Posted on 02/24/2020 11:18:53 AM PST by Steve Newton
The Silver Star Families of America, the SSFOA, is well aware of the dangers of opioids in all their various forms and, for the most part, agrees with the new federal and state guidelines that are tightening up the distribution of the drugs as long as it does not adversely affect the veteran population. https://www.cdc.gov/mmwr/volumes/65/rr/rr6501e1.htm
(Excerpt) Read more at silverstarfamilies.org ...
https://www.surveymonkey.com/r/BRFG8KW
The Silver Star Families of America, the SSFOA, is well aware of the dangers of opioids in all their various forms and, for the most part, agrees with the new federal and state guidelines that are tightening up the distribution of the drugs as long as it does not adversely affect the veteran population. https://www.cdc.gov/mmwr/volumes/65/rr/rr6501e1.htm
There was a time when V.A. doctors were trusted to use good judgment in the prescribing of opioids. While a few may have over prescribed most others were thoughtful and cautioned patients about abuse and prescribed opioids judiciously.
The DEA changed the rules in October, 2014 when they moved hydrocodone combination pain relievers (HCPs) like Norco and Vicodin from Schedule III to Schedule II. That meant no more electronic prescriptions to pharmacies and doctors could not call in a prescription. Each prescription was good for only one month. That meant it was much harder for veterans suffering from severe chronic pain to access opioids.
What exactly is an opioid? “Opioids are a powerful class of painkillers derived from opium that come from the poppy plant. These drugs, which come in pill or liquid form, are available by prescription.” These drugs include:
Hydrocodone (Vicodin)
Oxycodone (OxyContin, Percocet)
Morphine (Kadian, Avinza)
Codeine and related drugs
Heroin
http://www.lifescript.com/health/briefs/l/list_of_opioids.aspx
In this new “war on drugs” it must be remembered that veterans are a distinct group that does not necessarily reflect the same demographic as civilians. Many veterans suffer from horrendous injuries, both seen and unseen. We must proceed with the utmost caution before we succumb to “opioid paranoia” and withdrawn pain medication from those that need it.
The V.A. has reported that approximately 60 percent of military personnel returning from deployments in the Middle East and 50 percent of older veterans suffer from chronic pain. These rates exceed the reported 30 percent national average of chronic pain within the general American population.
https://www.addictionhope.com/blog/veterans-ptsd-addiction/
What we need to do is actually ask the people affected by the new guidelines what they think. And who are the people affected most----chronic pain sufferers. (See links at the end of this article)
https://www.merriam-webster.com/dictionary/chronic
Many doctors, including V.A. physicians are becoming more and more reluctant to prescribe any opioids, and/or are reducing the amount of the pain killers even as they more closely monitor patients. Monitoring can include giving urine tests, more frequent trips to the doctor and counselling. Problematic for some veterans if they must drive long distances for their primary care. And I’m not at all sure how well the “urine drug” tests will go over. Veterans are not children.
So how about the alternatives to opioids? The Veterans Administrations List of alternatives include things like biofeedback, acupuncture, cognitive behavioral therapy, alternative physical therapies including yoga.
https://www.pbm.va.gov/PBM/AcademicDetailingService/Documents/Academic_Detailing_Educational_Material_Catalog/Pain_ChronicPainProviderEducationalGuide_IB101000.pdf
And here is another situation where the government has not done its homework. Many Christians do not believe that yoga is acceptable:
“What does the term “yoga” actually means. “According to tradition, ‘yoga’ means ‘union,’ the union…of the finite ‘jiva’ (transitory self) with the infinite’…Brahman’ (eternal Self).” “Brahman” is a term often used for the Hindu concept of “God,” or Ultimate Reality. It is an impersonal, divine substance that “pervades, envelops, and underlies everything.” Courtesy: Michael Gleghorn https://probe.org/yoga-and-christianity-are-they-compatible/
“Yoga has demonic roots and it can’t be separated from Hinduism. You can’t put a Christian name tag on it and call it Christian.” http://biblereasons.com/yoga/
Ok. Let’s try acupuncture:
“Acupuncture is said to work because needles stimulate acupuncture points, releasing a flow of energy called qi, or chi. Acupuncture is a complementary medical practice that entails stimulating certain points on the body, most often with a needle penetrating the skin, to alleviate pain or to help treat various health conditions.” https://www.livescience.com/29494-acupuncture.html
Not sure you want your “qi” or “chi” releasing a flow of energy? Read on:
“In early 2009, the British Medical Journal published a new analysis of acupuncture for pain … with discouraging results. More recently and dramatically, the journal Pain did it again — one of the top ten journals for pain and injury science. In early 2011, Pain published a thorough and rather harsh scientific smack down of acupuncture, concluding that there is “little truly convincing evidence that acupuncture is effective in reducing pain, “or anything else. In 2016, acupuncture was officially scorned in the NICE guidelines for back pain, with the recommendation “do not offer.”
https://www.painscience.com/articles/acupuncture-for-pain.php
https://osteofm.com/2016/12/06/new-nice-guidelines-november-2016/
How about cognitive behavioral therapy?
The diagram depicts how emotions, thoughts, and behaviors all influence each other. The triangle in the middle represents CBT's tenet that all humans' core beliefs can be summed up in three categories: self, others, future
CBT focuses on the development of personal coping strategies that target solving current problems and changing unhelpful patterns in cognitions (e.g. thoughts, beliefs, and attitudes), behaviors, and emotional regulation. (How does this reduce pain?)
https://en.wikipedia.org/wiki/Cognitive_behavioral_therapy
So let’s review:
The Veterans Administration is now asking veterans who are in severe pain, to give up/reduce pain medications and as an alternative, try yoga which may violate Christian principles, or to release our “chi,” or treat the pain by changing “thoughts-behavior- and emotion or whatever the new/old fad might be. Poor choices for someone in real pain.
Should we just tell a veteran to rub some dirt on it and take a lap?
We give the V.A. credit because even with its short comings, we believe they are still ahead of the curve in research and development of pain management. https://www.research.va.gov/topics/pain.cfm
However there are many examples of the V.A. studies that show even they are not sure of their findings. Note below:
Veteran’s Opioid doses and risk of suicide
In a 2016 study, researchers with the VA Ann Arbor Healthcare System and University of Michigan found that Veterans receiving the highest doses of opioid painkillers were more than twice as likely to die by suicide, compared with those receiving the lowest doses.
The research team looked at nearly 124,000 Veterans who received VA care in 2004 and 2005. All had non-cancer chronic pain and received prescriptions for opioids. Using the National Death Index, the researchers identified 2,601 patients who died by suicide before the end of 2009.
They found that the suicide risk rose as dose increased. The researchers could not tell, however, whether there was a direct causal link between the pain medications and suicide risk. Instead, the high doses may be a marker for other factors that drive suicide, including unresolved severe chronic pain.
In other words a veteran suicide might be because he is in constant severe pain.
Conclusions
Again the Silver Star Families of America is aware of the dangers in opioid use. However it is strongly suggested that before someone is refused pain medication or that pain medication is reduced or eliminated, that careful consideration of the patient’s pain levels be taken into consideration.
The VA can’t afford to launch these well-intended but clumsy attempts at reducing pain medications at veteran expense. The nature of military service can lead to a lifetime of physical and mental pain for veterans.
It is always wise to consider very carefully the effects of the decisions we make concerning the lives of others. Sometimes the ramifications are not foreseen.
Respectfully submitted by: Steve Newton CEO The Silver Star Families of America
http://taskandpurpose.com/the-vas-attempt-to-fight-opioid-dependence-leaves-pain-patients-cut-off/
https://www.theguardian.com/us-news/2016/jul/12/prescription-drugs-what-if-you-depend-on-opioids-chronic-pain
https://www.peoplespharmacy.com/2017/03/13/war-on-opioids-punishes-desperate-pain-patients/
https://www.cdc.gov/mmwr/volumes/65/rr/rr6501e1.htm
https://www.pbm.va.gov/PBM/AcademicDetailingService/Documents/Academic_Detailing_Educational_Material_Catalog/Pain_ChronicPainProviderEducationalGuide_IB101000.pdf
Credits:
The Department of Veterans Affairs Wikipedia Pain Science NICE Probe.org Webster Addiction Hope CDC Lifescript
Folks we can really use your help. If your a veteran suffering with pain and have had the V.A. reduce or deny medication please go and take the quick survey. We must do something to stop this “war” on pain medication.
https://www.surveymonkey.com/r/BRFG8KW
Some people may think withholding pain medication is primarily happening with veterans or those on Medicade.
Talk to anyone who is suffering from pain right now and ask them if they have any trouble getting a prescription. It is impossible.
Once again, the bad guys are ruining it for everyone else. The thugs with illegal guns ruin it for responsible gun owners and now the drug addicts are ruining it for those in pain.
Wait till they find out first hand about the rationing that’s happening in medicine, especially for the over 65 crowd. Remember, it was Obama who said older people shouldn’t use up medical resources they should take a pain pill. Now they rationing pain pills.
“There was a time when V.A. doctors were trusted to use good judgment in the prescribing of opioids.”
They proved themselves not up to the task.
Still, not entirely their fault. Some of the fault resides with the veteran.
There’s a reason for PT and innumerable other pain management techniques. They often work over the long term, or work well enough.
And opioids only work over the long term at great personal cost and ever increasing dosage.
Sure, there are a very few who will require opioid therapy for the rest of their lives.
But it’s damn few. And I give my sympathy to them.
But to no other.
Yes, lets stop the over prescribing of opioids. Where else are we going to get the addicts that we love so much. Opioids are not the answer to long term pain. They have to be stopped. The VA created the largest percentage of addicts in our country.
I blame the the opiod epidemic on the 8 years of Obama. I personally believe the Obama administration medical solution to health care was to just take drugs to dull the pain. Don’t worry about fixing the medical problem, just escape from reality with highly addictive medicines.
I wonder how much those opiod manufacturers plowed back into the campaign coffers of Rats around America.
The new VA pain drug is turmeric. It helps arthritis and some other pain. They will not provide it you have to find it yourself. I buy one pound at a time. Get the 5% cur cumin variety.
I’m in pain about 50% of the time and typically take nothing for it as aspirin and ibuprofen are blood thinners, and cannot have them. I only take an OTC pain killer when I cannot sleep.
So may I ask, if you take turmeric 5% cur cumin variety, is it for arthritis and does it relieve the pain the same or better than ibuprofen?
Opioids work better to control pain than anything else.
Chronic pain requires chronic opioid treatment.
Do you know what the worst side effect of well-controlled chronic opioid use for chronic pain is? Constipation.
Drill down in all of these reports of opioid overdose deaths and you will find that most of them are due to street drugs - heroin and fentanyl - in spite of what Tucker Carlson states.
I’ve treated lots of vets who suffered terrible injuries during military service. They were stable on set doses of opioids, never asked for dose increases, never asked for early refills. They are targeted just like everyone else.
I agree! It’s not just vets but everyone.
“Opioids are not the answer to long term pain.”
Is that statement 100% true, yes or no?
Hum thank you. I will research this.
Is there a decision tree or a structured decision language algorithm for opiate prescribing?
Please provide links or article names if possible.
Any person who can not provide such an absolutely correct basis for opiate prescribing does not know enough. Yup, that includes me.
Well said. Again veterans are caught in the middle.
You stated you have treated veterans....Do you have any alternatives for pain? Or any idea’s on how to get the V.A. to reevaluate their position on pain medications?
The guidelines should be exactly the same, 100% perfect, for both veterans and civilians.
No state’s guidelines should significantly differ from any other state’s.
Guidelines based on uncertain information should clearly specify their knowledge base deficits.
First thing, i start reading the descriptions of altwrnatives to opioids, as though they were taken from The 700 Club Pat Robertson’ dictionary.
Demonic?? You do realize that not everry American GI/veteran is judeo-christian, or do I have to remind you that the V
A. was sued in 2007, for crapping on veterans about their headstone symbols?
Bttt.
5.56mm
Yes I understand that not every vet is a Christian and did not mean to infer that. However it IS a consideration for many.
The point being, does the alternatives relieve pain or are they just politically correct?
Agreed. To me its just another example of the pendulum swinging to far one way or the other. They can never seem to get it in the middle.
Not sure I agree. Yes one should not over prescribe but one should also not with hold medication for someone in chronic pain.
Pain can be a killer. Blood pressure increases, sleep interference and normal activity curtailed or stopped.
There must be a middle ground and not just a scorched earth policy.
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