STOP THE WAR AGAINST PAIN PATIENTS! – A Point Paper for Lobbying Legislators

STOP THE WAR AGAINST PAIN PATIENTS! – A Point Paper for Lobbying Legislators

By Richard A. (Red) Lawhern, Ph.D.

STOP THE WAR AGAINST PAIN PATIENTS! State and Federal law-makers must introduce legislation and hold public hearings to force recall and rewriting of 2016 CDC Opioid Prescription Guidelines, and repeal State laws that limit treatment of chronic pain patients.

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  • An estimated 100 -120 Million people in America will experience long-lasting pain at some point in their lives due to injury, disease, or medical error.
    • About 18 million people have pain lasting longer than 90 days in any given year.
    • 2.7 to 3.3 million will be prescribed an opioid for longer than 90 days.
    • Fewer than 10% will continue their prescription longer than one year. [Ref 1]
  • By Richard A. (Red) Lawhern, Ph.D.

    Faulty public policy on prescription of opioids is damaging hundreds of thousands of people whose only offense is that they hurt. Some are dying.  Many more are being forced into disability. [Ref 2]

    • Pain patients who have been stable and well managed on opioid analgesics for years are being forcibly tapered down or outright denied the only medicines which make their pain bearable.
      • The widespread result is a wave of agony and disability as patients become bed-ridden and lose function.
      • Some patients are forced into unmanaged opioid withdrawal because of too-rapid tapering or outright cold-turkey desertion.
      • Some who are unable to bear their agony are dying by suicide.
    • Scores of doctors are deserting their patients and leaving pain management practice for fear of losing their medical licenses.
    • In a larger context, enough physicians commit suicide every year to fill a class of medical students, and 50% of doctors suffer from burnout syndrome. [Ref 2A]
      • No one can now predict the future effects of the resulting shortage of doctors on chronic pain patients – even before large numbers have stopped prescribing opioids to patients in pain. [Ref 2B]
    • The US Drug Enforcement Administration is using extra-judicial persecution to drive pain doctors out of practice. [Ref 3]
      • Confiscation of doctor assets and patient records without a judicial trial or verdict
      • Public announcements intended to destroy doctors practices
      • Coercion of prosecution witnesses using plea bargains
      • Prolonged delays in court cases to increase financial pressure and force consent decrees.
    • A key enabling element in denial of pain treatment is the US Centers for Disease Control and Prevention 2016 Guidelines on prescription of opioids to adult non-cancer pain patients. [Ref 4]
      • Although written as voluntary, the Guidelines are widely being used to justify mandatory limits on opioid dosing.
      • The US Veterans Administration was directed by Congress in December 2015 to make adherence to the Guidelines mandatory, not voluntary (four months before publication).
      • Several US States have enacted arbitrary restrictions on opioid prescribing, referencing the CDC guidelines as a standard.
      • Even where not required by State laws, many medical practices are denying renewal of patient prescriptions or discharging patients.
    • The CDC opioid guidelines are fatally flawed by a combination of uncritical anti-opioid bias, weak medical evidence, cherry picking of research and dangerously incomplete analysis. [Ref 1, 5]
      • The “core experts group” selected by CDC was unduly influenced by anti-opioid partisans from “Physicians for Responsible Opioid Prescribing” (PROP).
        • PROP had previously lobbied FDA against opioids but major elements of their proposals were rejected. [Ref 6]
        • Congress directed CDC to open its deliberations to public review, following complaints of violations of transparency laws. [Ref 7]
        • None of the core experts group had ever worked in community pain management outside a hospital. [Ref 8].
        • Although available in CDC, medical ethics experts were not invited. [ibid Ref 8]
      • Research was selected in a manner calculated to disqualify opioid analgesics in favor of non-opioid medication or behavioral therapies – neither of which were better supported by medical evidence or studied longer than opioids. [Ref 10]
        • Research on opioids is mostly in studies of less than one year duration.
        • Guidelines falsely state there is no long term benefit from opioids. [ibid Ref 1, Ref 9]
      • CDC Guidelines drew “strong” conclusions from “weak” evidence and personal opinion, omitting many confounding factors and reservations and ignoring contradictions between studies. [ibid Ref 1, 11]
      • Particularly disqualifying, the Guidelines make no mention of the natural genetic variations (polymorphism) between individual patients which affect ability to metabolize opioids and benefit from their effects. [Ref 12 – 14]
        • “Hyper”-metabolizers may over-dose on some medications (e.g., codeine, tramadol) or so rapidly process other meds that pain is relieved only for minutes rather than hours.
        • “Poor” metabolizers need far higher dose levels to get the same pain management as “normal” metabolizers.
        • Published case reports ignored by CDC indicate that tens of thousands of US patients are well managed on ultra doses over 2500 MMED, with little risk of addiction.
      • Genetic polymorphism means there can be no “one size fits all” threshold of risk or maximum safe dose applied to all patients.
        • Patients must be evaluated and managed individually.
        • This reality was completely missed or deliberately ignored in the CDC guidelines.
      • The US has a real opioid crisis, but it wasn’t created by prescriptions managed by doctors — and it won’t be solved by restricting treatment of patients in agony. [Ref 15]
        • ~90% of all addicts first begin abusing alcohol or drugs in their teens – long before they are ever seen by a doctor for any pain condition. [Ref 16]
        • A second reliable predictor for addiction is a history of sustained unemployment or family trauma. [Ibid Ref 15]
        • Although some sources assert that 75% of addicts may “begin with prescription drugs”, the source isn’t a doctor’s prescription to a genuine pain patient. [Ref 17]
          • Most drugs first abused by addicts are stolen from a family medicine cabinet or diverted by a family member who hasn’t used up a previous prescription.
          • Millions of doses hit the street every year from pharmacy and hospital thefts. [Ref 18]
          • Among deaths which involve an opioid drug of any kind, less than a quarter of the victims have a current prescription. Many deaths involve alcohol or an anti-anxiety agent. Some “accidental” deaths are likely suicides by under-treated patients. [Ref 19]
        • Addiction is not primarily a disorder of drug exposure. It is a “disease” of social disintegration and alienation among people at the margins of failing social and family systems.
          • Addiction is not deterred by fear of prison or other punishment. [Ref 20]
          • Yet our prisons contain millions of non-violent drug offenders who consume tens of billions in resources.
        • Finding solutions for addiction and for the management of intractable pain will not be cheap or easy – but this is not an either/or issue.
          • Pain patients can become dependent on pain killers when used for long periods (weeks or longer). But they rarely become addicts. Dependency and addiction are different medical entities calling for different medical practice standards. [Ref 21]
          • Opioids should not be prescribed carelessly or casually, and for the most part they aren’t.
            • Pain patients are tried on opioids only after other therapies have failed.
            • For the most severe pain, behavioral therapy is never a substitute for opioid or non-opioid analgesics.
            • Non-opioid analgesics also have risks – 30,000+ hospital admissions per year for Tylenol toxicity, with 1500 deaths [Ref 22].
            • Clearly, additional research is needed on safer medications for chronic pain, and cures for many underlying conditions which cause it.
          • Pill counting and limitations on prescribing opioids will not “solve” a crisis created by aggressive marketing of street drugs to kids and compounded by adult unemployment. [Ref 23]
        • The purpose of all pain treatment is to relieve suffering and promote function. Denial of effective treatment for chronic pain is a fundamental abuse of human rights and a violation of the principle “First Do No Harm”.
        • To correct the harms now being done to pain patients, a first step must be withdrawal and rewriting of the CDC opioid prescription guidelines to correct the biased and unbalanced policy and implement known best practices of pain management. Several initiatives are also needed to better educate physicians and patients.
          • The central role of physicians and patients in selecting and managing care must be restored, with appropriate and prudent oversight of prescribers and patients, to detect drug diversion and “pill mills”.
          • Increased medical education and research funding must better delineate chronic pain, opioid therapy and co-therapies, and the risks and benefits of both opioids and alternative therapies for chronic pain.
          • Educate patients on risk of stomach ulcer and bleeds, heart attack and stroke from NSAIDs and aspirin.
          • Educate patients on risk of liver toxicity, liver failure, and death with acetaminophen or Tylenol.
          • State laws fixing maximum dose rate limits must be immediately repealed as unscientific and abusive of patients.
        • It is time to STOP THE WAR AGAINST PAIN PATIENTS!

REFERENCES:

      1. Stephen A. Martin, MD, EdM; Ruth A. Potee, MD, DABAM; and Andrew Lazris, MD, Neat, Plausible, and Generally Wrong: A Response to the CDC Recommendations for Chronic Opioid Use
      2. Pat Anson, Survey Finds CDC Opioid Guidelines Harming PatientsPain News Network, March 15, 2017. [Observations reinforced by hundreds of postings in Facebook groups focused on chronic pain patients, families, and medical professionals]. Also revealing: Bob Tedeschi, “A ‘civil war’ over painkillers rips apart the medical community – and leaves patients in fear”  STAT News, January 17, 2017, https://www.statnews.com/2017/01/17/chronic-pain-management-opioids/
        Ref 2a: Association of American Medical Colleges. Physician shortage and projections. Data and Reports. Workforce. Data and Analysis. AAMC. The 2017 update: complexities of physician supply and demand. Projections from 2015 to 2030. 2017. https://www.aamc.org/data/workforce/reports/439206/physicianshortageandprojections.html
        Ref 2b: BC Government News. “#BC is committed to listening to all voices in order to save lives and overcome the #opioid crisis.” July 28, 2017. Accessed August 9, 2017. https://twitter.com/BCGovNews/status/892151820394606592
      3. Funtony47 The War On Doctors: How The DEA is Scaring Doctors from Prescribing Pain Medications  Daily Kos, Apr 15, 2015  https://www.dailykos.com/stories/2015/4/15/1375189/-The-War-On-Doctors-How-The-DEA-is-Scaring-Doctors-from-Prescribing-Pain-Medications
      4. “CDC Guideline for Prescribing Opioids for Chronic Pain” – United States, 2016 http://www.cdc.gov/mmwr/volumes/65/rr/rr6501e1.htm
      5. Richard A. Lawhern, Ph.D. “Warning to the FDA: Beware of Simple Solutions In Chronic Pain and Addiction”. National Pain Report, June 1, 2017, http://nationalpainreport.com/warning-to-the-fda-beware-of-simple-solutions-in-chronic-pain-and-addiction-8833744.html
      6. Mark Maginn, “Living with Pain: FDA Ruling a Victory for Pain Patients and PROP” National Pain Report [Opinion], September 10, 2013, http://nationalpainreport.com/living-pain-fda-ruling-victory-pain-patients-prop-8821625.html
      7. Congress of the United States, House of Representatives Committee on Government Reform, Letter to Thomas Frieden, MD, Director CDC, December 18, 2015
      8. Christina Porucznik, PhD MSPH, “Observations presented to the National Center for Injury Prevention and Control’s Board of Scientific Counselors on behalf of the Opioid Guideline Workgroup”  [CDC Briefing, Spring 2016]
      9. Baraa O. Tayeb, MD Ana E. Barreiro, MPH Ylisabyth S. Bradshaw, DO, MS Kenneth K. H. Chui, PhD, Daniel B. Carr, AM, MD, DABPM, FFPMANZCA (Hon) Durations of Opioid, Nonopioid Drug, and Behavioral Clinical Trials for Chronic Pain: Adequate or Inadequate?  Pain Med. 2016 Nov; 17(11):2036-2046
      10. Richard A. Lawhern, Ph.D. “The CDC Opioid Guidelines Violate Standards of Scientific Research” – American Council for Science and Health, March 25, 2017. http://www.acsh.org/news/2017/03/25/cdc-opioid-guidelines-violate-standards-science-research-11050 Â
      11. Richard A. Lawhern, Ph.D. Tracking Down the ‘Research’ Behind the CDC’s Opioid Prescribing Guidelines, National Pain Report, August 10, 2016
      12. Steven H. Richeimer, MD and John J. Lee, MD Genetic Testing in Pain Medicine—The Future Is Coming, Practical Pain Management, October 17, 2016.
      13. Tom Lynch, PharmD and Amy Price MD, The Effect of Cytochrome P450 Metabolism on Drug Response, Interactions, and Adverse Events, American Family Physician,  August 1, 2007.
      14. Jennifer Schneider, MD; Alfred Anderson, MD; and Forest Tennant MD, Dr PH, “Patients Who Require Ultra-High Opioid Doses”, Practical Pain Management,  September 2009
      15. Maia Szlavavitz, Opioid Addiction Is a Huge Problem, but Pain Prescriptions Are Not the Cause – Cracking down on highly effective pain medications will make patients suffer for no good reason, Scientific American, May 10, 2016
      16. Podcast of the President’s Commission on Combating Addiction and the Opiod Crisis – Observations by a subject matter expert from the National Institute on Drug Abuse, June 2017.
      17. Pat Anson, Editor, Pennsylvania Overdoses Soar, But Not from Painkillers Pain News Network, July 27, 2017
      18. David E. Joranson, MSSW, Aaron M. Gilson, PhD, Pain & Policy Studies Group,University of Wisconsin – Madison Comprehensive Cancer Center; and World Health Organization Collaborating Center for Policy and Communications Madison, Wisconsin, USA “Drug Crime Is a Source of Abused Pain Medication in the United States”  Letters, Journal of Pain and Symptom Management , Vol. 30 No. 4 October 2005, Response to “How Prescription Drugs Get Onto the Street”.
      19. Roger Chriss, “The Myth of the Opioid Addicted Chronic Pain Patient” Pain News Network, July 25, 2017, https://www.painnewsnetwork.org/stories/2017/7/25/the-myth-of-the-opioid-addicted-chronic-pain-patient?rq=25%25
      20. Pew Charitable Trusts / Research and Analysis, “Pew Analysis Finds No Relationship Between Drug Imprisonment and Drug Problems”, June 19, 2017, http://www.pewtrusts.org/en/research-and-analysis/speeches-and-testimony/2017/06/pew-analysis-finds-no-relationship-between-drug-imprisonment-and-drug-problems
      21. Silvia Minozzi, Laura Amato & Marina Davoli, Department of Epidemiology, Lazio Regional Health Service, Cochrane Drugs and Alcohol Group, Rome, Italy “Development of dependence following treatment with opioid analgesics for pain relief: a systematic review” Addiction Review, pp1360-0443.2012. March 5 2012 Main points of this paper are reinforced by a 2010 Cochrane Review.
      22. Eric Yoon, Arooj Babar, Moaz Choudhary, Matthew Kutner, and Nikolaos Pyrsopoulos “Acetaminophen-Induced Hepatotoxicity: a Comprehensive Update” Journal of Clinical and Translational Hepatology, June 28, 2016, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4913076/
      23. Mallika L. Mundur, MD, MPH, Adam J. Gordon , MD, MPH & Stefan G. Kertesz, MD, MSc “Will strict limits on opioid prescription duration prevent addiction? advocating for evidence-based policymaking” 20 Jun 2017, http://www.tandfonline.com/doi/full/10.1080/08897077.2017.1345194

       

    1. About the Author: Richard A. Lawhern, Ph.D. is a technically trained non-physician with 20 years of experience in peer-to-peer patient support groups for chronic pain patients. His work and commentaries have been published or featured at the US Trigeminal Neuralgia Association, National Pain Report, Pain News Network, The American Council on Science and Health, The Journal of Medicine of the National College of Physicians, the National Institutes for Neurological Disorder and Stroke, Wikipedia, Mad in America, Psychiatric News and other online venues.

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There are 55 comments for this article
  1. Sandi Andreas at 12:33 pm

    Pain management Dr’s are managing my Pain Medication, however, they are Not managing my Pain !!!

  2. Sandi Andreas at 12:29 pm

    I have been made to feel as though I was an addict. I didn’t feel as though I was because I could go a week without opioids, and not feel anything like withdrawals, I just had more pain, and the more I was without opioids the more pain I had. This newsletter is such a blessing to me, just knowing I’m not alone, that there are others just like me, trying to use less than prescribed, saving as many pills as I could, because I knew they were going to take me off them completely soon. I’m now taking 1/2 a pill prescribed, instead of whole ones. I Knew I wasn’t an addict, I would tell my Dr. this but he still wouldn’t increase my prescription, even though I have pain in my shoulders still, (after surgery), I have pain in my back still, (after surgery), I have pain still in my knees still, (after surgery). I’m 80. now, and have gone from someone who was active ALL the time, to someone staying at home sitting, but I can’t even sit or sleep without pain so why am I here. Doesn’t seem worth it.

  3. Crystal at 9:08 pm

    Just a huge thank you, Red! As fellow advocate, patient and caregiver of a child debilitated with chronic pain, I have to say just how very blessed we are to have you fighting with us. Your research, information and guidance are invaluable and I am grateful to you.

  4. MyNameisNotYourBiz at 11:02 am

    We in America rely too much on pharmaceuticals. There is absolutely another way to combat pain.

    I suffer from Interstitial Cystitis, an incurable bladder disease that doctors say is as painful as cancer. I also suffer from neck pain related to two accidents, in which an MRI revealed a Herniated Disc, two pinched nerves, cervical osteoarthritis, ddd and bursitis. On top of that, add Fibromyalgia, insomnia, chronic fatigue and bipolar disorder with severe depression and insomnia.

    After bouncing from doctor to doctor never getting more than a handful of scrips that would work for awhile but then stop working or being abruptly cut off because someone who isn’t me decided they were going to abuse prescription drugs, I decided I’d had enough of the doctor’s waiting room.

    Nearly all doctors I’ve seen, at least 98% of them anyway and I’ve seen many, treat us like cattle. They do not care, I mean truly care about our wellbeing. This is a job for them and is a means to make money.

    Don’t let anyone sway you from learning how to care for yourself using traditional medicinals. Modern medicine has only been around since the 1800’s and synthetic drugs and the human biology do not get along well which is why you have so many ugly side effects.

    Look into sacred plant medicine used by the indigenous peoples of the Amazon. And run the other way if someone tries to relate “homeopathy” with herbal medicine because they are not the same thing.

    Humans and plants coevolved and plants have served our need for medicine, housing, and most importantly – oxygen.

    Let me tell you, my pain is so bad that I can barely walk in the morning. But I get up and have coffee and I take my herbs, whether it be Chuchuhuasi, Kratom, Incarvellia, or Wild Lettuce and within an hour I feel human again without all the ugly side effects and without the endless doctor visits where I’m treated like crap.

    /overit

  5. Andrea Monty at 11:07 am

    I had chronic back pain until 12/2012 when I had a 2 stage discectomy with fusions and a lumbar laminectomy 6 months later in 6/2013. It had come to a point where I could not even lean over the bathtub to give my 3 year old a bath. All went well for awhile until life happened. I became legally separated. I wound up in a car accident that totaled out my car. Because of divorce my credit was shot and couldn’t get another car. So I had to walk everywhere for 8 months including walking with groceries for 5 miles to get home. This caused neck and lower back problems again as I should never lift anything heavier than a gallon of milk. I also wound up having to take a job lifting a lot of weight and standing for long periods of time, bending and twisting. This time around I realised I was having a hard time getting any doctor to listen to me as I moved to Indiana. My doctor of 14 years knew me and I had had no problems getting pain medication. I have had MRI’s of my neck and lower back. I have herniated disks in my neck again and the bulging disks I had in my lower back are now completely herniated and pressing on my spinal cord. I have severe disk degeneration (runs in my family-both mother and father have it). Last August I went to see a pain doctor here in Indiana. He accused me of abusing my pain medication. His reason was I am bipolar so I must abuse pain medications because and I quote “All bipolars and people who are depressed are drug addicts”. He stripped me of my pain medication and 12 hours later I was in full seizures and had to be rushed to the ER. The ER simply put in my electronic record I had opiate withdrawal. With that and that pain doctor red flagging me I now can not find any help. All over the state of Indiana this shows up immediately in the system. I can not walk sit or stand because the pain is so bad. It throbs and burns so badly that I can not focus on anything even to the point of being scared to drive. My child is now almost 17 and I am 50. My quality of life has become non existent. I am so depressed I feel useless and hopeless now. I need to work and can not now. Every day I do not want to wake up. This has to stop with criminalizing chronic pain patients. My MRI’s show the proof but I keep getting told that even though what the reports say there is no way I can be in this much pain. I have done PT and injections. I have done everything to satisfy these doctors and the insurance companies. I am taking way too much Tylenol and Aleve. I can not take aspirin or NSAIDS because I am severely allergic. No one will listen. I do not know how much longer I can go on like this.

    When did it become ok for our government to dictate what a doctor can and can not do. There is the Hippocratic Oath that ALL doctors are supposed to be abide by. Mine along with all of us here have had our human rights stripped away. And “The Do No Harm” well that is gone because ALL doctors are now harming their patients. Animals are treated better than a chronic pain sufferer.

    This part is not a political stance- it is my opinion of what is to come.
    Mr. Trump is bragging on how great he is doing with all the low unemployment numbers right he is taking credit for, well I predict either by this holiday season or next years unemployment is going to rise all because so many people are going to be forced to not work because of non care for pain patients. I hope Mr Trump also takes credit for that also.

    One last thing, For those who suggest yoga and any type of strengthening please be considerate. Some of us who have had any type of fusions , especially of the neck can not do that. Research and the ortho surgeons will tell a patient with a fusion most exercises can not be done. With my neck fusion I can not even swim. Thank you

  6. Susan Mapes at 4:38 am

    My husband and I are both chronic pain patients. I have been completely tapered off of my Tramadol for over a year. Everyday is a struggle to not want to die. I know that one of these times the pain is going to win and I won’t be here any longer. My husband is frightened to death that he is going to lose the only thing that makes him mobile the only thing that gets him out of bed. He has done said that if they take away his medicine his quality of life will not be worth living. He has said that the day they take away his pain medicine will be his last day on Earth. No we are not addicts. We have never misused our pain meds we have never diverted our pain meds. We have tried every other form of therapy available. Opioid medication is the only thing that brings our pain down to a bearable level. It is my belief the government is intentionally trying to push chronic pain patients into suicide so that they have less people on the Social Security disability rolls. If things continue the way they do they will have two less people to worry about. Our names are Richard Mapes and Susan Mapes we are the parents to seven boys and eight grandchildren. We are not just a number. We are people. We have lives and a purpose and families who love and need us. But even our family members understand that the pain we are in is unbearable without long term prescription opioid medication and say they with tears in their eyes that they will understand if we eventually have to take the final step because of the government’s interference and rules

  7. Lisa at 2:31 pm

    I am a chronic pain patient with multiple disc problems iny back, it took me five years to get a pain management Dr to finally believe I wasn’t “just a drug seeker” and take one simple x-ray, then another year or so to get my meds managed so that I wasn’t in excruciating pain. I have now been on a regimen – the same regimen- for 10 years. My pain is mostly controlled and I can function fairly well. Last appt with my pain management Dr I was told anyone taking over 100 mg per day of opioids is being asked to volunteer cutting back on meds or risk being cut off completely. I am terrified of going back to being in pain all the time and going through withdrawal, either of which could be the end of work for me as I stand 8 hrs a day.
    This problem in America was definitely not caused by patients like me who are so so grateful to have a bearable amount of pain. I don’t know what I will do but am so terrified. People need to speak out!

  8. Don at 12:49 pm

    I personally belive that we can as CPP do all the emailing, letter sending and face to faces that we want and it will be percived as addicts pissed off that we had our drugs taken away by the powers that be, in fact I bet they base their success on how many of is complain! This is the doctors fight, but apparently they choose to sit this one out. They still make the Same $ prescribing at 90 mme that they do at 150 mme, and after about a year of hearing CPP complain and getting rid of the ones who do comply they figure their job will be easier. They no longer have to hear patients ask for dose increases and do not have to worry about your level of pain. The CDC is your doctor now and they say 90mme is just fine for your pain. The doctors are breaking no laws how can they be persecuted? Sure the powers that be can make their life rough for awhile, but it’s rough on us, right? Doctors need to file a class action lawsuits, they have the resources. I have always wanted to see the letters the doctors received saying don’t go above 90mme or else, how does the language in the letter read to scare doctors into conforming? I want to read one of these letters, to any doctors out there, show us your correspondences you received from the CDC, DEA, etc telling you how THEY want you to practice, what do they do? Make you an offer you cannot refuse,MAFIA style? Lmao

  9. Sherry Sherman at 7:30 am

    I have multiple chronic diseases, require opioids, done all modalities, had surgeries (need 2 more), and refuse to have them due to Arachnoiditis. I’m an RN, obtained my MSN, but can’t work due to being reduced by the CDC guidelines. I’m on the opioid policy correspondent list with Red Lawhern, Ph.D with many others including doctors, reporters, nurses, and chronic pain patients who are advocating.
    I’ve met my legislators in Maryland to include my Senators, Governor Hogan, CMS, and the Department of Health and Human Services. I got through to one Senator, our Governor, HHS and meet them every chance I get. I did this while functioning and not functioning for all can be treated equally. I will continue to meet them, hope to continue making a difference and won’t take NO for an answer.
    My spouse has written on behalf of all being treated unfairly and will continue doing so, but due to his job can’t meet them.
    Petitions don’t work and if emailing worked we wouldn’t be here now. It’s time everyone start advocating for themself and many who commented here are doing so. If you’re unable to meet get your spouse, significant other, family member(s), or friends to go. I did it with emails, then a simple phone call and went from there. I found events happening in my area and made sure I went as a face of chronic pain.
    The paper is shared on Twitter, printed and will go with me to all future appointments and everyone needs to do the same.
    Thank you 😊 for leading the way Red Lawhern, Ph.D

  10. M.Billeaudeaux at 7:27 am

    I just received a letter from my prescription drug company and they are limiting the number of pills per 25-180 days I can fill. Unless they receive a call from my physician. I cannot believe it’s already begun.
    We must ALL write to our congressmen, and the president’s commission to NOT punish those in need of their medicine to live everyday.

  11. Kathleen Kempken at 5:30 am

    I’ve seen some great comments here. Getting these lies and untruths on CNN or one of the Sunday political shows would at least be a start. We need to get this data into the right hands, staring with our senators.
    A few weeks ago I wrote to Chris Christie, he’s on the ‘The presidents commission on combating drug addiction and the opioid crisis’ and on August 9, 2017 I received the same standard reply I’ve received from the three other folks I’ve already contacted. “yes the opioid crisis is a real problem” and then Mr. Christie quoted me statistics.
    I can’t get any one to address where has patient care gone, do no harm and where do true pain patients fit in with opioid crisis?

  12. nana at 9:10 am

    Winnie,
    I spoke to my mail order pharmacy because 4 months ago my Doctor started getting me “pre-certified” for lidocaine patches. They drew it out so long my Doctor dropped the prescription (actually she thought I got it)

    The pharmacy said “the feds make the insurance company pre-certify” this. (what. Do they think I will squeeze it out and drink it?) She followed up by saying “by next year I think EVERY analgesic will need to be precertified.”

    If they can’t make laws to stop the valid prescriptions from reaching pain patients they will make it take so long to “call in” a prescription” that Doctors will give up and patients will not receive it.

    Two routes to secure this PC. This Pain Patient Holocaust.

  13. Mariah Morrissey at 6:03 am

    I am a chronic pain patient. I have liver disease.I cannot take tylenol or ibuprofen, etc. I will cause more damage to my liver or get a GI bleed, both of which could be deadly. This article is wonderful. I do not think doctors prescribing pain meds to patients for a good reason and to have quality of life is what is causing the nations opioid epidemic.

  14. Denee Benson Hand at 12:54 am

    I am suffering from the reduction of my pain medication. It is being reduced to the level of CDC suggestions when the amount that I was taking since 1995 after the failure of laminectomy spinal surgery. I had my first spinal for curvature of the spine at age 14, had hardware breakage needed another fusion at ages 16, 20…finally I was much better until I began having bad pain 14 years later in my 30’s…this surgeon ruined my spine and chronic pain began. I tried to find help for a year and finally Emory University Hospital looked at my films and came in telling me that I had NO FUSION at any level and the metal plate that was in my spine had come out & it was lodged in my abdominal aorta. The next surgerynwss w a spinal specialist & a vascular surgeon…and the next year another 15 hour fusion on my backside. Unfortunately my spinal nerves had been damaged and even though my spine was supported now my pain is life long. It is cruel to take away medication that gave ones in chronic pain any semblance of a life.

  15. Richard A. Lawhern, Ph.D. at 2:18 pm

    The question has come up: if you’re in a State where restrictive laws haven’t yet been enacted against pain patients and opioids, what can you do. Several things, actually. And all of them involve the paper above.

    1. Your Senators and Representative are being lobbied by anti-opioid forces to deny pain relief to EVERYBODY in EVERY State. So these folks need to hear the same messages.

    2. Do the same kinds of in-person interviews with reporters on local television, newspapers or other Media. Demand that they commit themselves to balancing their news coverage and stop being accessories to the persecution of doctors by DEA and the abuse of patients by CDC and FDA.

    3. Talk with your Governor’s staff about getting their story straight concerning combating addiction. Addiction didn’t start with pain patients and it won’t be fixed by killing us off with desertion, abuse and denial of care. There is another paper on my personal publications site that speaks to what needs to be done to be effective in dealing with the opiod crisis. Print that one out and take it with you when you see any of the above… It’s also here on National Pain Report

    http://face-facts.org/a-second-open-letter-to-the-presidents-commission/

    I hope this helps. Keep on keeping on. Never give up. Kick ass and take names — but DO IT IN PERSON!

    Go in Peace and Power
    Red

  16. Winnie McDavid at 1:06 pm

    Due to the fear set forth over this so called opioid crisis some of us are being dropped by insurance or the insurance company demands doctors fill out paperwork that takes hours & of which there is no reimbursement. Having been able to return to work 9 years ago thru social security “ticket to work” program due to successful pain management I now am on the brink of BANKRUPTCY, loss of home etc., just like the years when out of work due to severe pain while awaiting disability. I’ve had to place 6 months of my pain medicine on a credit card while going thru appeal with BCBS of Tennessee where my Florida job headquarters located. Now I cannot afford an attorney to help me file a lawsuit as I’m old enough for Medicare but not allowed to change insurance in the middle of the year. There’s more but enough said here.

  17. Pam Hawthorne at 7:47 am

    Dian Lovejoy & Nancy K: Send your email to President Trump using this link, where you can just enter on a form: https://www.whitehouse.gov/contact
    As several others have provided here, the email address to send an email to the Opioid Commission is:commission@ondcp.eop.gov
    I have sent emails to both as well as many legislators. We need to keep on doing it! If physically able, an even better idea is to meet with your legislators personally:
    – Look up the phone numbers and locations of the nearest local offices of your State Senator, State Assembly person, Federal Senators and Congressional Representative.
    -Call and schedule an in-person appointment with either the office Chief of Staff or a Healthcare Legislative Assistant (or equivalent) to talk in their offices.
    – Drive there and sit down for half an hour to tell the legislator’s staff what we want them and their boss to do.
    – We want them to tell their boss that pain patients’ lives are being destroyed by legislation which restricts access to effective pain medications and drives pain doctors out of practice. As their constituents, we demand that they take a stand in stopping this abuse.
    – We also want the staff member to tell their boss that they need to schedule hearings for legislation to get the government out of medical practice and to repeal existing laws which restrict doctors from providing pain management to people in agony.
    – At Federal level, we want staff to tell their boss that the legislation most needed is direction to the US Centers for Disease Control and Prevention, to immediately retract the 2016 Opioid Guidelines for a major re-write by an unbiased expert group including pain patient advocates and pain doctors as members.

  18. SV at 6:09 am

    I mean’t to say, Amen! Bette! Medical Marijuana should be legal in every state!

  19. SV at 6:01 am

    Medical Marijuana needs to be legal in every state, so people living in chronic pain won’t need to be on addicting narcotic medications!

  20. Deborah at 5:37 am

    I think the article said it best. I feel like that “label ” has been stamped on my forehead for awhile now. Pain Management facilities care more about the money they’re raking in than the actual pain of the patient, in my experience. It’s a dog and pony show every month and I’m left wondering which hoop I need to jump through in order to satisfy my Dr next month.
    I’m a single mom with a 8yr old son. I would’ve never dreamed that at 48 I’d suffer this much on a daily basis. I can’t be the mom I want to be, while these Drs play games with our lives. I can never satisfy them enough. Is this really what I have to look forward to for the rest of my life? “Do no harm” means nothing anymore. When you look at your Dr crying in pain and begging for their help while all they can say is, “I’m sorry, I can’t help you,” then we have a serious problem.
    I can’t and won’t live the rest of my life like this. Thanks to new regulations, I’ve lost my medication, through no fault of my own. I’m now a shell of my former self, lying in bed everyday, and can no longer even walk. This is what the CDC has done to me. This isn’t living, it’s just merely existing.
    What can we do? What steps do we take now in order to change this? I fear for the future and what this has done to chronic pain patients. I waited 40yrs and said millions of prayers to finally become a mother, and for what? I can’t be a mother now. My son should never have to watch me cry in pain and misery on a daily basis. He deserves better.
    So please, tell me where do we go from here?

  21. Tim Mason at 2:52 am

    Bette, I am curious how this medical marijuana prescription program works. My daughter lives in Montrose CO and has a pinched C6 nerve. Her GP sent her to a neurologist that suggested the highly successful neck fusion. She could not commit to surgery at that time because it was during the middle of the school year and her students would be left w/o a teacher, She was sent to a pain management doctor for care until she could decide. She had been taking OTC analgesics for pain and being a runner they OTC meds were wrecking her kidneys and swelling her legs. He wrote her a prescription for Marijuana and said “it was preferred over the “Dr. Jekyll Mr. Hyde” opioids that kill 1000’s of people every day” (His own words }. She told the doctor that she could not use Marijuana because she was a special education school teacher and it use was prohibited by the system.
    My question is how do you treat morning pain before going to work? Do you smoke a quantity of the substance and then drive to your job? Small quantity, large quantity?
    I am not doubting that it works for pain but how does it affect one’s job performance? How do your colleagues feel about this?
    I am being serious with my questions. Are you using the CBD oil with the THC quantity low?
    I am about to be disabled by my employer and I have seen geriatric people like myself in the stores (TV documentary) buying pot for pain.
    Due to the side effects of pot I would guess this would be a medication for the retired, unemployed or disabled.
    Can you shed some light on this for me? Thanks.

  22. Cynthia o. at 10:34 pm

    Excellent, as usual from dr. Lawhern….one question. I live in a state where we still have pain doctors who are prescribing. But I would like to help others, in affected states…what is the best way?

  23. Christine Dix at 9:09 pm

    Wonderful! Am I to understand that this is to be a regular blog/magazine that will keep everyone up to date with factual articles, editorials and such? That would be great….

  24. MC Nana at 8:48 pm

    Dear Red,
    This is an extremely well researched and written article.As Usual you have helped us again and I hope you never stop. We need you and others like you to continue to stand up.

    The “algorithm” generally used because it is “comfortable” for those causing this Holocaust on pain patients just won’t work on all of us. We are all individual humans. All need to be treated humanely and individually- by doctors who are not hog-tied from doing their job by the very good intimidation currently being done by anyone who would like to join the popularity and limelight of jumping on the bandwagon. The PC BANDWAGON. The NON HUMANE BANDWAGON OF INTIMIDATION AND ABUSE OF POWER necessary to stop Doctors who care enough to actually treat their patients.

    I need an operation called a nissen fundoplication. For those of you who don’t know.. it is where (in “minimal surgery”) they wrap about a third of your stomach around your esophagus and sew it down. They attach what is left of your stomach to your diaphragm to keep it down, use your muscles in your shoulder to keep it up and for the first month you subsist on liquids and maalox and cream of wheat while your esophagus heals.

    I am terrified.

    This will cause a lot of pain on top of what I now have….So do I have it done? How do I get over it? (there is talk by some doctors of IV ibuprofen.) They don’t think you need pain meds post op- or think you could get by with 3-5 days worth…………….
    Well, if my stomach (with its ulcers ) could tolerate that- I still do not think it would be sufficient for post op pain.

    Some people are in such pain afterwards they have a fundoplication “takedown” where they attempt to undo the surgery. Takes months to recover. For some years.

    Should this War on pain patients step in and make my surgical decision? NO.
    But does it? You betcha!

    Actually. What happened to HIPPA? How come the “feds” are into our medical records? They are protected, are they not?

  25. Candace Way at 7:41 pm

    I forwarded this to CNN Health. I will also share on my FB and Instagram. We have to be our own advocates, no matter where we live. Share, share, share

  26. Richard A. Lawhern, Ph.D. at 6:58 pm

    Nancy wrote: “This is a very good article. My question is where does it go from here? Is it going to the government agencies creating these guidelines? Is it going to the President? Is it going where someone will look at the truth and actually act on it instead of fear of repercussions by the government, media, etc.?”

    Nancy, the title pretty much says it all. I urge each of you to read this material and then schedule in-person appointments at local district offices of your State legislators and your Congressman and Senators.
    – Take the paper with you and talk with either the office Chief of Staff or a legislative assistant for healthcare or community affairs.
    – Introduce yourself and briefly tell the staffer how you are affected by the CDC opioid guidelines and/or restrictive State laws. If your doctor is leaving pain management because of fear of losing their license, then say so.
    – Inform the staffer that you want them to brief the legislator that he or she needs to introduce legislation and hold public hearings to force withdrawal of the CDC guidelines and repeal restrictive State laws that are destroying the lives of chronic pain patients (like you or your family member).
    – Touch on at least a few highlights of the paper in conversation with the staffer. One of the better points is “properly managed prescriptions to valid chronic pain patients didn’t create the opioid crisis, and restricting prescriptions to people in agony won’t solve it. Possibly 90% of addicts first begin abusing drugs in their teens – long before they will ever see a medical doctor for pain severe enough to need opioids. Drugs are being stolen from medicine closets, pharmacies and hospitals — but relatively few addicts actually begin as pain patients”
    – When you leave the office, be sure the staffer has a paper copy of the paper as well as your email address and phone number. Promise them you will be watching to see if their legislator is on the right side of this issue. You don’t have to promise that you will work for their opponents if they don’t vote the right way. They should be able to “get” that.

    Feel free to follow up with me or other members of the policy group which I facilitate as a corresponding secretary. I can be reached at lawhern@hotmail.com

  27. Erik C. Stubblebine at 5:16 pm

    Thank you Red. I have been going through every hell you mention.

  28. Nancy K. at 4:34 pm

    This is a very good article. My question is where does it go from here? Is it going to the government agencies creating these guidelines? Is it going to the President? Is it going where someone will look at the truth and actually act on it instead of fear of repercussions by the government, media, etc.?

  29. Dian Lovejoy at 3:55 pm

    Great..thanks so much, we desperately need all help we can get..what address do we use to contact President Trump?..again thanks, my dosage of Oxycodone 5mgs every 6hrs, only helps for a short time, but I won’t ask for more because of fear of being labeled an addict…have EDS…which has caused many other problems of health…be safe an blessed.

  30. Teresa at 2:43 pm

    It’s so lovely to read a blog that truly understands the plight of people in pain, during the war on opioids. If I was able I would have stood and cheered, when you wrote about those of us thrown cold turkey after months of pain meds. I was referred to pain management
    The doctors there want to prescribe off label drugs like gabapentin, and elevil. Or burn nerves steroids. Anything but prescribe a Tylenol 3. Then if you do get a narcotic, you are treated like a criminal and must hover your broken body over a cup to provide clean urine. And the drug you prescribed had better be present. If you didn’t take it because it says as needed on the label, 3 days prior to drug test you will test negative, and they will have to do a pill count. That is too much hassle for a person on a walker from stenosis of the spine. Thank you for your hard work. I hope you can get the message through.

  31. M Wagner at 1:36 pm

    We need a spokes person to represent pain patients not recovering addicts like Kennady making secessions in our behalf,

  32. Richard A. Lawhern, Ph.D. at 12:49 pm

    Thanks to those who have joined the conversation thus far. And welcome to those who will choose to do so after reading. As we go forward, remember the title: this document is intended as a briefing paper to be left with legislators or their staffs, following a person to person interview that is intended to put a human face in front of a public issue.

    I invite readers to join a group of people committed to in-person lobbying of their legislators. See http://face-facts.org/lawhern/we-want-you/

    Keep the conversation going. Share this article with friends, family, and other publication venues. I hereby authorize re-print of this work by all comers.

    Regards and best.

  33. Kathy at 12:48 pm

    Thank you so-o very much for writing this article Dr.Lawhern! I have lived in chronic pain for a good part of my life. I entered a pain program in So. Calif. back in 1990. My Dr. Was fantastic–(he wrote one of the pain articles in Practical pain management-listed in your references section.). I had been in his program for more than 20 plus years–I would still see him, but I promised my husband that when he retired, we would move to Idaho. Here it is totally different. I see a pain Doctor-who is an Anesthesiologist. He is frightened by the so called opioid crisis.
    My Long acting meds are being decreased. So far I have been forced to adapt to the lower doses. You are correct about Pain Doctor’s with experience. If you have not been tested as a poor metabolizer etc., you fall into the category of one size fits all w/Medical dosing decreases. My pain Dr. Anesthesiologist is pretty much a person who does not know about drug metabolism testing of his pain patients. My former great pain Dr-had tested me for drug metabolism. I miss my former pain Doctor! So, I too am left fearing the unknown. It is downright wrong-for the CDC to be involved in this hysteria-and supplying wrong information to the Public.
    I will try to write my Senator or Congressmen here. I am one of the “good pain patients-“never abused my meds or anything!! I hope the CDC reads your article.
    Thank you for sticking up for we pain patients -who are doing all the right things!

  34. Candace Way at 12:27 pm

    This is a veery well informed and important article. I’m Canadian but our pain doctors have been stangleholded into abiding by this opioid guidelines as well. It has had the same effect on doctors and their patients who need, and accurately use, opioid medication for pain. Has it been forwarded to the people responsible for this mess. What about news broadcasters at CNN, etc.? I hear about the ‘opioid crisis’ on there often, and it frosts my cookies that they are innacurately reporting on this subject, and helping to maintain the bias, and destroy the lives of people who need these medication to live reasonably ‘normal’ lives.

  35. Deborah babcock at 10:28 am

    Now tru.p is declaring pain medicine a national epidemic and he will make it worse for us to get much needed pain relief..what has this world come to ? The pain med crisis is complete garbage and they’re statistics on it is very wrong. They are lying !!! All the when we all sit in pain. This is against every oath all involved have taken,,,our rights have been stomped on !!!!! Sickening sickening and junkies will always have their drugs. That’s where this should be focused on. The illegal drugs that are being made and sold,,that’s where the epidemic really is….!!!!

  36. Rich at 10:05 am

    You CANT …allow for the continued ‘pain shamming’ and short sighted Govt sanctioned torture.

    I have full body CRPS 2 and CAN NOT get medication to help me function. Opioids are not the silver bullet but contribute to my ability to take care of myself. I am in too much pain to argue.

    CRPS has been revealed as the most painful disease. Pain exceeds amputation.

    You are killing those like me.

    Richard

    —sent to all the primary contacts as suggested. We ALL need to get together before it becomes standard practice!!!!!

  37. C daily at 9:52 am

    Dr. Lawhern, you are the BEST! What’s happening in our country with chronic pain patients is cruel. I have been a RN for 30 and 5 years ago was diagnosed with rheumatoid arthritis. I’m fortunate to have a MD that will work with me. I was referred to pain Manangement by a Ortho spine specialist for two epidural. Being a patient in that setting can be humiliating.
    Thanks for what you do.

  38. Renee E Mace at 9:41 am

    Please Richard A. (Red) Lawhern, Ph.D. write it out as a petition, I and many of my friends would sign it right away. We need people such as yourself to keep sending out petitions out to everyone everyday until someone hears us. I am very bad on writing out my pains and aches, but with educated people such as yourself, you can be our Champion.

  39. HAZZY at 8:38 am

    I’ve been on Opioids for over 18 Years !!! What i have seen 90% of Chronic Pain Patients are not the ones Abusing their opioid meds, it is the people that just want to get HIGH and make it bad for us Chronic-Pain Patient’s. Doctors now have a site where they can key in your Name, Date of Birth and see all the Medications that have been prescribed. So, Doctors need to cut a little slack on Chronic-Pain Patients that do not ABUSE their PAIN MEDS !!!!! THANKS

  40. Sue Woodruff at 8:13 am

    Great article & appreciate someone on our side!
    What can we do ?

  41. connie at 7:54 am

    Everyone needs to share this and suggest that non chronic pain sufferers write or call their senators, congressman, the cdc,dea,fda and the news media! Their voices might be heard more than ours since we’re seen as a bunch of drug addicts!

  42. Bette at 6:36 am

    I would be in horrible shape from this mess if I had not just moved to Arizona. I can now be prescribed medical marijuana for my long term pain. It’s better than opioids, so I want to suggest that the Federal govt make marijuana legal. It would take care of the whole problem. It’s NOT addictive, you can not over dose on it. Problem solved.

  43. M.Billeaudeaux at 6:22 am

    Thank you Dr. Lawhern for your article. It was very informative and educational. Thank you also for standing for the pain patient’s rights. We cannot allow those in government to restrict our physicians who help us live somewhat normal lives.

  44. M.Billeaudeaux at 6:20 am

    Email the commission who is starting to hurt us. The email address is commission@ondcp.eop.gov
    I cannot emphasize enough the importance of contacting your congressmen, the president, Senator Price, etc. And keep on writing. They cannot be allowed to tie the hands of our pain physicians by not allowing them to write prescriptions for certain drugs, that help us maintain a somewhat normal lifestyle by working and spending time with our families.

    Please write.

  45. Barrow at 5:50 am

    Thank you Dr. Lawhern for saying this in no uncertain terms. I hope someone with the power to change things hears it. I hope the suffering of CCPs and our doctors ends soon. But it probably will be too late for me. Last month my doctor, who’s seen me for 10 years, was denied the right to continue practicing until a replacement can be found for his clinic partner who passed away. My doctor’s record is impeccable. So is mine. But because of the “opioid hysteria” the State of Georgia is requiring him to jump through hoops; and, finding a doctor willing to risk what’s happening to so many pain management doctors could take months or years, if one can be found at all. I am almost out of my medication. I’m taking tiny bits at a time. I’m already suffering withdrawal and it’s about to get much worse. I’m too weak and ill to go running from one office to another trying to find a doctor who will write my prescriptions until my doctor returns, or take me on as a patient if he never comes back. I’m an author in my 60s, writing a book I hope to finish. It almost certainly will be my last unless an absolute miracle occurs. I live alone. I am highly functional on my medications. Sick, in awful withdrawal with no medical support, and in pain, I am worthless. I’ll be happy if I can finish this book. If I can’t, I can’t. I never imagined my life ending this way. God bless you doctor, and God bless everyone out there in the same mess I’m in.

  46. Richard Dobson at 5:41 am

    All very good points, Mr. Lawhern. I think you have missed one vital issue. The mushrooming death toll in the past few years has been fueled by illegal poisons and NOT by prescription opioids. The deaths are fueled by NON-MEDICINAL fentanyl derivatives (e.g. carfentanil and furanylfentanyl) that are manufactured in China and shipped to the US, often via the US Post Office. Heroin and these fentanyl-poisons CANNOT be obtained via any medical mechanism….no doctor can prescribe them; no pharmacist can stock them; no pharmaceutical company can produce them for sale. The problem of addiction would still be there without them but the death toll would be far lower without this poisons that have such rapidly lethal effects.

  47. Bruce at 5:13 am

    Red – your hotmail account would not receive an email from me, perhaps your mailbox is full. I would like to volunteer my services, as requested by your previous post.
    Thanks,
    Bruce Stewart
    Bste111@yahoo.com

  48. Dana Shore at 5:10 am

    This was one of the best post I have had the pleasure of reading. It was certainly well researched and without a doubt publicized how the twisted minds of the CDC,the FDA and the damn federal government operate. The only way it could have been any better is if it would have ended with mass hanging, after a short trial of course, with the dirty bastards at the FDA & the CDC that have chosen to torture for no reason cronic pain patients. THE ONLY REASON FOR THEIR ACTIONS COULD BE TO GET NEW DRUGS WITH NEW PATENTS REPLACING OPIODS SO THE DRUG COMPANIES CAN RAPE THE PUBLIC WITH RIDICULOUSLY HIGH PRICES. My thanks and appreciation to the author.

  49. JoAnn Kulaski at 3:40 am

    Wonderful, informative article! I am very concerned that after being on opioid painkillers for 15 years, the government will force pain management doctors to cease writing all prescriptions for those of us who cannot function due to the physical pain in our lives. I am not addicted to my medication, but I do not tolerate horrific pain due to chronic illnesses.

  50. Tim Mason at 3:18 am

    Dr. Lawhern has brought us out of our “Fox Holes” and is leading the charge. I will follow. My copies are printed and will be mailed out beginning tomorrow.
    News agencies as well as many others will find out that misinformation and Inaccuracy in Media will no longer go in answered,
    People have simply stopped thinking for themselves.
    Even the major networks are misleading the people in their broadcasts and even have the president quoting misinformation and misdirecting taxpayer dollars to fix a false epidemic.
    The Government agencies at the highest level even know the information being fed the president is false.

    http://www.healthnewsreview.org/2016/01/the-opioid-crisis-facts-that-news-coverage-is-missing/

    Lying Statistics https://www.thefix.com/opioid-epidemic-exaggerated

    Drug abuse by age. https://www.samhsa.gov/prescription-drug-misuse-abuse/specific-populations

    They admit it is heroin not prescription drugs that is a problem. https://www.yahoo.com/news/the-campaign-heats-up-to-make-overdose-fighting-naloxone-available-everywhere-135455251.html

    Right now the TRUTH cannot be stated enough.

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