Punishing People in Pain

I have been conducting research or directing addiction research since 1976. Over the past 2 decades, physicians were increasingly being criticised in journal articles for underutilizing opioid medication to treat pain. The conventional wisdom at the time was that patients were needlessly suffering because physicians were overly concerned about addicting patients and/or an overly zealous DEA. Those criticisms were justified, and professional organizations began encouraging a reconsideration of pain medication practices.

Fast forward to today. Doubtless some physicians have gone overboard in prescribing opioids for pain. As an example, four years ago, my primary care physician recklessly prescribed a month’s supply of hydrocodone for an acute sciatica attack. I switched PC docs the next week.

Was the medical field wrong then and right now to curtail opioid prescriptions? Should healthcare turn back the clock and under prescribe for pain? Absolutely not.

What recent studies have been suggesting is that the bulk of overdosing is due to self-medication for psychological pain derived not from being cut by a scalpel, but being cut from the workforce.

Did Kasich’s order signal a return to undermedication for pain? NO. It simply require physicians to monitor more closely the need for opioid medication on a weekly basis. This is prudent patient supervision, and it will likely reduce the volume of legal opioids available for abuse. However, it will not stop the overdose problem – just move abusers to the illicit market.

Restore hope for a future is likely the most effective intervention Kasich could do if he was sincere about opioid abuse. President Trump has loudly asserted that he will restore everybody’s jobs — that is, when not distracted by insulting the media, Congress, most world leaders, and our intelligence. Let’s hope he can at least do that.

It’s just one more way to criminalize The Little People for living. The message is clear — suck it up and be obeisant slaves. At the same time, amidst the Russian Meddling scandalous spectacle, a legislative agenda is still being pushed through Congress and it’s basically being done under the cover of the scandalous spectacle that’s hogging the spotlight. Yesterday, Pence was the deciding vote in the Senate for the bill that defunds Planned Parenthood. Couple that with Trump signing the executive order allowing construction of the Keystone Pipeline to commence and the attack on Net Neutrality and Tax Reform that gives huge tax cuts to The Rich at the expense of programs like Meals on Wheels and a pattern emerges. It’s called Sadistic Feudalism without any pretense that it’s anything but.

One wonders, all those Russians connected to the alleged Russian Hacking of the Presidential Election and Trump’s alleged ties with the Russians that have ended up dead under mysterious circumstances, does it make Flynn a little nervous? He’s ready to spill the beans for immunity and we all know Putin despises rats. Does Putin have the balls to extinguish him like he did Erovinkin and Mikhailov. We’ll see.

Peter VE
March 31, 2017

Excellent; but be very careful; serious shit comes down on those who choose nature.

@ Peter VE: how ghastly and needless your friend’s suicide was; i’m so sorry for your loss.

as for growing papaver somniferum, i do as well. now it may just be due to the fact that we’re in about zone 6a or 6b, but the pods are small and don’t ooze latex when scored. dammit. i really want some for my alternative healing kit bag.

in the meantime, it’s one of the most gorgeous flowers on the planet, especially their reproductive organs.

sglover:
I keep telling people that if I came into $50 million somehow, I’d move back to CA(I was born there) and primary DiFi. I believe she’s up next year. Plenty of people are hoping she’ll retire and go away.

I read that Kentucky was about to enact a law like Ohio’s but with a 3 day limit.

I agree with Tomonthebeach. Addiction or chemical dependency is not defined by how much, how often, or how long a patient takes a medication, but whether it is being used to address pain or another issue. If for pain, no addiction. For something else, addiction.

The opioid epidemic is a direct reaction of people to seeing their lives destroyed by a rapacious, callous ruling class of kleptocrats. Their hypocrisy is manifold in that they destroy people’s chances of having a decent life, pushing them into using drugs, promoting many of those same drugs (like Oxycontin), and then prosecuting them as criminals for using and selling drugs.

Steeleweed, what I gave you is the clinical definition of addiction. Physical dependency is another issue. If someone stops opioids cold turkey, they will have withdrawal symptoms. Opioids are not the worst for withdrawal. Stopping medicines for high blood pressure can cause rebound hypertension. Stopping steroids after being on them for a while is dangerous and requires a taper. And suddenly stopping tranquillizers in the benzodiazepine family, like Valium, can kill you.

It is a question of calibrating the drug to the symptom. This is complicated by a patient being untruthful about their level of pain. There is a back and forth about this. The physician will likely see a discrepancy between the alleged level of pain and the underlying condition, note a pattern of drug seeking, and seek to limit and reduce the offending medications. The patient, on the other hand, may doctor shop or visit emergency rooms for medication, or buy illicitly.

Then there is the whole recreational drug dimension where medically treated pain is not an issue. Some recreational drugs like alcohol have been around for thousands of years. So the definition for addiction would be modified to the more generic criteria of some level of drug use at which the person can not function normally in the activities of their daily life and/or at which their drug use poses a significant threat to them physically.

As long as Americans are okay with a drug war, this shit will continue. It will take the millennials voting enmasse at state levels to effectively legalize drugs and move them to taxation. If we did this, the drug cartels go out of business and the gun crimes drop.

….instead of in the next generation by making post-secondary education available for free to any and all. a crime beyond description of evil.

A free college education for everyone is not all it’s cracked up to be. Many more people today are receiving college diplomas than forty years prior or even twenty years prior, but there is no indication they’re better off or any indication they are any more intelligent and able to think critically, independently and objectively for themselves.

As well, universities these days are rackets and increasingly corporatized, so what’s needed before handing out get-one free coupons to any & all is complete and comprehensive education reform at all levels, not just post-secondary.

Post-secondary administrative spending is off-the-charts and the funds are increasingly misspent and misdirected. Universities should be no frills environments and all about LEARNING. Everything else should be secondary, but as it stands now, everything else is first priority and LEARNING is secondary if it happens at all.

If you hand out a free post-secondary education to any & all without engaging in holistic, comprehensive education reform at all levels, you are throwing taxpayer money down the drain and into a black hole of unbridled, irresponsible, misdirected university administrative spending.

TSMB’s UCB management chart implies a business management culture gone horribly wrong.

Somewhat along the lines of the post, a credentialed physician informed me that my pain killer addicted friend must hit bottom, although every medical organization of which that doctor is a part advertises that this is not the case, and they can help. Do they just want the business? Since that doctors clinic corporatized, it has grown rapidly. But their reviews have tanked. I’m thinking the bean counter culture has ruined their core business, to the detriment of their customer, the patient.

On paper, providing a specific reason in the patient’s record isn’t a high bar. I think it’s very likely, though, that healthcare organizations will read this and impose prescription restrictions on their providers that go above and beyond the letter of the law.

Yes, what’s happening across the country now is crazy and cruel. More drug warriors.
http://acsh.org/news/2017/03/25/cdc-opioid-guidelines-violate-standards-science-research-11050

Many of the core assumptions of the CDC guidelines are supported by only the weakest medical evidence – and others are clearly contradicted by the evidence. Medical professionals have published sharp criticisms of the CDC guideline and of the anti-opioid biases of consultants who wrote the document. A recent paper in Pain Medicine [ref: Pain Med (2016) 17 (11): 2036-2046] offers analysis that shows the writers of the Guideline deliberately distorted the evidence they gathered.

CDC consultants performed a literature review on the effectiveness and risks of three classes of treatments for severe chronic pain: opioids, non-opioid medicines like Tylenol, and behavioral therapies like rational cognitive therapy. Based on this review, they declared that there is very little evidence that opioids work for pain over long periods of time. But they neglected to inform readers that they had rejected any study of opioid medications that hadn’t lasted at least a year, then declaring that there was no proof that opioids are effective over the long term. But they did NOT reject studies of non-opioid medications or behavioral therapies that were similarly short.

As the Pain Medicine paper states, “To dismiss trials as “inadequate” if their observation period is a year or less is inconsistent with current regulatory standards… Considering only duration of active treatment in efficacy or effectiveness trials, published evidence is no stronger for any major drug category or behavioral therapy than for opioids.”

This didn’t keep the writers of the CDC Guideline from recommending that non-opioid treatments be favored over opioids, despite lack of evidence that they work. Nor did it keep the writers from exaggerating opioid risks – using the term “overdose” no less than 150 times in their biased and unscientific practice standard.

It is time for the CDC to withdraw its misdirected “opioid guideline” for a major rewrite. This time, the effort should be led by pain management specialists, not addiction psychiatrists. Pain patients or their advocates should be voting members of the writers group.

At our clinic most of the doctors have stopped prescribing controlled substances completely. An increasing number have stopped renewing their DEA certificates so they aren’t even able to prescribe those drugs. So what happens is the patients with pain and other issues requiring controlled drugs are increasingly funneled to just one provider. And so a few weeks ago the closest pharmacy (CVS) decreed that this provider is prescribing too many narcotics and banned her and her patients. So all her patients are unable to use their neighborhood pharmacy, even the majority who never got a controlled substance prescription. This was approved by CVS corporate and there is apparently nothing we can do. It’s obvious that this is going to explode the black market for these necessary medications resulting in no regulation and more deaths. It’s already started.

@ Steve McQueen

dunno if you live in a state where mmj or rec mj is legal or not, but if so, mr. wendydavis had brought home some capsules of dried high cbd cannabis last week. the whole herb quasi-movement, remember it?

at any rate, after 5 capsules, i was slightly encouraged, esp. as i dinnae feel like filling the tub for a bath was akin to walking up the stairs to the guillotine. ( i fall sometimes now.) we’ll try to score some of those seeds to grow more.

oh, bother. the gong of real life just rang, but briefly: also googledy/bing: celadrin, topical and oral, turmeric (the curcumin) as anti-inflammatory, as are shitake mushrooms (taste like fish paste, ish), stopain x-strength w/ msn and glucosamine. oh, find relief; immobility and chronic pain suck. the permanent relief to it all sometimes beckon, but some of us have others to consider if we can provide strength and succor to them as we…live on.

best to you.

The idea the there is an opioid addiction epidemic caused by despair among white folk needs to be supported better than it has been. It’s a useful narrative for some political/economic interests — but is it true?

It’s much like the belief that the ghettos were filled with crack-heads back in the day (still?), or that tweakers ruled the margins of young white male society. Of course, in those days, it didn’t matter why there were crack-heads and tweakers. What mattered was eradicating them. Right?

Now we have a supposed situation with opioids — primarily legitimately used as pain killers — among despairing white folks who supposedly abuse them to escape their existential despair, rather than for the prescribed reason of pain relief. Why they despair is made much of. They’re white and they believe they have no future. Thus, supposedly, they turn to opioids. And they get addicted and overdose and die. And it’s a tragedy.

How do they get them? From doctors (for the most part) who — in my view — deliberately and with some malice over prescribe them. In effect, “eradicating” their patients.

Policy makers are apparently torn. They really don’t care about people in pain, as has been demonstrated over and over again with the increasing restrictions placed on pain management. These days, it can be difficult to get any sanctioned medical pain treatment at all, unless at the end of life when most restrictions come off.

On the other hand, because so many white folks are now on opioid pain meds for their despair and so many are dying because of it — so many so often, the morgues and funeral homes don’t have room for all the bodies, so they say — the already restricted or prohibited drugs for people in pain are to be further restricted and prohibited. Supposedly to “save” despairing white folks’ lives.

No, there’s something else going on, just as there was during all the other furious drug-panics going back to the turn of the twentieth century. When policy makers really don’t care a whit about people in pain but do care massively about restricting or prohibiting access to medications that effectively control pain, it should be obvious that this is about population control and revenues. Cui bono, eh?

Like many who have commented, and like our host, I live with a chronic condition that sometimes causes extreme and debilitating pain. I am being treated for the condition primarily with cortico-steroids and immunosuppressants, but I have received nothing at all specifically for pain for more than five years. It’s as if my doctors are so frightened of prescribing pain medication when needed that they won’t do it, period. What I was told to do during this latest episode of pain was “increase your steroid dose until the pain dissipates.”

Nothing else was even suggested.

As a former RN I am absolutely appalled by these stories. One of the first things we were taught in school is the patient’s pain is what he says it is. Everybody’s pain threshold is different, what is mild pain to one can be excruciating to another….and this does NOT mean some patients are people are wimpy.

Being a nurse is hard work, so I an now(in retirement) experiencing the pain from back injuries and arthritis. I am so glad I have a supportive doctor.

I finally bought a TENS machine last week and I find it helping. I add it to my regime of Physio and Massage. I want to postpone the narcotic solution as long as possible.

This is one of the cruelist parts of the US medical/legal racket. If you can’t afford care, not only are you expected to just die (and don’t be stupid, the Democrats are just as much at fault), but you are supposed to die in as much pain and misery as your disease and situation might dish out. You aren’t even allowed to crawl into some hole and self-medicate. No easy death for you, slacker!

@V. Arnold

Heroin? Nah. Morphine!

Seems there’s an issue being raised but not addressed about where and how all these “despairing” white folk get their opioids that are killing so many that the morgues have no room.

It should be obvious when manufacturers send many millions of pills to backwater pharmacies and — surprisingly — outbreaks of “opioid addiction” ensue. Doctors prescribe; pharmacies dispense; there’s no doubt a street trade with the prescriptions, but there are restrictions on how much can be dispensed at any one time. Are those restrictions being ignored? Are the pharmacies simply doling out the meds willy-nilly? Are doctors deliberately over-prescribing? Most of the problem is with prescription medications, not with heroin and such.

But what of the supposed black market?

Restricting access to pain medications for those who need them is cruel and stupid, especially when there is almost unlimited access to the same or similar medications for white folks in “despair.” Who, by the tens of thousands, OD and die. How convenient.

Perhaps that’s the point of this epidemic….

You are not a pariah – you are in pain.

(41 votes for blocking Gorsuch. Next up the nuke option.)

Tomonthebeach: “Did Kasich’s order signal a return to undermedication for pain? NO. It simply require physicians to monitor more closely the need for opioid medication on a weekly basis.”

I don’t agree. The new law in Ohio WILL increase the number of people who are already inadequately medicated for pain. Seeing a physician on a weekly basis is expensive, especially for people with poor health insurance coverage, and physicians really don’t have the time to see on a weekly basis all of the patients who are taking pain medications for chronic health conditions.

There’s a lot of paranoia about narcotic pain medications. Some physicians are very reluctant to prescribe them (when they should), and some kinds of health insurance refuse to pay for the prescriptions of narcotic pain medications, including chemically similar medications that are used to control diarrhea and other health problems, even though their narcotic effects are very mild.

As a result of this Ohio law, the number of people seeking pain relief drugs from illegal markets will likely increase. People obtaining pain relief in this manner will not be supervised by physicians and they are more likely to use drugs that are more powerful and addicting. In addition to these problems, more people will find themselves being arrested and becoming part of the swollen prison population of the United States.