Kolodny says no painkillers for intractable pain


Birmingham diabetes doctor Peter Alan Lodewick wrote a number of prescriptions for pain killers in the past two years.

He wrote them for his housekeeper, Margaret, her son Willie, Willie’s daughter Raven, Willie’s girlfriend Susie, and four other people, according to his plea agreement.

Specifically, Lodewick wrote prescriptions for the powerful opiates oxycodone, morphine sulfate, norcos, and the narcotic stimulant adderall, his plea agreement states. He wrote about 390 prescriptions for about 22,796 pills from January 2013 to December 2014…

Alabama has seen a rising problem with opiate addiction and painkiller prescription rates that are the highest in the nation. With 400 pain clinics and a lucrative black market, Lodewick is hardly alone…

Population of Alabama in 2014:  4.849 million.  That’s 12,000 people per pain clinic.

Dr. Andrew Kolodny, the New York-based president of Physicians for Responsible Opiod Prescribing, said that most doctors who overprescribe opiates are responsible practitioners, albeit naïve to the often ruinous and overpowering effects of chemical addiction. But he called the others, who knowingly and freely dispense the pills, “the Dr. Feelgoods.”

“They’re doing it because there’s a really good model there,” Kolodny said. “They have patients who never miss an opportunity. They have patients who will pay whatever price and will pay cash.  “Except for the fact you have a high rate of overdose death in patient population, it works out well for them.”

It’s funny how the media never fact-checks what Mr. Kolodny has to say.  A high rate of overdose deaths in which patient population?  Chronic pain patients?  Those who suffer from addiction?  Because there’s not a “high” rate of overdose deaths in either population.

Robert Thomas Jenkins, now serving time in Elmore Correctional Facility, filed a federal lawsuit last June alleging that Lodewick prescribed him pain pills that made him “severely ill and physically dependent on these drugs.” …

The lawsuit states that Lodewick continued to write prescriptions for Jenkins during monthly visits to Lodewick’s private office on Montevallo Road for about a year. Jenkins argues that Lodewick never examined him. Jenkins asserts that he paid Lodewick in cash on three to four occasions.

But in an interview with AL.com, Lawler dismissed the allegations as the “biggest crock of (crap) he had ever heard.”

Lawler, whose family owns Lawler Manufacturing in Lincoln, said that he was a former patient and friend of Lodewick. He recalled getting lunch with the recently arraigned doctor once a week at Ruby Tuesday.

At the time, Lawler said that Lodewick wrote him prescriptions for pain killers he takes as a result of more than 20 surgeries he has had related to Crohn’s disease and a childhood lawn mower accident that left him with a partially amputated right foot…

Kolodny credits the explosion in prescriptions to a philosophical change in the 1990s that coincided with the launch of OxyContin, an extended release form of the painkiller oxycodone. Doctors began to prescribe painkillers to treat patients with intractable pain, rather than reserving the powerful drug for patients with late-stage terminal illnesses, he said…

It’s hard not to hope that one day, Kolodny will suffer from an intractable pain condition.  I’m sure he’ll change his tune when he’s the one suffering.  And if only terminal patients are allowed pain medications, then this country is going to have millions of people filing for disability.  Of course, we’ll also have to cut back on surgeries — any kind of surgery.

It’s too bad that no one in the medical industry will stand up to Kolodny.  It’s shameful that no one in the medical industry is on the side of patients.  I don’t think doctors really understand the wide gulf opening up between doctors and patients, and how the war against pain patients will ultimately affect every doctor.

Because, guess what, doctors?  We don’t fucking need you anymore.  We’ve got all the medical information we need at the touch of our fingertips.  All you’re doing is pushing patients into the underground drug market, which will continue to grow and grow, while your businesses stagnate then decline.  There’s going to be a revolution, and no, it won’t be televised.  Nobody trusts the media anymore, or big pharma, and doctors will be next.

Are ‘Abuse-Resistant’ Painkillers Actually Effective in Reducing Overdose Deaths?


Herper tests out Purdue’s “abuse-resistant” version of OxyContin, called Hysingla, and confirms that the pill can not be crushed or dissolved in water. But Kolodny, who has worked with addicts for 10 years, says “I’ve very rarely come across people who’ve developed that disease [of addiction] from snorting or injecting the pills. People develop that disease from using the pills orally.”

Well, look, it’s Mr. Kolodny!  Dude, how are you doing?  Still busy being the spokesperson for the war against pain patients?

For someone who allegedly treats addiction, I find your lack of understanding of this illness to be rather sad.  It’s not the drugs that cause addiction, and you should know that.  But then, you used the word “developed,” not caused.  That might be a distinction you can get away with in the medical industry, but not anywhere else.

Heck, you could say that people develop addictions from being white, since most drug addicts are, in fact, white.  Or you could rightly say that people develop the disease of addiction from poverty, domestic abuse, rape, and child abuse.  Or from the under-treatment of pain.

In defense of his product, Haddox states that of the 16,000 overdose deaths in 2013, “the vast majority of those were poly-substance deaths,” meaning alcohol or other illegal drugs played a part. He also argues that painkillers have improved his patients lives, many of whom might commit suicide without pain treatments.

As far as patients suffering from chronic pain, Kolodny argues that “they need access to effective, evidence-based treatment. Giving people opioid painkillers is not going to help. In fact, if someone’s really suicidal because of their chronic pain, you’re putting a potentially lethal means in their hands.”

Poor Mr. Kolodny knows nothing about chronic pain (let alone addiction).  “Giving” pain patients access to opioids actually does help — it helps millions and millions of patients.  Out of the millions of pain patients who take opioids, only 16,000 have overdosed.  Let’s see, if there are, say, 40 million pain patients taking opioids, 16,000 would be 0.0004%.  Sound like an “epidemic” to you?

Of course, that’s not counting the overdoses that are actually suicides because pain patients just give up on having their pain adequately treated or are tired of being treated like criminals and drug addicts.

I wonder, Mr. Kolodny, how many suicides are you responsible for?  How many pain patients have killed themselves because they didn’t have access to opioids due to your advocacy work?

Why does the media keep pretending that Kolodny is an expert?  I’m not even a doctor and I know he’s full of shit.

Abandoned Painkiller Makes a Comeback


Funny how an article about pain medication is posted under Psychiatry and Addictions.

In 2006, in the midst of a growing opioid epidemic, the FDA approved the new narcotic painkiller Opana. It was a familiar drug. Under the name Numorphan, it had been abused in the 1960s and 1970s until it was removed from the market. When injected, the drug is 10 times as potent as morphine.

In 2006, we were in the midst of a growing opioid epidemic?  Seems like for some people, there’s always an ongoing opioid “epidemic.”

And since there are plenty of drugs other than pain medications that are abused, should they also be removed from the market?  No more Xanax or Valium?  I mean, damn, how many people abuse alcohol?  Should we try prohibition all over again?

Known generically as oxymorphone, the FDA approved the new version of the drug — made by Endo Pharmaceuticals — in 2006 as both an immediate-release and extended-release pill. Then in December 2011, the agency approved a new abuse-deterrent version — but users have been able to foil the anti-injection mechanism and have been shooting up Opana.

In addition to overdose risk, abuse of Opana by injection has been tied to a recent outbreak of HIV in rural Indiana as well as a surge in hepatitis C infections in several Appalachian states…

Because the recent outbreak of HIV is the drug’s fault, right?  Has nothing to do with the drug war or the DEA’s war against pain patients?  Lack of access to affordable mental health and addiction treatments?  Clean needle exchanges?  Poverty?

It also has been associated with a blood-clotting disorder and permanent organ damage — a problem that didn’t occur with injection abuse of generics and the earlier version of the drug.

Well, when you coat pain pills in plastic, or whatever these new abuse-deterrent drugs are covered in, you’re going to have problems, no?  Why not also mention problems like how hard these pills are to digest and how the time release mechanism doesn’t appear to work very well?

“There certainly didn’t seem to be a need for it,” said James Roberts, MD, a professor of emergency medicine at Drexel University College of Medicine in Philadelphia. “There are plenty of narcotics around for pain relief.

Gee, you’d think a doctor would know that many patients can’t tolerate a number of the legal narcotics that are “around.”  And some opioids work for some people but don’t work very well for others.  But why would doctors want more options for their patients?  Why, thinking about the needs of patients is just utter nonsense, especially for doctors.

The IMMPACT meetings helped develop a new approach to winning approval of drugs known as enriched enrollment. The approach allows drugs companies to weed out people who don’t respond well to a drug or who can’t tolerate taking it before an actual clinical trial for the drug begins.

Independent doctors say that approach makes it much more likely a drug will be found effective and possibly win FDA approval. It’s also cheaper for drug companies to conduct such trials. Critics say the approach essentially stacks the deck in favor of the drug. More importantly, experts say, drugs tested that way are not likely to reflect what will happen when a medication gets on the market and is prescribed for large numbers of people.

When Endo tried to get Opana approved in 2003, the FDA said the drug didn’t appear effective enough in clinical trials. It also raised safety concerns after several postoperative pain patients overdosed on the drug and had to be revived with naloxone. So Endo conducted new clinical trials using enriched enrollment…

Opana is not the only opioid approved using enriched enrollment. In 2013, drugmaker Zogenix used the strategy to win approval for Zohydro, a high-dose, hydrocodone-only drug that was originally approved without any abuse-deterrent mechanisms.

So, hydrocodone has never been approved before 2013?  You know, there aren’t too many people who would say that hydrocodone doesn’t work.  In fact, it works best for the largest number of people, with the least amount of side effects — which many other opioids do not.

The article says it was written by John Fauber and Kristina Fiore, and since they’ve reported on PFROP before, I have to wonder how cozy they are with Mr. Kolodny and his group. Perhaps even members?  Or maybe this is just a version of Fox News for the war against pain patients?


Drugs are very, very bad, and should be blamed for everything…


J&J and Other Drug Makers Tossed From Lawsuit Over Opioid Marketing

The lawsuits followed a failed bid by an advocacy group that petitioned the FDA to tighten labeling on opioid painkillers. Physicians For Responsible Opioid Prescribing argued the drugs lacked sufficient safety and effectiveness evidence for long-term use to manage non-cancer chronic pain, such as low back pain…

The evidence is lacking because the research hasn’t been done, something that Mr. Kolodny refuses to acknowledge, even in court.  It’s very sad that PFROP has been able to fund litigation for its own political and financial purposes, while pain patients continue to suffer.

“I’m not happy to hear this, but I’m hopeful we’ll ultimately see these companies held accountable for the public health crisis they created,” says Andrew Kolodny, chief medical officer at Phoenix House, a non-profit that runs alcohol and drug abuse treatment and prevention programs, and head of Physicians for Responsible Opioid Prescribing. “But the legal cases against big tobacco many years before they were successful. This may also take a long time.” ...

Mr. Kolodny, I think you should keep blaming drugs for the “public health crisis.”  It makes you look so smart.  (Can we start blaming guns for all the deaths they cause too?  Will PFROP be filing a lawsuit against gun manufacturers sometime in the near future?)

And really, any public health crisis will do.  Drugs are very, very bad, and should be blamed for everything, even addiction. When you blame drugs, that keeps you in business, does it not? Keeps those federal dollars rolling in.  I mean, it’s not like you can treat someone for poverty, a condition that can cause addiction.  And with your specialty in addiction “medicine,” it’s not like you can treat PTSD or depression, two conditions that can also lead to addiction.

Enjoy rolling in those federal dollars and your popularity while they last, Kolodny.  Enjoy being a spokesperson for the drug war… maybe you won’t end up looking as bad as the DEA.  (But I doubt it.)

Why are politicians still referring to marijuana as a gateway drug?


When analyzing what acts as a “gateway” to hard drug use, there are a number of factors at play. None involve marijuana.

-Poverty and poor social environment is a gateway to drugs, according to much research.

-Association with people who use hard drugs is a better predictor of harder drug use.

-Certain mental illnesses, such as antisocial personality and bipolar disorder, are found to pre-dispose some people to use drugs.

-Other research notes that criminalization and prohibition are real gateways to harder drugs…

Meanwhile, in the United States, addiction researchers and addiction treatment professionals are heavily invested in the weakly supported claim that marijuana is a gateway to hard drugs. For decades, scientists who study addiction have received millions in government and pharmaceutical funding to perpetuate the gateway hypothesis. Many would lose their respected reputations (or continued funding) if a gateway mechanism is not a legitimate research goal.

Those who work in the vast addiction treatment profession are especially invested in keeping the gateway theory believable, since the majority of their treatment patients are marijuana users. Their jobs depend on a belief in addiction as a disease and on marijuana being an addictive drug…

Studies consistently find that the traumatic experience of being arrested and incarcerated for marijuana possession is the most harmful aspect of marijuana among young people. Arrest for possession can result in devastating – often permanent – legal and social problems, especially for minority youth and low-income families…

On the periphery of the marijuana-as-gateway-drug debates are studies showing marijuana as beneficial for the treatment of opiate addicts…

Dr. Hamburg Leaving FDA


Margaret Hamburg, M.D., who became the 21st commissioner of the FDA (Food and Drug Administration) almost six years ago, is reportedly leaving the agency. The Washington Post reported on February 5, 2015 that Stephen Ostroff, the FDA’s chief scientist and a former official at the Centers for Disease Control and Prevention, will take over as acting commissioner…

But everyone wasn’t gracious in bidding the Commissioner adieu. If industry liked her, she must be suspect. “I’m pleased to see her go,” said Andrew Kolodny, president of Physicians for Responsible Opioid Prescribing and the head of an addiction treatment center in New York. The Post said Kolodny clashed with the FDA over its failure to curb abuse of the powerful drugs. “Her administration consistently put the interests of the drug companies ahead of public health.”

Tell me, Mr. Kolodny, which interests are you putting first?  Your own?  The DEA’s?  Wouldn’t want to risk all those federal dollars that end up in your bank account, right?  Your interests are causing a lot of suffering in the pain patient population, many of whom cannot find a doctor to treat them.  I wonder how many suicides your “advocacy” is ultimately responsible for?

And wouldn’t it be nice if reporters actually investigated their own stories?  Mr. Kolodny is not just “the head of an addiction treatment center in New York.”  How many Phoenix Houses are there now?  I’ve lost count.

Before she arrived, the agency had failed to warn of the dangers of the pain drug Vioxx. In 2005, then commissioner Lester Crawford, who had hidden ownership of stock in companies the agency was regulating, abruptly resigned…

Andrew Kolodny makes money while pain patients suffer

Click to access NCADD-RA-Annual-Luncheon-Registration-Brochure-May-2015.pdf

National Council on Alcoholism and Drug Dependence

2015 Annual Luncheon

Keynote Speaker: Andrew Kolodny, M.D.
“Responding to the Opioid Epidemic”

Hey, Mr. Kolodny, are you going to talk about how pain patients in New York can’t find a doctor? How they’ve been abandoned, partly due to your “advocacy” work?  And by the way, how much do you get paid for these speaking engagements?

Why Supposedly Abuse-Proof Pills Won’t Stop Opioid Overdose Deaths


Oral pain pills containing opioid have become a big business, drawing in companies including Purdue Pharma, Pfizer, and Zogenix. But they’ve also become a huge public health problem, leading to record numbers of drug overdose deaths. In 2013, more than 16,000 people died of opiate analgesic drug overdoses, up from 4,000 a decade ago.

So when Purdue, the maker of the category-defining Oxycodone, asked to come by to show me the abuse-resistant technology in its new Hysingla pill, I was game: I hit it with a hammer, squeezed it with wire cutters, and soaked it in water. The pill was almost impossible to make into anything that you can snort or inject.

Hey dude, have you heard of the internet?  Of drug websites?  A microwave?  Did you think it might be considered responsible reporting to look up this information before you wrote this article?  You know, in case you were wrong?

But critics of these narcotic pills say that most patients take the pills by mouth, and that many who overdose initially got the medicines from their doctors, not from the black market. So is this new technology enough? Probably not.

Watch me try to destroy Hysingla, and talk to David Haddox, a Purdue executive, and Andrew Kolodny, who runs addiction treatment facility Phoenix House, in the video below, and watch to the end for my summation of why these new abuse resistant technologies, though neat, are not enough of a step to deal with what has become a giant public health problem.

A “huge public health problem.”  A “giant public health problem.”  Hey, Matthew Herper of Forbes, have you ever considered that when the media distorts this issue, it is part of the freaking problem?  Have you considered talking to pain patients to get their input on how the drug war is affecting them?  Of course not, why should you care?

Opioid Misuse In Chronic Pain Patients Is Around 25%, New Study Shows


A new report — which was published in the April issue of PAIN, the official journal of the International Association for the Study of Pain (IASP) — found that 20-30% of opioids prescribed for chronic pain are being misused. It also concluded that the rate of addiction is approximately 10%. The journal is published by Wolters Kluwer.

Ten percent is an estimate, but since 9% of any population suffers from drug addiction, it’s not that bad.  Say, did ya’ll look at the reason why pain patients misuse their medications?  Or is that not even important anymore?

Wikipedia:  The IASP was founded in 1973 under the leadership of John Bonica. Its secretariat, formerly based in Seattle, Washington is now located in Washington, DC.

Well, well, based in Washington, DC, huh? That says a lot about this group.  More political than patient-focused.  And Mr. Bonica was an anesthesiologist, so that says a lot too:

The years of gladiatorial competition left Dr. Bonica a chronic pain sufferer himself, and thus empathizer with his patients. He would be awarded the Professional Wrestling Hall of Fame New York State Award in 2004.

Perhaps after his death in 1994, this group changed its focus?

Wikipedia:  In 2004, supported by various IASP chapters and federations holding their own local events and activities worldwide, IASP initiated its first “Global Year Against Pain” with the motto “The Relief of Pain Should be a Human Right.” Every year, the focus is on another aspect of pain.

Looks like this association has done a 180 since 2004.  Could it be that it gets funding from the federal government?  That the federal government dictates this group’s goals and the types of research it does?  Could it be that this group works closely with the DEA?

“We find that although opioid misuse (the usage of opioids contrary to medical instructions) and addiction occur in a minority of opiate users, prescribers should closely monitor their patients for signs of these aberrant behaviors,” said study co-author David N. van der Goes, assistant professor in the Department of Economics at the University of New Mexico. “Prescribers can also compare their outcomes to the baseline presented in the paper.”

So, now an assistant professor in the economics department (and in my home state, at that) has decided that pain patients need to face even MORE scrutiny.  I really don’t see how that’s possible.  And really, Mr. van der Goes, I’d like to monitor you for signs of “aberrant” behaviors. Let’s see how normal you are.

Did the University of New Mexico disclose any conflicts of interest with this study?  Like Project ECHO?


 And what about this report from UNM in October 2013?


24 studies with 2,057 patients with rate of 3.27% for abuse/addiction.
Rate of abuse/addiction in patients with no past or current SUD was 0.19%

Gee, this current study didn’t break it down like this, I wonder why?

Also, these aberrant behaviors have been defined by the addiction and psychiatric industries. Now, I wonder why these doctors want more patients to be diagnosed with addiction?  And if pain patients do become addicted (not just dependent) on their medications, could it be because the pain management industry has failed so horribly in treating pain?

Tell me, if we’re talking about a minority of pain patients, why do so many call this an epidemic?

“Some people who become addicted develop the disease from misuse, but people can just as easily become addicted taking pills exactly prescribed,” said Dr. Andrew Kolodny, who is the chief medical officer at Phoenix House, a drug treatment provider, in an interview. “Once addicted, misuse (i.e. taking more pills than prescribed or crushing and snorting pills) becomes more common, but again, keep in mind that patients can still be addicted without misuse.”

Why, hello again, Mr. Kolodny.  Are you enjoying Washington and the millions of dollars in funding from the federal government?  And how is the addiction industry these days?  Still making a lot of money off the backs of desperately ill patients?  I know, I know, once you’ve treated all the drug addicts, who’s left?  Why, there are millions and millions of chronic pain patients that need to be treated for addiction, right?

Tell me, Mr. Kolodny, what’s the difference between addiction and dependence?  Do you even know?

Dr. Jane C. Ballantyne, a retired professor of Anesthesiology and Pain Medicine at the University of Washington, questioned the results of the PAIN study in her own response to the report, noting that it’s fairly difficult to define what addiction is when it arises during chronic pain treatment with opioids. “But, could rates of addiction have been underestimated because there cannot be clear distinctions between misuse and addiction, despite the apparent clarify of the definitions?” she asked…

Dr. Ballantyne, you’re not helping matters.  Could it be that the rate of misuse is directly connected to the amount of under-treated or mistreated pain?  Have you heard about that epidemic?

Researchers reviewed 38 articles on the topic of problematic opioid use in chronic pain patients. According to the report’s authors, 76% of the articles contributed information on opioid misuse and 32% of them provided additional insight on opioid addiction. Only one of the studies used for the research reported on opioid abuse.

The study did not look at opioid tolerance — which can be considered to be the “greatest obstacle to the development of effective opioid treatment for intractable pain” — in chronic pain patients. ”Opioid tolerance, while a real issue for both providers and patients, was outside of the scope of this study,” said Dr. John Ney, co-author of the report…

Not much of a study, then, huh?  Did ya’ll look at suicide rates in the pain patient population? How about looking at the percentage of pain patients who have been harmed by the non-narcotic treatment options, like injections and surgery?  Medical errors?  How many chronic pain patients have been created by the medical industry?

Under comments:

Martha Petersen 1 day ago

…Kolodny, until you have changed from a dignified human being to one crawling on the floor, moaning, hopeless, unable to process anything but a universe of suffering, begging for anyone to help—as I have—you ought to shut your damned mouth.

Dear CJ Arlotta (the “reporter” for this article):  WTF?  Do you work for Forbes or the DEA?

The Irrationality of Alcoholics Anonymous


Nowhere in the field of medicine is treatment less grounded in modern science. A 2012 report by the National Center on Addiction and Substance Abuse at Columbia University compared the current state of addiction medicine to general medicine in the early 1900s, when quacks worked alongside graduates of leading medical schools. The American Medical Association estimates that out of nearly 1 million doctors in the United States, only 582 identify themselves as addiction specialists. (The Columbia report notes that there may be additional doctors who have a subspecialty in addiction.) Most treatment providers carry the credential of addiction counselor or substance-abuse counselor, for which many states require little more than a high-school diploma or a GED. Many counselors are in recovery themselves. The report stated: “The vast majority of people in need of addiction treatment do not receive anything that approximates evidence-based care.”

This begs the question:  Dr. Kolodny, are you a drug addict in recovery?

Alcoholics Anonymous was established in 1935, when knowledge of the brain was in its infancy…

A meticulous analysis of treatments, published more than a decade ago in The Handbook of Alcoholism Treatment Approaches but still considered one of the most comprehensive comparisons, ranks AA 38th out of 48 methods…

AA truisms have so infiltrated our culture that many people believe heavy drinkers cannot recover before they “hit bottom.” Researchers I’ve talked with say that’s akin to offering antidepressants only to those who have attempted suicide, or prescribing insulin only after a patient has lapsed into a diabetic coma…

Part of the problem is our one-size-fits-all approach…

Sinclair called this the alcohol-deprivation effect, and his laboratory results, which have since been confirmed by many other studies, suggested a fundamental flaw in abstinence-based treatment: going cold turkey only intensifies cravings. This discovery helped explain why relapses are common…

I didn’t mention that some bare-bones facilities charge as much as $40,000 a month and offer no treatment beyond AA sessions led by minimally qualified counselors…

In 1934, just after Prohibition’s repeal, a failed stockbroker named Bill Wilson staggered into a Manhattan hospital. Wilson was known to drink two quarts of whiskey a day, a habit he’d attempted to kick many times. He was given the hallucinogen belladonna, an experimental treatment for addictions, and from his hospital bed he called out to God to loosen alcohol’s grip. He reported seeing a flash of light and feeling a serenity he had never before experienced. He quit booze for good. The next year, he co-founded Alcoholics Anonymous…

Alcohol acts on many parts of the brain, making it in some ways more complex than drugs like cocaine and heroin, which target just one area of the brain. Among other effects, alcohol increases the amount of GABA (gamma-aminobutyric acid), a chemical that slows down activity in the nervous system, and decreases the flow of glutamate, which activates the nervous system. (This is why drinking can make you relax, shed inhibitions, and forget your worries.) Alcohol also prompts the brain to release dopamine, a chemical associated with pleasure…

Still, science can’t yet fully explain why some heavy drinkers become physiologically dependent on alcohol and others don’t, or why some recover while others f[l]ounder…

What if it’s in the tastebuds?  Part of the reason some people don’t drink is because of the taste of alcohol, which could be described as an “acquired” taste.  And one reason some people love beer and wine is because, to them, they taste good.  But people like different foods and have different tastes — I dunno, there seems to be some kind of connection there…

There is no mandatory national certification exam for addiction counselors. The 2012 Columbia University report on addiction medicine found that only six states required alcohol- and substance-abuse counselors to have at least a bachelor’s degree and that only one state, Vermont, required a master’s degree. Fourteen states had no license requirements whatsoever—not even a GED or an introductory training course was necessary—and yet counselors are often called on by the judicial system and medical boards to give expert opinions on their clients’ prospects for recovery…

“What’s wrong,” he asked me rhetorically, “with people with no qualifications or talents—other than being recovering alcoholics—being licensed as professionals with decision-making authority over whether you are imprisoned or lose your medical license? …

Reid K. Hester, a psychologist and the director of research at Behavior Therapy Associates, an organization of psychologists in Albuquerque…

It seems like New Mexico is a state where all forms of treatment for addiction can be found, and yet that hasn’t made the problems of alcohol and drug addiction any better.  I guess it all comes down to affordability and easy access to treatment, along with the biases some patients have about their own addictions.  Of course, sustainable jobs is one of the only things that really makes a difference in how people use and abuse drugs.

Candy Land


It’s easy to read the linked article and focus on one part of the problem with managing and treating pain:  drugs.  But while we work our way through this well-done article, let’s look more at what’s not being said.

This isn’t a story about drugs, the drug war, or the war against pain patients.  The term “chronic pain” isn’t even mentioned in this report.  These veterans appear to be seeking treatment from the VA psychiatric hospital for PTSD, not pain management.  And yet, with the high prevalence of chronic pain in the veteran community, I think it’s odd that this term isn’t a part of the article.

One of the reasons it’s so hard to treat veterans who suffer from chronic pain is that a significant portion of these patients are also suffering from PTSD, along with depression, bipolar, and other mental health conditions.  (I don’t believe that’s true for the overall pain patient population, although comorbid conditions, like mental illness, can be part of illnesses involving chronic pain.)

With pain patients who suffer from mental illness, doctors are attempting to treat two serious conditions — a very tricky thing to do, especially when using a hodgepodge of pharmaceuticals. Doctors tend to rely too much on what studies and research have shown about the effectiveness of these drugs, instead of individually monitoring each patient.  For instance, a sign of addiction in one patient may be a sign of something else in another, but every pain patient is labeled as a potential addict (and all the shame that goes along with that label).

After reading through this article several times, my overall impression is that this VA hospital and these veterans were trying to treat the after-effects of war, not chronic pain.  I don’t know how you can successfully treat the men and women who have seen and done such atrocities, but the VA has been trying for a very long time and the reason they’re unsuccessful is that the solution is antithetical to the agency’s reason for being — if you stop sending these people to war, a large part of the problem would be solved.  At least in the veteran community.

While the number of people who suffer from crime-related PTSD has decreased overall in the last few decades, the drug war has created more than enough PTSD victims to make up for this decline. The unstable economy has created even more cases of this illness, along with America’s crappy health care system.  And if the result of attempting to treat a chronic illness is bankruptcy, many people just go without treatment or self-medicate.  Some end up addicted to drugs and alcohol.

So, the question of how to effectively treat PTSD has still not been answered, at least with current treatments.  But like chronic pain and addiction, learning to manage and treat PTSD is so uniquely individual that the answer is not one treatment over another, one drug or another, but a combination of whatever works for each patient.  Standardizing the treatment of pain or any of these other conditions does not help patients.

The VA hospital in this article is not a pain clinic — it’s a psychiatric facility for veterans, and it has all the problems that go along with treating that patient population.  I think I can assume that these same problems existed with Vietnam veterans back then, and sadly, continue to exist today.  With all the marvels of medical science and technology, it is still quite difficult to treat the victims of conflict and war.  This is the price we all pay when we vote for continuing whatever war is being fought in our name.

In other words, the military created the problems described in this article, and it’s a freaking tragedy that we are focusing on PTSD and drugs when the real problem is war and all of its victims.  Men and women, paid to fight whatever enemies we create, come home and are expected to just get back to their lives… almost as if nothing happened.  Like their trauma didn’t happen.  It wasn’t real.  Like their pain… isn’t real.

Veterans are angry.  Many have been angry and hopeless enough to commit suicide.  Some use their anger to commit crimes, like domestic violence and robbery.  Some veterans prefer to be homeless rather than let their anger consume them.  Yet other veterans have decided to self-medicate their anger away.  Obviously, the system continues to fail them.

I understand anger and I know a lot about pain, but I’m not a veteran.  I don’t have the answers — but then, no one is depending on me to find them. Unfortunately, the VA doesn’t have the answers either, but they have millions of men and women depending on them.  And even more unfortunately, they are using the advice of “experts” like Andrew Kolodny of PFROP in their effort to change things, which I think is a mistake.  And so, the internet is now having to suffer from my long-winded responses to articles like this… unfortunately.

Maybe, in the future, long after I’m gone, the internet will decide that I knew what I was talking about.  New “experts” will look back and label me a genius. (It could happen.)  They’ll say, look, isn’t this what Johnna said would happen 40 years ago?  Why didn’t we just listen to her back then?  Ah, hindsight… on the internet… from words and visuals memorialized in the cloud.  It’s a wonderful thing…


Dr. G. Caleb Alexander, co-director of the Center for Drug Safety and Effectiveness at the Johns Hopkins Bloomberg School of Public Health, has studied the widespread damage caused by opiates, which he attributes to their addictive potential and their ability to impair judgment.

Once again, much of the blame is going to opiates, when it’s drug combinations that are causing all this harm.

“You don’t have to be a criminologist to know that people who have dependence on these products may be driven to great lengths to self-medicate and treat their addiction,” Alexander said. “When these drugs are overprescribed…

Treat their addiction or treat their pain?  I wonder, how do you measure the pain levels of a veteran suffering from PTSD?  Or do I have to be a criminologist to understand pain and addiction?

And although it’s not mentioned, one of the “great lengths” patients go to for treating their pain is suicide, especially in the veteran population.  If veterans are self-medicating, does that suggest a problem of mistreating and under-treating their medical conditions?  Problems with affordability and access?

The report’s author, VA interim Undersecretary for Health Carolyn Clancy, told journalists that “a very large percentage of those patients” also receive benzodiazepine tranquilizers, such as Valium and Xanax, a combination that she said increases the risk for what she called “patient safety events.”

Yes, that’s true.  Valium can work for insomnia and Xanax treats anxiety, two problems that shouldn’t be under-treated.  But I think these drugs should be used in lower doses when they are used in combination with opiates, especially in patient populations with a high prevalence of alcohol use and abuse.

When police interrogated Schuster, he confessed to being an addict but said he had been to rehab and no longer abused the oxycodone Houlihan prescribed; nor, he said, did he abuse any of the other opiates, tranquilizers, antidepressants or antipsychotics officers had found at the scene…

Anti-psychotics to treat pain, no, but to treat PTSD?  Seems to me those drugs would just make things worse for PTSD patients.  Anti-depressants are successful in treating pain in a small percentage of patient populations, but only for certain conditions, like fibromyalgia.  Treating a chronic pain patient suffering from Traumatic Brain Injury with anti-depressants?  That doesn’t sound like a good idea.  And tranquilizers like Ambien?  I’d say that wasn’t a great idea either.

“We have a major problem with prescription drug abuse, but I don’t think we have a handle on it like we do with heroin and meth,” said Wausau police Chief Jeff Hardel.

I’m sorry, did I miss the report about how we have a handle on heroin and meth?

After McGovern was jailed, sheriff’s deputies charged him with criminal damage to property. He had used a juice box to carve the words “Kill Me Kill Me Kill Them” into his cell wall…

Sounds more like schizophrenia.

Five months after the theft, a police officer in Adams, Wisconsin, found Zimmerman passed out in the middle of the street with a .40-caliber Smith & Wesson handgun sticking out of the bottom of his shorts…

I guess anybody but a veteran found in that condition would have been quickly locked up in a psychiatric facility.  But veterans found with guns, even if suicidal, doesn’t seem to be too concerning to law enforcement.  Police have no trouble confiscated drugs, but guns?

When police asked him why a bottle of oxycodone prescribed the day before was empty, Ehlert said he had been selling the VA-prescribed narcotics in front of the hospital’s addiction treatment center. He also mentioned that he had shared his painkillers at least a dozen times with McGovern, who promised to pay him but never did…

The drug war and America’s health care system create the conditions for narcotics to be sold under the table — to people who can’t afford to see a doctor, for people who self-medicate rather than face the shame of being treated for drug addiction, for immigrants unable to access health care services in this country, to drug dealers unable to find work that pays enough to feed their families.

Soon, Jason Bishop was receiving a witches’ brew of powerful medications, including amphetamines, benzodiazepine tranquilizers and two types of morphine… Hospital staff call the combination of medications prescribed to Jason Bishop the “Houlihan Cocktail.” …

C’mon, “witches’ brew”?  Are doctors witches now?

The Houlihan Cocktail runs counter to the VA’s own regulations, which warn doctors to be especially cautious when prescribing addictive narcotics to patients with mental illness. Doctors also are supposed to avoid prescribing tranquilizers and opiates to the same patients, because the combination can cause them to stop breathing…

How do you treat insomnia in a chronic pain patient?  Drugs, or tranquilizers, is one way.  And I tell you what, not treating insomnia really shouldn’t be an option.  As both old and new research indicates, sleep is one of the most important functions of the human body.  The brain cannot function with adequate sleep.

“Using amphetamines off-label for PTSD sounds strange, and that would be a controversial use of amphetamine,” said Andrew Kolodny, the Phoenix House medical officer. “I would hope that a physician engaging in a dangerous and questionable practice would be able to point to real evidence supporting that practice.” …

Well, hello Mr. Kolodny, how’ve you been?  Are you still working in New York or do you spend most of your time with the big boys in Washington, D.C.?  And are you up to your old tricks of confusing the issue again?

Using drugs off-label is not a “dangerous and questionable practice” — doctors do it all the time, and sometimes it works.   In fact, I saw a headline the other day about how they’re using Prozac to treat… well, it wasn’t to treat depression. Using stimulants to treat PTSD does sound strange, but pain specialists use these drugs to counteract the effects of opioids, so it’s not unheard of.

Really, Mr. Kolodny, you have a bad habit of questioning the practices of other doctors, willy-nilly, as if it was nothing.  How do you feel when one of these doctors you preach against winds up in jail?  Does that make you feel good?  What happens when the DEA comes for you?  Or did you just quit prescribing drugs on the DEA’s watch list, like other doctors?  Yeah, as long as bupe is being supported by the federal government, you’re in a nice, cushy place.  How long before bupe has the same reputation as methadone?  Dude, did you forget about the drug war?

In his patients’ medical charts, Houlihan justified his use of amphetamines for PTSD patients by citing research – a paper published in 2011 in the Journal of Psychopharmacology by Dr. David Houlihan.

The paper is not based on a typical double-blind study, with one group of patients receiving an experimental treatment and a control group of patients receiving a placebo or conventional therapy. Instead, it is a narrative describing three combat veterans who Houlihan said improved after he provided them with Ritalin, a stimulant typically associated with reducing hyperactivity in children…

I suppose Dr. Houlihan might have had trouble if he tried to get a trial started treating PTSD with Ritalin.  As those who suffer from PTSD also suffer from hyper-awareness, I would think Ritalin wouldn’t be a good fit.  And doctors who treat PTSD (like those who treat chronic pain) don’t have a lot of options for patients, so trying new things isn’t necessarily a bad thing.  But using all of his other patients as guinea pigs in his own Ritalin experiment obviously was not a good thing.

While I was seeing Dr. Hochman in Texas (see my post, “In Memory of Dr. Joel Hochman from Texas”), he once tried to run a trial for some new kind of treatment. It was similar to the TENS unit. I wanted to help him, so I tried it a few times; but not only was it ineffective, it was irritating and unpleasant.  I don’t know what happened with that research, but I suppose if it had been successful, that product would be flying off the shelves.

Morphine, Ritalin, and Xanax, the Houlihan cocktail.  Mr. Bishop was on 4+ milligrams of Xanax per day, which I believe is close to or at the maximum dosage for that drug.  He was prescribed morphine at 30mg dosages, one in the immediate release formulation, and an extended release version — I don’t think that’s a very high dosage of opioids. The quick-action and sustained-release dosages of Ritalin, at 10mg and 20mg respectively, don’t seem that high either, but I don’t know very much about Ritalin.

For his part, Jason Bishop said he’s been seeking acupuncture, surgery and other treatments to get to the root of his pain. His medical record shows he’s been receiving the Houlihan Cocktail, but he said he hasn’t been taking all of his pills.

Instead, he’s hidden nearly full bottles of morphine sulfate, Xanax and Ritalin in a drawer underneath his bed where his daughter won’t see them.

“Every time I went in there, I would get asked, ‘Do you need more?’ ” Jason Bishop said of Houlihan and other doctors at the Tomah VA. “I would say, ‘No, I don’t need more, I don’t want more, find something that works for me and fix the problem.’ ”

And here is the main problem:  Mr. Bishop, like many pain patients, believes his pain can be fixed. By more surgery?  The odds of pain relief obtained from surgery are rather low.  And why is he hiding his pills?  Why pay for treatment you’re not going to use?  That doesn’t make sense.

No, what Mr. Bishop needs is the drug of acceptance.  Unfortunately, that doesn’t come in a pill.

I don’t know if I can identify the people in this article as victims of the drug war — but they are victims of war, so here are their names:

Brian Witkus

Angela Colby

Matthew Schuster

Jason Simcakoski

Jacob Ward

Michael Bobak

Tracey Small

Derik McGovern

Lucian McGovern

Damien Ehlert

Jacob Zimmerman

Timothy Benton

Kevin Underwood

Jason Bishop

Ada Mae Miller and her family

(And seriously, thanks for reading all the way to the end of this very long post. Gracias.)

It’s your fault


(2/11/2015) The Prescription Opioid and Heroin Crisis: A Public Health Approach to an Epidemic of Addiction

Andrew Kolodny,1,2,3

email: akolodny@phoenixhouse.org, Phoenix House Foundation, New York, NY 10023

However, policy makers who focus solely on reducing nonmedical use are failing to appreciate the high opioid-related morbidity and mortality in pain patients receiving OPR prescriptions for medical purposes…


Well, it’s official.  Kolodny has been able to publish this… this… one-sided crap.  In case you can’t read through the medical B.S., Kolodny is no longer blaming drug addicts for the opioid “epidemic” — now he’s only focusing on chronic pain patients (and their doctors).  He’s not only blaming opioid abuse and poisonings on pain patients, he’s also tagging us for the heroin “epidemic.”

Kolodny says, no, the “epidemic” isn’t caused by recreational drug use, or illegal drug use on the street.  No, the real reason for the overdose “epidemic” is you, dear pain patient — you and your doctor.

I didn’t read this whole paper, but I don’t see any mention of suicide:

Keywords: prescription drug abuse, heroin, overdose deaths, chronic pain, opioid, addiction

We describe the scope of this public health crisis…

It’s hard to believe that “experts” can publish a paper like this without mentioning suicide, and that not all drug overdoses are unintentional accidents.  Of course, then the “experts” would have to admit that there is most definitely an epidemic of under-treated pain, along with an enormous lack of quality mental health care.

No negative peer reviews for this paper?  If this had been a biased article on cannabis, there would have been plenty of rebuttals published.  I guess no one’s willing to stand up for pain patients.

How could Kolodny hawk his services in the treatment of addiction if he doesn’t point the finger at chronic pain patients?  Yeah, treating drug addicts is one thing — but they’re only a small percentage of the population, and treating those patients is full of discrimination, low insurance coverage rates, and shame. However, chronic pain patients are “legitimate” patients, with “legitimate” pain, and “legitimate” addictions to drugs prescribed by doctors.

After Kolodny gets done pointing the finger at pain patients (and now, student athletes), I expect him to take a corporate job at Indivior, one of the makers of bupe:


Vyvanse for binge eating disorder


Shire is pushing full steam ahead to get the word out on binge eating disorder (BED), the new indication it snagged for blockbuster Vyvanse last month…

But all of these activities worry some medical professionals, considering that Vyvanse is essentially an amphetamine, The New York Times notes. And amphetamines have a long history of triggering abuse in overweight patients, a category that describes about 80% of binge-eaters, according to Shire–though the company notes that Vyvanse shouldn’t be used as a weight loss or obesity treatment…

“Now we have another reason for the public to learn about the glories of amphetamine–it’s very worrisome,” one behavioral pediatrician told the paper. The chief medical officer of Phoenix House, a drug treatment organization, remarked that there are “so many reasons to be concerned about this.”

What, no mention of this person’s name?  Could that be… Mr. Kolodny?

Shire’s track record isn’t helping much. Last fall, the pharma shelled out $56.6 million to settle federal charges that it crossed the line while promoting Vyvanse, the Times notes. Among the claims was that Shire played down Vyvanse’s addiction potential–an allegation the company denies…

Safe Streets Alliance


Group opposed to legal marijuana plans to sue Colorado and industry participants

Now, Safe Streets Alliance, an anti-crime group led by a Reagan-administration veteran, is bringing forward two more suits in federal court. Safe Streets Chairman James Wootton, who according to his Web site biography served in in the Reagan Justice Department, had already thrown his support behind the Oklahoma and Nebraska lawsuit this month…

Under comments:
Frank Long 10:58 AM MST
I went to the web site for the “Safe Street Alliance”. On their front page they had a link to the following:  “Survey: Teen marijuana use declines even as states legalize” Does anyone see the irony here?

Safe Streets Alliance is a District of Columbia Corporation filed on August 9, 1982. The company’s filing status is listed as Revoked and its File Number is 823684.

The Registered Agent on file for this company is Alan P. Dye and is located at 1747 Pa. Ave., N.w. Washington, District Of Columbia 20006-0000.


All trademarks indicate “cancelled.”


(Undated) WASHINGTON – Alan P. Dye, legal counsel to the American Legislative Exchange Council (ALEC)…


(2007) Attorneys Alan P. Dye and Bruce Fein Join Congressman Paul’s Presidential Exploratory Committee…


From PDF file:

A Human Capital Perspective on Criminal Careers, Journal of Applied Business Research, Volume 11, Number 3 (9/26/2011)

21. Wootton, James, “Truth in Sentencing,” published by the Safe Streets Alliance in Washington, District of Columbia, 1993.


Indeed, prisons and jails have lost their purpose of being a place where a convict expresses “penitence.” We derive our word “penitentiary” from this purpose. Instead, modern prisons foster a sense of impunity. Statistically, convicts serve only a fraction of their sentences. According to James Wootton of the Safe Streets Alliance, “Judges pretend that defendants will get long sentences, and they get out of the back door.”


_Road_To_Civil_Justice_Reform.pdf (May 2004)

About the Author

Before this appointment, Mr. Wootton was president of two related non-profit corporations that he formed in 1992. The Safe Streets Alliance, a public charity dedicated to education about crime and creating youth leadership opportunities, and the Safe Streets Coalition, a public advocacy group with over 130,000 members. As president of Safe Streets, Mr. Wootton was principal drafter and advocate for the truth-in-sentencing provisions of the 1994 Crime Bill, which authorized over $5.7 billion for prison construction in the states. Articles by Mr. Wootton have appeared in Newsweek magazine and newspapers across the country. In addition, he has appeared on the Today Show, Good Morning America, NBC Nightly News, C-Span, CNN, ESPN, CNBC, Newstalk, The Phil Donahue Show, The Jesse Jackson Show, Court-TV, Fox Morning News, Dateline NBC, and numerous radio talk shows. Mr. Wootton authored two backgrounders for the Heritage Foundation on truth-in-sentencing and juvenile crime and edited the book Freed to Kill.

by Thomas A. Gottschalk
Executive Vice-President & General Counsel
General Motors Corporation

… Certainly, the interests of the larger society are not being represented by the personal injury attorneys who in the last decade walked away with literally billions of dollars in multi-year fee awards for representing individual states in lawsuits against tobacco manufacturers…

Click to access GettingToughOnCrime.pdf


For many years a powerful, highly-organized network of right-ward leaning policy groups (Heritage, ALEC, NCPA, and the NRA) had worked to promote a broad program of deeply conservative criminal justice reforms… (Page 27)

Ah, it looks like the prison industrial complex has reignited “Safe Streets Alliance” to fight cannabis legalization.  Hey, Kolodny with PFROP began his work treating addiction in the prison population in New York… coincidence?

New rules on narcotic painkillers cause grief for veterans and VA


But after the DEA regulations were put in place, he was unable to get an appointment to see his doctor for nearly five months, [Craig] Schroeder said. He stayed in bed at his home in North Carolina much of that time…

His wife, Stephanie Schroeder, said getting him a VA appointment turned into a part-time job and her “main mission in life.” While part of the problem was a shortage of doctors, she said she also noticed that VA had become hostile toward patients who asked for painkillers.

“Suddenly, the VA treats people on pain meds like the new lepers,” she said. “It feels like they told us for years to take these drugs, didn’t offer us any other ideas and now we’re suddenly demonized, second-class citizens.”

The agency recently set up a Choice Card program for veterans, which would allow those facing long wait lists or who live more than 40 miles away from a VA hospital to use private clinic visits. Veterans say the initiative is complicated and confusing. VA officials acknowledged this month that veterans have been using this program at a lower rate than anticipated…

As part of a $21.7 million initiative with the National Institutes of Health, VA is looking for therapies that could substitute for opioids…

Yeah, perhaps the NIH and the VA should have started this initiative BEFORE the DEA began its war on pain patients.

But Andrew Kolodny, president of Physicians for Responsible Opioid Prescribing, called the new DEA rules “the single most important change that could happen. The best way to treat any disease, whether it’s Ebola or opioid addiction, is to stop creating more people with the disease.

This is “the single most important change that could happen” — for doctors who treat addiction ($$$$$). And the best way to stop chronic pain is to aggressively treat acute and severe pain before it becomes chronic and intractable.  It’s called prevention, although Kolodny appears unfamiliar with that term.  Perhaps because he knows nothing about pain management. After all, if you successfully prevent addiction, Kolodny (and Jennifer Weiss) would be out of work.

But no, the DEA, PFROP, and the medical industry would prefer to see people suffer.  When in fact, they’re just creating more pain patients, drug addicts, and patients on disability. And when all this untreated pain turns into chronic pain, what then?  Massages and acupuncture for everyone?

The disease is the drug war.  Let’s stop creating more people who suffer from this disease.