AMA Chief Adds Voice to Opioid Debate

AMA Chief Adds Voice to Opioid Debate

By Ed Coghlan

The president of the American Medical Association has added his voice to the national discussion on the use of opioid medication. The AMA has released findings from a national physician survey that show support for policies and recommendations regarding the opioid epidemic in the United States.

“One of the great hallmarks of our profession is to run toward an emergency, to stand with our patients in the midst of their most pressing needs and to show the nation a clear path forward,” wrote Steven J. Stack, MD, AMA president on the organization’s website.

Commissioned by the AMA and the AMA Task Force to Reduce Prescription Opioid Abuse, the survey included over 2,100 physicians who work at least 20 hours each week, have a license to prescribe Schedule II controlled substances and prescribe opioids at least weekly.

Here’s what the survey found:

  • 87% of physicians say prescription drug monitoring programs are valuable in helping doctors understand a patient’s prescription history;
  • Prescription drug monitoring programs would be more effective if they included features such as real-time data usage and electronic health record integration;
  • Physicians want more opioid-related continuing medical education — 68% have taken safe prescribing CME and 55% have taken opioid alternative pain management CME, however one fourth of physicians reported that the opioid CME they needed was not available;
  • More than 80% of physicians agreed that patients who are at risk of an overdose should have access to naloxone by a standing order or agreement with a pharmacist;
  • Physicians said that barriers include a lack of insurance coverage, difficulties finding specialists for referral and pressure for high patient satisfaction scores.

“The next step to help increase access to naloxone is for physicians to co-prescribe this life-saving medication to patients at risk for overdose,” Stack said in the press release. “Just as we would co-prescribe an epi-pen to a person at risk for a life-threatening allergic reaction, we should co-prescribe naloxone to a patient at risk for overdose.”

The survey found strong support for increasing access to naloxone. More than 80 percent of physicians said that naloxone should be available to a patient via a standing order or collaborative practice agreement with a pharmacist.

“Our nation’s opioid epidemic won’t end unless we become leaders by supporting the necessary policies and making the necessary practice changes,” Stack said in his viewpoint. “I urge you to join me in taking these steps today. Now is the time to act — this is our moment to turn the tide.”

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Authored by: Ed Coghlan

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Mary Dunigan

People are sooo confused between the difference between physical dependency on a medication and having addiction issues. If you take pain medication to medicate mental pain you got problems. If you are taking meds for the physical pain in your body so you can live some quality of life that is a different story. There are millions of people that are taking their opiate prescribed meds responsibly everyday. Sadly those people will definitely be affected adversely by this and send people spinning! Personally I feel that opiates are a terrible long term option because at some point for everybody they stop working! And people only end up staying on them to avoid withdrawal or what they perceive might be an increase in their already intractable pain. Anyway, it just sucks that people are having such a hard time deciphering between addiction and dependency. Two separate things!!!!

Dr. Oberg, thanks for your acknowledgment. I frequently interface with and provide online support to literally thousands of chronic neuropathic face pain patients in Facebook groups dedicated to Trigeminal Neuralgia and related disorders. I am careful to identify myself as a technically trained medical layman who has read a lot of medical literature, rather than a medical doctor. And I reflect a lot of patients back to their doctors or to other physicians for second opinions, with new questions to ask.

That said, I suggest that you find and comment upon a recent article on the NPR website which addresses the recent FDA imposition of new Black Box warnings on opioids. Your public commentary as a trained physician can be invaluable to challenging the CDC and FDA propaganda blitz.

A valuable resource in this project may be a 2014 series of four articles in the Los Angeles Times titled “Dying for Relief”. Reporters from the Times analyzed accidental overdose deaths in counties near Los Angeles, associated with prescription opioids. They found that the overdose problem was dominated by deaths associated with a very limited number of physicians. It was NOT a generalized problem in the chronic pain patient population.

If you would like to chat more personally, I’m easy to locate online. My personal website is

Richard Oberg M.D.

Richard L. – thanks for your great comments. You’re spot on and I generally say physicians are ‘risk averse’ and won’t get in the middle of a political firestorm under any conditions unless, sadly, it’s income related. I had to respond positively to an NPR post you did – I’ve altered it slightly and am submitting for possible guest post here. The CDC is so far out of line I can’t believe they’ve gotten away with falsehood after falsehood then picked up by the media echo chamber. Seems no one does math anymore but I do and have laid out the absurdity of pain patients not getting meds anymore. The FDA was the last holdout and now they’re capitulating likely by force I suspect. Once the ‘most doctors agree with the guidelines’ thing happened the AMA fell in line – I guess they don’t want to go below 15% membership. There’s never been an epidemic of anything here and anyone who says it doesn’t know what they’re talking about.

I’m personally fed up with addicts getting their share of opioids denied to pain patients who then go on to abuse THEM. I’m tired of doing everything correct yet having my care dictated nationally to by addiction people – this is nonsense. Primary care providers (mostly internists) should be allowed to get chronic pain certified since they’re the workhorses of much of front line medical care with the best training overall though most probably don’t need it. They’re INFINITELY more qualified than any anesthesiologist or psychiatrist based pain care (chronic pain SPECIALISTS!!!) who do far less rigorous internships and nothing like internal medicine. Systems are in place to monitor and practices need to adapt – it’s not rocket science.

I intend to spend the rest of my career fighting this and agree it’s going to take major legwork to get it done – but it must. I’d love to know what ‘insider’ dealings went on after Frieden took over the CDC and let these people in to start dictating care to everyone. It must be stopped. There’s no reason substitute opioids are necessary – the ones already there are just fine for the vast majority of us.

Sheryl Donnell

True, but in light of the CDC recommendations, the Malpractice Insurance rates for doctors prescribing these drugs can be raised across the board for being at high risk. Insurance companies are notarious for doing this to physicians. 20 years ago it was OB/GYNs.

I think it does nobody any good to accuse doctors of lying to patients whom they have treated for chronic pain and no longer find that they “can” treat, under the prevailing conditions of their profession. Few physicians are brave enough to confront authorities of government or large insurance companies about the harms that are being done to patients by the CDC and American Medical Association in their “war on drugs” mythology. Doctors are normal people too. They have substantial overheads in malpractice insurance and office expenses. They have educational debts. They have kids getting ready to go to college. When they say “can’t” prescribe opioids, they mostly aren’t talking about legal conditions. They’re talking about a judgment that they have too much to lose and the legal environment is too hostile.

In my view, this situation likely isn’t going to change until a class action successfully sues a State government for negligent harms done to patients by failure to render (or allow) appropriate pain care. Alternately, families of patients who have suicided due to denial of opioid pain management may have to sue the CDC for negligence and malfeasance in its unbalanced revisions to practice standards.

Meantime, chronic pain patients can bombard the major television networks with short letters of protest and complaint over the atrocity being worked by CDC, and its ignorant complicity with other government figures who have so completely misread the “crisis” in US health care. If you want to be heard, you will have to shout where you can be heard. The offices of your Congressmen and Senators are another target of opportunity. And it may take literally MILLIONS of letters to make a difference. This isn’t going to come easily.


Sheryl Donnell, the CDC Guidelines were for Primary Care Physicians. Nothing was said about it being mandatory that chronic pain patients be sent to Pain Management Drs. I can’t imagine a malpractice insurance company telling a dr that if they prescribe opiates that they won’t be coverd. The FDA and Controlled Dangerous Substance License that drs have is not something that anyone can get, although all drs that have not lost their medical licenses and their ability to prescribe these meds have them. No dr is going to give up their DEA and State Controlled Dangerous Substance Licenses just because someone doesn’t want them prescribing pain meds.


HOWARD H HEROLD, I know it is hard to accept, but yes, your dr lied to you when she said that she can’t prescribe your pain meds. What she should have said is that she “won’t” prescribe your pain meds. “Can’t”, means she has no choice, “won’t’ means it is her decision. Drs lie to patients about this because patients don’t give the drs as hard a time if they say they “can’t” as patients do if drs say they “won’t”. Ask you dr for a copy of the law that says that she can’t prescribe your pain meds. If she doesn’t have a copy, which she won’t ask her for a statue number, which she won’t have either. The vast majority of patients don’t know what the laws say and they don’t keep up with them so they don’t know that drs are lying.

Sheryl Donnell

If your doctor is part of a practice, it is quite possible that they cannot prescribe any longer, because the practice has made that decision, or that the doctors malpractice insurance is now using the CDC upcoming guidelines to tell this doctor that is he/she prescribes opioids and they are sued, they will not be covered. I would not go so far as to decide your doctor is lying to you. They too are in a whole new world and trying to navigate it. Perhaps an open dialogue asking them for a referral with notes on how you have been a patient in very good standing for ten years would help you with your next doctor. This is a terrible position to be in and I hate to see you there but perhaps if you try to see why your doctor is in this position, they may work to help you transition too. I really hope so.

Sheryl Donnell

The reason more and more doctors are refusing to prescribe opioids is because the new CDC guidelines will require physicians to send their patients to pain management doctors to prescribe opiates in the future. Many doctors are just adopting this stance now. Unfortunately, there have never been enough well trained pain management doctors available to those who chose to go that route before, now, with the CDC pending changes, it will likely be impossible to even get an appointment with a pain management doctor. This is just crazy.




HOWARD H HEROLD, Internal Medicine Doctors and any other Doctor Can Prescribe Opiate Meds. BUT, it is up to each doctor the patients they do and don’t prescribe them to. Just because a doctor says that he can’t prescribe opiates does not mean that he is telling the truth. Unfortunately, doctors lie about not being able to prescribe opaites frequently.


If pain medicine doctors can prescribe opioids, then why can’t an internal medical doctor do the same. The addicts are at fault that we all can no longer get the pain meds we need to control our CHRONIC PAIN !!!!!!

Sheryl Donnell

Well said! Thank you!

Jean Price

Kathy…I agree whole heartedly. And tens units and pumps are invasive procedures with risks too. It’s like they have taken the wrong first step in trying to curb drub addiction and it’s turned into a witch hunt and Puitanical law rules…whoever has the power, prestige, and money will be heard! No matter how aberrant their ideas or rulings are. They’ve taken something simple and turned it into a nightmare. And we’re the casualties..the patients with pain. It very much is an us versus them problem when you live with chronic pain! And very few pain organizations are making any progress, from what I read.


Suzanne, I didn’t mean my reply to sound the way that you took it, I apologize. I do have a question. Why haven’t you seen more pain management drs to see if you can find one that will treat your pain adequately ? Trying ti find a dr that will treat us and one that we can have a good relationship with is not dr hopping or dr shopping. If I’ve misunderstood, I again apologize.

Kathy Cooper

Following this thread is kind of irritating. First of all there is no “Debate”. Opiates have been used for millennia for pain control. Among most qualified Pain Management Physicians who have been prescribing Opiates, there is no Debate. Opiates have been used to treat pain effectively, Studies of long term pain management using Opiates have shown no significant issues due to the Opiates. Efforts to substitute other Medications for Chronic Pain are not very effective for long pain relief, Some of these Medications are more dangerous, expensive, and have more side effects than opiates . There is no debate, that should be clear. the only debate is one created by the Media to sensationalize the Heroin Epidemic, and the use of Opiates by addicts and experimenters. The Statistics they used are misleading to enforce the scare tactics.
Does anyone notice the lack of any mention of the numbers or the Quotes of a Pain Management Physician in this Debate? How about other National issues in the US, not much mention of the “Facts”. It might be significant that this information is left out of the “Debate.” Pain Patients are stigmatized for speaking up and are often too tired or in Pain. Physicians are afraid to speak up. This is a scary climate where people involved are not even mentioned for fear of attracting negative attention.
Another “Fact” in this Debate is that many State created Legislation after the Oxycontin “Epidemic”. This Legislation led to many Physicians either not prescribing anymore, and dropping patient for no fault of the Patient. Some Doctors are afraid, and others needed further Education to Prescribe. The Medications themselves have been reformulated to prevent abuse as required by Law already in Many States.
We need to counter this nonsense with Facts instead of letting the Media, Big Pharma, and the Insurance companies who all Profit by the Debate. There is no Debate. Insurance Companies Profit by this confusion, and the resistance to diagnose chronic pain. In many cases Pain is a symptom of a serious condition, the failure to even acknowledge pain may cause more death and disability, even in cases where no opiate would be required.

BL, I think that you don’t know me and that’s not your fault. I think that I didn’t divulge enough info about my own journey because it wasn’t about that. But due to the nature of your comment I wish to “defend myself”. Also, I’d like to say how in all of my years of suffering w-chronic pain and “severe systemic CRPS” (& so many other real chronic pain issues);This is the 1st time I’ve had to defend myself & it’s with another pain patient! This saddens me. I’ve NEVER been called anything remotely close to “drug seeker, fake, addicted person, etc.. ” (by any Physicians or anyone)…in fact I’ve been called “health advocate, strong, tenacious”,and more! I’ve had only two pain Dr’s in my entire lifetime of 54 years. The first pain Dr and I parted ways amicably, because I went through all of the “steps” & he said I would’ve been a pain pump candidate, if not for the fact that I have “SCID- Severe Combined Immune Deficiency Disease” & Thus my immune disease made me a non-candidate for a pump; due to possibility of infection or/& paralysis etc. So he turned me back over to my GP (where I’ve gone to the same office since 1985!) for pain control using Opiod Medication. He told me he’d have kept me on as a patient but that pain Dr’s are “looked at under microscopes & he prefer if I’m going to be on pain meds that I go to my long time GP”. He told me that he’d be there if the GP needed his advice or a consult….I went on this way with my GP being what he called “the eye I the middle of my storm” from 2005 May Thru Dec 2014. At that time, I rec’d a letter stating that my GP of all those yrs was leaving. I had my last visit with him that same week. He’d promised to call my former pain Dr. (*the only one I’d ever been to…& it was s/p a horrible MVA that included chronic intractable pain, 8 surgeries, 2 screws, 2 pacemakers and later in 2007, I was dx with CRPS & so much more). He’d promised to send all of my records and personally speak to him about his leaving, why I Was on the meds that I was on (which were approved by the medical director of my and where I was in my treatment. I was devastated about my Dr. leaving and terribly upset about the whole situation. Well, although I was a good patient in every way, my old pain Dr. refused to see me or “any of my old GP’s ex patients!” He said he was “inundated by patients in pain from my old GP” and he couldn’t take them all. Also he said “though I am a good patient with real & many pain issues, “he couldn’t help me due to the immune deficiency disease and my not being able to… Read more »


HOWARD H HEROLD, it is up to each dr to decide if they want to prescribe pain meds to their chronic pain patients. They “can legally” but if they decide they don’t want to prescribe pain meds to any of their patients or just you, there is nothing that you can do, but find a dr that will. I know of a number of drs that have told patients that they “can’t” prescribe their pain meds, but they still have what is legally required to do so and all of these dr still prescribe pain meds. It is a drs right to decide which patients they want to prescribe them to and which ones they don’t.



Sheryl Donnell

THANK YOU! I’ve been saying the same thing over and over. All he talked about was addicts and limits. Nothing about helping us, the chronic pain care patient who just needs their pain medication to get through an average day!


Suzanne, how many other pain management drs have you been to ? Not all pain management drs are alike. I have noticed that patients that take high doses of opiates are the ones that usually have problems finding pain management and/or their meds. Drs can’t continue to just increase the dosage of the opiates, more is not always better. Patients also have to do all they can to help with adding non merdication forms of pain management. Have you discussed loweriing the dosage of the opiates you’re now on with your dr ? It may not be pleasant, but it is better than not having anything for your pain. Our bodies do adjust, given time. It took time for your body to get use to the higher doses of opiates and for them to no longer work, so it will take time for your body to get use to lower doses. It seems like a choice of not having your pain managed adequately for a short term compared to not having it managed long term. All the things that you won’t be able to do when your pain isn’t managed, you will be able to do again.

BL & Howard H Harold, it’s true though it may not be “the law”! My GP won’t prescribe opioids anymore and because many many other GP’s are not writing for the opioids any longer either! They …or a huge amount of Dr’s now GP’s, Ortho’s etc, are sending their patients to pain management Dr’s now! They will not prescribe the opioids any longer because they’re “looked into” and “looked down upon” & don’t want the fear or hassle or both! It’s true then what I said,”they won’t prescribe anymore” -or most won’t & say they “can’t” ! They’re looked at under a microscope my old pain mgmt Dr even said same things and now, if his patients are not candidates for pumps or SCS’s (like me, due to combined immune deficiency disease) he tries to pass off all of us/them to “pain treatment centers”!!! Run by Dr’s who are schooled in withdrawals, Suboxone, Methadone and Naltrexone !! These are drug addict treatment centers and I AM NOT A DRUG ADDICT! I have full body/systemic CRPS & Chiari I malformation, multiple herniated/bulging discs s/p MVA 2002! I have Degenerative Disc Disease and Lack of Loradic curvature, L4-5,S-1 & C4,5,6 Radiculopathy, along with Polyneuropathy in Collagen Vascular Disease, Coronary spasms/prinzmetal angina and more!! I’m a chronic pain patient with a letter from a pain Psychologist stating that “I do not have an addictive personality”! I never smoked, drank nor did any kind of drugs! I never even took an Aspirin for a headache prior to being hit by a guy who drove Thru a red light! Now “I’m the bad guy”?? Nooo!! This isn’t right or fair!! The one person who says their GP doesn’t listen but just asks them “how much they’re going down off their pain meds each visit?”…I went thru that too!!My GP of 12 yrs is now working at an urgent care and got fired for prescribing pain med’s to people who truly need it! People like me! So he left me “hanging” and promised to call the old pain Dr who saw me for 4 yrs s/p my MVA! He promised to send records but he did none of that! So the old pain Dr said he “didn’t want any part of that offices mess”(so I’m a “mess ” now because the dr got in trouble?)… He said that I “had every right & reason to be on the pain meds I was on but that the Govt. or FDA wouldn’t see it that way!” He sent me on my way with nothing and would not take me because of my immune def disease, which makes me a non candidate for the pump & SCS…and he sent me to this “drug treatment center”! I’m NOT an addict and it was proven even by a shrink who works with a lot of pain patients!! I was crying and afraid and angry, lost, hurt!! But I went back to the GP’s partner & as long as I promised to… Read more »

Jean Price

To all those who have applauded the AMA…read this article again, please! I know we are all upset and disillusioned about our pain care and would grasp at straws or a kind word. But unless I didn’t read this article thoroughly enough…this is nothing but more of the same folks. THERE IS NOT ONE WORD ABOUT PEOPLE WHO TAKE OPIOIDS FOR CHRONIC PAIN!! Abuse and overdose is once again their focus. Please don’t thank the AMA! They’re not talking about patients with pain! They are on the side of more regulations and alternatives treatments and more education that will undoubtedly be against using opioids. I didn’t see ONE reference to us…and I don’t call that support!


HOWARD H HEROLD, any dr can write pain meds for chronic paii patients. but many are choosing not to.

Hello again … I’m sorry Sheryl D. I did read this article and so many others. I guess I should’ve been more clear in that I meant that not only did Obama help us a bit lately by declining to sign on to the limiting of opioid prescribing; but The AMA has said that the “limiting” is limited to GP’s and to new patients coming in today. The limiting doesn’t pertain to long time chronic pain patients being prescribed opioids by legitimate pain physicians.
I saw this:
“One of the great hallmarks of our profession is to run toward an emergency, to stand with our patients in the midst of their most pressing needs and to show the nation a clear path forward,” wrote Steven J. Stack, MD, AMA president on the organization’s website.”
And then after much research I found that it’s mostly the new pain patients we need to rally behind . Also if you are going to a legitimate “pain Dr.” And have taken Opiods and they’ve worked for a long time without increases, they aren’t bothering these pain patients. It’s the people going to GP’s.& the newer pain patients that we need to help rally behind! I should’ve been more clear and in all honesty I suffer from a TBI along with long term full body CRPS & other forms of non malignant chronic pain. I was not at all totally clear and for that I apologize and am greatly embarrassed for. I hope this is more clear, I apologize to all.

Sheryl D. You say my sentiments exactly! It’s so sad but very real!

Sheryl Donnell

I’m so sorry but welcome to the world the rest of the chronic pain patients are living in. Even though you are not an addict and have been stable on your medication for years, you are now being treated like an addict. You will have to develop a whole new relationship with a stranger, go through mandatory drug testing (even though they have more false positives than can be coubted and cost you a fortune) and pill counts every visit. You can no longer have you meds filled wherever you want. One pharmacy only. And, if that pharmacy decides you are a drug seeker, God help you. Why? Because some people are addicted to Heroin which has no direct link to chronically ill patients. We are being discriminated against and it’s wrong.


Ive had two failed back surgeries, one is a fusion at L4/L5, I take opiods for over ten years!! I take them as prescribed, because my spouse gives them to me, the are locked up in a lock box and in a safe, because i had them stolen from a so called friend that lived across the street, i had to suffer the rest of the month because of him. Yesterday i was told by my Internal Medicine Doctor that she will not be able to Prescribe Opiod’s I don’t understand, I thought a Doctor can Prescribe opiods, so now she said i have to go to a Pain Managment Doctor for my Pain Meds !! Am i missing something ? or does she have to pay a yearly fee to prescribe Pain Meds. All Doctors need to be in Pain like us Chronic Pain Patients. Thanks

Angie Heavner

I find this very ironic. For yrs when people went to the er for injuries, sprains, strains, fractures, breaks, stitches, etc, they doctors use to give out Tylenol with codeine or vicodine or something similar. Didn’t matter what they said their pain levels were those prescriptions were given regularly. Then the shift to ultram, and naproxen, and percocet and other stronger meds. Again with no one listening to the pain levels or the patient. I have personally ripped up several of these types of prescriptions that were given to me or my children instead of filling them.
Now when I need them due to CRPS from an iv 5 yrs ago, I am being told they are going to cut them. The problem isn’t the chronic pain patients, the problem started with doctors giving these out when it wasn’t necessary. Now when they become necessary we are “drug seekers”. No not even close. I take as little as possible to get through the day and be able to function. Otherwise I would be in screaming pain and unable to do anything. That includes taking a shower even eating.
Stop and think and go back and readjust what the “medical professionals” started and remember there is a huge difference between a drug addict and a chronic pain patient. Drug addict will do anything; lie, cheat, steal, etc, to get their drugs. A chronic pain patient just wants enough relief to function. Most of us are happy with getting pain levels down to 5-6 as we are usually living with 8-10 daily.
Its not in our head, its well documented we have a MEDICAL CONDITION, so don’t treat us as second class citizens. Thanks


Im glad the AMA, has realized that Chronic Pain is a real Desease!!! I have been on pain meds for two failed back Surgeries !! I can’t do alot of strenuous things I can only lift 25 pds
It was either have surgury and not walk, but i didn’t know i would be years in pain. THANKS FOR HEARING ME OUT!!!

Sheryl Donnell

Actually, the AMA is against us. They are totally siding with the CDC if you read the message. So far, only President Obama is on our side.

I am happy that the AMA has sided with the pain patients and are trying to stand up for what is right! I’m happy that Mr Obama refused to sign for limiting Dr’s in the prescribing of Opioids for the right reasons! Who do Dr.’s Such as Jane Ballantyne think they are? All the while belittling pain patients, trying to take away our dignity? Who are these Dr’s, as Sheryl D. Says, that are supposed to “1st do no harm”? Where are they now when we need them? There’s no difference proven between malignant and non malignant pain!! We should have the right to use whatever method of pain relief that works individually for each one of us!! I am a chronic pain patient and definitely not now nor ever have I been an addict! I shouldn’t be treated as such and neither should any one of my friends here! We shouldn’t be forced into dangerous surgeries so companies that make pain pumps & SCS get rich !!! Also the Dr’s that perform these surgeries are somewhat cowardice if they’re doing it for the wrong reason! That reason being that they’re just too fearful to give out a pill to relieve someone’s pain! Some of us have medical reasons why we must use medications such as Opioids to reduce our daily, “on fire”, horrible 24/7/365 chronic nerve pain! Please AMA keep listening, trying to help! Don’t give up on us we are definitely pained lives that matter!!

Sheryl Donnell

THANK YOU!!!! Your response was life affirming as a chronic pain patient. I appreciate your support. Please keep writing and helping us. Most of us are in too much pain to do much more than write a few letters, which is the hardest part of this whole fiasco. Most other groups who have something like this happen to them, can organize and start marches and picket. We are all far too disabled to be able to do much of anything. We need the support of people like you to help us. Thank you again.


Jean- you have to offer free season passes to sports events, or fly them to palm beach for a round of golf, or offer them a $150 dinner before theyll consider your opinion- just keep in mind how the competition woos the AMA

Too bad that such a educated bunch of healthcare professionals put so much faith into the PMP system. Totally out of touch with the abundance of fake driver’s licenses and a growing problem of hacked health insurance information and those “insurance cards” being faked/forged as well. Our local hospital system was forced to install a digital finger print reader to attach attached a digital print to a pt’s electronic medical records…because they had multiple people showing up with hacked, forged, altered health insurance medical cards being granted services to only find out later about the bogus medical health insurance ID. All healthcare professionals need for starters is access to the state’s BMV’s on-line data base.. be able to verify name, dob, pic against the person requesting service, and the driver’s license presented and the image of the driver’s license that was issued with that particular number. No match.. no service… but ask the BMV to give you that ability and odds are.. they will tell you that is a violation of privacy… Isn’t like healthcare professionals is in charge of something like all a pt’s personal health information and subject to HIPAA regulations

This evening, I attempted to send the following comment to the AMA. It appears that their site tech support has turned off the public comment gateway by reducing the number of characters permitted in the comment field to “null”. I intend to print this out and send it by snail mail. Others may wish to consider similar steps.


I write as a 20-year advocate for chronic neurological face pain patients, and author of multiple public commentaries addressing physical and mental health issues. I wrote and coordinated the Trigeminal Neuralgia Fact Sheet at US NINDS, and most of the entry on Atypical Trigeminal Neuralgia at Wikipedia. I daily support thousands of patients and families online who suffer in agony and very often are stigmatized not only by family but by ill-trained doctors who have little to offer them. From this background, I urge you to reconsider your uncritical support for the proposed CDC guidelines on prescription of opiates for chronic pain.

There is ample evidence in the published working papers of the CDC and FDA that both are using inflated and distorted statistics when they claim 30,000 deaths per year due to opiate use — and confuse these deaths with those from overdoses of prescription opiates. Reality is far more complex. Many deaths attributed to prescription opiates are almost certainly caused by street drugs or patient suicide. Under-treatment of chronic pain plays a serious role in both categories.

There are 100 million chronic pain patients in the US alone. But not one of those patients participated in working groups at CDC which are busily (in effect) throwing hundreds of thousands of pain patients under a bus. The great majority of patients prescribed opiates do not want to be on such drugs and are not drug abusers. I daily hear the stories of chronic pain patients who are denied medication by doctors or pharmacists who are unwilling to embrace the increasing harassment visited upon them by government authorities. In many cases, these are the only medications which have made their lives even marginally livable for years.

I urge the AMA to take note of President Obama’s recent refusal to sign legislation limiting the initial prescription of opiods. Unlike CDC, FDA, and your new AMA Chairman, the President has pointed out that chronic pain is also a real problem in America, and one that requires much more thoughtful and balanced treatment than you are providing.

Back up and start over, people. Your recent policy positions on opioid management simply do not meet any rational standard of due care, and will almost certainly harm or kill thousands of people.


Richard A. Lawhern, Ph.D.
Patient Advocate.

Please do not punish those of us with chronic pain to save others. It’s so hard to suffer daily without more worry, hoops to jump through to not suffer, we are dependent on the meds to survive that’s what they were created for punish the abusers not me it’s hard enough

Sheryl Donnell

I always write my posts in Word or something I can save, then copy and paste them to.avoid this problem. Sorry that happened. I learned my lesson the hard way too on these sights trying to get my point across. Please try again for all of us!

Jean Price

Dr. Lawhern, I just wrote the AMA on your recommended site. And to my utter dismay, after spending the energy and pain to edit and clarify my point…they said there was an error in their system that made it impossible to accept my post!! Hopefully, I will have the umphh to try again later! Right now I’m trying to feel like the whole world isn’t against us! And that tells me my pain needs some attention!

Sheryl Donnell

The longer I think about this the angrier I have gotten. No where does the AMA address the real needs of the chronic pain patient, the real reason the drugs exist for a large part. It lump us into the group with addicts just reiterates what the medical professionals have been telling us at every meeting we have had all along. You don’t matter. We don’t want to treat patients who don’t get better, you bum us out, so go away. It’s easier for us to decide you are drug seekers than to believe you are really in pain and I am ignoring you. Yep, you are and you have been. Everyone of us has multiple stories of mistreatment at the hands of medical professionals from lab techs to nurses to physicians. Over and over. And now you tell us it’s going to get worse. Shame on you. The hippocratic oath says you must first do no harm. Ladies and Gentlemen, you have been and continue to do great harm. People in chronic pain are committing suicide in increasingly greater numbers because their pain is so out of control and they have lost all hope in their medical professionals. Please stop and think, then help us all!

Barb Hite

Please help people like me that are in pain 24/7 due to multiple pain diseases but can’t get the medication I was getting because my family doctor too scared to prescribe it for me anymore.


To Sheryl D. Thank you so much for your great letter here. It rang so true for me. You really told it like it is, for me at least. Gosh, I’m fighting so many battles right now…escalating rents and having to move again, to who knows where, increasing pain and fear of losing meds, income going down while everything else goes up…etc etc. why is American life like this now? Why is everything a battle? Why isn’t justice and “good” being given a voice? I am 69 and I’ve never seen my country like,this before. It feels like no one is listening to pain patients, or the poor, the elderly poor, the young poor, etc etc. it’s hard to be positive when you are in pain, to begin with. And REALLY hard now, with no one listening who has power to help. I saw Obama’s comments this week, and now the AMA….don’t hear much real understanding or caring.

Karthy Kooper

I have been following this “Debate” since 2001. 15 Years later my observation is that things are worse much worse. There is no improvement at all. There is a clear false narrative about Both Chronic Pain and the “Opiod Epidemic”. I have been shut down and ridiculed for speaking up. I have had to hear spittle accented tirades about “people like me'”. I had no choice but to go on SS, I can not work. I have been in Limbo, since I injured my spine. My first surgery failed to stop the pain. It had taken 5 years to get a diagnosis. When I did try to return to work, I was denied even basic ergonomic help to avoid more back pain. It took 4 years to even see a Neurosurgeon. Now that second surgery a C-spine implant is failing. I am seeing a pattern in what is an alignment of interests, the Insurance Companies that Dole out Medicare, don’t want to pay for the conditions that cause chronic pain. This whole “Opiod Epidemic” is a way to vilify pain patients so that they can continue to deny care that is unprofitable. There also appears to be a trend to try to shift Chronic Pain and other diseases into the Mental health category. In this way they can further deny care. In my State they had a “Crackdown” which led to many Physicians refusing to prescribe, and diverting Pain Patients to a couple of Pain Physicians. I am actually afraid for my Pain Doctor, he is very careful and follows every Law to the letter, but the number of people he sees could be red flag in this climate of witch hunts. I am tired of seeing this “Empowering Patients” and other strategies that lead nowhere. As long as the Media keeps repeating this one sided extremist version of People dying from Opiates and scaring the heck out of people, we wont get any traction. I no longer have any expectation of things improving. There is a massive amount of money being spent to mislead the public. Even Doctor are afraid to speak up, for fear of ruining their reputation. These misreported Numbers, and out of context facts are also good for Law enforcement, they are getting more funding for their “Drug War’. The number of aligned interests and the amount of money at stake is enough to stifle any reasonable response or Scientific reasoning. There are no reports on the number of people who have pain because they were denied basic medical care and it aggravated their condition. there is also no record of how many people who died from opiates were already dying or had significant untreated pain. In the last 15 Years there has been no application of any new research, no new spine surgeries, no improvement. The Steroid Injections that many people were forced into instead of Opiates have been found to have done more damage and scarred the spine. There are no new surgical options… Read more »


Nosal one for those at risk? Those at risk do not see a Doctor period! So stupid and ignorant I am surprised he graduated High School let alone making it to head the AMA, OH my!

Dave write “Unless and until people in pain accept some responsibility for creating a better pain care system-then they will continue to be subject to the designs of others- professionals, insurers, government, etc” While some might find your input a bit hard, there is truth in what you say. I wonder how many of those who have read the article and comments, will choose to visit the website of the AMA and register their objections there, using the link I offered. If patients don’t speak up, then there don’t seem to be many who will.

Jean Price

Daria, just to clarify something because I feel strongly the word addiction should only be used when talking about people who are addicts, truly in trouble with drugs and take them illegally, without a medical condition of pain. When addiction gets used to mean something different, like I think you meant…it can muddy the waters for people with pain. Saying all medications cause chemical changes in a person’s body is a more true way to talk about the use of medications, including those for pain. Chemical changes are not what causes actual addiction…although addicts have that also. Addiction is about craving and seeking a usually illegally obtained drug to block mental anguish, to escape reality and not think about your life because a person feels overwhelmed. It’s an attempt to withdraw from life and block out the world. The chemical changes a chronic pain person goes through aren’t about dependence or addiction….and their goal is 360 degrees different. They want to function better, to embrace life, and to join the world that physical pain has denied them. It’s a little oversimplified, but even when we say dependent, It smacks of addiction. A person who takes meds for chronic pain ONLY has a chemically altered body…not an altered state of mind or an altered view of reality or a desire to block out the world or a dependence based on addictive goals. I’m neither dependent nor addicted because of long term use. I do however have an altered body chemistry from opioids and a number of other meds for other issues. That’s to be expected and is a normal issue for anyone who uses any medication long term. Puts us back in the “okay person” category, I think!, As for the AMA article…I see nothing but meaningless rhetoric! And once again, an emphasis on those who might overdose…as in addicts! How many chronic pain patients overdose, Doctor? When my mother was overdosed in a nursing care facility because of a computer error, they couldn’t give her naloxone because they “didn’t have staff qualified and it was against policy”. She would have to go to the ER! If this is an real issue, how would addicts qualify to take their own? Actually, this is not a question they even need to address of behalf of patients with chronic pain, because we aren’t addicts and we don’t overdose! And now they have all that money to play with for addiction…so just give it to those at risk!! More of the same absurd stuff we’ve been dealing with for years! Nothing new at the zoo, folks! I viewed a great video Donna had posted on FB from five years ago…actually supporting our plight. Nothing has changed, except possibly for the worse. People often post “jokes” from a nursing website and many of them are so abusive it’s absurd. I’m assuming it’s mostly nurses who post them and comment..and the comments make me cringe. Any one in pain is viewed as an imposition to the… Read more »


Unless and until people in pain accept some responsibility for creating a better pain care system-then they will continue to be subject to the designs of others- professionals, insurers, government, etc. Needless to say- government, insurers, providers have done what is best for them and not people in pain. Now- all of them will profit at the expense of people in pain- they will get more money now for urine drug test, more money for counseling people about opioids, more money controlling people in pain. What will people in pain get in return?- more burdensome and time consuming treatment- and less and less say in their own care.
So people in pain need to be more active politically and try to gain more control over their care as a matter of right. Failing that- I think pain care will become worse-and its already pretty intolerable for too many in pain.


So now chronic pain patients are so irresponsible that they need naloxone prescribed along with their opiates ? Naloxone is used in cases of overdose. Naloxone is not needed by chronic pain patients that take their pain meds as prescribed, don’t take other drugs not prescribed, illegal drugs or drink. I doubt that they mean a dr is going to prescribe pain meds at such a high dose that a patient taking them as prescribed could overdose. Again, chronic pain patientrs are being lumped in with those that abuse drugs and are addicted to them. Chronic pain patients have been invisible and silent for too long, and now it is too late.


Gosh, wouldn’t it be amazing if there were an alternative to opioids that was legal on a national level? What an incredible idea!
But I suppose pharmaceutical companies would oppose that.
I’ve heard that opioids deaths are down quite a bit in Colorado.
Something to think about.

Sheryl Donnell

Well, I had really hoped for a lot more from the AMA than this. I am more than disappointed. I am downright angry. As someone who has lived with chronic pain every single day of my life since 2002, with it only getting even worse in 2007 when I developed Chronic Regional Pain Syndrome, a rare disorder rated as one of the most painful diagnoses known to man, all I can say is shame on the AMA. Where is their first do no harm? All he has discussed is the addict. Of patients who are prescribed pain medication, 3% become addicted. THREE PERCENT. The other 97% of us, take our medication exactly as it is prescribed. We often take less than is prescribed for fear of doctors or families will think we are addicts!! We go in more pain than we should all the time, just so others do not think we are addicts, or when we really do need an increase in medication because our condition has worsened, we do not dare ask for it, because we ARE labeled as drug seekers. And now this. Can you imagine if a diabetic acted this way? They would be labeled as someone who wasn’t trying to control their diabetes. But, if I try to control my pain, I am a drug seeker, an addict, a baby, have a low pain tolerance, must have done drugs when I was younger, faking my pain, trying to get attention, just want to get high, and any other number of things THAT I HAVE ACTUALLY BEEN TOLD BY MEDICAL PROFESSIONALS! Can you imagine living like this? And guess what? That was years before these new “GUIDELINES” came out. I have refused to go the emergency room for broken bones because of the horrible treatment I have had there in the past. I will wait and see a doctor I know, at the risk on my own disease spreading, to avoid that. EVEN WHEN I TELL a doctor outright, I DO NOT WANT ANY PAIN MEDICATION, they still label me a drug seeker, when all I am trying to do is figure out a new symptom.. I have been on the exact same dose of my pain medication for the last four years. I have not increased it at all. I am not an addict. I go days without taking my oral breakthrough meds on good days. I do have an implanted pain pump and a spinal cord stimulator, as I could not live with my pain without them. But, on bad days I do need my breakthrough meds. I have not slept longer than 3 hours in a row in 7 years. I have done it 3 times and it was miraculous each time. So, when you hear a doctor talk like this, think of me and the 100’s of thousands others like me. I have never gotten a buzz from my meds. I only take them to feel a little closer to normal, to… Read more »