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.

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…

No More Shame and Blame

http://www.theguardian.com/society/2016/feb/25/by-understanding-why-people-use-drugs-i-now-know-why-i-dont-use-them

(2/25/2016) Why I don’t use heroin by Chris Arnade

I spent the last five years documenting drug traps in neighborhoods poorer than is decent for such a rich country. I have become close friends with women and men who live under bridges and earn money for heroin by selling themselves for sex. I have bought heroin for them, unable to stand by as their body rejected the lack of drugs. I have provided them with clean needles, water, and a safe space to inject…

I am surrounded by heroin but have never used, because I am not in pain and have it good. I grew up with parents who cared about me and kept me safe, surrounding me with books and toys. I was encouraged, and expected, to finish high school, and to keep learning beyond that. After my education I was lucky to find a job (I was good at thinking in numbers), and was paid well.  The people I met in the drug traps had none of that. Their parents, if around, were too busy with their own problems to keep them safe. Many did far worse, abusing them physically and sexually. If the abuse didn’t come from a parent, it came from an uncle, or the mother’s boyfriend, or a stepbrother, but the abuse almost always came. It was the ultimate betrayal of trust: being raped by men who were supposed to keep them safe.

Their childhoods were spent dealing with problems that would break most adults…

And so drugs are popular, because drugs work. They allow people in pain, whom society has rejected, a way to integrate into a community that does work for them. How much someone uses drugs is often a measure of how much pain they have suffered, how isolated they are…

That in any city or town, across all of America, people live on the streets, shooting up, selling themselves for another bag, should make us all stop and ask ourselves “why does our society create and allow such pain?”.

I never saw Bernice again, she disappeared from the streets, presumably into a rehab, jail, or perhaps she moved to another town. Still, I cannot forget the last thing she said to me, “Why am I using drugs and hustling? Because I am out here trying to kill myself. I want to get a gun and do it faster, but I am too scared to blow my head off.”

Try not to judge people for how they decide to manage their pain. I know that many of these ways are often destructive, like my addiction to cigarettes. I don’t have the looks to be able to sell my body, but I know what desperation and pain can drive a person to do. And if you don’t understand that kind of desperation, then you’re lucky.

According to all of my reading on this subject, most drug addicts are like the ones described in this article. And so I’m wondering about the homes they ran away from, specifically if most drug addicts are from poor neighborhoods. According to the government’s statistics, most heroin addicts are white people from middle-class homes. I’m not sure about the government’s definition of “middle-class,” but I know that most patients who can afford an addiction clinic are usually from the middle-class.

And so I’m wondering, what kind of pain are these middle-class heroin addicts running from? I’ve been comparing the current heroin “epidemic” to the drug epidemics of the past, specifically in the middle-class. It seems like boredom is one of the reasons for drug use in the upper classes, and I suppose we can also blame the immaturity of young brains.

I used to think I was in the middle-class, perhaps lower middle-class. It’s hard to remember every day of my life, but I don’t think I’ve ever been offered heroin. I don’t know what kind of crowd you have to hang out with to be exposed to drugs like that, but I’m guessing it’s people with a lot more money than I’ve ever had. And perhaps, also, people with a lot less than I have.

I can see why a lot of parents blame legal drugs and drug dealers (I mean, doctors). Who else is left to blame? There are many people who believe that parents are to blame when children do things like take drugs. But parents who don’t take drugs also have children who do, and vice versa, so I think the blame falls more on our DNA (along with the types of drugs that one is exposed to). And yet, there’s all this violence, abuse, rape, and bullying, that contributes to drug addiction…

Does the white middle-class really want to stop the heroin “epidemic”? Does it really want to delve into the reasons for addiction? Abuse and violence are already against the law, yet that hasn’t stopped drug use and abuse. The drug war hasn’t stopped it either.

People abuse sex, just like they abuse drugs. In the past, most people felt that unmarried women having babies was shameful (only for the woman, of course). People used to think that women who took the pill were sluts. One day, our society will progress to the point of not shaming those who use drugs, for whatever reason.

Thinking of you, Bernice.

Title fight: Big Pharma vs. The Feds

http://bigstory.ap.org/article/765439c771b649a7b6940fda87595735/effort-curb-painkiller-prescribing-faces-stiff-opposition

But industry-funded groups like the U.S. Pain Foundation and the American Academy of Pain Management warn that the CDC guidelines could block patient access to medications if adopted by state health systems, insurers and hospitals. Such organizations often look to the federal government for health care policies.

“Could block patient access”?  When will everyone else join pain patients in the real world? Patient access has already been blocked, patients have been abandoned by doctors, and these groups are still saying this “could” happen?

Which is better, groups funded by industry or those funded by the federal government? What about all of the people who don’t have the funds to pay for representation?

The CDC decision to delay its guidelines followed months of lobbying by physician and patient groups aligned with the pharmaceutical industry, who have almost always had a seat at the table in federal discussions on painkillers. As a result, they have had far more influence over federal policy than addiction activists, according to experts.

I can report that there are millions and millions of pain patients who are not “aligned” with anyone; do not have a seat at any table for discussions on painkillers; and have absolutely no influence whatsoever over federal policy. I can also report that there are thousands of drug addicts who similarly have no voice in this fight.

“They’re very well-funded and they have a lot of pharma money behind them,” said Dr. Lewis Nelson of New York University, an FDA adviser who is also advising the CDC on its guidelines. “And then you have the anti-addiction groups on the other side, which is clearly much less funded and organized.”

It’s funny how some people — usually those sitting in a seat of privilege — live in a bubble of their own made-up reality. Since Big Pharma funds both sides of this issue, and the federal government only funds the anti-drug side, which side is clearly better funded? And which side does the media report on?

CDC’s Frieden says more Americans are “primed” for heroin use because of their exposure to painkillers.

I call bullshit. There are hundreds of millions of Americans who have been exposed to painkillers with no problems whatsoever.

The CDC had not publicly disclosed the panel’s membership, but Twillman and other pain advocates identified several members, including two who are leaders with Physicians for Responsible Opioid Prescribing, a group working to reduce painkiller prescribing. That group is backed by Phoenix House, a network of rehabilitation clinics.

Also backed by the federal government, along with anonymous, right-wing, private donors (like ALEC  and the prison industry).

My comment:

I want to thank the AP for not describing Mr. Kolodny from PFROP as some kind of expert on pain management (as many other media outlets have done). Unfortunately, I can’t thank the AP for its biased reporting on these issues.

As a 30-year intractable pain survivor, I’m sad to say that my voice isn’t a part of the media’s reporting on the opioid war. But what’s really tragic are the millions of pain patients who also have no voice (or a seat at any table), silently suffering and fueling a suicide epidemic that everyone refuses to talk about. Because when up to three times as many people die by suicide every day than by drug overdose — and all the CDC (and the media) can talk about is how doctors are over-treating pain — then something is terribly wrong. Maybe one day, someone will figure out how to report on the difference between tens of millions of pain patients, and the thousands of patients who suffer from drug addiction. (And maybe one day, the word “epidemic” will have meaning again.)

Since I was able to recover from my addiction to the medical industry, I can only hope that other pain patients are able to do the same. I was very lucky to survive this addiction, but there will be many who do not. While almost everyone blames suicide on the victim, my own experiences have shown me that the blame doesn’t belong there. In fact, agencies like the CDC and DEA should be held accountable for every pain patient who chooses suicide as a last resort to manage their pain, and for every pain patient who ends up in jail for being forced to turn to the underground drug market.

#InTheDoghouse2016

https://painkills2.wordpress.com/2014/12/24/buds-most-wanted-list-2015/

DEA

CDC

PFROP

Medical Industry

Addiction Industry

NEJM

Thinking of you, Martin Szczupak

http://www.reuters.com/article/2015/09/02/us-usa-rehab-phoenixhouse-specialreport-idUSKCN0R21PY20150902

(9/2/2015) Special Report: Renowned U.S. drug-rehab program spun out of control

Martin Szczupak had already been in and out of rehab when, for a misdemeanor possession charge, a judge sent the 21-year-old heroin addict to a century-old estate in the wooded hills of upstate New York for another chance to clean up…

By December 2012, he had given up on the treatment program. He felt he would be stuck going from “dead end job and rehab and jail until I eventually drop dead,” he wrote in a letter to his fiancée. “You deserve better than that.” He didn’t want to use drugs anymore, he wrote, “but realistically the odds are against me.”

Szczupak never sent the letter. Three weeks later, he walked out of Belle Terre without permission. One day after that, police visited Szczupak’s mother, Inez, at her Staten Island home to tell her that her son had been found dead from a drug overdose…

In 2012, the U.S. criminal justice system sent 580,000 people to drug treatment…

At Belle Terre, criminal-justice referrals account for the majority of residents. The facility is run by Phoenix Houses of New York, whose parent foundation is one of the nation’s largest drug treatment nonprofits, operating in 10 states and the District of Columbia. In the year ended June 20, 2014, the Phoenix House Foundation and its affiliates reported operating revenue of $141 million.

Phoenix Houses of New York is 95 percent publicly funded and enjoys star-studded endorsements. Beyonce donated a cosmetology center at a Brooklyn facility. Financier Pete Peterson chaired a summer fundraiser in 2013 in the posh Hamptons on New York’s Long Island…

The closures that preceded Szczupak’s arrival weren’t the last. And nor is Belle Terre an anomaly. In November last year, OASAS suspended admissions to Belle Terre and four other Phoenix Houses of New York facilities. In a letter to Phoenix House’s then-chief executive in November 2014, OASAS said Phoenix House had “persistent regulatory violations and resident/patient care concerns dating back several years.”

An OASAS site report on the five facilities went into graphic detail. The regulator’s findings at some or all of the facilities included use of marijuana, cocaine, heroin and other illegal drugs; sexual activity among residents; reports of violence and sexual assault; insufficient, inadequately trained or abusive staff; dirty premises; and lax security, with residents coming and going as they wished…

In November 2014, regulators again suspended admissions at Belle Terre, as well as four other Phoenix House facilities. State regulators noted high staff turnover and need for improved clinical practices at Belle Terre. They also warned the facility to let clients speak to their attorneys without staff present.

OASAS let Belle Terre reopen in January 2015. Three of the other centers were reopened with limited admissions in late 2014 and early 2015. The Shrub Oak teen residential treatment facility was closed permanently in June 2015.

In March, OASAS inspected Belle Terre again, prompted by unspecified complaints against director Alan Hargrove, OASAS reported. Phoenix House then fired Hargrove, based on OASAS’s feedback.

Hargrove declined to comment.

Phoenix House announced on Aug. 19 it would be closing Belle Terre and the 185th Street facility…

Perhaps Mr. Kolodny should attend to his own affairs, instead of fighting the war against pain patients.

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

http://www.pharmaciststeve.com/?p=10350

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.)

Dr. Hamburg Leaving FDA

http://ryortho.com/2015/02/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…

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

http://www.forbes.com/sites/cjarlotta/2015/04/01/opioid-misuse-in-chronic-pain-patients-is-around-25-new-study-shows/#comment-29

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?

https://painkills2.wordpress.com/2014/12/31/nm-behavioral-health-subcommittee-1172014/

 And what about this report from UNM in October 2013?

https://painkills2.wordpress.com/2015/01/06/the-epidemic-of-chronic-pain/

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

http://www.theatlantic.com/features/archive/2015/03/the-irrationality-of-alcoholics-anonymous/386255/?src=longreads

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

http://www.revealnews.org/article/the-death-of-baby-ada-mae-and-the-tragic-effects-of-addicted-veterans/?Src=longreads

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…

http://www.revealnews.org/article/the-death-of-baby-ada-mae-and-the-tragic-effects-of-addicted-veterans/?Src=longreads

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

http://www.annualreviews.org/doi/pdf/10.1146/annurev-publhealth-031914-122957

(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…

https://painkills2.wordpress.com/2015/02/06/another-advertisement-for-bupe/

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:

https://painkills2.wordpress.com/2015/01/05/indivior-ceo-looks-beyond-2015-after-troubled-reckitt-pharma-units-spinoff/

Vyvanse for binge eating disorder

http://www.fiercepharmamarketing.com/story/shires-vyvanse-brand-team-draws-fire-aggressive-binge-eating-push/2015-02-25

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…

Reviews for jobs at Phoenix House

http://www.indeed.com/cmp/Phoenix-House/reviews

Counselor (Former Employee), Descanso, CA – October 7, 2014
Cons: work environment

This is an awful place to work. It is run like a boot camp and is FAR FROM TRAUMA INFORMED. Management has no clue about current modalities in recovery and the bottom line is that this place is basically a money making machine. “Counselors” are really just glorified baby sitters and the guy that runs the day to day program enjoys shaming both the residents and the staff.

The kids are bored to death and the case workers and counselors are bottom of the barrel and uninspired. Sad excuse for a recovery program.

If you are hired as a “counselor” you will spend your time standing around making sure the kids aren’t chewing gum or policing dress code issues.

Additionally, there is absolutely NO teamwork. If you are a lowly counselor you are disrespected by office staff, case workers, managers, the facilities guy..etc.. even the cook is allowed to run roughshot over the counselors. I am telling you, this place is just about as sick as they come….
avoid this place …at least you have that choice, the poor kids placed here don’t.