The Other Side of the Pain Story by guest Richard L. Martin
The Other Side of the Pain Story
By Richard L. Martin, BSPharm (retired)
I was a hospital pharmacist for twenty-five years. The last four years in practice, I was involved with the cancer ward helping oncologists, recommending pain medications, adjusting pain medications, and safely switching patients from one medication to another. Even though it’s been some fifteen years since I worked in the hospital, I still have at least a rudimentary knowledge of prescription pain management. I am now sixty-four years old.
Misrepresenting and Misinterpreting the Opioid Epidemic
Because of my personal experience as a pain patient, I’ve come to represent the non-cancer chronic pain patients who are being thrown under the bus. The opioid-phobic media, politicians, insurance companies, and addiction treatment centers are misrepresenting and misinterpreting — and, in some cases, outright lying — about the opioid epidemic. I want to share my story to illustrate some of what is NOT being talked about.
I was successfully treated for five years on what would be considered a high dose of opioids. I have had 3 failed surgeries, physical therapy, multiple injections, radio frequency ablation, and use of a TENS units. My primary physician worked with me to find an optimum dose of opioids, in conjunction with non-steroidal anti-inflammatory drugs (NSAIDS), glucosamine, and so forth. He retired, and the new primary MD continued my medications until last July 2015. At that time, he bluntly told me that he would give me no more Rx’s, and I had to find a pain management specialist.
I finally found a pain management doctor who would work with me after I was turned down, ridiculed, and embarrassed by others. He immediately reduced my opioids. That was catastrophic for me. Before that reduction, I was able to walk 1 to 3 miles every other day. Now I am mostly homebound. My blood sugars and A1c have increased with the lack of walking. I may have to start insulin for my Type II diabetes.
That was bad enough. But, the story gets worse. In May of 2016, my pain management doctor announced to me that he and his two partners in the pain management clinic are reducing all non-cancer chronic pain patients’ medication to the CDC’s guidelines of 90 morphine mg equivalents. He insisted they had to follow these guidelines. He told me that all doctors in Las Vegas, Clark County, Nevada, and across the nation are doing this. He told me they are all afraid of the CDC, the DEA, the FDA, and the Nevada Medical Board.
The CDC Guidelines for Opioid Prescribing in Chronic Pain are Voluntary!
I wrote letters to all 27 members on the organizational chart at the CDC. In those letters, I addressed how doctors were treating their guidelines as a law, and now were cutting everyone back to 90 MME’s per day. I have a letter, dated June 1, 2016, from Dr. Debra Houry at the CDC who oversaw development of the CDC Guidelines for Opioid Prescribing in Chronic Pain. In it, she reaffirms that the CDC guidelines are voluntary, not mandatory. I believe the guidelines should never have been generally applied to all pain patients.
On page 2 of the CDC guidelines, it is reported that “a recent study of patients 15–64 years receiving opioids for chronic non-cancer pain and followed for up to 13 years revealed that one in 550 patients died from opioid-related overdose at a median of 2.6 years from their first opioid prescription.” That is less that 1%. To be exact, it is 0.2%. And 1 in 32 patients who escalated to opioid dosages greater than 200 morphine mg equivalents died from opioid-related overdose. That is 3.1% of patients prescribed opioids for pain.
Is that an epidemic of overdoses in the chronic pain patients? It is tragic that any overdose occurs, but most overdoses do not appear to be in patients prescribed the medication for pain. Many, if not most, did not even have a prescription for opioids. They were using diverted opioids.
The CDC recommends other alternatives for the treatment of pain — for example, nonsteroidal anti-inflammatory drugs (NSAIDS). But they, too, have serious side effects or adverse reactions. NSAIDS are certainly not a panacea.
I have tried to make a case that the media, politicians, and insurance companies are cherry picking what they want to report, and they are almost certainly misrepresenting the CDC’s guidelines and studies. This is not only my opinion. According to Science Daily, there is a recent article, July 13, 2016, in the Journal of Pain and Palliative Care Pharmacotherapy that suggests “the opioid epidemic has at times been misrepresented by politicians and the media.” The article “advocates balanced and comprehensive drug control policies” — that is, common sense and not myopic hysteria.
Those Who Vilify the Use of Opioids
I am very angry at the media, politicians, insurance companies, and all others who are vilifying the use of opioids. They have no compassion, empathy, or interest in telling the whole story. Whatever happened to investigative journalism? What happened to “fair and balanced” reporting?
This lack of compassion for people in pain is why I am so motivated to share my experiences. Until my health conditions are once again under control, I am making it my mission to tell the other side of the story.
Purchase my book The Painful Truth: What Chronic Pain Is Really Like and Why It Matters to Each of Us (available on Amazon) or read a free excerpt here.
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Copyright 2016, Lynn Webster, MD
Mr. Martin, I submitted a letter to the US Office for National Drug Control Policy and the Office of Intergovernmental and Public Liaison at the White House, just today, incorporating many of the concerns you voice in this article.
To the Office of Intergovernmental & Public Liaison.
The White House
Dear Staffer,
I am writing to you as a non-physician chronic pain advocate with 20 years of experience and study in the field. I now support 15,000 chronic pain patients in 20 groups on Facebook. Every week I see more reports of pain patients being involuntarily weaned down or forced off opioids by doctors who fear persecution by the DEA unless they obey scientifically weak and professionally biased “voluntary” guidelines on prescription of opioids in adult non-cancer chronic pain.
Make no mistake — this is truly “persecution” not just prosecution. Doctors are leaving pain management practice because they can no longer effectively treat their patients without fear or DEA reprisals. Highly competent practitioners have already been subjected to trumped-up charges in what amounts to a public witch hunt. Patients are being deserted without opioid withdrawal management. Thousands are allowed to spiral into agony when forced to attempt other non-opioid therapies that didn’t work in the first place and won’t work now. Some patients are on the brink of suicide. Deaths have already occurred. And responsibility for this state of affairs clearly lies with the medical negligence and addiction bias of the CDC.
The CDC voluntary practice guidelines are in truth neither voluntary nor “guidelines”. They are read by doctors as a restrictive standard that is being used to justify DEA prosecutions. And they were written by a consultants’ working group that failed to include a SINGLE Board Certified pain management specialist who actually sees patients regularly. Careful analysis of medical literature quoted as justification of these standards reveals a plethora of major issues of weak methodology, bad science and biased selection of data to support political agendas or professional economic self-interest.
Despite the propaganda now circulating about a supposed “epidemic” of deaths due to prescription opioids, medical reality is vastly different from the dominant narrative. Among properly screened chronic pain patients who are periodically monitored, the risk of addiction disorder is small — certainly under 10%, probably under 3%. People in chronic pain do not experience an opioid high in the manner of addicts. Nor do any great number of them develop the drug-seeking behaviors characteristic of substance abuse disorder. Some become physically dependent on opioid meds for pain relief. They will experience withdrawal symptoms and breakthrough pain when rapidly withdrawn — but these symptoms are NOT the same thing as addiction.
The most fundamental error of the CDC has been to deliberately misinterpret an absence of published long-term trials on opioid effectiveness, to substitute the fraudulent message that opioids don’t work. Doctors don’t know definitively whether or how well these medications work, because nobody has ASKED, and research organizations haven’t wanted to risk liability by conducting double-blind opioid trials.
Also false is the assertion that all patients develop tolerance or hyperalgesia when using opioid medication. Hyperagesia (increased sensitivity to pain after medical suppression) is very likely a made-up medical mythology, not a fact. The methodology underlying Morphine Milligram Equivalent Dose levels is also founded on pseudoscience and opinion, not metrics. And reports used by the CDC to justify upper limits on opioid prescription levels were wildly internally contradictory and subject to multiple confounding factors.
Drug addiction and deaths due to street drugs are indeed a major public health issue in the US. But prescription drugs did not cause this issue, and the abuse of chronic pain patients won’t solve it. Some sources quote rising numbers of accidental deaths due to opioids, on the order of 32,000 per year in 2014. But well over half of these deaths are due to street drugs, and many of the remaining deaths are likely misidentified by ill-trained and poorly resourced medical examiners. Overshadowing these statistics is the reality that there are over 100 Million chronic pain patients in the US, millions of whom are successfully treated by opioid medication under regular medical oversight.
As noted by neuro-science journalist Maia Szalavitz in her excellent article on Scientific American, the most reliable predictors for death by opioid overdose are unemployment, a family history of trauma, and status as an adolescent. Diversion of prescription drugs from legitimate pain patients to the street are a definite issue. But deaths among people with a current prescription are relatively rare. Thus the CDC and DEA are trying to “solve” a largely non-existent problem by means which impose agony on hundreds of thousands of patients — or more.
I implore the White House staff to take off the blinders. It is time that CDC practice guidelines are withdrawn and rewritten to recognize the indispensable role of opiod medications in the management of chronic pain. Also needed is support for the central role of the individual physician in evaluating what works and what doesn’t. The days of pill mills are largely over. And the “war on drugs” has been an abject failure. Please do not contribute to the further persecution and abuse of millions of chronic pain patients and their doctors!
Stop the war against chronic pain patients and their doctors!
Sincerely,
—
============================
Richard A. “Red” Lawhern, Ph.D.
Twitter: @lawhern1, #SpotsOfLight
Personal Website: http://www.lawhern.org
Thank you for writing the truth. We do not get “high” on our medications nor do we take more than we are supposed to take because if we do we will be in agonizing pain waiting until our next Dr’s appointment so we follow our Dr’s orders. We do not go out on the street to buy pain pills because 1 it’s dangerous and 2 if something shows up in a Drug test we risk being cut off from the ONLY THING THAT GIVES US SOME RELIEF. The war on drugs the dea is losing. Americans have realized that they have been lied to about medical marijuana. Marijuana is nothing like the stupid movie “Reefer Madness ” which is full of lies. But the DEA doesn’t want to reschedule it out of class 1 because it’s to easy of a bust and they have to show the government they are doing something with all the money they give them. This is only going to cause more problems for chronic pain suffers. The suicide rate is already going up since the “guidelines ” have been put out. Dr’s are scared to help their own patients for fear that they will be arrested
And now they are wanting copies of our personal medical records which they don’t have a clue what they codes mean. They arn’t drs…they are dea agents that most haven’t even been to college. This is disgusting and disgraceful.I gave 5 conditions that cause chronic pain. There is no cure for these conditions but opioids are the ONLY thing that helps.
A very disgusted pain patient.
Bravo!
Thank you Richard Lawhern
This is another exceptional
action on behalf of the Chronic Pain Suffers across this land!
I for one am so greatful for all you are doing on our behalf.
Thank you so much Dr.Lawhern!
Thank you, Dr. Lawhern! I just started a petition that all my fellow chronic pain patients need to sign to make our voices heard: https://www.change.org/p/centers-for-disease-control-and-prevention-make-opioids-available-to-chronic-pain-patients-again
I would appreciate everyone sharing on as many Facebook pages and Message Boards as possible!
I think the petition is a great start but we really need to organize and March on Washington DC so these politicians can see firsthand what they’re doing and how these CDC guidelines are destroying lives!!
I was pain med compliant for 15+ years. Never popped positive on any mandatory drug screens or messed up a pill count. I was able to continue teaching, sponsoring a club, coach soccer, basketball, and little league baseball. I was able to take my sons fishing and hiking all because of pain meds… Unfortunately, my spine did not stop deteriorating and the VAMC has done nothing to fix the damage… instead I have been refused repeatedly for surgery as the damage and scar tissue is too severe and too old. The VA doc I had was awesome as we worked together to manage the pain meds with my pain and other medications. Then he retired and after a series of kooks, I ended up with a nurse practitioner who told me that I had the normal back of any other 50 year American male and that the VA had adopted the new “opioid safety initiative” and would be denying 90% of veterans being served there all pain meds. She did this by phone!!! No discussion with other physicians, pharmacists, psychologists, physical therapists (even Senator Corker’s request for new PCP was denied). I have been through every pain management program offered to include chiropractors, acupuncturists, yoga and even aroma therapy for my spine before this NP decided to deny pain meds without even bothering to read my chart (for which I have evidence).
Since 12/29/2016, I have had nothing but Tylenol and Motrin I have had to purchase myself… I am going CRAZY because of the pain and burning up with ANGER at the VA, the CDC and DEA for what they are doing to so many Americans and veterans. Occasionally (my wife says all the time for the last thirty years), I am an obnoxious asshole. A title I proudly hold and whenever I see injustices, I get upset and the asshole rears its ugly head. If I am attacked or someone I care for such as veterans or the American people, I strike back with the speed of a rattlesnake and the ferocity of a Devil Dog! Please visit FB page Vets Fight Back for more important information for CIVILIANS and VETERANS.
Robert D. Rose Jr.,
BSW, MEd., USMC
Semper Fidelis
“Teufelshunde”