The Effectiveness of Pills

When I was under a doctor’s “care,” I was required to fill out a daily chart, which included monitoring every pill I took and my pain level at that time. It was like homework that lasted for 24 hours, and then was graded by the “school principal” every month (while I forked over hundreds of dollars for the privilege). It caused me to be overly analytical about my pain, almost like having to track, record, and analyze my every breath. (I’m exhausted just thinking about it.)

Of course, since I’ve recovered from my addiction to doctors, I’ve been busy analyzing other things. (Seriously, I don’t think I think too much, I know it.)

One of the things I was thinking about today (in my sleepless stupor) was the fact that pills are not as effective as the labels and recommended dosages suggest. When I was taking pain pills, I blamed myself when they didn’t last for, say, 12 hours. But my allergy pills work the same way, in that the effects don’t last for a full 12 (or 24) hours.

So, you’ll be sitting there, breathing just fine — then, all of a sudden, you lose the effect of the medication and it feels like you haven’t taken anything at all…

Wait, did I take a sugar pill? Is Big Pharma trying to save money by replacing some of my allergy pills with placebos? What other explanation could there be?

Even though I’ve been taking allergy medicine for decades, I don’t believe this is about a rebound effect or a problem with high tolerance. Since I recently spent a couple of weeks without allergy medicine, I’m using that as a comparison. When 12-hour Claritin-D periodically stops working within that 12 hours, I feel just like I did when I was without it. (The 24-hour dosage works in a similar way, at least for me.)

Most pain patients and doctors think that 12-hour formulations work better, giving a consistent dosage of medication over a longer period of time than four-to-six hour pills.

Yes, it’s true that you take fewer pills, but is it really more effective?

Perhaps the 12-hour pills are more effective for some pain patients, but I didn’t think so. When experiencing those periods of ineffectiveness, it was easier for me to hold off taking another pill when I knew I would be able to do so in a shorter period of time — something I don’t have the option of doing with my 12-hour allergy medication. And I thought the four-to-six hour dosages gave me more relief for a longer period of time, at least compared with the 12-hour pills.

How much time throughout the day are you getting relief? If the pills worked as advertised, they would work for a full 12 hours. Patients wouldn’t need to take more than the recommended dosage and there would be a lot less abuse and overdoses. Is it how a pill is digested? The length of time it takes to work? If a better way of getting our vitamins and minerals is through food (not vitamins), what would be the comparison for pain and allergy medications? Something to think about. (Free the Weed.)

This just goes to show you that every patient is different. But I also want pain patients to do their own analyzing — is all that we’ve been taught to believe really accurate?

This is also about the new abuse-deterrent formulations for pain medications, which also have a problem with effectiveness. It appears that patients are having problems digesting these new Big Pharma formulations. (And I have to wonder why the allergy industry hasn’t come up with their own versions of these formulations.)

Trying to outsmart those who don’t use drugs as recommended seems illogical to me — has that ever happen? And I just don’t think that patients deserve all the blame in the drug war, whether we suffer from chronic pain, addiction, or a mental illness. If you take prescribed medication or illegal drugs for any condition, it’s important to know the limitations and risks of those drugs. Don’t leave it up to Big Pharma, the government, or doctors to tell you about your medications — you’re only getting their side of the story.

When privileged politicians, law enforcement, and doctors try to outsmart street smarts, they will always end up looking stupid. Maybe that’s not a nice thing to say, but I think it’s the unvarnished truth. If it wasn’t true, wouldn’t the drug war be a success?

Okay, I’m done thinking now. Thanks for reading. 🙂

How to Fix Drug Courts

http://www.bloombergview.com/articles/2016-01-13/how-to-fix-drug-courts

But to make the courts work in practice, states need to see that they’re adequately funded and properly run. Typically, states offer drug courts as an alternative to prison for addicts who are arrested for nonviolent crimes only: In exchange for pleading guilty, a defendant can spend a year undergoing assessment, treatment and monitoring. Crucially, this opportunity is offered under the threat of sanctions (including jail time) for not following the program…

Many drug courts also need better management. Consider that judges, rather than physicians or other medical professionals, determine people’s treatment…

Indeed, a 2013 study found that two-thirds of drug courts prevented those who had been using illegal opioids from being treated with methadone or similar medication, often on the mistaken belief that such drugs prolong addiction…

My comment:

It seems we’ve gathered a lot of information and statistics for how the drug court system works. Since the opioid war is being blamed on pain patients and their doctors, what I’d like to know is how many of these tragic souls who end up in drug court are classified as suffering from addiction and how many are classified as chronic pain patients? How many of these drug war victims are suffering from depression, bipolar, PTSD, homelessness, or grief?

Let’s say I’m a 25-year-old woman who was abused as a child and have never dealt with it. I’ve been drinking and partying to block my pain, which exposed me to the variety of drugs that I became addicted to. Now, I’ve been arrested, caught selling 10 Vicodin to a friend, and stand in front of a judge in the criminal court system.

This process just increases the shame I feel, not only from my past but from being labeled a criminal for life because of a handful of hydrocodone. Caught in the system, I’m placed in an addiction treatment center, surrounded by other people who know better than anyone else how to find more drugs. Then, I’m given bupe or methadone to treat my addiction, introducing me to new drugs I can use to cover my mental pain.

The reason there is such a high recidivism rate for drug addicts is because the system only tries to treat the addiction, not any of the underlying causes or triggers. In fact, the system appears to create more addicts than it successfully treats.

Americans don’t care about pain patients

Almost 200,000 People Have Signed Petitions Asking Obama to Pardon the ‘Making a Murderer’ Subject

https://www.vice.com/read/almost-200000-people-have-signed-petitions-asking-obama-to-pardon-the-making-a-murderer-subject-vgtrn

As of this moment, there are 1,793 comments on the CDC’s website regarding the new regulations:

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

A search for the word “suicide” brought back 239 results in the comment section:

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

The same search has 3 results in the CDC’s supporting documents:

http://www.regulations.gov/#!docketBrowser;rpp=25;po=0;s=suicide;dct=SR;D=CDC-2015-0112

First Do No Harm: The DEA targets Physicians who treat their patients pain.

8,829 People Have Sent 21,065 Letters and Emails

http://www.petition2congress.com/5202/first-do-no-harm-dea-targets-physicians-who-treat-their-patients/view/

(1 day ago) Kristin K. from Central Point, OR writes:

It’s a relief to see that people are starting to recognize the demoralizing, and downright appalling scrutiny so many are dealing with. And most are guilty of nothing more than suffering with chronic pain. Depressing, devastating, and most often debilitating, chronic pain.

For twenty years I’ve watched my dad suffer in pain. For the first ten years he was prescribed oxycontin, a very strong, long-acting narcotic, for a spinal cord injury. He hated the way it made him numb emotionally. So he decided, on his own to discontinue the pain meds, and sought out a new doctor, hoping to fond an alternative. After a horrible withdrawal period, that caused mini strokes, he continued pain med free for several weeks. He came to realize he needed the relief the pain meds provided more than once thought.

However, his previous attempt to go drug free had caused his new doctor to red flag him, making it near impossible to get help in the way of narcotic pain medication, despite numerous MRI’s, and x-rays of his extensive injuries. It took going to the local Methadone Clinic, and asking who was known to have the worst reputation when it came to prescribing painpills too easily. They gave me a name and i had dad in to see him the next week. I needed to be sure we were going to a doctor that hadn’t become so fearful of DEA scrutinizing, that he would compromise morhis oath as a doctor, or his morals as a human being. It’s been a battle to say the least. Dad is now on a pain pump, and making slow progress. But, there should have never been a day go by that he had to suffer like he did.

(4 days ago) Someone from Superior, WI writes:

In my area it’s next to impossible to receive opiods for pain relief, chronic and acute. Just in my circle of loved ones, I have seen the following:

A 45 year old woman who cannot get pain medication after major abdominal surgery because her primary care physician wasn’t the prescriber. It was the surgeon who prescribed it, so insurance won’t cover it, and the pharmacy refuses to let her pay in cash.

A 74 year old accused of being a drug seeker when she was brought to the ER with back pain. Turned out she had kidney stones and a UTI.

A 44 year old veteran denied pain meds for a severe, permanent knee injury that forced him into early retirement from the military.

A 21 year old male accused of faking groin and back pain to access narcotics, even though he turned down hydromorphone and asked for Toradol. He ended up needing surgery to remove several 10 mm size kidney stones.

A 42 year old female denied pain medication for multiple foot fractures after an accident.

A 43 year old woman told to increase her doses of naproxen after calling her dr to report renal and stomach side effects. She’s currently in the hospital after developing a GI bleed.

A 55 year old veteran accused of drug seeking when he was brought to the ER with head trauma after being robbed and beaten. Funny how the addict who did this to him is treated more compassionately than the guy he brutalized.

A 38 year old female denied pain meds while having shingles.

And these are just acute pain patients. This doesn’t mention those of us with chronic pain diseases that are denied pain relief. Those of us with chronic pancreatitis, rheumatoid arthritis, numerous back problems, severe osteoarthritis, stress fractures in the spine, neuropathy from diabetes and blood clots, fibromyalgia, CRPS..,,the list goes on. Not one of us can get help from our doctors. Every single one of us in my group have side effects from this lack of treatment. Many of us have uncontrolled high blood pressure from stress and pain, most of us have varying levels of PTSD and depression because of these accusations. One patient has started getting panic attacks every time they enter a medical facility.

Despite opiods being next to impossible to get here, heroin use has risen dramatically…

(2 days ago) Maureen S. from Clifton Park, NY writes:

Very well written! I am tired of being treated like a criminal by my doctor, I am tired of the friggin’ cashier at the pharmacy giving me the stink eye.

I am weary of thinking about suicide almost every day.

http://www.pharmaciststeve.com/?p=13163

Centers for Disease Control and Prevention (CDC) is hosting a public conference call on its controversial Guidelines for Prescribing Opioids for Chronic Pain Thursday, January 7, 2016, at 9:00 am ET.

ER Horror Story

https://www.facebook.com/PatientsUnitedForDeaReform

Donald Moore‎
December 23 at 9:17pm · Belfast, ME

I recently moved to Maine from Portland, Oregon… I have been in chronic, 24 hour a day pain for almost 15 years…

But the story I’d like to relate today happened to me last week at the St.Joseph Hospital in Bangor, Maine.

When I arrived in Maine about 3 months ago, I had about 6 weeks of pain medication remaining. I thought that, even under the worst conditions, I would be able to find a doctor to take over my treatment. I was mistaken. Because an outright “drug war” declared on Heroin and other forms of opioids declared by Governor LaPage, “opioidphobia” (not my word) has met, or surpassed Islamophobia in popularity. I waited six weeks for an appointment at a pain clinic, and after driving two hours and forking over nearly $400 of my own money, I was informed that it would be my only appointment there, as they had decided to close the practice. It’s a story that is repeating all over the United States: Doctors with hundreds of patients who come to them for the medications they need for legitimate medical conditions are closing down with little or no notice. Even as I sat waiting for my first and last appointment, three different people, coming for their monthly refills, were informed of the closure. One was in shock, one was angry and the third sat on the chair across from me and wept.

I called more pain management clinics. Several of them I spoke with were either not taking anymore patients, while several others made it very clear that they were no longer prescribing narcotic pain medications for chronic pain…PAIN CLINICS! …

So it was that I found myself forced to discontinue the regimen that had kept me a productive member of society for 15 years… As many of you know, the withdrawal symptoms were acute; I spent a better part of six weeks going form the couch to the bed to the chair to the bed in a losing battle to find some position, any position that would give me some relief from the pain. There wasn’t any.

Even though the withdrawal symptoms eventually eased, the pain didn’t. I now suffer from 8/10 to 10/10 pain that has no end. It is entirely life consuming. I can’t sleep, eat or stand long enough to shower. I’ve gone from a person who owned and operated a restaurant for 10 years, spent the last 4 years driving a cab 12 hours a day, and then drove, alone from Oregon to Maine, rented a house and moved myself in. Now I don’t go outside, can’t take care of myself, and literally stood at the bottom of the stairs and peed myself because the pain was so bad I couldn’t get to the top of the stairs.

Finally I could take no more and we drove the hour to St.Joseph Hospital in Bangor to go to the ER. In triage, I told the intake nurse that what I felt like I needed was an emergency neurosurgical consult and an MRI. My last neurosurgeon had instructed me that if I had new or worsening symptoms (the bottom of my left foot seems to have gone numb permanently, and clearly I am having some control problems with my bladder.) I told them I was scared. I told them I didn’t feel like my life was worth living this way and I felt like what I really needed was to be admitted to a hospital until a solution could be found.

I want to be very clear here: AT NO POINT DURING MY VISIT DID I EVER MENTION OR REQUEST ANY KIND OF PAIN MEDICATION, ESPECIALLY OPIOID PAIN MEDICATION. I know better…

For 7 hours, during which time I was not seen by a doctor, a physicians assistant, or a nurse practitioner. After 5 hours, and more repeated requests for a neuro consult and MRI, a nurse appeared and gave me two Tylenol, and two Ibuprofen. A man with 9/10 pain and multiple surgeries on my Lumbar spine was left to writhe on a 2-inch-thick foam pad on top of a hospital gurney, without so much as a interview, physical examination, or even a visit with an M.D…

Continuing to do my best to be “calm and compliant”, I asked again for a neuro consult, an MRI, or to be admitted. Dr. Matthew Duhl, M.D. informed me that I did not meet the criteria for a neruo consult or an emergent MRI. He went on to tell me that there was no way he was going to give me anything substantive for pain and that he believed that I was using a suicide threat “as a bargaining chip to get narcotics”

Are Antibiotics Making People Larger?

http://www.theatlantic.com/health/archive/2015/12/obesity-antibiotics-microbiome/421344/

But the idea that a person can essentially contract obesity because of a change in gut microbes is at once exciting and unnerving—because exposure to microbe-altering drugs in day-to-day life has become almost inevitable. This month, the U.S. Food and Drug Administration quietly released a report that said over the past year, antibiotics sold annually for use in food animals increased to 33,860,000 pounds.

That’s a 22 percent increase since five years prior (which was the first time the amount was even measured). Usage also increased in 2014 alone, despite several prominent food producers and restaurants like Whole Foods and Chipotle swearing off antibiotic-raised animal products. Most of those antibiotics are “medically important,” meaning they are used in humans to treat diseases. But a majority of antibiotics are not absorbed by the animal, just excreted. So even those that are not medically important manage to find their ways into soil and water as they become part of the 18 gallons of manure that every cow produces every day.

Antibiotics in manure that seep into soil have been detected in carrots, lettuce, and green onions. Some antibiotics remain active for months after passing through the animal and are detectable in rivers miles from their use; a study of a river in Colorado found several antibiotics everywhere except for “a pristine site in the mountains before the river had encountered urban or agricultural landscapes.” Antibiotic overuse turned the Hudson River into a breeding ground for drug-resistant bacteria…

In 2014, Martin Blaser and colleagues at New York University found that steady exposure of mice to penicillin early in life predisposed them to become obese…

The doctors note that using antibiotics to grow meat results in deadly “superbugs” that now sicken more than two million Americans every year and kill 23,000

In a video segment at the museum, there’s a bit where Stanford microbiologist Justin Sonnenburg says that with every dose of antibiotics you take, you do damage to the microbiome. It recovers, but it never recovers to the place that it was before…

The difference in how the abuse of antibiotics and opioids are treated by the CDC is very clearly discrimination (not only against the drugs, but against the patients who use them):

https://www.washingtonpost.com/news/to-your-health/wp/2015/12/11/deaths-from-heroin-overdoses-surged-in-2014/

The 10,574 heroin deaths and the 18,893 deaths from prescription opioids were two big contributors to a sharp increase in fatal drug overdoses last year…

Frieden said the data, which was published this week, may change after CDC has a chance to review them and parse out cases of people who died with both heroin and prescription drugs in their systems. But even if some individuals were counted twice, he said, “It’s clear that the opiate epidemic from 2013 to 2014 got worse, not better.” …

http://www.vox.com/2015/10/1/9433099/opioid-painkiller-heroin-epidemic

As Sabet acknowledged, the government knew this was a possibility — but the feds still thought it was worth cutting off the supply of painkillers to prevent doctors and pharmacists from creating even more generations of painkiller addicts…

I can’t be sure, but I think this is the first time I’ve seen the government acknowledge that they knew the tragic results of the opioid war before they decided who deserves treatment and who deserves to suffer (and die).

The desire to treat pain led to a devastating epidemic…

That’s what the federal government and the anti-drug advocates want everyone to believe, but I don’t think that’s true.  They want to demonize the treatment of pain, especially with certain drugs, and the only way to do that is to say treating pain has lead to this abuse “epidemic” — that treating pain with opioids always leads to addiction. Otherwise, not treating pain would be seen as the torture that it is.

So, now the government thinks that if they refuse to treat pain, less people will end up as drug addicts. I don’t know if that’s naive or just plain ignorant. Yes, no doubt the opioid war will stop a very small percentage of people from becoming addicted — but just to certain opioids, not any other drugs. Drug addiction is not only about opioids and heroin, and if these drugs were somehow removed from all markets, drug addiction would still exist.

In fact, when you remove the safer drugs from legal markets, the underground market just creates more dangerous drugs. And although I can’t be sure of this, I believe the underground market will always be smarter than all the law enforcement trying to eradicate it.

https://www.washingtonpost.com/news/to-your-health/wp/2015/12/21/florida-pill-mill-crackdown-also-may-have-reduced-heroin-deaths-researchers-find/

Under comments:

Don Sharp
12/21/2015 3:58 PM MST
The headline and the text of the article are at complete odds.

The headline makes it out as if cracking down on prescription pain pills “curbed” (and in “lessened”) heroin deaths.

The text of the article make it clear that is not the case, since heroin deaths “surged”.

Is the author a complete moron… or is the editor a complete moron… cause apparently one or both of them think that “curbed” and “surged” are the same word.

Barton1216
12/21/2015 5:13 PM MST
Besides all this nonsense, you might want to note that it has become damn near unheard-of to get a prescription for even tramadol in Florida. Most doctors have simply stopped treating pain with anything other than NSAIDs. And that doesn’t even consider the instances we’ve had of cancer patients having to go to multiple pharmacies to find ONE willing to dispense their pain meds. The “war on drugs” is one of the least humane wars there is, and no one appears motivated to stop it.

timtiminhouston
6:40 AM MST
What this article fails to mention is that the same day we had to dump my uncle Manuel Edgin at a Harris County Hospital called LBJ there were several cars doing the same thing we were doing: dumping elderly people.

If you are an elderly person the recent changes to end of life pain management mean you will be far worse off than any generation in the last century. Now when it is time for you to die, you will have an actual reason to cry. And the only possible relief, thanks to the DEA, is death.

May you lay in the bed you made, and may you leave the world the way my uncle Manuel Edgin left: kicking, screaming, and wishing for death. This is the death you have created for us all…I curse every drug warrior to suffer this fate they wish upon us.

My family could no longer get his prescriptions of hydrocodone or morphine filled, so even though he had two types of cancer and had yellow puss coming out of every pore in his body, we could not treat his pain. We had to dump him on Harris County tax payers to save him.

Thinking of you, Manuel Edgin

0DSC09287 (3)

Dr. Shame

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

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

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

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

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

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

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

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

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

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

And so enters the black knight in tarnished armor…

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Brainwashing or placebo effect?

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

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

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

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

Total number of suicides in Oregon (2013):  698

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

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

Can addiction be cured?

http://www.painmedicinenews.com/ViewArticle.aspx?d=Policy%2b%26%2bManagement&d_id=83&i=November+2015&i_id=1244&a_id=34181&tab=MostEmailed

“The difference between a patient in chronic pain and a person who is addicted is, with addiction, we expect a cure,” Dr. Lewis said. “We expect the patient will recover to the point that they can maintain some cured state—even if they’re on methadone; the goal is to integrate them back into society.

“That doesn’t happen with chronic pain,” she continued. “Chronic pain is progressive. It’s associated with a multisystem injury to the body, and it’s not going to be cured. So what we want to do is give that person the most optimal tools, in spite of what has happened to them. It’s a big difference in approach.” …

This is a good point, but I’m not sure that we should expect those who suffer from addiction to be “cured.”  Maybe “recovered” is a better term. Because I’ve had addictions that I’ve overcome, although I can’t say that I’m “addiction-free.” After all, I’m human, not a robot. (C’mon, sugar isn’t as bad as heroin, right?)

So, if someone’s using methadone to successfully treat a drug addiction, does that mean they’re “cured”?  Here’s what I’m saying:  Some drug addictions will require life-long management, so forcing the expectation of a “cure” on addicts is not the way to go. Just like the pain management industry should stop telling patients that their pain can be “cured.”

Thinking of you, Nicklaus Ellison

http://www.nytimes.com/2015/11/03/business/dealbook/in-religious-arbitration-scripture-is-the-rule-of-law.html

A few months before he took a toxic mix of drugs and died on a stranger’s couch, Nicklaus Ellison wrote a letter to his little sister.

He asked for Jolly Ranchers, Starburst and Silly Bandz bracelets, some of the treats permitted at the substance abuse program he attended in Florida. Then, almost as an aside, Mr. Ellison wrote about how the Christian-run program that was supposed to cure his drug and alcohol problem had instead “de-gayed” him…

After breaking his probation sentence for drunken driving and crashing into four parked cars, Mr. Ellison faced a year in jail. As an alternative, the prosecutor in the case agreed to Mr. Ellison’s enrolling in Teen Challenge, a program that teaches participants to overcome addiction by studying the Bible and becoming more “Christ-like.”

Teen Challenge was highlighted by President George W. Bush as a successful faith-based program that deserved federal funding…

His yearlong program in Pensacola, Fla., consisted of doing manual labor for many hours a day. Local landscaping companies, carwashes and a fish market employed the men, former participants and their families said. Teen Challenge said money from the “work assignments” helped cover some expenses and the men were not entitled to compensation, according to a participant consent form.

“This wasn’t treatment, this was free labor,” said Angie Helms, whose son Tyler attended Teen Challenge with Mr. Ellison.

Teen Challenge explained that working was a way for the men in the program to overcome their addiction. Work is “one of the central purposes for human existence,” according to the consent forms…

Centuries later, Paul’s writings inspired a group of lawyers in Los Angeles to develop the practice of Christian conciliation. The group’s work ultimately gave rise to Peacemaker Ministries, a nonprofit that devised a legal process that draws on the Bible.

The peacemaker method is used by private schools, Christian lawyers and others. Clauses requiring Americans to use Christian arbitration instead of civil court now appear in thousands of agreements like the one Mr. Ellison signed with Teen Challenge…

Ms. Spivey had to pay a $5,000 retainer and a $750 fee to Peacemaker Ministries, her lawyer said in court papers…

His family said they thought it was hypocritical that Teen Challenge was willing to collect food stamp subsidies to feed participants in the program, but insisted on the separation of church and state when it came to their legal case…

Thinking of you, Tyler Sash

http://espn.go.com/college-football/story/_/id/13879204/former-nfl-player-tyler-sash-overdosed-pain-meds-autopsy-shows

IOWA CITY, Iowa — Former NFL and Iowa safety Tyler Sash died from an accidental overdose after mixing two powerful pain medications, and a history of painful injuries was a contributing factor, a medical examiner said Tuesday…

Sash, a standout safety at Iowa who won a Super Bowl during his rookie season with the New York Giants in 2012, was found dead at his home in Oskaloosa, Iowa, on Sept. 8…

The autopsy determined the cause and manner of death was an “accidental mixed drug toxicity involving methadone and hydrocodone,” the office said Tuesday. Both are legal narcotics used to relieve severe pain, but are also highly addictive.

The medical examiner said that a recent shoulder dislocation and a history of chronic shoulder pain suffered by Sash were also “significant conditions” in the death.

Oskaloosa Police Chief Jake McGee said investigators learned that Sash had a doctor’s prescription for hydrocodone but are not sure about how he obtained methadone…

Can Addicts Finally Force the War on Drugs to End?

by Maia Szalavitz

https://www.vice.com/read/can-addicts-finally-force-the-war-on-drugs-to-end-928

But now a group called Unite to Face Addiction is planning a massive rally in Washington, DC, to attack stigma and call for change. On Sunday, October 4, big names like Steven Tyler, Joe Walsh, Jason Isbell of the Drive-By Truckers, and Sheryl Crow will perform. Speakers will include former Congressman Patrick Kennedy, former baseball player Darryl Strawberry, author William Cope Moyers and current “drug czar” Michael Botticelli, who is in recovery himself…

But while there’s general agreement about what not to do, the movement will ultimately face a difficult battle over its agenda and how, exactly, to address drug addiction without waging “war.”

Too late. The war just keeps getting bigger and bigger, now including pain patients and really anyone who is prescribed an opioid.

Spearheaded by Greg Williams, a 32-year-old filmmaker who kicked OxyContin and other drug addictions 14 years ago, the organization has what he says is a “multimillion-dollar” budget. Over 650 different addiction-related groups are sending members. Among the biggest donors are the Conrad Hilton Foundation and Marriott. “We have [around] 100 different major sources of funding, meaning $10,000 or more,” he tells VICE…

Pharmacies not accepting new Suboxone patients

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

jrhea0095
Mon Dec 22, 2014 6:51 pm

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

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

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

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

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

Redtail
Junior Member

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

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

Hyperalgesia

http://suicideproject.org/2015/08/can-people-in-chronic-pain-be-prescribed-morphine/

August 25th, 2015 by wndozh8er

just curious if doctors would prescribe morphine tablets to people with severe and incurable chronic pain?

Somebody Insignificant
AUG 25, 2015
The old thought was that your body adapts to the morphine so you need more and more the longer you are on the drug. For people who have chronic pain this means that Doctors had to keep increasing their dosage.

So now the new thought is that our bodies don’t get used to the morphine. The morphine actually sensitizes your body to pain so that the longer you have been taking morphine and at increasing doses you are making your body more sensitive to pain. This allows the Doctors to tell yo that you need to stop taking morphine and eventually your body will return to normal and will not be so sensitive to pain so you will not need pain meds and wont be in any pain at all…

I guess the commenter is speaking of the theory of hyperalgesia. There are doctors who believe in hyperalgesia (even though no one can say how prevalent it is), and I guess they’ve convinced some patients, too. But I still wonder if it exists.

One way to treat it is by reducing or stopping opioid use, but it’s also treated with rotation of the medications. However, expecting to be pain free after reducing or stopping opioid treatment would be something akin to magic. It’s not like the pain that existed before this alleged hyperalgesia condition is going anywhere.

http://www.amepc.org/apm/article/view/466/536

(2012) Opioid-induced hyperalgesia: What to do when it occurs?

Opioid-induced hyperalgesia has been defined as increasing pain sensitivity in patients chronically exposed to opioids without any evidence for new causes of pain…

That doesn’t make sense. A patient “chronically exposed to opioids” would be a chronic pain patient. Chronic pain doesn’t get better; it just gets worse. So looking for evidence of “new” causes of pain isn’t even necessary. And it’s confusing why increased pain would always mean a new cause, otherwise you’re suffering from hyperalgesia or drug addiction. Aren’t all the old causes (and old age) enough evidence of increased pain, or do patients have to continually prove their pain levels with new medical conditions?

While the phenomenon has been well studied in many animal experiments subsequent to this first description, there is ongoing debate about the clinical relevance of this phenomenon, exemplified by the title of a most recent review “Opioid induced hyperalgesia: Clinically relevant or extraneous research phenomenon?”

UNM Project ECHO bites the dust

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

“This is a witch hunt of epic proportions.”

http://ravallirepublic.com/missoula/news/local/article_cdbc86b1-205f-5c1c-b547-25cc5eaa5913.html

HAMILTON – A Florence physician was arrested at his home Thursday morning and charged with more than 400 felonies, including two counts of negligent homicide.

Dr. Chris Christensen, 67, has been under investigation since his Florence clinic, Big Creek Family Medicine, and his home were raided by a joint local, state and federal drug task force in April 2014…

Christensen’s business operated almost exclusively in cash, the affidavit stated. Financial records indicated the business earned about $2,500 a day and grossed more than $500,000 annually…

The DEA believes that any pain doctor that doesn’t take insurance is running a pill mill, and of course that’s very far from the truth. And it seems like the DEA can only charge pain doctors if any of their patients die of a drug overdose.  In Dr. Christensen’s case — a doctor that has been practicing for a very long time — all they found were two deaths. Considering the kinds of patients that pain doctors treat, I’d say two patient deaths out of thousands is not bad at all.

At a news conference Thursday, the special agent in charge of the U.S. Drug Enforcement Administration’s Denver Field Division, Barbara Roach, said Christensen’s patients traveled to his clinic from 10 different states, from as far away as Oregon, Nevada and even Ohio. In Montana, Christensen’s patients came from 62 different cities and towns.

Instead of realizing that the reason for this is that pain patients are unable to find access to health care in their own states, the DEA looks at this as criminal activity. Because… drug war.

Roach said investigators compared the number of prescriptions for controlled substances written by Christensen against seven other physicians from similarly sized communities. Christensen wrote more prescriptions for those type of medications than all of the seven doctors combined, she said.

You can’t compare one physician’s prescribing habits against others, unless you are comparing apples to apples. Were these seven physicians practicing pain management? Were they treating cancer pain? Were they treating pain patients from out-of-state?

The case against Christensen focuses on 11 patients selected by the Ravalli County Attorney’s Office and the drug task force. In nearly all of those cases, Christensen neither contacted the patients’ former physicians nor reviewed medical records before prescribing drugs including methadone, oxycodone and Dilaudid, the affidavit stated…

See, they only found 11 patient records out of thousands. And is there a law that says a doctor is required to contact former physicians for every patient they see? Please, someone show me where this law is located.

After the DEA attempted to contact Marchand, he said he alerted Christensen. The doctor allegedly replied “the DEA can’t do anything to me,” the affidavit stated.

Christensen was indicted in U.S. District Court in Idaho in 2005 on 18 counts of distribution of controlled substances outside the course of a professional practice and without legitimate medical purpose. He was acquitted on those charges in 2010…

Looks like the DEA is after revenge.

The maximum penalty Christensen could face is 388 life sentences, plus 135 years in prison and fines of $20 million.

The DEA overloads the charges like this to put fear in the hearts of their victims. And it works. Fear and the inability of victims to pay for an adequate defense gives the DEA an incredible amount of power that is rarely defeated.

“This has been a long process,” Fulbright said. “More than a year of investigation work was completed before search warrants were issued for Dr. Christensen’s office and home. Those searches … resulted in the task force seizing 4,718 medical patient files, and 1,500 additional files for medical marijuana patients…

Does the DEA realize that these pain patients cannot find another doctor without their freaking medical records? (As if they’re going to be able to find another doctor anyway.) Where are these records now? Is the DEA following HIPAA rules while working with them? Will each of these patient’s records now come with warnings:  Treated by a doctor arrested by the DEA. Drug addict.

Where will over 6,000 patients find another doctor willing to treat them? The State of Montana should be prepared for a rise in heroin use and overdoses, new cases of patients suffering from addiction, and suicides.

Citizens of Montana, don’t blame drugs for the additional medical problems and deaths you will be seeing in your family members — blame the DEA.

Dr. Walter Hofman: Coroner addresses local heroin deaths

http://www.timesherald.com/opinion/20150713/dr-walter-hofman-coroner-addresses-local-heroin-deaths

Montgomery County, with almost 800,000 inhabitants, is the 3rd largest population in the Commonwealth of Pennsylvania. In 2014, the deaths of 161 citizens were reported by the Montgomery County Coroner due to overdoses of prescription and /or non-prescription drugs. The manner of death was predominantly accidental but some were suicidal…

These drugs are all too easy to obtain. In almost 100 percent of the cases, patients go to multiple doctors for the same ailment, receive a number of prescriptions for the same drug, and fill them all at one neighborhood pharmacy…

In 100 percent of cases, are these patients paying cash?  Because paying cash for multiple doctors and prescriptions for the same drug is very expensive.  And insurance doesn’t cover the same service multiple times in the same day or month.

Who are these patients who can afford such costs? Are they drug dealers from the street or from Wall Street?  Are they pain patients hoarding medications out of fear? Are patients taking these large amounts by themselves and not selling any?

It may come as a surprise to many, but the majority of the overdose cases we examine are not facilitated by shady transactions with a drug dealer in a dark alley, but filled by prescription at local pharmacies.

A legal drug dealer, out in the open, in public, filling prescriptions for legal drugs.  Why is one transaction shady and the other isn’t?  They’re selling the same products. But one dealer paid the government for a license and is selling government-approved drugs, while the street dealer doesn’t have the money or connections to do the same. Plus, the street dealer’s customers — unlike the pharmacy’s — usually don’t have insurance.

Even though more people now have insurance, there are still millions who don’t have any. And even with insurance, there will still be plenty of patients who can’t afford to regularly see a doctor. The cost of seeing a doctor is added to the cost of every prescription, which is one of the reasons it’s cheaper to buy drugs on the street.

Fentanyl is a drug 10-20 times stronger than heroin and is most often prescribed for pain. When scraping the fentanyl patches or crushing lozenges, and then mixing with heroin, an even more dangerous situation occurs…  Other opioid analgesics that are being used with heroin are hydromorphone, levophanol, meperidine, methadone, morphine, oxycodone and oxymorphone…

Finally, it has been stated that “some people who use large amounts of drugs often and long enough become addicted.” Not always true. Using a drug for a short time is adequate to become “hooked,” and sometimes only requires one use…

Dr. Walter Hofman is a board-certified Forensic Pathologist and cororner of Montgomery County

Sometimes only requires one use…  “Sometimes” is pretty vague, but I’d say the more accurate description is that addiction rarely happens with a single use of a drug.

http://ireta.org/2015/05/26/updates-on-a-prescription-drug-monitoring-program-in-pennsylvania/

On October 27, 2014, Pennsylvania passed a law that will modernize our prescription drug monitoring program and undoubtedly save lives. However, implementation will be even more complex than the lengthy legislative process we’ve already seen. We’ll continue to share information about our PDMP as the program gets off the ground. Look for further blog posts about the role of prescription monitoring as part of a public health effort to reduce overdose, address risky substance use and addiction, and most importantly, to improve the quality of care that all patients receive.