Distinguishing Intractable Pain Patients from Drug Addicts

Distinguishing Intractable Pain Patients from Drug Addicts

By Joel S. Hochman, MD

http://bit.ly/IPvsAddict


Maybe one of you will better understand what appears to me to be nothing but an excuse to keep pain patients from getting their meds. It seems to me that fear of Diversion is a poor excuse for denying legitimate pain patients access to opioids, especially when nothing else works. The DEA has NO AUTHORITY to regulate medicine, they can only go after a doctor if (s)he prescribes "outside of medical practice", meaning that they were intentionally writing prescriptions that were not intended to treat a legitimate medical condition. Unfortunately, doctors don't decide which doctors are prescribing in the "due course of medical practice", and neither do any other medical professionals. DEA agents (glorified cops) and prosecutors make these decisions. They've scared doctors to the point where the doctors have started to lie to their patients in order to reduce the number of controlled substances (especially opioids) that they prescribe.

My biggest question is this....

If physicians can distinguish so easily between addicts and legitimate pain patients (which I do believe that they can), why is it that the DEA can't tell the difference between prescriptions to legitimate patients and prescriptions written to addicts?

-Steve

FDA: Naloxone Injector Not Just for Drug Abusers - National Pain Report

FDA: Naloxone Injector Not Just for Drug Abusers - National Pain Report

http://bit.ly/1kEtGLQ

This is SCARY! This device would be scary enough, but to advocate its use on pain patients is somewhere between malpractice & medical terrorism. Instead of reposting my thoughts here, I've included the comments that say it all.

Even if unconscious, it is illegal to administer naloxone unless you are a doctor or an EMT being actively advised by a physician. I doubt that these laypeople will bother along for consent. Without significantly training (like the REMS programs for Accutane & Xyrem), this is scary.

Why was this rushed through approval?

~~~~~
Kurt says:
April 4, 2014 at 7:14 pm
I guess I need a new Medic Alert tab for my necklace in case I faint the next time I am in Safeways shopping for dinner, and succumb to shock over the high prices they’re charging these days for a pound of hamburger.

I am a chronic pain patient maintained on opiates.

DO NOT INJECT WITH NALOXONE. I am opiate tolerant and not likely to overdose on opiates. Naloxone could put me into immediate opiate withdrawal causing a health crisis.

Lord keep us safe from do-gooders.

~~~~~~~~~~~~~~~
Steve says:
April 7, 2014 at 6:36 pm

Exactly, Kurt! Thank you!...

[trimmed]

...I’m considering a permanent tattoo claiming allergy to naloxone. I already have a DNR refusing naloxone, but where I live DNRs are ignored in the prehospital setting (ambulance, etcetera), which is why I’m thinking about the allergy tattoo, I’d love your thoughts.

~~~~~~~~~~~~~~~
Steve says:

April 7, 2014 at 6:29 pm
Naloxone only reverses opioids, but the vast majority of overdose deaths are not opioid only, they usually involve alcohol and/or benzodiazepines (Valium/diazepam, Xanax/alprazolam, Ativan/lorazepam, etcetera)

This is deeply rooted in opiophobia.

Also, of they really wanted to help people, it would be OTC or OTC worth log book (like pseudoephedrine/Sudafed), but then they wouldn’t benefit from Rx insurance reimbursement. This should be “Pharmacy Only Medicine”, like Imitrex in the UK, where you don’t need a doctor’s prescription, just counseling with the pharmacist (slightly more restricted than Sudafed because training should be required).

This product is used to COMPLETELY reverse opioids, which is fine for an opioid-naive overdose, but would kill an opioid tolerant IP patients like myself. Without dose control, it could kill. Without dose control, I’d imagine most Heroin addicts will refuse a dose because every documentary that I’ve seen involves a human going around with naloxone and they always have trouble convincing these people to take the naloxone. They frequently convince them to take half of a dose.

Pain patients rarely overdose. Family members who can’t mind their own business and don’t know ANYTHING about opioids will abuse this and/or abuse their pain patient family members.

This is all about money, generic naloxone is ~$0.50/dose

Steve

Medication Jeopardy - National Pain Report

A Pained Life: Medication Jeopardy - National Pain Report

http://bit.ly/1lGjvrJ

"I was concerned about being able to get methadone when I returned home to New York City.

“My mentor is there. He’ll give you the prescriptions. Don’t worry,” Friedman said.

Unfortunately, he was wrong.

When I told the doctor, “Dr. Friedman told me you would write the methadone prescriptions for me,” he stood up, said he would not, ended the appointment, and sent me on my way – with no prescription or instructions about stopping the drug."

My comments:
~~~~~ Comment #1 ~~~~~
I was cold turkeyed from methadone (although I had oxycodone, which helped with the mu-opioid activity, but not kappa-opioid or NMDA).

Methadone it's cheap and effective, but it is also misunderstood because of a few overdoses caused by uneducated physicians. Methadone should NEVER be increased more than once every 5-7 days. Other opioids can be increased every few days or even every few hours. If a doctor increases methadone as often as they increase oxycodone, oxymorphone, morphine, or fentanyl, the patient could overdose.

There is a irrational fear surrounding methadone and because it is about $10/month, there's no incentive for drug companies to spend money dispelling those myths. Some brand name drug companies will scare doctors away from methadone to boost sales of OxyContin (oxycodone ER - major culprit), Kadian (12 hr morphine ER), Avinza (24 hour morphine ER), Exalgo (24 hr hydromorphone ER), Opana ER (oxymorphone ER), and, now, Zohydro (12 hr hydrocodone ER).
Sorry, I don't mean to sound like a conspiracy theorist.

Duragesic/fentanyl patches 400mcg/hr have no effect on my neuropathic leg pain, but low dose methadone (even 5mg/day) can have huge effects.

Methadone is uniquely effective because it it's not a pure mu-opioid (like morphine, oxycodone, fentanyl, sufentanil, alfentanil/Alfenta, oxymorphone, hydrocodone, hydromorphone, codeine, and remifentanil). Methadone is a mu-opioid, but it's also a kappa-opioid, an NMDA receptor antagonist. Methadone is ideal for nerve pain, but it is also effective for back pain and cancer pain.

Steve
~~~~~end~~~~~

~~~~~ Comment # 2 ~~~~~
Robert is correct, this is medical malpractice.

Untreated and under treated intractable pain can and do kill, usually through cardiac over-stimulation and various changes in the cardiac, pituitary, and adrenal systems. Dr. Forest Tennant explains it best in 'The Intractable Pain Patients' Handbook for Survival', which is (legally) available for free.

http://bit.ly/PainGuidePDF

Dennis is correct, pain patients need to be given a voice among those who regulate pain treatment. To those who lost kids, I'm sorry, but you kids was an addict who broke the law and took powerful medications without any regard for the directions.  These kids toss random points in a "candy dish" and swallow handfuls, you can't regulate that kind of stupidity. We pain patients are completely different from the drug abusers who make our lives hell.
~~~~~end~~~~~

Steve

Ask the Pharmacist: Why Am I Being Denied a Pain Medication? - National Pain Report

Ask the Pharmacist: Why Am I Being Denied a Pain Medication? - National Pain Report

http://bit.ly/1hVfr2n

I know what you're thinking, another link, really? Unfortunately, I haven't felt up to posting any personal posts. Fortunately, I've been running across quote a few great articles.

Steve

BALANCED Opioid Article

It's unprecedented, but the media has finally realized that the patients' perspective in the debate over prescription opioids belongs in the article, not the comments section.

I urge you to read and pass along this well written, well thought out article...

Why are patients shut out of the debate over prescription pain medicine? - The Washington Post

http://wapo.st/P6xOuA

Article: Fibromyalgia Mystery Finally Solved! Researchers Find Main Source of Pain in Blood Vessels

Fibromyalgia Mystery Finally Solved!
Researchers Find Main Source of Pain in Blood Vessels

http://bit.ly/1c4Q0yu

This is a more laymen-friendly version of an article from several months ago that explains that Fibromyalgia isn't Psychiatric, but neuropathic. The pain is the result of abnormal nerve fibers, which improperly manage the blood vessels. This article focuses on the fact that Fibromyalgia is not Psychiatric, but I'll repost the more in depth article later.

The worst part is that, thanks to the War on Drugs, War on Doctors, and the newest war, the War on Patients, Fibromyalgia patients will still be given useless SSRIs (Prozac/fluoxetine, Paxil/paroxetine, Zoloft/sertraline, etcetera), SSNRIs (Cymbalta/duloxetine, Effexor/venlafaxine, Pristiq/desvenlafaxine,  tramadol/Ultram/Ryzolt, Nucynta/tapentadol, Savella/milnacipran, etcetera), and mood stabilizers (antipsychotics & anti-epileptics; gabapentin/Neurontin/Gralise, Lyrica/pregabalin, Lamictal, Abilify/aripiprazole, Seroquel, etcetera). Unfortunately, antiopioid propaganda and the DEA are preventing most physicians from prescribing pain medications for pain. Opioids are the safest (especially in the longterm), most efficacious (with adequate dosing) solution for any chronic pain condition.

Remember, acetaminophen/paracetamol/Tylenol alone kills more people than all opioids combined. NSAIDs aren't as deadly as acetaminophen/paracetamol, but they're still more deadly than opioids. Actually, even diacetylmorphine/diamorphine/Heroin rarely kills on its own, drug abusers die from mixed drug toxicity (combining alcohol and/or sedatives with opioids). Of course, opioid related deaths are almost all drug abusers. The statistics are never deaths caused by opioids, they're "opioid related deaths" or "drug related deaths", meaning any death that occurs with a drug peripherally involved, even if it is completely unrelated to the actual cause of death.

Steve

New Drug Law To Relieve Pain For India’s Chronically Ill - India Real Time - Wall Street Journal

New Drug Law To Relieve Pain For India’s Chronically Ill - India Real Time - Wall Street Journal
http://on.wsj.com/1bfce0P

Walgreens is Ruining My Life - National Pain Report

My Story: Walgreens is Ruining My Life - National Pain Report
http://bit.ly/1dgNjnj

Okay, so I got a little carried sweaty with my comment, but that's no reason not to share it with you guys!

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This is all part of the DEA's war on doctors and war on patients. Drug dealers aren't easy to go after and they fight back. Doctors have plenty of non-hidden resources and admit they dispensed the meds. The DEA is made up of a bunch of cops who are too ignorant to acknowledge their own medical ignorance who can't tell the difference between medical practice (which they are expressly forbidden from governing under the constitution- legitimate medical practice is exclusively governed by the states) and pill mills. Unfortunately, the DEA is left to determine what is legitimate medical practice with no medical training and AUSA (Assistant US Attorneys) have been know to later bribe "medical experts" up to $40,000 to say that the accused doctors are out of bounds.

Even if a doctor wins their case, they end up hundreds of thousands of dollars (easily $750,000) in the hole with NO MEANS TO REPAY THAT DEBT because they lose their medical licenses automatically.

Our entire legal system is BROKEN! The accused are GUILTY UNLESS PROVEN INNOCENT, instead of INNOCENT UNTIL & UNLESS PROVEN GUILTY. That's a big problem, but it can be fixed in pieces. For example, doctors should be judged by THEIR PEERS, OTHER DOCTORS, not cops. The DEA should have NO POWER over medical practice and allegations of overprescribing should be handled by state boards with criminal charges being decided by state DAs and this should be ONLY AFTER there medical board determined that their actions were outside of the scope of medical practice.

Doctors must stand up against the DEA's tyranny and we must stand up for our doctors. Enough of the DEA's games, enough of the scapegoats, enough of the lies from doctors, from pharmacists, from drug companies, and ENOUGH of the DEA's lies.

Knowledge is POWER and the DEA knows that and that is why they spread their propaganda. We must counter their lies with smart, level headed rebuttals. Statistics are powerful and we must remember to use specific statistics and clinical trial results because, while our individual stories are powerful, large trials sway opinion faster. Everyone who is comfortable doing so should call their local news stations and encourage them to do stories about the suffering of CP/IP (chronic pain/intractable pain) patients as a whole AND about our individual struggles. We must rebut the DEA's "Opioid Epidemic" and reminds the nation, and the world, that the true epidemic is underprescribing and undertreatment. The 'Epidemic of Undertreatment' is a threat to our national and economic security.

Our comments here are a start, but I encourage all of you to branch out beyond the CP/IP world. Post this and every other article and opinion publicly on your Facebook, Twitter, Google+, and every other site. Branch out beyond the internet (if you are able). Write to your elected officials, medical boards, medical societies, and anyone else who might listen.

Above all else, STOP BITING YOUR TONGUE WHEN YOU'RE LIED TO!!! When your doctor says that there is a "new law" causing him/her to reduce your meds, instead of admitting his/her cowardice, POLITELY inform him/her that you mean no disrespect and are not arguing with his/her decision, but there are no new laws governing prescriptions, however you understand that the DEA has been overly aggressive. You stop the lies, build a report (silent 'T'), and it can cause your doctor to consider more adequate prescribing because you can build trust through honesty.

Although I worded this all as "directions", I mean it all as suggestions and I hope that you all can understand my passion for this subject and not hold my wording against me.

Steve

If anyone knows of any articles or studies that I can add to http://bit.ly/IPkills in order to represent what chronic pain is really like for patients, physicians, pharmacists, nurses, caregivers, physician extenders, family members, etcetera, please email a link to me. I'm also working on a less personal site, essentially an encyclopedia of chronic/intractable pain. Any articles for that site are also welcome.
IntractablePainKills at gmail.com