Posted on 07/13/2019 5:27:23 AM PDT by GailA
Senator Joe Manchin (D-WV) and Mike Braun (R-IN) are still trying to address the fentanyl and heroin overdose crisis—soon to be joined by a methamphetamine and cocaine overdose crisis—by denying chronic pain patients access to pain relief. They have just introduced a bill they call The FDA Opioid Labeling Accuracy Act, which would “prohibit the Food and Drug Administration (FDA) from allowing opioids to be labeled for intended use of ‘around-the-clock, long-term opioid treatment’ until a study can be completed on the long-term use of opioids.”
Set aside the fact that most pain specialists agree that, in some cases, long-term opioid therapy is all that works for some chronic pain patients. The 2016 guidelines on opioid prescribing put forth by the Centers for Disease Control and Prevention have already been misinterpreted and misapplied by legislators and regulators, leading to forced and rapid tapering off of opioids in many chronic pain patients, causing many to resume lives immobilized by pain, and in many cases, seek relief in the black market or by suicide. It has gotten so bad that the CDC recently issued a “clarification” in April, reminding regulators that the guidelines were only meant to be suggestive, not prescriptive, and did not in any way mean to encourage the rapid tapering of patients on chronic opioids for pain management. Johns Hopkins bioethicist Travis Rieder, PhD delves deeply into this subject and relates his own experiences in his book, In Pain.
(Excerpt) Read more at cato.org ...
When I was in the Army I had a Major come in who was more than a little upset. I prescribed antibiotics for her UTI and she got a case of vaginal candidiasis. His complaint was that I had cured one condition but gave her the same symptoms. We had a discussion that would have dovetailed nicely with “Who’s on first?”
Should read “for his wife’s UTI”. Sorry.
I hope I never confront terminal cancer. I understand it can be a long painful death. Maybe an accidental overdose, and I mean accidental as I am against suicide and euthanasia, is not a bad thing. I guess I believe in miracles, and terminal cancer is not terminal until you are recalled, but by no explicit action to hasten the end. Reading up on dosages, acquiring illegal fentanyl, is ok in my book if modern science says you are beyond the help of science and the end is near. Taking fentanyl because you are a screw-up or just plain weak is an entirely different matter.
The first attack lasted about 2 months. Evidently, the herniation shifted slightly and I had immediate relief. With physical therapy and traction to the neck, this shift happens frequently and the person moves on with his life and never needs surgery.
About 2 years later, it happened again. It was more than a month before all the doctors’ visits could be scheduled along with an MRI. Apparently the MRI showed the disc as being sufficiently severe that surgery was scheduled about 2 weeks later.
I was in intense pain before the surgery and woke up in the recovery room pain free. It was like a miracle.
So cruel. My son has nerve and spine damage from 2 back surgeries gone wrong, and a broken foot with 11 plates and pins. He would probably end his life if he was denied pain medication. He changed his work due to his disabilities, but still works and pays for his own insurance and prescriptions and has no assistance. He is only dependent on pain killers because he cant function without them.
Bear with me. I am seriously not wanting to piss you off. The precise diagnosis would be “ACUTE herniated cervical nucleus pulposus.” Since you had a diagnosis that was not only acute but amenable to surgical intervention and your care providers attended to your needs promptly you never took the narctotics for chronic pain or for over 6 weeks. Because that is the threshold for “chronic pain”. Six weeks. IOW acute diagnosis, less than 6 weeks anticipated use, favorable prospects for surgical intervention (depending on how you define “successful” anywhere from 60 to 90%). Your case is a text book example in the appropriate use of narcotics.
And in the book “Pain and the Neurosurgeon” IIRC I can think of several surgical interventions that would greatly relieve his suffering without narcotics. The problem is finding a neurosurgeon that will do the procedures is difficult. Largely because of the opiate situation. Look up “Spinothalamic tractotomy”. It may or may not be appropriate in his case.
CATO has that pegged at 4 decades of failure. Newest bright idea is Blister packs. JOKE, when Predisone when to them they went to $50. Loose ones are $4.00.
I lost both my parents to Lung Cancer, thankfully far enough back they had all the pain meds they needed.
My Niece has the worse form of Lupus, Systemic Lupus Erythematosus she’s dying, Lungs, Kidney’s Liver are all trash; after this last ER trip from the Lung docs office to the Hospital Downstairs via wheel chair, it took 3 months to get her into a Cardio. Now this Guy is a real winner I DON’T TREAT BP. Yet he ordered a Echo and a Chem stress test. Her Renal Arteries are clogged with plaque, when she gets these 2 test run they will show the cardio arteries are too. He told her to go back to her Rhuemy or Kidney doc to treat her BP, the family doc had her Under dosed. Because she is on Placquenil she is Labeled a DRUG SEEKER. It is a Freaking Anti-Malarial drug that destroy’s kidneys.
Her 14 yr old son has the beginnings of Duchenes MD. What my sister doesn’t understand is she is going to have to deal with his MD along with his grandfather’s as his mom won’t live to 40. He is NOT under treatment either.
Rural med is horrid. Both hubby and I see same Cardio here in Memphis and HE prescribes our BP meds. NOT any other doc. He wants complete control of his Specialty. Last time the Internist ran his EKG he had a Cow. Because he couldn’t get the test results. So I had to have a Cardio Ultrasound, just to get around the Dup testing Medicare has gone to.
Computers don’t talk to each other even in the same health system. Both were Methodist.
Manchin is posturing as he always does. Trying to find that “sweet spot” of being conservative enough to remain acceptable to his electorate yet liberal enough to be viable for the Rat VP nomination. (Even the Rat Prez nomination if the stars align right!)
Terminal illness is not chronic pain. Don’t let the Brown SHirt Media gaslight you.
I’m sure you know that some people with chronic lower back pain have had multiple spine surgeries, aracnoditis from multiple epidural steroids, or inoperable spinal nerve or cord compression from arthritis or disc disease. Sometimes people with kidney disease, allergies, DM etc and shouldn’t take NSAIDS. All of the non opiate treatment such as back surgery for chronic pain, epidurals, PT, psych do not show sustained long term benefit. People with chronic pain have typically tried and failed with these modalities, not just once, but over and over. So, the advice to try yoga, cognitive behavioral therapy and take an ibuprofen is ignorant and insulting to these patients. Just the time of crap you’d expect from bureaucrats and politicians.
That being said the use of opiates for chronic pain is over. With most pain clinics closing, doctors going to prison and the remaining pain clinics avoiding opioid prescribing, there will be no studies on the use of opiates in chronic pain. We will never know the right doses and the best ways to use these medicines because of wreckless manner the federal government has intervened by excessively criminalizing this medical and public health controversy. Residents will not go into pain management (even interventional only) because the field has been tarnished forever. Those going into other specialties will stipulate that they won’t have to prescribe opiates. The government will continue their march on prosecuting prescribers for amphetamine and benzodiazepines. My advice to psychiatrists and family doctors that prescribe these drugs for ADHD and anxiety disorders is to get out right now before you’re raided.
I really think that doctors will just give up their DEA numbers except anesthesiologists in the OR, addictionologists for Suboxone, oncologists, and some surgeons might still need to prescribe after major surgery.
It amazes me how he continues to con the people of West Virginia into voting for him.
Sorry to hear about your niece (and the rest of your family’s suffering). If she has High BP due to renal artery stenosis you really do want a nephrologist to manage that and I’m sure they would all be the first to agree. If she is as far along as you describe this would really fall under “terminal illness” more than chronic pain. If she also has renal failure a nephrologist might also want to manage her other required drugs, including narcotics. Again, don’t conflate terminal illness with chronic pain.
We have millennia of experience treating chronic pain with opiates. Yes, in my years of Residency I saw many people with “failed backs”. Again, there are a number of interventions a neurosurgeon can do to relieve their suffering without narcotics. What is needed is to really, almost insist that they offer these procedures as they really are “in the scope of the practice”. Yes, these procedures are all “destructive” and do require destruction of sometimes very small parts of the nervous system and do produce “side effects” that have to be considered and attended to. IMHO that is a small price to pay to be free of suffering and not addicted to opiates.
Listen, you have a background in medicine, but you aren’t giving the right definition of an addict. I’m sure you know that addiction involves obtaining a drug for euphoria and the compulsive use of the drug despite causing physical or functional harm to the individual. People with chronic pain on opiates become tolerant to opiates (withdrawal syndrome), but they use the medications for pain control, improvements in function, keeping a job etc; they do not use the medicine to get high.
But the fundamental thing we gave to keep in mind with this failed policy is that opioid prescriptions are way down, but opioid related deaths are not. We all know drug seekers are going to the street for drugs and the drugs on the street are of course less safe. I think it’s apparent that the politicians, justice, and bureaucrats are fully aware of the situation and intend on continuing and advancing this policy. I believe that they do want more deaths and drug criminals to prosecute. I seriously doubt that there will be any reduction in illicit drug activity because government derives too much benefit from the drug trade at all levels from prisons, protection rackets, money laundering.
This type of legislation proves it.
There are Intractable Pain Patients who have been on a set dose of Pain Meds for 10-40 yrs. While they became dependent on them, they were not addicted in that sense a Illicit drug junkie is.
We are as dependent on them as a Type 1 Diabetic is on Insulin. Since we were FORCED off them we have become house bound, non drivers, in wheelchairs or bedridden.
100 Autoimmunes are known they all come with that 4 letter word PAIN.
Well here’s why:
His organization is deeply intertwined into local county & city politics. The GOP here still has a long way to go to have a similar ground level organization to counter that.
WV’ians still prefer “native sons” unless they’re very rich! Manchin’s 2016 Senate campaign ads hardly ever mentioned any Manchin accomplishments as Senator. He had virtually none. He hid under a rock rather then defend the coal industry during the Zero years. All the ads did was highlight Manchin’s WV roots - played football at WVU. (Set the bench but was on the team!) & contrast with Morrissey’s non-WV roots. Morrissey was not a very good candidate even though he has won two state-wide elections. Boring speaker & personality and a personal story that’s easy to paint as being a carpetbagger. He’s not rich so he couldn’t paper his story over with money.
The only thing you are accomplishing by treating chronic pain with opiates is you are creating an addict. You aren’t doing anyone any favors. There will never be an effective analgesic that is not addictive. Big Pharma has been trying for 100 years or more. We already have treatments that are effective and they have been known since long before the publication of White’s textbook. What we don’t have is public awareness these treatments exist. I can think of a number of reasons for that. The surgeons don’t want to do them because that means they have to deal with people who have almost all been turned into addicts already. Most doctors are unaware they exist.
I don’t know how many adddicts you have dealt with but they all have one thing in common. They will do ANYTHING to fill that need. Prostitution, whatever, you name it. ANYTHING. IMHO it is immoral to turn a legit patient that is just trying to seek relief into a narcotics addict. They will never come back and thank you. Our current situation is a disgrace. I spent decades trying to educate my colleagues and was almost casually dismissed because for some reason our government spent 15 years encouraging people to prescribe narcotics for chronic pain. I told everyone that would listen it was a massive mistake. Now here we are and the government has suddenly changed it’s position because of the train wreck the politicians created.
I talked to a cab driver in Juarez 30 years ago who had been a junkie for 40 years at that time. If you live in a place where heroin is easy to get you don’t need to be a prostitute or burglar. Which is why I say let us doctors out of the “getting high” business. Let people have access to regulated quality drugs if they desire to waste their lives and move the entire thing right out of the “healthcare” domain.
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