The Fake Opioid Crisis

The Ohio Attorney General recently announced law suits against 5 manufacturers of opioid-based medicines.  This has struck fear in the hearts of intractable pain sufferers, because they know that from every government effort to control opioids, the bottom line net effect is ALWAYS punishment of the legitimate pain patient.

Things have gotten so bizarre, that we now have people in the Center for Disease Control saying that, “Opioids are not effective pain relievers”.

What?

That is like saying that water is not effective as we think at quenching thirst.

Why is this happening?  Well, it is a good example of political correctness gone amock.  It is literally now out of control, causing even very bright persons to conclude that 2+2=5, not 4.

Think about this folks, why do army medics carry morphine sticks onto the battlefield?  Are we really supposed to believe that a man laying on the ground, missing a right foot and a left leg after an IED explosion will have his pain relieved by taking a few aspirins?  By taking some Advil or Tylenol?

No, he won’t be relieved of his pain until he is given several morphine doses, and THAT”S A FACT.  The people who are claiming that opioids are not effective pain relievers have never experienced intractable pain.  Don’t believe them.

Agenda-Less Studies Ignored

The question is, why are they so arrogant that they unilaterally proclaim that what we know as patients is not true, but somehow they know better, as though they feel what we feel?  Also, why do they ignore other studies, that are readily available:

https://blogs.scientificamerican.com/mind-guest-blog/opioid-addiction-is-a-huge-problem-but-pain-prescriptions-are-not-the-cause/

http://www.acsh.org/news/2017/03/25/cdc-opioid-guidelines-violate-standards-science-research-11050

http://www.acsh.org/news/2016/11/10/search-sane-pain-policies-interview-richard-lawhern-phd-10430

http://www.acsh.org/news/2017/01/24/doctors-and-legislators%C2%A0-listen-patients-not-cdc-10758

“Opioid painkillers cause chronic pain” stories leave physician reader in agony

Strict limits on opioid prescribing risk the ‘inhumane treatment’ of pain patients

It is incredible that otherwise bright physicians and researchers let the “opioid crisis” cloud their judgement when it comes to understanding what works and what doesn’t.  Many of the studies done to date have been driven by the “crisis” agenda, and the outcomes are predictable.  Many are driven by the marijuana lobby, who would rather see opioids completely eliminated from the market.  Back to my battlefield example, can you image a medic giving the wounded soldier a joint rather than an injection of morphine?

Not all Opioids are alike; Patients Differ

It is also true that there are a variety of opioid formulations.  Some are more effective than others for a given patient, and every patient is different.  Usually the oral and IV equivalent off a given opioid are compared to 10mg of morphine.  Thus, it is already scientifically established, and has been for some time, that certain opioids are far more powerful than others based on this equivalency estimate:

https://en.wikipedia.org/wiki/Equianalgesic

For example, it is well known that oxymorphone and fentanyl are far more powerful than ocycodone/oxycontin, so when prescribing these medicines, the physician will “dose adjust” based on the “estimated equivalency”.  These are estimates and they may need to be adjusted on an individual basis.  In addition, each medication has a different molecular composition, and therefore, impacts the locus ceruleu (LC)s in different ways.  This structure is the part of the brain which has a number of receptor sites responsible for the effect of opiates and opiate withdrawal, and different opioids have different effects on this region.  When one stops taking opioids, the LC becomes “agitated” in a sense (increased neuron firing) because it has adapted physiologically and chemically to the opiate.

As far back as 1995, it was well established that opioids introducted at the LC decreased sensation of pain:

http://jn.physiology.org/content/74/2/519

https://www.ebmconsult.com/articles/opioid-agonist-pain-mechanism-cns

but because of the “Opioid Crisis”, there has been attempt after attempt to ignore such results, and to produce other results that were agenda driven.  Hence today we see results from agenda-driven studies that conclude opiates are ineffective pain relievers, contrary to past “scientific” studies, and contrary to patient experience.

The New Opioid Prescribing Guideline: Flawed and Worrisome

http://www.npr.org/sections/health-shots/2017/04/06/522262881/how-flawed-science-is-undermining-good-medicine

Evidence Against CDC Opioid Guidelines

The point is that every individual is not wired identically, especially at the LC site, and hence, each opioid formulation works differently for each individual.  A given patient may respond to oxycontin but not the equivalent oxymorphone dose, or another patient may respond to NSAIDs and not need opioids. But it is well known, and HAS BEEN WELL KNOWN, that opioids DO WORK to decrease pain.  It’s called “Science”, well established research.

Before I went in for open, invasisve back surgery, I visited a few surgeons to get their views on what needed to be done to fix the pars fractures I had on L5.  One doctor told me it would be “very invasive and painful” and then he said, “and we don’t prescribe opioids for pain”.  When I told him that I was severely allergic to NSAIDs and steroids, he looked at me like I had two heads, and he said, “Well, we can then prescribe opioids as a last resort, but we don’t think they are effeective at controlling pain.”  I turned to my wife and said, “Let’s get the hell out of here.”  I was not about to go through such a surgery without effective pain management.

The next question is, why are we sitting back and taking this?  You know that these same politicians who are making these insane laws to restrict opioids, who are suing producers, will be the FIRST to scream for morphine when they come out of the OR after insertion of a cage where L5 used to be on their spine.  You know that they will be laid up in bed and magically will be able to get more than a 5-day supply of pain medicine while at home.  I’m fairly certain that Chris Christie will get whatever he needs.

Think of it this way..once the government intrudes into one area of healthcare, in this case pain management, then they can and WILL interfere in other areas.  Your privacy is gone, completely gone, and how you are treated by a physician will be determined by a non-physician politician.  Case in point, have you seen the governor of NJ lately?  He is on a crusade to severely limit opioids because a frind of his died from an opioid overdose.  Never mind that most overdoses are from street drugs, not validly prescribed opioids, and further, they are from improper mixing of illegal drugs.

The Truth, the FACTS

For many patients with acute or chronic intractable pain, due to horrible injuries and effects from surgeries, there are just two choices in their daily lives when opioids are restricted:

1) Live with chronic intractable pain

2) End their own lives.

With rare exception, these pain patients have tried every pain modality known to man.  Many are severely allergic to NSAIDs, like Ibuprofen, and steroids, injections, and other modalities like acupuncture, exercise, physical therapy, etc., simply DO NOT WORK.  Many, like myself, have participated in research studies at well known university hospitals, and have tried the new “experimenta”, pre-market drugs that are supposedly a more effective method of controlling pain than opioids.  They simply do not work for many of us, but these arrogant politicians and a minority of researchers and physicians don’t believe us.

The ONLY currently available medicine that controls their pain is opioid-based medicine.
Yet, the effect of new laws, which see now on a daily basis, is to severely limit the available supply of opioid-based medicnes.  For people with chronic intractable pain, every 30 days they, or their family members, must go on long treks to pharmacies after receiving their pain medicine scripts from their physician.  For example, in Florida, it is not unusual for patients or family members to visit upwards of 30-40 pharmacies before they find a pharmacy that both have the medicine and are willing to dispense it.  In most states, pharmacies can turn down a patient presenting a valid script for whatever reason they feel necessary.  They are also not obligated to provide a reason for a rejection..they can simply say no.

Now, imagine that you have chronic intractable pain and you or a loved one or friend is driving around for hours simply to find medicine for pain relief.  There are already several restrictions that make it illegal for pharmacists to refill the same opioid prior to the 28th day from the last refill, and in many cases, they do not count the day you pick up the medicine.  Therefore, you may go in on the 28th day, but they tell you to come back the next day, which will be the 29th day because they did not count the previous refill day.  You might say that this sounds reasonable, because in theory your medicine would not run out until the 30th day, but remember, chances are that the first pharmacy you go to will NOT have the medicine, and you therrefore need the extra 2 days just for medicine shopping, and often 2 days is not adequate.

I know people with excruciating pain, and if they can’t find a pharmacy from the 28th day to the 30th day from the last refill day, then they not only experience a severe increase in pain, but they also start physical withdrawal from the medicine, which can be extremely unpleasant.  I have driven with some of these folks as they “go on the hunt” for a pharmacy, and they are experiencing the worst pain possible while at the same time experiencing diahrea, stomach cramps with vomiting, hot flashes, anxiety, and a host of other very unpleasant withdrawal symptoms.  Just picture that in your minds eye and you will get an idea of what chronic pain sufferers go through each month.

These patients with intractable pain will NOT resort to street drugs, because they are not psychologically addicted to the medicine.  They would rather tough out the withdrawal symptoms than commit a crime, and they would be ashamed to commit such crimes.

Now, while the legit patient is driving around, or being driven, looking for a pharmacy that has the medicine, the addict is having a fine day.  The addict simply goes to his/her street supplier, pays a heavy price in dollars, and then gets high.  He is not worried about anything other than the very small risk of arrest.  Do you think he cares about the Ohio AG lawsuits or Chris Christie’s 5-day limit for pain medications?  No he does not.

Chronic pain patients say the crackdown on opioids means they’re now treated like addicts

Opioid Hysteria and Mis-information Campaign

It is a FACT that the vast majority of legitimately prescribed opioids are NOT abused.  They are not sold (diverted), they are not stored in home medicine cabinets, they are not given to friends, and they are not abused by the patient.  The vast majority of patients who use opioids use them as directed, and are safe and effective for the treatment of pain.

But, today, the phrase “Opioid Crisis” has caught on.  It is now “PC” to join in the chorus and say, “Hey, did you hear about the opioid crisis?  Oh boy, yeah, it is really terrible.  Really, really terrible.”  However, most people who are saying this know nothing about opioids, have never used them, and don’t know anyone who is abusing them.  it is simply a new phrase in the modern venacular that has caught on like wild fire.  It is hysteria, pure and simple.

So what is going on in actual fact?  The facts are much different than the hysteria.

Recently, my 85 year old mom, who lives in NJ, had spine surgery.  She developed a leak at the base of her spine and was ordered by her surgeon to stay bed ridden, on her back, for 2 weeks past the surgery date.  Unfortunately, because of Chris Christie’s crackdown on opioids, her pain medicine prescription for percocet was limited to 5 days.  She ran out on the 5th day and was unable to get back to her physician because of her surgeon’s orders to stay confined to the bed (so much so that she had to use a bed pan).  Her pain after Day 5 was HORRENDOUS and nothing else was working to control the pain.  She is severely allergic to NSAIDs, and acetametaphine alone was not working.  My mom was wrything in pain, it was horrible.  I can still hear her screams to this day, and the surgery was in late February of this year.

Now, why on God’s green earth would you ever have invasive surgery in NJ when the probability of acute post-op pain is very high?  Why would you willingly agree to have a physician open you up, fix something inside of you, and then just give you an aspirin?  If you are allergic to NSAIDs, you are now down to even fewer choices.

My poor mom suffered uncontrollably.

The media and many politicians are as ignorant regarding pain management as CNN is on Russian spying.  They are performing a severe dis-service to those of us with chronic intractable pain, and to those with pain related to acute trauma.  The media won’t bring in experts who can speak to the “other side” of this story because that would ruin the narrative, which is based on a false premise and a conflation of inappropriate use of pain medicine and validly prescribed, validly used medication.
In the end, all that happens with the media and political war on opioids and the subsequent government crackdown on opioids is the inability of pain patients with intractable chronic pain or acute severe pain to achieve the pain relief we need to function, to literally survive.  The addict and criminal user continue to get their drugs from the illegal market, while the pain patient is in agony, unable to get the medicine that actually works.

Ask any patient with intractable pain what they have to go through just to fill a valid script so you can actually understand the impact that media reporting and government crackdown on opioids actually has.

Unfortunately, the crackdown on opioids will have extremely negative consequences for people with severe acute and chronic pain. It is equivalent to gun control, where because of abuse and crime, innocent gun owners are punished.
In addition, it is very unusual that politicians have singled out opioids. The facts are that only a small percentage of opioid deaths are from legitimate prescriptions. Most of the deaths are from improper use and illegal use, but the consequences of the government crackdown on opioids is a literal hell on earth for people with severe pain, primarily because as governments pass new laws for opioid restrictions, people with severe pain can no longer find the medication they need. This has become a major issue in the pain management community because of the nanny state.

How  many People Die from Drugs each Year?

Each year many people die from many different things.  People die from slipping in the shower, choking on food, allergic reactions to food, car crashes, plane crashes, tylenol, advil, aspirin, peanuts, chocolate, bee stings, spider bites, and a whole host of things.

Do we really want the government to be our nanny, who makes sure we won’t die from anything?

Is it reasonable for the government to impose some regulations?  Sure, it is reasonable, but thee problem is, once you give the government an inch, they take a mile.

Right now the “Opioid Crisis” is a politiccally correct headline.  Everyone resonates with it.  The problem is, it is not the worst crisis BY FAR.  There are so many other drugs that are more dangerous, yet nary a word from the same politicians or media outlets.

For example, have you ever heard a politician talk about the “NSAID Crisis” or the “Acetemetaphine Crisis” or the “Antidepressant Crisis”?  Probably not, but in terms of numbers, these drugs, among others, are worse than legally prescribed opiates for pain management.

Every year 88,000 people die from alcohol poisoning. There is no government “war on alcohol”.
https://www.niaaa.nih.gov/alcohol-health/overview-alcohol-consumption/alcohol-facts-and-statistics

Every year over 40,000 people die from anti-depressants. There is no war on antidepressants.
http://articles.mercola.com/sites/articles/archive/2011/05/03/tips-to-avoiding-depression.aspx

Every year over 15,000 people die from NSAIDs (e.g., Ibuprofen).  100,000 go to the ER.  There is no government war on NSAIDs.
http://www.mercola.com/infographics/nsaids.htm

Every year thousands drop dead from pregabalin (aka Lyrica), or commit suicide from its side effects, but there is no war on Lyrica.
http://www.ehealthme.com/ds/lyrica/sudden%20death/

Every year, deaths from alcohol, anti-depressants, NSAIDs, and Lyrica FAR EXCEED deaths from opioids, yet it is the opioid that is getting all of the attention. Every year, far more people die from illnesses that cause their pain, than people die from legitimate opioid use, where a pain management specialist is caring for a patient to help them manage their pain.

Government Intrusion into Individual Liberty and the Right to Pain Relief

So, when we see the AG of Ohio filing suit against opioid manufacturers, we chronic pain patients knew full well that this just means more restrictions for us.  The people that are addicts and criminals will continue to support their habit through the illegal market, but the pain patient will continue to live a life of hell, and it just gets worse.  We don’t go to the illegal market when there are further limitations, we drive around in excruciating pain looking for a pharmacy that can fill our legitimate script.

There are pain advocacy groups which try mightily to get the attention of politicians to show them how the opioid data is being conflated, that is, conflation of illegal and inappropriate use with legitimate, medically based use.  These advocacy groups show how the CDC manipulates data, and uses unscientific methods because of “agendas”.  It is a horrible situation for pain patients, who are dismissed as drug addicts, but who in fact are using opioids as a last resort.
https://www.thefix.com/content/fake-prescription-painkiller-epidemic9028?page=all
http://www.chronicmom.com/2016/07/how-the-opioid-epidemic-hurts-people-with-chronic-pain.html/

As pain patients, we cringe in fear every time we see the “opioid war” headlines and the new initiatives to combat opioids, because we know that WE are the ones who will pay the price, not the addict, not the criminal, much like when a nut case opens fire and kills people, gun owners know that the new restrictions will impact them, not the criminals.

Chris Christie, governor of NJ, pushed for and successfully convinced his legislators to pass very restrictive pain medicine laws.  Since I am originally from NJ, and most of my family still lives there, I have seen first hand the devestating consequences these restrictions have had on family members.

As of four years ago, I now live in Bradenton, Florida.  I have had 18 invasive surgeries since 2008, and most recently, I suffered from sepsis after a shoulder replacement in August, 2016 at Sarasota Memorial. The infection required 3 additional surgeries, two of which were emergency surgeries as the infection developed.  They had to completely remove the prosthesis and insert a PICC line through which they fed broad spectrum antibiotics 3 times per day.

There was no way I would have been able to get up after 5 days to visit my doctor just to refill pain medicine.  But NJ’s recently enacted laws, if instituted across the country, would have required me to do that, since an initial script from the physician is limited to 5 days by law.  I was hard down, dealing with horrible pain in my shoulder, and because the antibiotics were “broad spectrum”, even good bacteria was being killed in my body, resulting in severe fatigue and other complications.  Thank God that Florida law allows for prescriptions of pain medicine beyond 5 days.

 

But the Ohio AG is now going after the producers of the medicines that I LEGITIMATELY use, and my fear is that my monthly trek for pain relief will just get worse, and I fear that the ONLY modality that I have for pain relief will go away because of politicians like the Ohio AG and the governor of NJ.

I also suffer from intractable, chronic pain because I have developed debilitating arthritis as a consequence of all of my surgeries.  The restrictions that NJ has instituted if implemented in Florida will make my life a living hell.  I have tried every other pain treatment modality, and opioid-based pain medicine is the only modality that works for me.

 

Physicians in NJ are very much opposed to Christie’s model, but it was forced upon them anyway.
http://www.nj.com/politics/index.ssf/2017/01/nj_doctor_group_opposes_christie_plan_to_limit_pai.html

This is an unbelievable intrusion into the doctor-patient relationship.  Why is it that Republicans are so hell bent on government intrusion when it comes to legitimate use of medicines?  This is INSANITY. Republicans are “supposedly” the “individual liberty” party?

This is very reminiscent of the gun debate, where because of the abusers, the majority are punished.
This is going to cause literal hell on earth for patients with legitimate acute and chronic intractable pain.  It has already had life-threatening consequences in states with similar restrictions:

http://www.seattletimes.com/seattle-news/times-watchdog/new-state-law-leaves-patients-in-pain/

Why are Pain Patients Victimized because of Addicts?

Isn’t it curious that the government always winds up punishing the innocent for the ills of society. Whenever there is a mass shooting, new gun laws simply result in more restrictions for innocent and law abiding citizens.  John Lott, a renowned economist, has proven over and over again that when gun laws become more restrictive, the bad guys still get guns and crimes with illegally obtained guns by criminals goes up in gun-free zones.

In the same way, every single opioid restriction enacted by local, state, and federal government bodies results in restrictions for pain patients.  But unlike the gun example, in the case of medicine for pain, the only net effect is the patients with intractable pain, whether chronic or acute, cannot obtain the medicine they know works for them in a timely manner.  Very recently, the FDA voted 18-8 to remove Oxymorphone Extended Release from the market.  Right now, it is voluntary for drug companies to do so, but we all know that this eventually becomes law.  I know several cancer patients who depend on this medication to live out a comfortable last few years, yet 18 bureaucrats want it pulled from the market because a small minority of drug users, criminals, want to break the pills apart and snort it.  So people with unimaginable pain suffer as a consequenc.

http://www.cnn.com/2017/06/08/health/fda-opioid-opana-er-bn/index.html

The FDA panel voted in the majority, with 8 dissenters, and 18 in the affirmative.  How is it that these 18 know much more than the researchers who have tested this medicine on appropriate use cases over many years?  How is it that Chris Christie of NJ knows more about treating pain than a maajority of physicians in his state who disagreed with his restrictions, calling them “cruel”?  How is it than the AG of Ohio knows more about pain management than all of the physicians in Ohio, the majority of whom think his effort is a misuse of resources?  How is it than a minority of physicians with an agenda, such as those in the marijuana lobby, can influence the political class more than the majority of orthopedists, oncologists, pain management specialists, and other physicians?  How is it that the government, including the Republican party, the party of “Iniividual Liberty”, can be so intrusive into a patient’s care?

What is Addiction?

Addiction is often mis-interpreted and is a useless term in the legitimate, pain management context.

A person who has horrific acute injury which causes intractable pain and requires opioids to help reduce the pain is not an “addict”.  It is a person in need of urgent healthcare, someone who urgently needs medical attention and relief from pain, like the survivors of the club shooting in Orlando.  Advil, Tylenol, aspirin, prednisone, and other anti-inflammatory are simply additive to morphine-like immediate treaatment.  This person absolutely needs immediate and powerful opioid-based relief.  But when the government limits what is available, this patient may just have to suffer through the horror.

A person who has chronic “intractable” pain and who has tried all known modalities for pain treatment, including, NSAIDs, injections, accupuncture, physical therapy, experimental medicines, etc, and opioids are the only treatments that work for that patient, then this medicine MUST be available to them, or in many cases,  they will consider suicide.  Very few individuals can live with intractable pain, and when their loved ones have to drive to 30-40 pharmacies before they find the medicine, if they find the medicine, then the government restrictions are adding insult to injury.  This person is NOT AN ADDICT.

Addicts are the relatively small number of individuals who abuse opioids, often obtaining them illegally, who seek out drugs to the exclusion of everything else.  They will ignore their loved ones, their work, their church, their well being in pursuit of drugs, and will do it at any expense.  People who are legitimate pain patients with legitimately prescribed pain medicine, who take it as directed (the majority of opioid users), are NOT this person.  Yet, they are the ones who are punished because of the addict.  Why?

As I had previously noted, the Locus Ceruleus DOES become habituated to opioids over an extended period of use.  The period is different for every individual.  Once this occurs, even patients who have been treated professionally and legally may suffer withdrawal sickness as they are weened from opioids as the LC becomes increasingly more active in the presence of drug diminution. This is all the more reason why availability should be stress free and should not be an issue for legitimate patients.  Most patients who have acccess to medicine are successfully weened from the medication without rehab and these patients, who are law abiding, DO NOT resort to street drugs to stop the withdrawal.

The Role of the Locus Ceruleus in the Human Brain

The Time to Act is NOW!

It is time for a full court press in DC.  If you have acute or chronic intractable pain, I am advising you to act, to do something to preserve your rights.  Pain is a disease, and for people who have tried all modalities and opioids are truly the only solution, we are about to lose access to the medicine that gives us some semblance of a normal life.

We anticipate that soon an Executive Order mirroring the misguided NJ restrictions will ne issued by Trump, in essence trampling on our ability to obtain pain relief, because these politicians are listening to people who have agendas, with agenda-driven studies, who think they know more about our pain than we do.
It is funny and sad how these same politicians ignore the 15,000+ deaths per year from NSAIDs, which are readily available to any school aged kid at most convenience stores.  In addition, anti-depressants used for pain relief, such as Cymbalta, result in over 40,000 deaths per year.  Pregabalin (Lyrica), causes sudden death.  But nary a word from these politicians regarding these dangerous medicines:

http://www.webmd.com/heart/news/20150710/fda-warning-nsaids-heart_risks#1
http://drpescatore.com/nsaids-kill-more-than-just-pain
http://www.spine-health.com/treatment/pain-medication/potential-risks-and-complications-nsaids
http://www.mercola.com/infographics/nsaids.htm
http://consumerpainadvocacy.org/twitter-chat/
https://www.statnews.com/2017/01/17/chronic-pain-management-opioids
http://www.collective-evolution.com/2017/02/06/over-the-counter-drugs-ibuprofentylenol-kills-thousands-each-year-so-heres-the-alternative/
http://www.seattletimes.com/seattle-news/times-watchdog/new-state-law-leaves-patients-in-pain/
https://www.painnewsnetwork.org/stories/2017/3/1/how-the-cdc-opioid-guidelines-have-affected-me
http://www.wellnessresources.com/freedom/articles/neurontin_and_lyrica_are_a_death_sentence_for_new_brain_synapses/
http://articles.mercola.com/sites/articles/archive/2011/05/03/tips-to-avoiding-depression.aspx
http://www.ehealthme.com/ds/lyrica/sudden%20death/
https://www.niaaa.nih.gov/alcohol-health/overview-alcohol-consumption/alcohol-facts-and-statistics

We should not be further punished because of people with addiction illness.  Of course they need to be helped, but restricting access for law abiding, non-addicted patients is an outrage because the net effect is an inability to get the medicines we need to alleviate our pain.  It is already difficult enough to get pain medicine in Florida, often requiring visits to upwards of 30 or more pharmacies before one finds a pharmacist willing to fill a script.  The Ohio AG and politicians like Chris Christie are just making our suffering worse by their irresponsible law actions.

I have often thought about suicide because of my pain.  Many others have as well.  If additional restrictions are forthcoming from DC, then many of us will face life and death decisions related to our intractable pain.

It is time for action before our right to pain relief is taken from us.  DO NOT LISTEN to the arrogant politicians, media celebrtities, and physicians with biased research and claims that they “know better alternatives.”  Only YOU know what works for YOU and you need to fight before it’s too late!