The War Against Patients in Pain. Beware, this could be you!

LittleLab4CF

Super Moderator
In 2014 most states implemented some form of Policy for Prescribing and Dispensing Opioids. (Opioids are Narcotics). The policy outline and related material was distributed at the 2013 National Governor's Conference and it has been cookie cuttered into most state's DORA or Department of Regulatory Agencies. The action was in response to the declaration by the CDC that we were in the midst of an epidemic of prescription opioid overdoses.

As with any law or regulation, the motives for it vary. It took a law ticketing drivers for impeding traffic to stop angry citizens from clogging the fast lane because "they were speeding". If we are even close to the quadrupling of prescription narcotics overdoses since 2000, we have to address the issue. The first casualty in war is the truth and the war against chronic pain patients begins in the statistics. By their own admission the CDC lacks information like whether the people overdosing on prescription drugs are being prescribed the lethal drug. A chronic pain website has a credible author with a breakdown of how the CDC arrived arrived at their numbers. He claims that the majority of overdose numbers aren't patients at all, rather addicts with illicit prescription narcotics in the post mortem reports. The reason for the increase could be absolutely spot on and the reason could be wrong. Rural drug use has been out of control, we have been at War with foreign countries for fifteen years, aging baby boomers are washing up on the shores of lake Doctor, and recreation today means eXtreme sports, complete with extreme injuries. There has been an economic depression and no jobs means no healthcare, the problem is more complicated than some spontaneous loss of doctors' abilities to safely manage their patients pain. I'm a firm believer in statistical analysis and statistical validity. I don't see how it could be so simple as Doctors and patients missing the point that narcotics suppress respiration. What is a fact is fentanyl is routinely packaged as heroin. Fentanyl is a prescription drug, its source may be illicit. Self medicating with fentanyl is asking for death.

In 2014 the Opioid Policy for Colorado went into effect. My Pain Management (PM) doctor retired, I began a year long quest for a new one and my (newly retired) wife joined the Colorado Consortium for Prescription Drug Abuse Prevention and the PDMP work group for the past eighteen months. She had worked in government and had an idea of how things worked. This is where motives are powerful.

"Stakeholders" is a new name for interested parties. Something like this consortium is the ideal place for interested parties. Her interest was to steer the policy away from throwing the baby out with the bathwater. It is important for all of us to have access to quality medical treatment. My wife's involvement with the Consortium is almost full time. It's that important to us.

Across the country Doctors categorically voted against any new opioid policy interfering with their treatment of patients. In retrospect, I wish they would have offered their expertise because the policies are in effect. There hasn't been a reduction in prescription narcotics overdose deaths. Earlier this year I attended a CME (Continuing Medical Education) seminar put on by the Colorado Pain Society. DORA's speaker made a point of the fact that the opioid policy was for PCP's. I forget the exact numbers but ~50% of primary care physician's visits are regarding pain and over 70% of ED visits are for pain exacerbations from existing conditions. Most people who have visited an ED since 2014 have discovered that this isn't what they are all about anymore. It's getting worse by the day.

Somewhat out of necessity I have become an expert in pain management. PM specialists who begin in the specialty and those who have a sub-specialty have been my teachers in part. I dealt with annoying pain and discomfort beginning in my teens. Arthritis in my back caused by a climbing accident at 20 began to be more than annoying by my late thirties. I spent 5 years attending a non-narcotic program for back pain and sciatica. I tried several other therapies from acupuncture to a number of physical therapies. I find value in biofeedback and back exercise, even pilates. I hate drugs. Being able to think critically is my source of enjoyment, how I made a living and understanding is far better than ignorant anger, IMHO. Fortunately I am not in a drugged stupor but I would prefer to have nothing distracting me.

For the record, there's a distinction between chronic pain treated using narcotics (opioids) and an addict. Medically a chronic pain patient such as myself, can be habituated or addicted to an opioid or opioids. Except for adjusting for tolerance, I have been compliant with the rules set by the PM practice for 20 years. For a chronic pain patient two things are critical, continuity of care and a good record of compliance. This in itself is an onerous requisite and frankly a bit demeaning.

Ever heard of or met Dr. Vivack Murthy? Yeah, me neither but he's doing his best to drive 55 mph in the passing lane. The U.S. Surgeon General (Murthy) has recently mailed a letter to every medical practitioner in the U.S. urging them to cut back on prescribing opioid prescriptions or narcotics. You have it, it's really true and if this isn't a textbook example of using a government office to intimidate and coerce OUR Doctors into conforming to a personal agenda, I don't know what is.

This isn't a personal diatribe over a Surgeon General, I doubt he's going to make a bunch of money from his inappropriate interference. What seemed to be a letter according to CNN is packaged with a very professional brochure, of sorts. The brochure is in fact the Surgeon General soliciting doctors to "PLEDGE" to be a player and adhere to something no physician can sign without violating oaths they have already pledged. What are doctors going to do? This is the Surgeon General talking to you, a Doctor who defies the SG could easily be working as a drug rep trying to pay off that student loan.

I'm more than dismayed, I am faced with a future, possibly without pain management. When I was diagnosed with CF I had just finished a pancreatic function test that may have been a world record, it was the North American record for sure. My wife and I had a serious discussion about ending my life if the pain couldn't be controlled. It's been sixteen years and this year we talked about it again.

I'm not into conspiracy theories and I feel that all people believe that they are good. I am generally speaking, knowledgeable, absent of malice and trusting. It's been my fatal flaw and now I try to make more in depth observations. Screw the letter, what is disturbing is reversethetiderx.org, the Information and what the SG wants Doctors to sign up to adhere to. The graphics are too slick, don't relate to the text of the document and it's quoting the same CDC statistics in pretty graphs. A busy Doctor scanning the flood of material to keep current is naturally drawn to the graphics and pictures. What is a picture of a prescription pad and 50% opioid reduction in bold text have to do with the letter from the Surgeon General? Few things are more dangerous than being a licensed professional and refuse to play with the very people who hold your livelihood in their hands. I cannot emphasize strongly enough to make a difference. Call your doctor and urge them to keep patients in mind when considering pledging or complying to suggestions like they fell from heaven. Get active.

This may not be affecting you at the moment and it could be the hell I've been going through but it will affect all of us if we don't act. CF is a painful condition and it can be intolerable in so many cases from neuropathy from IV's to double lung transplants. Something is Rotten in Denmark but it's roses compared to the stench in DC. The Cancer Centers of America made a bunch of Addiction Centers of America. I have a strong sense that there's something in the pipeline and we won't like it. I am confident that a sincere and heartfelt effort is up front and genuinely want to end the tragedy of parents who have had the horror of finding a dead child, spouse or such from an overdose. On this day in 2008 I received a panicked call from my 11yr old niece screaming that her mother was not waking up. I instructed her to call 911 and I was on my way. In two minutes I walked in to find my sister cold as ice and my niece fully expecting me to revive her. I performed CPR including mouth to mouth for the half hour it took the EMT's to arrive. Now she's a statistic, my niece is an orphan and "kissing your sister" has given me new meaning.

This isn't fun and it is far from funny. Our lives are in the hands of well intended people who are charged with regulatory authority. Colorado published this policy of gentle suggestions under the heading of "DISCIPLINARY ACTIONS"!!!! I can't wait to see if all the states made the same "slip up".

Anyone having problems?
LL
turnthetiderx.org
 
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