Opioids: Chasing the Wrong ‘Epidemic’

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Photo by Damian Gadal via Flickr

Every first responder is familiar with the scenario. You are called to the scene of yet another drug overdose. Naloxone is administered. The comatose “victim” rouses and groggily stands up. Many refuse to be taken to hospitals and drift away.

You are tempted to call out “see you again soon…”

Odds are good that you will. Though Naloxone saves thousands from overdose, death is too often postponed rather than prevented.

I have never personally witnessed this scenario. I work the other side of the street. I’m a health care writer, patient advocate and social media moderator who interacts daily with thousands of chronic pain patients and their families. My wife and daughter are among them.

These are the people whom government policy is turning into scapegoats for the so-called “opioid epidemic.”

They are increasingly being told that because the nation must deal with its addiction crisis, and that they must be denied or taken off the only medical therapy which offers them even marginal quality of life. By this I mean opioid pain relief managed by their doctors.

This is a false policy choice, founded more on mythology than facts.

The US is now chasing the wrong epidemic in its efforts to reduce the death toll from narcotic drugs. Both pain patients and addicts are paying the ultimate price for this misdirection. Addicts die in droves from street drugs—mostly heroin and fentanyl. Patients denied effective pain management spiral into agony, disability, and sometimes suicide.

Doctors leave pain management practice, afraid of losing their licenses and livelihoods to a widely perceived Drug Enforcement Administration (DEA) witch hunt and a hostile regulatory environment. Meanwhile, other doctors, in frustration, have argued for a better “balance” in assessing the use of prescription drugs for chronic pain. Others have gone even further by calling the application of strict limits on opioid prescriptions “inhumane.”

The death toll from government policy is founded on mythology. One myth is that the relaxed opioid prescribing of the 1990s led to a wave of addiction and death. It is also claimed that over three-quarters of addicts begin with prescription drugs. Both statements are readily shown to be misleading distortions.

The demographics that supposedly connect chronic pain to addiction don’t work. The typical new addict is an adolescent or early-20s male with a history of family trauma, mental-health issues and prolonged unemployment. Young men from economically depressed areas are rarely treated long-term for pain severe enough to justify use of opioids.

By contrast, a majority of chronic pain patients (by a ratio of 60/40 or higher) are women in their 40s or older with a history of accident trauma, failed back surgery, fibromyalgia, or facial neuropathy. Women of this age whose lives are stable enough to allow them to see a doctor don’t often become addicts.

The second myth, that prescription drugs caused our addiction crisis, is also a distortion. A Cochrane Review in 2010 revealed that among properly evaluated pain patients who haven’t abused drugs before, risk of opioid abuse disorder was less than 0.5 percent during the first year of treatment for chronic pain.

Many young people first abuse prescription drugs and alcohol—but the drugs aren’t provided to them by a doctor. They are stolen from home medicine closets or purchased from street dealers. Drugs stolen at home or given by a family member cannot account for high volumes. Abusers quickly switch to drugs they can purchase elsewhere. We may now be coming to understand where some of that much higher volume originates. A Dec. 18 article in the Washington Post offers a startling story.

In the Post article, DEA investigators complain of being stymied by their own lawyers and Department of Justice prosecutors, when they sought to prosecute multi-billion-dollar national drug distribution companies for clear failures to report patterns of suspicious opioid deliveries.

Huge volumes that could never have been justified by medical demand were shipped into rural counties in West Virginia and western States. Proof was conclusive. But distributors were allowed to get off with what amounted to a minor tap on the wrist.

It seems highly plausible to many readers that DEA lawyers were likely bought by the companies they were supposed to regulate. The process was the same revolving-door policy that guarantees the complicity of Representatives and Senators who anticipate being paid well as lobbyists or defense lawyers if they are miraculously turned out of office by voters.

Turn a blind eye and your future is bright. Come after us and we’ll crush you.

This is not the end of the story. Unable or unwilling to pursue the truly major players in drug diversion, the DEA instead went after lower hanging fruit. They attacked independent pharmacies and pain management doctors who prescribe high dose opioids in local practices.

When they attack individuals, DEA “Diversion Investigators” appear to lack the tools or training to distinguish between small-scale pill mills versus doctors who specialize in difficult cases where high dose opioids are the only therapy that works. As multiple doctors have told me, DEA instead employs an arsenal of extra-judicial tools in this persecution:

  • Prominent announcements of doctors under investigation, intended to ruin professional reputations and influence potential jurors;
  • Confiscation of doctor (or pharmacy) assets, to render legal defense more difficult;
  •  Suborning witnesses by threatening prosecution unless they testify to doctor misbehavior;
  •  Deliberate delays of prosecution, grand jury proceedings and court proceedings, to put further financial pressure on doctors to sign consent decrees before cases go to court.

The number of doctors prosecuted isn’t high. But using press as a messenger works very well. Prescriptions of opioid pain killers are dropping steadily even as overdose deaths climb.

Denying pain management to people in agony doesn’t help anybody. But we know what is needed. For that story, we’ll need another article.

Richard Lawhern

Richard A. Lawhern

Richard A Lawhern, PhD, is Co-Founder and Corresponding Secretary of the Alliance for the Treatment of Intractable Pain. A non-physician patient advocate and writer with 20 years of volunteer public service. he has written for The Journal of Medicine, National Pain Report, Pain News Network and other online media. His wife and daughter are pain patients. He welcomes comments from readers.

43 thoughts on “Opioids: Chasing the Wrong ‘Epidemic’

    • I’m an intractable pain patient of 19 yrs. I have a rare spinal cord disease called adhesive arachnoiditis. It’s where the spinal cord nerves adhere to the arachnoid lining of the spinal cord and begin clumping. Its a progressive disease with no cure when it gets to this stage. The pain has been compared to stage 4 cancer. I belong to several AA (adhesive arachnoiditis) groups and I hear daily of people being cut off their opiates and turned away from ER’s refusing to treat their pain. I also hear often people committing suicide. I’ve been lowered 62% on my opiate medications and have to come down 28% more because of this epidemic. I hurt so bad I just can’t explain the pain. I now understand how people can take their life because of pain and how pain can take your life from your body being under such stress of 24hr intractable pain. I’m begging people to listen. Thank you

    • And to think if our government was so worried about addiction like they claim then why is it that there is a plant called the crepe jasmine that grows in florida that produces a sap/alkaloid more powerful than morphine and is NON ADDICTIVE and NO side effects, and has been studied and proven by testing on mice, yet they and the FDA will not approve it? It’s is obvious they are pure “EVIL”.. just Google /NON-NARCOTIC-NATURAL-PAIN-KILLER-SYNTHISIZED/SCIENCE-AND. Tell every one possible and just this one plant will prove they are life destroyers and murders all because of there selfish, evil, greed…

  1. I am a chronic pain sufferer. I use my medication as prescribed bc of the fear it will stop working. This opioid crisis business scares me. I’m not sure what I’ll do if they are taken from me. I have anesthesia dolorosa of the 5th trigeminal nerve. To sum it all up, I have pain 24/7, 365 days of the year. Excruciating, debilitating pain.

  2. Dr Lawhern:
    Your article is prescient.
    I hope it gets some readership.
    There are 100,000,000 pain patients in America.
    There are 2.5 million addicts.
    Pain patients who do not abuse medications are killing them selves due to lost access.
    I hope and pray we stop the war on patients and doctors.

  3. Great article, in which I completely agree. A friend and I run an online support group for folks with pain issues and it’s discouraging (to say the least) how many chronic pain patients are either having their opiate pain medications reduced, or worse, taken away all-together. I have my own pain issues and have discussed the so-called ‘opiate crisis’ with my pain management physician (he specializes in epidurals and ablations)… he’s frustrated with the whole thing for the very reasons Red Lawhern outlined in this article.

  4. I have a chronic pain neurological disease called Adhesive Arachnoiditis. It is classified as rare but is, in fact, getting quite common in patients all over the world. Our pain is so severe as well as chronic that I am forced to lie down on my bed all the time. I do everything lying down including eating as a I cannot sit without acute nerve pain and disc degeneration and protruding discs. Our pain is documented as worse than stage 4 cancer, and yet, unlike cancer, patients ate being denied opioids they desperately need. We are not drug seekers and never abuse our medication but many patients are denied adequate meds and care we need. Why are AA patients being treated like this? Where has compassion gone? Where has common sense gone? Why are all chronic pain patients being judged in this way? It is inhumane and causing many patients to seek a way out from their pain through suicide.

  5. Very well said. As a patient who has had chronic pain for all of my 44 years and intractable pain for the past 20 years, it is extremely disheartening to find that so many patients with chronic and intractable pain have simply been discarded, either by health care professionals and/or pharmacies. There are whole states that do not have pain management doctors or PCP’S that are willing to prescribe more than acetaminophen, and the patients are either given the same treatments that failed previously and led them to be on opioid medications or given NOTHING.
    It is painfully obvious that most of the facts and figures used when the “opioid crisis” or “epidemic” is talked about are pretty much like most things in the media these days: alternate facts. When you take a hard look at the numbers of chronic or intractable pain patients that have addiction problems, you begin to see the truth. We are scared to death that our medications will be reduced or withdrawn, so we don’t abuse them. If I take an extra pill tonight, I may be in even more pain tomorrow, so I’ll take my regular dosage and deal with the pain somehow.
    Another thing you’ll notice, if you take the time to listen to us, is that we did not end up taking opioid medications right off the bat. Most of us have tried every available alternative, often to the detriment of our wallets, before we have “given in” and taken opioid medications to relieve our pain. If most of us had a choice, we would most likely not take them, because no one likes taking medication and/or being dependent on said medications to be able to get out of bed every day. But we have lives, of sorts, and families that we want to support and be involved in! And if we and our doctor have discussed these matters and decided that opioids are appropriate for treatment, why do our pharmacists, families, and others feel that they have a right to deny giving us our medications or give us heck because we do take them so we can function, even if it’s for a short time?

  6. Thank you for standing up for us.
    I have adhesive arachnoiditis. There is no cure. I got this from a misplaced epidural injection during the birth of my child. The only relief i get is from opiod pain meds. They have been drasticaly reduced over past yr. I dont know what will happen to me if this continues. Intractable pain is unbearable.

    • Hi Teresa! I’m so sorry to hear that an epidural caused u so much pain. I thought I was crazy [and so did everyone I know] when I too had a very painful and horrible experience while in labor with my 1st born. I was in labor over 36+ hrs and an epidural was attempted 8 times [bc of the huge arch in my back from years of competitive gymnastics and cheerleading] it kept popping out and they kept trying over n over until I just couldn’t take the pain of being in labor so long + the digging of needles in and out of my back. Needless to say it was unsuccessful and I had all my kids naturally, without pain meds or epidurals. However, all those attempts left me with lifelong back pain and I now have DDD, 2 bulging discs and chronic daily migraines so debilitating that I had to give up a career I really enjoyed. I have lost most of my friends and even family members bc of my pain issues. Some who just didn’t believe me, some who think I overexaggerate it, those who just can’t deal with seeing my pain and others who have given up on me bc I’m always canceling things at the last min.[which I no longer do bc I know how great the possibility is that I will cancel.] I have tried everything under the sun, moon and stars to ease my pain and NOTHING helps other than pain meds. It’s sad bc I’ve come to the point where I hoard my pain pills and take the minimum so that if the day ever arrives that I too, get my meds cut down or cut off completely, I will have enough saved to carry me thru until I pass on. It’s sad and infuriating that “real” pain patients like us have to resort to doing things like this. Thank u for sharing your story. It validates mine. I always knew there had to be ppl out there who’ve also suffered the effects of a bad epidural. Again, I’m sorry this happened to you.🥀

  7. Thank you Red, you Sir are an asset to the pain community. I was,abandoned by my dr of 5yrs due to the fictious opiod epidemic and gov.christies tighter restrictions on opiods. My ex dr flat out told me his license was more important than treating pain pts!! He cut my meds way back, last scripts, and sent me on my way, not caring if I lived or died. It’s been hell trying to find a pm dr here in NJ. I have been treated like some dirt bag off the streets, I’ve been disrespected and called a drug addict, I’ve been turned away by the emergency room, as I layer in the fetal position in agony, thst er dr accused me of drug seeking, told me to go to detox, and that they don’t treat chronic pain pts! !! I left there in tears wanting to wrap my car around a tree to end it all. By the way not a day goes by that I beg God to take me, end the pain, stop the torture inflicted on my body at the hands of the corrupt government! !! I had to go to a suboxone dr weekly as I ran out of meds and was terrified of withdrawing on top of the severe pain. No the suboxone did nothing for the pain, just helped with withdrawal. I found a pm dr few months ago who put me on methadone for pain. I don’t understand this hell anymore. I HAD A QUALITY OF LIFE WHEN I WAS ON THE RIGHT DOSES OF PAIN MEDICATION FOR 8 YEARS ON THE SAME STABLE DOSE . I have decades worth of medical records with every alternative treatment that was tried and failed including failed spinal fusions that left me with severe nerve damage. What is being done to legitimate chronic intractable pain pts is horrific and inhumane! !! We wouldn’t allow our furbabies to suffer, if nothing more could be done we put the animals down, we don’t let them exist the rest of thier lives in pain so bad they would rather die than take another step! We humanely put them to sleep, but humans ??? We are our own worst enemy. The corrupt government enforcing laws on us that leaves us in agony is shameful! !! Intractable pain pts deserve relief from the daily torture thier bodies are being put thru!!

  8. Thank you Red for everything that you fight for. To the DEA I will simply say this. Absolute power corrupts absolutely. These days money is the only voice. Your blind arrogance has already killed too many lives and the ones who are using every part of themselves to barely survive are left being tortured (My wife and I) because we either can’t get any relief because your teams are literally attacking doctors and their practices, i.e., Dr. Forrest Tennant. A dedicated physician who stood up to your organization and said “No”. A great man who was not given a fair trial, another example of this agency’s abuse of power. The other form of torture being patients who have been on opioids for years functioning within society. Then all of a sudden their doctors are abandoning them without any explanation, aka desertion, also illegal.

    Here’s my final question: I want you to give me one time in the history of our planet where taking something that’s benefiting the majority of the population and in return having a positive impact.
    The Answer: You can’t because it’s impossible.

  9. I am a chronic pain patient. I have been for quite some time, multiple surgeries, many have failed and caused major side effects. I am not an abuser of medication, I’m a human being that needs to be able to lift my head, move my body and try to function, the only way is with – medication. I hate, detest, daily to have to swallow pills. I have Trigeminal Neuralgia, chronic face & head pain. Surgeries that failed, scar tissue affecting the nerve more along with radiation to the brain that left more side effects that continue to worsen. This along with a very chronic bad spine. Two neck surgeries, the last one just found out that the fusion never HEALED, going in for another neck surgery now. Lower back surgery, and my spine is getting worse not better. I have a syrinx in my spinal cord. It is throughout the entire cord, I have to be very careful as the only way to drain it is to cut open my spinal cord. Very very risky. Than I have the spine fusing itself together, each vertebrae has multiple bone spurs that have attached themselves to each other and I have no disc space anymore. This along with fibromyalgia, skin biopsy results came back, there is no cure. I suffer every single day , my shoulders were both operated on. Bone spurs snapped the rotator cuff, my hands have diminishing tendons and the joints are swollen and pretty much in operable. My hands are to tiny, cannot even pin them or fuse the bones. Add that along with unknown source as to why my feet burn like they are exploding in flames. I cannot go one day without medication, I cannot move. There is no physical therapy to replace my spine, nor will it help, there is no aspirin that can reduce the inflammation and knee dropping pain. There is no chiropractor that can touch my back as it could cause injury to my spinal cord. There is no injection through pain management that has helped, they have no other resources. Steroids was a one year daily treatment between Injections, epidurals and pills. That does a number to your body. I am allergic to gabapentin, maxed out on dosages of seizure meds that did nothing but serious side effects. Lidocaine does nothing, Cbd oil does nothing, I cannot tolerate certain meds they make me very sick. I use toradol for chronic pain and when needed I have to go to the emergency room for intravenous meds. Morphine if they will give it to me, but it’s hesitated and I become unglued inside my brain can’t handle the pain. My blood pressure is high, try to keep it co trolled so when pain increases it does not raise that threshold to a 100 on a pain scale. The hunt for opioid addiction will cripple all chronic pain patients. You cannot shut the doors on us, we already have unleashed hell. I wrote as much detail as I could so someone can stand in my shoes for 5 minutes and say oh hell no, I can’t handle this pain. It’s a wonderful life to open your eyes, I wish the view was that of a person with no chronic pain. Those officials & lobbyists that have funds needing to be spent on research, use it to cure us not kill us.

    • The burning in your feet can very well be attributed to adhesive arachnoiditis. I have this spinal cord disease and burning feet is the symptom most sufferers with Arachnoiditis has. Considering the amount of trauma to your spinal cord, I’m relatively certain you have it. If your MRI has ever shown clumping of the nerves, that’s what it is. I suggest you Google this Gloria Schumacher

  10. Same old, same old, without a solution. Words, words, words. Even though there is truth in what you say, you still fail to recognize what it will take to stop these attacks. That is the recognition that drugs don’t cause abuse, and that the attack on drugs has been a 100 year political racist attack as part of Jim Crow legislation to disenfranchise minorities. It’s only become an “epidemic” in order to illegally attack more physicians for money and eradicate through legal genocide the “expendable” populations.

    For the readers: the REAL cause of addiction and abuse, however, is known and treatable. You can see the REAL cause on the video by that name on https://www.doctorsofcourage.org/videos. Watch and share. Join us on DoC in the fight to stop this unethical, immoral, and illegal attack on good, compassionate physicians and the patients they treat.

  11. The CDC released new updates last month and finally admitted that heroin and fentanyl are the leading cause of this opioid epidemic yet they refuse to withdraw their guidelines with are severely flawed and dangerous, and the DEA is still going after legit physicians who are trying to help legit pain patients! So someone PLEASE explain to ME and ALL the rest of us who are suffering with incurable chronic pain diseases such as Adhesive Arachnoiditis, Tarlov Cyst Disease, and RSD/CRPS all of which have NO cure, can still be ignored and left to suffer and die needlessly due to false reporting by media, and state/federal officials refusing to listen to the thousand of patients in pain crying out for help!
    I spoke with an official in our state (Mississippi) who admitted that a BIG problem was the coroner’s in our state NOT reporting what type of drug was used for OD so they just call it opioid induced OD! Even though most of the deaths are from illicit fentanyl and heroin! So her inlies another major hurdle for legit pain patients! WE need our voices heard! We are sick, in pain, and NO ONE cares!

  12. I never thought I would be in continual pain at 55! But, here I am, with Denerative Disc Disease, and treated like a common criminal because of it, with urine tests and pill counts at every doctors appointment. My pain medication is not an opiate, but it works on opioid receptors, so in prescribing, it’s treated as one. In all the literature written about my medication it is stated that it is to be prescribed and taken every 4 to 6 hours. But, because of some ill-researched and published CDC “guidelines” doctors are afraid to prescribe more than 90 pills per month regardless of the efficacy and prescribing instructions of the medication, lest the DEA raids their office and takes their assets and destroys their career. So, I have 6 hours of untreated pain every day. I’ve taken 4 different muscle relaxants and 2 anti inflammatories, and they do not work. My doctor prescribed Lyrica, and I dutifully tried to take it. I teach high school math and I can’t do my job with the brain fog from this medication. I’ve done physical therapy 3 days a week for a year, massage therapy, 8 facet injections, and 3 radio frequency ablations to the tune of tens of thousands of dollars. At best, some of these therapies gave a few hours of relief, but the ablations increased my pain exponentially. But I must keep having these injections (by the way, the depro medrol in these injections are not FDA approved for spinal injections, and the FDA sent the drug maker a nasty gram about selling it off label without the proper warnings, but what the heck, let’s do it anyway), or I will not get any medication to treat my pain. The pain that is real. That is documented in a series of X-rays and MRIs that show my condition as progressively getting worse. I don’t get high on my pain medications, but I can function as a mom/step-mom of 8, very involved Nana of 11, care-giver to my mom with dementia, and a master degreed math teacher. But, at my next injection, I’ll be subjected to a urine test where the nurse squirts betadine in the toilet and I can’t flush or wash my hands until the nurse has my urine in her/his hands. I’ll have a pill count and if I’m one pill short I will be dropped from treatment as a drug addict. But, the real addicts are still getting their drugs off the streets and are still getting high or over-dosing from the drugs coming across the border from China and Mexico. And the cartels are laughing all the way to the bank over our opioid crisis being addressed in doctors offices, while their drugs fill our communities with heroin and fentenyl.

    • Sounds like my life!! I was going to comment but this says it all!! I’m so frustrated I can no longer get pain relief and have no life as I can’t function!! I’m so ready to give up!!

    • I suggest you discontinue lyrica. It’s been prescribed off label to chronic pain patients. It’s intended use is for seizures and epilepsy. It works by stopping new brain synapses resulting in cognitive function impairment, memory problems, and other serious problems related to thought and speech. Do not suddenly stop taking Lyrica, you have to be tapered off or risk serious health problems, including possible death. The same goes for its sister prescription, Neurontin

      • I recommend a diet change. Paleo or ketogenic is best to reduce neuroinflammation, but at the minimum, try a very low carb diet and high protein. Eat lots of vegetables, no refined sugar, soda diet or regular, eat as much organic as you can and no gluten. Drink lots of water and exercise. It doesn’t have to be aerobics, gentle stretching and light walking everyday. These are the two life changes I’ve made in the last 19 yrs of having an injured spinal cord (AA) also getting out of bed between 6 am and 10 am the time when your body rejuvinates it’s nerves.

        • Also, epidural corticosteroid injections can cause arachnoiditis which leads to adhesive arachnoiditis, an progressive disease that used to be rare but is now common because of these facet joint injections. The pain from the nerve roots clumping due to them adhering to the arachnoid membrane has been compared to stage 4 cancer. It’s blackmail to force you to get them in exchange for pain medication. People afflicted with this horrible disease (me) needs to start a class action lawsuit. I implore you to research this disease.

  13. Here are three questions everyone should ask themselves, especially those deciding the fate of intractable pain patients;
    1. Is there any respect left for human life?
    2. Should an affluent country extend the quality and length of life of a suffering pain patient?
    3. Are we willing to train and allow specialist physicians to treat difficult, rare and complex pain cases?
    Dr Forrest Tennant
    Nobody expects to have to live their life enduring severe intractable pain, 24 hours a day. So remember the proverb, “there but for the grace of God go I”.

  14. https://twitter.com/StefanKertesz/status/947930901836595205
    Evidence based decision making needs to be front and center, and intractable pain patients should be included as stakeholders in the process. So far, addictionologists have been the loudest voices in the room, and chronic pain patients have the misfortune of not being professionally organized and represented in the process. Doctors who agree that opioids have a place in stable multimodel treatment plans for those of us with untreatable lifelong disease processes causing agony, suffering, loss of function and intractable pain are afraid to come forward in our defense. They are rightfully worried that their practices will be targeted by overzealous DEA agents that don’t understand the science and evidence behind the judicious use of opioids in refractory chronic pain.
    It is becoming more and more evident that the number of new prescriptions is no longer correlated with the number of opioid deaths; the top killer, illicit fentanyl, is being found in heroin. The initiating opioid is most cases if heroin, not prescription drugs. And for those whose addiction IS initiated by prescription drugs, the majority have been pills taken from someone else’s prescription. Overdose deaths occur mostly in young men in their 20s with history of mental illness, prior addiction or illicit drug use. Most prescriptions go to women over the age of 40 with autoimmune or spinal issues. There is no longer any correlation, and certainly no evidence that these prescriptions remain the cause of the current opioid epidemic. Anyone who thinks that taking treatment away from patients with chronic disease helps the epidemic is certainly not taking the time to read the evidence.
    Please see citations above.

  15. Excellent article! On high-dose opiate therapy for 17 year combined with complimentaty therapy Dx- several autoimmune disorders and a driver who ran a red light damaging my spine. I Led a Sucessful life, a single female homeowner, active as possible to tmaintain flexibility.
    I Weaned myself off opiates 8 months ago. Why? To the rude and judgmental pharmacists, all the way to the corrupt government…I knew I was not the drug addict the public has been led to believe! My life now? I survive. My house is falling apart, my pain is terrible a lot, I’m out of shape.
    A Recluse. What kind of life should I expect? I am disabled and diseased. Pain control seems logical? A Brilliant Dr’s fear of pain control due to profiling?-
    I don’t blame them. The suffering and premature death of those diseased and disabled seems quite logical! We are a drain on the system- scary.

  16. Chronic pain patients are being viciously attacked and grouped in with addicts. This war on chronic pain leaves millions in agony. No matter how loudly we scream in terror- our representatives and the CDC and the DEA are not listening. These 2016 “voluntary” guidelines were written by insurance co representatives, the government, and those that stand to benefit from increased funding for recovery programs.

    MEQ of <100 is an arbitrary number. Your genetics dictates how quickly you break down different types of medication. This arbitrary number makes no sense and does not allow Drs to take into account the genetics of each patient.

    The anxiety of knowing that at anytime that the medication that allows for any quality of life could be taken away by your insurance, your pharmacist, your doctor, or your dr may not have a choice and be forced to change his/her practice. How many people can now practice medicine without a degree. I guess the more people that commit suicide, the fewer people the system will have to take care of. Its hard to imagine living all the time with intractable pain but this heavy burden exists and its real and we need help. IS ANYONE LISTENING!!!!!

  17. A thought particularly for regular readers of the Crime Report:

    The comments you are seeing in this thread may seem unusual in a publication venue which is directed to law enforcement professionals. However, I would voice my support for both the pain patients commenting and regular readers who serve in law enforcement. Both audiences face almost impossible conditions and demands when they deal with presently prevailing government policy on opioid addiction.

    Pain patients are being labeled and stigmatized as drug seekers, when most of what we know about addiction supports the understanding that medical treatment of pain only rarely leads to addiction. Police officers are being charged with both punishment (or deterrence) of drug-related offenses, and cleaning up the mess when addicts overdose. Meantime, it is clear that opioid addiction is far more often a social problem than a medical one. We are informed by the Pew Charitable Trusts that law enforcement policy has almost no impact on addiction or recovery, except to make addiction even more isolating for former inmates who cannot be employed after release.

    I would encourage readers who serve in law enforcement to voice their opinions concerning the known example of Portugal, where drug possession has been De-criminalized since 2003. Opioid-related overdoses in Portugal have dropped to almost zero and heroin addiction has dropped by 75%. What do we think might be the outcomes in America if we tried the same experiment here?

    Respectfully,
    Richard A Lawhern, Ph.D.

    • Thank you Red, for your timely and important article. Thanks for all you do for those in chronic pain. I would like to add that my doctor has been threatened with loss of her license if she did not cut back on her opioid prescriptions. I have undifferentiated connective tissue disorder, fibromyalgia, degenerative disc disease in my cervical spine, arthritis and pain in my legs from problems with veins. I was on a stable amount of medication for a number of years. I was reduced by 30 plus told I must fill my prescription on the same day of the month, not allowing for 31 days. She had to cut prescriptions to her regular patients because she wrote for hospice, taking up a lot of her allowance as well as the nursing home. All she could say was that she was sorry. My insurance company would have allowed the 31st day as well as the pharmacist, but her licensing board and DEA would not allow it. What are they thinking? These issues should be considered, not the total amount written. It is very painful. So, I have a choice: hold back 2 for 2 days so I have 3 painful days or on the 31st day, just lay around wishing I was dead. There are grey areas! Please let’s get some common sense in rules/laws/recommendations.
      Thank you,
      Christine Smith

  18. Red, I was rendered speechless by this article. Ask my husband and children (all who watch me struggle EVERY single day!) and they’d all tell you I’m NOT at ALL easily left speechless!! As a matter of fact I talk and type to a fault. I had my pain start at age 22 and at the time saw a very irresponsible PCP who was prescribing obscene/later told dangerous/unethical amounts of pain meds and no I don’t agree with that at ALL!! I actually put myself through a detox because I kept hearing “you can’t possibly be in that much pain” or “it must be hyperalagesia” or the absolute worst “you’re addicted”…I wasn’t addicted I was in pain and she chose NOT to do her job (the hospital did an MRI that CLEARLY showed the cause of pain) and just kept feeding me pain pills. It was my pharmacists words, kind and gentle, about the amount of meds she was prescribing that got me thinking and I, as I stated, ultimately put myself into a voluntary detox program cuz I HAD to know for sure. Guess what? I found out!! I was in PAIN and after finding a new doc who referred me to PROPER Dr’s (pain management and neurosurgery) for my wasted spine (multiple spinal conditions, 6 or 7 back surgeries, coming up on 7th or 8th plus implant of pain pump and my back is a mess again BUT at least being treated by responsible physicians!) who’s job it actually IS to manage pain/spinal conditions! Oh and before I go much further, I have this to say to the dea and cdc: you don’t know me and likely couldn’t handle 72 hours in my shoes let alone SEVENTEEN YEARS! Before you pass judgement you’re NOT qualified to make, just TRY and walk for a couple days in a pain patients shoes…not a ONE of you could do it! Leave pain management patients ALONE! We don’t want a high, we just wanna do simple things you all take for granted like take a bath/shower unassisted, go to the bathroom without wanting to cry, pick up something dropped without wanting to scream, cook a meal for my family, drive myself someplace…it should NOT be govt regs that determines what my pain doc who is trained in pain management and anesthesiology does for me or any other patient they’re treating! They are the ones trained and they are the ones that DO KNOW THEIR PATIENTS NOT BIG GOVT!!!
    I’ll go on now because I could say so much more but don’t wanna go on for a dozen “pages”.
    I for one despise my pain medication. I had a pain pump put in in 2011. Everything was GREAT for just shy of 4 yrs, they weaned me off oral meds as they upped my pump dose (with a pain pump you get better quality pain relief but with 4/500% less medication because of delivery method (that said NOT everyone qualifies for a pain pump it’s a long process…) and I felt AMAZING!! I swore I’d NEVER need or take oral opioids that I hated ever again! Then something changed. I initially wrote off the change to stress because our middle son was also going thru a VERY rough medical patch but one day driving, a Friday in June to be precise (I caught the office manager who thank God caught my doctor who waited for me instead of cutting out early like they usually do on Friday’s cuz they knew something was VERY wrong if I was calling the office…it’s something I just don’t do outside of making an appointment but I was also stuck on the side of the road physically unable to continue driving…) I made an urgent call to pain management doc cuz something was wrong (pain pumps, my neurosurgeon’s words, do not cover new pain) and I was in excruciating agony. He did an eval and flouroscopy (sorry if misspelled) xrays but couldn’t see anything with what he had available in his office (he does procedures too like epidurals and caudals and facet joint blocks…SOME respond great to those, I actually had worsened pain and horrible reactions to almost every injection) but because he’s been my doc for years and is TRAINED IN PAIN CARE he wrote me an opioid prescription. I literally was dry heaving in the office I was SO beyond upset that the ONE thing I NEVER wanted again was being brought back into my life. I was devastated. Did I start the meds? Yes I did because I HAD to NOT because I wanted to. I do not like the way I feel with opiod meds but I have a husband and 3 kids who need me to be able to semi function at bare minimum at least. Fast forward four yrs and I now know that the degenerative changes seen in the MRI they did when it started again was the cause and I have another completely blown disc in my (narrowed) spine and have to have surgery…AGAIN…I’m torn between not wanting to go thru that again and wanting to try anything that might help so surgery is going to be scheduled. Also add into the mix that my pain doc is now getting VERY afraid JUST TO DO HIS JOB AND TREAT ME FOR MY CHRONIC PAIN BECAUSE OF IDIOTIC GUIDELINES AIMED AT AND DESTROYING THE WRONG GROUP OF PEOPLE!!!! We as pain patients have a love/hate relationship with our medications (and meds we have to take to counteract the crappy side effects of pain meds like almost constant nausea!) because the vast majority would prefer to be pill free but HAVE to take meds just to semi function physically! It’s a lose/lose situation because I know these meds have horrible side effects and can do damage to other organs in my body but dang it, I’d LOVE to get up and just go to the bathroom without wanting to SCREAM! Think about that law enforcement (by the way, I did criminal justice with academy to become law enforcement myself…guess what the chief in my town told me (he knew all I had left was the academy) after back surgery 1? He said: even if you can get your doc to sign, and I don’t believe you will, that your okay enough to do the academy, even with your grades and qualifications you’d be SO far down on an eligibility list just because you’re a walking liability already…I was wowed but appreciated his candor and his unwillingness to bs me and so I didn’t waste thousands morepursuing the law enforcement field) what if it was absolute torture just to rise up from a chair and go to the bathroom? What would happen if you did deal with pain and it kicked in while chasing down a felonious assault or DV suspect? What would you do? What if you couldn’t pull back/move fast enough because of PAIN when you’re handing someone a ticket on the freeway and you see the idiot out of control headed right for you?!? WHAT WOULD YOU DO??? YOU’D TAKE THE MEDICATION!!!! Until you’ve walked in mine and hundreds of thousands (severe underestimate!) of other pain patients shoes, something I wouldn’t wish on my worst enemy, don’t judge us or call us abusers or addicts or drug seekers. We have LEGITIMATE, documented for MANY years, conditions that our TRAINED physicians feel warrant treatment with high dose opioids! Let them do THEIR JOB!!! Go after the real criminals, not a happily married mom of 3 or a dad working to support a family of 6 or even 2 who just happen to have multiple debilitating conditions!

    • For DoIHaveto: (and our law enforcement readers)

      Your narrative reflects many others I have read in the past 20 years of talking with chronic pain patients. It is a horrid reality that medical schools rarely require their students to take more than one course on treatment of pain — despite the fact that pain is the condition which most frequently brings people to a doctor’s office. There is also evidence that some medical interventions may actually make pain worse by increasing nerve damage. This seems to be the case with adhesive arachnoiditis (a kind of nerve damage that causes the myelin layer on the surface of nerves to bond with adjacent tissues). Many patients are convinced that their arachnoiditis was caused by misapplication or too-frequent application of steroid shots into the spinal column. Doctors who may make thousands of dollars per injection staunchly oppose these assertions.

      A hundred million people in America are affected by moderate to severe pain, and on the order of 20 million are treated with opioid analgesics in any given year for acute, chronic, or terminal pain. About 3 million will be treated for longer than 90 days. One of the other horrid realities that many physicians and government bureaucrats refuse to embrace, is that for most pain patients, most of the time, non-opioid therapies contribute only marginally to pain control.

      In December 2017 The US Agency for Healthcare Research Quality (AHRQ) circulated a draft of a landmark “systematic review” of published trials for non-invasive, non-pharmacological therapies. Over 4500 trials were identified from literature in a rigorous evaluation process directed to five types of pain and about 20 types of non-opiod therapy. Of those 4500 trials, only 245 met the rigorous criteria that AHRQ set forth for including their results. And among the 245 trials, the term “Strength of Evidence Weak” appears more than 100 times.

      AHRQ investigators tried to put the best possible face on their findings. But a deep reading of their report reveals that we really don’t know if non-invasive alternatives to opioids work any better than placebos. Thus ongoing patient access to opioid pain relief is an absolute necessity at the present state of medical knowledge. Arguably, the refusal to provide such relief is a fundamental violation of human rights by torture.

  19. Im going to be 47 in a few days yet due to the multiple autoimmune illnesses including one very rare one that causes agonizing pain every minute of my life i cant stand walk or sit dress myself drive myself or take care of myself ive been on same dose of pain meds 8 yrs they dont touch my pain anymore i have no quality of life any longer im actually considering going off all meds and going on hospice it’s a shame being that im so young and have 2 beautiful grandbabies 1 ive not even met because i cant travel all this because the DEA us practicing medicine without a license how us it even legal for them to do that? TY SO much for fighting for those of us that just can’t fight for ourselves any longer

  20. Most people in intractable chronic pain have incorporated a number of these alternative treatments into their multi model treatment plans even before opioids are ever considered. Many only have their function for daily activities of living returned once an opioid is added to the plan
    I have never heard of anyone maintained on opioids only. Anti convulscants, antidepressants, NSAIDS, muscle relaxers, PT, OT, acupuncture, massage, supplements, magnets, CBT, mindfulness, biofeedback etc all tried and incorporated if effective. But oftentimes it’s only by adding a stable dose of opioids that we regain our function.
    Prior to the opioid crisis my doctor, thinking I had FM at the time, asked me to consider weaning to ensure the 60 MG bid dose I had been stable on for 8 years was not causing problems. I had no problems weaning over a month or two, at least from withdrawal perspective.
    The pain however went wild. Though some say it’s the withdrawal itself that causes pain, I doubt that, given the pain was precisely of the same quality and location of my disease processes pre- treatment. My six hours a day in my power chair became impossible and I became fully bedridden and housebound once again.
    90 days of agony just to determine if opioids were of more benefit than harm to me.
    Once opioid TX resumed it required the next higher dose compared to before the test. I have ended up on stable dose of 90 mme of mscontin bid (180 mme a day) for the 10 years since.
    Longterm stable opioid treatment has anecdotal evidence supporting it’s use quite strongly.

    • Lori, your experience of breakthrough pain is quite typical. Likewise, so is the disability you have suffered since being coerced to taper down on your medications. My personal opinion — and that of an increasing number of medical professionals who know a great deal more than I do — is that there is no medical or ethical basis for tapering down a pain patient who is otherwise well managed and stable, no matter HOW high the current dose level.

      One of the worst errors of the 2016 CDC opioid prescription guidelines is their failure to acknowledge the wide variability in opioid metabolism between individuals. Due to what is called “genetic polymorphism” , there are millions of patients in the US who naturally metabolize (break down and absorb) opioids either poorly or extremely rapidly. These millions will fail opioid therapy that is restricted to the magical and scientifically unsupported 90 morphine milligram equivalent daily dose (MMEDD) of the CDC guidelines.

      I have personally met more than one pain patient who is doing well on daily doses exceeding 2,000 MMEDD – lucid, alert, aware, and able to experience at least a limited quality of life. But the CDC totally ignored these millions. And these patients now face physicians who are terrified of losing their licenses to a DEA witch hunt that characterizes such prescriptions as a “red flag” for drug diversion.

      As one of my closest friends used to say “Oh piffley rot!”

  21. In a second…that’s all it took. I was ‘T-Boned’ by an incapacitated driver who ran a red light. The next second, I was a patient. I went from an active, full-time hairstylist (a profession I’d loved for 35 years), a golfer, water-skier, walker, grand-babysitter, loving wife, mom, sis, daughter, to a human being writhing in pain.
    Nine years later, a motivated pursuer of relief 24/7, 365 days a year. I did everything prescribed. Every modality, every prescription, every excercise, meditation, mindfulness, nutritional modes, …everything we could do, we (I ) did. Some was barely helpful. The meds put me to sleep. In year 8, I had a Medtronic spinal stimulator implanted. That helps my pain from the waist down. For the waist up, my Pain Specialist prescribed a low dose of oxycodone. Along with gabapentin and a low dose of Cymbalta, we finally have the right mode of relief. The rest of the pain I make myself cope with.
    I can finally make supper. The next day I can do a load of laundry. ALL BY MYSELF! I can have coffee with a girlfriend!
    I will never give away a single pill. To do so would mean I can’t contribute to my marriage, be useful, feel somewhat …..worthy.
    The war on drugs is inhumane to those of us who need medication to manage….at all.

  22. This article makes such important points. Especially that the “opioid Problem” is in fact really a substance abuse problem. It needs to be recognized that the majority of pain patients who take opioids do NOT abuse or become addicted to opioids prescribed for pain. I am in that category of patients described in the article who are older people who develop intractable pain, but who become stable + do well on opioids, without developing any abuse or addiction problems. In my fifties, I developed spinal arachnoiditis, along with a worsening of pain due to other kinds of spinal problems/degeneration. Since then, I have been on a long acting opioid for 14 years, without any problems with side effects, tolerance or abuse/addiction. Much greater recognition is needed among doctors, the CDC + the general public of the fact that patients like me can + do greatly benefit from longterm prescription opioids for chronic intractable pain. Sometimes opioids are the only pain treatment that helps, especially when “everything imaginable” has already been tried + failed to help.

  23. As a patient with several incurable, extremely painful conditions it’s been hard watching the war on Chronic Pain Patients (CPP) unfold. I have been very blessed (many CPPs are not as lucky as me) to have worked my way away from opioids with help from kratom, CBD, yoga & meditation. Now the FDA is threatening to turn me into a criminal and Schedule 1 Kratom, as well as kill medical cannabis.
    Kratom is not only beneficial to CPP’s, but also to people who truly are addicts. They wean off of hard drugs using it. The Government claims to care about the addiction epidemic, yet the things that help people to get away from being addicted are being taken away. It’s nonsensical.
    Recently the UN published a report saying that the treatment of CPP’s in this country is tantamount to “torture”, that it is “inhumane”. What has happened to this country, to treat her citizens this way? To stimagtize and torture people who are already hurting, people who have done absolutely nothing wrong except to have broken bodies? And where have our doctors disappeared to? Why won’t they fight for us? They took an oath, yet they’re effectively torturing & deserting their patients on a routine basis. In my eyes, these doctors acquiescence to the current regime constitutes a medical malpractice so large, it hurts to consider the cruelty contained in it.
    As a medical patient, I have lost absolutely all the trust I ever had in doctors. I don’t feel the medical establishment wants to help people anymore; collectively they seem, at best, indifferent. Perhaps the medical system is broken in more ways than one, in this country, if these sad, spineless, compassionless people who are becoming doctors are the best that society has to offer.

  24. Another excellent article, Red. I want to thank you from the bottom of my heart for speaking the truth for those of us that can’t. Before adhesive arachnoiditis and gabapentin I was an articulate RN running a program at my local hospital. Now it’s difficult for me to complete a sentence. This is due to the brain fog from pain and the low dose gabapentin that I can’t seem to get off of because of the burning pain in my back, abdomen and legs that only this evil med (gaba) and opioids can quiet. Again, I thank you.

  25. Wonderful article. I am very appreciative of the author remarking on the Other side of the opioid issue.

    I have adhesive arachnoiditis, I am 44 years old. I was an extremely active individual prior to contracting the disease for the medical injury due to a combination of too many epidural Cortisone injections and epidural cortisone injections gone wrong. I believed that a person could overcome their pain with their mind and tell my pain became uncontrollable. I destroyed my adrenal glands by “being tough”.
    Now, approximately 12 years after my first Cortizone injection, I am on able to get out of bed without opioids. I’m very responsible with them, I’m very careful with them, and they are the only reason I have even a small semblance of a quality-of-life. I do not feel it is fair or right on any level to take those away for me because others become addicted. This issue affects me partly from worry that I will not be able to receive medical treatment as long as I need it, therefore shortening my life possibly by decades. But also I live in Montana and so far have not found a single doctor that will treat me in the entire state. Of course due to my illness I have not been able to go to every single doctor, but I’ve tried so many that I gave up. I have to travel 2200 miles round-trip and order to get treatment for my disease. This is absolutely ridiculous and unnecessary and it’s due to the hysteria around opioids. Doctors are too scared to treat people like me and people on opioids are labeled addicts across-the-board whether we are or not . It is imperative that the truth come out about this issue. Addiction and intractable chronic pain need to be separated and treated as separate diseases because they are. Those of us in chronic intractable pain deserve medical treatment. We do not deserve to be punished, pushed aside, and marginalized because other people become addicted. This entire side of the story is being overlooked what a general media, population and doctors. There are a few people that are fighting very hard to bring awareness to it, and to bring fairness to it, and to keep medical treatment for their loved ones in themselves. I very much appreciate this article as it was very good at outlining the problem.

    • Unfortunately I have to use talk to text and there are quite a few typos in my comment I hope that it is still understandable.

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