The Debate: Are Laws Controlling Opioid Painkillers Hurting People in Pain?

Are Laws Controlling Opioid Painkillers Hurting People

As the U.S. witnesses the ongoing devastation of the opioid epidemic — increasing rates of misuse, abuse, dependence, addiction and overdose from prescription painkillers and heroin — federal, state and local governments are ramping up initiatives to stop the problem in its tracks.

Some believe that laws limiting prescription painkillers — designed to curb the supply of narcotic painkillers — are preventing people with chronic pain from getting the relief they desperately need. Others see these regulations as crucial to preventing more addiction and overdose deaths from these powerful medications, which include hydrocodone and oxycodone, among others. asked Bob Twillman, PhD, executive director of the American Academy of Pain Management, and Andrew Kolodny, MD, chief medical officer at Phoenix House, in New York City, to share their expertise on either side of this complex, controversial issue.





DrBobTwillmanBob Twillman, PhD, is the executive director at the American Academy of Pain Management, based in Sonora, California, an organization that advocates for an integrative approach to managing pain. Dr. Twillman is also responsible for overseeing the Academy’s response to federal and state pain management policy developments and chairs the Prescription Monitoring Program Advisory Committee for the Kansas Board of Pharmacy. He received his doctorate in clinical psychology at the University of California in Los Angeles.

Dr. Twillman: Yes, laws regulating opioid painkillers are keeping people who need pain relief from getting it.

“I believe laws, regulations and guidelines aimed at reducing prescription drug abuse are, indeed, keeping people with a legitimate medical need for opioid analgesics from getting them. It’s hard to measure the extent to which this is occurring because it would entail measuring services that are not delivered, but from the volume of calls received by the American Academy of Pain Management and many patient advocacy organizations, I have no doubt that access to medications is a problem for some patients. I’ve talked to people with pain who have been unable to fill their prescriptions despite visiting as many as three dozen pharmacies. The problem has gotten so bad in Florida that both the Attorney General’s office and the state Board of Pharmacy are taking steps to address it.

Part of the reason this is happening, I think, is because we are taking an overly simplistic approach to a very complex problem. When we ask, ‘how can we reduce the supply of prescription opioids?’ we’re asking the wrong question; the right question is, ‘how can we reduce the supply of excess prescription opioids?’ Naturally, that complicates things because we first have to define ‘excess’ and then know when that’s what we’re dealing with. While opioid analgesics are not the appropriate treatment for all people with chronic pain, there is a subgroup that needs them to achieve good pain control and improved function. The NIH and other agencies have noted that we lack evidence regarding the overall effectiveness of long-term opioid therapy, but we need to remember that the absence of evidence is not evidence of absence; i.e., that lack of evidence does not mean that long-term opioid therapy is not effective for anyone with chronic pain that is not related to cancer or end-of-life situations. Anti-opioid advocates who call for a broad-brush approach that would deny opioids to people outside of these specific circumstances are being overly simplistic in their approach and, as a result, creating the potential for people who benefit from opioid therapy to be harmed.

When we have the simple goal of reducing prescription opioid supplies, then we run the risk of restricting access to them for both people who misuse and abuse them as well those who use them to relieve their pain. It’s rather like the inverse of the saying ‘a rising tide lifts all boats.’ Yet, whenever we see a new policy instituted, the primary outcome measure is almost invariably the degree to which medication dispensing is reduced, with no attempt to discern how much of that reduction affected people who should not have been affected.”

DrAndrewKolodnyAndrew Kolodny, MD, is the chief medical officer at Phoenix House, a national, non-profit addiction treatment agency. Before joining the Phoenix House team, Dr. Kolodny served as chair of psychiatry at Maimonides Medical Center, in Brooklyn, New York. He co-founded Physicians for Responsible Opioid Prescribing, an organization that promotes responsible opioid-prescribing practices. Dr. Kolodny previously worked for the New York City Department of Health and Mental Hygiene as the Medical Director in the Office of the Executive Deputy Commissioner.

Dr. Kolodny: No, laws regulating opioid painkillers are not preventing patients with chronic pain from accessing safe and effective treatment. Opioid painkillers are not an appropriate option for most patients with chronic pain.

“I think the question you’re really asking is, ‘Are new laws about opioid painkillers preventing patients from accessing opioid painkillers?’ There is a problem with your question. It equates relieving pain with taking opioids. Although opioids can help ease suffering at the end of life and can relieve pain when used on a short-term basis, they don’t work well when taken regularly. Long-term use may be more likely to harm patients than help them because opioids, a class of drug that includes heroin, are highly addictive and because their ability to relieve pain declines over time. Long-term use can even make pain worse, a phenomenon called hyperalgesia. A recent report from the federal government’s Agency for Healthcare Research and Quality concluded that the chronic use of opioids, especially at high doses, is dangerous and evidence of effectiveness is lacking.

The opioid lobby, which includes opioid manufacturers, wholesalers, retailers, pill mills and industry-funded pain organizations, would like policymakers and the public to believe that opioid harms are limited to so-called ‘drug abusers’ and that millions of patients with chronic pain are helped by opioids. This is totally false. In fact, it is people who suffer with chronic pain that have been disproportionately harmed by opioid overprescribing. A study of opioid overdoses in Utah found that 92% of the people who had died from a prescription overdose in 2008 were receiving legitimate prescriptions for chronic pain. And the demographic group that has seen the greatest increase in opioid overdose deaths is middle-aged women, a group that disproportionately receives treatment for chronic pain.

The Centers for Disease Control (CDC) has been very clear about the cause of our epidemic of opioid addiction and overdose deaths. The CDC has demonstrated that as opioid prescriptions began to skyrocket in the late 1990s, it led to parallel increases in addiction and overdose deaths. The CDC’s message is clear: Reductions in opioid prescribing are required to bring our epidemic of opioid addiction under control. With only 5% of the world’s population, the U.S. is consuming more than 80% of the world’s oxycodone supply and more than 99% of the hydrocodone supply. And despite the enormous public health price we’re paying for our overconsumption of opioids, there is not one shred of evidence that we do a better job of treating pain than in Western Europe, where opioids are prescribed much more cautiously.

Not surprisingly, the opioid lobby does not like the CDC’s message and does not want to see prescribing reduced. They have even attacked the CDC for suggesting that overprescribing is the root of the problem. An excellent example of the opioid lobby’s antagonism toward the CDC can be found in the [2011] editorial titled ‘A Call To Stop The “Epidemic” Of Opioid Pain Medicine Overdoses,’ written by Bob Twillman in a Capitol Hill newspaper.

I do believe that there are patients on high daily doses of opioids who are having a harder time these days getting doctors to continue prescribing for them. But new laws have not caused this. What is happening is that the medical community is starting to understand that long-term opioids are not safe or effective for common conditions like low back pain, fibromyalgia and chronic headache. Doctors who have lost patients to overdose deaths may feel especially reluctant to continue prescribing opioids for chronic pain. These patients are in a difficult situation because coming off of opioid painkillers can be very difficult, even in patients who are motivated to come off.”

Q: Is there a way we might use laws or other policies to curb opioid overdose and abuse without giving pain patients fewer options for managing their pain?

Dr. Twillman: “I think there are several things we can do to strike this peculiar kind of balance. First, we need to increase our emphasis on addressing the demand side of the supply-and-demand equation involved in drug abuse, i.e., we need to increase availability of treatment resources for people with a substance use disorder and invest in effective primary prevention. As long as our entire focus is on curbing supplies, all we are doing is ‘squeezing the balloon’ and causing people to shift from one drug of abuse to another. Only when we let the air out of that balloon by reducing the demand will we be successful.

We also need to address the factors that cause prescribers to over-prescribe opioid analgesics. There are several of these, including inadequate education about pain management in general and non-pharmacological pain management in particular, and about substance abuse; reimbursement models that reward prescribers for writing prescriptions but not for taking the time needed to understand and appropriately care for someone with pain; inadequate access to, and reimbursement for, non-pharmacological treatments for pain; and support for basic research to develop new, non-addictive tools to treat pain, as well as clinical research about how to better use the tools we already have. All of these things are, to some extent, good targets for policymakers.”

Dr. Kolodny: “I have a problem with the way you’re asking this question, too. The question accepts the opioid lobby’s framework. It implies that we have two distinct groups — pain patients who are supposedly helped by opioids and so-called ‘drug abusers’ who are harmed. The reality is that opioid addiction can develop in people who take opioids exactly as prescribed just as it can develop in recreational users. The majority of overdose deaths appear to occur in pain patients receiving legitimate prescriptions. We need cautious prescribing practices to protect medical and non-medical users.

There’s one law already on the books that if properly enforced would help bring our opioid addiction epidemic under control without impacting appropriate access to opioids. I’m referring to the Federal Food, Drug and Cosmetics Act. This law gives the FDA the authority to prohibit drug companies from promoting products for conditions where risks of a drug’s use are likely to outweigh benefits. If the FDA had been enforcing this law, drug companies never would have been permitted to promote long-term and high-dose opioids for common problems. We might not have an opioid crisis today had the FDA properly enforced this law going back to the late 1990s, when OxyContin was released. And if the FDA were to start enforcing this law now the CDC would have a much easier time convincing doctors of the need to prescribe more cautiously.”

Q: Who or what is/are to blame for the growing addiction to opioids and skyrocketing overdose rates?

Dr. Twillman: “I think there’s more than enough blame to go around. Society’s desire for a ‘magic pill’ that will fix whatever ails you produces too great a focus on medications and leads to inappropriate prescribing. Clinicians who are pressed to turn over their exam rooms every 15 minutes contribute because the only way they can keep up that pace when caring for someone with chronic pain is to just write another prescription. Insurance plans that pay for prescriptions and procedures but not for adequate physical therapy, psychotherapy, acupuncture, massage, chiropractic care, etc., drive both clinicians and people with pain toward treatments that may be less effective in treating chronic pain and more prone to causing a substance use disorder. Marketing practices by pharmaceutical manufacturers have reinforced the primacy of opioids as a treatment for all kinds of pain. Drug control efforts that only focus on half of the problem (i.e., supply) without addressing the other half (i.e., demand) are completely ineffective at reducing the rate of substance abuse. In light of all these factors, and others that may be in play, is it really any wonder that this has been a pretty intractable problem?”

Dr. Kolodny: “There’s lots of blame to go around but I believe the root of the problem was a brilliant marketing campaign launched 20 years ago by opioid manufacturers. The campaign misinformed the medical community. The risks of opioids, especially the risk of addiction, were downplayed and the benefits were exaggerated. Doctors were misled to believe that the compassionate way to treat just about any complaint of pain was with an opioid prescription. In response to this campaign, prescribing took off and led to parallel increases in rates of addiction and overdose deaths. Millions of dollars were spent misinforming prescribers and very little has been done to correct the record.”

Q: What’s the best way(s) to manage chronic pain?

Dr. Twillman: “Every person with pain is different and thus needs an individualized care plan. To properly care for someone with pain, it is necessary to understand the biological, psychological, social and spiritual factors that contribute to that person’s pain experience. This explains, to some extent, why two people with exactly the same injury can experience vastly different levels of pain intensity and functional impairment. Once the clinician determines each person’s unique combination of these factors, it is possible to craft a unique combination of treatments in order to achieve the best possible pain relief and functional improvement. Forming an effective, caring treatment relationship requires considerable effort and time on the part of both the clinician and the person with pain, but without that investment it is very difficult to achieve optimal outcomes. That sense of being in a caring relationship is also important and the connection between the person with pain and the clinician that it fosters can, in itself, be healing. When a caring therapeutic relationship is established, both parties can find alignment with respect to the goals of care and the means to achieve those goals.”

Dr. Kolodny: “There are many treatments for pain that are effective. They include non-opioid medications like non-steroidal anti-inflammatory drugs (i.e., Advil) and acetaminophen. These medicines also carry risks but they are sold over-the counter for a reason — they are safer. And according to the National Safety Council, when drugs like Advil are combined with Tylenol, they can be more effective than opioids, even for severe pain. There are also non-pharmacological approaches. The problem is that many of these treatments involve more effort and expense than simply giving out pills. As a society, we’ve grown accustomed to believe there’s a pill for every ill. This mindset has been encouraged by the pharmaceutical industry. In the short run, this also works out well for health insurance companies because a quick primary care visit and a prescription may cost less than more effective treatments and interdisciplinary care.” 

What do you think: Are laws controlling opioid painkillers hurting people in pain?

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31 Responses to The Debate: Are Laws Controlling Opioid Painkillers Hurting People in Pain?

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    AddictionMyth August 3, 2015 at 8:54 pm #

    What a great article! I think the underlying reasons for the overdose epidemic is not overprescribing but first of all the crackdown – life with chronic pain sucks and gets way worse when your dr tells you he has to cut you down to avoid DEA scrutiny. And secondly by ‘treatment’ at the suicide bullying cults known as the the ’12 Steps’. These are both very testable hypotheses (just interview survivors and get treatment history), and I hope that someone out there is working on it!

    It’s so important to decouple addiction and overdose because you are barking up the wrong tree. Most people dying are middle age men, yet the diversion is happening with kids (who get ‘hooked’ on a single pill, even half a pill). So preventing diversion will not address the bulk of the problem. Also we should be telling kids: “Don’t steal drugs from granny’s medicine cabinet” not “If you steal drugs from granny’s medicine cabinet and do this continuously for months you could develop a disease that makes you steal drugs from granny’s medicine cabinet.” LOL

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      Julie August 12, 2015 at 7:08 am #

      As a Nurse and a chronic pain sufferer, I see both sides. To say the new laws do not impact pain patients treatment us inaccurate, these new laws and regulations have effected my treatment at my pain management center.
      I was there the other day for my 3 months check up, prescription refills etc..this discussion came up with my Physician feels his hands are tied, if he gives what he feels is what would fit my specific individualized needs, he could be scrutinized by an audit, so to decrease his and his clinics possibility of being “red flagged” he decreased my dose and amount of pain medication (which I have been on for 12 years). Also he told me of a recent encounter with a referral for a patient with end stage cancer..her physician asked for a consult because he thought she may be addicted to her pain meds. As my physician said “who cares she’s got less than a month to live”? I agree..
      In my 12 year journey with chronic pain, I can say I’ve tried every thing that has been offered other than medications ..I under go a surgical procedure every 4 months for my one disease to help relieve my pain, I do massage therapy, aqua exercise and heat and ice as needed..I do believe there r non pharmaceutical things that can help but without my 3 pain pills a day I wouldn’t be able to function and enjoy
      It’s obvious that if u take anything daily for 12 years of course the body gets used to it and if its stopped abruptly yes u will show withdrawal symptoms, that’s basic in its basic definition yes it is addiction..but the difference lies in the.osycholigical, I don’t NEED the oai meds psychologically ..when they cut the dose and amount I didn’t panic or creak out, I simply readjusted…I think that’s what constitutes true ” addiction” do you need the med psychologically ??
      It’s so sad to me as a Hospice Nurse, knowing physicians do not want to answer to higher ups so the pain patients r definitely paying the price..I also worked in a chemical dependency unit and trust me, they can write all the laws they want, ppl who are truly “addicted” will find their drug if choice despite laws, regulations etc..the old saying ” where there’s a will there’s a way”

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        Mary August 12, 2015 at 12:15 pm #

        Thank you for your reply to this article on opioids. I feel the same way! I was on an opiate had no troubles coming off of it. However, I never took more than two a day. They had put me on nuerontin (because it’s not addictive they said) and I when i slowly stopped taking it I had extreme withdraws from that medication! Now I am facing having my bladder taken out to be able to have a life.

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          Laurie Moody-Elizondo April 1, 2016 at 2:52 am #

          Neurontin!!!! That drug is a joke they want to pawn that off as the next great drug for nerve pain, but what they don’t tell you is that it screws with your vision, can cause anxiety worse than any other drug l have ever been on. MedI cations for everyone are a lock and key fit. What works for one may not work for someone else and unfortunately we are all used as guinea pigs by big pharm. You won’t know the worst side effects of these crappy meds until the commercials come out from the ambulance chasing lawyers. Isn’t it funny how the Dr. who doesn’t feel that pain pts are effected also sat on psychiatry board. He can’t wait to prescribe those nasty psych meds.

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        Elizabeth August 12, 2015 at 12:16 pm #

        Well written. I myself am in pain management. When Zohydro came on the market it could have really made a difference in my quality of life. You see I’m allergic to ALL of the other pain medications due to the sulfite,sulfate content that the pills are made with. My doctor wrote the Rx but NO pharmacy would fill it. Not one. Why? Because of the hype. It was all over news stations how since it didn’t have the protective coating the addicts would overdose and die. Well, I’m one of the few that’s ALLERGIC to the coating. What about us? The people it would help? I find it appallingly the way pain management patients are treated. Believe me,I fought going to p.m. for 5years due to the stigma associated with it. Finally I was bedridden and had no choice (if I wanted any sort of quality of life). God help these people if they ever find themselves on the other side of this argument.

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        Jan May 11, 2016 at 7:36 pm #

        I agree completely! I can NOT take any ibuprofen product, Celebrex ,that a doctor gave me saying it doesn’t have ibuprofen in it, it does and I threw up for hours! Till there was blood in my vomit from it! Not everyone is an addict or abuses what their physician prescibes! Everyone they are talking about either mixed legal with illegal or did NOT follow the prescribed dosage. I’m not a teen, I’m a middle aged woman who’s had extremely physical jobs, very athletic and have hip and knee pain constantly. Without the low dose of Norco I’m prescribed my quality of living, now retired but still highly athletic, would be horrible. My Doctor and I have tried many different meds for me to be able to do the activities I enjoy. Why should I be punished with chronic pain because addicts go to the streets for drugs, or people take more just to get high! Enough! 99.9% of doctors don’t want to KILL you, they just want you to have a better life. This crazy attack on pain meds is insane! We’ll make people like me and many others suffer so addicts can’t get it? Believe me THEY WILL still get it! It will only hurt the ones that need it!

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    Jeremy Zgoodwin. MS, MD August 4, 2015 at 12:42 am #

    it saddens me to read a specialist’s perspective such as Dr. Kolodny’s that lacks any understanding of the complexity of pain and the need for a multimodal approach that should be able to include opioids at whatever dose works for an individual. It is not a playground for recipes and neither should pain from cancer or at the end of life be taken more seriously than pain ruining life on a long term basis. Since when should we be allowed to die with dignity yet be forced to live life without it?

    Furthermore, Dr. Joking has no understanding of statistics. Yes, the USA has around 5-6% of the world’s population but if most of the world is UNDERTREATED then the amount consumed by those suffering pain within that 5% will appear disproportionately large.

    I also have a problem with the concept of hyperalgesis being used as a frequent or even innevitable consequence of opioid use over time. First, it happens uncommonly ( no one knows exactly how often but in my 25 years as a doctor I have seen it only rarely although it is often misdiagnosed). Second, there are simple ways to treat it via opioid rotation along with reduction coupled with other treatments.

    Last, the studies are poor in that the subsets of patients who do well or poorly or who did of an overdose are not well separated at all. Co-morbidity, including but not limited to substance abuse, improper monitoring and prescribing, concurrently taken controlled ( ie Valium) or legally bought substances such as alcohol may all play a role. And yet the benzodiazepines can be appropriately dosed along with opioids. They can prove opioid soaring too. Same with medical marijuana.

    As Dr. Twillman mentioned, the situation differs
    from person to person snd each should be evaluated and treated per their own needs. Insurance often refuses to pay for an integrative approach let alone the necessary emotional coping with pain training sometimes applied best within a group psychoeducational setting snd at other times, through individual therapy ( and NOT just CBT!).

    I see and hear not only of improperly snd inappropriate weaning but lack of supplies at pharmacies and clinicians who treat patients as drug addicts, children or as athletes ready to be caught ‘doping’ and who will then be punished. We are an arrogant profession and should show patients greater levels of respect, understanding and compassion. It also takes time. A ten minute office visit simply will not suffice.

    We ARE approaching s problem simplistically, irresponsibly snd from a political perspective not an evidenced based one. End points of return to work should not be the only or main defining reason to continue, discontinue or to modify the dose. And the 120 mg of oral morphine or its equivalent is arbitrary. Dosing can vary by 40 times between individuals with similar needs due to
    tolerance, receptor sensitivity variability, other medications, metabolism and amount of sleep, anxiety and general conditioning and attitude.

    In my opinion, Dr Twillman has an understanding of the subject while Dr Kolodny needs
    to study it in greater depth and likely gain experience treating without imposing prejudice on the patients in question.

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      Rose August 12, 2015 at 10:10 am #

      Thank you for your very appropriate and educated response. One major factor I have faced as a medical professional as well as a chronic pain sufferer is that my insure will readily pay for pain medication, but not give options for therapies, or any other alternative treatments. As a mother of 4 young children I pray every day the injuries I have will heal. I can not afford to take off 6 months of work to appropriately heal from major spine surgery, yet if I continue on with the status I’m at now I may be a paraplegic before 40. What good is socialized medicine if there are no options for treatment and you can’t be seen by a specialist for 3 to 6 months? Our country is in crisis, and it is a very scary time to be living in.

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      Parker August 13, 2015 at 4:42 pm #

      I want to say Thank you,

      It’s good to know your medical philosphy is based on fact and not on crafty statistics. The Pain managmemt community needs support from like minded professionas who’s knowledge base expands past the media hype. Real people who suffer horrendously have the right to improved Quality of life, discarding treatment options is the same as discarding this group as a whole.

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      Laurie Moody-Elizondo April 1, 2016 at 3:10 am #

      I don’t think Dr Kolody is a psychiatrist rather than an MD. He wouldn’t know the difference between someone in chronic pain and the prescription drug addict because to him they are both the same. His agenda is to have everyone on a psychoactive medication. If he can chemically screw up the brain he can dx them with a conclusive mental illness and render the pt unable to verbally complain of pain.

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    Lynn Webster August 5, 2015 at 4:25 pm #

    Great questions but no simple answers. It is a complex problem that cannot be adequately addressed in a reductionist approach. Far too often attitudes and policies toward people in pain and people with addictions pit one against the other. This should not be the case. We cannot solve these dueling crises without thoughtful discussions and policy making for both issues. One group should not be harmed to protect the other.

    It is important to correct a statement above. The referenced Utah study of overdose mortality misstated the facts.

    Although the study reported 91.5% of decedents suffered from chronic pain this does not mean they were all receiving “regular” prescriptions. It also reported 91.2 % of decedents who used pain meds had gotten some medications by prescription during the past year but it did not report the amount of opioid prescribed within 30 days of the death. The report also lists multiple other illicit sources and doesn’t say which sources led to the deaths.

    Certainly people in pain die of overdose from prescriptions. In fact about one third of the deaths in the Utah study and from CDC data are due to methadone, most of which is being prescribed for pain. The important question is what role do payers play in the harm from opioids by limiting treatment options to only methadone.

    Other parts of the Utah study that can shed light on the etiology and thereby potential solutions to both problems are rarely mentioned.

    Here are the stats:

    63% of decedents were unemployed during the last two months of life
    58% of respondents (usually a family member) reported that the decedent had a financial problem during the tow months prior to death
    27% of individuals were uninsured at the time of death. (higher than statewide rate of 14%)

    49% of decedents had ever received treatment for substance abuse
    49% were reported to have been diagnosed with a mental illness by a healthcare provider
    24% of decedents had been hospitalized for psychiatric reasons.
    76.7% of decedents used medication to relieve stress or anxiety.

    Pain, financial problems, past history of substance abuse & mental illness are major factors for overdose. Is the treatment or lack of effective treatment the root cause(s) to most deaths? There are solutions but we can’t get there without acknowledging all of the factors contributing to these serious problems.

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    Kay Faust August 12, 2015 at 9:42 am #

    I live with a condition called IC or painful bladder disease. Since the changes in the pain medications my life or so called life is hell. I am in pain all the time. Plain and simple if this continues I will not die from a overdose I will die by my own hands from suicide. I cannot live the rest of my life in this kind of pain period. So keep worrying about preventing addiction and watch the suicides increase at alarming rates because for people with extreme pain they will. For Dr. Kolodny I pray you never get a chronic painful disease and if you do I hope you have extreme difficulty getting pain relief. You are totally ignorant about pain and you also probably are a egomaniac also like most doctors who think they know it all.

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      Stacey Rabin February 3, 2016 at 11:30 am #

      I feel the same way Kay. I have Ehlers Danlos Syndrome for which there is no cure and very few treatments. By 30 years old, i had already had 24 surgeries trying to correct my joint problems including a right shoulder fusion but none of them took care of the pain. I am 38 now and have daily dislocations of various joints which is obviously extremely painful. Before I had been able to get into a pain management center for opioid treatment, I had attempted suicide 4 times. Since I am allergic to NSAIDs and aspirin, opioids were my only choice. Since I have been taking oxycodone and have had my pain under control, suicide has not even crossed my mind. I can tell you now though that my disease has progressed and there is no way I could face every day in that much pain. I do not think I am alone in this either. If they take the medications away, accidental overdoses may decrease some but that number will be far surpassed by the increase in suicides by patients with chronic pain. We don’t take these medications because it is fun or to get high. We take them so we can face life every day. If the goal is truly to save lives, then put more warnings on the medications to inform people but let us keep taking the meds that allow us to actually live. I am completely aware of think risk of accidental overdose and I am willing to take the chance because without them I will surely die by my own hands or other means. Does anyone know how us patients in chronic pain cam fight these new laws? We need to band together and help the “number crunchers” to realize how their actions will affect real people in real life.

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    H Platt August 12, 2015 at 11:35 am #

    Dr Kolodny talks like a robot with no humanity whatsoever in his person….a soulless ghoul if you may. If and when he is ever faced with a chronic pain condition then he will probably change his tune. These statements are ignorant to say the least, and having been medically retired from LE (for over 17 years) I have dealt with drug addicts, substance abusers, etc. And most addicts I ran across all had that psychological need for whatever substance, so I arrested them for criminal charges to fulfill that need. So I can relate to what the last poster stated. Most of these overdoses are to problematic people (mental issues, illegal drug abuser, substance abuse, etc), and this will only serve to limit a person’s quality of life. As a sufferer of IC the last 12 years I have used both non-opioid resources as well as opioid when it was necessary. This just means my quality of life will decline simply because of legality concerns (scared of their own shadow) and DEA audits from those who are not afflicted with a chronic condition. This just means doctors will write less to none for patients who need them simply to make their own lives easier. It is as simple as that.

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    Susan August 12, 2015 at 12:44 pm #

    Oh yes….I’m suffering from Atypical Trigeminal Neuralgia (for 15 years), Fibromyalgia and Interstitial Cystitis‎.
    For example I had two flare ups with shingles in 3 weeks which has caused me extremely pain and suffering.
    I can neither go to Urgent Care nor the ER.
    As soon as they see my medical history the always getting ignorant. Waste of time and money and of course more suffering.
    My condition is not visible, does that necessarily mean I’m well???
    Every month the fight with getting my medications, always be short because I just can pick it up on the fill date which means I can not take the needed long acting at night because I need it in the morning to get out off my bed.
    I suffer not just from this horrible condition, I also suffer from the ignorance of doctors and nurses. I even got kicked out of a pain management because I was accused just being a drug seeker
    This all is very heavy on my back and does not help me felling any better.
    Honestly if I wouldn’t have a family to live for and I love, would you really think I would be still here? NO!
    I keep fighting for our rights and acceptance, its not our chronic pain patients fault if a doctor is not able to see the difference in WHO really needs it and WHO is a drug seeker.
    All the big pharmacies like CVS and Walgreens will turn you down or even let you wait for days to get your fill.
    No, and I do not wish anyone pain, but sometimes it would be more than necessary to actually FEEL what it means living the daily hell of pain.
    We are getting punished for ignorance of some doctors and pharmacies.

    Its a shame, really!

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    Susan August 12, 2015 at 12:51 pm #

    Dr. Kolodny one question:

    If you can NOT tolerate like Lyrica and Neurontin and other might helpful medications and you’ve tried EVERYTHING and after 15 years of trying EVERYTHING what can YOU offer me???????

    Its NERV pain and there’s not much to help with it , and opiates are not even take it away BUT I can LIVE a bit!

    Would you rather suggest killing myself?


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    Krystal Paracy August 12, 2015 at 7:25 pm #

    This makes me so angry. I started reading and thought great. ..someone is finally getting it right. But then…I saw 3 or 4 more articles written by suit wearing smiling faced schmucks who’ve never lain on their bathroom floor counting the agonizing seconds and knowing they simply cannot live cannot breathe with this agonizing pain another minute. ..let alone 24 hours after 24 hours.

    Have they been treated like a drug seeking cretin? Like a sub species of human being…less than human….by the doctors sworn to do no harm ? I cannot count thr amount of times I’ve been subjected to heinous and inhumane treatment by arrogant and cowardly physicians who refuse to even allow me to speak let alone hear what I have to say. I’ve had them speak over me…down to me…backing out of thr room with their hands up like I’m so bomb about to go off. Me. A quiet educated well dressed soft spoken intelligent human being. A woman. A mother. A daughter. I have been through over 15 episodes of that recently when dumped by my physical who suddenly didn’t want a chronic pain patient on his roster so hr dropped me at Xmas time when it was impossible to find anyone to write my prescription. ..causing me no end of pain withdrawal agony stress and terror. Only to be repeatedly treated like garbage in my search for a new doctor….I threatened to complain about the doctor who dropped me but he beat me to it posy dating a report that made me look bad of course and he looked like a shining angel. I still remember the woman from addiction services calling. What a joke.

    Some people have real pain. There is a less than one percent chance of my becoming addicted because my pain is real. I am not afraid of addiction but more bureaucracy that may someday block my ability to love live qnd breathe free from pain. For me opiods are a godsend and I use them daily to live free of hellish pain. There are side effects I don’t love but the good outweighs the bad…for those of us smart enough and responsible enough to know you have to choose a new life free from alcohol and any other medications and be constantly vigilant and careful about what you take and when you take it. I have never taken an opiod or even over the counter medication without writing it down. Time day date.

    I only pray someone stands up and fights for us….those who truly need it. I’ll fight for myself. Where do I sign up?

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      Stacey Rabin February 3, 2016 at 11:39 am #

      Krystal, I want to fight this too but i don’t know how. Are there any groups out there for chronic pain patients to turn to for help? We need to stop these legislators before it is too late. I am terrified that they are going to take away any chance I have to actually have a life. We all need to fight this together.

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    Tom Daniels Sr. August 13, 2015 at 4:58 am #

    The day that Darvocet (in my opinion… a much safer drug) was removed from the market, tied the hand of doctors. Their only choice was to move to a much more dangerous group of drugs.
    The FDA started this mess. Now is the time to return Darvocet to the market and give doctors a better, safer option.

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      Laurie Moody-Elizondo April 1, 2016 at 3:29 am #

      Darvocet was removed because when the medication broke down in the body it left crystals in the kidneys. These small crystals were causing damage to pts that were on it long term because the crystals could not pass out. However, Oxycontin needs to be taken off the market. That drug is a powerful painkiller but the only people that need to be on anything that powerful are the ones that are on thier way out of this world. Big pharm misled physicians regarding that med for years causing this abuse epidemic now what the FDA needs to do is make the damn company open rehab facilities for the people that have been affected by the damn crap. America needs to get a class action law suit going for the millions that got addicted to oxycontin. Not go after opiates altogether oversimplification is not the answer.

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    Andrew Devoti September 2, 2015 at 7:48 pm #

    Longtime nationally syndicated health columnist Judy Foreman is the author of the forthcoming book, “A Nation in Pain Healing Our Biggest Health Problem” coming out in February, 2014 from Oxford University Press. She looks here at the FDA s latest move to tighten control of painkillers.

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    S.A.D. March 29, 2016 at 4:08 pm #

    I think it’s pretty obvious that OF COURSE the current regulations and laws have had and continue to have a detrimental effect on pain patients. Absolutely. Doctors fear of the DEA. To pharmacies not stocking the meds, and their pharmacists denying filling them. To insurance carriers de authorizing them, and (arbitrarily) limiting quantities.
    These and many other effects have had and continue to have DEVASTATING effects on pain patient’s health , pain, and quality of life. Who speaks up for them and the pain their families have to endure? Who stands up for them in front of Congress to demand action on their maligning, persecution, and Under treated pain??

    The continued disregard, exclusion,and apathy for the millions of pain patients is cruel, unprofessional, cold, and almost hints at some ulterior motive or agenda.
    Pain patients depend on these medicines. Frankly, they have no other choice. No other alternatives. In addition, NOTHING on the market even compares to the relief that pain patients can benefit from these medications. Let’s stop trying to fool ourselves (and others). They aren’t a panacea or cure all. But they allow pain patients to decrease the volume (when given a sufficient enough dose, which sadly is uncommon nowadays) and intensity of the pain. Which is what they need. The decrease in pain allows them to stay active. To stay involved. To stay less isolated. To continue to work (and pay taxes and not be a ‘drain’ ) for many. Raise their children. Have relationships. Pursue hobbies, and make plans. These are now becoming faded memories for most pain patients unfortunately.
    The War on Drugs should focus more on heroin, which is the real culprit in these ‘opiate’ incidences, and actually reverse many of the draconian laws, and regulations inflicted upon innocent pain patients who depend on these medically researched, studied, and tested, prescription pain medications, which were meant only for pain patients, not for recreational use.
    Think how many millions have taken these medications and not become addicted. Addicts will be addicted to anything. There are people that are addicted to couch foam. People are addicted to alcohol. Does that mean if you drink a beer, you’re an alcoholic? right there after that one beer, you must have more and can’t stop?? Nonsense. So please. Stop this paranoia and hysteria, based on misguided, and downright harmful notions and pseudoscience.
    NO , ‘mindfulness’, meditation, etc do not often help most pain patients. NO, Tylenol, Ibuprofen, Naproxen et al, barely scratch the surface of most pain patient’s pain, not to say the damaging effects on their liver and kidneys at the dosages recommended to help pain. All for the sake of not taking opioid pain medications? sorry, but to do more harm to avoid a lesser harm is a poor trade off. One that you cannot sell on the American public.

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    Amy Vallejo March 29, 2016 at 6:02 pm #

    IMO you are torturing your own blood flor something someone else did. I was a Vice President of Risk Operations at a Bank before stepping off a side walk and breaking my foot which resulted in CRPS complex Regional Pain Syndrome which is more painful than non terminal cancer but you want me to take an Advil?? If your child had CRPS and was screaming in pain because they were burning 24/7 and felt like their bones were being crushed would you give your child and Advil or NSAIDs and say sorry honey I can’t give you anything else for the pain you will just have to suffer? I have tried everything and I don’t just have CRPS with CRPS comes comorbities but you should know all this before you cut a million or more of us plus military vets who fought for the country OFF OF MEDS with no step down!! Insurance companies denying meds, doctors scared and limited drugs at the pharmacy. It’s a mess!!! You are torturing people who are fighting to LIVE! I have 5 or 6 RARE diseases that get ZERO government funding they have no cure no insurance coverage for treatments and I can no longer work. I’d give anything to go back to fighting the real criminals instead of being treated like I’m an addict and I’m not worthy of treatment in ER’s. I’ve had my paperwork referral from my doctor and still what will it take to be treated like a respectable human being who has multiple PROGRESSIVE chronic pain diseases that have NO CURE and limited Treatments on the McGill pain scale our pain is higher than untrained childbirth, amputation of a digit and Nonterminal CANCER!!! Please help us

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    Emily Raven March 30, 2016 at 1:55 am #

    So uh yeah… I hope Mr Kolodony realizes that the reason America uses 99% of the hydrocodone supply is because the rest of the world uses hydromorphone. We use the hydrocodone here because american drug companies had to change it to patent it to make money off it. Same thing with oxy, but I do not remember the other chemical it has an equivalent to. Boy are we all letting the wool be pulled over our eyes on this one. /quack

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    Chickie June 2, 2016 at 1:32 pm #

    I am a pain patient. I recently moved and have had to search for a new doctor. Its been many months since I’ve had pain meds. I do use medical marijuana, but that is usually just for the evenings when I need to sleep. The docs around here wont give me Vicodin. I have tried all of the other pain meds and that is the only one that actually helps me. The doc said he would give me morphine but not vicodin! I already tried the morphine with my old doc, it didnt work. Its been months since I had any pain meds. I am NOT an addict. The only thing that makes me FEEL like an addict is the fact that I have to go and “shop” for a doctor who will give me the medicine that I know works! This is embarrassing! I am in so much pain I can barely walk!

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    derk July 18, 2016 at 2:24 am #

    I have a problem with the debate above…now how does that make me sound. What we have above, is a debate between two men with an agenda, fighting over whether dependency exists. One has the drive of helping people , not only one, but two, maybe three types of people. While he acknowledges the issue afoot with opioid abuse, he also acknowledges the need for opioids for some, and the need for other treatments for others. He is simply asking that the pathways for freedom of treatment and the practice of medicine to be upheld in a truely human fashon. Because of his passion, he clearly cares to understand more than just the basic behavior and tendencies of these drugs. The secone man hold the agenda of pushing the CDCs unfounded claims, basing his entire argument off what the first has already covered (studies which do not exist, but claims that say their is evidence otherwise). He goes as far as to say, that opioids are not effective in most (which we could argue that MOST is an exaggeration by anyones standard given his stance, and would mean that there IS still a portion for whom they ARE), then proceeds to suggest that those people that ARE helped …deserve less respect or treatment than those who would abuse the medication, for fun. The agendas are clear…and so are the lies surrounding the push against. Opioids have been a staple in our pain fighting arsenal for centuries, and there is a reason for that. We did not wake up one day, to find that the human body has suddenly changed drastically, and no longer benefits from the analgesic properties of opioids. We have basically seen our regulatory system approach a societal problem, dream out loud: “Wouldn’t it be so much easier if we didn’t really need these, and could just tell people it was all in their head”….and never snap out of it, because they later realized it was profitable. The CDC/DEA know their claims are based on their profit as a regulatory agency(and quite honestly the DEAs legitimacy at this point), and not the best interest of the patient. There are far more people helped by opioids in the chronic setting, than there are people who abuse them, and anyone wanting to know the truth can ask those who live with this battle mentally physically financially and now legally/politically…daily. The patients are ignored and literally left to rot, while demonized for fighting for exactly what any person in their position would. This IS the definition of both deceit extortion, and possibly a few other things lacking morality/humanity.

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    L. Merlin July 30, 2016 at 8:21 am #

    Dr. Kolodny says, “The risks of opioids, especially the risk of addiction, were downplayed and the benefits were exaggerated.” That is the exact opposite of the truth. The risks of addiction is greatly exaggerated while the benefits are being downplayed. For example it’s now being said that opiods actually cause pain! The rhetoric of tolerance leads to addiction is akin to reefer madness propaganda. While very, very FEW individuals every experience it, it is simply not a practical argument for leaving people in pain. It IS torture and that is the point. First came morphene, which works. Then came other derivitives, which worked less than morphine. Then came non-opiates which don’t work at all which are very dangerous to your organs. Now you are told “no pain killer for you”(in Nazi’s accent). Don’t you see? First we have painkillers that work whititled away to nothing at all. If you ask for what works you must be a seeker, but if you don’t ask for what works you will be given dangerous NSAIDS that don’t work. It’s reverse psychology and drug war propaganda speech everywhere. By the way, reverse psychology is not an accidental behavior, it is strategy.

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    Blue and depressed August 6, 2016 at 3:14 pm #

    Chronic pain sufferers were never given a voice on this matter and are now left to suffer continually due to the government making the decisions instead of the doctors who have the medical training!!! Most all the US government officials have been bombarded with people who have lost a loved one due to some kind of overdose. Using statistics from one pool of information is a prime example of what our professor said on the first day of engineering statistics…”there are lies, damn lies, and statistics. I’m going to teach statistics”. Did the people with chronic pain have any input into the new laws against “opioid abuse”? I really feel like anyone who uses opioids are considered addicts! I would call that discrimination and defamation of character!!! My life has consisted of a large number of accidents. My left thumb was pinched off and reattached. Now I have two finger nails on my thumb, one of which I have to dig out of my skin so that I can trim the nail and reduce the pain. My ring finger was pinched off. The doctors said I wouldn’t have a nail on it. They were wrong. My finger nail on my ring finger starts where it was pinched off and grows back into my skin. It feels like the bone is sticking out and I have to endure a constant feeling of an ingrown finger nail on both digits, 24 hours a day. Then there is the 12 inch scar where my left knee was rebuilt. Working as a licensed surveyor and engineer, we raised an industrial manhole cover to measure the depth of the manhole and the sizes of the influent and effluent pipe lines. Two men released the huge steel manhole lid which then slid out of my hands and crushed my foot. It shattered the bones, ligament and nerves in my foot to the extent that the doctors said that all they could do is stitch the skin back together because the bones were shattered and they would have to heal in the position they were in. I can’t bend most of my toes and the top of my foot is discolored due to inadequate blood flow. Even though I am a professional surveyor and engineer, my love of farming has continued since before my fingers were pinched off by a tractor and my knee was busted by livestock. I can’t find good part time help on a small farm, so I handle it myself, mainly as an additional source of income, since I’ve been farming all my life. A few years ago I was unloading large rolls of hay, enduring the pain with the help of God and oxycodone, when the strings snapped. I went flying backwards off the hay trailer and landed on my upper back. I was on the side of a hill unloading hay so as to build up the organics for vegetation growth. In effect, I broke my spine just below my neck. This accident, in addition to a dog bite which broke my right jaw, has caused me to have debilitating headaches! The other damage to my body has caused me to desire death. The thing is, I have three girls, a boy and a wife to take care of. My first wife didn’t understand the agonizing pain that some people have to endure 24 hours a day, 7 days a week. My wife now understands since she was kicked in the back, which broke her spine. Subsequently she has had 17 back surgeries on her lower back but even with all that, she still has debilitating pain!!! At least she understands and will get me a cold wash cloth at night, since that helps with my headaches!
    I do NOT wish anyone chronic, incurable, pain and suffering, day and night, for the rest of their life!!! I do long for relief, and it really makes me sad to know that the trained, educated professional doctors in this country are being told that they can’t treat their patients like they have in the past, or they will lose their license. I have been going to pain management for about 20 years. During that time, my life has been endurable. I have accepted the fact that I will never have a “normal” body, and that I am going to have to deal with pain. Not just the occasional bump or scrape, but persistent, non-stop, chronic, debilitating, and embarrassment from pain! Over the past 20 years, I have only been to two different pain management doctors. The first doctor’s office was over an hour away. I drove that far just so that I wouldn’t have to deal with the judgement that inevitably comes with someone who takes medicine for pain. I guess I became jaded enough and financially broke enough to see a local pain management doctor. Now the trouble is that, even though I have been taken down to the amount of medicine that I was receiving 15 years ago, I went to get my prescriptions filled and the pharmacy said that the DEA/CDC or whomever has pulled my doctor’s license and I can’t get my medicine. Now what the crap am I supposed to do? I’ve been going to the same doctor for approximately 12 years! I have 10 employees working under me with over 20 projects that employ an additional 100+ people. The projects that I am over are located in 6+ counties and stimulate the economy by $10M+. I can’t physically endure walking long distances, the climbing in and out of ditches, trudging through rough terrain, walking over huge rocks to inspect structures, blazing trails through the woods or even typing on the computer without excruciating pain. The damn politicians need to leave the medical decisions to the trained Physicians, and care about the people like us that are in constant agony! Otherwise, we will have just as many deaths from suicide, but I guess we don’t matter to anyone!!! Are we addicts??? “Judge not lest ye be judged”!!! Walk a day in my shoes before passing controlling laws. #prayingforamiracle

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    Ryan Lankford August 16, 2016 at 12:16 am #

    Once again, Andrew Kolodny’s playing fast and loose with statistics and language. He likes to parrot the line about the US using 99% of the world’s hydrocodone, but he NEVER mentions the fact that we’re one of only a handful of nations that even *uses* hydrocodone! Why doesn’t he mention the fact that the US uses 0% of the world’s supply of dihydrocodeine? Oh yeah, because it doesn’t fit his narrative. There’s a good reason why Andrew Kolodny’s social media and YouTube channel don’t allow comments: it’s because he knows when his narrative is challenged or scrutinized, it falls apart. Why do you think he was TERRIFIED of patients having any voice whatsoever when he and his PROP buddies were shoehorning the new guidelines through the hearing process?

    Andrew Kolodny is a psychiatrist, not a pain specialist, and his conflicts of interest are glaring. He has a financial stake in a large chain of rehabs that stand to make MILLIONS of dollars off of pain patients going through opioid withdrawal. I’d also like to see the stock portfolios of both Andrew and his wife; I’d bet dollars to donuts that they hold stock in companies that produce buprenorphine products such as Suboxone.

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    Karen Smith September 3, 2016 at 6:36 am #

    There is HUGE discrimination and hardship being caused to chronic pain sufferers, as well as denial of our civil rights. I’ve been on my medications, for almost 2 decades, never increasing in dosage, but I have decreased in dosage because of pressure from my pain management doctor and because of the limited available that occurs. Despite not EVER asking for an increase in medication, calling for more pills due to loss etc, and never failing the urine tests, I am treated like a drug addict and a criminal by the facility. A lot of that attitude stems from the FEDERAL GOVERNMENT! These laws also put me under bigger financial strain because I have to see the doctor EVERY 28 DAYS or else, so the co-pays add up, I have to get transportation to and from and those costs add up, and now urine testing is mandated by THE FED, not my MD, every 3 to six months, and they’re several hundred dollars out of pocket expenses each time! My husband and I had planned to be RVers when he retires, that plan is out the window, as well as extended stays with our kids in other states because I have to be back at my doctor’s every three weeks! Why are those of us who follow the laws and do what we are supposed to do being penalized for those who are breaking the law? I stay in pain because my doctor is mandated to reduce my prescriptions, I have contemplated suicide because I hurt so much and am tired of being treated like a criminal just for taking the medications that I was prescribed 20 YEARS ago. FIX THESE LAWS PLEASE!

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    Sick and Tired October 15, 2016 at 4:34 pm #

    My heart hurts for all of the people who have left comments about their personal struggles and the dehumanizing treatment they have received at the hands of ignorant (in the literal sense of the word) doctors who lack compassion or the willingness to educate themselves on this issue.

    I’m a Canadian who has suffered from very severe chronic myofascial (or “trigger point” pain since my early teens.

    I’ve overcome many challenges in my life through medical help & perseverance, including a nearly fatal battle with eating disorder – the kind that most people never fully recover from – when I was 15 as well as an abusive (on all levels) family. I’m also a survivor of sexual assault. Hard work & a commitment to overcoming these and other challenges, coupled with compassionate & professional therapists has allowed me to put those things behind me & live what would otherwise be a normal, productive life – if it weren’t for the soul crushing chronic pain. For years my life consisted of being bed-ridden & getting helped into menthol/Epsom salt baths, then back into bed by my mother & sister. A well-meaning psychiatrist finally prescribed meperidine (Demerol) which was the only real option he had at the time. Unfortunately this is a short acting drug that breaks down into a neurotoxici metabolite & severely alters cognition (i.e. gets you “high”). I just went on to being bed-ridden in less pain but still unable to function “normally”.

    When Ocycontin became available I spent a year seeing a pain specialist every week who ran appropriate tests & monitored me closely until we arrived at a dosing schedule that worked for me. By today’s standards it would be considered fairly high but I’ve never become so “opiate tolerant” that the meds stopped helping or asked for my dose to be increased. It changed my life completely – which is to say I finally had quality of life. He worked with my G.P. who subsequently took over the prescribing & monitoring of my meds.

    FOR OVER 20 YEARS I led a productive life: I enrolled in University & was on the Dean’s List with High Honors. I started working out & became involved in things I had a passion for. I survived finding the dead body of my father who was my best friend and later that of my husband who died of a “fluke” (coroner’s words) cardiac arrest during a nap ay 38. Then my doctor retired from family practice. The only person who would continue to fill my script was the woman who took over his practice (I say “woman” because to call her a doctor would be an insult to the profession). From day one she saw me as a problem & kept trying to put me in a psych ward despite the fact there was no basis for it other than her ulterior motive of getting me off opiates. Very recently I injured myself & ended up in a physical rehab hospital for several weeks. I was told the pharmacy at that hospital couldn’t fill my script – instead I was given the equivalent of my breakthrough medication which I used infrequently anyways. I just kept taking my own meds, but was referred to a psychiatrist who put me back on antidepressants & VERY SHORTLY afterwards an “adjunct” antipsychotic. Apparently these drugs are all well & fine, despite the severe side effects & the way the latter can interfere with the cardiac rhythm.

    My G.P. got a communication from her that advised to not increase my opiates. She used it as an excuse to cut me off completely & suddenly. Despite the fact that with pharmacy records in hand to prove I didn’t order as often as I was allowed to i tried to negotiate a taper or an increase in the interval I could order, she wouldn’t compromise or even engage with me on anything resembling a human level. “You’re an addict & belong on methadone!”, she kept shrieking. Obviously she’s not familiar with the distinction between addiction & dependence as outlined by pain specialists-and feels no need to educate herself about it. If I were an “addict” I’d be ordering as frequently as allowed, not trying to moderate the dose myself. But it seems no matter what we are all now “addicts” & are diverted to programs for such.

    So I’m left with withdrawal & the creeping back of the pain that made my life hell.

    I feel bad for the people who have overdosed & for their families, but as many have said above, what about the suicides of those who’d rather be dead than go back to the non-lives they had before this medication?? The hysteria around these drugs has become absurd. Cutting prescriptions off isn’t going to put this genie back into the bottle – it will just increase drug trafficking & trade, and potentially drive responsible users to the streets or death at their own hands.
    Yet no one seems to be anticipating THESE crises.

    And yes, I’ve had nerve block, engage in relaxation & mindfulness meditation, done CBT – you name it. Pain kills life. Pain relievers are the only thing that worked for me.

    God help us all.

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