Repealing opioids when there are no replacements is ignorant and barbaric

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

My comment:

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

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

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

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

Pain patients have no support from media

http://abcnews.go.com/US/fentanyl-deaths-spiked-us-sign-slowing/story?id=44554601

My comment:

I find it odd that the media doesn’t connect the dramatic increase in fentanyl deaths to the federal government’s opioid war. It’s not surprising that deaths in Florida are up 70%, as the DEA began its increased crackdown on pill mills in that state. As the DEA took its opioid war from state to state, those who suffer from drug addiction have had even fewer safe choices. It’s almost like, because prohibition was so long ago, the government has forgotten the lessons learned from that huge mistake.

When the CDC passed new opioid guidelines this year, the agency knew that one of the effects would be an increase in drug overdoses and suicides. Andrew Kolodny from PFROP (the addiction industry group that worked with the CDC on the guidelines) admitted as much. They believe that it’s more important to save people from a potential future addiction than it is to save the people who are now dying. Since the guidelines only went into effect this year, overdose deaths will keep increasing.

Those who suffer from addiction are not the only people who have been and will be adversely affected by the government’s opioid war. If you suffer from any kind of pain, you will also be affected — if not now, then sometime in the future.

A recent poll showed that over 60% of doctors don’t believe that painkillers work for chronic pain. Many doctors have stopped prescribing painkillers altogether. You may think this is a great idea — until your doctor refuses to treat your pain. And you may be surprised to learn that, just because you have a serious medical condition like cancer, that doesn’t mean you’ll have access to painkillers. Also be ready for a lecture from your doctor about the horrors of addiction whenever a painkiller is prescribed, regardless of whether you’re part of the 10% of people who may suffer from addiction.

Everyone agrees that the drug war has been a huge and expensive failure (except the DEA). Isn’t it time we had a war against pain instead of the drugs that can treat it?

For every story about someone who suffers from addiction, if the media wanted to, it could find 20 stories of people suffering from chronic pain. I wonder if someone could tell me why the media refuses to report on the millions of chronic pain patients who are the latest victims in the drug war.

Yes, the CDC is on Facebook

http://www.facebook.com/CDC

I was just thinking about how much fun it would be to leave a daily message for the CDC. Something like…

Hey, CDC, my name is Johnna Stahl. I’ve suffered from intractable pain for 30 years. Your opioid rules may help a few people who could suffer from addiction in the future, but what are you going to do, right now, to help me and 40 million other chronic pain patients?

Hey, CDC, it’s me, Johnna from Albuquerque. I’m back again to remind you that everybody knows the drug war is a failure. Your opioid war is an even bigger failure. How many people have to suffer and die before you come to your senses?

Yes, it’s me again, Johnna from the Q. When will the CDC approve assisted suicide for chronic pain patients?

Hey, CDC, where did you find Kolodny from PFROP? Are all of your “experts” as ignorant as Mr. Kolodny about the treatment of pain?

Hey, CDC, how does it feel to ruin people’s lives? To make them feel like outcasts and drug addicts when they suffer from constant pain? What’s the CDC’s position on creating stigma? Seems like that should be against the law.

Does anybody want to join me in hounding the CDC? I don’t mind being the only one, but maybe I should wait until after payday (budday). I use too many swear words when I don’t have my bud. Just 3 more days…

When an expert is not an expert

I used to read articles at Vice until they published an article about cannabis that was ignorant and wrong. Let’s see what Vice is getting wrong today, shall we?

This article is full of incorrect statistics and biased conclusions that are endemic in the media. And guess who Vice chose as their addiction “expert”?

http://www.news.vice.com/story/opioids-chronic-pain

The CDC insists it isn’t trying to create barriers to legitimate treatment. The new guidelines, the agency says, are the result of extensive input from “experts” and a thorough review of the available “evidence.” They don’t explicitly rule out opioids for chronic pain, but they do send a clear message that opioids should not be considered a first-line treatment…

I’m sure everyone’s experience is different, but my experience has been that doctors don’t consider opioids as a first-line treatment for anything except acute pain, if then. This makes it sound like chronic pain patients just want an easy fix, the pills. That’s very wrong (as my bank account can attest). In other words, the CDC didn’t need to create regulations because of this issue. I’d say that about 95% of doctors already practiced that way. But wait, we need to punish that 5% of doctors who aren’t following the rules, just like we’re punishing pain patients for those who suffer from addiction. Because drug war.

Alternatives do exist. For instance, the CDC says exercise therapy has been shown to improve physical function in some patients. Non-opioid medications, such as acetaminophen or ibuprofen, can be useful for conditions like arthritis and lower back pain, and some antidepressants and anticonvulsants are also effective.

Tell me, how are people in pain supposed to exercise without any pain relief? Sure, exercise will improve my physical function, but why would I want to increase my pain levels without anything to relieve the increased pain? That would make me stupid. Or a masochist. And speaking of masochists…

Hey Kolodny, are you going to treat the conditions that arise from taking acetaminophen or ibuprofen on a long-term basis? Even the CDC advises against that. How about when an antidepressant causes suicidal ideation? Do your addiction centers treat that, too?

In 1996, the American Pain Society launched its influential “fifth vital sign” campaign, giving pain equal billing with blood pressure, pulse, temperature, and rate of breathing… Just as the “fifth vital sign” campaign encouraged physicians to prescribe opioids indiscriminately…

The media and the medical industry love to place blame on the fifth vital sign. Tell me, what does monitoring pain levels (along with blood pressure, etc.) have to do with drug addiction? No, no, no, the fifth vital sign campaign did not encourage doctors to prescribe opioids indiscriminately. That’s doctors talking, blaming overdoses and addiction on pain patients.

That same year, Purdue Pharma released OxyContin, a powerful painkiller sold as a slow-release pill, which the company aggressively marketed as a godsend for pain patients, often to doctors with little knowledge of abuse-disorder warning signs. OxyContin was a blockbuster, reaching sales of over $1 billion by the end of the decade. But it turned out the drug was also pretty easy to crush, snort, and inject for a high — and Purdue downplayed the risk of patients becoming addicted. In 2007, the company and its executives agreed to pay fines of $635 million for misleading the public.

Sure, blame Purdue. Don’t blame doctors, who use ignorance of treating pain and addiction as the reason for Oxy’s popularity. Bullshit. Doctors have always known that Oxy is addictive. All painkillers can be addicting in a small percentage of patients and doctors know that.

One study the CDC looked at showed that dependence among patients on opioid therapy was as high as 26 percent…

Actually, there are studies that show the addiction rate for pain patients at about 3% to 10%, but the CDC wasn’t interested in any information that was contrary to what their “experts” wanted. Why would the CDC base the treatment of pain on this one study? And why is the CDC making regulations according to 26% of the population? What about the other 74%? I can’t be sure, but I believe that constitutes a majority.

But if the evidence doesn’t support opioid treatment for long-term pain, why are so many chronic pain patients convinced they need the drugs to function? Andrew Kolodny, an influential substance-abuse expert and one of the country’s most vocal critics of opioid overprescribing, thinks he has a pretty good answer. Those patients, he says, are probably dependent on the drugs and may be addicted.

Actually, the lack of “evidence” to support opioid treatment for chronic pain has more to do with who funds the research. No one wants to fund research for chronic pain, even if they could find volunteers who would agree to treat their pain with a placebo. Those funding research on pain are connected to addiction, like the NIDA. And when others perform research on pain, if it doesn’t comport with the government’s program on addiction, the research is buried or not even published.

Kolodny doesn’t waver when I mention the desperation I’ve heard from sufferers. “You’ve found a group of very vocal patients who are convinced that everyone is trying to take their opiates away from them,” he said. “They believe that the CDC guidelines — that advocacy groups like mine — that what we’re really after is stopping drug abusers, and that they’re being made to pay the price. That’s totally not what’s going on. What’s motivating us is an understanding that opioids are lousy drugs for chronic pain.”

Pain patients are having their medications taken away from them — not just opioids and not just pain patients. Doctors don’t want to treat any kind of pain because they’re scared. No, doctors would rather blame pain patients, stop treating them, and move on. How many pain doctors have switched to treating addiction (see the first link following my rant)?

Kolodny reminds me of people who think that addiction doesn’t exist. I think he believes that chronic pain doesn’t really exist. For Kolodny, only addiction exists.

Anyone who says that opioids are lousy drugs for chronic pain has never suffered from chronic pain — and is an ignorant asshole. This is who the CDC used as an “expert.”

For consensus, Kolodny says to look to the country’s leading pain clinics. The Cleveland Clinic, the Mayo Clinic, and the Washington University School of Medicine are a few of the institutions whose experts now say long-term opioid treatments are ineffective and risky. But there are still pain specialists who disagree…

Why doesn’t the media talk to patients who’ve been treated by these allegedly illustrious clinics? I want to hear from them. Actually, I do hear from patients who’ve been treated at these clinics, in comment sections all over the internet. And it’s nothing good.

“The language that they’ll use to describe how they think opioids are helping them is the exact same language my heroin-using patients use,” Kolodny told me. “I’ve been treating opioid addiction for about 15 years. They use the same exact language: ‘Doc, imagine what it feels like every morning — feeling like you’ve been hit in the chest with a baseball bat until you take your first dose.’”

First of all, Kolodny is neither an addiction expert or an expert on the treatment of pain. He’s a dickhead with a lot of power and money behind him, hoping to move up to bigger and better things, probably in politics.

How much has Kolodny’s income increased since he joined the opioid war? How many patients have died while being treated at one of Kolodny’s addiction clinics? Why isn’t he being held responsible for these deaths, like pain doctors are being prosecuted for their patients’ deaths? Why doesn’t the media include the crimes being committed at these clinics when using Kolodny as an “expert”?

Kolodny says he’s been treating addiction for 15 years. Has he ever suffered from addiction or chronic pain? I’ve suffered from intractable pain for 30 years and I think I know more about addiction than he does.

In Kolodny’s view, these patients are feeling better from opioids not because the medication is treating an underlying pain problem but because it’s treating their withdrawal pain. And his view holds a lot of sway….

Really? Seriously? Well, Mr. Kolodny, I haven’t taken opioids to treat my intractable pain for about 6 years now. Why am I still in a suicidal amount of pain? Because the “pain problem” is not an underlying condition — it is the main condition. And it deserves treatment, just like any other medical condition.

Even Kolodny concedes that some patients have been on opioids so long that they may never be able to function without them. Long-term use can cause physical changes in the brain that are potentially irreversible. “What we don’t want is for primary care doctors to just start firing these patients,” he said. “That would be really bad. It’s a problem that we need good solutions for.

Chronic and intractable pain can also cause physical changes in the brain that are not “potentially” irreversible, but always irreversible.

Thanks to the CDC and the media, Kolodny is the #1 enemy of pain patients. And I think he enjoys being seen this way, as it makes him look like a hero to all of his followers. If he can diagnose me as a drug addict because I suffer from intractable pain, then I’m diagnosing him as a masochist who enjoys seeing people suffer. That’s probably why he got into treating addiction in the first place.

Hey, Kolodny, pain patients are being abandoned left and right, and have been for years. Where the fuck have you been? I know, your only interest is addiction. You care nothing for pain patients, yet you claim to be an expert and the CDC and the media treat you like one. But I know what you are. I know you’re partially responsible for an immeasurable amount of suffering and many deaths. How the fuck do you sleep at night?

http://www.nationalpainreport.com/15-years-with-my-pain-dr-and-my-last-appointment-became-my-final-appointment-8831814.html

http://www.painnewsnetwork.org/stories/2016/10/25/unwilling-to-suffer-in-silence-over-cdc-opioid-guidelines

Jo
I have had reflex sympathetic dystrophy since I was 13 I am now 39. My left leg was amputated due to complications from the RSD. Unfortunately it spread to my right leg about ten yrs ago and again I’m have major complications. I was in fentanyl pops along w Oxy contin and both were helping me make it through the day . The insurance company or drug company changed the label on the fentanyl to cancer patients only and took out chronic pain sufferers. So now my insurance co will no longer cover it bc I do not have cancer. I was on this drug for years , I didn’t abuse I didn’t sell it I used it bc I’m in extreme pain and it helped, but now that was taken away. My legs keep getting worse I have terrible phantom pain in addition to the RSD pain in both legs and my right arm spread to…

Tina
I had my right hip replaced in 2014. DDD, osteoarthritis, and avascular necrosis on top of rheumatoid arthritis disease. During the surgery the muscle tore off the bone creating an avulsion fracture. Discharged home with a prescription. I went 2 weeks not being able to do my physical therapy or anything for that matter all because non of the pharmacies in our area that accepted my insurance would fill the prescription. Talk about torture.

http://www.petition2congress.com/5202/first-do-no-harm-dea-targets-physicians-who-treat-their-patients/comments/page/350

Doris W. from Lyman, SC writes:
My son is a dialysis patient with a severely deteriorated body. He has severe and very painful bone disease, osteomylatia, with bone forming throughout his body. He currently has open wounds on his legs and scrotum that won’t heal. His health is being undermined because he is in so much pain that he can not complete his hemo dialysis treatments, yet we can find anyone who will provide him pain management. All his doctors say they no longer write opiods. They are AFRAID to do so or it’s against their corporate owner’s policy. He is only 37 years old and doesn’t want to give up treatment. This is terrible malpractice and a real shame in a first world country.

Sharon S. from Wilmington, DE writes:
I am a cancer patient; stage 2 lymphoma and the chemo drugs have left me with peripheral neuropathy. Not finished with this devastation yet. The pain from this condition is with me every day now. After several requests to my doctors for pain meds, I was prescribed Gabapentin. Doesn’t work. After reading through the comments here on this site regarding the failures of the American Medical system and the many people who are suffering as a result, I have to say, I am not at all surprised but I am scared.

Malinda S. from Memphis, TN writes:
Yeah I asked my doctor about the First Do No Harm. He told it wasn’t my license on the line. That was when I truly no longer wanted to live. I felt nothing. With no insurance and trying to get my disability, I am no longer per my neurologist allowed the take pain meds over the counter or prescription. So I have to live in pain 24/7. I have to smile when I want to cry but one of my diseases keeps me from psychically crying. I am in constant pain in my bones, joints, muscles, & chronic migraines. I may be in pain everyday and night, the constant is that I keep loosing friends and family. They just don’t want to deal with me anymore.

Mark N. from Brookfield, IL writes:
For the pain I’ve been put through and the way that I’ve been treated since the beginning of this year, I will, as long as I live never trust or respect Doctors again.

As many times as I try to release my anger, it comes back. Reading about the suffering of other pain patients brings back painful memories for me, but I can’t stop. Maybe I’m the masochist.

Et tu, John Oliver?

Maybe you will recall an article in the New York Times this year about the ER at St. Joseph’s Regional Medical Center in Paterson, New Jersey, deciding to use opioids only as a “last resort” to treat pain:

https://painkills2.wordpress.com/2016/06/15/dear-ny-times-you-suck/

Here’s a recent article praising the virtues of these new programs to treat pain from the American Hospital Association:

http://www.hhnmag.com/articles/7653-overthrowing-todays-pain-paradigm

When leaders set out to create a more uniform approach to emergency pain treatment, the original goal was to run an “opioid-free ED.” However, Rosenberg says they soon realized that this was unrealistic and, instead, have fostered a culture in which physicians have a broader range of resources. Opioids are now the last line of defense.The medical center’s Alternatives to Opioids program was launched in January for patients who present with one of five acute pain diagnoses — headache, long bone fractures, kidney stones, back pain and other musculoskeletal pain…

Since January, St. Joe’s already has cut the number of opioids prescribed in its ED by 38 percent…

The opioid war loves to tell us how much the supply of opioids has been decreasing. How wonderful. But this one statistic doesn’t tell us much. Why don’t we visit Paterson, NJ, and see how it’s doing?

http://www.nj.com/passaic-county/index.ssf/2016/10/7_drug_overdoses_reported_over_1-day_period_in_pat.html

Seven people overdosed on drugs in a 24-hour period Thursday in Paterson – four of them in a one-hour period in a park on Ward Street, authorities said Friday…  All seven victims survived after receiving medical treatment, police said…

“Fentanyl and carafentinal are increasingly apparent and becoming a national problem,” Speziale said Friday. “Many toxicology reports come back with what is categorized as polypharm, which means there’s a combination of heroin, fentanyl and other opiods.” …

http://www.recordonline.com/article/20160109/NEWS/160109447

In fact, law enforcement intelligence points to Paterson and Newark, N.J., as the sources for much of the heroin that’s plaguing the lower Hudson Valley, northern New Jersey and the Tri-State area where Port Jervis sits.

“For western Orange County, Paterson is the connection,” said Orange County District Attorney David Hoovler. Why Paterson? Heroin there is cheap and accessible…

The treatment courts are full. The narcotics unit is running full bore. Meanwhile, overdoses are worsening…

Back to the article by the American Hospital Association:

The massive Veterans Health Administration — with more than 1,700 care sites treating nearly 9 million patients annually — recently rolled out a systemwide effort to better address the complex pain from which returning vets often suffer. Dubbed the Opioid Safety Initiative, it targets individuals on high-dose prescriptions, and helps them to treat their pain through education, a mobile app called Pain Coach, and such alternative treatments as acupuncture. At the initial implementation sites, the VA reduced high-dose opioid use by more than 50 percent, with no rise in pain scores…

With no rise in pain scores? (I’m sorry, but if you believe that, I want to sell you some bitcoins.) Even with those patients who didn’t see a rise in their pain scores after being forced off of opioids, that just means their pain scores didn’t change and are still high.

Rollin Gallagher, M.D., the deputy national program director for pain management at the VA, believes these results can be duplicated easily at any hospital…

Groups like the American Hospital Association urged the Centers for Medicare & Medicaid Services to remove pain-related questions from patient satisfaction surveys and, in July, CMS agreed to do so…

From a graphic in the article:

The U.S. has experienced a 300 percent surge in prescription opioids dispensing since 1999, with no corresponding drop in the amount of pain reported by Americans.

I don’t know where they got this information, and I’m not sure what it’s supposed to be telling us. Opioids help manage pain, they don’t get rid of it, so why would there be a drop in the amount of pain reported? Using this questionable information, we could also say that there hasn’t been an increase in the amount of pain reported by Americans. And that would be a good thing, but we’re not allowed to give any credit to opioids.

http://www.painnewsnetwork.org/stories/2016/10/20/fewer-pain-meds-but-more-overdoses-in-massachusetts

The CDC said it will “take time” before overdoses start to decline.

“Reducing the level of opioid prescribing is a long term strategy to limit exposure to these drugs. Mortality outcomes would not be expected to change for several years after implementation, and impact would be complicated by the increasing supply of illicit opioids,” Courtney Lenard, a CDC spokesperson, said in an email to Pain News Network…

The actions of the DEA, CDC, and VA have actually increased the size of the underground drug market. They have created this demand. They are the reason that people are overdosing on unsafe, illegal drugs. But you see, these government agencies have decided that they’re okay with that. This is a “long term strategy,” and they know that some people will be lost. They think they’re saving lives in the future, which for some reason, is more important than saving lives in the present.

The thing is, everything may be getting even worse for pain patients. Because, allegedly, corporate power has been hampering the DEA’s efforts to get at suppliers and distributors, at least according to recent articles in the Washington Post. Even if Big Pharma just keeps getting a slap on the wrist, that doesn’t mean they’re still operating in the same way. They don’t want to pay more fines and they’re spending millions to develop new and “safe” painkillers (which will be expensive, probably less effective, and out of reach for many patients). And there are millions of corporate dollars funding the opioid war, matched by our tax dollars.

http://www.washingtonpost.com/investigations/the-dea-slowed-enforcement-while-the-opioid-epidemic-grew-out-of-control/2016/10/22/aea2bf8e-7f71-11e6-8d13-d7c704ef9fd9_story.html

Before Reeves’s arrival, Geldhof said, investigators had to demonstrate that they had amassed “a preponderance of evidence” before moving forward with enforcement cases, which are administrative, not criminal. Under Reeves, Geldhof said, investigators had to establish that their evidence was “beyond a reasonable doubt,” a much higher standard used in criminal ­cases…

You can label a case as “administrative,” but it still involves drugs and crime, so why shouldn’t the agency be required to prove the higher standard? It appears that the DEA has been stripped of some of its abusive power — and they want it back. So, they’re blaming corporate power for the slowdown in cases. Will Congress give this power back to the DEA? Perhaps I should say, when Congress gives this power back to the DEA, things will get worse for pain patients.

To top it all off, the latest episode of John Oliver is about the opioid “crisis.” I don’t think he added any new information about the opioid war, but he appeared to be on the side of the CDC. He mentioned that opioids were only previously prescribed for acute pain. He included a video from PFROP. He made one slight mention of patients who need these medications, but he mostly blamed the whole thing on Big Pharma, singling out Purdue. He mentions how insurance needs to cover alternative treatments, without including the fact that alternative treatments only work for a small percentage of patients.

For me — who finds humor in just about anything (even Trump) — I didn’t find anything funny in John Oliver’s take on the opioid “crisis.” For the first time, I’m disappointed in Mr. Oliver. I’m sad that so many intelligent people cannot see the whole picture of the opioid war. Cannot see the millions of chronic pain patients who are suffering. And why doesn’t the media ever mention the epidemic of suicide in this country? It’s as if those deaths have nothing to do with pain and the opioid war.

Today I’m very sad that there is not one person with any power who is willing to stand up for pain patients. As if we are unimportant and mean absolutely nothing. As if science means absolutely nothing.

Thanks for reading. Sorry if I bummed you out. Blame John Oliver and Trump. 🙂

When no one believes you

http://www.painnewsnetwork.org/stories/2016/8/11/prop-ends-affiliation-with-phoenix-house

Like PROP, the foundation’s main goal is to reduce opioid prescribing. It is named after Steve Rummler, a Minnesota pain patient who became addicted to opioid medication while being treated for a back injury.

After several attempts at addiction treatment, Rummler relapsed and died of a heroin overdose at the age of 43.

“He struggled with the pain for a long time,” said Judy Rummler, Steve’s mother and chief financial officer of the foundation. “He had what I think later was figured out to be some damage to the nervous system around his spinal cord because he had what he described as shooting electric shock-like sensations that would shoot up his back into his head and down his legs into his feet.”

Steve sought help from many doctors, but never received a treatable diagnosis. He started taking OxyContin for pain relief. “Once he was prescribed the opioids in 2005, then he didn’t care about getting answers anymore,” his mother said.

After Steve’s death in 2011, the Rummler family established the foundation with the goal of helping others who also struggle with chronic pain and addiction. It was PROP’s founder and chief executive, Andrew Kolodny, MD, who approached the foundation with the idea of joining forces…

“Basically as the fiscal sponsor we accept donations and we manage the funding. We don’t set any policy for him,” Judy Rummler told Pain News Network. “Obviously our missions are similar. We are very concerned about the overprescribing of opioids. Yet I know if my son were alive today he would probably be telling you what you hear from so many other pain patients; that he couldn’t live without them. But the problem was he died as a result of it.

“I know there are a lot of people who are going to be hurt by cutting back on the prescribing, but I just think a lot of them are addicted as my son was. Yet he would have been the first one to scream and yell about having his pills cutoff.”

The Rummler Foundation calls this tug-of-war between opioids and addiction “The Dilemma.” It advocates for wholesale change in the treatment of chronic pain, emphasizing “wellness rather than drugs” and the use of “a wide array of non-opioid options.”

Opioid medication should not be prescribed for chronic pain, according to Rummler…

Poor Steve. So desperate and in so much pain — but he had nowhere to turn for help. He was being treated for addiction, not chronic pain. His chronic pain was ignored, even though it was the constant pain that caused Steve to become addicted to pain relief in the first place.

(Let me just say that I’m not sure Steve was suffering from addiction, but that is what he was being treated for.)

I’m sure that most chronic pain patients understand Steve’s desperation. Personally, I’m beginning to think that desperation is my middle name.

It was his pain (environment) and his DNA that made Steve susceptible to addiction. (DNA, by the way, he got from his parents.) A part of his addiction was probably caused by low self-esteem due to the censure of his loved ones and the shame all drug addicts feel (also his environment). There’s no shame in suffering from cancer, but those who suffer from addiction and chronic pain are weak and morally corrupt — according to the anti-opioid lobby. According to the drug war.

I consider it hypocritical and ignorant when anyone claims there’s no evidence that opioids work for chronic pain. (I also find the medical industry’s use of the word “evidence” to always be suspect. After all, I’m not a mouse. And my intractable pain is as unique as my DNA.) You can’t tell me that opioids don’t work — I took them for 10 years. You can’t tell millions of chronic pain patients that opioids don’t work — they’ve taken them for years, too.

Denying reality has always been helpful when fighting on the side of the drug war. #DenyingReality #ItsAllAboutFear (#DonaldDrumpf)

To all you hypocrites:  How much unbiased “evidence” exists that shows antidepressants or cortisone injections work for chronic pain? Denying adequate treatment for those in constant pain is the definition of torture. So, when someone advocates against the option of opioids to treat chronic pain, then that person is advocating for torture. (It seems there’s a high percentage of masochists within the 200 million people who don’t suffer from chronic pain in this country.)

Grief can motivate a person to do great things, but the reverse is also true. Rich, grieving parents, too blinded by their own pain to see anyone else’s. Like their grief is so raw and overwhelming that it destroys any empathy those people may have had for anyone else. Like their pain is more important than anything else. Like they’re more important than anyone else. (#TrumpSyndrome)

Let’s get this straight: Steve was not your average chronic pain patient. (To learn a little more about Steve’s story, click on the link below.) But, Steve is an example of the suffering that pain patients, who also suffer from drug addiction, go through. If you have a history of drug addiction, no one believes you’re in pain. And I know many chronic pain patients can understand what it feels like when no one believes you.

https://painkills2.wordpress.com/2015/09/22/the-epidemic-of-grief-stricken-parents/

Dr. Hypocrisy

Here we have another one-sided article from the New York Times, this one about the abuse of drugs used to treat addiction.

http://www.edsinfo.wordpress.com/2016/06/28/addicted-to-a-treatment-for-addiction/

http://www.nytimes.com/2016/05/29/opinion/sunday/addicted-to-a-treatment-for-addiction.html?_r=0

“Let’s be clear,” said Dr. Andrew Kolodny, a longtime Suboxone prescriber in New York and executive director of Physicians for Responsible Opioid Prescribing. “The real crisis is the severe epidemic of opioid addiction and overdose deaths that’s devastating families across the country.”

And here we have Mr. Kolodny, still trying to convince everyone that drugs like Suboxone aren’t part of the opioid family. As if there aren’t any families that have been devastated by deaths related to the use of bupe, methadone, and Suboxone.

It says a lot about how lazy the media is that it uses “experts” like Kolodny. And they never include important facts about Kolodny, like the criminal investigations into some of his Phoenix Houses. Like how Kolodny started his work with addiction in the New York prison system, specifically with bupe.

And before Kolodny began his work in the prison system, in 1996, France approved bupe (Suboxone) for the treatment of addiction. The current situation in France is that, along with methadone, buprenorphine is the opioid that’s causing the most damage:

https://painkills2.wordpress.com/2014/12/02/whats-the-drugopioid-epidemic-look-like-in-france/

Dr. Kolodny ranks anti-Suboxone judges like Judge Moore in a category with climate-change deniers and people who believe vaccines cause autism. “When there’s really dangerous heroin on the streets, I’d rather see Suboxone out there, even if it is being prescribed irresponsibly or is being sold by drug dealers,” he said…

And here we have Mr. Kolodny advocating for the underground Suboxone market, which really makes him look like a drug dealer. I wonder if he gets a percentage of all Suboxone sales… Or maybe he’s been promised a better job with the government or Big Pharma.

Hey, Kolodny, don’t you understand that doctors are drug dealers, too? Do you think the drugs that doctors prescribe never do any damage, never kill anyone? Perhaps you should change your name to Dr. Hypocrisy.

Under comments:

Steven A. King, M.D., Philadelphia, May 29, 2016

The issues of using buprenorphine for opioid use disorders are not as clear cut as the author appears to be making them.

Some of what Judge Moore believes is true and some of what Drs. Volkow and Kolodny say is misleading.

As a physician who specializes in pain management, I know that there are a not insignificant number patients prescribed opioids for legitimate pain complaints who end up abusing and becoming addicted to these, and although it is often reported that we’ve only become recently aware of this in fact there is research going back 25 years demonstrating this.

However, there are no studies showing that either buprenorphine or methadone are appropriate treatments for these patients. As these both provide analgesia equal to the other opioids, if these were the proper treatment for these patients then it would make sense to make them the first line opioids for pain as we would be prescribing the appropriate treatment for the problem at the same time we were prescribing the cause of the problem.

Sorry, bupe and methadone do NOT provide analgesia equal to other opioids. Yes, they help some pain patients, but their strength is more in line with, say, codeine, if that.

I’m not exactly sure what this pain doctor is trying to say, but I think pain patients will increasingly be offered bupe and methadone, whether they’ve been red-flagged for addiction or not.

Facebook comments that disappear

I use Facebook to make comments, but I’m not that familiar with how the software works. When I made a comment on this Consumer Affairs article through my Facebook account, I expected it to show up in my activity log. But my comment was deleted by Consumer Affairs, so it doesn’t appear in my Facebook account. (I guess everybody hates — and prefers to silence — a critic.)

That doesn’t seem right, but I guess it’s just another reason to dislike Facebook. After all, why would I want to use the same blogging platform as Mark Zuckerberg?

https://www.consumeraffairs.com/news/study-most-patients-getting-opioids-have-leftover-pills-061516.html

My censored comment:

Most deaths related to an opioid overdose are due to a combination of drugs, not just the opioid. If Consumer Affairs would like to see responsible reporting on the drug war, here’s one (lonely) example:

http://www.theguardian.com/us-news/commentisfree/2016/jun/08/opioid-epidemic-drug-mix-overdose-death

“Opioid use on its own is not dangerous, and it’s time we stop demonizing it.”

New York (with Bloomberg at the helm) is the poster state for how not to fight the drug war. That state (with help from Kolodny and PFROP) has been at the forefront of restricting access to prescription pain medications and increasing the amount of addiction clinics (along with the use of drugs like methadone, bupe, and Narcan).

http://www.huffingtonpost.com/2013/01/11/new-victims-in-the-war-on_n_2455917.html

And look where New York is at now — they’ve gone from bad to worse.

This study is a day late and a dollar short. The problems with diversion aren’t being caused by patients anymore, and it was only a small percentage of patients who were responsible for diversion anyway. If Consumer Affairs is going to “report” on the drug war, it should include other stories about diversion, like from DEA agents, pharmacies, hospitals, and nurses. The longer the medical industry blames patients, the more guilty it looks.

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.

Blatant discrimination and faulty science

http://www.pressherald.com/2016/03/27/maine-health-officials-working-to-prevent-unintended-consequences-from-opioid-prescribing-bill/

Dr. Christopher Pezzullo, Maine’s chief health officer, said the dosage maximum is important because the science does not support such high doses. The dosage cap of 100 morphine milligram equivalents proposed in the bill closely coincides with U.S. Centers for Disease Control and Prevention guidelines on prescribing opioids that were released last week…

Pezzullo pointed to recent research that shows over-the-counter pain medications are more effective than opioids at controlling pain…

As far as I can tell, this doctor is referring to a paper by this man at the National Safety Council, an alleged “nonprofit, nongovernmental public service organization.”

Donald Teater is responsible for advising National Safety Council advocacy initiatives to reduce deaths and injuries associated with prescription drug overdoses. Teater is a patient advocate who specializes in psychiatric services and opioid dependence treatment. Prior to joining NSC, Teater held positions at Blue Ridge Family Practice as a physician, and at the Mountaintop Healthcare and Good Samaritan Clinic of Haywood County as a physician and medical director. At present, along with his role at NSC, Teater treats opioid dependence at Meridian Behavioral Health Services and Mountain Area Recovery Center, along with volunteer work in the field.

Looks like Kolodny from PFROP has been cloned. From the National Safety Council Wikipedia page:  “The Board of Delegates develops the mission agenda, creates public policies, and tracks safety, health and environmental trends.” It seems everybody’s on board for the opioid war.

Click to access Evidence-Efficacy-Pain-Medications.pdf

For example, when testing pain medications, the intervention is the dose of pain medication and the effect is usually 50 percent pain relief. Fifty percent relief of pain is considered effective treatment, allowing people increased functional abilities and an improved quality of life (Cochrane. org, 2014). So the question becomes, how many people must be treated with a certain dose of a medication for one person to receive 50 percent pain relief (effective relief)?

The whole white paper is based on this notion that pain medication can be 50% effective, and that it’s only effective if the patient experiences 50% relief. How many patients experience 50% relief with drugs? It can’t be that big of a percentage, because 50% relief seems almost miraculous to me. Most chronic pain patients, including me, estimate relief derived from drugs at 25% to 30%.

Dental pain:  A recent review article in the Journal of the American Dental Association addressing the treatment of dental pain following wisdom tooth extraction concluded that 325 mg of acetaminophen (APAP) taken with 200 mg of ibuprofen provides better pain relief than oral opioids. Moore et al. concluded, “The results of the quantitative systematic reviews indicated that the ibuprofen-APAP combination may be a more effective analgesic, with fewer untoward effects, than are many of the currently available opioid-containing formulations.” (Moore, 2013, p. 898)

For one thing, there’s usually an end to dental pain, especially wisdom tooth extraction (although some patients experience phantom tooth and nerve pain afterwards). And the key words here are “with fewer untoward effects, than are many of the currently available opioid-containing formulations.”

Sure, for acute pain, the effects of taking over-the-counter drugs is mostly positive. That is, if they work. If a dentist told me to take Tylenol after a wisdom tooth extraction, I’d tell him to fuck off. No, before the procedure, I’d find out what the pain management program was going to be, and if I didn’t agree, the wisdom teeth would stay in.

The problem is the long-term effects of taking these drugs (along with their efficacy), although doctors don’t seem to care about that. Or else, they care more about the “epidemic” of addiction than the damaging results of long-term use of OTC drugs.

http://www.nsc.org/learn/about/Pages/Over-the-counter-pain-medications.aspx

(10/6/2014) National Safety Council: Over-the-counter pain medications are more effective for acute pain than prescribed painkillers

In certain circumstances, opioid painkillers are an appropriate treatment option. NSC Medical Advisor Dr. Donald Teater points to research showing short-term opioid painkiller use can be helpful when treating patients recovering from surgery. These medications also can be effective in treating chronic pain associated with terminal cancer because opioids have positive psychotherapeutic effects that help offset depression and anxiety.

So, cancer and terminal patients deserve these psychotherapeutic effects, but chronic pain patients don’t? This is what you call discrimination against the disabled.

The new standards would allow for exceptions for end-of-life care, palliative care, cancer pain and potentially other diagnoses. Also, those currently on higher doses – the 16,000 taking more than 100 morphine milligram equivalents per days – would be given until July 2017 to taper to lower doses.

This reminds me of medical cannabis programs, all of which have a list of qualifying conditions. Is there a list of qualifying conditions for other drugs? Yes, now for opioids, thanks so much to all who have contributed to this blatant discrimination.

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…

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.

Dr. Jane Ballantyne of PFROP

Featured photo found at:

http://www.nytimes.com/2012/04/09/health/opioid-painkiller-prescriptions-pose-danger-without-oversight.html

http://www.vitals.com/doctors/Dr_Jane_Ballantyne/reviews

by Anonymous on Apr 5th, 2013
This doctor has very poor bedside manner. She had an intern review my history and records and didn’t even ask me why I was in her office for a consultatation. She merely entered the room, sat on the edge of the table and sneered at me, apparently at my choice of blouses which was an imitation of an expensive designer silk in less expensive polyester. She has published books and articles about her disdain for American doctors’ irresponsible use of opioid prescription drugs in the treatment of chronic pain and apparently is on the lookout for any patient that according to her isn’t “dying, or completely incapacitated”, the only valid reasons, in her opinion for prescribing these types of drugs. When she offered me no other solutions to help with my chronic pain and I wept at her decision to deny me a prescription for pain medication that my previous doctor has written for the past 4 months, she looked away. The only thing that came out of this visit was a referral to a psychiatrist on her staff and a suggestion that I try an antideppressant for sleep and pain. I had already told her assistant and I had repeated that I could not tolerate the side effects for these medications. I think that because of my British surname she expected a white person but was disgusted by my appearance when she entered the room (I am Native American), it seems hard for her to hide her disdain for others. It seems she has been pumped up so much by her staff and peers. I do have a valid reason for medication use, and have never abused it. I brought evidence of this, conclusive radiological reports and physician chart notes. Had she reviewed these, even for five minutes, she would have agreed.

—–

CDC’s Primary Care and Public Health Initiative
Balancing Pain Management and Prescription Opioid Abuse
October 24, 2012

Lieutenant Commander Christopher M. Jones, PharmD, MPH, serves as the acting team lead for the prescription drug overdose team in the Division of Unintentional Injury Prevention in CDC’s National Center for Injury Prevention and Control…  Prior to joining CDC, Chris completed a one-year detail to the White House Office of National Drug Control Policy, serving as the senior public health advisor where he co-lead the development of the administration’s prescription drug abuse prevention plan…

Our next presenter is Dr. Jane Ballantyne, who is a professor of anesthesiology and pain management at the University of Washington in Seattle…

—–

Ballantyne, JC. Opioid analgesia: perspectives on right use and utility. Pain Physician 2007

https://www.ncbi.nlm.nih.gov/pubmed/17525783

Do you get the feeling that a few of Ms. Ballantyne’s patients were mean to her, and this is her revenge?

http://www.npr.org/2015/12/29/461409296/draft-of-cdcs-new-prescribing-guidelines-stirs-debate

BALLANTYNE:  If you give people opiates, they think you’re the best thing since sliced bread. They love you. They just worship the ground you walk on. The moment you suggest that you want to try and get them down on their dose or, worse still, say you can’t carry on prescribing – not that I do that myself; I never cut people off; I don’t think people should be cut off, but I do try and persuade them to come down on their dose – they are so awful. And you can see why people who are not seeped in this stuff – the young primary care physicians just don’t know what to make of it. They don’t want to be abused. They want to be loved like everybody else does. We go into medicine to try and help people. And when you get abused and, you know, insulted, you can see why it perpetuates itself.

I find it hard to believe that Ms. Ballantyne “never” cut a patient off. Maybe the reason is that she hardly ever prescribed any drugs that, in her opinion, patients needed to be cut off from. (Antidepressants for everyone!)

For 20 years, Dr. Ballantyne directed the Center for Pain Medicine at Massachusetts General Hospital in Boston…

If you are a pain patient who was abandoned by Ms. Ballantyne, please email me at painkills2@aol.com. I would love to hear your story.

The brain on chronic pain

It’s important for pain patients to know how to combat ignorance like this:

http://www.painnewsnetwork.org/stories/2015/12/31/all-things-considered-except-patients

Under comments:

Joan Anundson Ahr (a week ago)

My experience with family members who have rheumatoid arthritis, as well as in my job as an assistant to an orthopedic spine surgeon for many years, is that narcotic pain meds work for acute pain while waiting for surgery, pain relief immediately after surgery, and for emergency care for an acute severe injury. Using narcotics any other way, except perhaps for end of life pain relief, invites layering more problems on top of the original cause for chronic pain.

Functional MRI studies of the brain have shown the damaging effects from addictions to alcohol and narcotics. A person who’s brain has become accustomed to the drug doing the work of dealing with pain sensations loses his natural function of producing calming and soothing responses to pain signals…

When you look at the management of pain only from the side of addiction, you have a very narrow view. And you also begin to see all pain patients as having the potential for addiction (when, in fact, only a small percentage are in danger of it). You believe that dependence and addiction are the same thing. You believe that there is never a reason to abuse these drugs, even if the result of this abuse turns out to be either beneficial or of no concern to the patient.

How should we even define drug “abuse” and “addiction”? Only through the eyes of the psychiatric community? Only through the lens of certain drugs?

Even while we are learning more about the brain, we’re not really sure what it all means. If experts don’t know, what makes anyone think they know?

A person who’s brain has become accustomed to the drug doing the work of dealing with pain sensations loses his natural function of producing calming and soothing responses to pain signals…

Our ignorance of how the brain works often gets in the way, giving us beliefs that are, shall we say, incorrect.

So, do you think this woman knows what a brain on chronic pain looks like? Or is she only concerned with what an addicted brain looks like? Does she understand that many pain patients have already lost the natural ability to produce “calming and soothing responses” to continuous pain signals?

Like, duh. (I mean, seriously, duh.)

Without opioids, do pain patients regain this “natural function”?  Well, this pain patient didn’t, and from what I’ve read, other pain patients haven’t, either.

A question in my search terms today:

“Is hyperalgesia being used by dr to refuse opioids for chronic pain?”

Again I say, duh. And again, just like other doctors who blame pain patients:

“Ballantyne told the program that during her lengthy career in pain management she and other doctors were sometimes abused and insulted by ‘awful’ pain patients when they tried to wean them off opiates.”

Because pain patients should respond like robots, right? Why should we care when our suffering is increased because of opioid phobia? We should be happy that our doctors think they know what’s best for us, right? (Doctors suck.)

Opioids can give pain patients a synthetic version of their body’s own pain-fighting endorphins, allowing them to regain this ability. Cannabis does the same thing, only in a more natural way. But natural or synthetic, these drugs give pain patients the ability to be active in their own lives. And I’ll just add that, regardless of a patient’s activity level, opioids relieve suffering — and that has to count for something.

Hey, lady, drug addiction and chronic pain are two separate medical conditions. How often do I have to repeat this fact?

Janice Reynolds (a week ago)

If opioids do not work for Chronic Pain, why would they work suddenly at the end of life? …

20 Extremely Well-Mannered Insults To Use On Your Worst Enemy

http://www.tickld.com/x/jaw/20-extremely-well-mannered-insults-to-use-on-your-worst-enemy-number

1. May the chocolate chips in your cookies always turn out to be raisins.

4. May your article load that extra little bit as you’re about to click a link so you click an ad instead.

15. May your cookie always be slightly too large to fit inside your glass of milk.

18. May you never be quite certain whether that pressure is a fart or poop.