will be a building where all sound is cushioned, and another one where patients celebrate loud music. There will be a building for those who like to pray, and bakery therapy for those who like to eat.

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There will be grief counseling (and comedy therapy) for all.

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Patients will move at their own pace, not dictated by schedules and appointments with professionals.

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I also picture a building where the mastery of pain management is taught. Newly-defined experts will come from all over the world to share experiences and discuss the many different issues surrounding pain and the brain.

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Patients will come and go; some staying for a day or two, and some for the rest of their lives. But everyone will be treated equally at Honeysuckle Haven (where eviction is against the law).

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Thanks for sharing my dream with me, and have a nice weekend. 🙂

Thanks, Senator Warren

http://www.thecannabist.co/

Can pot help with the opioid crisis? This U.S. senator wants to know more

Massachusetts Sen. Elizabeth Warren is urging the CDC to look into marijuana as a possible antidote to painkiller deaths

My comment:

I thank Senator Warren for bringing up this issue. Hopefully, it will save the lives of some pain patients — at least, in the long run. Maybe she can also make a request to Medicare, asking it to cover medical cannabis. Too bad these actions weren’t taken before the CDC and FDA decided to join PFROP and the anti-opioid advocacy crowd, and BEFORE doctors began refusing to treat pain patients, forcing many into cold-turkey detoxes and suicide.

When more people die from suicide than from opioid-related causes, which is the epidemic?

It’s obvious that Senator Warren doesn’t understand what it means to suffer from chronic pain. Patients need equal and affordable access to ALL treatment options, not just the ones that politicians think we should have. Restricting access to one drug, while showing favoritism to another, is not really how medical science is supposed to work. After all, tens of millions of pain patients benefit from taking opioids, yet it’s only thousands who suffer from drug abuse and addiction.

The failed drug war has taught us that when restrictions are placed on one drug, it just results in the increase of more dangerous drugs. (For example, cannabis and Spice. And, of course, opioids and illegal heroin.)

We all know that drugs don’t cause addiction — it’s not that simple. And when you discriminate against one drug, you discriminate against all of them.

Thinking of those who go unnamed

https://www.cchrint.org/2015/09/25/another-uhs-psych-facility-another-patient-death/

Pembroke psychiatric hospital, owned by Universal Health Services (UHS) as part of Arbour Health Systems in Massachusetts, is under investigation over a patient death in August. Pembroke Hospital has had 7 patient deaths this year (out of 49 statewide) and this is the first to happen at the facility. The other 6 died within 30 days of being discharged—fueling concerns about not only the lack of workability of psychiatric treatment in general but also its propensity to cause death…

CCHR has been investigating complaints from UHS psychiatric facility patients, their families and former UHS mental health staff since 2012. In complaints filed with MA health and law enforcement officials this year, CCHR reported that in 2013, 18 psychiatrists affiliated with 10 UHS facilities in MA billed Medicare more than $2.1 million, of which 6 accounted for $1.19 million. Four UHS-affiliated psychiatrists were among the top ranked state prescribers of several psychotropic drugs, including a psychostimulant and antipsychotic…

Patient deaths have been raised by CCHR to other state authorities, including:

There was wrongful death lawsuit filed 14 March 2012 against Arbour, Walden Behavioral Care and a treating psychiatrist that included allegedly increasing the patient’s psychiatric drug doses and failing to properly treat him in the week before he committed suicide…

A 2012 lawsuit filed against River Oaks in Louisiana alleged a boy was physically restrained by hospital staff and shot up with sedatives while a staff member sat on his chest. He stopped breathing and his lips had turned blue before CPR was used unsuccessfully and the boy was pronounced dead…

CCHR calls on any UHS former employees, patients and families to report any abuses or billing and other concerns to CCHR. Click here to file a report.