Opioid Bill Heading to the White House – It’s About Addiction Not Chronic Pain

National Pain Report ^ | October 4, 2018 | Ed Coghlan.

[GailA]

STREET JUNKIES DREAM BILL

“We’ve seen the rise of powerful synthetic drugs like fentanyl that have the potential to make an already terrible problem worse. Exposure to miniscule amounts can have deadly consequences for users as well as first responders. That’s why this bill takes a broad-spectrum approach to meet the opioid crisis head on.”

“The bill reauthorizes critical substance abuse prevention programs, expands access to treatment and provides law enforcement with tools to stop the trafficking of illicit substances.”

The bill certainly gives more attention to treatment of addiction – creating a grant program to comprehensive recovery centers that include housing and job training and would also increase access to “medication-assisted” treatment to help people with substance abuse disorders wean themselves.

But it is silent on the chronic pain issue and the patients who use opioids to manage their pain—again pointing out the lack of attention that elected officials are giving to the 100 million Americans who have chronic pain.

[from occupied ga]

The ONLY person to blame for addiction is the addict. Did anyone put a gun to their head and say I'll kill you unless you start popping pills (or shooting up or whatever) Pretty sure that didn't happen.

Addicts are like drunks you can't trust them with anything and they can ruin the lives of those around them so I can understand the frustration in dealing with them; however, blaming the substance that is abused rather than the abuser is like blaming guns for murder (Oh wait morons do that too). I have a different take on addicts - let them have all they want, but if they OD treat them ONLY if they can pay (up front) for the treatment. Otherwise let them live or die as fate would have it.

[nikos1121]

I’m boarded in Preventive Medicine with my specialty in Occupational Medicine. I’m also a staff physician at our campus Wound Care Clinic. I’d say 90% of my practice involves muscle skeletal injuries. The Wound Care cases are chronic and sad. Many are diabetics or with peripheral limb disease. The pain is excruciating for them. Funny, buy I don’t see many of the truly in pain wound patients addicted to the pain meds.

[gas_dr]

While I certainly agree with your tag line, your definition of addiction paints with broad strokes. Here is my question for you and the other physician (who has not identified what kind of medicine practiced) ... what is the definition of addiction?

[TonyM]

I remember the movie “Reefer Madness”. This war on opioids has put the same kind of mania into a largely misinformed populace about usefull drugs to control pain. The people who are not suffering from intractible pain from things like back conditions that seven surgeries could not fix along with fibromialgia and widespread arthritis should keep their opions to themselves. That is where my wife is at and watching her deteriorate more every day as her pain doctor is forced to reduce her pain meds to where a government bureaucrat who does not know her thinks it should be. I pray and watch over her constantly to try and make sure she does not commit suicide. I sincerely hope all the know-it-alls never have to be in my shoes or god forbid, her shoes.

[gas_dr]

Career paths include managed care, public health, occupational medicine, aerospace medicine, clinical medicine, informatics, policy development, academic medicine, international medicine, and research, covering all levels of government, educational institutions, organized medical care programs in industry, as well as voluntary health agencies and professional health organizations.

The above is from the board of preventive medicine website. Is it possible that your training is leading to an observer bias? I now understand your perspective. As for your diabetics and peripheral vascular patients probably suffer from neuropathic pain and certainly could benefit from analgesics specific to that which or course are non narcotic. However I think that perhaps your training has lead to certain black and white stsremrs rendered above for which there is considerable debate in the literature. Certainly the science is not as accepted as you would lead others to believe in any event.

[wgmalabama]

Your ignorance is amazing. I predict your not a doctor or if you are you are a bad one. I see malpractice in your future if any of your patients read your post and connect it back to you. Untreated chronic pain leads to early death. It’s that simple. And yes, people can be treated for chronic pain and still function. That is the purpose of treating.

Is it over prescribed? Yes. That is no reason to stop everyone. If that was the logic dentists would have to stop extracting all wisdom teeth because often it’s not needed.

[from occupied ga]

I've had 7 kidney stones and never took any pain medication for any of them - every one had different levels of pain, but they all were extremely unpleasant while they were passing, but after they passed it was like someone flipped a switch.

I also had a right hemicolectomy, and I guarantee for the first three postop days dilaudid was my friend, but I switched to Advil at the end of day three, and although the pain level increased it was tolerable. I was more worried about the constipation effects if I stayed on dilaudid than I was about the pain.

Not saying it's the right thing to do, but China had a severe addiction problem prior to the communist takeover. They solved it by the brutal expedient of executing every addict they could catch. I'm not advocating this solution here, but it's illustrative of the fact that drugs don't cause addiction, because after the addicts were dispatched the drugs remained, but China no longer had an addiction problem. The problem was the addicts not the drugs. Likewise the problem here is the people abusing the drugs, not the drugs themselves.

[nikos1121]

Observer? You mean like, an arm chair? I don’t know of any MD who just “observes” unless they’re into Ethics or are administrators.

I’ve been in the field for over 30 years. I see patients. Probably 10s of thousands over the years. I’m the medical director for large to small companies that employ 100s to over 5000 people. I provide nursing staffs and physicians to these companies. I also see patients in the clinic which is hospital based.

Like I said before. I tell my patients who have chronic pain...who are dependent on pain meds. Do you want to feel better, or do you want to get better? That’s where we start. If they just want to feel better, because it satisfies a lot of psycho social issues in their life, then go somewhere else. If they want to get better, I can help you.

I’m missing your point here, and in fact, I have to run.

[from occupied ga]

I’m not a physician - my daughter is. But you want MY definition of addiction? Mine is probably not an accepted one, but OK here it is: Addiction is the taking of chemical substances for recreation that has proceeded to the point where the person taking them is either psychologically or physically dependent on the substance to maintain their wellbeing.

[nikos1121]

“Untreated chronic pain leads to early death.” It’s just the opposite.

I’ve never been sued or had a malpractice claim. My patients actually like me, even though someone else, (ie their company) pays their bill.

I know a lot of physicians sued for over prescribing. I know of many cases of death from overdosing pain meds.

I’ve testified in wrongful death suits where a doctor passed a person on a DOT of FAA exam who was addicted to pain meds, and the driver or pilot ended up in an accident where they survived but it caused the death of others.

Since, you’re getting insulting... I think we’ll end this discussion. I’m not responding anymore to you. Have a good day.

[CAluvdubya]

Tylenol actually is quite effective esp for degenerative disc problems.

No it isn't. Most that are on something like Norco for disc pain started off on Tylenol. That didn't work so they moved on.

Also, as you should know, surgery may work for a time but the chances of adhesions growing on the surgical area, creating the same pain, is common.

[Retvet]

I was on opioids I did not like there side effects. I now take 4 prescription level ibuprofen tablets a day. I retired early because of pain. Doctors prefer to give drugs to recommending disability. Plus the government which I served in 2 professions for over 40 years drags their feet on my disability request. Better pain management and drug control are needed.

[gas_dr]

That’s actually the correct definition. Addiction is using a medication or substance for other than its intended purpose to achieve a desired or pleasurable effect. So you are correct. Using something for what it is not meant for. In the case of pain giving narcotics cannot lead to addiction as the receptors for pain relief are present. If you are in pain and get a narcotic then you don’t get the euphoria of taking opioids when not in pain. So it is almost impossible to addict someone in true pain. What often confuses people is that occasionally one can become tolerant and require increasing doses. My job as an anesthesiologist is tomorovode safe and effidroce pain relief at the minimal dose possible. It takes a lot of time and understanding of the patients unique needs.

[nikos1121]

I agree with the statement about surgery.

Anyone with neck or low back pain that does not resolve over a 6 to 8 weeks period on their own, should see a McKenzie Cerfified therapist in their area. You can look them up at:

Mckenzie Institute dot com

[BlackbirdSST]

So glad you are not my doctor.

I second that notion.

[cyclotic]

I had to travel by car cross country when I had mine. It was pretty expedient.

I have sympathy for people who get hooked on prescribed meds. A friend recently lost his son to that. Got hooked and then couldn’t break it. Very sad.

I tacitly agree with the sympathetic law enforcement approach to get the distributors, not the users. If they can control the flow, users can’t get the stuff.

The son of another friend was clean for 5 years, he used once and OD’d. Survived. His friends broke his ribs doing CPR and it got infected leading to a long hospital stay. Best thing that could have happened. He moved to a farm based rehab ministry to get away from the temptation.

[mabarker1]

I'll add one more vote to the it is a damned good that you are NOT My doctor. Tylenol is USELESS for Severe Pain!

I have Bilateral Neuropathy in all 4 extremities and have had it for 10+ years and it continues to get worse. So far it has gone from toes in the early stage and has progressed as far up as My knees. What used to be in My fingers has progressed to halfway up both forearms.

I live with feet that are like hundreds of needles poking them, cramps, lightning bolt zots (Not Sciatica, I know the difference) extreme cold, sometimes numb but still painful, pressure on/off My feet is one of the worst problems, My hands are the same plus loss of dexterity in addition to all the problems in My feet.

I've been to a herd of Doctors from GP to Surgeon, Neurological (2 different ones), had CT and MRI's, EMG Testing and the best diagnosis I've been given is the epineurium has broken down and the nerves are "shorting out".

The neurologist even wanted to have a 4 inch section of the main nerve in My calf removed for Testing.I have had 2 spinal taps done for 2 different neurologists.

I have found that Morphine ER Tablets provide the best control of the endless pains and allow Me to have a semi-normal life. Without the Pain Meds I can't pickup small or even medium sized objects, change My Grandson's diaper, safely use kitchen utensils, turn door knobs, walk around, take out the trash, Etc. Things most people take for granted every day. I choose to not drive because I have to look at the pedals to make sure I pick the right one. Not driving was My choice for Everyone's safety.

So until/unless you have lived like this day after day DON'T TELL ME TO TAKE TYLENOL BECAUSE IT DOESN'T WORK!!!

[nikos1121]

I don’t think I used the word “severe.”

I know there are people out there who seek out physicians who will prescribe them narcotics. States are becoming more responsive to this, and require that we consult the State Registries on Drug Prescriptions before and while we prescribe these meds. It’s got to the point where everyone knows of someone who has ODs on opioids.

So, this is a good one, I’m a “quack” because I am careful when prescribing pain meds. lol

I’ve seen thousands of people for muscle skeletal pain. I have zero... that’s right zero on chronic pain meds from me. Zero.

And, I have zero... that’s right zero active patients who’s quality of life is not better thru exercise.

My wound care patients are a different story. I don’t have a good answer to their pain, esp if a diabetic neuropathy is involved, but I will say that the opioids over time has made them more sensitive to pain.

[Jemian]

My pain was low back pain. It went on for 22.5 years. I was suddenly and totally cured of the pain in 2013. There has been no pain since and I don’t take pain meds any more. I do agree it is a difficult subject and even more difficult to treat. I am thankful I am no longer in need of it.

[nikos1121]

Have you looked into a morphine pain pump device?