Criminalizing the Opioid Epidemic is No Way to Help Chronic Pain Sufferers

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Photo by Neon Tommy via Flickr

According to the best evidence we have, prescribing opioid pain killers for chronic pain patients has played only a minor role (if any) in yearly increases of overdose-related deaths.

As I wrote recently in the The Crime Report, “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.”

The opioid crisis was not caused by medical exposure.

The root causes of addiction are primarily social. They include family trauma, and stress from economic hardship and family disintegration, sometimes mental health issues.

Although many young people first begin abusing prescription drugs (and alcohol), these drugs are not given to them by doctors. They are initially diverted by theft, provided by family members, or bought on the street. As drug involvement increases, it is almost entirely fed by street drugs—most often heroin and fentanyl, both of which are cheap and plentiful.

Although there were serious errors in the report of the President’s Commission on Combating Addiction and the Opioid Crisis, the Commission got one thing pretty much right. Processing non-violent drug offenders through the prison system is counter-productive.

Having a criminal record raises major barriers to community reintegration and employment after release. Diversion into community-based drug treatment programs offers at least marginally better chances for harm reduction, even if a road to assured abstinence and recovery presently escapes us.

If 40 years of the so-called “War on Drugs” have shown us anything, it should be that counter-drug law enforcement policy and prisons do nothing to reduce addiction or promote recovery. A June 2017 report by the Pew Charitable Trusts confirms these outcomes.

If law enforcement is not an effective policy instrument in combating addiction, then it is fair to ask what might be better.

The broad outlines of the necessary ways forward are known and some of them are represented among recommendations of the President’s Commission. However, none of those steps outlined in the Commission involves reducing the availability of pain management to millions of people in agony.

Recommendation #4, for example, suggested aggressively adding addiction prevention to the education curriculum, staring as early as middle school. “Just say no” was a miserable failure, but other programs have better track records.

The commission also suggested improving access to drug overdose intervention (Naloxone) delivered by first responders. A key element in making this possible might turn out to be cost control as manufacturers repeatedly raise prices.

The program needs appear to be much larger than those contemplated in the Commission’s report:

  • Improved addiction recognition and intervention training for community-based physicians and counselors;
  • Providing access to Medication Assisted Therapy programs, allowing for methadone or buprenorphine to be administered in accessible community settings.
  • Developing community reintegration programs that providing safe / sober housing to addicts who will otherwise become homeless, if they are not already.
  • Establishing job development and training programs in economically depressed regions. Jobless addicts become pushers out of dire economic necessity, not moral failure.
  • Funding long-term community-based counseling and support programs for addicts in recovery─many of whom will relapse repeatedly.

We also know what doesn’t work:

  • 28-day detox centers don’t work when patients are discharged without ongoing community support, back into the conditions which made them vulnerable to drug abuse in the first place (See comments by Dr. Kelly Clark of the American Society of Addiction Medicine during the June 2017 meeting of the President’s Commission);
  • Narcotics Anonymous and other abstinence-based programs also have very high relapse rates when used alone;
  • Restriction or withdrawal of opioid prescribing to otherwise well-managed chronic pain patients have no positive effect on risk of addiction. (On the contrary, coerced tapering off medication is a known health and mortality risk.)

Arguably, there is no objective evidence that drug contracts or short-notice urine testing of chronic pain patients have saved a single life. But there is ample evidence that false positives in urine tests can lead to patient discharge by doctors afraid of losing their licenses—followed by decline of the patient into agony and disability.

The Real Barriers to Effective Prevention

Given the complexity of human behavior and biology, we might never have a “cure” for addiction. However, present barriers to effective prevention in youth and harm reduction among addicted adults are not conceptual.

They are political and financial.

Serious programs of community reintegration, job development and safe housing will cost billions of dollars per year for the foreseeable future.

We have already seen an example in the 1960s, when governments refused to embrace similar issues. Americans decided that it was no longer acceptable to incarcerate mentally disorganized people who were merely strange rather than dangerous. Mental health assistance was supposed to come from community outpatient programs. But programs failed to materialize and thousands of patients became homeless on our streets as a result.

In the political climate of 2018, political conservatives are determined to reduce the size and scope of government programs. This goal seems incompatible with harm reduction for hundreds of thousands of addicts. The majority of programs around which treatment would be expanded are administered under US Medicare.

There is yet one more unacknowledged elephant in this room of hard choices. Why not decriminalize possession of small amounts of presently illicit opioids, even if possession for sale remains a criminal offense?

Richard Lawhern

Richard A. Lawhern

Portugal has already done this experiment with promising results. Since 2001, the number of opioid-related overdose deaths in Portugal has dropped to near zero, and rates of heroin addiction are significantly down.

A Post Script from the author to regular readers of The Crime Report. January 10, 2017 

In the 24 hours following publication of this article, 16 people in pain have commented — some of them at great length. While their thoughts might seem off-topic to the concerns of regular readers, I encourage law enforcement professionals to at least sample from the ideas expressed here. You will rarely hear these views in the forums where you commonly circulate. But the commentators know things that you do not.

This disconnect in personal realities is in a serious sense, “the problem” on which I’ve written. To use a meme common among chronic pain communities, “patients are not addicts”. In an even broader sense, addicts are not “junkies” either — nor is either stigmatized group often seriously engaged by people who write national policy. When given an opportunity to speak, these folks are desperate to be heard. They are too often the dispossessed, the disregarded, the scapegoats, the silent walking-wounded of a generations-long and horridly unsuccessful “war on drugs” that has lately become a regulatory war against doctors and people in agony as well. It is time for both wars to stop.

What we’ve been doing about addiction as a nation and in law enforcement isn’t working. To get to better places, we have to recognize that addiction is not a disorder of medical exposure. It is largely a disorder of social disintegration and the failure of traditional communities. Laws or regulations alone cannot correct this failure. But laws written without subtlety or enforced without compassion can add to the problem. And this is occurring widely.

Thus I implore readers: sample some of what follows. Take it in. Let your hearts be moved or torn. Then “let change begin with me”. Advocate to include patients and addicts in forums where policy and laws are debated and made for either group. And please add your thoughts to the comments below.

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. Comments from law enforcement professionals are invited and welcome.

38 thoughts on “Criminalizing the Opioid Epidemic is No Way to Help Chronic Pain Sufferers

  1. I am a chronic pain patient and I am also a law abiding citizen.
    ONE time have I had my legitimate prescription stolen from my home along with other items. When the police showed up, I was treated as though I was the criminal. I did not know that having your pain medicine stolen was a red flag TOWARDS ME!!
    If I had known, I never would have called 911 and reported the break in.
    The officers treated me awful only after I included, “my rx of … was stolen”. Then, after I reported it to my dr (as required by my pain contract), I was discharged as another red flag. I WAS THE VICTIM!! I was victimized more by law enforcement and my dr than by the person who violated me by breaking in my home because they’re supposed to be there to help me, protect me and be a “safe place” for me. Or, so I thought.
    I now advocate for myself. I keep myself safe.
    Law officers need to remember the chronic pain community is a target for not only thieves but also government, federal, state and local. We are victims who need your help not condemnation.

    • In Jan of 2003 I was injured while at my fulltime job, I was 33 years old.
      I used to think I could overcome anything life might throw at me, using only my strength and resourcefulness…how young and naive I was. I’d never thought about an accident, that was anything worse than some broken bones, happening to me.
      Since then, I’ve had 15 major surgeries (5 of them failed open back surgeries), numerous outpatient procedures and countless tests.
      I now suffer from debilitating chronic pain almost 24 hrs a day. Occasionally getting relief from what’s left (meaning what I’ve been forced to wean down to and what the law says I’m still allowed to take) of my prescription pain meds.

      I’ve also had my prescriptions stolen, by a neighbor who doesn’t work and who knew my car and when I was or wasn’t home.
      The officer did believe me, after I showed her pictures of my xrays, but the station refused to allow me to pick up a copy of my incident report, telling me it was “policy” and I had to put my request in writing and mail it to Albany; after which it could take between two weeks and two months to receive it!?
      By this time in my life, I’d given up on the pill pushing pain clinics (search Dr. Gosy) and had found a wonderful PCP, who has treated me with nothing but respect and compassion, for over four years now.
      She told me I had to obtain a copy of this report in order to get a new prescription sent to the pharmacy. I’d actually called her first, not wanting to involve the police, because I’d heard horror stories like the one above.
      Meanwhile, I’m running out of time and will soon be in full blown withdrawal. If you don’t know what withdrawal from opiates feels like, especially when you’ve been on them for years, it is hard to describe, but I’m going to try…you shake and shiver because of cold sweats, your muscles involuntarily contract and spasm in wave after wave, your nose may start running or sneezing uncontrollably, you can keep nothing in your stomach and must be very close to a toilet because of vomiting and diarrhea, often at the same time…. Until I’d gone through this I’d never understood, what about drugs, would cause people to do some of the things they do to get more.
      All this, because I took medications. as prescribed, by my doctors.
      My doctor offered to call the police station to vouch that I wasn’t an addict and to ask that I be given a copy of my report as soon as it was finished.
      Thankfully, they agreed. I thought I was good to go and was so relieved to know I wouldn’t have to go through withdrawal. I then had to contact Worker’s Comp, because now I would be getting my meds early and I needed their approval, to have them paid for. My doctor also called them. It didn’t matter that I had the incident report, nor that doctor was willing to vouch for me, they refused to fill them.
      Next I called the pharmacy to see how much they would cost if I paid for them myself.
      Fortunately, my doctor is a wonderful human being and together we figured out what else could help and she wrote a completely different script.
      I keep repeating how fortunate I am to have such a caring individual, because it’s so unusual for a doctor to go out of their way to help a patient. I believe anyone who’s had to deal with any type of long-term illness and deal with many different doctors will agree.
      If I had not been able to get a different prescription, I don’t know what I would have done. Some people may suggest going to the ER. It has been a long time since any ER will help a chronic patient who’s in pain. They’re so biased and afraid they will give you nothing-except a bill….
      I would ask the law enforcement community to please refrain from policies such that deny citizens their reports and to please try not to be too jaded when dealing with with disabled people. I understand you see a lot of bad things and are lied to all the time, and I also know you have to follow the law, but there are times when the decision of what to do lies solely with you.Thank you for the opportunity to share my story. [EDITOR’S NOTE: THIS COMMENT HAS BEEN CONDENSED FOR SPACE]

  2. An overlooked cause of illicit opioid demand, is stimulant use and abuse. Methamphetamine remains on DEA Schedule II, available by prescription for cases of Attention Deficit/Hyperactivity Disorder that do not respond to any federally-legal US drug. (Research in Europe, showing that the cannabis-derived drug Sativex gives better control of ADHD with fewer side effects, has not persuaded DEA to consider re-scheduling cannabis onto Schedule II, III, or IV, so that US patients may be prescribed Sativex, in place of dangerous Methamphetamine.). However, most US methamphetamine is illicitly-produced in clandestine laboratories…often the same laboratories that also make fentanyl derivatives and other synthetics that react with the human brain’s opioid receptors.

    The problem with Methamphetamine, apparently, is that it disrupts the human brain’s internal mechanism for regulating sleep. Meth users lose a brain chemical that’s needed to enter the sleep state. After several weeks of meth use, the user becomes profoundly tired but is unable to fall asleep and get needed rest. Users have the choice of quitting the Meth and experiencing extreme paranoia during withdrawal, or taking another drug to induce themselves to sleep. I recently wrote a research paper to inform the Food and Drug Administration on this very topic…interested persons may read it here. ( ).

    The rising tide of illicit fentanyl deaths, in the very same communities of rural West Virginia where methamphetamine use has run rampant, demonstrates why doctors got US states to license them to practice medicine a century ago: Ignorant crooks who can mix chemicals together, are clueless how to use their chemical products safely. Thousands of Americans are dying of ingesting homemade fentanyl mixed with sleeping pills and booze, because they’ve become addicted to homemade meth and now cannot sleep.

    DEA is sending America’s children the wrong message, by prohibiting cannabis research for treating ADHD while leaving dangerous methamphetamine available as an ADHD treatment. Perhaps it should seek advice from real doctors about the drugs it chooses to regulate, as the Controlled Substances Act instructs it to do but it has, for 44 years, failed to do.

  3. I think something needs to be done about the number of pain patients that are now being hit with DUI’s. If someone is obviously impaired then they need the help then, but our medications (opioids and others) do not give us a high. Period. Some education on how opioids work in a patient with chronic or intractable pain would benefit law enforcement greatly. I don’t want to have to give up driving at 44 just because others drove while intoxicated.

    • I’m wondering how it can be proven that a person is on the medication at the exact time they are driving? There is no test to indicate the person hadn’t abstained use of the medication for 8 hours prior to the time they began operating the vehicle. The only tests available can only indicate that the medication was consumed some time within the broad spectrum of the at least the past few days, so how can it be proven that someone was impaired at the exact time they are pulled over. Some might try to say that the driving is erratic, but I’ve seen sober people driving like idiots while texting or fighting with children in the back seat and I assume they are not drinking.

      I also agree with Audrey – the metabolic process of a person in pain taking an opioid analgesic is completely different than that of a person who is not experiencing pain. The healthy person taking the opioid for reasons other than pain will have empty neurotransmitter receptors that are flooded with Dopamine, the feel-good chemicals, creating euphoria. A person in pain will have receptors overcrowded with pain signals that are neutralized by the Dopamine, creating only the sense of effective pain reduction. Pain sufferers do not get high, and those who have used their medications for extended periods of time know how it affects themselves.

      • Completely agree! If your unlucky enough to have genetic abnormalities like me (I have a CYP2D6 enzyme deficiency. I process drugs like vicodin and oxycodone at 50% efficacy) you have the added burden of your labs being inaccurate. It looks like more oxy is in my system because of this. When I used to be on dilaudid, I processed it faster, too, so my pain Dr thought I was lying about taking it. A lot of jobs don’t allow you to be on drugs either even if it’s by prescription and it has not affected your work. Good luck keeping the job if you abstain!

  4. This is the clearest statement evwr on how pain patients have been penalized.time has come to return meds to the sufferers and justify thentrue crime,war on pain patients is not the cause oe solution to the heroin and meth cpp for 14 yrs now suffering to write this and thinking street drugs or suicide this year.

  5. Very good report. However I do believe as a pancreatic cancer patient although in remission it still needs to be reconized the extent of Whipple surgery to remove the cancer and the side effects of chemo still cause horrific pain yet I still struggle to get adequate pain relief because of my pcp being afraid to prescribe. Cancer and chronic pain patients DO NOT get high they simply are able to live a life of some quality with this medicine. Its awful that I have maybe 3-4 days a month of life the rest is in bed crying in pain wanting to just go to sleep and not wake up.

    • im stage 4, they took my pain meds away at the time cancer came back, i did use meth, it helps pain, thx DEA after 7yr sober for that temp relapse! medical marijuana has rescued me, but it’s illegal…and wrong to be…WAR ON DRUGS, EPIC FAILURE

  6. No one would ever think that a diabetic was “addicted” to insulin. Diabetics are “dependent” on insulin in order to function, not addicted to it. Chronic intractable pain sufferers do not get high from their medication any more than a diabetic gets high from their medication. The medication, like any other, enables them to function. Their pain is never eradicated, but kept at a level that can be tolerated along with pacing activities and frequent rest. Chronic intractable pain sufferers are being vilified and demonized as well as causing them more suffering; some so much that they are taking their own lives.

    • Maureen, please visit my new FB group called End Chronic Pain Suicide. I’m hoping we can all gather to discuss ways for creating awareness of innocent suffering victims of circumstance who are dying because of misguided and misinformed governmental policies and manufactured misdirection of the opioid statistics, especially the lack of disclosure that a vast majority of the opioid overdose deaths include illegal opioids in the deceaseds’ Medical Record of Death, or Death Certificate, which is what the CDC uses to calculate “prescription overdose deaths” – a person can ingest a lethal dose of heroin, but if they took one Vicodin pill, their death would be classified as a “prescription overdose death.” The 100 million Americans suffering from Chronic Pain must come together and use our numbers to translate into voting for law and legislation that protects people who are suffering intractable perpetual pain.

  7. Too many people are being battered by constant pain that exceeds levels the body and mind can tolerate. The government is restricting access to medications that easily alleviate this suffering. The flood of patients being abandoned by doctors leaves opioid analgesic-dependent, suffering pain sufferers with 2 choices, both affecting Law Enforcement:
    1. Obtain painkillers illegally from the streets
    2. Commit suicide – end their lives to end the pain

    Innocent tortured Americans with persistent perpetual physical pain once had their medication dose, quantity, and contraindications monitored and the medications’ purity was guaranteed by pharmacies. Forced to the streets, their potential risk for overdose increases exponentially due to unregulated drugs of unknown purity. Taking advantage of the new source of customers, makers of illegal Fentanyl disguise it as Percocet and Vicodin, and these “death pills” run rampant. Those who go the route of suicide make for messes that create branches of devastated individuals the police must sweep up.

    The current system calls for restricting opioid pain analgesics at the doctors’ level, creating a slow ramp up to Prohibition-like disorder. Millions of patients are suffering. The number of prescriptions written continues downward despite what should be an expected downturn as Baby Boomers hit the age where painful conditions become rampant. Despite the lower number of available prescriptions, the number of opioid-related deaths has skyrocketed disproportionately! Because most of the deaths include a combination of mostly illegal opiates. I believe that it is the responsibility of Law Enforcement to arrest the REAL criminals on the streets, where the crime ACTUALLY is committed. For the sake of the millions of suffering innocent citizens being unnecessarily put in danger of death, Law Enforcement officials and individuals should push for a lifting of the prescription opiate analgesic medication restrictions. This will allow for less suffering, fewer overdoses, and decreased suicides.

    • **Correction**
      The numbers of prescriptions written continue to decrease despite what should be an expected SURPLUS of INCREASED PRESCRIPTIONS WRITTEN as THE SURGE of Baby Boomers hit the age where painful conditions become increasingly MORE COMMON. Despite the number of written prescriptions that began decreasing significantly since 2014, the number of yearly opioid-related deaths has actually continued to skyrocket disproportionately! THIS IS BECAUSE PAIN PATIENTS ARE NOT CRIMINALS! MOST OF THE OVERDOSE DEATHS ARE CRIMINALS USING ILLEGAL DRUGS. In the few cases where people DIE directly from an overdose of PRESCRIPTION OPIOIDS, THOSE MEDICATIONS ARE ALMOST ALWAYS OBTAINED THROUGH ILLEGAL ACTION.

    • Although it may be cheaper to police and restrict pain medications through the coercion of doctors by threatening them to restrict prescriptions for opioid medications, this strategy is proving to be completely ineffective. Statistics PROVE that restricting opioid analgesic prescriptions has NO limiting effect on the amount of overdose deaths. The current increase of Opioid Overdose Deaths have shown to be a DIRECT result of the widespread availability of cheap illegal Fentanyl combined with an uncontrolled increase in the supply of heroin.

      It is up to the citizens in the sector of Law Enforcement to stop the illegal sale of prescription medications exactly where the criminal act occurs – on the street! Set up unmarked cars around hospitals and clinics and watch people coming out of the pharmacy to meet people in cars parked in the vicinity. Set up a hotline where people can leave anonymous tips regarding illegal sales of prescription medications. Concerned loved ones will call with suspicious behavior. Work with contacts in the Judicial Branch to eliminate the persecution of the doctors that swore an oath to give effective relief to those with legitimate intractable pain. Speak out about what you already see – argue that Prescription Pain Medications are a small part of the “Opioid Problem” when compared to heroin and fentanyl. Don’t perpetuate the over-dramatized notion of prescription medications being a large issue of “epidemic” proportions. That’s just propaganda!

  8. Very well written and true. Addicts are not finding the right help, as the programs are not expanded nor available. Incarceration is not the answer and they know this. It has gone on too long, it’s insanity as it gets the same result each time. The system is broken, it needs fixing and that is not to make regulations even more stipend to make things worse. Experienced & Qualified individuals should be the ones looking at the reports, not politicians. Programs are not working, and the chronic pain patients are being dragged into a dark hole with this mess. The restrictions or refusal of help to anyone in need is not the answer. There are many suffering with daily chronic pain , I am one of them. I have prescriptions that are not abused and I’m worried about what is to come and if those doors get closed, what help will I have? There are many that have no relief , the only thing that helps is morphine or another opioid medication. Each persons illness is different and should be treated as such, not classified into one group. We are not a study, like the hunt for contamination of methane gas from fracking from the gas industry. I bring this point up as there was a federal program for two years or more straight to investigate at the cost of a billion dollars a year. The findings were the same before the EPA came in and they still did the investigation because a politician got involved and the money was there to spend. Period. It was all about the money and who was getting paid. This left landowners in a mess and it’s still there and not going away. This is what happens when you have uneducated political agendas going on and you put everything into one box that is not making any sense. Your doing this to addicts and pain patients now as you are finding a new program adventure with political and financial groups and someone needs to get that paycheck instead of helping the addict or the chronic pain patient. We are all not the same, they know this but there are deals being made that are hurting everyone involved in this witch hunt. There are deals with the drug manufacturers that get kickbacks for their medications, that’s something that needs to be addressed as not every medication fits all. There are many prescribing cymbalta, I was told it would give me a better quality of life! Well that was great news, it made me severely sick to my stomach, could not function at all, that was a wonderful quality I was looking for. This was prescribed to me as epidurals for my neck was not working. The problem was I went for rotator cuff surgery, the surgeon put me into a one size fits all therapy, which caused me not to be able to lift my arm at all. Three months of physical therapy, epidurals, nothing worked. Went to additional therapy , found a helpful therapist, and was able to lift my arm up. The surgeon failed, the pain specialist wanted his kickbacks and I suffered. I still do to this day. No one seemed to look at my scan and see that my neck fusion never healed, I will be undergoing an additional surgery next month. This is why I’m here, I have chronic pain, from surgery side effects, this includes brain surgery side effects. I have to have pain relievers, I have to be able to function and move. My body is affected with my spine fusing itself together with a syrinx growing in the spinal cord as well. I have to be very careful of what I do, and I take medications every single day. I’m not an addict, I’m not a drug abuser, I’m a human being that lives with daily pain. I wish to God for a cure, a spine replacement, nerve fiber neuropathy to disappear, my brain to heal itself, it’s Not going to happen. I’m the one that lives with this, I am thankful to be alive. I am not thankful for those who do not stand in anyone’s shoes like mine and dictate what they feel should be law. It’s not going to happen, it’s not going to work! Please , what ever official that is reading this, please educate yourself. Go to a hospital, clinic or rehab and sit next to a human being suffering from cancer, or in chronic pain by means of disease or disorder resulting from birth, war, surgery, accident. What result would you want if this was you in this position. Those making these changes and laws better hope that one day they are not in any of our shoes, that’s the only way unfortunately that you might understand what we are going through.

  9. Dear Law Enforcement,

    Live in my body. Just one day. You can’t, I hope you never have to. The UN deems untreated and undertreated pain as a human rights violation. The ADA requires adequate pain relief to accomplish activities of daily living; getting dressed, bending, showering, making small meals. 90 meq of morphine was intended to be for acute pain patients, which I still disagree with. Why? Not everyone responds to treatment, in the same way, that is why these are guidelines and not mandatory laws (CDC opiate prescribing guidelines). I used to be a respiratory therapist, it is recommended that I do not allow peak inspiratory pressure (PIP) to be above 40, or I risk the patient developing a pneumothorax (collapsed lung). However, some patients are so sick that if I don’t allow their PIP to be above 40, They DIE because I am not ventilating them (moving air in and out of the lungs). The same is happening with opiate treatment. Law enforcement sees any physician writing for greater than the 90meq of morphine and the automatically assume that the doctor is allowing their patients to sell their drugs. This happened with Dr. Forrest Tennant. This is not the case, these doctors are giving individualized care based on the medical status of the patient based on that patient’s physical exam, level of pain, and level of functionality. MOST physicians write for the least amount of pain medication an individual needs to be functional MOST, not all, of the time. The physicians also provide comprehensive care, MOST of them do. This means exercise programs, physical therapy, TENS units, massage therapy, chiropractic care, and interventional pain management procedures. There are very FEW, less than 1% of doctors that only write for opiates and only write for high doses. My doctor will not write for more than 90meq of morphine because he fears the DEA will raid his office and therefore not allow him to treat patients anymore. Even if there are no charges filed, this ruins reputations, it ruins the physicians moral and trust, and it affects the relationship with the patients. It effectively snuffs out pain management as a practice of medicine. Combine that with the laws that primary care physicians can only write for x number of days at x dosage for patients in pain, and you leave chronic pain patients with a plan to put a gun in the back of the throat and pull the trigger.

    I am not being dramatic, that is my plan if I ever have to live without pain management. I am going to list the name of 23 individuals that left suicide notes before they committed suicide due to lack of pain management. I know you think you are preserving life by acting on physicians writing for more than 90meq of morphine, but unfortunately, those practices of going after every doctor that writes for more than 90meq when you are not a doctor to make those determinations is doing the exact opposite. For those you haven’t lead to suicide, you are inflicting torture. You are directly responsible for individuals not being able to get out of bed and play with their children, walk their dog, take a shower, put on shoes and socks. Those tactics cannot be allowed to continue. Stop bullying our doctors.

    By the way, addiction is a choice. One has to make the decision to use more medication than they are prescribed, they have to make a choice to use it when they don’t need it, they have to make a choice to ask for a refill when they don’t need it, they have to make the choice to seek out a drug dealer, they have to make a choice not to ask for help with dependence. DEPENDANCE IS NOT ADDICTION. Dependence will not make you sell your body for medication, it will not make you leave your children, lie, steal, or cheat. People have to make a choice, there is no one alive in our society that does not know that opiates have a potential for addiction. Keyword Potential, not everyone is subject to addition. Additionally, pain patients do not have euphoria with their pain medications, why, because we are still in pain even with them, it’s just not as intense of pain. Do not lead to the deaths of people that did not ask to be sick or injured. Addicts will be addicts whether you crack down on drugs or not, they will find a way no matter what you do, they will find a way. ….

    Think twice, check for bias before you go to the doctor, send in undercover patients to see if they can score big, do not use my dosage as a reason to shut down my doctor or any other pain doctor at that….

    [editors note: this comment has been condensed for space]

  10. I Lost two Dr’s one I seen for 10 years I never abused my meds. real Pain patients don’t ! The Dr after that was on the up & up too gone now my meds are being taken lower every time I go I’m back to can’t sit go out bedroom someone has to help me do everything !

  11. I am a Chronic Pain Patient. I was on high dose opioids for 6 years. That treatment stopped working for me.

    Regrettably the Opioid Hysteria that has affected the nation has already caused great harm to the chronic pain community.

    Suicides are being reported because the patients medical providers discontinued treatment due the “Opioid Crisis” and the patients could no longer stand to live with the pain any longer. They chose to end their lives rather than to turn to the streets for “alternative” pain relief.

    I am the member of several support groups with thousands of members in each. Each of whom tells of their struggle to obtain effective pain management care.


    Their doctor will no longer prescribe opioids. Their doctors will no longer treat them.

    No… it’s not that they don’t need them… it’s not that they have misused or abused them. It’s all due to the “Opioid Crisis”.

    One patient called today when they realized tgat their prescription was due for refill on the 20th.

    They were told… “Sorry, you will have to find another doctor, we’re not writing anymore opioids”.

    Another members provider told her he was going to take her off the Opioids due to the Opioid Crisis. Then put her on such a severely rapid taper down that home health recommended Hospice. She was having 10 -15 seizures a day, was unable to walk unassisted to eat or drink and nearly died. All because her doctor was scared to continue to prescribe the medication she needed for her chronic pain conditions.

    Even if you have a prescription, getting it filled can be a challenge. You have a Pain contract that requires you to use a single pharmacy. But… it’s not uncommon for the pharmacy to be out of the medication you need, or not have enough to fill your prescription.

    Because it’s a controller substance, you can’t get a partial fill. Well, you can. But, if you do, you don’t get the rest of your medication.

    Or… some pharmacies now have polices where they think they can over rule the doctors.

    Chronic Pain Patients have been left with three options.

    1. Live in misery.
    2. Commit suicide.
    3. Turn to illegal street drugs.

    Few will choose option 3. The reason is simple.
    We would rather live or die with dignity than to allow our pain to be used to support this hoax that has been perpetrated on the American public.

  12. I have read all the replies. I agree with all. I am a chronic pain sufferer. I was released from my doctor over a year ago. I suffer everyday. I have tried to find another doctor. One not afraid to stand up for their patients. I am on my 3rd and still not help. I have been on a waiting list for a pain clinic that has no intention of seeing me. One reason is that I am on Medicaid. Another is because I have PTSD. The trauma I experienced was abuse from a dentist as a 10 year old child. I have had many other negative experiences with doctors as an adult. One almost cost me my life. I see a counselor. I refuse anxiety medication because it causes me to be extremely depressed. I feel like I am being punished by society for things not caused by me. When people fear the government it is a sure sign we are living under tyranny. My story is long and complicated. No doctor wants to hear it. Time is money and my Medicaid does not pay them well enough to go the extra mile.
    I will suffer because I will not risk my freedom on purpose. I also know how painful it is to your loved ones when you commit suicide. My younger sister killed herself almost two years ago. My mother has aged 10 years in 2 and cries everyday. I won’t do that. Please listen to the people this is affecting. They are telling you the truth. Why should millions of pain sufferers have to live this way because of the 5% that will always find something to abuse. It seems like common sense but that is what is missing in these new guild lines.

  13. I would like those working in the law enforcement field to realize that it is cruel and unsual punishment to withold legal pescriptions from a chronic pain patient in jail especially when they are merely accused of a crime! A no tolerance policy is extremely unjust and should be illegal. I personally endured a panic/asthma attack because of such policies. Only when I couldn’t breathe, did anybody properly explain this policy to me and get the nurse. My BP was through the roof. I was in there for DWI, a very good lawyer later proved my healtj conditions affected the breathalyzer results. I suffered immensly because of this flawed technology. Be aware that is probably more common than one would think!

    • 1:02 PM
    Rick Busse
    To pauldrooney
    Hi Paul,

    This is well written. You are doing a good job advocating for the rights of seniors dealing with chronic pain. I trust this begins to generate some positive discussion and ultimately change for the betterment of patients.


  15. Despite community mobilization efforts, patients suffering lifetime intractable pain have not been allowed in the ongoing efforts as stakeholders in this crisis. Yet the class of meds that addicts have chosen also happen to be the linchpin in many patients’ multi model treatment plans.
    Who are we who say we are in chronic pain? We are gunshot victims, trauma and burn victims, spinal cord injury sufferers, & victims of painful neuro degenerative diseases. Intense, non stop nerve pain like when your tooth is broken but throughout entire areas of our bodies.
    For most of us, there is no treatment or cures available. Patients take years with trial and error before getting their maximal treatment plans. Opioids are usually last line therapy available only to those who remain refractory despite including CBT, acupuncture, mindfulness, “pain acceptance”, supplements, other pain management medications and PT.
    For most, opioid therapy is the only thing that restores function to those otherwise bedridden in pain.
    It is hard for others not experiencing intractable pain to understand the level of non stop suffering that humans can endure. Eventually the agony becomes too much and with their stable medications suddenly removed, life is simply too torturous. Our community can lost nearly 40 known suicides in the last 18 months due to this misguided policy.
    Patients on stable, longterm opioid therapy do not divert their medications; the relief is far too valuable. We don’t contribute to the black market sources causing the opioidemic.” We must be allowed to be heard as stakeholders in any further CDC/ DEA opioid prescription decisions.

  16. I’m a chronic pain patient. I’ve tried every medication my doctors recommended, some with disastrous side effects. The only medication that has given me any relief has been low dose morphine and oxycontin. It does not give me euphoria. It doesn’t even entirely erase the pain. It just makes it bearable. It meant the difference between bedridden agony and being able to dress myself and attend physical therapy. I’ve followed every rule with my medication and worked hard at learning how to live with constant pain. I do not drive because a sudden sharp pain is too distracting. I am not an addict and don’t know addicts or hang out with them. (I was an elementary teacher.) I keep my medicine locked up and have never shared a single pill, nor would I. I’ve supported all regulations about monitoring usage. Still, my doctor has placed me on a forced tapering off. Not based on a change in my condition or on any testing, solely because of fear of losing his license. I’m slowly losing all of the progress I’ve fought so hard for. I can no longer stand to be touched, am having difficulties dressing myself and taking care of basic daily living tasks, wake constantly in such pain I cry in my sleep, and can only expect it to get worse. So far, I can still manage to get to the bathroom alone, but soon, even that will become impossible. I’m being punished by society for contracting an illness with no known cause or cure.
    My options are live in hellish pain, seek illegal drugs, or commit suicide. Illegal drugs are not an option I would choose. I’m not a criminal.

  17. I have lived with extreme pain for over a decade. After attempting every option before opioid pain relievers TO no avail, I allowed my doctor to slowly give me opioid pain relievers. It started with norco, after two weeks nothing, then oxycodone, nothing. Then my doctor took metabolism test, only to find that opioids will work for me , but the DOSES must be higher. He put me on oxycontin 80 mg. It worked. I was able to function. After about a month I told the doctor that the medicine would wear off to quick so he gave me oxycodone for breather pain. My pain went from a bedridden screaming pain from my base of skull to lower spine. I have many ct scans and mri to prove the pain IS real.
    For over 7 years I took my medicine as directed, never had a drink and never smoked any pot.Fast forward my doctor told me because of the ABUSERS of the world the DEA is harassing him regarding my prescriptions. I then had to move. Kaiser became my new HMO. THEY SAW MY PREVIOUS Doctors’s report and continued treatments. HEN THE CDC AND DEA GOT INVOLVED.MY Doctor WAS FORCED TO CUT ME AND EVERY OTHER PAIN PATIENT.

    I MUST SAY MY PAIN WASNT ALL GONE BUT I WAS ABLE TO DO MINOR CHORES GO FOR WALKS AND BE INTIMATE WITH MY WIFE. I AM AT 50% of my stablizing dose. My pain is back 50% stronger. I can not do more then 10 minutes of activity, with.out needing to lay down. I now have heart desease and need bypass surgery. If I get that surgery I will not get any more medicine then I get now for post surgery. That amount of pain is unacceptable to me. They tell me to exercise. I ask how? If you gave me back my stablizing dose and was able to exercise could I put off this bypass surgery. The surgeon said yes, for POSSIBLY years, but kaiser wont approve the increase.

    Many years ago the DEA started a date BASE, it allowed drs and pharmacists to communicate and make sure people weren’t dr shopping. That data base pretty much got the bad drs and PHARMACIES our of business. BUT THAT WASNT ENOUGH.the DEA conti.ued to threaten all pain drs with jail and loss of License,MANY LEFT THE PRACTICE ENTIRELY AND MANY PRIMARY Doctors REFUSE TO WRITE OPIOID PRESCRIPTIONS. …THE AMOUNT OF PAIN PATIENTS GROW DAY BY DAY. ….

    We must be allowed to get the amount of medicine we got before the CDC Guidelines came out….
    [editors note: this comment has been edited and condensed for space]

  18. It was nice to hug my kids and go for walks
    My pain medication allowed that. NOW without it, I spend most of my day in bed waiting for my next dose, never feeling better then a 7/10. I USED to be at a 2/3.
    What the DEA fda and govt is doing to us is Inhumane torture. I guess selective population reduction is a thing. They starting with the disabled americans. What o the country throws injured desease people in pain to the streets but wants to help junkies other then AMERICA and NAZI germany.

  19. I’m not sure what a “junkie” is. My primary concern is for pain sufferers who USE PRESCRIPTION DRUGS RESPONSIBLY.
    I hope that addicts are able to unscramble the problems they have with substance abuse. If someone became addicted to a drug because they were misdiagnosed or were not given proper care by a physician, that is a problem which should be addressed quickly, comprehensively, and compassionately. Regularly, complaints are made about such incidents at V.A. facilities.
    There are also desperate pain sufferers who have been DENIED merciful pain intervention, which prescription opioid drugs ABSOLUTELY do provide!!! I used a prescription opioid RESPONSIBLY and SUCCESSFULLY for 23 years. I accidentally had world-class medical care, because I lived in a major U.S. city. Several physicians, including our family doctor of many years, ALL told me that I NEVER showed ANY sign of addiction or even tolerance to that opioid. I had a simple, inexpensive drug test twice a year to make sure the opioids were not causing damage to my internal organs or body systems. NEVER did long-term opioid use damage me..NEVER. Instead, that opioid intervention allowed me to function more fully and optimize my physical capacity, even though I have a debilitating disease. I always wrote down when I took opioid drugs, along with the amount I consumed. I had little calendar books FULL of those records. I also made sure that I had some type of food in my stomach to lessen any irritation which MIGHT be caused by “taking drugs on an empty stomach”. I WAS EXTREMELY RESPONSIBLE, AND I HAVE BEEN TREATED LIKE A COMMON CRIMINAL, DENIED HEALTH CARE, AND FORCED, UNDER DURESS, TO GIVE UP BASIC CONSTITUTIONAL RIGHTS!!!
    Prior to contracting an incurable condition which causes chronic pain, I wouldn’t even take an aspirin unless I really needed it. It NEVER bothered me to use any drug I needed, but I also NEVER abused any drug.
    No one wakes up one day and says, “Oh, I think I’ll go find an incurable condition which causes a lifetime of chronic pain. Yet, the victims of such conditions (millions) have been kicked out of practices, clinics, and hospitals. Even in smaller geographic areas, many health care practices exist as large, multi-facility operations . If an innocent opioid user is permanently kicked out of such a facility, even in a medium-size community, their access to basic medical care is restricted or completely unavailable! SUCH PUNISHMENT, WITHOUT CAUSE OR RECOURSE, simply because they use opioids for inescapable pain?!! Some of those former pain patients are desperately taking to the streets to find pain relief from illegal drug trade, ONLY because of the pride, arrogance, cowardess, and incompetence of federal agencies and health-care professionals. Also tragically, other unmedicated pain sufferers are committing suicide.
    DRUG PARTIERS MAKE CHOICES which have caused problems for responsible people, AS DO DRUG DEALERS. Federal agencies should focus their efforts on PROTECTING U.S. CITIZENS, by stopping the flow of illegal drugs across U.S. borders, INSTEAD OF interfering with beneficial relationships between physicians and patients and their choice to use prescription opioid drugs RESPONSIBLY.
    In order to engage in addiction, most addicts have to DECIDE at least twice to bypass ordinary cautions about using drugs safely. Some make poor choices out of ignorance or desperation. Yet, there are others who do so with adequate warning and with a disregard for their own welfare and the welfare of others. They can make better choices or suffer the consequences of their poor choices.
    Drug enforcement needs to return to preventing DANGEROUS drugs from crossing U.S. borders. On the other hand, I AND MY PHYSICIAN SHOULD BE LEFT ALONE AND NOT INTERFERED WITH. I HAVE SUFFERED EXPLOITATION, HARASSMENT, STIGNATIZATION, AND DURESS, WHICH WAS TOTALLY UNNECESSARY. I have unaggressively, but firmly, stood up for myself…FOR 10 YEARS…against abuse from the entire HEALTH-CARE INDUSTRY and MY OWN GOVERNMENT…ESPECIALLY THE CDC!!!

  20. I’ve been on an opioid pain management program for 5yrs now. I go to the same P.M. physician, get the same medicine and the exact same number of pills every single month. I go to the same pharmacy & see the same pharmacist each & every time. I’m given a random urinalysis approximately every 90 days that checks to make sure I’ve got the right amount of product in my system. No more, which would mean I was abusing the meds by taking too frequently. No less which could mean I was selling my medication & not taking it all myself. I’ve never been flagged. I’ve never missed an appointment. I’m in mental health counseling in 2 different places. I’m also returning to school in the hopes of getting the education I will need to re-enter the work force & get off disability.
    How is forcing my doctor to decrease the amount of medicine he prescribes to me going to affect the opioid epidemic? I’m being discriminated against because of the type of medicine I take. I’m not the criminal. I didn’t ask for this! I realize that not everyone is honest, I get it. However I’m not the criminal here. Without the medicine I take I’m unable to manage my pain. I’m unable to do much of anything. My medication allows me to have some quality of life. Can someone explain to me how MY opioid pain management program contributes to any type of criminal activity? Lowering my dosage amount will do nothing to help the opioid epidemic. It will not affect anyone at all except for me. I’m being discriminated against because of the type of medicine I take, it’s clearly discrimination!! You can change the laws, you can put restrictions on the physicians, restrictions on the patients that don’t misuse or abuse it none of that will help the problem. The criminal users will still find ways to get the drugs they want. They always find a way! My opioid use, my LEGAL medically necessary use of pain medicines has nothing to do with the current problem our country faces. The only thing that will happen is my quality of life will be drastically compromised!

  21. Very good report, thank you for writing it. Are used to be an extremely active outdoor person, extremely ambitious in my career and had chosen not to get married or have children and have a career instead. At 37 I went back to college to pursue my lifelong dream of becoming a chemist or an engineer or both. Instead, I received a medical injury from Cortizone injections and contracted adhesive arachnoiditis in At least two places in my spine. The end result is intractable chronic 24 seven unbearable pain. I also have damage nerves to my intestines so I don’t absorb food or medication like I should. And I have many genetic mutations, several of which results in my inability to absorb all of opioid medication meaning that I have to take a higher dose to Control the pain I am in. I have always been an extremely responsible and careful person with medications, choosing natural remedies over synthetic ones whenever possible. My disease forced me to take many drugs that I never in a million years I imagined I would be on.
    It is very stressful because I am now aware that just because I have a medical injury, and contracted a disease I didn’t want, I didn’t ask for and I definitely didn’t deserve, I will now always be looked at with suspicion by medical professionals and law-enforcement as either a drug abuser or a drug dealer. I shouldn’t even have to say that I am neither. The fact that I have to say those words offends me. I feel that I have been extremely discriminated against because I received a medical injury from a Doctor(s) Who we’re not practicing responsible medicine, though accidents happen and yet after it happened to me they did not do anything to try to help me recover or prevent developing adhesive arachnoiditis. I can tell you that it is extremely painful and normal people could not live with it. I barely live with it. And I make an extremely stubborn, determined, and used to be a vivacious person.
    My comment may not go very well with the article. But my point in writing it is to differentiate between people that are in and chronic intractable pain like me, people that are not, and people that are addicted. Even someone that is addicted is not automatically an evil person. Someone that gets addicted is just someone that has problems that are separate from chronic pain. Those problems can be dealt with separately, and should be dealt with separately. They are not the same as patients like me who have chronic intractable pain. That means that I have pain 24-7. It means it never stops and never goes away I never have a break. I don’t mean like a little pain, like my back aches or my ankle eggs or something. I mean like I have burning on the bottoms of my feet all of the time, stinging down my legs and often my left leg will not work. That is a lot different than someone who sprains their ankle and wants some of yours. Problem in this country is lack of education. Everybody needs educated. Law-enforcement needs educated, even doctors need educated, the CDC needs educated, the DEA needs educated, the FDA needs educated, I could go on anon you get my point. It is time for everybody to stand up and make their voices heard that just because you’re on a certain medication does not make you a criminal. Diabetic needles are used my hair when addicts and yet are people with diabetes labeled addicts even though some sell there needles
    TO addicts? No they aren’t. They are treated with compassion and kindness. What is different about pain patients? What makes us invisible, and discarded? There needs to be a serious focus, and a serious effort to make The distinction of all three groups, and a plan to treat all three groups. Also medical treatment needs to be put back in the hands of medical professionals. People that do not have extensive medical training have absolutely no business involved Period. Unfortunately there are only a few people standing up for us, like the author of this article, and because we are all sick people we are not able to do much for ourselves. That means it’s all the more important that we all stick together and make our voices heard. We are not asdicts, we are not criminals, we are victims of a disease and often times that disease as a medical injury NONE of us asked for. Everybody has to participate in this. That means law-enforcement have to use their brains and give people the benefit of the doubt and compassion. The regulating agencies need to start using their brains and thinking about things and looking at evidence instead of following along like sheep. Patients need to start speaking up as much as possible. And anybody that’s close to patient’s needs to advocate for them as much as possible, like this author is doing. Medicine is being criminalized and that is ludicrous in the country that we live in.

    • Unfortunately I am unable to type because my hands do not work properly due to my disease therefore I do talk to text. I read it as I said and it says the right words, but after I am done it often changes words that don’t make sense. That’s why my above comment has weird words in it. It makes me look unprofessional, and I am apologizing for that. Whoever reads it will just have to try to understand what words I meant to say. I would fix it but it doesn’t allow me to edit it.

  22. Red, thank you for continuing to advocate for the chronic pain community!! Since this is The Crime Report, perhaps we should look at the opioid’epidemic’ through a different lens. ..Is our government guilty of torture? They are punishing pain patients for the acts of another: addicts.

    They are telling physicians to withhold or decrease pain medication for patients in excruciating pain strictly because someone else is abusing heroin or fentanyl….. Is the government not using coercion via the DEA to intimidate doctors into no longer prescribing pain medication to patients? Many of the patients who are being suddenly cut off or rapidly tapered from opioids have been on stable doses for decades. What purpose does this serve, other than to torture?

    As a chronic pain patient who just spent two nights inpatient after loss of function in my right leg, my pain medications were intentionally withheld after being admitted. The internal medicine physician on my case denied my nurses pleas to increase my dosage to at LEAST the amount I am prescribed, which she had verified by taking my prescription bottle and calling the pharmacy to confirm that indeed was my dose, and has been my dose for over a year. The physician STILL refused!!! How is this not torture? …Once in a while you encounter a few medical professionals who show compassion (like the nurse who went to bat for me, but was ignored), but more often than not we are met with suspicion, disbelief, and ignorance.

    Yes, the addiction community needs help. But how in the hell is torturing the chronic pain community helping the addiction community? It’s not.

    Let’s focus on helping the addiction community by adding treatment options that work for them. Because the attempts to help addicts by removing treatment options from a group of disabled individuals has got to stop. You’re literally killing us. And in the process, you’re still not saving the addicts.

  23. To sum up the impact on people suffering from chronic pain, they seem to have been involuntarily expatriated, exiled in their own land. They are denied equal access to medical care, banished to a life of subsistence in isolation bordering on solitary confinement. And all the time the people who are dying, predominantly younger white men who are addicted or recreational users, are also denied appropriate treatment. Meaningful scientific reviews, such as the annual ones from Pennsylvania, show that prescription pain medications play a minor role in deaths. The major killers are illicit fentanyl, and the regulators have done nothing to stem the flow of these literal poisons. The cost of this colossal failure to control the poisons that are flowing into the US can be counted in deaths of too many, but also in the decades of enhanced torture being imposed on those who suffer chronic diseases that cause intractable torturous pain.

  24. As long as we live on this earth people will become addicted to drugs, gambling, shopping and the like. Many people are born with an addiction personality trait and there is no way to change that. People are now resorting to laundry pods as the latest crazy way to get high.
    I was recently seeing a pain management doctor who treated me so badly and had me stressed out. He didn’t communicate with me or involve me in my own treatment plan, told me my pain was in my head (I don’t why, but I honestly thought I wouldn’t ever hear those words), didn’t even tell me he was tapering my pain meds- I found out at the pharmacy. We are humans too and deserve to be treated as such. I have trigeminal neuralgia that was caused by dental work and it turned my life upside down in unimaginable ways. Don’t think it can’t happen to you? Neither did I. Anyone can wakeup one day with trigeminal neuralgia caused either by dental work, because the trigeminal nerve went haywire or one of the other numerous reasons. Please stop frowning on chronic pain patients or their doctors, reinstate doctors prescribing pain management medications and let them practice medicine which they studied for years and went into debt.

  25. Our government claims it cares about addicts and those dying from overdoses but when it’s time to show up and “walk the walk” they are nowhere to be found. The money doesn’t come. The political will from the Republican majority is simply not there. They are for arresting addicts and forcing them to detox cold turkey in jail. If they die– so what? They don’t want to spend tax dollars on trying to solve the problems that lead to addiction and they sure don’t want to spend them on helping addicts gain control of their lives and become productive citizens. That would take time, money and a caring, compassionate way of thinking.

    A year after Trump was elected president there is still no director of the Office of National Drug Control Policy. The person who is Chief of Staff is a 24-year-old who’s only professional experience after collage is that he worked on Trump’s campaign. He has no experience in anything related to drugs, health care or public policy. He is running this office which has no director. Last year, the Office of Management and Budget proposed cuts that would have effectively eliminated the ONDCP for the fiscal year that began in October. The White House abandoned the plan after objections from a bipartisan group of senators. This shows the attitude this administration takes to the drug addiction issue. * Spend no money, run programs with incompetence, hope no one notices and the addicts will eventually die of OD’s so the problem solves itself.

    They do not care to know about chronic pain patients and how they are affected by their policies. To them we are weak and sick with little to no voice in the matter and in time will also go away due to the policies of the CDC and DEA. Another problem solved.

    If I’m wrong I’d love to see proof that shows otherwise.

    *Meet the 24-year-old Trump campaign worker appointed to help lead the government’s drug policy office – The Washington Post, 1/14/2018

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