Stop The War On Chronic Pain Patients

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Readers of Mad in America are deeply familiar with the tangles of public policy which surround voluntary or compelled interventions with psycho-active drugs in people who are experiencing life crisis. Some readers will also be familiar with a different kind of crisis and its policy tangles, in the difficulty which many people encounter getting medical assistance for chronic intractable pain.

I have previously written at MIA concerning the inappropriate application of psychosomatic medicine to people who are written off as “head cases.” (See “It’s NOT All In Your Head”) I would now suggest that a largely bogus “war on drugs” has also become a war against pain patients. And at this stage of public discussion, pain patients seem to be losing.

Much has been written lately about an “epidemic” of opioid overdose deaths, in some cases advocating for a blanket reduction in the availability of prescription opioids. Regrettably, many readers will not penetrate beneath the sensational headlines to grapple with the complicated realities of this issue.  Few who aren’t themselves in pain may realize what harm such articles are doing to tens of millions of people.

In March of this year, the US Centers for Disease Control released “voluntary guidelines” on prescription of opioid medications to adults with chronic non-cancer pain.  Unfortunately for 100 Million US chronic pain patients (estimated by the US Institute of Medicine), the document is in actuality neither voluntary nor a guideline.  Combined with recent draconian laws in several US States, the CDC protocols have become a mandatory restrictive practice standard which is driving doctors out of pain management and patients into agony by the thousands.  Patients are being involuntarily taken off opioids — or outright deserted without referral by doctors who fear US Drug Enforcement Administration prosecution if they continue to prescribe the only treatments which give many people even a marginal quality of life.

None of this is to say that over-prescription or diversion of prescription opioids never happens or that prescription overdose deaths do not occur.  Clearly both are real issues in public health, and tragedies for families most directly affected. But there is ample evidence that neither sad outcome is the core reality of drug abuse in the US.  As recently explained in Scientific American by neuroscience journalist Maia Szalavitz ,  “Opioid Addiction is a Huge Problem, but Pain Prescriptions Are Not the Cause.”

As Szalavitz points out, “efforts to reduce opioid deaths will fail unless we acknowledge that the problem is actually driven by illicit — not medical — use.”  Likewise, “…according to the large, annually repeated and representative National Survey on Drug Use and Health, 75 percent of all opioid misuse starts with people using medication that wasn’t prescribed for them—obtained from a friend, family member or dealer.”  The real problem is not chronic pain patients.  Part of the solution might be securing of potentially addictive medications under lock and key when used at home.

The largest contributing factors in drug abuse are not medical prescriptions.  Again from Maia Szalavitz,  “If we want to reduce opioid addiction, we have to target the real risk factors for it: child trauma, mental illness and unemployment.”  Not coincidentally, people who experience these problems are much less likely to receive medical treatment for any cause, including chronic pain.  Moreover,  “…in general, new addictions are uncommon among people who take opioids for pain in general. A Cochrane review of opioid prescribing for chronic pain found that less than one percent of those who were well-screened for drug problems developed new addictions during pain care…”

There is real and valid concern for the avoidable death and destruction which are wrought by illicit opioids in the US.  But the contribution of prescription opioids in pain patients is tiny, and even the number of deaths is over-blown.  Why do we ignore the 88,000 alcohol-related deaths that occur every year? Or the even larger number of deaths by medical misadventure and error – the third highest cause of death in the US?  Something seems seriously out of whack with our sense of proportions.

Present public attitudes and assumptions toward chronic pain must change. A fraction of the millions diagnosed with incurable pain conditions will be prescribed opioids.  But among that minority, opioids are a last resort and a necessary enabler of life.  Take them away, and you may contribute to a wave of suicides and a surge of people seeking street drugs out of desperation.

A huge majority of pain patients are not addicts or abusers.  Most do not get a high from taking prescription opioids, even if they become physically dependent on them for pain control. We cannot reduce drug overdose deaths by denying relief for the agony of millions.

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Adapted from Richard Lawhern’s article in the National Pain Report

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Mad in America hosts blogs by a diverse group of writers. These posts are designed to serve as a public forum for a discussion—broadly speaking—of psychiatry and its treatments. The opinions expressed are the writers’ own.

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167 COMMENTS

    • As a matter of fact,I’m not one of those “authorities”. There is ample evidence that Cannabis may have a constructive role to play in pain treatment for large numbers of people. Likewise, Acupuncture, osteopathic massage, and fascial release therapies seem to help some people some of the time. Cervical chiropractic also helps some people in chronic pain, though none of these therapies is a “cure” — and for the large majority, none of them are uniformly effective for periods of years.

      Prescription opioids are generally the last choice after many other approaches have failed. And they are not a panacea. Some patients aren’t helped by them at all, and others are hypersensitive (sometimes to *ALL* medications). In those whom opioids help, some will rapidly build tolerance, and may experience rebound pain when the nervous system becomes sensitized and hyper-reactive. No physician should prescribe opioids casually or without significant initial assessment, regular monitoring and follow-up.

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      • Iam a law abiding grandmother who will probably have to go out on the street to get my pain relief because the doctor insists I should try some dangerous drugs before I can have any pain meds. Gabapentin, Lyrica, and potent nsaids. The risks of these are worse than codeine. We dont need doctors anymore we have the D.E.A. . and druggies and congressmen to
        decide what is best.
        I guess old people will be the new heroin addicts and jailbirds. Why are doctors so silent on this subject? Dont they have the balls to stand up for their chonic pain patients? What happened to do no harm? Sorry but their silence IS causing great harm.

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        • You are right…doctors got scared when THEY locked up a few of them and took a few more of them’s licenses. So, the docs went from drug dealers to drug cops, basically. Assuming everyone who takes drugs is going to abuse them…or get addicted…etc. How do I know? Because I’ve had the drug war on me for about 40 years already and suffered many horrific abuses by cops and so-called providers (of misery). When I had my knee separated in ’99, THEY followed me into the doctor’s office. THEY caused a lot of things in my life and NEVER anything GOOD! We need an OVERHAUL of healthcare, the SYSTEM, and need to educate the public as a whole…where the propaganda is concerned. OR WE’RE ALL SCREWED! I make one mistake, because I can’t see a doctor when I need to and get cut off. Meanwhile, everyone around me gets a free pass to screw over their fellow man or woman!

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        • Your absolutely correct! My body is riddled with pain. Every inch of it. Why doesn’t the DEA take a look at my case!!! Then they’d see how very very wrong and full of themselves they are. I hope they ALL suffer in horrible horrible pain forever. We don’t need this stress. It just exacerbates our pain!!!

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        • Drs are scared of losing their license they can’t even treat their patients as they are threatened by DEA an pharmacist like CVS Walgreens now who think they are Drs. Limiting a 7 day script for pain medication!! Why Dt ppl Stop giving these pharmacies business?? Boycott all who wants to make our lives not worth living as they do not care about anyone bt their own power ! Boycott run them out of business would be a start as they are pressuring Drs just as much as DEA!! We can’t give up an stay in bed an die ! We can’t let them win !!! That’s what they want to weaken us even more!

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        • Finally I find a person with the exact words I have been saying since 2014 thru today, it’s just I find myself ranting over and over not getting anywhere. My dr has informed me over the past few years a small amount of what’s really going on. It is a nightmare, my pain is so miserable to endure 24-7 when before I was on such a pathetically low amount of pain Meds for over 10 years same dose daily with no sides, able to work, play and enjoy life, then suddenly I’m told some people got high on these pills, hah what a joke, so I’m cut cold turkey no refills, am sent to several pain clinics, one prescription here or there $500 a pop, told my pain treatment was above his pay grade, by the last quack so guess where I go next? No brainer, keep these idiots out of our private dr patient privaledge used to be now I have to see some CDC,DEA,FDA, GOVERNMENT hack to approve what my trained physician knows how to treat me. I don’t see M.D. on their credentials. One last ? When know all’s get in car wrecks, knee surgery, gun shots whatever that will and is going to happen (can we take a wild guess and say do you need anything for the pain) what will they do, no Tylenol will be fine……….

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      • Interesting how we’ve written several articles that are similar. I remember when you were asking me questions about this fight so many of us are in. I helped direct you to many places where you could do your research and was happy to do so, then your articles were sounding like mine, just like one that just came out. Again, similar to the one I just published in the National Pain Report. You take on a lot of authority, Richard, and do not give credit to anyone but yourself.

        http://nationalpainreport.com/my-response-to-the-cdcs-campaign-to-spend-4-8-million-to-raise-awareness-about-prescription-opioid-abuse-8832626.html

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      • Ive been on pain management for many years. Ive had 2 cervical fusions, lower back surgery , knee scope, rotator cuff surgery, ans both hands carpal tunnel surgery. The doctors say i will need more neck and back surgery. And yet the government seems to think that my pain level is or should be no more than a guy who stubbed his toe. I think the government should stay out of it unless they can have a day in my shoes. And there are a lot worse off people than me.

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      • I was severely injured by a semi truck rear ended my SUV. It’s took 2 years for a dr to dx correctly and send me to a Neurosurgeon. I have a TBI, CRPS, Piriformis syndrome and need a cervical fusion and spinal surgery. The Neurosurgeon knows that I have intractable muscle spasms and chronic pain and is doing the surgeries ASAP The PM dr lowered my dose and is lowering it more. I can’t even function to take care of myself. If I wasn’t having the surgeries soon I would commit suicide. I could never live like this. Spinal pain and CRPS is worse than cancer pain but people with it have to live on with no life. I pray that who made these regulations get pain for a few months. It will take every bit of my will to make it through surgeries. Plus surgeries do not heal as well with unmanaged pain. I can see why people turn to street drugs or suicide

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    • No. Dr Lawhern is speaking out against groups like PROP & CDC. He’s well known on NPR and a real advocate for Pain Patients. I thank God He’s a voice for Patients like me.

      He’s the go/to guy for Pain Patients and we need more like him,

      He’s well published & you can read his work, he won’t bad mouth MM

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  1. I know that this is a complex issue. We even have some people on this forum who to me seem both self aware and informed, who insist that a few psych meds really do help them. Though these people are a minority, I do take them seriously.

    I have never had to endure chronic pain. To me, being placed on maintenance drugs amounts to a death sentence. But sometimes it is unavoidable.

    I don’t really know anything about these opioids, except that there is a class action law suit.

    But I also know that in WV they are saying that they have huge numbers of people addicted to prescription med, and that they are callng the people, ‘pillbillies”. So I am convinced that there is a problem.

    For myself, I am opposed to psychotherapy and recovery, because they are simply ways of shifting blame to the victims of childhood familial abuses. I am for restorative justice and holding parents accountable.

    But I am not claiming that this drug issue is simple. Should we just de-criminalize all of this stuff together? I am confused.

    I think yoga and meditation should be used as much as possible, instead of drugs.

    And bcharris, while I don’t think criminalization of cannabis works, I still do not approve of its use, even for chronic pain.

    Nomadic

    send PM’s, connect, organize, act, Join My Forum
    http://freedomtoexpress.freeforums.org/survivors-of-the-middle-class-family-t243.html

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  2. Just Google Walgreen’s Sucks. Wait, I am going to find that thread myself with the stories of pain patients treated like criminals.

    Read 195 patient comments http://commonhealth.wbur.org/2013/08/walgreens-painkiller-crackdown.

    I gave up motorcycles but if I get hurt somehow I don’t need a DEA agent sitting in with me and my doctor, just a little informed consent and that’s it.

    What I think is really going on with the opiate ‘epidemic’ is that the prison industrial complex has come under fire lately and they need a ‘crisis’ to ‘save’ us from to make revenue for themselves and the failed drug war has always delivered that revenue.

    Check out the meme I made about drug courts practicing medicine without a license http://s32.postimg.org/6qc7hn8p1/Clinton_drug_court.png

    First anxiety or depression leads to addiction, you get caught, then the system screws your life and finances giving you more anxiety and depression hoping you say ‘screw it’ and use for relief so they can screw your life and finances more giving you more anxiety or depression hoping you say ‘screw it’ and use so they can catch you again and make lots of cash to buy those fancy cars you see in the parking lots of those court buildings they drive home to fancy houses.

    Drug war explained.

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    • It was so bad what they did to my friend, she was drinking cough medicine to get to sleep and the cheap drug tests those soulless psychos in those courts use showed positive for PCP. THIS woman was not using PCP or was anyone else in this town or city but instead of admitting to the mistake like honorable people they did some sneaky crap to get an admission of “guilt” and collect court fees get money. Three weeks my friend had panic attacks over the coming court date.

      The world would be a better place if all those court psychos got sick and dropped dead tomorrow.

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    • There is also speculation in a few corners that Big Pharma may be encouraging the rejection of opioid medications that are no longer under patent, as a step toward blitzing the media with yet another wave of re-purposed or newly developed pain drugs that will be advertised as non-addictive (whether or not they are in actuality). The evidence is obvious and widespread that these companies have committed outright fraud in the past with anti-psychotic meds that they knew were ineffective or dangerous. It’s not beyond belief that they would do so again.

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      • Yikes ! But that makes perfect sense.

        What I see going on in the addictions field, drug reps showing up pushing these Vivitrol injections full force not just for opiate enthusiasts, now people are being told it helps with anxiety in alcoholics… It blocks the high (from everything in life)… and here are some psychiatric drugs that we are going to give you despite our knowledge that you will very likely drink/use on top of them in the near future based on known relapse rates.

        Its just so bad and me in the addictions field and a survivor I should be doing angry posts about these “evil” pain medications. Nope , I know better.

        I was actually dependent on benzodiazepines/alcohol but the worst part was the “non addictive” SSRIs and mood pills ‘for anxiety’ that came after.

        “Suboxone” Reckitt had filed a petition with the FDA last year to block generic tablets from coming on the market – claiming they were a safety risk to children. Reckitt also said it would stop selling the tablets in the United States, replacing them with a film version of Soboxone. Reckitt’s patent on Suboxone tablets expired three years ago, while its patent on Suboxone film doesn’t expire until 2022. Planned obsolescence. Its just such a crooked mess.

        And of course the courts and pharma teamed up to extra screw everyone, “Florida Partners in Crisis” http://flpic.org/ Right on the front page Sponsors Eli LIlly Novartis … Court ordered “treatment” Suboxone Vivitrol injections Zyprexa … drug testing… psych lockups… lets get rich !

        Crooked crooked crooked mess.

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      • I would not be surprised about the repurposing- given the innovation gap and problems- especially costs involved in developing nde’s. In fact I have seen some research on using anti-psychotics for chronic pain.
        The capitalistic/modernistic/scientistic model of pain care is assumed to be right as the natural order of things by its purveyors. Im a Christion- and my religion tells me there are many false prophets and to “test everything” So Im not stuck on buying into the modern way of pain care and its frequent use of the big lie technique to market its products. I use critical theory to see what is not there so to speak and the modern way of pain care is lacking in many ways. Its anti-democratic and divisive and social darwinism writ large. I believe in a more classical approach- more inclusive and syncretistic approach to pain care. But such an approach i s a great threat to the egos of the powers that be that dont believe all elements of society should work together to improve pain care.

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  3. I am a chronic pain patient. I have had neck and back surgery and suffer from degenerative disc disease. I also suffer from some kind of osteoarthritis that has attacked just about all of my joints. I need hip replacements, knee and ankle surgery. I am only 47 so having these joint replacements now would not last me to the end of my life. So I have been told to wait until I am at least 60. I have already been through pain management doctors who love the crack down on pain meds. They don’t make much on writing scripts but they make thousands with nerve blocks and steroid injections. So I only treat with my GP. Just recently The State Medical Board told my GP to cut everyone’s pain medication. I have been taking Tramadol for 7 years at one 50 mg. pill every 6 hours. It helps and is worth taking for pain, but I got cut by 25%. So now it is every 8 hours. The drug wears off in 4 or 5 hours. So my pain goes off the charts when it wears off. I think all legit pain patients should get together and sue the organizations who are making our lives more difficult. I am disabled and on Medicare. I can still go get my joint replacements done now that will cost the tax payer 100’s of thousands and might very well kill me or leave me worse off than I am now. But a $5 generic prescription of Tramadol is too deadly, however I will get Oxycotin and later Lortab in the weeks after each of my joint replacements. So I can still get pain medication if I let a surgeon cut on me every few months. Thank God I am not an addict because I won’t be having all these surgeries just to get relief from my chronic pain but many in this country are. I bet the surgeries kill more people than the medications do.On top of that this is bankrupting our country and makes heath care too costly for Us all which in turn makes all of Us less healthy.

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    • I think all legit pain patients should get together and sue the organizations who are making our lives more difficult.

      I am into this cause if anything just to bring trouble to the omnipotent moral busybodies behind all this.

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      • My old pain management doctor did more injections in one year, than I had over the previous 12 years combined. My pain contract stated that, “the patient must follow recommended advice and procedures….Otherwise, your physician has the right to discontinue treatment, including medications. At which time, the patient will be put on a rapid taper of their medications.”

        It’s essentially blackmail. “Do this procedure or injection or I won’t give you your medication.” I found out after he did radiofrequency ablation on me, that I wasn’t even a candidate. Most insurance companies require a 50% or more reduction in pain from 2 sets of facet joint injections. I said, “I don’t know. Maybe 10%, but I could be imagining that the injections helped a little bit”–those were my exact words. My PM doctor said, “That’s great. We’ll schedule you for RFA.” He never explained the procedure. I wasn’t even sedated. Because sedating a patient, would slow down his assembly line of patients getting injections and procedures done. I ended up being in more pain (which is normal) after having RFA, but the increased pain never went away. I also developed other issues immediately after. He should have never done the procedure on me…he just wanted the money. And, since Medicare doesn’t require a prior-auth, it makes it easy for them to get away with it.

        Who is telling the doctors that medications need to be decreased? No where in the CDC guidelines does it state to reduce a patient’s medication. I now have a new pain management doctor. Whenever I state that my medication isn’t working, he tells me that I’m on the “maximum” dose. I was a pharmacy tech, before having to go on SSD..I know I’m not on the maximum. No where near it. I don’t understand why when a patient is on a dose of medication that is working, why a doctor is reducing the dose. (Especially with tramadol?)

        I run a chronic pain/pain advocacy support group on Facebook. I can’t tell you how many members have had their medications reduced or have been cut off of their medications completely. Chronic pain patients do need to get together and advocate. There are so many people in chronic pain in the US…and more of us need to stand up for our rights. This problem is only going to get worse.

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        • Your posting was so unbelievably similar to my own recent experience that I felt compelled to reply. It is now 2020 and I find myself in this exact situation so apparently nothing has improved. My doctor and PA have now told me that they are going to take me off of my pain medication altogether. They are trying to force me to have procedures such as epidurals and radio frequency ablation, which I have already tried, that were ineffective for me. I felt like the word that came to my mind was “blackmail” and so I could relate when you used that exact word. My PA told me that the ablation can be repeated every 6 months. How laughable! A procedure that did me no good the first time (and costs an arm and a leg) is something they would have me repeat, and often. How ethical is that? I was so mad I could spit, and I filed a complaint with the Iowa Board of Medical Examiners for whatever that’s worth. Isn’t this insurance fraud as well as unethical?

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    • I too am a legitimate chronic intractable pain patient. I have MULTIPLE DEBILITATING INCURABLE CONDITIONS that cause me severe 24/7 pain UNLESS I am taking the pain medication that gets me thru the day. I just love those who no nothing ab ut chronic pain, but base their opinions on say coworkers who died from opiods, or by getting their propaganda BS info from corrupt organizations like the DEA, CDC, FDA and the government. First off THERE IS NO OPIOD EPIDEMIC! The CDC used FALSE DATA, and created FALSIFIED STATISTICS made to fit the governments addiction driven agenda. The CDC admits to MISCLASSIFYING MANY MANY heroin and fentanyl deaths as a prescription pill death. Suicides from legitimate chronic pain patients who took their lives due to inadequate pain relief were also listed as a prescription pill death. The CDC doubled one persons death, multile times, They did everything they could with opiod zealots leading the way, such as Dr Kolodny and Ballantyne, who lost lids to OD’s, Kolodny is the owner of the phoenix house detox ctrs and his sidekick Ballantyne, the director. Both of them feel those of us in debilitating pain should just suck it up cuz “it can’t be that bad”. They demonize our LIFE SAVING MEDICATIONS, stigmatize chronic pain pts as addicts, pill seeking junkies and we are treated like dam criminals.

      I was on the SAME STABLE DOSE for eight years with success, Never failed a piss test, have years and years of medical records that document my DEBILITATING CONDITIONS, such as ; CRPS/RSD AKA THE SUICIDE DISEASE, three herniated discs, fibromyalgia, DDD, cervical disc degeneration, osteoarthritis, severe stenosis, neuropathy, radiculopathy, sciatica, pancreatitis, cholecystitis, migraines, two FAILED spinal fusions that left me with severe nerve damage. I have tried the alternative therapies MY BODY, NOT ANYONE ELSE’s and surely not someone who knows nothing about what severe non sto pain is like, MY BODY could take and wallet could not afford including: YEARS of physical therapy, massage, chiro, accupuncture, TENS, epidurals that left me worse off, discographies, facet injections, nerve blocks, nerves burned, steriods, trigger point injections, OTC AND NSAIDS that tore my stomach and liver up and two FAILED spinal fusions, MY BODY has had enough of being poked and injected, twisted and manipulated and surely will never be cut open again. I have tried God only knows how many different muscle relaxers and many different types of pain relievers. Many of those alternative therapies left me worse off, many I got bad side effects from. When I wasn’t my surgeon at the time, walking success story he shived me off to pain management. The doctor I was with at the time was so compassionate and really care for those of us who are in severe pain. We finally found what meds worked for me and I was finally given some QUALITY OF LIFE. Then he left the practice, about four years ago and trying to find a new pain dr to take over was like finding a needle in a haystack. Even back then the stigma on the back of a chonic pain patient was horrible. I was NEGLECTED, MISTREATED, DEGRADED AND DISCRIMINATED AGAINST. I couldn’t find anyone in NJ and was so disgusted in our medical community and still am. I finally. found a dr thru my pharmacist. I’ve been with him for four years, come to find out he is my pharmacist husband. At first he was very compassionate and believed in me, no reason not to. I was on the same stable dose all these years until last March, then my world as I knew it came crashing down. My dr came in and tells me he has to lower everyones meds due to pressure from the DEA. I have been in a living hell ever since. My dr has played medication roulette, writing my scripts each month for all kinds of shit meds, I have a collection of pill bottles locked away, it sickens me to even look at them, as Ive tried all these meds years ago and did nothing for me but mostly make me sick. In December I pleaded with my dr to put me back on the mgs that worked for me. Oh he also took away the only muscle relaxer that helped me, told me it couldnt be combined with the pain meds, LIAR. My dr then tried to make me feel like I am something I AM NOT, Told me I was bargaining just to get pills and I got very uoset and told him DO NOT make me feel that way when you know dam well I am a legit patient. He agreed to putting the mgs back to what worked BUT only for three times a day, well I am NOT making ut every eight hours, I do not sleep but two hours at night. My health has greatly deteriorated since he lowered my meds and took some away. He tried me on gabapentin and lyrica, horrible drugs for me. Gave me a brain zapping sensation and did not agree with me. He cut my exteneded release to one a day which does nothing, surely dont last 24 hrs

      All I can do is shake my head at those who feel opiods harm you if on them for years. and those who say theres no proof what they do long term, step in the shoes of a chronic pain pt..What all these corrupt organizations are doing is INHUMANE AND BARBARIC. The most important people are left out-CHRONIC INTRACTABLE PAIN PATIENTS, OUR VOICES ARE NOT HEARD. It’s all about the $$$, and those of you who think there is a opiod epidemic, please educate yourself, for a start go to the painnewsnetwork.org page, search CDC and you will find many articles based on facts and truths, instead of listening to the mass hysteria bs the media reports, all one sided. In fact, the CDC is being sued by the WLF, for violating FACA laws, the way they went about the guidelines, what a nightmare.

      Taking opiods off the shelves and DENYING LEGITIMATE pain pts our HUMAN RIGHT to treat our pain with DIGNITY AND RESPECT, and with what tools work for each individual is not going to stop the addicts from getting their fix. I am so disgusted and am sick and tired of paying the very high price with my health and overall well being because of those who CHOOSE TO ABUSE! Chronic pain pts may become DEPENDENT on opiods for a QUALITY OF LIFE, BUT WE ARE NOT ADDICTED! I now suffer from anxiety and depression, I can no longer do the simple things like a daily shower, vaccum the rugs, cook a meal for my kid, walk my dog, sit at my sons basketball games, attend family gatherings and so on. When I was on the correct stable dose I was able to live life. Most days now I beg God to take me and ened my suffering, For all of you who pass judgement onto those of us who depend on opiods, allow a chonic pain pt to beat your back with a baseball bat everydya, as thats how mine feels and looks as well. Half of my back is bruised, discolored, and extremely painful. Its as if my spine is being crushed by a steam truck roller, my hips feel like they are being dragged on the concrete, my knees feel like they are being hit with a hammer, I get electric shocks in my right keg into my foot, puercing, stabbing, burning, shooting pains down to the ankle where my foot feels like its in a bearclaw trap, my right foot on pins and needles since the day I woke from surgery in 2008. Untreated chronic intractable pain kills. I choose QUALITY OF LIFE and would much rather live life on opiods for the rest of my life then stay bedridden daily. I am physically, emotionally and mentally exhausted. Remember, chronic pain does not discriminate and can affect anyone. What makes me even more furious is the lack of care one gets when going to an ER. Ive read horror stories and even witnessed my brother who has been thru hell since December, had six back surgeries since then, contacted MRSA from a botched up surgery and he went to the ER after the surgery in December,mhe was in severe pain,and the surgeon put him on the wrong pain meds, didnt bother to check his records to see what he previously was on, The ER did NOTHING for him, oh they gave him tylnol how can I forget that, My brother sat there for six hours in severe pain,,They told him they can’t give him anything u til the surgeon called in b/c the surgeon wasn’t affiliated with the hosp. The surgeon never called and my brother was left to suffer in agony, Ive read many stories from others who went to the ER in severe pain, only to be treated like an addict, pill seeking junkie, degraded, their pain went untreated, told theres nothing wrong, they were not offered anything for pain, and several of these pts died right in the parking lot due to the fact that the er drs couldn’t do their job correctly.

      What’s even more infuriating is that addicts, people who CHOOSE TO BREAK THE LAW, CHOOSE TO ABUSE AND GET HIGH, are being put front and center, offered all kinds of compassionate treatment, are given many chances to screw up and welcomed back, hell the government even passes out ckean needles and gives addicts a place to shoot their shit up with. Be a chronic intractable pain sufferer , a law abiding chronically ill person from debilitating incurable diseases, someone who follows all the rules, and we get NEGKECTED, ABUSED, MISTREATED, DEGRADED AND DISCRIMINATED AGAINST. Drs are closing their doors and turning their backs on us, We are treated like dam criminals with having to do drug tests monthly, surprise pill counts, its like your checking in with a probation officer and not a caring physician. The DEA continues with their failed war on drugs, they stand alongside the cartel,wash my hand ill wash yours, heroin is out of control and yet that does not come from our drs. If the dam government was so concerned about saving lives then they shoukd target alcohol and tobacco whise death rates FAR EXCEED THE FALSIFIED IVERDOSE DEATHRATE. But noo thats the accepted drug, Just imagine the outrage if people could no longer have their wine at night, no more getting drunk, etc..or if the government restricted people from smoking, We treat animals better in this country, if I were to allow my dog to suffer in pain I’d be arrested on animal cruelty charges, why is it acceptable to torture human beings!?!? I am at war with my body and the severe pain is winning, My kids are suffering because of me.They see their mom giving up, see me crying in severe pain, hell i cant even drive to my onky daughters house for visits anymore.

      Mr. Lawhern, thank you for this spot on article! We need to fight for our human rights to pain medications. As the UN has stated the US is in a human rights crisis. DENYING legitimate pain pts relief from the torture that is raging thru our bodies is GENOCIDE! We are left with two options, turn to the streets for relief getting God knows what, or SUICIDE! And if the CDC and whoever else is labeling a,l these suicides as overdoses boy would the numbers be much much different. Suicide should never be an option, and yet its what the government, DEA, CDC, FDA are pushing legitimate pain pts to. We are being forced to exist in severe pain, forced to endure even more pain and suffering, We need a class action lawsuit against these murderers, who have the blood of many legitimate pain pts on their hands. Our rights as citizens of this country are being violated bigtime.

      Thank you Mr. Lawhern for all you are doing and for this spot on article! I am willing to help anyway I can. Ive been writing to senators, the president, the DEA ( i did get a letter back frim them, stating they are not targeting drs and pain pts, smdh, nothing but lies) the CDC, FDA, multiplemedia outlets. When A person has years and years of medical records, mri’s, xrays, scans tests, have debilitating diagnosis, and have tried what their body coukd take there shoukd be absolutely NO reason to be denied medication to relieve the pain. We DO NOT get high or any euphoria, we get pain relief!

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      • To advocate for compassionate care for people who have chronic pain issues and have been on opiate drugs for years should not mean that people at the same time need to deny that there is a major problem with excessive opiate prescribing in this country. These are dual problems that require complex solutions.

        Just as with benzodiazepines, people who have become dependent on opiate drugs for whatever reason (and especially for chronic pain) SHOULD NOT be punished or ripped off their drugs. This needs to be a safely negotiated dialogue between doctor and patient.

        The medical establishment must take responsibility for its decades of prolific prescribing of this category of drug. Neither THEY nor WE should blame the victims of these practices. Organized medicine must develop a safe and deliberate way to resolve this crisis and it may take many years (or decades) of concentrated efforts. The first step for any type of restrictive prescribing may have to focus on people who have never been prescribed this category of drug for any extensive period of time.

        And another matter for investigation, perhaps the high rates of suicide among chronic pain victims could be related to the negative side effects of antidepressant drugs that also seemed to be highly prescribed to these patients.

        Richard

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        • I don’t think antidepressants are to blame for the suicides. There’s a common event that has taken place–the doctor has either reduced the patient’s pain medication or took them off of their medication completely. Then, the patient commits suicide, when they can no longer take the pain. You can’t blame the antidepressants, if the person was mentally stable, prior to the reduction or stopping their medications. A lot of patients are practically forced to go on antidepressants. Doctors tell patients that it will help their pain. (There is evidence cymbalta and tricyclic antidepressants do offer relief in some patients). If a patient does not at least try the medication, the doctor can dismiss them as a patient.

          The problem is recreational drug use and heroin. The problem is not with chronic pain patients. If a chronic pain patient was an addict, it would be discovered very quickly. With drug screens, pill counts, and the national drug database…along with the behavior an addict displays, it would be really hard for an addict to go unnoticed.

          Is there a problem with addiction? Yes. But it’s being handled wrong and innocent people are being punished.

          As is, there aren’t enough treatment centers. Addicts, who ask for help are put on a waiting list. When it’s extremely important to get an addict into treatment immediately. Treatment centers are underfunded. Centers don’t have medication for proper detox and management of withdrawal symptoms. This leads to patients leaving treatment. (Some go straight back to drugs because they’re so uncomfortable. Too many people have died because they’ve overestimated the dose they could use.)

          Then there are the treatment facilities that are $30,000 or more a month, that only the wealthy can afford.

          After treatment care is just as important and resources are lacking. How do we expect someone just out of treatment, to drive hours every day to a methadone clinic? Most don’t have access to a car, so they’re relying on public transportation. Getting their maintenance medication becomes a whole day event. How do we expect them to get jobs? It almost makes it easier to begin shooting up again or using their drug of choice.

          The focus needs to be on addiction and treatment. Allowing every addict access to the same treatment the wealthy get. Also, providing sober living facilities and treatment to get back to living a normal life–not a day spent on a bus getting their daily dose of methadone.

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          • Richard, Pres. Obama just released tens of thousands of dollars to devote to addiction clinics. I don’t remember the exact number, but 80,000 comes to mind. Maybe it was millions, but the government is very interested in funding addiction clinics and if you read their websites, you will see.

            Addicts need their fair treatment and I have always believed that. But so do patients, no matter what the disease.

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  4. Richard

    There are so many problems with this blog I don’t know where to begin.

    There is little to no evidence that opiate drug use appropriately manages chronic pain issues in the long term: in fact the exact opposite is true. Functionality assessments for long term opiate users shows a disabling decline on many levels similar to other categories of psychiatric drugs. Some experts believe that long term use of opiates can cause a GREATER sensitivity to pain over the long haul. Readers should google “opioid induced hyperalgesia” for a description of one aspect of this phenomena. This process is very similar to the compensatory push back reaction the brain has to perturbing serotonin and dopamine systems in brain neurochemistry.

    Are there some people who may benefit from prolonged use of opiates for pain management? I am sure there is a subset of these people, as there may be with benzodiazepine use, for a certain small number of medical conditions. Are you going to argue that some of us are also promoting hysteria around benzos too, and that this will deny “millions of anxiety suffers” their needed “medicines”?

    Of course certain pain suffers (especially those with cancer etc.) should not be denied these drugs or stigmatized. But these people are a minority, and up until now opiate drugs have been more than readily available in thousands of profitable pain clinics and with doctors who have a guaranteed number of returning patients on a regular basis. Even with all the recent publicity there is little evidence prescriptions have declined

    Evidence indicates that the rise in opiate prescriptions has fueled the opiate epidemic. 60 percent of all new heroin/opiate addicts came to this condition via their access to opiate drug prescriptions. I don’t care if it was their own prescription or pills stolen from the family bathroom vanity; it all came with the same rise in opiate prescriptions starting in the mid 1990’s.

    Why is it that you made no mention of the “Fifth Vital Sign Campaign” that was launched in the mid 1990’s when the drug oxycontin was first put on the market. This drug was marketed as LESS addictive than other opioid drugs and subsequently made billions for Purdue Pharmaceuticals. As is usual with drug marketing it turned out to be MORE addictive and no more effective for chronic pain than a host of other opiate drugs on the market. There are a number of major law suits that have been filed against Purdue and they are being forced to reveal the contents of previously hidden internal documents that covered up the dangers and false marketing related to oxycontin.

    They (Purdue) launched a heavily funded campaign (Fifth Vital Sign) to require all doctors to check pain levels for all patients receiving medical care. They encouraged an atmosphere where doctors could be punished if they failed to prescribe opiates to patients who described a certain level of pain. It was this campaign that led to a proliferation of very profitable pain clinics and “pill mills” all over the country. In Florida they were located in multiple strip malls in practically every city throughout the state. I had a former client who told me he flew to Florida on a monthly basis to pick up a cache’ of opiate prescriptions that he would profitably sell when he flew back to Massachusetts.

    There are multiple sources of evidence that shows the connection between the rapid rise in opiate prescriptions starting in the mid 1990’s and the expansion of the opiate overdose epidemic sweeping the country. And BTW, this also parallels the rise in benzodiazepine prescriptions that took off after Psychiatry (starting in the late 1980’s) successfully marketed these drugs for a host of anxiety “disorders.” Hence we now have the “perfect storm” of dependency and addiction where benzos have become the decisive added component in a deadly cocktail of drugs.

    You said: ” There is real and valid concern for the avoidable death and destruction which are wrought by illicit opioids in the US. But the contribution of prescription opioids in pain patients is tiny, and even the number of deaths is over-blown.”

    I’d say that 4 deaths a day in Massachusetts alone is not overblown. And this has to be well over 15 a day throughout the U.S. How many deaths would it take to get your attention or before you thought there might be a problem?

    I could go on and on about the misdirected nature of the content of this blog. The only statement in this entire blog that I agree with is the following quote you included: ” “If we want to reduce opioid addiction, we have to target the real risk factors for it: child trauma, mental illness and unemployment.”

    As with all the extreme psychological distress discussed here at MIA, in the long term we must advocate for major systemic changes in our society that challenge the inequities in a class based profit system. However, in the short term we can’t ignore the more overt examples of a runaway medical model doing the profitable bidding of an omnipotent pharmaceutical industry.

    If you are trying to advocate for people with chronic pain issues you have done them a great disservice with these sort of arguments. And most importantly you have denied the existence of a major epidemic of opiate drug prescribing of epic proportions that is causing great harm to millions of people.

    Richard

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    • Not everyone is convinced that “opioid induced hyperalgesia” exists, but even if it does, it’s rare.

      “Are you going to argue that some of us are also promoting hysteria around benzos too, and that this will deny ‘millions of anxiety suffers’ their needed ‘medicines’?”

      Actually, yes, I am. While opioids get major media coverage, there are plenty of stories on the internet about doctors refusing to prescribe (and pharmacists refusing to fill) both anti-anxiety and ADHD medications. Along with the fact that if pain patients are taking opioids, they are often refused medication to treat anxiety, a common comorbid condition.

      “Of course certain pain suffers (especially those with cancer etc.) should not be denied these drugs or stigmatized. But these people are a minority, and up until now opiate drugs have been more than readily available in thousands of profitable pain clinics and with doctors who have a guaranteed number of returning patients on a regular basis. Even with all the recent publicity there is little evidence prescriptions have declined.”

      Methinks you don’t live in the real world, or else you get all of your information from the media, instead of directly from pain patients. Every pain patient knows that their stories are not being told in the media. In fact, both cancer and terminal patients are being denied opioids. And if you can show me proof that cancer pain is different than any other type of chronic pain, then maybe you’d have a minute argument for discriminating against chronic pain patients and their therapeutic use of opioids.

      What has been overblown is the description of the opioid war as an “epidemic” of drug addiction. Tell me, if more people die from suicide than from opioid-related causes, which is the epidemic? If tens of millions of people suffer from chronic pain and only thousands suffer from addiction, why not use perspective and call this “epidemic” what it is — just an extension of the failed drug war?

      “If you are trying to advocate for people with chronic pain issues you have done them a great disservice with these sort of arguments.”

      I’m curious, do you suffer from intractable pain, Richard? Because as a 30-year intractable pain survivor, I think you don’t know what you’re talking about. Your arguments are old and have no depth. I wonder, is your ignorance purposeful or unintentional? I’m also wondering, do you usually communicate in such a flamboyant fashion? Omnipotent, major epidemic, epic proportions? When language doesn’t match the facts, I’d call that overblown.

      The great harm being caused to millions of people is the drug war. Even those who suffer from addiction will benefit from the end of the worst crime perpetrated against the American people in this nation’s 240-year history.

      Johnna

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      • Thanks Johnna. Methinks also that he has never suffered chronic pain himself. Real patients are not statistics. Real patients are not “studies”. We are individuals each with our own stories to tell. I suffer chronic migraines, and I have since my teens. I suffered for so many years and even considered applying for disability in my 30s because my chronic head and neck pain was hindering my ability to do my job as a registered nurse (I also did nursing school with this chronic pain, was a wife, maintained a home, and raised 3 sons). I finally found relief with a pain specialist who treated my neck and shoulders with Botox, and put me on a low dose of Opana. I have maintained that low dose for eight years. I have never needed to increase my dose. My chronic pain has gotten better, not worse, and I’ve been able to LIVE again. I am not a statistic! Please don’t generalize chronic pain sufferers.

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        • Thanks for your response, Jana. And Happy Nurses Appreciation Week, late but still important. 🙂

          Millions of pain patients have stories of how opioids have helped them carry on with their lives despite constant pain. I took pills for 10 years, and during that time, my pain levels were fairly stable (although I’m not sure I appreciated it at the time). After a forced cold-turkey detox, I switched a bucket of pills for medical cannabis. I won’t go into how difficult it is to find and afford quality medical cannabis, but I will say that my pain levels are no longer stable. And I now have pain storms that I didn’t experience when I was taking pills.

          Pain patients don’t take medications to get better — medication is a treatment not a cure — they take them to survive. This is about quality of life, and I’m happy to hear that you’ve found what you need to LIVE again. I know how much courage and strength that takes, on a daily basis. Good for you. 🙂

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      • While I have not yet developed a “position” on this and, since I am not a chronic pain-sufferer, I don’t really have a right to such, nonetheless:

        “Are you going to argue that some of us are also promoting hysteria around benzos too, and that this will deny ‘millions of anxiety suffers’ their needed ‘medicines’?”

        Actually, yes, I am.

        You have just discredited yourself with this interchange to point where I would be compelled to take anything else you might have to say with a grain of salt.

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        • I don’t understand the problem you have with this exchange, but you can believe what I say or not, your choice. After all, 30 years of living with constant pain doesn’t make me a doctor, so why should you believe me?

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          • Being a doctor would not enhance your credibility if you’re trying to minimize the destructiveness of benzos, it would be business as usual. No one is trying to deny your subjective experience, but there are vast websites dedicated to helping people get off of benzos, which to them is just as life and death a situation as your own.

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        • You’re assuming that I’m trying to minimize the negative side effects of taking benzos, which I’m not. But there are negative side effects with almost every drug, and some users will suffer effects that can be described as destructive. Just like pain patients who feel the need to denigrate those who suffer from addiction, patients who take benzos without any problems also tend to look down on those who experience destructive side effects when their own medications are being denied, placing blame where it doesn’t belong.

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    • Mr. Lewis, (to avoid confusion on which Richard is commenting), it is possible that you and I see or perceive very different worlds and people. I’m not just “trying” to advocate for people with chronic pain issues. I’m actually doing so, and I do it every day for over 12,000 members of 15 Facebook groups focused in this area of shared concerns.

      As noted in the article above, there are an estimated 100 million chronic pain patients in the US alone. Among these people, a minority are prescribed opioid medications to manage their pain. Such prescriptions are almost always a last resort in chronic pain — even though they are routinely prescribed (and over-prescribed) for acute post-surgical pain.

      People with intractable pain conditions are put on opioids when conventional medical therapy and alternative medicine have failed them. Though some are helped by acupuncture or chiropractic or aroma therapy or cognitive behavior therapy (and others), none of these modalities is reliable for the majority, and none of them is an acceptable substitute for pain medication.

      There are indeed risks to be managed when opioids become a part of a long term pain management plan. Hyperalgesia is one of those risks. As the body builds up tolerance, people can also experience severe breakthrough pain, requiring that they be tapered off one opioid before being tried on another.

      But these factors being acknowledged, I still talk with many people who have successfully used opioids under medical supervision for many years and frequently at high dose levels. One of the complicating factors in this public discussion is that (as far as I’ve been able to determine), medical researchers have not even TRIED to assess the long term outcomes of opiate therapy. So when somebody says “There is little to no evidence that opiate drug use appropriately manages chronic pain issues in the long term” they are both correct and perhaps unintentionally disingenuous. We don’t know because nobody as tried to find out.

      I do not minimize the horrid reality of opioid overdose deaths in the US. But I must point out that the significant majority of people do not become opioid abusers as a consequence of being medically treated for chronic pain. And statistics on prescription overdoses quoted by some of the more self-interested agencies in public health or law enforcement are seriously suspect.

      As I referenced in the article, “Opioid Addiction is a Huge Problem, but Pain Prescriptions Are Not the Cause.” Likewise, we cannot hope to reduce the death and destruction wrought by opioids if we are addressing the wrong end of the elephant.

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      • Mr. Lawhern

        You have not responded directly to any of the major points I’ve made in prior comments.

        Moving on…in the above comment you said: “…there are an estimated 100 million chronic pain patients in the US alone. Among these people, a minority are prescribed opioid medications to manage their pain. Such prescriptions are almost always a last resort in chronic pain — even though they are routinely prescribed (and over-prescribed) for acute post-surgical pain.”

        “People with intractable pain conditions are put on opioids when conventional medical therapy and alternative medicine have failed them.”

        The above statement is simply not an accurate portrayal of the current reality in medical care. It is hard for me to believe anything you say when you make statements like this.

        Yes, I believe many doctors get nervous when patients have been on high levels of pain drugs and come in and report that they are no longer working ((or that they ran out of their pills or lost their prescription bottle, true or not) and they need a higher dose or a new prescription for another drug. I am sure all kinds of prejudices and liability alarms go off for these doctors and they become very distrustful of their patients and sometimes deny them more prescriptions.

        However, the reality is that most chronic pain patients are still getting opiate drugs, if in some cases, very reluctantly from their doctors. If this were not true then who the hell is getting the millions of opiate prescriptions written in this country every year that has risen exponentially over the past two decades.

        And for you to say …such prescriptions are almost always a last resort in chronic pain… ignores the reality that almost all people who report pain symptoms to a doctor have routinely been offered pain drugs over the years. I live in an area of Massachusetts where there is a very high per capita rate of heroin addiction and overdose fatalities. These drugs have been handed out like candy for years, and this STILL happens routinely in our area hospital ER’s despite all the recent publicity.

        For decades opiates have been the FIRST LINE of treatment for pain and ALTERNATIVES are only proposed when various other problems arise or nothing changes for the patient. This is the exact opposite of what you have stated.

        And just how many of these chronic pain cases were actually INITIATED or CAUSED by those first stages of treatment where pain drugs dominated (over a significant period of time) the patient’s initial treatment plan?

        After all, just like a benzo for a high degree of anxiety, opiate drugs are extremely effective (in the earlier stages) for acute pain, and “the path of least resistance” for any human being (including the doctor) is to want the quickest and most pragmatic solution to take way uncomfortable pain or anxiety. For some people this could be the start of a whole chain reaction of events that destines certain patients to a lifetime of failed medical treatment and a chronically disabled condition.

        We all should now be learning that once tolerance and other brain responses to the drug’s effect on neurochemistry take over a whole NEW set of potential problems can emerge for an unsuspecting patient. In the mean time many people become both physically AND psychologically dependent on these drugs and often become VERY impatient when other longer term (not so immediate pain reducing) alternatives are suggested. This is human nature for all of us. And this is especially true when people have acute memory pathways of the first stages of treatment when opiate drugs were very effective.

        I know that what I just stated does NOT apply to every patient, but to ignore or not explore all of these tender and sensitive issues is to not do justice to the enormity of these problems and the complexities of finding helpful solutions for those experiencing chronic pain.

        Richard

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        • Let me introduce you to reality, Mr. Lewis. After 30 years of constant pain and being treated like a drug addict and a criminal, I’ve had enough. I’ve been talking to an attorney who handles right-to-die cases and I’m hoping she will take me on as a client who is not terminal. But I’m not going to rely on the law and the government to give me rights which I should already have, including how to treat my pain or how to die. That would be short-sighted and stupid, and I haven’t survived for the last 30 torturous years by being either.

          I think the medical industry should expand palliative treatment to include a suicide clinic on every corner, just like drug stores and places to buy alcohol and cigarettes. Because the reality is that no one wants to be tortured by unrelieved pain, which is what you’re advocating for.

          But as pain patients have learned, we can’t rely on opinions, experts, doctors, or the government to help us. We’re all learning how to help ourselves. Unfortunately, many are choosing suicide as their last option for pain relief. And some are choosing to find their pain relief in the underground market and are poisoned as a result of this desperation.

          This is my reality, Mr. Lewis. I’m in so much unrelieved pain that life isn’t worth living. And do you think I’m the only one? This is what you’re advocating for, sir, nothing else.

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          • I’m not going to rely on the law and the government to give me rights which I should already have, including how to treat my pain or how to die.

            I agree with you wholeheartedly. I believe that each of us, if we are truly being honest with ourselves, has a Fates Worse Than Death List: those circumstances/situations we would rather die than life through, or life in the aftermath of. Think about it (something people often try hard to avoid doing)- have you ever read the classic Poe stories? Ever seen the film Open Water? or Boxing Helena? What exactly your list consists of, and why, depends on a lot of things. Mine is based on my own personal values, and what gives my life meaning. I learned long ago that I am, in many ways, essentially different from most people, and this definitely includes my beliefs and values regarding death. I do not belief anyone should ever be asked to suffer that which they find intolerable. Most especially if the person is suffering with no end in sight. And here’s the thing: NOBODY BUT YOU can assess what is tolerable, or for how long, or what circumstances you’d list as a fate worse than death. Because NOBODY BUT YOU experiences your life: your joys, your pain, your sources of meaning and belonging. Nobody can even begin to map that terrain but you. I know that I do not deserve to wither away institutionalized because my body, mind, or both, no longer support me living the life I choose. I will either die by the hand of fate before that time, or by my own hand when I’ve determined my life has reached that crossroads. I’ve stated this to those I love, and let them know that though I do have advance directives, my Prime Directive (to borrow from Star Trek) is: Do Not Call 911, because frankly a DNR is about as much protection as an Order of Protection. Both get routinely discarded. And now that 1 in 6 hospital beds is under the Catholic Bishops’ Directives, they state right in those that their religion trumps the patient’s. No CPR, No Blood, No Intubation, No Meds, just a whole lotta Leave Me Be, Let Me Go, and Do Not Interfere.

            I had the natural birth I chose, and did not get bullied into unnecessary interventions during that vulnerable time, by refusing the very first one: the IV the nurse wanted to place “just in case.” Um, no. I am not going to consent to something that makes it easier to disregard my right to informed consent. No nausea, no dehydration, so no IV.
            By the same token, no 911 means no opportunity for anyone to decide otherwise once I (or fate) have decided it’s my last day.

            I think we all should have the right to die when/how we choose, but I also think it’s shameful of policymakers to force people’s hands who’d much rather have access to whatever works to help them find relief enough that makes their life a Life Worth Living rather than a Fate Worse Than Death.

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          • Johnna: Thank you for raising this important aspect of the situation. I also completely agree (with LavenderSage’s comments as well) and would be one of the first in line for such a facility. We should most certainly have that right. It is a scary, lonely place to be – I think that is a big part of why I haven’t already tried to go. To have someone, a place, that would help usher us in (out, rather!) gracefully would truly be a godsend.

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        • LavenderSage: Thanks for letting me know that a DNR is usually ignored. I also fear the religious take-over of hospitals, but it’s not like there’s any help for pain patients at an emergency room or hospital anyway. I’ve been without a phone for years, so no one will be calling 911 from my home. And I’m guessing that as baby boomers age, more of them will agree with you and I about our right to die. May your life, however long it is, be filled with laughter, good food, and the people you care about. 🙂

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        • As one who was unnecessarily prescribed a “safe pain killer” / dangerous mind altering “dirty” opioid, after a “bad fix” on a broken bone, unknowingly by the wife of the “attending physician” at a “bad fix” on a broken bone of mine. I must agree, too many opioids are being unnecessarily, and with misinformed concent, prescribed by PCP’s to cover up easily recognized iatrogenesis.

          However, I do believe those who truly suffer from chronic pain should be given treatment that they’ve found helpful. We have a problem with unethical, greed inspired, and / or misinformed doctors in this world, who’ve been given way too much power. And absolute power corrupts absolutely. Doctors are not gods, and should not be given the power to behave as such, be it to force unneeded addictive drugs upon people, or to deny needed drugs upon people.

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        • Mr. Lewis, I can’t speak for all chronic pain patients. Neither can you. What I do know from talking for 20 years to chronic facial neuropathic pain patients, is that opioids are almost NEVER the treatment of first resort in this class of disorders. Treatments of choice — in order of physician offerings to patients with neuropathy of several types — are (1) anti-seizure meds like Tegretol and Trileptal used off-label for pain, (2) tri-cyclic antidepressant meds like Amitriptyline and Nortriptyline, which have a cross-over action in chronic neuropathy, and (3) combinations of drugs that may include muscle relaxants (flexeril, others), low-dose tranquilizers (Valium), anti-anxiety agents like Xanax, SSRIs, Steroids, Botox or Phenol nerve blocks, or NSAIDs (notably Naproxin Sodium). Over 70 combinations are sometimes offered in atypical forms of facial neuropathy. And for many patients, medication changes will be necessary over time, due to failure of combinations that once worked for them.

          I do now know with any precision the order of medications offered in chronic pain conditions such as failed back syndrome or psoriatric arthritis. But I DO know that thousands of chronic pain patients are being deserted by prosecution-shy doctors, and quite a number of pain managements docs are leaving practice. The docs have seen the actions of the DEA and heard the so-called “voluntary guidelines” which advise against prescribing more than 50 Morphine Equivalent Daily Dose levels. A particularly telling article on this issue is “DEA Inflicts Harm on Chronic Pain Patients [see “http://www.lynnwebstermd.com/dea-inflicts-harm-on-chronic-pain-patients/ ] Many of the over 600 comments on this article are written by doctors who have treated chronic pain for years and now feel that they can no longer do so.

          I personally know of one case where a patient was forced off high doses of opioids cold-turkey when their doctor discharged them without referral or management of withdrawal symptoms. The patient’s blood pressure went through the roof. He began projectile vomiting, fell in a shower and lay unconscious for two days after inhaling his own vomitus. He is now in a coma and not expected to wake up.

          It is cases like these that reveal just how wrong-headed and destructive the official suppression of opioids can be for pain patients who need them and have no other viable alternatives.

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    • I know thise of us when nhave been on opiods for years will definitely not agree with your first paragraph, No evidence? Why is that? Maybe because the anti opiod zealots, your so called panel of experts, who are nothing but addiction drs who know nothing about long term chronic debilitating pain. They have everything to gain by stripping legitimate pain pts of our lifesaving meds, Dr. Kolodny, the kingpin addiction specialist and his sidekick Ballantyne have lots of $$$ to put in the pockets of greedy politicans, they stand to gain a fortune as many of these legitimate pain pts will be forced into detox ctrs, put on suboxone, which Kolodny just raves how effective it is, ITS AN ADDICTIVE OPIOD , that takes the withdrawal away, they say it reliefes pain, but it did nothing for me. Please go soend some time with the suffering, Are you aware that senior citizens in nursing homes are being forced into agony!?!? Many have debilitating conditions and exist in severe pain, I read an article from a nurse in a nursing home and her outrage over the lack of care our senior citizens are receiving. They are suffering in pain and are offered one ibuprofen pill in the morning, She stated how these people are being abused and denied pain relief, Did you know our VETS are being hit real hard, the people who selflessly out their lives in harms way to pritect your freedom, who come home wounded with missing limbs are being DENIED pain relief, why do you think the suicide rates among our VETS have increased!? Do you know if you go in for major surgery, you will onky be given three days of pain meds for post op care!? Regardless of the surgery done, and many surgeries take up to a year to recover, but yeah lets just remove pain medication from a persons post op care. The DEA/government have no business coming between a dr and patient and yet our rights to privacy, HIPPA and ADA laws stomped on, our human right to medical treatment stomped on, I use to say Id never wish my pain on anyonem not even the man who abused me, but not anymore, I wouLD love for all these anti-opiod zealots, those of you who judge and label a pain pts because they are dependent on medication for a QUALITY OF LIFE, who think our pain can’t be that bad, just walk it off, its all in your head, and so on, My wish is for all of them to walk in my shoes for a week without anything for the pain, you would be putting a gun to your head.

      You state there is little evidence the amount of prescriptions has declined, lmao, really!?!? maybe you ought to join some chronic pain groups or here’s a petition for you to google. one of many, where there are over 27,000 and growing hartbreaking stories of legitimate pain pts who have had meds lowered to ineffective doses or abruptly stopped, leaving a person in agony. In fact, the number of scripts written for opiods has declined greatly. We can’t even find drs willing to treat our pain. Some pain pts are driving hours to a dr, or out if state.. These people are not addicts, they are suffering in severe pain, and are seeking relief from hell. Does a chronic pain pt experience withdrawal if taken off meds and not weaned off,mhell yes they do, not because they are addicted, because they are dependentm theres a big difference between the two, just like a diabetic is DEPENDENT on insulin, or a heart pt DEPENDENT on heart medication, what would happen to those ppl should their lifesaving meds be suddenly stopped!? I imagine their bodies would start shutting down, they will become very sick, and probably die. So should we be labeling these patients as addicts b/c their bodies are DEPENDENT on the meds they need for a QUALITY OF LIFE!?

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      • The petition to google is : petition2congress first do no harm..

        Also under moveon.org search cdc guidelines , thousands have signed that one as well, and there are plenty more going around. The DEA’s war on drugs is a war on legitimate chronic intractable pain patients and our drs.

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      • Pam

        Neither myself nor others in this particular dialogue have EVER called chronic pain patients opiate “addicts.” We can agree that for many this is an issue of physical dependency and not addiction.. In this respect the situation is very similar to how benzodiazepines have been prescribed in this country and the resulting dependency issues that are facing millions of people.

        Richard

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        • https://edsinfo.wordpress.com/2016/05/28/former-fda-commissioner-slanders-pain-patients/

          In a recent New York Times op/ed, Dr. David Kessler, the former head of the FDA, labelled chronic pain patients as addicts if they insist they need opioid painkillers like OxyContin to control debilitating pain.

          The piece was ostensibly about the failure of the medical profession to foresee the prescription opioid epidemic, but Mr. Kessler’s harshest words fell on patients.

          “Some patients will make heart-rending pleas that they cannot live without their opioids. But we have failed to see this for what it is, the signature of addiction: ‘I need it. I can’t get better or normal without it,’” he wrote.

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          • Johnna

            Again, I have NOT ever used the term “addict” to describe chronic pain patient nor do I support Dr Kessler. The FDA has acted like a criminal organization doing the bidding of Big Pharma for many years.

            I am Not in favor of denying chronic pain patients access to opiate drugs, especially those people who have been on them for years. For many of these people it may be far to late for any alternative forms of treatment to be successful due to a host of reasons.

            There can be no dialogue here if you continue to distort my position (and others in this discussion) on these matters.

            However, I would suggest that for first time patients with chronic pain problems there are far better alternatives than use of opiates. I believe that these drugs, similar to some categories of psychiatric drugs, can lead to internal processes that create the basis for increased sensitivity to pain and increased potential for long term physical and psychological disability. Does any one else here believe this may be possible?

            Lastly, why won’t people here address the five questions I raised earlier which I believe are very pertinent to this discussion? I will include them again below.

            1) What percentage of chronic pain patients have also been given some type of psychiatric diagnosis along with various cocktails of psychiatric drugs?

            2) What role has the use of psychiatric drugs, with all their negative side and “main” effects (and the use of psychiatric labeling in these cases) had in the progression of the chronic nature of protracted pain disability?

            3) Should the use of antidepressants in these cases be looked at as a causative factor in the high numbers of suicides?

            4) Should we call opioid dependency in some cases “iatrogenic dependency” as has been advocated for with benzodiazepine dependency?

            5) Are a certain percentage of chronic pain patients victims of “iatrogenic opioid dependency” (that is, medically induced and damaging dependency encouraged by Big Pharma and poor medical practices) which initiates a cascade of unforeseen medical and psychological deterioration in these patients – all of which leads people into the clutches of Biological Psychiatry and their brain disease/drug based paradigm of “treatment?”

            Richard

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          • All good questions that I would like to hear addressed, and it makes one wonder why they have been ignored in favor of emotionalism and conclusion-jumping.

            Again, I have no particular “side ” to push here as far as the content, but the style of quasi-personal attacks on R.L.’s position is hard to deal with.

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          • Mr. Lewis

            “Again, I have NOT ever used the term ‘addict’ to describe chronic pain patient…”

            Have I claimed otherwise? Who do you think has more power in the media, Dr. Kessler or you?

            “For many of these people it may be far to late for any alternative forms of treatment to be successful due to a host of reasons.”

            I love it when those who don’t suffer from chronic pain talk about alternative treatments, as if there were tons of them, and all covered by insurance. As if the majority of chronic pain patients haven’t already shelled out thousands of dollars for these “alternative” treatments, all of which have failed or caused more damage. As if alternative treatments had a better success rate than opioids. As if there was proof that alternative treatments work better than painkillers. The medical industry has been unable to conduct research on the long-term effects of opioid use in chronic pain patients, but they’ve also failed to show that any other treatment is superior.

            “There can be no dialogue here if you continue to distort my position (and others in this discussion) on these matters.”

            I don’t believe I’m distorting your position — after all, you’ve communicated your opinions here, just as I have. Let the reader decide what they want to believe.

            “However, I would suggest that for first time patients with chronic pain problems there are far better alternatives than use of opiates. I believe that these drugs, similar to some categories of psychiatric drugs, can lead to internal processes that create the basis for increased sensitivity to pain and increased potential for long term physical and psychological disability. Does any one else here believe this may be possible?”

            First-time patients? If you’re a patient with a label of “chronic pain,” you’re not a first-time patient. Your theory is interesting, and when you prove it, I’ll be happy to agree that it may be possible.

            Let me try to answer the questions you seem so focused on:

            1) What percentage of chronic pain patients have also been given some type of psychiatric diagnosis along with various cocktails of psychiatric drugs?

            There is a small percentage of chronic pain patients who also suffer from psychiatric conditions, like bipolar and major depressive disorder, many of whom are being denied treatment with opioids.

            2) What role has the use of psychiatric drugs, with all their negative side and “main” effects (and the use of psychiatric labeling in these cases) had in the progression of the chronic nature of protracted pain disability?

            In the 1980s, patients were only given antidepressants to treat chronic pain. Lots and lots of antidepressants. My personal experience is that antidepressants did nothing for my pain, while some of them actually made me depressed.

            If you think that psychiatric drugs can cause pain conditions to linger or become protracted, then maybe you should do something about that. But if you think the medical industry is interested in this area of study, then I believe you’d be wrong.

            I wonder what role cancer treatment drugs have in causing chronic pain conditions. Then there’s surgery, which can both create and increase a pain condition. And let’s not forget about injections: the pain patients who were given infected injections are still waiting for their money from the lawsuit. That is, the ones who survived:

            From Wikipedia: “A New England Compounding Center meningitis outbreak which began in September 2012 sickened over 800 individuals and resulted in the death of 64.”

            3) Should the use of antidepressants in these cases be looked at as a causative factor in the high numbers of suicides?

            Antidepressants can cause suicide. That’s a fact. There’s even a black warning box on the label. And from the stories I’ve read from other patients, detox from antidepressants can be as bad as that from other drugs, including opioids.

            4) Should we call opioid dependency in some cases “iatrogenic dependency” as has been advocated for with benzodiazepine dependency?

            What should we call insulin dependency? Dependency on blood thinners or heart medications? No matter what you call it, I still believe that hyperalgesia is rare. And when I say rare, I mean a very small percentage of the tens of millions of patients who take opioids.

            5) Are a certain percentage of chronic pain patients victims of “iatrogenic opioid dependency” (that is, medically induced and damaging dependency encouraged by Big Pharma and poor medical practices) which initiates a cascade of unforeseen medical and psychological deterioration in these patients – all of which leads people into the clutches of Biological Psychiatry and their brain disease/drug based paradigm of “treatment?”

            Again, if you want the answer to this question, perhaps you should do something about it. And again, I’ll say that the medical industry is not interested in any research involving opioids, unless it proves these drugs are harmful. (Similar to cannabis studies.)

            While you’re so focused on the opioid war, your state has an even bigger crisis:

            http://www.wickedlocal.com/article/20160106/NEWS/160108114

            BOSTON – More Massachusetts residents committed suicide in 2013 than died as a result of car crashes and homicides combined… “Similar to what has been happening in the whole of the U.S., the rate has been going up and the number has been going up,” said Alan Holmlund, director of the Massachusetts Suicide Prevention Program. “And similarly to the nation, the group that we’ve identified as driving the increases is the same: middle-aged white men in particular.”

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    • Richard said, “Evidence indicates that the rise in opiate prescriptions has fueled the opiate epidemic. 60 percent of all new heroin/opiate addicts came to this condition via their access to opiate drug prescriptions. ”

      WHAT IS YOUR SOURCE FOR THIS? I ABSOLUTELY DON’T BELIEVE IT.

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      • When a “heroin addict” dies of a “fentanyl overdose”, how does ANYBODY KNOW whether that fentanyl was cooked in a clandestine lab in China or Mexico, or sold by Janssen Pharma of CT?…..And, even if it was a “prescription pill”, was it stolen, or “diverted’ from the “legitimate patient”…. I’m doing my best to remain neutral here, but the HYSTERIA I read in the “pain patient” comments makes that neutrality difficult to maintain….

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    • You, quite obviously, are not a person that suffers from intractable pain. Do you know how many other options were tried before a person had to resort to opiate use? No you do not! Tell me one thing. What BETTER option is available to pain sufferers? Nothing! Nothing they haven’t already tried! When they come up with a better option, then perhaps we can talk about the discontinued use of opiates. My pain issues are well documented and I don’t find it necessary to justify myself to you. But I am on a minimal amount of pain medication for the last 3 years. I am not addicted but I am dependent due to my pain issues. I have almost no quality of life now and what do you propose the alternative to opiate use is? You don’t have an answer! People much more intelligent and qualified than you don’t have an answer either! Until someone comes up with an answer, allowing people to suffer, including those WITH cancer, is not humane! Furthermore I don’t have a problem with urine tests, counting my pills, doctor appointments every 3 months or any other hoops they want me to jump through because I do everything right! And still I’m threatened with having what little medication and relief I find in life taken away, because someone else isn’t doing it right! Does THAT make sense?

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  5. There is nothing more dignified than giving every mentally sound individual an opportunity to make their own decisions. These are your treatment options and these are the risks.

    And I read this stuff about chronic pain patients being forced to take drugs tests.

    <i. "In late 2012 I was told by my doctor that I would be required to submit to a random drug screen and sign what was referred to as a “pain contract.” I was told that if I declined, I would no longer receive my medication." http://nationalpainreport.com/my-story-drug-tests-and-pain-contracts-violate-patient-rights-8824576.html

    “_____ I will come in for drug testing and counting of my pills within 24 hours of being called. I understand that I must make sure the office has current contact information in order to reach me, and that any missed tests will be considered positive for drugs.”

    The form https://www.drugabuse.gov/sites/default/files/files/SamplePatientAgreementForms.pdf

    What the F ??? This is America if their is ANYONE left who remembers what we stand for or STOOD for. Is there ANYONE left ??

    The Fourth Amendment of the U.S. Constitution provides, “[t]he right of the people to be secure in their persons, houses, papers, and effects, against unreasonable searches and seizures, shall not be violated, and no Warrants shall issue, but upon probable cause, supported by Oath or affirmation, and particularly describing the place to be searched, and the persons or things to be seized.”

    “and that any missed tests will be considered positive for drugs.”

    Guilty till proven innocent, of course, F the American way, its for ‘safety’ and we have a ‘crisis’.

    I could be the best liberty writer on the net and most of you will still care more about what phony celebrity had an affair this week than your rights.

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  6. Thank you and thank you again. I suffered intractable chronic pain with my rheumatoid for years without taking anything and it contributed to by diagnosis of depression, Acute and untreated ;pain is just plain cruel and no way to live. Now, at 64, I have a low dose of morphine, the only thing I can take because I do not have the enzymes for other drugs (CYP2d6), I feel like a different person. Antidepressants should never be given for pain. I should never have been on those drugs to begin with because of the enzyme deficits. I am functionally pretty normal, suffer no side effects and my dose is low. Would never consider abusing it. I do not get high on it and am simply grateful someone took me serious. Of course, I had to go to Mexico to get treated. They always told me I was just depressed. Anyone can be depressed when they hurt all of the time. Now that the pain is gone, and I am getting really happy, I know that is not true. Intractable pain causes depression because one cannot function that way. What a different life I could have had. Thank you

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  7. I really wish I could believe that the opioid painkiller crisis was a made-up thing. Bur as a paralegal in workers comp, I deal with it every day. In the past few years I have lost two clients to drug overdoses, and had a third come close to dying from severe bowel impaction. Another developed such profound osteoporosis that his tibia snapped like a twig one morning when he got out of bed. All of them began with significant pain from significant musculo-skeletal injuries. And all came to grief through following their doctor’s orders.

    I can think of a couple dozen more clients whom I’ve accompanied on the journey from being in moderate pain, and only able to do light-duty work, to being in severe pain, and unable to work at all. Thanks to long-term, ever-escalating doses of OxyContin, Norco, Opana, Percocet, Duragesic Patch, Zohydro and all the rest … I wish I could believe that hyperalgesia, or intensified pain response as a consequence of chronic opioid therapy, was rare. However, I spend a portion of each workweek on the phone with people in the throes of it. I also wish I could believe that the profit had gone out of opioid medications, so that Pharma would start badmouthing them the better to sell other drugs. But too many “novel” formulations of the same old stuff keep getting approved. Check out the price of extended-release and allegedly “abuse-deterrent’ Opana, to name just one. Not to mention Tarqiniq, Hysingla, Exalgo, Zohydro, or all the various fentanyl products approved for cancer patients and then marketed 80% to non-cancer patients…

    You know who is REALLY responsible for blaming and shaming these patients? The drug companies. Purdue, Endo, Cephalon and the rest. They have perpetrated the Big Lie that these drugs are terribly addictive for “drug abusers”, but absolutely safe and non-addictive for “legitimate pain patients.” They are now pushing a form of “prescriber education” that teaches docs there are no bad drugs, just bad patients. Their phony “Risk Evaluation and Mitigation Strategies” are aimed at teaching doctors to identify the “drug seeker” or the “high risk patient.” (Unfortunately I have to include the National Pain Report, the National Pain Foundation and many other nonprofit entities in this project:) In reality, we may have differing degrees of vulnerability to opiate addiction — but there really are no low-risk patients. Use the stuff long enough and you will become dependent. We’ve known this at least since the Civil War.

    This is not an easy issue, and there may be a small number of patients with trigeminal neuralgia, sickle-cell or some other conditions for whom long-term opioids are the best option available. They are certainly indispensible for major surgery and for terminal cancer. But no one can honestly deny they’ve also been massively overprescribed to people with back injuries, shoulder surgeries, migraines, fibromyalgia and a host of other conditions for which better strategies exist. It’s highly profitable, it’s a convenient substitute for quality medical care, and it’s tragic.

    I often recommend this video to help people sort out the issue: a followup on 7 Purdue “success stories” featured in promotional materials for OxyContin. Two are still on the drug and think it’s a decent solution. Two are dead of drug-related causes. One managed to quit at great personal price, and would never go back. Two others could not be located:

    http://www.jsonline.com/watchdog/watchdogreports/what-happened-to-the-poster-children-of-oxycontin-r65r0lo-169056206.html

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    • Maybe you’d like a Purdue Pharmaceutical clipboard, too. You can’t have one of mine, but I’m sure the company would be willing to get you one if you could feed them, a suitable excuse (actually, I don’t recall how I got mine, not having done any opioids since a car wreck 11 years ago).

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    • I have been stable on the same dose of opioids for numerous, incurable, untreatable chronic pain conditions. I undergo a ridiculous amount of extra appointments to pain management and specialists. Drug screenings and pill counts are part of my life. I never fail a test, I’m never off on my count. But I AM vilified by anti-opioid zealots who want to blame me and my doctors for their loved ones demise.

      I know nobody becomes addicted from one doctor visit. People need to learn more about what their loved ones were REALLY doing, not just what they were told. As for lawsuits, what can I say, lawyers see one side and it’s the side that brings in the most money. Tell me that’s not true.

      I believe you don’t sue people for problems you caused yourself, blaming the doctors, blaming the drugs. Who kept returning to the doctor asking for more and more? Who lied and went to many doctors and many pharmacies to get more drugs than their doctors knew they were taking? When people own up to their actions, the truth will become evident, but then how will lawyers and people make money suing for their own actions?

      Guess chronic pain patients are going to continue to pay for lying and greed as well as misinformation. We suffer while others get rich. It’s the American way.

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  8. “Contrary to general belief, there is no federal law against growing P. somniferum.”—Martha Stewart Living

    1 OUNCE OPIUM POPPY SEEDS – Papaver Somniferum L – High Alkaloid Variety, High Germination Rate $5.00 + $4.49 shipping http://www.amazon.com/OUNCE-OPIUM-POPPY-SEEDS-Germination/dp/B00VCJLN9A

    Grow Opium Poppies http://www.motherearthliving.com/gardening/poppy-fields-forever.aspx Harvest https://www.youtube.com/watch?v=ZLp07XnKFDI

    Imagine that, pain relief growing in the back yard and no need for the medical gestapo of 2016 .

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  9. As an FYI, I don’t have pain issues but am interested in this issue knowing that one unfortunately life circumstance could change everything.

    Richard, I am not sure I understand your points. Yeah, I don’t doubt that long term use of Opoids could be bad news.

    But are you honestly going to tell patients who feel being on these meds is their only option and are not experiencing side effects that the studies show they are wrong? Kind of reminds me of psychiatrists telling folks the studies show they aren’t experience side effects or withdrawal symptoms when we knew better.

    Recently, I read alot of comments when there was an article in the New York Times about this issue. It broke my heart when so many people feared their lives would be destroyed if their pain meds got reduced, particularly when they mentioned they had tried alternative means.

    It just seems to me that Richard Lawhern is right. Pain patients are being unfairly punished for this opioid crisis and that is so wrong. But no one seems to care.

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    • Apologies for repeating myself … but it is the drug industry that is “punishing pain patients” in order to take the heat off themselves and their drugs. They push the myth that we are dealing with two separate & competing problems: “Drug abusers” who use the pills to get high and then get addicted or overdose, and “legitimate pain patients” who supposedly can never get addicted and will only be helped, never harmed. They have a multi-million dollar PR campaign to push this point of view, and dozens of respectable well-heeled medical nonprofits at their service. (BTW they have also mobilized all this money and talent to “warn of the dangers of cannabis” and keep it from being a legal option.)

      But the bulk of the overdose deaths are among people like my two dead workers-comp clients: middle-aged men and women who got prescriptions from doctors for real chronic pain. Many of them are veterans “treated” with opioid-benzo combinations in our VA hospitals.

      As for the antidepressant comparison, here’s my take: I spent years feeling miserable and thinking SSRI’s were my only shot at normalcy. After all, no matter how bad I felt while taking them it was NOTHING to the way I felt each time I tried to quit! The medical profession and NAMI assured me this proved my brain needed the drugs, and I shouldn’t listen to any of those horrible people who criticized the life-saving antidepressants.

      Many people on long-term opioids are caught in the same cruel cycle. Their pain is real, and it is significantly WORSE than it was before they started taking opioids for their injury! And any new injury to a different part of the body will be excruciating from the git-go because of the drug-induced hypersensitivity. It happens to a LOT of people, and it makes a LOT of profits for Purdue, Endo, Cephalon et al.

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      • Johanna

        No apologies necessary. You are speaking the truth and it needs to be repeated in multiple ways.

        Exposure of nefarious and dangerous drug promotion and prescribing by Big Pharma is NOT part of the War on Drugs.

        I think everyone in this discussion would agree that the War on Drugs was a very harmful government strategy of misdirection that covered up its own failings and targeted society’s victims trying to survive in the underclasses.

        Richard

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          • Non-drug pain and distress relief? Meditation and mindfulness has shown promising results.

            As for drug but non-pharmaceutical options, try weed. Weed is a wonder drug. Well, more of a medicine really (not medication). It’s not the devil drug that governments have demonized over the years. Honestly, governments making weed illegal and locking people up for smoking it is a crime against humanity.

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          • Fiachra

            There are no easy solutions or “one size fits all” approach because every medical condition is different.

            Based on information I have encountered over the years here are some initial thoughts on areas to investigate with appropriate medical guidance:

            1) Physical Rehabilitation with specific exercises designed to strengthen muscles and tissue surrounding the areas and sources of pain.

            2) On going exercise of all kinds (especially walking and adapted forms of yoga) that can be safely tolerated while pushing the boundaries of frustration/tolerance limits for each individual.

            3) Mindfulness Meditation, also has scientifically proven benefits for chronic pain and anxiety.

            I hesitate to even mention these options because I know that some people reading this will say that either they have tried these before without success, or that their medical condition precludes them from any of these activities. Although meditation can be practiced by anyone if they persevere long enough in the learning process.

            There is no way of having this discussion without offending someone or being accused of insensitivity or being told you have no right to speak unless you yourself are a chronic pain patient. But you did ask for thoughts and I have tried to respectfully reply.

            Richard

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          • I ain’t no expert … but workers’ comp clients, friends and relatives have shared a variety of things that have worked …

            In some cases the trick is to *reduce* the need for opioids rather than cut them out altogether. If you can’t totally stop, cutting down can vastly improve your quality of life by reducing drowsiness, testosterone suppression, dizziness, weight gain, depression, osteoporosis, and all the other joys of long-term Oxy or Percocet.

            What’s really needed is long-term, hands-on, individualized care that acts as if people’s lives matter. That is much harder to make a profit on than Oxycontin or Opana ER (or epidural steroid injections). Anyway, here goes:

            1. Physical therapy: Most patients get very limited physical therapy which is focused on an eight-week course of exercise and physical treatments like hot packs and ultrasound. A more gentle, gradual and individually-focused exercise program can sometimes work wonders – especially if it incorporates water-based exercise.

            2. TENS units and other “nerve-stimulation” technologies. The TENS is a portable unit that uses a mild electrical signal to disrupt the transmission of pain stimuli to the brain. It works well for some. There are also implantable “spinal stimulators” for more intractable problems.

            3. Biofeedback, guided relaxation and some mindfulness therapies help some people cope with pain that can’t be eliminated.

            4. Acupuncture helps some folks tremendously – sometimes the relief is just temporary but you can say the same for those epidural steroid injections which are a lot more invasive. Traction is one stodgy old “Western” treatment that helped me hugely with a painful sacro-iliac injury years ago.

            5. Other medicines: Part of Pharma’s campaign to sell opioids has been a HUGE overestimation of the dangers of ibuprofen, naproxen and other “NSAID” painkillers. They actually persuaded many doctors that opiates were “safer” than Motrin and Aleve! It’s true they can cause gastric or cardiac problems for some vulnerable individuals – but most non-elderly folks can tolerate them well. A friend with chronic back pain really had his life transformed by a prescription for Voltaren (diclofenac). Lidocaine patches have also helped many folks sharply reduce or even stop their opioid intake. Anti-convulsants work for some people with central nervous system disorders although caution is needed with them as well (Neurontin is a godsend for some and a nightmare for others …)

            6. Cannabis and cannabis derivatives: These have worked MUCH better than opioids for many chronic pain sufferers though not all. They’re especially good for any pain that involves muscle spasms. Many Iraq war veterans who have been horribly damaged by the VA’s opioid-benzos-and-Seroquel program have found pot to be a godsend. (If you are suffering from both physical and emotional injuries, opiates can be particularly dangerous … )

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      • Johanna, we agree that any public discussion of opioids is complicated by the frauds being worked by pharmaceutical companies. But I suggest that you also read the other side of the story, represented by chronic pain patients in this very thread. From years of doing just that, I am convinced that the great, great majority of people in chronic pain are not addicts. They are responsible, concerned people for whom properly managed opiates make possible the only quality of life that they are able to sustain. If they are denied these medications without realistic alternatives, some of them will commit suicide — but others will be driven into street drugs from sheer desperation.

        There is simply no way on the Green earth that driving more people in to agony and more doctors out of pain management practice is going to “reduce” deaths by opioid overdose. If anything, quite the opposite will occur.

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        • Richard, there is no way in hell that anyone here wants to outlaw opioids or shut down all the pain management clinics. And no one here is “stigmatizing” people in serious pain who have been put on these drugs and given no good alternative. As someone who deals with the practical aspects of this mess every day (including hours on the phone fighting for our clients to GET their opioids reliably!) I am well aware that patients who are on these drugs face increased barriers and increased, demeaning scrutiny. They are being blamed for something that is not their fault. The question is: WHY?

          First of all, because Purdue Pharma & friends (and the professional guilds and nonprofits that live to serve them) have chosen a deliberate strategy of BLAME THE PATIENT. They are the ones who have designed and sold these bogus “Risk Evaluation and Mitigation Strategies” that have made so many patients feel criminalized. They want to convince people that there is nothing wrong with the drugs, as long as we learn how to weed out the bad patients. They are NOT your friends, or the friends of the folks you’re trying to help.

          They are now conducting a very sophisticated, well-funded smear campaign against those who stand up to them, trying to label us as Drug War zealots who don’t understand and don’t care about people in real pain. It is very clever, and deeply dishonest. The object of the game is to get us fighting each other while they laugh all the way to the bank.

          Please. Don’t fall for it. THEY are the ones who are pushing this stupid, conterproductive REMS Crackdown. (Meanwhile, many of the people who are standing up to Pharma and the AAPM have also been standing up to the “drug war” and mass incarceration for thirty years or more.)

          And if I have to say it 1,000 times, I will: There may be some people for whom nothing else works. Okay. I am all for them getting whatever help they need. But I am seeing too many people placed on these drugs inappropriately, chewed up and spit out by this system. And even as the drug companies shame and blame the patient who has already been harmed by this model of “care,” they are busy signing up five more new ones. That is their business model. They don’t care if the drugs do great good, or great harm, or nothing at all. The money is just as green either way.

          People should not die in their forties and fifties of a bad back, or a torn rotator cuff, like my clients. Or severe osteoarthritis, like poor Prince. He was certainly not a recreational drug user; as a Jehovah Witness, he had religious scruples against getting high that would make most of us look like mindless thrill-seekers. And he was certainly in serious, chronic pain with two bad hips. And certainly no one took his meds away; he had all the best doctors and all the opioids he wanted. And he turned blue and died.

          Prince wanted out of that trap, very badly; apparently he was planning to fly to California to find a doctor who could help him escape. But it was a little too late. A very good man, a responsible man, working hard and heading up an impressive business empire. And despite having all those millions, he was caught in the same trap as many of my workers’ comp clients.

          I am simply sick and tired of seeing that happen, and I want people to have alternatives. That’s all. We are not enemies. But I’m afraid groups like the National Pain Foundation are trying hard to make us enemies. This is a trap. Let’s not fall in.

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      • There are people finding cannabis very helpful in breaking free of opiates. And smoking it is not the only option. There are cannabis mints and hard candies, and now even melt-away strips, that begin to take effect as you suck on them, entering your system sublingually and through the cheek/gums. Inhalation brings the quickest pain relief, but we also have endo-cannabinoid receptors in the gut. Lots of people find that eating cannabis-infused food relieves their pain long enough to get a full night’s sleep. The indica strains with a good ratio of CBD to THC are particularly effective for this purpose.

        There are also topical cannabis preparations (balms, salves, lotions and liniments) that are applied directly to the painful area instead of being taken systemically. Just like rubbing alcohol doesn’t get you drunk, topical cannabis doesn’t get you high. Depending on the type and source of the pain, these can be very effective, though the relief is not as long-lasting as eating cannabis edibles. Topicals usually need to be re-applied every couple/few hours.

        The safety and efficacy of cannabis seem pretty well proven, since it’s been used medicinally by so many cultures for centuries– the ancient Egyptians used it! And the side effects are predictable and manageable. I’ve known people who use it for chronic pain, and others who’ve used cannabis to ease the withdrawal from psychopharms, and from opiates.

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    • AA, From a chronic Intractable pain patient, thank you. We are being unfairly punished and it’s a living hell. Everything Mr. Lawhern states is the truth. The government just keeps on creating mass hysteria , feeding the people of this country a bunch of horse shit. And what a bunch of hypocrits they are. I don’t doubt for a second that many of those in congress, dea, cdc fda or their loved ones depend on pain meds for a QUALITY OF LIFE, there is no way they are all in such perfect health, but they have their private drs and pharmacies in their back pocket and aren’t put thru the hell we are put thru, pharmacies denying to fill legitimate prescriptions, even if you’ve been with the same pharmacy for many years, they are now denying to fill lifesaving scripts, sending people on whats called the pharmacy crawl, they want us to stay with one pharmacy and yet the pharmacy refuses to fill the script. When we go to another pharmacy then we are flagged a drug seeker, If we go to see another dr, for another opinion, bam flagged again as a dr shopper, when all we want is to live the rest of our lives in as less pain as possible. The pendulum has swung way to far, its GENOCIDE , no other way to put it,mwhen legitimate pain pts are being denied the one treatment they gave them QUALITY OF LIFE. Another thing that infuriates me is how many drs hold our scripts hostage, forcing us into injections that most times do not work, but if we don’t do them we cant have the script. No other medical condition is a patient put thru such hell. We can’t even take a vacation with families as we are “on call” to be brought in at anytime for a ridiculous pill count, give me a break. Im 51 yrs old, and honestly am way beyond my breaking point,

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  10. In this blog Richard Lawhern uses statistics from the Cochrane Review Groups to support his contention that there is no opiate drug prescription problem. It is interesting that if you actual read the source he uses to bolster his argument you find the following quote from Cochrane: “…the evidence supporting the conclusions is weak and long term studies are needed to actually identify the patients who are most likely to benefit from treatment.”

    And further check out this quote from The National Institutes of Health article titled “Pathways to Prevention: The Role of Opioids in the Treatment of Chronic pain” : “… long-term opioid use can also result in physical dependence, making it difficult to discontinue use even when the original cause of pain is no longer present. Furthermore, there is mounting evidence that long-term opioid use for pain can actually produce a chronic pain state, whereby patients find themselves in a vicious cycle, where opioids are used to treat pain caused by previous opioid use.”

    “Data from the Centers for Disease Control and Prevention indicate that the prescribing of opioids by clinicians has increased threefold in the last 20 years, contributing to the problem of prescription opioid abuse.1 Today, the number of people who die from prescription opioids exceeds the number of those who die from heroin and cocaine, combined.”

    Richard

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  11. Thank you for this very interesting article. It is helpful to get as many perspectives as possible. The causes of chronic pain are so varied, and I believe the priority for people is to relieve their suffering, first and foremost.

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  12. My next toothache should be fun, not. Not at all.

    If it really hurts and they profile me and send me home with Motrin that’s useless against that pain I will just go downtown and buy a few bags of dope. So what if I have to pay $20 for $10 bags cause I am not a regular and just want to be served. Tooth aches are no joke. I am not going to stay up all night in toothache hell.

    I tried heroin against benzo withdrawals after the medical mafia rudely cut me off for my own good I guess, I sniffed half a bag and it barely touched that panic anxiety nightmare. That was the time “insurance said” I couldn’t have my script cause it wasn’t 30 days yet but the doctor upped it from 3 mg to 4 so it was technically a new script. I will pay cash didn’t work.

    I was going to go to the ER but I really really didn’t want to risk being subject to the psych lockup thing for a $750 2mg Ativan . Hey friends and family can you feed my cat ? I went to the ER for anxiety and I am stuck in psych now .. No thanks, so I tried some dope. I am glad the benzo days are long over.

    Heroin would actually be a good thing to have in your tool kit on an adventure into the wilderness or a long sailing trip far from help if you were to get a nasty toothache, a badly twisted ankle or something like that. A $100 investment could really save your butt.

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  13. I mean really. Everyday of the week we are reading about celebrities who kick the bucket owing to an overdose of pain killers, and I imagine the numbers of non-celebrities to be even greater still. I’m sure “chronic pain” may be a problem with some folks, however it seems that toxic pain killers have created of that problem a much bigger problem. There must be other, and better, ways to relieve chronic pain. Relieving the client of life with the pain strikes me as excessive. I think only ignorance would compel a person, regardless of this study or that, to ignore such evidence as is received from his or her senses with the evening news.

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    • Only ignorant people continue to believe the media bs. ‘yoyr sure chronic pain maybe a problem with some folks” Its more than just a problem, its life threatening. Do you have any idea what it feels like to have your back feel and look like its been freshly bearen with a baseball bat, ir your knees feeling like a hammer is hitting them or your hips feeling like they are being dragged on the concrete chipping away at your bones or the sensation of electric type shocks running down your legs, piercing, burning stabbing pain that runs into your feet where your foit feels like its caught in a bearclaw trap, If you dont know what it feels like to exist in severe pain every day of your life, allow me to show you, i am not a violent person but in order for you to experience what myself and thousands upon thousands, millions even, allow me to swing a bat to your back nonstop cuz my pain never goes away unless i take the meds LEGALLY prescribed to me, then my pain is tolerable, butin order for you to get the full affect, you will be denied anything for the severe pain you are about to be in. While your back is being tortured your knees will be beat with a hammer, coukd you imagine the pain!? I have MULTIPLE DEBILITATING CONDITIONS INCURABLE CONDITIONS, look up CRPS/RSD AKA THE SUICIDE DISEASE, just one of many conditions I have, Let me know when your up for the challenge..

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      • I’m not denying the reality of pain, nor that it can be a serious problem for some people. I’m also not denying that there are people who have died because of excessive use of pain killers. I believe that in many cases those deaths might have been preventable, and the person involved would have had many years of productive life ahead of them. As others have said, it is a complex issue, and to oversimplify the matter would benefit nobody. That said, this nation has a serious prescription drug problem, and pain killers, including opioids, are an issue when it comes to early mortality. Premature death, to my way of thinking, is a much more serious concern than chronic pain, and so it should be treated. That there are people in constant pain, and thus in constant need of some kind of palliative relief, certainly. I just don’t think death the best form of pain relief going, and when people are overdosing on these substances, doctors need to be held accountable. You don’t hold doctors accountable by being dismissive of the issue.

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        • As the only one here that identifies as an “addict”, the scapegoat in all of this, do me a YUGE favor. Don’t save me from myself. If I want to get high its my problem if I OD and die.

          Of course am not the mouthpiece for all addicts but I have hung around enough of them. How we think.

          The doctor that screwed years of my life, fed my addiction is still walking and talking. I have never taken any action against that POS. And I am the kind of person that kind of likes revenge. He didn’t do anything to me, I did it to me, its even my fault for believing that chemical imbalance lie. I should have questioned it.

          And nobody can save an addict but him or her self. Eventually you get sick of being sick.

          I should be the one saying F those doctors and make more laws to control those pills. I would be the most selfish SOB on the planet saying so what if it harms people with chronic pain cause I have an anxiety problem and like doing drugs for relief, protect me, protect me from me !

          I could make the ATM , the liqueur store and the spot and be high as a kite within 60 minutes if I want.

          Leave these people alone.

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          • Of course, destroying yourself is your own prerogative, The -cat. I’m not one to encourage it though. Nor am I selling physician assisted murder, nor any other form of euthanasia. You may have a dealer of opioids, over the counter or under, but it’s not me. I don’t make my living that way.

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  14. A hypocrite is the kind of politician who would cut down a redwood tree, then mount the stump and make a speech for conservation.

    I can’t believe all the hypocrites on MIA.

    They go around from story to story writing nasty comments in opposition forced psychiatric drugging saying everyone has the right to say what does and does not go into their own bodies, that each man is the guardian of his own health !

    Until they get to this story and now it’s just fine for doctors, moral busybodies and police state types to tell people what kind of treatment they are allowed to have. Now its OK to disregard what a patient thinks is best for what the state decides is best ‘for their own good’.

    I have never seen such hypocrisy on this site before.

    Tell me what the difference is between the right of a patient to refuse treatment from the right of a patient to choose treatments ?

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    • Pain patients don’t have the right to refuse treatment anymore — many are being forced to try other treatments besides opioids or else their doctor will abandon them. Cut them off, usually without any tapering at all. Patient abandonment is rampant and should be against the law.

      When my pain doctor abandoned me, forcing me into a cold-turkey detox, I almost committed suicide. And living in constant, unrelieved pain keeps those thoughts in my mind, whether I like it or not. Animals aren’t forced to suffer like this, why are we? Because drug war. Because hypocrisy.

      We can’t do anything about hypocrisy — after all, it’s what the failed drug war was founded on — but we should be able to do something about discrimination. ACLU, where are you when we need you?

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    • “Tell me what the difference is between the right of a patient to refuse treatment from the right of a patient to choose treatments ?”

      This, exactly!

      I also think that those of us who are demonstrating critical thinking skills and making assertive, educated choices about the substances we ingest into our own bodies have a valuable role to play in raising expectations and standards of care within the current system.

      We need to hold our heads high and refuse to be shamed and silenced by anyone, for any reason, on this one.

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  15. I have been suffering from chronic pain for 13 years. As a chronic pain patient, I take my medications as prescribed. On my own, I sought out a psychiatrist, who specializes in treating patients with chronic pain. Chronic pain patients have been lumped together in to the same group as addicts. Research indicates a very low percentage of chronic pain patients become addicted. Yet, we’re forced to sign pain contracts, have urine drugs tests, pill counts, and our doctors monitor our prescriptions in the national drug database (which, I believe is 100% necessary). The drug database shows when a prescription is filled, at what pharmacy, and by what doctor. This prevents doctor shopping and patients filling multiple scripts from different doctors. With all these safeguards, in addition, to screening a patient’s behavior–it makes it very difficult for an addict to go unnoticed.

    Since the DEA crackdown and now the CDC guidelines, chronic pain patients are suffering more than ever. Most chronic pain patients were already under treated. Now, their medications are being reduced or they’re being completely cut off from all their medications. Research shows that persistent, uncontrolled pain can affect the body, causing harm to the cardiovascular, endocrine, immune, neurologic , and musculo-skeletal systems . Not to mention the psychiatric conditions, such as anxiety and depression, that accompanies living a life with chronic pain.

    Chronic pain patients are stigmatized. People don’t think we’ve tried conservative therapies. I have tried physical therapy, a TENS unit, too many injections to count over the past 13 years, braces, radiofrequency ablation, antidepressants, anticonvulsants (gabapentin, lyrica,topamax), steroids, NSAIDs (even though I’m not supposed to take them, due to my crohn’s disease, hiatal hernia, and history of ulcers), acetaminophen (which I took, until my liver enzymes were too high, and I had to stop), and surgeries. I’ve had a total of 22 surgeries. I’m 35 years old.

    I had to stop working at the age of 24. Years ago, my pain was managed better, so I could have some resemblance of a life. Now, my pain is under treated. My medication takes the edge off of my pain. I basically live a life on house arrest, but without doing a crime. I’m being punished for having chronic pain. I suffer from Hashimoto’s, crohn’s, ankylosing spondylitis ( I have severe stenosis at several levels of my spine, compressing nerves), herniated discs (one compressing my spinal cord), DDD, bone spurs, and arthritis throughout my spine and other joints. I have terrible migraines. Severe pitting edema, which doctors have yet to find the cause. I am swollen from my stomach to my feet–walking is extremely painful. My shower is on the second floor. There are days (sadly, more days than not, that I can’t even make it up the stairs to shower.) I was also diagnosed with a reproductive cancer. I had 2 fertility sparing surgeries. I now need a hysterectomy. My pain management doctor told me that I would not receive any extra pain medication, other than what I’m taking. Chronic pain patients need extra medications after a surgery or injury, but because of the guidelines, I will not receive any extra medication to control my pain after a major surgery. So, I’ve been putting off a life saving surgery because I know I cannot take the pain of a major surgery on top of the pain I deal with on a daily basis. I am not only dealing with chronic pain, I’m also sick–which is a double whammy.

    I don’t understand how people can judge chronic pain patients. Have these people never experienced pain? Or had a loved one with a disease or condition, which caused chronic pain? When you see someone in pain, how can people not empathize? Everyone has been in pain. Imagine having that pain every day of your life. Having major surgery and being sent home without pain medications–then having that pain for the rest of your life. That’s chronic pain. I would not wish my life or my pain on anyone.

    These CDC guidelines are not only targeting chronic pain patients…it’s every one. Hospitals are giving patients in pain NSAIDs to treat their pain, or nothing at all. Opiates are rarely being used. The guidelines suggest giving out a 3 day supply of pain medication after surgery. I’ve never had a surgery where 3 days of pain medication would have been sufficient. These guidelines are now not just voluntary..in some states, the guidelines are mandatory.

    It’s 2016, we have access to medications to control pain, and patients who are in legitimate pain are being denied these medications. These medications help people in pain live a better, quality life. Without these medications, chronic pain patients will become desperate and resort to buying drugs off the streets…..and suicide. It’s already happening. Why are chronic pain patients being forced to suffer, when we’re not the problem? We’re the LEAST likely group to become addicted, but we’re being punished? I can’t imagine living the rest of my life without medications. Chronic pain patients are screaming and advocating. Nobody’s listening. I don’t think anyone will listen until too many lives are lost. One life lost is one too many.

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    • I too am so sorry your are also a victim of this war on CPP’s. I feel like im at war with my own body, every part of me being ripped to shred, a war I cannot win without the proper medication to lessen the pain. Ive already been down the alternative therapy route, thousands of dollars in debt, was stuck with even more pain after god only knows how many injections, epidurals, nerves burned, steriods, Years of PT, massage, chiro, accupuncture, two failed spinal fusions..Like you stated, innocent law abiding chronically ill citizens are being forced to turn to the streets for relief or suicide. Last week aline Ive read of 20 suicides from legitimate pain pts who were stripped of their life saving meds, who were treated like some low class citizen, a pill seeking junkie, Your dam right im seeking pills, pills that gave me a QUALITY OF LIFE!

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      • Thank you. 🙂

        I’m sorry that you’re living in pain too, Pam. People who don’t live with chronic pain and suggest alternative treatments, don’t realize that we’ve tried them ALL. I have Medicare, which covers 20%. Medicaid doesn’t kick in for me, until I spend half of what I get each month from SSD. I have so much medical debt, that I will never be able to pay.

        When there was an open commenting period for the public, regarding the CDC guidelines, CPP’s stated that there would be a rise in suicides, and patients would resort to illegal measures to obtain relief. And, it’s already happening. These are patients that followed their pain contracts, passed their drugs tests, and pill counts. But doctors are now afraid to prescribe medication, or an appropriate dosage to relieve a patient’s pain…for fear their license will be taken away. CPP’s have documentation (whether it’s imaging, blood work, etc..) to confirm their disease or condition. If a patient has a disease or condition known to be painful, and has documentation to prove it, I don’t understand how doctors and the government are going to allow people to suffer needlessly.

        Everyone deserves to live a meaningful, quality life, with as little pain as possible. CPP’s know that they’ll never be pain free, but we shouldn’t be denied medications that provide us a life worth living.

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    • Pain patients are being lulled into thinking that the PDMP databases are necessary, not only to fight the drug war, but to have access to their preferred medications. But these databases were created and are used by law enforcement, even though some are now run by states. What the PDMPs really amount to are a blacklist for pain patients. And do you think the DEA will stop at just blacklisting those who take opioids?

      “The latest change in the program will be implemented on Oct. 1, when Connecticut doctors will be required to check the database if prescribing more than a 72-hour supply of a drug listed on Schedule II through Schedule V of the federal controlled substance law. Those drugs include stimulants like amphetamines, anabolic steroids, opioids and other narcotics…”

      https://painkills2.wordpress.com/2015/01/09/2009-the-influence-of-prescription-monitoring-programs-on-chronic-pain-management/

      https://painkills2.wordpress.com/2015/05/29/discrimination-by-database/

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  16. Decriminalization/legalization is necessary, it needs to be backed up with public health announcements explaining exactly why it is needed. Its not in any way condoning the abuse of addictors, it is done bc the alternative, the drug war, has made things infinitely worse on almost every level, to include making all drugs abundantly available to any & all that wants them. We need to pull LE out of the drug biz – that will free up a lot of resources currently chasing their collective tails. When the laws create more harm and cause more damage than they prevent, its time to change the laws. The $1 TRILLION so-called war on drugs is a massive big government failure – on nearly every single level. Its way past time to put the cartels & black market drug dealers out of business. Mass incarceration has failed. We need the science of addiction causation to guide prevention, treatment, recovery & public policies. Otherwise, things will inexorably just continue to worsen & no progress will be made. Addiction causation research has continued to show that some people (suffering with addiction) have a “hypo-active endogenous opioid system.” This is the (real) brain disease, making addiction a symptom, not a disease itself. One disease, one pathology. Policy must be made reflecting addiction(s) as a health issue. The war on drugs is an apotheosis of the largest & longest war failure in history. It actually exposes our children to more harm & risk and does not protect them whatsoever. In all actuality, the war on drugs is nothing more than an international projection of a domestic psychosis, it is not the “great child protection act,” its actually the complete opposite. We need common sense harm reduction approaches desperately. MAT (medication assisted treatment) and HAT (heroin assisted treatment) must be available options. Of course, MJ should not be a sched drug at all.

    “Prohibition goes beyond the bounds of reason in that it attempts to control a man’s appetite by legislation and makes a crime out of things that are not crimes. A prohibition law strikes a blow at the very principles upon which our government was founded.”

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  17. Thanks for the post. As you indicated this is a very complicated issue. In the post by Maia Szalzvitz, she indicated that the majority of pain patients use their medications responsibly. There is research to support this assumption. However, it does not follow that the current epidemic is therefore not attributable to the increase in pain medication prescriptions. What preceded the current opioid epidemic was a new emphasis in the medical community on treating the fifth vital sign viz., pain. In the 1980s opiate medications were just not around in household medicine cabinets. Now, with the promotion of treating pain aggressively, there is widespread access to these pills because of the escalation in prescribing. The demographic group with the biggest rise in the use of illicit opiates is middle class, white young people. Most of these young people are introduced to opiates through the family medicine cabinet. Moreover, most teenagers and young adults probably do not regard the ubiquitous OxyContin tablets as risky, because, after all, doctors would not give people these chemicals if they weren’t safe. The problem is that when opiates are readily available and labeled as medicine, then more people will experiment. The treatment of all degrees of pain will ensure that more opiates will be in the family medicine chest, unless the guy with a backache wants to show up every morning at 6 am at the methadone clinic, the only way to ensure that the stuff won’t be in the family medicine cabinet.

    Some believe that trauma, PTSD, distress are the major causes of addiction. There is research supporting the higher rate of trauma, PTSD, distress in those with addictions compared to the general population. However, one is making the ecological fallacy when drawing the inference, that trauma, PTSD, and/or distress is the major cause of addiction. Many animal studies prove that exposure to addictive chemicals causes compulsive seeking of drugs. The animals used in the research were not distressed or abused, they just had access to chemicals. Stated alternatively, exposure to high concentration addictive chemicals causes addiction. In fact, this view comports with my experience as a substance abuse treatment provider. Most of the alcoholics and drug addicts I knew were very well adjusted, cheerful people, when they weren’t using. Most had been raised in supportive home-environments. They became addicted because they got exposed. This is also consistent with the conclusions of alcohol researchers, George Valliant and Marc Schuckit.

    With regard to more treatment for those who are addicted, many believe that those with addiction should be receive “Medication Assisted Treatment”. This means that the treatment will be the administration of a mu-opiate receptor agonist (methadone or buprenorphine). Presently, there is no clear definition of addiction. Many of the current users of illicit opiates are not physically dependent, although they do seek drugs. If these non-physically addicted people enter treatment with methadone or buprenorphine, which requires that the opiate receptor drugs are constantly in the body, they will become physically addicted. The treatment will thus move them from the category of occasional user to truly dependent. Moreover, there will be another type of opiate drug in the family medicine chest: buprenorphine and perhaps, methadone, if the client has qualified for take-home privileges. More young people will then have another source for experimentation which they are being told is medicine.

    Consistent with the point Richard Lewis previously stated, ironically, opiates may not even be a good solution for ameliorating the distress of those in chronic pain. There is a pretty big literature showing that chronic use of opiates enhances pain transmission in the spinal cord. (The explanation has to do with foreign molecules activating the immune system and the white blood cell hormones then enhancing pain transmission. See the review article by Hutchinson, Shavit, Grace, Rice, Maier, & Watkins in Pharmacological Reviews.) Readers of this web site, may recognize a familiar story. As with antidepressants, in the long run, the drug makes the condition the drug was intended to ameliorate even worse. I’m not suggesting that opiates should not be used to ameliorate of the terminally ill cancer patient. I am saying that the pain patient who has reason to believe he/she won’t be dying in the near future, should seek a better solution.

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    • Dr. Littrell, at the very least tens (quite possibly hundreds) of thousands of chronic pain patients on opioid medications – and their doctors – have found that there IS NO BETTER SOLUTION! At least not yet.

      Significant numbers of patients are able to function, work, maintain a home and relationships when they are on opioid medications — and utterly UNABLE to do so when they aren’t. See Mrs. Spero’s post below, as but one example among thousands. What would you do for those who have chronic pain that doesn’t respond to non-opioid measures?

      For that matter, why is physical dependence on medication for pain control considered to be such a horror in view of the alternatives? Chronic pain patients on opioids are NOT addicts! Most do not get a high from using these medications, even if they may display both horrid pain and physical withdrawal symptoms if suddenly withdrawn from them.

      We cannot decrease opioid overdose deaths by ratcheting up the agony of millions of people!

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      • Dr. Litrell, Have you ever experienced severe debilitating pain? Pain so bad you curl up in a ball and beg God to take you?! DOUBTFUL. I don’t expect anything less from addiction specialists such as yourself who make it sound so easy, Opiod therapy is the LAST RESORT for nearly all chronic pain pts, such as myself. Opiods finally gave me a QUALITY OF LIFE (when I was on the right dose) Not anymore though. Im left bedridden, in agony, as my meds gave been reduced more than half, This is sheer torture. It is INHUMANE AND BARBARIC to allow the chronically ill to suffer.! So you are saying only those on their deathbeds should have access to pain relief!? Do you even realize that many pain pts are on their deathbeds!? We are at war with our own bodies everyday, Everyday another piece of me dies as I watch the workd go on without me. If it weren’t for my kids Id be another statistic, . Im lucky to get two hours of sleep at night , I open my eyes filled with tears from the pain. only to start the hell all over again. This is wrong! And it is also GENOCIDE!

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      • “chronic facial neuropathic pain”

        Had this along with severe migraine, it was related to bruxism and relieved by a special mouth guard during sleep and pretty much gone along with the migraine since the use of magnesium citrate. Hope that helps sufferers. No doubt the doctor will disagree. But I do understand the use of these terrible drugs: it is horrific pain. What I do not understand is the unwillingness to move away from this linear, stick to the rules – even though it’s killed a load of people – thinking.

        Reference:

        http://www.ijrrms.com/pdf/2013/jan-mar-13-pdf/10.pdf

        Magnesium blocks the NMDA receptor (can be seen as a antagonist) allows for normal transmission of glutamate.

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    • Many animal studies prove that exposure to addictive chemicals causes compulsive seeking of drugs.

      In the 1980s

      Rat Park was a study into drug addiction conducted in the late 1970s (and published in 1981) by Canadian psychologist Bruce K. Alexander and his colleagues at Simon Fraser University in British Columbia, Canada… http://www.google.com/search?q=rat+park+study

      Remember that ?

      The reason more young people are doing drugs like opiates is essentially because the “park” has been closed. That park we had the keg parties in pre 1990s “broken windows” policing when groups of young people were allowed to congregate and socialize and have fun.

      Crack down, zero tolerance, war on fun… we can even call it ‘police state’. 2016 is alot different than in the 1980s when only the popular places checked ID and we gathered in parking lots to drink and play stereos.

      The young people now they can’t go out and play like we did, no way, so they might hit the medicine cabinets and play video games then nod out in mom and dads basement or for danger adventure fun get street drugs hide out and do them cause the fun stuff we did in the 80s is all shut down.

      No way at all is the current drug problem related to left over oxys in the medicine cabinet. No way.

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      • One of the ways this theory was first established is through rat experiments — ones that were injected into the American psyche in the 1980s, in a famous advert by the Partnership for a Drug-Free America. You may remember it. The experiment is simple. Put a rat in a cage, alone, with two water bottles. One is just water. The other is water laced with heroin or cocaine. Almost every time you run this experiment, the rat will become obsessed with the drugged water, and keep coming back for more and more, until it kills itself.

        The advert explains: “Only one drug is so addictive, nine out of ten laboratory rats will use it. And use it. And use it. Until dead. It’s called cocaine. And it can do the same thing to you.”

        But in the 1970s, a professor of Psychology in Vancouver called Bruce Alexander noticed something odd about this experiment. The rat is put in the cage all alone. It has nothing to do but take the drugs. What would happen, he wondered, if we tried this differently? So Professor Alexander built Rat Park. It is a lush cage where the rats would have colored balls and the best rat-food and tunnels to scamper down and plenty of friends: everything a rat about town could want. What, Alexander wanted to know, will happen then?

        In Rat Park, all the rats obviously tried both water bottles, because they didn’t know what was in them. But what happened next was startling.

        The rats with good lives didn’t like the drugged water. They mostly shunned it, consuming less than a quarter of the drugs the isolated rats used. None of them died. While all the rats who were alone and unhappy became heavy users, none of the rats who had a happy environment did.

        http://www.huffingtonpost.com/johann-hari/the-real-cause-of-addicti_b_6506936.html

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        • ….the book you’re quoting the “Rat Park” experiment from is called “Chasing the Scream”, by Johann Hari, as you cited above….I had the great luck to hear Mr. Hari speak in person a couple weeks ago….I recommend the book highly. He was a very good speaker. The so-called “War On(some)DRUGS(sometimes)” is exactly the failure that it was designed to be…. And so-called “mental illnesses” are exactly as real as presents from Santa Claus, but not more real….The DSM-5 exists to list 300+ excuses to $ell Drug$…..
          ~The_Dog 😉

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  18. I have Lupus and very BAD Trigeminal neuralgia. My doctor is wonderful. I can’t take Gabapentin. I have serotonin issues and it made me crazy. I am on an opiate which my doctor has given to me. He has me taking it in a certain way so that I am benefiting from it, because my body is unique-as everyone’s is, he sees that we are not made from one cookie cutter. And yes, it is working on the
    Trigeminal neuralgia. So many doctors will tell you opiates don’t work on that kind of pain. Not true.
    If doctors were allowed to MOLD each treatment to fit each of their patients needs it would be wonderful. Funny thing when doctors were told to treat pain aggressively I was on a large dose-1 to 2 pain pills every 3 to 4 hours. I NEVER became addicted nor did I crave the medicine. The other thing was because I was trusted and allowed to make some decisions on when I would take my meds, I had more control. I felt good and was able to stop my panic meds. Of course, now that dosage would be considered excessive, but I was on that amount for years and never took more than needed.
    If doctors made us feel safe and trusted it would be a whole different world. I may be on a much lower dose now, BUT if I ever felt I was becoming addicted I could tell my doctor. He would help in every way possible. You see, it goes back to the patient and doctor making those decisions and nobody getting in between that relationship. I have some very serious pain. I don’t talk about it much, but I am pretty much encased in a pain-riddled body. All my muscles, face, neck, shoulders, arms, legs, back, feet and hips. (very long story) Before I met my current doctor, I went to at least 15 doctors. I gave up. The way I started thinking was so scary. I was now home bound, and could not even talk with my kids. My thought was “Well I am going to die. Once I die they will do an autopsy..and THEN THEY WILL HAVE TO BELIEVE ME”. I was that way for several years. Another thing we don’t talk about much, is that it isn’t JUST the physical pain, it’s what it does mentally. It’s like having someone singing the worst song you have ever heard in your head forever. Sounds funny but think about it- He is singing while you try to watch TV, eat, hold a job, sleep, take a shower and so on. It’s a different version of the Chinese water torture. People can only take it for so long before they explode! Some look to street drugs to relieve the pain- others, desperate to end their suffering, choose to end their lives. You are then not just looking for pain relief, but relief in your head.
    Sticking people on depression meds is COMPLETELY the wrong thing to do, but as long as the doctor is giving them “something”, they are treating them right? It looks good for them. In my group online, we have had over 14 suicides in the last year. And no, these are not people in crisis because of withdrawal or because they couldn’t get high. I did a survey for myself. I asked 300 people in my group if any of them were on depression meds, instead of pain meds. Out of 300 people, 274 were on one form or another- (Paxil, Zofoft, etc). Out of the 274 , 256 had no idea why they were on them. They were all assured it would alleviate their pain, yet only 3 said it might be helping. 268 felt they were not themselves on the meds. Only two felt they had actual depression, but the pain was not relieved with anti-depressants. When you have your pain medication taken from you, your whole life changes in 24 hours. You are not even given time to figure out what to do with your life. The whole thing changes in a few hours. I think it’s pretty normal to be scared and sad when this happens. It’s not depression, but a natural reaction. When you are diagnosed with a disease, at least you have time to get things in order. When your meds are taken you have no time.
    I own a very successful business, I have to move around a lot. I’m also a very high functioning person. Take away my medication and in a day I lose everything. I become a person who can not concentrate. My day moves from thinking about my next design to really nothing. Just crying, exhausted, and in pain. I can not even concentrate on TV shows or reading a book. It is a terrifying thought. Funny thing, all these groups and media personalities will talk about opioid use, but it’s very one sided. I run 3 groups. There are well over 5000 pain sufferers in these groups. Not one of us has ever been asked to do an interview. I’ve invited hundreds to join my groups to hear the other side -the pain sufferers’ side. Nobody will take me up on it. There are many of us. We are being abused, called names and made to feel very small because we have chronic pain. BUT we are starting to come out. We just are not a fearful anymore. We WILL find a way to be heard. If this doesn’t stop, in a few years we all will be on heavy depression meds, in pain and jumping off bridges in mass amounts. You can only be tortured for so long.

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    • “Sticking people on antidepressants is COMPLETELY the wrong thing to do ….” I do know from my experience of being prescribed an opioid (Ultram), in conjunction with an antidepressant (Wellbutrin), that combining these drugs is COMPLETELY the wrong thing to do, since they do have a major drug interaction warning on drugs.com.

      I’m not certain whether this is true for most opioids and antidepressants, but I do recommend checking drugs.com for drug interactions. And, absolutely, the antidepressants do NOT alleviate pain, but they do result in symptoms that get misdiagnosed as “major mental illness.”

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  19. Out of the blue my pain management doctor decided not to refill my opiod script till my next visit in June, it was nearly 3 weeks. I had to call and call just to get someone to answer my call. (lousy office management). They didn’t have or read my records and thought it was for breakthrough pain when it was the only medication I had for pain. Finally I got through to them and had to drive the hour and a half one way to pick up the script and go back home.

    I had to go to the ER the night before because my Occipital Neuralgia was out of control and I had no treatment to even lessen the pain, my second trip in as many weeks. Even the hand held scripts that have to be picked up versus letting the doctors call in the drugs like they used to can be a huge burden since many many people live in small towns and have to make long drives for pain management care. Being a pain patient is rife with problems that too easily cause our pain to become out of control requiring expensive ER visits when the doctors try to limit our opiods out of fear of the suggested guidelines for primary doctors, not for them, instead of doing what needs to be done to help prevent and not just treat our pain when it occurs. I have acute exacerbations of my types of pain, Trigeminal and Occipital Neuralgia. I was even put in the ICU when my pain became intractable from ineffective medications. The CDC needs to see the what it is like to be a pain patient and learn from us that we are not addicts. We don’t fit the DSMV criteria in any way. That we use our drugs correctly, except for a very very few. We should not be punished for what addicts do, they will always be able to get their drugs of choice. The rest of us have no idea how to do acquire illegal drugs and would not do it unless the CDC continues to push us further and further over the cliff. It will eventually be down to very few choices, live with unbearable pain, commit suicide, buy illegal drugs unless we are lucky enough to live in a state with legal medical marijuana and have a condition that is covered in the short lists of conditions allowed. (I am in Illinois). I don’t know how else I will be able to treat my pain if my access to effective treatments both opiods is limited. Other modalities can help but when they are not 100% effective, I, we often an opiod so we don’t suffer day in and day out. or live in near paralyzing fear of the next acute attack.

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  20. To Richard Lawhern and others

    Stepping back for a moment from the contentious nature of this dialogue I would like to pose the following questions:

    1) What percentage of chronic pain patients have also been given some type of psychiatric diagnosis along with various cocktails of psychiatric drugs?

    2) What role has the use of psychiatric drugs, with all their negative side and “main” effects (and the use of psychiatric labeling in these cases) had in the progression of the chronic nature of protracted pain disability?

    3) Should the use of antidepressants in these cases be looked at as a causative factor in the high numbers of suicides?

    4) Should we call opioid dependency in some cases “iatrogenic dependency” as has been advocated for with benzodiazepine dependency?

    5) Are a certain percentage of chronic pain patients victims of “iatrogenic opioid dependency” (that is, medically induced and damaging dependency encouraged by Big Pharma and poor medical practices) which initiates a cascade of unforeseen medical and psychological deterioration in these patients – all of which leads people into the clutches of Biological Psychiatry and their brain disease/drug based paradigm of “treatment?”

    Richard

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    • To Richard D Lewis (addiction specialist 19 years), and Johanna (paralegal/workers comp)

      I have been a physical rehabilitation therapist for over 35 years and have worked with thousands of children and adults with a variety of diseases and conditions, to include work in pain management clinics and psychiatric units. I have performed many worker’s comp evaluations and made many recommendations. Richard Lewis (addictions clinician for 19 years) asks the question whether or not there are coexisting psychiatric diagnoses in chronic pain patients. Ms. Johanna(worker’s comp and paralegal) and Mr. Lewis also seem to think that the “new” alternatives for pain management lie in exercise, rehabilitation/PT, and OTC medications. Anyone who has chronic pain themselves or has worked with multi-disciplinary teams in pain management to include physicians, surgeons, physical therapists, psychologists, worker’s comp/work hardening programs etc. knows that we need to use a combination of treatments to include pain meds, and there is a mix of so-called “normal every day people” coming in for treatment with the intention of returning to work or other “functional” roles, and the ones we consider “malingerers” or those with so-called ” co-existing psychosomatic or psychiatric illnesses”. The latter are a low percentage. There is nothing new about genetics and epi-genetics. There is nothing new about trying to attach any of these diagnoses, or for that matter misdiagnosis, to assist in determining a patient treatment plan. There is definitely nothing new about the prescription of non-narcotic and OTC medicines, alternative therapies such as physical therapy, acupuncture, massage, myofacial release, TENS, galvanic stimulation and many, many more. The idea that we are re-packaging these same treatments and selling them as “new” is a fallacy. Many chronic pain patients started out trying all of these so-called treatments being sold as “cures”. There is also nothing new about pain psychology or the use of psych meds to treat mental illness or the accompanying anxiety and depression that goes along with chronic pain and illness. Many have failed these over and over. Is that the patient’s fault?

      Treatment teams routinely encounter these issues on the front-lines every day. If you have been in the business long enough you do not need to argue whether or not these populations exist or require some expensive research study or war of the minds to determine efficacy or incidence. Furthermore, it is likely that the very people who are wearing the “white lab coats and carrying the clipboards” who assess these patients, may have similar conditions to include co-existing psychiatric diagnoses and/or personality disorders etc, along with a variety of medical conditions. If we drug tested and psychologically evaluated every person in the US we would probably find a significant number have some underlying behavioral dysfunction or are taking legitimate narcotic pain or psychiatric prescriptions on the job to maintain function in the work place and home. Let’s not kid ourselves. There are millions of people in the work force taking narcotics and psych meds for a variety of legitimate conditions and continue to be high functioning productive members of society. Now many of those have been added to the disability roles because they have been denied the pain medication or psych meds that helped them function. Big Brother and risk management departments everywhere know exactly what prescriptions you are on and how much you or your family costs the company and country in healthcare. That my friends is what this war is all about, money, and weeding out of the weak and “burdens on society.

      So this brings us back to the war on innocent pain patients. Does it really matter who has a co-existing psychiatric disorder and chronic pain? Schizophrenics develop the same painful and debilitating conditions as the rest of us. I urge you to stop in to your local hospital burn unit, children’s cancer ward, nursing home, or veterans rehab unit. You will see “real pain”. Someday we will all face pain and suffering. The Federal and State Intractable Pain Laws, American’s With Disabilities Act, Civil Rights Laws, and the AMA, all give patients the right to be treated with medications to include narcotics, to relieve suffering, and choose medications over other therapies or invasive treatments. Where are all the fancy disability attorneys, politicians, federal, state, and non-profit advocacy groups who signed these guidelines into law? We have not heard a peep from them. If we are keepers of the law we know that what has been thrust upon thousands of innocent people everywhere may be considered at the very least medical negligence and abandonment.
      When will Modern Medicine,Psychiatry, and Alternative therapies admit that although we have made gains, the fact remains that over decades we have not been able to, without the use of medications to include supplemental opioids, effectively treat or cure human diseases and psychiatric conditions that have existed for centuries. We just keep billing Medicare, Medicaid and private insurance for the same failed treatments over and over. Medicine is a business as is Psychiatry, and Alternative Therapies.

      In my opinion we have become nothing more than greedy salesmen burning the engines of corporate profits and patient care at both ends. We have become nothing more than boasters of knowledge, all at the expense of innocent people we call “patients.” My plea is for you all to take off your white lab coats, erase your credentials, and put down your clipboards. Listen to what legitimate people in pain are saying. They have been trying alternative treatments for years with limited long-term relief. They are saying opioids have been the least restrictive and have provided optimal function for many years. Who needs to do a study? We have thousands writing congressman with their stories. There are bad side effects for just as many OTC drugs. Do we tell diabetics that they cannot have their insulin because they are overweight and have bad eating habits? There are people suffering and threatening to commit suicide. This is Auschwitz revisited. There are too many of us too far removed from the reality of this situation.
      Let’s see what we can agree on and do about this mess of innocent human suffering we are seeing as a result of this so-called war on drugs.

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    • Mister Lewis,

      You posted five questions in what you and I both acknowledge to be a contentious discussion. In a spirit of fairness, I’d like to respond to your questions even if incompletely:

      ollowing questions:

      1) What percentage of chronic pain patients have also been given some type of psychiatric diagnosis along with various cocktails of psychiatric drugs?

      <<<<I don't know the percentages in this specific population (chronic pain patients prescribed psychiatric drugs). I rather doubt that much has been published, apart from some of the studies mentioned by Maia Slavovitz. But one thing I do know: depression and anxiety are widely known to be comorbid with chronic pain. They are natural reactions to the circumstances and isolation which chronic pain creates in family and social life.

      I also know that when a medical or psychiatric professional misinterprets cause and effect in these circumstances, chronic pain patients suffer. When a diagnosis of "psychogenic pain" is appended to a patient's medical records, the reliable result is that the patient will thereafter have much more trouble being taken seriously when they report symptoms — and that many will be labeled drug seekers. I have addressed this outcome in a researched paper published by the Society for Humanistic Psychology: "Psychogenic Pain and Iatrogenic Suicide."

      2) What role has the use of psychiatric drugs, with all their negative side and “main” effects (and the use of psychiatric labeling in these cases) had in the progression of the chronic nature of protracted pain disability?

      <<<<<The underlying and unspoken assumption of your question is that psychiatric drugs promote disability by causing progression of pain. That may be true in some people. The side effects of both antidepressants and anti-anxiety agents can include sexual dysfunction, mood swings, emotional volatility, cognitive and word finding difficulty, and a host of related problems that directly impact the patient's ability to work and function socially.

      An important reservation applies, however: these effects will vary greatly in any population placed on the same dose of the same medications. And the variation appears to be at a genetic level, in the efficiency of metabolism for the specific drugs. So it is very hard to draw seriously useful generalizations from this outcome.

      3) Should the use of antidepressants in these cases be looked at as a causative factor in the high numbers of suicides?

      <<<<It is now generally known that use of antidepressants in ALL cases (not just chronic pain patients) are associated with increased rates of suicide. One factor that may be operating in this outcome is that it is also known that antidepressants are no more effective than placebo in treating mild to moderate clinical depression. Patients expecting to improve markedly rather often have their expectations dashed. Some patients "crash" emotionally. So there is at least a plausible connection quite separate from the chronic pain experience.

      Suicide has been studied seriously for many years. One of the better studies of chronic non-cancer pain and suicide was done by Mark Ilgen and his colleagues at the Veterans Administration, following over four million VA patients with seven types of non-cancer pain for three years. The highest risk was in patients diagnosed with "psychogenic" pain, 90% of whom also had diagnoses of one of six other types of chronic pain. But the evidence supports the insight that it was the diagnosis itself which caused the increased risk, by driving patients into despair and denying them further medical support and investigation for their actual medical disorders.

      4) Should we call opioid dependency in some cases “iatrogenic dependency” as has been advocated for with benzodiazepine dependency?

      <<<<Note that physical dependency is not the same as addiction. Disproportionate drug-seeking behaviors and obsession do not occur in the great majority of chronic pain patients. Nor do they get a euphoric high.

      I am not at all sure that association of "iatrogenic" (caused by treatment) and "dependency" is particularly useful in this context. The patient is using opioids because nothing else works for their pain. Despite the over-confident assertions of some addiction specialists that alternatives exist and are effective, patient experience largely doesn't support that conclusion. These alternatives can be adjuncts in a larger treatment plan that includes opioids as a central element of pain management. But make no mistake: even when opioid dose levels can be decreased, total withdrawal of these meds will often plunge the patient into agony.

      5) Are a certain percentage of chronic pain patients victims of “iatrogenic opioid dependency” (that is, medically induced and damaging dependency encouraged by Big Pharma and poor medical practices) which initiates a cascade of unforeseen medical and psychological deterioration in these patients – all of which leads people into the clutches of Biological Psychiatry and their brain disease/drug based paradigm of “treatment?”

      <<<<Your premise is complicated, Mister Lewis. Without doubt, Big Pharma has fraudulently misrepresented the risks of opioid treatment. But whether psychological deterioration of chronic pain patients is among those risks, remains a speculation that clearly doesn't apply to all of those who are prescribed opioids under medical management. In many people with whom I have personally interacted, opioids have stabilized their lives and allowed them to function, to work, and to maintain a compromised but still viable family life. We don't typically see those outcomes in addiction to illicit drugs.

      There is no one size fits all "solution" for either chronic pain or addiction to illegal opioids. Many factors must come together. High on the list of those factors must be better doctor training in the management of chronic pain, and recognition that a large majority of properly screened and managed patients are at low risk for addiction. That said, there is definitely a need to better manage and restrict diversion of medications used at home.

      Regards, Red

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      • To Richard Lawhern and Johnna

        Thank you for your thoughtful and pointed responses to my 5 provocative and complex questions.

        This blog was published at the Mad in America website which focuses its writings and dialogue on a critical appraisal of modern psychiatry and the current “mental health system. Mr. Lawhern, there had to be some related reasons for you to have published this blog here and I am trying to draw out some of those connections.

        And to Johnna, when you challenge me by saying “why don’t you do something about it” regarding Psychiatry and their mass drugging and psychiatric labeling of people (including chronic Pain Patients – CPP): I want to respond by saying that I worked for 22 years in the community mental health system and have fought hard from the inside opposing the takeover by Biological Psychiatry. I am also a frequent writer here at MIA and have authored over a dozen blogs critical of disease based labeling and psych drugging.

        In fact I would say that psychiatric drugging has overwhelmingly replaced therapy as the standard of care in this system and it has been disastrous for millions of innocent people. I now have zero trust in Psychiatry and only believe a tiny percentage of psychiatrists can actually help people, and only those who reject the diseased/drug based approaches to care.

        So all the labeling that you refer to such as Bipolar Disorder, Depressive Disorders and Anxiety Disorders that frequently get attached to Chronic Pain Patients, I believe are fictitious and very harmful to people, especially the cocktails of Psych drugs that follow the label. Of course some of the feelings and behaviors that get labeled as “symptoms” are real, but I believe they are clearly a result of a person’s own conflict with their environment, and the related disabling effects of unresolved pain.

        To build off of your answers to my questions I would like to offer my own observations and speculation on these questions.

        I would venture to say that the vast majority of CPPs have been labeled (especially with Depressive and Anxiety “Disorders”) and given various cocktails of drugs. While these drugs may not have caused an actual increased sensitivity to pain I believe they would have certainly EXACERBATED these conditions and created a host of separate, and no less debilitating type problems, that would only compound the totality of disabling effects.

        Increasing evidence indicates that antidepressants are a causative factor in suicide and acts of violence against others (look more closely at the spate of mass shootings and their connection to psych drugging). These drugs can escalate depressive type feelings to a level of agitation that often provides enough energy and “edge” to that state of mind where suddenly suicide progresses from only thoughts to some type of decisive action. All of this must be seriously looked at when discussing and evaluating the high rate of suicide among CPPs. This is NOT meant to minimize the horrors of chronic pain by itself, but to look more carefully at ALL factors involved in these cases.

        For all these reasons, I believe as much anger and angst expressed against the medical establishment’s treatment of CPP’s for withdrawal of opiates (and targeting as “addicts”) should be directed towards Psychiatry and the “mental health’ system for all its labeling and dangerous psych drugging which compounds and escalates disability issues.

        While we may have some difference over the actual nature of the opioid crisis and the long term role of opiates as a standard of treatment for these problems, we actually have far more in common when it come to mounting mutual forms of opposition to psychiatric abuse. We can’t under estimate how much this could be a factor in CPP cases.

        That is all I have time to comment on at this time. Thanks again for your responses to my questions.

        Respectfully, Richard

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  21. I was just wondering if either Mr. Lewis or Mrs. Ryan suffer with chronic pain issues? I was born with hip dysplasia and now have no cartilage left in my hips. Bone on bone condition with bone spurs and bone cysts. I do physical therapy everyday. It is necessary to keep muscle strength but in no way does it make my pain go away. In most cases more use means more pain.

    I guess what I am asking is do either you have a clue about what real pain is? If either of you do suffer from long term chronic pain, then have the measures you just listed kept it at bay without any pain medication? If either of you don’t have chronic pain and you are just repeating what the anti-pain med lobby is advocating then I don’t think either of you can speak for those of us who have used medication responsibly for real conditions involving pain.

    Also the New Heroin Epidemic has been created by this movement to deny pain medication to legitimate pain patients. So in a way those who are pushed into street drugs or take their lives and die as a result should be considered premeditated murder victims. Murdered by the persons who are pushing this agenda. Just like denying food and shelter to a child resulting in death would be.

    I read an article on Prince’s death that talked about the records that are generated when a person fills a prescription. The data is being stored but no one is looking at it until a person dies. The records that show Prince was filling multiple Percocet prescriptions may have saved his life if someone was paying attention. I have no problem with these records being kept because I am not doctor shopping or losing my meds all the time. To keep such records and then say we can’t look at them because it violates one’s HIPPA rights it just stupid. However, it is perfectly fine to violate all my civil rights as a legitimate chronic pain patient who does not abuse drugs.

    I really think all of this needs to challenged in court. People’s pain and suffering is being exploited. State and Federal Enforcement Agents are actually killing people through not using the information right in front of them. As well as pushing people affected to dangerous street drugs and or suicide. Some others are having risky surgeries because their meds have been cut down or cut off only too be in more pain and possibly worse off or dead.

    I appeal to all the personal injury attorneys out there. People are being injured and we need legal help. Start helping those of us who can stand up in court and defend ourselves to have some quality of life. Maybe if all of us filled a complaint with the ACLU nationwide we might start something in the courts. We have got to start somewhere or very soon all of us will be labeled as drug addicts with no credibility what so ever. This has already taken root since people like Mr. Lewis state we are all addicts no matter what and to just do the things on his list and you will be fine.

    Last question. Are we all food, water and air addicts because we seek this stuff out continuously in order to live? Overeating and Obesity is killing more than drug overdoses, but nobody is restricting all the junk food or preventing those who should not eat it from doing so. Ultimately people die from this and it cost the taxpayer huge amounts of money for disability and healthcare.

    We just need reasonable and rational ways to provide the care that is needed. We also need to be on the lookout for those who do have problems with habit forming drugs. Any of us can fall into that trap, but there are some with a genetic predisposition to abuse drugs . I heard that in my State when a person gets a DWI now they are tested for the addiction gene profile. If they carry the genes that make addiction more likely the system takes special precautions to prevent a relapse with that person. Basically they are followed more closely and offered the support to stay out of trouble. These things can be accomplished instead of making everyone suffer for the behavior that a few out of many are faced with.

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    • “The records that show Prince was filling multiple Percocet prescriptions may have saved his life if someone was paying attention.”

      Maybe prince but if they would have caught me all I would have gotten is screwed , traumatized and turned into cash cow for the state.

      “If a person is convicted of doctor shopping, the penalties are rather severe. That person would be guilty of a felony and may be imprisoned for not more than eight years or fined not more than $50,000.00, or both.” http://www.google.com/search?q=doctor+shopping+laws

      I would have been coerced into a plea bargain and then set up to fail by the requirement that I stay sober that I would have disregarded when the first or second post acute withdrawal panic attack hit. Of course then I would test dirty and get further screwed , jailed traumatized… maybe get out if I agree to comply with psychiatric treatment… SSRIs lithium maybe some Zyprexa.

      Believe me a system designed to punish criminals does little but drive more addicts to suicide and overdose. I have been though the system do to drug / alcohol dependency, years later here we are and look at my posts.

      “The world would be a better place if all those court psychos got sick and dropped dead tomorrow.”

      Do I sound like a person that was helped ?? Gee thanks I had an anxiety problem and got caught up in pills, “thanks” for helping me. You can go to hell now.

      The criminal justice system was designed to deal with people who rape women, murder and do genuinely evil things that damage other people.

      Guns in case they need to kill you and handcuffs and cages, these are not the tools to “help” people, they are some of the most hideous things ever invented by mankind.

      If they really want to help us “addicts” they should try some care and understanding, maybe sacrifice a little of their budget money for prosecutors and guns and handcuffs and tasers and cages and make you suffer things for some better treatment options.

      I really didn’t plan on a harsh rant like that, sorry, its not you, memories came back. Maybe they would have helped Prince with his team of high priced lawyers but if you are a regular person with a public pretender and an addiction problem YOU are screwed. Its like falling into a venomous snake pit.

      I can’t speak for all “addicts” I hate that label , I can’t speak for all but I would prefer that if addiction ever gets its hooks into me again they just let me die instead of making me go through that hell they call help again.

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        • You have read enough of my posts to know my view on that. Its not really rich vs poor or racial at all. Its Liberty vs Tyranny.

          Rich people just have a better chance against the tyrants.

          When exactly was it when people stopped saying “its a free country” as a comeback to an argument ? Say that today and people give you that ‘not really’ look.

          And also you have 24 hours to show ID then pee in this cup wile we look at you genitals …

          Have a nice day.

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          • Why I said “unwitting” is that you describe very passionately the outrages of class rule — such as the differences in justice and “treatment” for rich and poor — but still seem determined to call it something else. A tyrant without money is just a loser.

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          • When white people owned black people, they were not free, and when black people are denied the same opportunities that white people get as a rule, they are not as free those whites who are so privileged. Ditto, brown,yellow, red and purple people.

            Liberty without social justice is going to be one form of tyranny or another because that’s how tyrants get to be tyrants, through the exercise of their precious freedoms, specifically the freedom to attain more for oneself by taking it from others. King of the mountain, Mr.This Or That spawn of the age of industrialism, didn’t get there by being Mr. Nice Guy, he got there by exercising his freedom to step all over the freedoms of other people.

            If you were to judge people totally on their estimated market value, as most of us aren’t valued that much on Wall Street, what you’d get would be an absolutely fascist situation. There is the 60 billion $ man, for instance, together with his comperes on some Forbes Magazine list, and then there is most of the population. I’d say the time is long over due to give some ear to the concerns of people who don’t own their own private jets.

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    • I just have to correct one thing about your comments on Prince. He didn’t die from the Percocet, he died from illicit Fentanyl that was not prescribed. In addition he left a suicide note, but the main news media didn’t cover that. He was in a lot of hip pain. I believe he just reached the end of his rope with regard to the hip pain and it very well could be that the percocet prescriptions he was given were not adequate for his pain, hence he was filling them constantly. In the end though he bought powdered illicit fentanyl and that is what killed him. The heroin epidemic and deaths we are currently seeing now are actually due to Fentanyl that is coming in from China and being “cut” into the heroin and sold. The CDC statistics are terribly flawed and they even admitted that the numbers are wrong but have yet to correct this on their website. From this site here some quotes: “turns out many of those deaths may have actually been caused by fentanyl, a synthetic opioid 50 to 100 times more potent than morphine. We’re not talking about pharmaceutical grade fentanyl legally prescribed in transdermal patches or lozenges to treat chronic pain, but bootleg white powder fentanyl manufactured in China and smuggled into the U.S.

      The DEA says there were 5,544 deaths caused by fentanyl and other synthetic opioids in 2014, but admits “the true number is most likely higher.” The actual number is not known because many coroners and state crime laboratories do not test for fentanyl.

      What medical examiners do often test for in suspected drug overdoses is heroin – and that is why the statistics on heroin should be taken with a grain of salt. Because the real culprit is often fentanyl.

      “Most of the areas affected by the fentanyl overdoses are in the eastern United States, where white powder heroin is used,” the DEA report states. “Fentanyl is most commonly mixed with white powder heroin or is sold disguised as white powder heroin.”

      Massachusetts and Rhode Island – two eastern states with big heroin problems – recently came out with reports showing that fentanyl, not heroin, was to blame for nearly 60 percent of their opioid overdose deaths. The states used toxicology tests that are far more accurate than the death certificate codes used by the DEA and the Centers for Disease Control and Prevention.

      The DEA and CDC overdose statistics are muddied even further by the fact that heroin deaths are “often undercounted” and blamed on morphine, a prescription painkiller.

      “Many medical examiners are reluctant to characterize a death as heroin related,” the DEA admits. “Thus many heroin deaths are reported as morphine-related deaths. Further, there is no standardized system for reporting drug related deaths in the United States. The manner of collecting and reporting death data varies with each medical examiner and coroner.”

      Why does any of this matter to chronic pain patients? Because deaths caused by fentanyl and heroin are being lumped together with overdoses caused by prescription painkillers. The CDC has been doing it for years to build a case against opioid pain medication and to justify its release of guidelines that discourage doctors from prescribing opioids for chronic pain.

      Prescribing of opioid pain medication has been in decline for several years and hydrocodone prescriptions have fallen by 30 percent since 2011. Yet the CDC claims there was a sudden spike in opioid analgesic deaths in 2014 and that nearly 19,000 Americans died.” http://www.painnewsnetwork.org/stories/2016/7/1/dea-hundreds-of-thousands-of-fake-pills-in-us

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  22. What I would like to share is the number one reason there is so much abusive crap in this country or world. The reason there is so much abuse in so many different ways is because for some reason abusers get a free pass if they are “just doing their job”.

    The government or any entity will come up with some policy that’s anything from really unfair all the way to the most horrific things that go on behind locked doors. It doesn’t matter what it is, the people doing it somehow get a free pass if they are “just doing their jobs”.

    You get angry and complain to other people about it and more often then not many will tell you not to be upset because they were “just doing their job”. That free pass people get for “just doing there job” is absolutely the most damaging thing in our entire society.

    How how how is it OK to hurt people just cause its your job ??? I see YOU need a paycheck so I have to take this crap, selfish F

    THIS entire subject of the war on pain patients wouldn’t even be here if people were mean and nasty to other people who are “just doing their job” of instituting abusive policies. If someone is just doing there job hurting you it is OK to hate them. But only bad people hate… That is not true.

    Why do I try and stir up hate ??

    The name of this is the WAR on pain patients and to win a war you always need hate for the other side in your heart.

    Now think about those selfish politicians that don’t give a crap about pain patients and just want to look good in the newspapers “doing something” with full knowledge that people are getting hurt.

    How many of you would like to bust a knee cap of a person who called you a drug seeker then tell them they are faking the pain ??? Its OK to think it, its human, just don’t do it or you will get in some nasty trouble

    Hating the opposition doesn’t make you a bad person, it helps you win.

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  23. It was reckless and stupid of the government to take pain medications away from patients without having anything to replace them with. The DEA caused the heroin “epidemic,” and the CDC and FDA are just making it worse.

    But I think pain patients don’t understand that the government knew this would happen. Certain “experts” have admitted as much. The government knew desperate patients, including those suffering from pain and/or addiction, would go to the streets to use unregulated and often poisonous substitutes. They believe that the opioid war will save lives — in the future, not now. Less patients being offered opioids. Less doctors prescribing them. Less drug addicts. And if anyone in the government really understood addiction, then they would know that it doesn’t work this way.

    Denying medications to those who suffer from acute, chronic, or terminal pain amounts to torture. And anyone who believes that restricting the supply will decrease the demand needs to get their head examined.

    No More Drug War.

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  24. I generally agree more than not with what you have written, but I do have to write some things, things that even the most anti-drug war people seem to be unaware of, but is vitally important. And this is that no drug is inherently addictive. There is absolutely no evidence of any kind of brain disorder. There are certain neural correlates in heavy users (every behavior has neural correlates, every habit, not just drug use), but there is absolutely no causal link established in all the literature on the topic. There isn’t even any established correlation between an increase in preference and neural correlates. Not even for heroin.

    Which brings us to the core of the issue: You have to believe you are addicted to feel addicted. This might sound surprising but evidence shows that it is our ideas about drugs that lead us to behave in certain ways. As such, the percentage of users of a certain substance who have a problem with it is not fixed. Right now, in the US, about 17% of nonmedical users of opioids are problem users (yes, even problematic nonmedical users are actually a minority of all nonmedical users). The % for heroin is higher but this has much more to do with social and psychological context and set than with the drug itself.

    There have been historical periods where only 1% (!) of opium users were actually excessive users. I believe the Punjab region at some point. And generally, moderate opium use was the characteristic use of the majority of Asian users.

    A highly recommended book is The Cult of Pharmacology. I would also recommend the writings of Steven Slate.

    I write none of this to encourage drug use. But I believe a paradigm shift is necessary. The sooner it happens, the better.

    I would also point out research that deals with predicting relapse. The two most important factors predicting it are lack of coping skills and…..belief in the disease model of addiction. Therefore, the mainstream model is actually HARMING people, not helping them.

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  25. Welcome to the official IPA (International Paruresis Association) website.

    This site is provided as a resource for people who find it difficult or impossible to urinate in the presence of others, either in their own home or in public facilities. Also, for people who have difficulty under the stress of time pressure, when being observed, when others are close by and might hear them, or when traveling on moving vehicles. http://paruresis.org/

    The wantpeople peeing in cups for their fascist anti drug programs but for many people observed drug testing, eventually public urination, is very difficult or impossible.

    Applying Americans With Disabilities Act law to persons with paruresis and drug testing, one must show that paruresis creates an impairment (i.e. inability to urinate), that this impairment qualifies as a disability for purposes of the ADA, and that the condition “substantially impairs” one or more major life activities.

    More http://paruresis.org/drug-testing-reform/

    Fight back.

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    • eventually public urination… NO essentially public urination
      Stupid Spell check .

      But anyway pass on this information to as many people as possible, its just EVIL when you can’t pee and then get people make accusations of drug use.

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    • You know its embarrassing but I have this condition.

      I was in treatment and they did testing and my anxiety turned to anger having to explain myself and I let everyone have it real bad.

      Calm down you are scaring people… Good now you all know how anxiety feels. Not one of my best days.

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  26. I am a chronic pain patient on opiods since 2010. I have never broken my contract with my pain management doctor. Never sold or bought my pills illegally, use only one pharmacy. Never tried other illegal substances.

    Suffice it to say that without sufficient control of my pain I would not be writing this reply today. I even spent 4 days in the ICU when my pain became impossible to be controlled any other way and I was afraid I might take my life out of desperation to end the pain.

    If those of us who depend on opiod pain management are not allowed to have opiods; a scenario that is not unimanginable anymore, I fear what might happen when my pain is at a level 10 and nothing works.

    I have nerve pain, neuropathy, Trigeminal and Occipital neuralgia all caused by toxic medications that permanently damaged my neurological system. There is no physical therapy, TENS units don’t work, psychotherapy will not make it go away, OTC meds are useless. Believe me, before my diagnosis, I tried every single thing I could out of desperation for relief. I ended up putting myself in a psychiatric unit before diagnosis because I thought I was going crazy. Turns out is was the Trigeminal Neuralgia.

    Opiods, taken in small doses, allow me to do more than I would without them. Still, I am permanently disabled but being able to cook a simple meal or sew or create my art are only possible when my pain is controlled by low dose opiods. I do not like taking them and do not want to take them but my other choice is to live in the ER or consider taking my life because I am in untreatable agony. Surgery is out of the question because I do not have a functional cause, just toxic damage.

    If the United States would make Medical Marijuana legal in all states for any chronic pain cause, some of the need for opiods could be lessened but there will never not be a need to treat chronic pain patients with opiod pain relievers. They give us quality of life, in fact for many, they keep us alive. Very few of us abuse them or misuse them or seek drugs illegally. We are the ones who are going to suffer if these new policies are implemented. The poor maligned addict will not suffer, they will always be able to find and buy illegal substances. Whereas most pain patients, including myself will not do this nor do many of us know how to buy illegal drugs. Many of us are afraid we would be arrested and end up in prison. So either way, take away our legal pain medications or make us learn how to buy them illegally, is not a choice for us. It is sad that we are being blamed for prescription drug deaths and inhuman that we even have to fear not having adequate treatement for our pain. I hope our drug czar and the CDC are listening.

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    • RE: I hope our drug czar and the CDC are listening.

      How everyone start printing all these testimonials and then start mailing them to these people.

      If there are and militant types in this movement it would be easy to get a can of spray paint and write The War On Chronic Pain Patients on a wall by a busy intersection and a hashtag.

      Better, rent a billboard.

      Outdoor Advertising – Billboards for Rent
      http://www.outdoorbillboard.com/billboards-for-rent

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      • Dear all,
        I’m in the UK. Here in our pain clinics we offer all the wrap around non med interventions and some people also take opiate meds. Pain is pain and needs to be treated compassionately allowing dignity.

        There is now lots of evidence to show that when pain medication is stopped people seek out illicit ways to manage their pain taking tables bought on the internet, heroin and drugs like Fentanyl. This has produced high overdose rates. People are dying. Its human nature to want to feel better and get rid of pain. Just because a Dr has stopped an opiate pain meds prescription does not mean the person will just suddenly stop needing that medication.

        Richard I did look at your questions, and you seem very passionate about this subject but it looked like you were trying to prove your own hypothesis. Im not sure what your driver is? It looked like you wanted to know the impact of people taking psychiatric meds and whether or not they also took pain meds in some kind of combo. Where you looking at consent and capacity? Im not sure.

        America has got a shocking human rights deficit on non treatment for people who are addicts. Twelve steps dominates the treatment culture and it is only now being looked at to introduce a medically managed route. This is due to the high number of deaths from people self medicating.

        Its got very messy and the two cultures are meeting. People who have had their pain meds stopped are now entering a criminal culture to get relief from pain.

        Forcing people to stop opiate medication for pain relief will not work. We need compassion, dignity and choice of treatment. We need support for people who do want to try a non opiate pain pathway. We need less people overdosing on illicit medication.

        Kind regards,
        Josephine

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  27. If I did not have access to pain meds, I would not be able to work and I would likely commit suicide.

    I have tried everything: physical therapy, chiropractic, heat, ice, acupuncture, massage, NSAIDs, epidural injections, radiofrequency ablation, surgery, TENS units, yoga, t’ai chi, even an implanted spinal cord stimulator. That thing worked only until I had a lumber fusion; then the battery pack was more painful than other parts of my body so I had to have it removed. Ultimately caused more trouble than it resolved.

    My sister, who lives in a small town, cannot get pain meds from her primary doc because he’s afraid of the DEA. So she now has to travel 100 miles every month to a big city, just to get a paper prescription.

    Neither of us is on a high dose of meds: just Vicodin. We’ve both been stable on these meds for a long time, with an occasional bump for things like travel. I used to be on a lot more meds but tapered myself down to the lowest possible dose on which I can function (work). I used to get my meds from a pain doc, who counted my pills every month and reviewed prescribing information. She also drug tested me every month. I finally fired her after she got furious that I had gone to the ER (I had pneumonia) and they gave me a few pain pills because I separated ribs coughing. She thought I was drug-seeking. I had missed three weeks of work from that illness.

    Now, fortunately, my PCP prescribes my pain meds. She drug tests me once a year because she has to, and I am on a pain contract but she’s not all freaked out about it. She doesn’t question my judgment; she knows I will stay on the lowest possible dose. But I am really tired of being treated like a dope fiend at the pharmacy. I even once had a pharmacy that routinely shorted my narcotic pain meds, knowing I couldn’t complain without sounding like an addict. I am also fortunate to live in a state where they will treat post-surgical pain fairly aggressively, at least for 10-14 days post-op. It’s also a right-to-die state. I know it may come to that some day but I hope it’s a very long time, assuming I can get adequate treatment.

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    • I’m a member who chooses to take one psychoactive drug, and has withdrawn from others. I don’t use pain meds but I sympathise with the OP’s overall message.

      I’ve just about reached the “You’re dead to me” stage of grieving for that subsection of Online Mental Health Helpers that somehow feel entitled to comment on the substances that I ingest into my own body. I only give my doctor permission to make an arms-length contribution to my final decision, so I’m not about to hand over control to a bunch of internet strangers just yet! 😉

      I do wonder why there is any need to engage in war with patients/service users at all, for any reason? What purpose does that serve, except to alienate potential allies?

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  28. You know, this is why I don’t have time for this community anymore. First because, an article like this one is on the front page, which is a complete and total waste of time and space. Second, because there’s then a discussion thread so long that were I to actually try to do anything other than skim it, I’d be here for hours. But since I’m up early this morning for no clear reason, I’ll go ahead and have something to say:

    In reality, speaking as both a chronic pain sufferer and a therapist working with sufferers of chronic pain, the issue is actually incredibly simple:

    Doctors were encouraged, and chose to, prescribe opioids like candy in ridiculous ways making lots of money doing it, while no one cared about the consequences. Then, when the consequences of such reckless and unprofessional prescribing practices started to enter mainstream consciousness, and doctors began to face scrutiny and inquiry, the chosen strategy has been to deny any accountability and focus completely blaming the patient, who was guilty of nothing other than FOLLOWING DOCTORS ORDERS.

    That said, denying an opiod problem is patently absurd. Claiming that the problem neatly rests only with unprescribed / recreational / street use and not through prescription is patently absurd. There is and has been a massive problem with opioid prescribing – and the fault and responsibility lies with the PRESCRIBERS not the patients following instructions. The outrage among chronic pain sufferers, including myself, is at being treated like criminals when we did nothing wrong. The outrage is NOT because changes are coming. Changes need to come. Its that right now the wrong kind of changes are happening.

    Thankfully there are good complimentary or alternative supports for chronic pain issues in addition to or in lieu of drugs. We are working in my local community to offer, health and wellness, mindfulness and meditation, acceptance and commitment based therapy for chronic pain, naturalistic alternatives all presented in the form of community groups and individual support coaches. We’re also offering harm-reduction approach support in dealing with withdrawal from opiods if that is a situation a person finds themselves in.

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  29. I suffer from serious chronic pain. I have had over 4 surgeries of the spine, and have done everything from intervertebral injections, physical therapy, and even bought a “tens unit” on the suggestion of my pain doctor. I went through zoloft, celebrex, some parkinson disease medication, and many many others that made me so sick and did nothing to give pain relief. In the end it was opioid pain medication that helped and gave me the ability to function again and be semi-active. I never had the need to keep increasing my dosage much, and generally my pain doctor would titrate me up a tad when my pain got bad then titrate me back down. I had to sign pain contracts, was forced to see and pay for psychiatrists to learn “mindfulness” techniques for me pain, I went through piss tests, blood tests, and buccal swabs, all of it billed to me. I am on a fixed income and on disability. I cannot tell you how all these “alternative” type treatments have cost me and I simply am unable to pay all these bills. My pain doctor was seeing me for over 5 years and then right after the CDC’s so called “guidelines” she dropped all her chronic pain patients and gave no referrals. I begged her to help me wean off these medications slowly for fear of going into severe withdrawal and being hospital bound, but she wouldn’t do it. She is scared to death of the DEA and what is happening with this whole “drug crisis” thing. Let me tell you, it is damned near impossible to find a good pain management doctor now. They have all closed their offices, or transferred to some other area of medicine. As a pain patient you can’t even get seen by a general practitioner the minute they hear you are a chronic pain patient with various health issues. I barely was able to find a doctor before running out of my medications and after seeing him for one month he too left and moved his officer an hour away from where I live! Yes, I have seriously thought that I should end my life, because being in so much pain and not being able to participate with your family and do simple tasks around the house like cleaning or getting dressed is not living at all. I can understand why many pain patients like me go out on the streets seeking medication. This isn’t something I personally would do, but ending my life is if I am back to being bed ridden and in so much pain all the time. The news is constantly making people like me out to be a drug addict and carrying on about how pain patients are the problem with the increase in opioids deaths, I am just sick of it. It is untrue, it is sensationalizing, and very stigmatizing. You can’t even go to the ER anymore without doctors and nurses thinking your drug seeking and wagging a finger out you. I give up. I really do. I feel like the Government has just gone so over board there is very little care for someone like me anymore.

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  30. Late stage Lyme now for 18 years.. for which the wonderful medical system could not help me. 5 years later they did however give me the “MS ALS” diagnosis. By luck I had a friend and began the “Lyme journey”. Years and years of pay out of pocket meds, traveling far to a Doctor willing to treat me.. 8 years later I was as well as I was going to get. Meaning.. the worst of the symptoms were gone.. paralysis and such better.. but left with what they were calling “post Lyme syndrome”.. severe muscular pain and damage and arthritis. It was better than before.. and with the pain pills my local Dr convinced me to go on, I was able to go to the gym and get myself stronger. I thought I was winning this war and at least maybe could go back to work doing something less physical. I could live some kind of a life.. even if it was never going to be like it was before the illness.. 5 years ago I started with these attacks in my stomach. Severe pancreatic attacks. Again.. no one seemed to know. Ended up going again.. far away at a University hospital where they found I had a choledochal cyst wrapped around my common bile duct that was stopping my digestion and also.. causing the pancreatic attacks. Spent these last 5 years going again from Dr to Dr looking for help.. the surgery is way too risky they say.. 2 months ago my family Dr wanted me to come down so he could talk to me. As i sat there.. he explained that the FDA, CDC and DEA have decided that there will be no more pain pills. This was the last rug i had to be pulled out from under me. I have been an anxiety ridden mess since.. worrying.. what will happen as I slowly go lower and lower where I no longer even have pain pills at all and how I will even exist or get out of bed. The one thing these Drs were good for is now gone.. and this is what I have to look forward to. I am told this cyst tangled around my common bile duct will eventually turn to Cancer.. that’s what I have to look forward to. The anxiety and upset over this last rug of “guess what.. not only will you die.. but in horrible pain” being pulled out has caused me such stress that my lyme is getting bad again.. At this point.. my only option I can see is to take myself out of the equation. THIS.. is what this has done. And believe me.. I am one of many who feel this way. I have become paranoid.. thinking maybe they are doing this to get the chronically ill people to end themselves.. Why else would they do this?

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  31. 37 years this December, severe injuries- C1-C2 neck fusion, severe head injury not conscious of existing for a month and far from up to par, and multiple head and upper body injuries, which caused a daily constant Severe Chronic Pain. Spent 10 years suffering daily constant Pain while trying to find something to ease the daily constant Pain. The only thing that worked- was strong Narcotics, but that was forbidden to use. They told me strong Narcotics wouldn’t work for long term Pain. That I’d have to keep taking a higher dose of the Medicine, because it wouldn’t work, and it would just make me a drug addict.
    Well after going to Doctors, Hospitals, Specialists, in different States, it was found that my fusion wasn’t exactly in place as it should be and was causing my Pain which I knew pretty much that was the case- and these severe injuries were all due to an illegally drunk 18-wheeler truck driver who caused and was at fault of a head on collision with a vehicle I was in (killed my two friends 19 & 20 years old, and I was 18 years old), and just at this time I had no other direction for help from the Pain. The Pain was slowly killing me, my health was the pits due to daily constant Pain. Pain that would escalate so bad at times it would peak all day and at times for days just 10+ and I would end up vomiting from the neck Pain. It had nothing to do with my stomach, it was all due to Pain in my neck, and I also get Pain in my face, eyes, head, shoulders, upper chest, arms, and hands. Pain without Morphine rules my existence!
    The last hope was a Pain Clinic. I went to the Pain Clinic and fortunately the Doctor saw the true extent of daily constant Pain on me, and that nothing eased it, but strong Narcotics- I’d spent 10 years trying the different things, drugs, machines, acupuncture, nerves burned in my neck, I tried more than I can even begin to remember. But none of it worked! The one thing that did work I had been forbidden to use. Being like I said the strong Narcotics. Now As I was to learn, all the things they told me as to why I couldn’t use strong Narcotics for long term Pain, it turned out to be as I was to learn and prove, that it was all one BIG MASSIVE LIE or MANY LIES! How ever a person prefers to put it, but it still stands to be NOT at all true. All that I was told as to why I couldn’t use strong Narcotics for long term Pain, was NOT at all True!
    I have needed to use and have also used the Morphine- RESPONSIBLY! I also used a high dose of Morphine for my Severe Chronic Pain, and that I have taken it daily for the past 25 years with NOT one problem!
    Morphine saved my life, it also gave me the best possible life that I have had since the injuries occurred. Without the Morphine I would NOT be here, I could NOT have gone on, I was starting to lose my mind from Pain and I had NO control over it whatsoever! I was also 18 to 30 years old then, and now I’m 55. Yet what do I get at the age of 55, they now are taking my Medicine away from me (the Morphine I’ve used for 25 years and NOT one problem.
    But now at 55 years old, I get to wake up to a real live actual Nightmare, now I awake each day to this Nightmare! Plus I also once again get to suffer with Pain. Yeah it’s bad now and I haven’t even gotten way down yet to the useless dosage they are forcing me to drop to. But what would I know about Morphine, I’ve only used it daily for 25 years now.
    Yes they are taking Morphine away from us, and I have no Doctor to turn to, NO Pain Clinic to turn to. They have as good as tied the hands of all Doctors. It is as if I never went to the Pain Clinic, I never had to suffer for more than 10 years and go through what I did- and to finally have Doctors treat me with Morphine. Yeah that must be all in my imagination or something.
    I wonder how long before they start taking Insulin away from Diabetics, that is lessening their dosage to less than 1/5th of what they need. Or taking Heart Medicine away and from people with Heart ailments. I mean hey they’re doing it to us people with Severe Chronic Pain, why not all the others, they could also save a lot of money for the U.S..
    The illegally drunk truck driver who caused all of this is still free and doing fine, and I’m paying for his wrongs, still getting punished for it all!
    All I want is to continue with my Medicine so I can have somewhat of a life, I believe I deserve at least that.
    Just wish to get normal respect. They allow a person to criminally kill my two friends and ruin my life, not even close to compensated for what I lost and have gone through for Pain and suffering (2 lives turned out to be a cash void and not in favor of the two people in the Cemetery), and whoa that I should dare to NOT want to suffer greatly and thus have some kind of a life- and i.e. to get to continue the Medicine I have been responsibly using now for 25 years- to ease my daily constant Pain (though I should greatly check to see if I am listed as a person or some lesser than a person).
    Think about it- maybe they should just deny all Medicine to people, it would lower the population as the Georgia stone does imply that some people here in the U.S. and about- have a great desire for!

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  32. WolfWolvesWolf,

    My heart goes out to you. As I have previously mentioned in comments, I am horrified at how patients like you are being scapegoated.

    I wish I had some words of wisdom but unfortunately, I don’t

    Best of luck to you.

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  34. What we need is someone like you to stand up along with us victims and present the Chronic Pain Patient Protection Act . I am so sick of this nonsense as my medication slowly get reduced with no rationale other than the government is in control of my care . My pain increases with each reduction and although I certainly do not mind taking less medications , there should be REASON FOR IT . My standard of living is completely going to hell the less medication I take to treat my chronic condition . This is a disgusting demonstration of Hysteria . People prescribed these medication legally are not overdosing are for the most part are not addicts . It is an outrage and I am sick of it . Write your congress representatives . FIGHT !!

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  35. This isn’t the first time this has happened. Back in the late 90s I had a major injury involving a broken knee and broken ankle. The knee break did not become known until I developed arthritis and an MRI was done. So basically I was sent home on crutches bearing all my weight on a broken knee. Later I came down with the shingles which causes horrendous pain. But at that time the maximum number of pills you could get was one month’s worth. No more refills. I drank myself to sleep and just suffered the rest of the time (try going to work with the shingles).

    So, it was actually WORSE for pain patients under the Clinton Administration, much worse. I now have another chronic pain condition which is very difficult to treat, and lasts for years. This also was made worse when a doctor performed prostate surgery on me and later admitted that he probably shouldn’t have done it
    I have spent thousands of dollars (with insurance) to solve the problem and the ONLY thing that helped at all was oxycontin. I am definitely addicted to it and don’t care. I’m 60 and will probably have this constant pain for the rest of my life and when I asked for 10mg more than my current dose the doctor told me to go and join their meditation clinic that is too far away for me to drive to (sitting anywhere but on my recliner and cushions is excruciating). And I can’t bring my recliner with me to the clinic anyway.

    I am certain that the people who are making these decisions have never experienced chronic pain much less life long chronic pain. Over prescribing is wrong but letting good people suffer for the poor judgement of a much smaller number of people is cruel.

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  36. I just found this site and this page… I didn’t even know what was going on, until it just happened to me. My doc tried to hold out, but has now been cowed by the Powers that Be. Its useless for me to recount all my pain conditions (and probably boring), but let’s just say that I cannot take such drugs as Celebrex, Lyrica, Gabapentin, and antidepressants (I lose my memory, cannot think, cannot function…or suffer severe akasthenia, or feeling as though I were going to jump out of my skin). I have had my pain controlled on and off for 40 years with a low dose of this particular class of drugs in question; on bad days, I am still able to function– with it. Not without it. I do not want to go the route of being labeled either an addict or a psych patient. Been there, done that (none of that helped– about 20 years ago). I just discovered last week that I’d no longer be able to obtain my meds. I am trying to “cut down”, and praying for a miracle. I am a Roman Catholic, and already pray; I do not want to add New Age meditation to my repertoire, either.

    I have been in and out (mostly out) of the psych system for the past 10 years, and have seen its subtle mind control. I also believe that drug company profits have a lot to do with these actions. I simply don’t want any part of it. Thank you for this site and for all your posts, but why is it that now– 2018– I do not see anything recent on here? What has become of those who were posting in 2016? Thank God, my doc held out as long as he did, but now, I’m in trouble! Nor can I score pot: I live in federal housing. Don’t want to add to my problems… Desperately seeking “help” that is legitimate. I refuse to call myself an addict or a psych patient. I am a pain patient, whether our current gov’t accepts that terminology and reality, or not. I realize that in our current political climate, my post is dangerous. This is the only reason I can think of that no one is currently posting on here; or have their problems become worse? Or have they committed suicide? Or are there simply no viable solutions? Also, whatever happened to that collective ACLU action? Whatever. I simply don’t know what to do, now, in order both to control my pain and to maintain my integrity. Thanks.

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  37. Thank you, & Bravo, Richard Lawhern, PhD, for this very timely, appropriate and factual article!

    I am a chronic pain patient for over 14 years, who suffers from a hereditary degenerative and crippling disease. It is getting more difficult by the day, it seems, to get my doctor to prescribe what it takes so that I have that “quality of life” that you refer to in your article. My GP doc (pain management clinics are too far away) has had me on the same regimen, without an increase, of Oxycodone for the past 3 years but is constantly attempting to have me “try to take less” than my daily allowance. I remind him constantly that I have a degenerative disease, not a regenerative one!

    Three weeks ago, I fell and broke a rib in my mid-back. My doctor ordered X-Rays which initially didn’t show the fracture but, my pain continued to worsen. It hurt to breathe, cough, laugh, or sneeze. I could not sleep unless I was flat on my back and I could not turn over into my normal sleep position. My fiancé convinced me that I should return to the doc. He ordered more X-rays that this time, showed the break, but he would not give me the OK to take additional meds for an off the charts pain level. I finally said, “Look, I’m sorry doc, I’ve had to take extra because I’m in agony and I am asking only that you refill my script only 2 days early.” He wouldn’t do it and proceeded to scold me as if I were 5 or 6 and not 65 years of age. It was Friday when I asked that he refill my script so that I could get through the weekend. He said, No! and told me that he would not waste another moment of his or his staff’s time on my drug requests. He told me that I had only myself to blame for my predicament of not putting back extra tablets for times like these and although he knew I would indeed have a rough weekend, he goes on to say “many people break ribs and don’t need narcotics”. I can’t tell you how incredibly ridiculous that sounded coming from a doctor who has been in practice for over 40 years!
    This morning, I copied your article and sent it to him in a patient portal. I prefaced your article with these words: Dr. ____, I thought you might enjoy this article. As we hear dogmatic arguments from both sides of the political spectrum relating to the “addiction epidemic”, this article, I feel, expresses not only a non-fanatical but rather a factual point of view. It certainly represents the voice of those of us who now apparently stand without defense or have been muted.

    Thank you, Doctor Lawhern, for your fine article and the voice of reason!
    Maestro101

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