How Has CDC Opioid Guideline Affected You?

This article, in a slightly edited form, first appeared on Pain News Network on March 2, 2019.

The controversial CDC Guideline for Prescribing Opioids for Chronic Pain was released on March 15, 2016 in an effort to curb the opioid crisis. While “largely supportive” of the guideline at the time, the American Medical Association had concerns about how it would be implemented.

“We remain concerned about the evidence base informing some of the recommendations; conflicts with existing state laws and product labeling; and possible unintended consequences associated with implementation, which includes access and insurance coverage limitations for non-pharmacologic treatments, especially comprehensive care; and the potential effects of strict dosage and duration limits on patient care,” said Patrice Harris, MD, then board chair-elect of the AMA.

Dr. Harris proved to be prescient. In the last three years, insurance companies, healthcare systems and dozens of states have imposed limits – based on the CDC guideline — on the quantity and dose of opioids dispensed to people with pain.

Oregon has even drafted a plan to stop opioid prescribing for many Medicaid patients and require that they use alternative treatments. Here was my response to Oregon’s plan, in which I warned that “forcing opioid tapers is not an appropriate or compassionate solution” and could drive some patients to suicide.

Pharmacies are also imposing limits. In 2017, CVS announced it would limit the number of pills for new patients with acute pain to 7 days’ supply, saying “the CDC Guideline should become the default approach to prescribing opiates.”

That same year, the giant prescription benefits manager Express Scripts also started limiting new opioid prescriptions and set a dosage limit “based on CDC prescribing guidelines.”

This January, the Centers for Medicare and Medicaid Services made it more difficult for over a million Medicare patients to receive doses above 90 MME (morphine milligram equivalent) which they consider a high dose. CMS also imposed a seven-day limit on all patients receiving a new opioid prescription. The CMS rules are based on evidence “cited in the CDC Guideline.”

‘Revisit This Guideline’

When it first published its recommendations, CDC pledged to “revisit this guideline as new evidence becomes available” and said it was “committed to evaluating the guideline to identify the impact of the recommendations on clinician and patient outcomes, both intended and unintended, and revising the recommendations in future updates when warranted.”

In a recent statement to PNN, the CDC said there are “several studies underway with external researchers” evaluating the impact of its guideline on opioid prescribing and patient outcomes. The agency also said it recently commissioned a review by Agency for Healthcare Research & Quality (AHRQ) “to determine what new scientific evidence has been released” on the effectiveness of opioid and non-opioid pain relievers.

In the meantime, no revision of the guideline is being planned.

The CDC guideline was well-intentioned and included many wise principles of opioid prescribing. But it appears to be more about limiting the supply of opioids than improving clinical care for pain patients. Limiting opioid access may be good for some patients, but for many it means more pain and a worsened quality of life.

There is little evidence that limiting supply reduces opioid addiction and overdoses. Opioid prescribing in the United States has significantly declined since 2012, yet opioid overdoses continue rising – primarily due to illicit fentanyl, heroin and counterfeit drugs, not prescription opioids. The CDC’s reevaluation of the guideline should take this into consideration.

In 2018, the National Institutes of Health’s Interagency Pain Research Coordinating Committee recommended that the CDC “engage with advocates and patients, who have been negatively impacted by the unintended consequences of the CDC guideline.” It also called on the FDA and the CDC to work together to “update and improve” the guideline.

Rather than seeing the CDC guideline as a resource or helpful tool, many prescribers live in fear of it. The DEA now routinely monitors prescription drug databases, looking for “red flags” that indicate a doctor is prescribing opioids at doses above those recommended by the CDC. The AMA last year took a stand against this “inappropriate use” of the guideline, and passed a resolution stating that doctors should not be subject to criminal prosecution or other penalties solely for prescribing opioids at higher dosages.

Pain News Network is now conducting a survey with the intent of finding out how the CDC guideline is affecting both providers and patients. Click here to take it. Hopefully, readers will complete the survey and forward it to their medical colleagues and people with pain to complete.

 

11 Comments

  1. Maggie Pepper on March 10, 2019 at 12:45 am

    For those who experience REAL pain the doctors are now discriminating. I moved to my present residence and tried to find a new doctor, each one I called asked immediately did I take pain medication. When I answered to the affirmative they stated they didn’t take patients on pain medication…WHAT? Even after explaining my conditions, no and then a hang up. I am 69 yrs old with osteoporosis, RA and Fibromyalgia, I have been on medication since 1998 and although by today’s standars I may be addicted I need my medication or I would go out of my mind in pain. Do you mean to tell me doctors can’t tell the difference between a sick person in need and a junkie? I blame the doctor’s for this crisis, who started these people on the opiod path? A doctor that’s who.

  2. Claudia Regenos on March 10, 2019 at 8:47 am

    The American medical system as created by the AMA and insurance companies back in the 70’s called Standardized Care, is a for-profit endeavor.

    What can we possibly say? Insurance companies don’t want to pay out malpractice awards for ODs. They don’t want doctors getting sued. Yet every time we go to a doctor to beg for our lives, we get told “OH Hell No – you have to go home and die the best you can because I”m not losing my license over you.” What can we say? Good-bye, cruel world?

    And you know the kicker. We still have to pay doctors to turn us out. What a racket. We’re not allowed to help ourselves, but we do have to swallow whatever poison the system churns out.

    If this seems a little dramatic, Doctor, be mindful I was told last week that I’ve lost 4% of my brain mass, likely due to chronic pain over a 15 year period I haven’t found any studies that indicate that brain tissue regenerates, so I have to assume that’s now a permanent feature. I expect an invoice for that any day now. Who am I gonna owe for killing off my brain? And how much does that cost cuz I’m down to living on disability these days…and all for the stupidity of surviving cancer treatments. .

  3. Eden on March 10, 2019 at 10:42 am

    Thanks for your advocacy- it’s so important and n ended. Yours is a voice of reason!

  4. jim on March 10, 2019 at 2:20 pm

    I do not have a life. I’m a lump of coal sitting in a chair while life passes me by. I don’t think doctors realize that you can eventually reach a point where life is no longer important. I see people my age 75 or older enjoying life, going and doing. Do no harm to your patient but that is long gone. I wonder what it would be like to take a trip and enjoy myself.

  5. David Blachura on March 10, 2019 at 6:26 pm

    I understand the intent of the tightened opioid restrictions, but it seems all opioid users have been categorized as abusers, addicted, or low lifes… This is not the case. There are successful, competent, and respected people out here that require the option to utilize prescription opioids, and the right to remain functional as professionals, parents, spouses and neighbors. There are also those that dread waking up every morning because the PAIN is unbearable, and any remnants of spirit and hope are slowing being stripped away. In many cases, these people have chosen to responsibly use opioids, maintaining accountability to their physicians, and living a life with tolerable pain. A quality of life decision that many have made for decades. Is there and opioid abuse problem?? The answer is YES, but not all users are abusers. I love our country, but the government and politicians have this one wrong. Again, not all opioid users are abusers. Those that have discovered an improved quality of life from opioid treatment are USERS, and should not be forced to discontinue them. If they must, a new, effective, pain relieving option must become available very soon. If not, these new opioid restrictions will quickly create a new sub culture of people unable to physically function, who rely on their local street pharmacist for meds, or choose death as treatment for their chronic pain..
    Again, not all opioid users are abusers
    DFB

  6. Larry Wilson on March 16, 2019 at 7:51 pm

    Does anyone know how to contact SAMHSA? I sent Trump a letter a year ago and he had someone reply. Later I got a letter from Vanila Singh Chief Medical Officer for the Office of the Assistant Secretary for Health at the U.S. Department of Health and Human bla bla gee what a title . Whoever wrote this letter to me explained about all the task programs Trump had started to stop opiate deaths and all about SAMHSA that was there to help me. Well, I have been trying a year to contact them and no one will return calls . Vanilla Singh office won’t return my calls. The only doc I found who can dispense Subutex wants 600 bucks up front and 150 a month for a visit every single month and then the cost of the doipe . Which aIN’T CHEAP! Is this SAMHSA supposed to be a fed funded program or not? I don’t have insurance I am 100 miles from the city I can’t drive there anymore cause I am supposed to be getting disability if SSDI ever gets off their tail and decides I am worthy. I was medically approved 5 months ago what is the holdup?
    And to help things out more my doctor quit so I have this wet behind the ears kid who wants to cut my meds more and try all this other worthless crap I cannot take and I already proved it to the last doctor. God help me for ever being so stupid that I thought I could get help. I

  7. Danell Williams on March 16, 2019 at 11:44 pm

    So Medicaid in oregon wont pay for pain medication but I would venture to bet that since Oregon is the state we are all turning to for assisted suicide, that Medicaid would pay to help you end your like “death with dignity” The up side is…LOOK AT THE MONEY THEY WILL SAVE! If they get all severe intractable pain patients to do a one time script for suicide, they will not have to worry about the extended monthly costs of medication and hospital visits for the chronically ill, those with intractable pain or cancer. It is a win-win for their bottom line and a black mark against our “civilized” nation

  8. Ed on March 17, 2019 at 7:24 pm

    I truly believe that this whole opiate epidemic was created to invent a new way to scam patients and insurance companies across our country. I am a retired construction worker and this career that I spent my life doing has destroyed my back and joints. I wake up every day in severe pain. I have been on pain medication long before I finally retired. If it wasn’t for the pain medication I would have never made it to retirement and more than likely been unable to work and on Medicaid. Thank god I had a compassionate pain doctor who helped me get to where I could retire with a full pension. Shortly after I retired this new law went into effect and my pain doctor made the decision to close his practice rather than deal with the new government regulations. He tried to continue to treat patients as he did in the past but the new government regulation made it impossible for him to treat his patients with compassion without getting into trouble. All they wanted him to do was to reduce the number of opiate prescriptions without taking his patients’ wellbeing into consideration. I know all this because I personally knew this doctor and we had a long discussion regarding the new regulations he was having to deal with.
    The reason I make the statement that this opiate epidemic has turned into no more than a healthcare scam now that the government regulation has been enacted. I use to see my pain doctor 2 times a year. When my pain got to the point that I could not bare it even on pain medication I would call my doctor and ask for a spinal injection. We started with epidurals (which I have had many) when the epidurals not longer helped I had radio frequency procedure ( had the nerves burnt on 3 different occasions). After my doctor closed his practice of course I had to find a new pain doctor on very short notice. I managed to find a pain doctor who was taking patients and on my first visit (consultation visit) I got told by this new doctor that he would not prescribe any of his patients the amount of pain medication that I was taking and he said that if I were to continue being treated by his practice I had to be seen in his office on a monthly basis and deal with less pain medication. He made all these statements without ever looking at my past medical history that he required me to provide prior to my first visit. He then said that I needed to get a MRI of my back prior to my next visit. I said that there were recent MRIs in my medical history documents. He replied that he requires his own and does not rely on past information. I got the MRI as requested and from that day on I have not been seen by the doctor. I am only seen by a nurse practitioner. Right off the bat my pain medication was reduced by an amount that no patient who has been on pain medication as long as I have should be reduced by without assistance. Almost every month I am told that I need an epidural injection to help with my pain. I keep telling them that I have had several of these types of injections in the past and it was not worth the amount of money it cost to have this procedure done when they never last me longer than a month maybe two. Plus I do not have someone who can be there to drive me home after the procedure. Of course these facts on deaf ears. Of course now I have to submit to urine testing. Now you tell me if this a scam or not, when it cost $100 per visit to see the nurse and it cost $360 for the collection of the urine sample. Then the sample is sent off to some lab, in my case its Millennium Health LLC for further testing. I live in Indiana and this lab is clear out in San Diego , CA. as to why my pain doctor sends its urine samples to this lab makes no sense to me when this doctor is affiliated with a local hospital. The first claim sent to my insurance provider from the lab was for over $3,700.00. Of course my insurance denied this claim. I did some research on Millennium Health LLC and found that back in 2015 this company settled a lawsuit for over $254 million for their tactics relating to how they promoted their services to pain doctors. Now my insurance provider is telling me that they are dealing with this type of outrageous charges not only from Millennium but from other labs like Quest labs and providers of rehabilitation services.
    What use to cost me for seeing a pain doctor who really cared about his patients is a fraction of what it now cost me to see a pain doctor who only want to push expensive procedures and really does not care what a patient is telling them regarding their past experience with the procedures and personal situation.
    Today I live with pain that is not being treated properly (in my opinion), unable to do normal daily tasks as I was able to when my pain was treated by doctor who cared and listened to his patients more than what he cared about the all mighty dollar and what the government report looked liked. Not all pain patients are drug addicts and should not be treated as such. I have a hard time understanding why it is that the rights of patients are not being taken into consideration. I guess the Hippocratic Oath does not mean the same as it use to. Doctors like the one I am currently see are more than likely responsible for some of the pain patients who seek help for their pain on the black market and later become a statistic from an overdose or suicide. I recommend that pain patients contact their state and federal representative as I have if they are having to deal with the same things that I have been dealing with. Patients deserve the right to proper treatment for their pain so they can have a decent quality of life and not be treated like they are all addicts.

    • Teri Pezzella on March 26, 2019 at 6:54 pm

      Dear Ed and others. I’m going to tell you all a bit of my history then I’m going to give you the site I found that won’t cost you a cent and keeps me from feeling hopeless and helpless! A chance to join the fight for our rights. To tell your story and be heard. The chance to help yourselves, the chronic pain sufferers to not be hopeless or helpless. An avenue to turn this around for all of us. Our veterans, civilians, disabled and all the chronically ill suffering. I feel so bad for you and know you’re not alone. I’m a CPP, chronic pain patient. I spent yrs going thru, taking, getting, paying for, every kind of treatment, medication, therapies, injections, blocks, you name it I’ve been there. After finally, two years, getting approved for SSDI and Medicare i found a pain mgmt specialist who literally saved my life. Although the cupboards were & are bare, so to speak, I could get out of bed w/o thoughts of just wanting to end it all! Today and many days now I feel I’m in morning, for the life I once had, person i once was. This is not the first time feeling like this but thought after the near 10yrs of fighting this pain and the system, that was all behind me? My biggest worry was what if something should happen to my doc. He always assured me, he was going nowhere. Then this happened.
      I was not a social media type person, far from it. Didn’t even know how it worked. One day about a year ago, after my doc informed me of the cdc guidelines and that he was going to be tapering me, I saw this thing/person online, Ken McKim. He has many videos on YouTube about ppl who have chronic disease and how they’re treated. Through him or his sites, which are excellent by the way, I found Dontpunishpainrally.com. This is a nationwide group of cpps who are fighting for everyone’s rights, not just ours. It’s not so much a support group as it is a rally/protests organization. We are on Facebook, look up site I just gave you. That will give you the start, from there look up your state. There’re many who, anyone can, put together rallies on a chosen date and locations all over the country. There’s so much to see there. We also then have our national page, Dontpunishpainrally.nat. Where you’ll find so many posts from legitimate ppl and places of importance to our plight! Governments, regulatory boards, task forces, CDC, DEA, hho, AMA, PROP, and so on, too many to name. Majority of us are cpps and many are advocating for our rights, etc. There is loads of media attention, videos of past rallies, we’ve had 3, the last being Jan 29, this yr. You can see the vid put to music of our last protest on YouTube’s Dontpunishpainrally organization I believe? Gives a pretty good idea of what we do. The next is set to happen May 22. Discussion is ongoing wether doing it at CDC, etc. We are nonprofit but do have personal donates for our TV commercial, t-shirts, bracelets, flyers, etc. Yes, we do have our own commercial. I’m not trying to advertise membership. I’m just giving my personal experience of having my meds cut down to near nothing and unable to function, questioning whether or not I even wanted to keep trying. We have over 9000 members and like I said requires nothing of you. Just maybe it gives you hope, piece of mind, like it did me. Some place with ppl like ourselves and heroes who have the ability and experience to lead us into fixing this mess. A place where we understand what you are going through, to help yourselves and others give us a fighting chance. There’s so much more I could say but then i get angrier thinking about some of it, politicians, alphabets, Kolodny, cohorts, etc. This is not the time or place. I’m kind of questioning if I’m even allowed to say all this, here on comments section? I just feel so bad reading your stories and knowing how you feel and what helped and is helping me and so many others. Maybe they won’t post this but felt i had to at least try to share some hope! Took me a while to type this, one fingered, from my chair, on my tablet. I hope they post, more importantly you guys who’s stories I’ve read today, get the msg. ?✌

  9. Kia Gary on March 27, 2019 at 12:55 am

    I have had chronic pain since a neck injury at age 19 (I’m 60 now). I used chiropractic care & alternative therapies to manage my pain until my 40’s when my migraines began to last days & weeks at a time. About 15 years ago I was also diagnosed with severe degenerative disc disease C1-C7 (inoperable) & Fibromyalgia. It was then my neurologist said he could no longer treat me & referred me to my first pain management doctor.

    Through my first pain doctor’s compassionate care I was able to continue working full-time (I’m a RN), care for my family, stay active in my church & lose 25lbs due to exercise & the practice of yoga. Life was good despite my underlying pain. My excrutiating pain was managed through a mix of Norco, Morphone, Lyrica & muscle relaxers & it worked!

    Then my pain doctor chose to retire. I was fortunate to find another pain management doctor to take my case but immediately he began tapering my meds & my quality of life went into the toilet. Not to mention the withdrawal symptoms were torture, but I have always remained compliant, never took more than I was prescribed & never used any illicit drugs. I also drink little alcohol because why would I want to do something that would only make me feel worse the next day? Especially with how bad I feel all the time anyway!

    I have continued to fight for some semblance of my life & career despite the worsening of my condition. Five years ago I even battled back by declaring myself disabled & demanding special accommodation to work from home (as a legal nurse I helped defend a large hospital system) utilizing intermittentent FMLA to rest when needed. Though difficult & my days now filled with suffering, through the special accomodation I was able to continue working, but that was all. I never felt well enough to exercise, care for my family & all volunteer activities fell to the wayside. For the next 5 years I worked & rested in bed so I could work the next day & the next.

    Then the 2016 CDC guidelines came along & things actually got worse, as if being robbed of my life wasn’t enough! My pain doctor was forced to taper me more & to prescribe expensive alternative meds & treatments not covered by my insurance so not really accessible for me & if we did pay the price, not effective for my condition, so I just had to do without. I tried to continue on working. Then, my insurance company became involved; denying what medications my pain doctor would prescribe either outright or only approving what they considered equivalent (& cheaper) than what was prescribed by my doctor even if it didn’t work as well for me. I began to be denied the basics I needed desperately like Lyrica, Norco, & injections for my migraines. It became more & more difficult to work.

    This last winter was the worst (cold weather exacerbates Fibromyalgia). Already poorly managed thanks to the war on opiods, I could no longer function during my Fibromyalgia flares, which had increased in frequency, intensity & duration. Finally, in January I was forced to end my 40 year career. Thanks to the war on opioids, the misinformation & prejudices showered down upon me without any provocation by me & met only with my compliance!

    This whole mess has caused me to be denied my right to live the best life I can possibly live or any version of a productive life! Without my pain, I’m actually a very healthy 60 year-old female. I don’t suffer from hypertention, diabetes or any heart condition. My only problems are related to my chronic pain. I was once a CPP (chronic pain patient) with a productive life, now I have been robbed of everything because people with influence, political agenda & power but no understanding of the CPP condition have been allowed to determine what is appropriate for my treatment instead of my doctor! As any reasonable person would expect, the results have been disastrous! A CPP on adequate pain management does not equal addict, it equals a productive, giving mother, wife, volunteer & career professional. The 2016 guidelines, along with its ramifications have taken all that away. Now I’m a finacially strapped unemployed miserable excuse for a human being unable to enjoy the simplest pleasures in life and I am one of the blessed ones because my husband hasn’t given up & left. Through him I do have insurance & we are trying to live off his pay check with one more child still in college. Now, I am about to begin the long battle of trying to obtain disability benefits through social security when I shouldn’t & wouldn’t be a burden to amyone if my doctor was allowed to treat me as I need! At the least, I should be working, saving for a real retirement while helping our son finish his education & become a productive person as well! Instead, proponents of the CDC Guidelines would rather see those like me with no recourse but to check out of life one way or another (suicides are on the rise in the CPP & cancer population in direct correlation). This is too much power in the wrong hands & it has been mightily misused!! PLEASE, I need my pain management doctor to be able to freely determine the best plan of care for me! Then, I should be able to expect my insurance to cover what is prescribed, or if benefits are denied it is only due to an issue of safety as supported by objective data & never for financial reasons. Thank you!!

  10. Dijon Evans on March 28, 2019 at 11:19 pm

    I can’t thank you enough for writing an article,  and wanting both sides. This is greatly appreciated!

    An interesting tidbit: 1963 GlaxoSmith
    Eventually GlaxoSmithKline applied for ~20 patents on the alkaloids of kratom…
    Hmmm, Who has ties to this company…

    A little bit of why kratom matters to me: To the Doctors, CDC, FDA…
    You have taken away my pain meds. Put me through withdrawals, without a thought of what that may be like.
    I am not a slacker. I am educated, and if I had things my way, I wouldn’t be taking anything. I used to be extremely active
    I had plans and goals for my life.

    When I turned 16, my first real job was as a lifeguard.
    I got my foot caught on the outside of the pool, as I went in, to get a little boy.
    I dislocated my ankle, and had a cast put on too tight. It cut off the circulation and killed the nerves.
    My leg was allowed to remain on too long and the nerve damage spread, it’s now full body CRPS ( CAUSALGIA), including trigeminal and ocular nerve damage- as well as now being documented in my brain.
    It’s shutting down my organs one by one and it will eventually kill me.

    It has caused me to have gangrene, pulmonary embolisms (2), sepsis, blood poisoning,  infections so bad I’d spend 2 months in the hospital, and 4 months in a nursing home- with debris occurring 2 times a day, every day. A wire brush scrubbing on my bones because I’ve had 11 bouts of osteomyelitis. Pic lines for 6 months to a year.

    Because of the damage to my sympathetic nervous system, I have such brittle bones that my vertebrae are either broken, fractured or collapsed, an artificial hip – my other hip and knee need to be replaced.  200 + surgeries, trials, guanethadine experiments,  “tried to shock my nerves into functioning,” … a human Guinea pig…
    Lumbar sympathectomies, brachial plexus surgeries… contrast therapy, desensitization therapy, physical therapy and skills for daily living ( of which, I could teach them!)
    Psychological counseling, at which I was tested, and informed that this was my new life, it was not psychosomatic,  but I would eventually experience the mental treats that come along with what is considered the most PAINFUL condition known to humans; depression, isolation and anxiety… but I must fight it..
    As well as what would come with all of this-.others walking out of my life, because they couldn’t deal with it.
    Doctors who weren’t able to help, so the blame game began… “malingering” ” med seeking” ” attention seeking ” etc
    .. referred to more psychologists, psychiatrists…
    Sent away, and told to find a qualified specialist who knew about the condition that I had…
    That’s not even mentioning the 3 amputations…

    I’ve been undergoing jaw surgery, bone grafts and screws in my jaw… only to find out that it’s all got to be removed.  Large amounts of bone has been lost. So now my teeth are going to be lost. No implants.  And dentures aren’t covered by Medicare or Medicaid.
    Large pieces of bone will now have to be placed and screwed in…  and guess what- Novocaine doesn’t work on me, and nobody will put me under.
    I SCREAMED, CRIED AND TRIED TO COVER MY MOUTH, the first time they did this to me… and now it must be removed and I know what is coming, now.
    No pain meds, no sedation, no matter… I am just a tortured person who doesn’t matter to my government.

    I have been on Every medication,  and taught, or learned self hypnosis, biofeedback, visualization and any form of dissociation that I can do.
    I’ve been put on meds that NEVER underwent trials, for conditions that they’re being used for.
    I was compliant on my opioid PRESCRIBED medications for almost 30 years. No request for early refills, no lost prescriptions, no failed hoop jumping.
    I HATED WHAT THEY DID TO MY HEAD!
    It was always a battle within: don’t take them= pain becomes out of control and hard to get on top of
    Take them= my mind was numbed, not the pain.  My world became veiled by a grey, mind numbing fog. No colors, no beauty, joy… I lost all hope.

    It’s called full body CRPS w/ additional complications, organ involvement; that’s what the cast caused.

    There’s not one aspect or person ( family/ friend/ co-worker/ or even doctors) that hasn’t been negatively affected by the pain or medical events, that I deal with every second, of every minute, every hour of every day – week- month and year since I was 16.
    I am now 56 years old.
    Doctors won’t perform any surgical procedures unless it is life saving due to how high risk I am.

    However, you actually did me a favor by helping me find other methods of pain relief through your false opioid prescription action…..

    Until now…

    Yes, this nerve damage is going to kill me, and I’ve been on death’s door far too many times to count!

    Because of your “new guidelines,” I don’t fall into your terminal cancer pigeonhole.

    Even if I wanted to be back on opiates, I wouldn’t be able to find a doctor who would prescribe them; my doctors and medical coverage just dropped all of the pain management patients. Unless you were a terminal cancer patient.
    And recently even the terminal cancer patients, have been dropped.

    So I found something ” other than opioids.”
    Just as the CDC GUIDELINES state to do… and are being acted upon as if they are law, when the CDC IS NOT ABLE TO ENACT LAWS

    Kratom:
    lets me have a clear head
    Helps with the pain
    (far more than the pills).
    I am able to get myself out of bed [the past 10 years I’ve been bedridden].
    NOW I can get into my wheelchair and into the front room.
    I have been sincerely smiling.
    Laughing.
    Trying to find a way to do a hobby or something.

    At least I have a desire to try,
    instead of arguing with the doctors about quality of life/vs no quality of life.

    I take a total of 1 1/2 tsp a day, of kratom.
    Not all at once.
    No, it doesn’t get rid of all of the pain
    but I am able to tolerate what I have, far more than I ever could have on the pills!
    I can once again see beauty, feel joy and experience the intense differences between colors.

    Kratom has allowed me to find a little saving grace in my world of sheer agony

    Why do they want to take that away?

    Why don’t they do an experiment: for one month… Just one.

    Put themselves/yourselves in a wheelchair, tie your legs together so you can’t use them.

    Get up, get dressed, fix your food, go to work ( no servers, no drivers, nobody doing anything for you….) It’s only 30 -31 days.

    In fact: get by on 876 a month… take buses, go from pharmacy to pharmacy, and doctors office – pay copays, rent. You know that kind of thing.

    Do it while you’re in so much pain, you have to remember to breathe

    .. all the while remaining by yourself because you are just as tired of talking about the pain and “what now” things, as everyone else is, hearing about it.

    Only 30 days. ..

    It’s Not a lifetime, like, we are subjected to.

    Most of all because of Kratom I found a very special group of people! The love and appreciation that I have for you is beyond deep!
    I’ve gained so very much, in a short amount of time…

    A herb.. 
    A frigging leaf . .

    I learned more,
    discovered more,
    felt more.
    I have experienced more love and acceptance then I have in my entire life.

    Incredible  !

    The thing is, is that herbs don’t work for everyone. Opioid don’t work for everyone. We are Individuals, not pigeons, fitting in pigeon holes.
    I have CRPS, the most PAINFUL condition known to humans, and there are times when the only form of peace that I can get, is with opioids.
    I HAVE NEVER ABUSED THEM, OR ANY OTHER SUBSTANCE AND I DON’T APPRECIATE BEING TREATED OTHERWISE!
    Even if I had become addicted, who made the meds ADDICTIVE and lied about it

    I wrote this as a part of a speech that I did, for a rally at the Capitol in Sacramento Ca.  

    So if things aren’t exactly “fitting ” too this correspondence, that is why. 

    But I would be more than happy to speak with you,  should you want to do so. I have a couple of other writings, that others wanted me to send you- but I was under the impression that testimonies were wanted.
    As you can imagine, after almost 40 years of well documented, complicated medical history.. it’s not a “brief” subject to write about. 

    Again, I really appreciate your willingness to listen to us!

    Thank you very much 

    Dijon Evans 

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