An Open Letter to the President’s Commission on Combating Addiction and the Opioid Crisis: You Need to Hear a Tenth Voice

An Open Letter to the President’s Commission on Combating Addiction and the Opioid Crisis: You Need to Hear a Tenth Voice

By Richard A. Lawhern, Ph.D.

This article is edited from correspondence sent to the Office of National Drug Control Policy on June 17th, 2017.  Others who wish to make their voices heard may also do so by email to commission@ondcp.eop.gov .

— — —

With many others, I listened and watched for two hours of the first working meeting of the Commission on Friday June 16, 2017.  The Commission was addressed by leaders of nine Non Profit Organizations engaged with various aspects of addiction treatment.  Much of the input seemed quite apropos.  But one voice was missing from the session that is vital if the Commission is to arrive at safe and supportable recommendations on this important public health issue.

Speakers failed to include even one practicing physician or advocate for pain patients who have largely and unfairly been blamed for the so-called “opioid epidemic”.  I urge the Commission to remedy this exclusion by inviting participation in an additional session by organizations such as the American Academy of Pain Medicine, the American Academy of Integrative Pain Management,  the National College of Physicians,  PAINWeek, Pain News Network, National Pain Report, and/or the US Pain Foundation.  Commission staff should be able to identify other physicians who are deeply trained in this field.

Richard A. Lawhern, Ph.D.

In the absence of such input, I offer my own insights as a 20-year volunteer advocate who daily interacts with more than 20,000 chronic pain patients, among the estimated 100 million Americans affected by persistent, long-lasting pain (by the American Academies of Medicine).   Within this group, an estimated 16 Million are treated in any given year for recurrent persistent pain, and on the order of 3 Million are treated for more than 90 days with opioid analgesics. [1] [See “Neat, Plausible, and Generally Wrong — A Response to the CDC Recommendations for Chronic Use” by Stephen A. Martin, MD, EdM; Ruth A. Potee, MD, DABAM; and Andrew Lazris, MD  https://medium.com/@stmartin/neat-plausible-and-generally-wrong-a-response-to-the-cdc-recommendations-for-chronic-opioid-use-5c9d9d319f71   ]

I am myself neither a physician nor an expert in addiction. My training is in systems engineering, experimental design and technology analysis.  My wife and daughter are the pain patients in my family.  But I talk with and read the work of many medical and pharmacy professionals, including several who were originally copied on this letter — all of whom have published in this field.

I believe I can lend support or amplification to several points made by speakers in the first session of the Commission.   Certain aspects of the discussion stand out.

  1. A large number of addiction treatment and recovery programs now operating in the US are funded by Medicare.  To address the “opioid crisis”, the Commission must be prepared to advise President Trump to expand the scope of conditions treated under Medicare, not reduce it.
  2. As several speakers suggested, effective programs to reduce the death and destruction wrought by illicit drugs must be multi-dimensional.  Five aspects must be addressed.  None is adequate to stand alone, or will be effective standing alone.  There are no simple solutions here.

a.  Prevention in kids, beginning in Middle School, continuing through High School and beyond.

b.  Prevention in adults, focusing on employment development and the creation of hope.  Addiction in adults is not primarily a disorder created by drug exposure.  It is created by social disintegration and hopelessness that leave people vulnerable.

c.  Initial recognition of addiction by properly trained community medical professionals.

d.  Ongoing community engagement and support for recovering addicts over periods of at least 3-5 years and possibly longer.  Relapse is an ongoing issue for which there are no simple, one-size-fits-all solutions.

e.  Diversion of addicted kids and adults out of the prison system and into community treatment and re-integration programs.

As noted by Governor Christie, overshadowing all of these dimensions is the reality that we must reduce the moral condemnation and stigma now assigned to addicts in order to be able to engage them, their families, and their communities in corrective initiatives.   Not mentioned in the proceedings, the same is true of the stigma and abuse which are regularly experienced by long term pain patients and by doctors who attempt to treat their pain.

  1. As several speakers suggested, any program recommendations must be evidence-based and reinforced by sustained observation of outcomes.  We should not be wasting limited resources on measures that don’t work.  Some of the statements of participants stand out in flashing lights.  These can be readily confirmed by even minimal research on the part of Commission staff.

   a.  90% of drug addicts first encounter opioids or other intoxicants as adolescents, either on the street or by diversion or theft from family members.  Not explicit in the proceedings is the reality that it is unusual for adolescents to have medical encounters which require treatment with opioid analgesics.  Thus this statistic makes clear that prescription drugs under active physician management are NOT the primary cause of the opioid epidemic and likely never were.  Further restriction of prescriptions to people in agony will not be a solution for this essentially “social” problem.

b.  The most effective interventions for confirmed addiction are medication-assisted.  This means programs like Methadone maintenance.  We have multiple international examples of maintenance programs which work.  For the politically bravest of the brave, we should also examine the experience of Portugal, where possession of drugs has been decriminalized for 14 years — and where overdose deaths have dropped to near zero as rates of addiction are dropping.

c.  Although community-based therapy in the 12-Step model might be a supporting element in recovery, this model is clearly inadequate by itself.  Relapse rates into addiction by 12-step attendees are abysmally high.

d.  As one speaker noted, “more beds are not the answer”.   28-day detox programs — including those used in the Phoenix House chain of addiction treatment centers, on the Board of which one of the speakers participates — are ineffective when not backed by ongoing community interventions.  Media are littered with stories of addicts whose first act after leaving a treatment center is to find a dealer and shoot up.  Some published figures on relapse rates for discharged addicts approach 95% within one year.  This too can be confirmed by Commission staff.

  1. I note in passing, that the Commission must also wrestle with a contentious reality:  not all sources of advice are equally credible.  My sense of the working session was that some of those who addressed the Commission were financially or professionally self-interested.  I personally have particular reservations concerning the helpfulness of psychiatric care, given that the entire field of psychiatry is now experiencing a crisis in public confidence due to scientific corruption and over-medication promoted by pharmaceutical companies.

While we know that many addicts also deal with life crisis problems called “mental disorder”, there is legitimate doubt that psychiatry presently has reliable remedies to offer.  More basically,  use of anti-psychotic drugs has been associated with a marked drop in life expectancy and function among patients who are medicated involuntarily.  For further on this subject, a useful resource is “Psychiatry Under the Influence – Institutional Corruption, Social Harms, and Prescriptions for Change” by Whittaker and Cosgrove, available on Amazon.  I would advise the Commission to apply the same standards of evidence to psychiatric programs as to all others considered.

  1. If the Commission is to seek solutions to the addiction crisis, then it seems to me that they must first be able to separate out hype from facts in understanding what is going on. I offer the following in my role as an advocate for people in agony who stand to be grievously harmed if the Commission gets this narrative wrong.

   a.  Origins of the rising tide of opioid-related deaths are frequently attributed to careless prescribing practices of the 1990s, encouraged by pharmaceutical companies who touted “Pain as the 5th Vital Sign”.   It is certainly evident that prescribing practices were greatly liberalized during that period.  What is not so obvious is that ill-trained physicians not only over-prescribed to patients whose pain might have been managed by other means, but also to undetected addicts who shammed pain to get safe and regulated drugs of choice.

b.  The impact of over-prescribing was arguably and primarily NOT on legitimate pain patients themselves.  A Cochrane Review of 2010 of long term effectiveness and risks of opioids, found that among patients who were previously opioid-naive, the number who later presented with opioid abuse disorder was fewer than 1%.  Other and later studies have placed abuse rates at 5-10%. [3,4] [Ibid Martin et al..  See also “Warning to the FDA – Beware of Simple Solutions for Chronic Pain and Addiction”,  R.A. Lawhern, Ph.D., http://nationalpainreport.com/warning-to-the-fda-beware-of-simple-solutions-in-chronic-pain-and-addiction-8833744.html .  This article has since been featured in PAINWeek with a short introduction, as “What If Prescribing Standards Were Patient Centered?”]

c.  Much of the present “crisis” in opioid related deaths can  be laid at the feet of the FDA, when they forced the reformulation of OxyContin into “abuse resistant” form in 2010.  In the next three years, deaths attributed to heroin increased by more than 200% while prescriptions of Oxycontin dropped by 66%.  [5]

[“Have Opioid Restrictions Made Things Better or Worse?” by Josh Bloom, Ph.D.,  http://www.acsh.org/news/2016/11/03/have-opioid-restrictions-made-things-better-or-worse-10400 ].  Heroin deaths continued to skyrocket in 2014-2015.  A plausible explanation for these statistics is that addicts who previously used Oxycontin found that they no longer got high on it, and were forced into unsafe street drugs.

d.  Whatever we may believe concerning how the “opioid epidemic” got started, there is ample evidence that it is no longer sustained by prescribed analgesics if it ever was.  Mortality statistics of the CDC itself reveal that in 2015, deaths attributed to overdose were dominated by heroin, imported fentanyl, diverted or stolen morphine and methadone.  Co-prescription of anti-anxiety medications (Benzodiazepine) was observed in about half of the 33,000 estimated accidental overdose deaths in 2015, and alcohol played a role in more than half. [6]

[“New CDC Overdose Study Reduces Role of Pain Meds” – Pain News Network, December 26, 2016,  https://www.painnewsnetwork.org/stories/2016/12/26/new-cdc-overdose-study-reduces-role-of-pain-meds ]

In States like Massachusetts where mortality statistics have been compared with prescription databases, it is found that fewer than a quarter of the deaths attributed to opioids occurred among people who had a current prescription for them.  It also seems likely that many deaths reported as accidental were in fact suicides or sudden cardiac arrests caused by unsupervised sudden withdrawal of opioids by physicians leaving pain management.   Veteran suicide due to denial of pain relief is an even more evident trend.

e.  One of the speakers to the Commission asserted that simple “enforcement” of the March 2016 CDC Guidelines might reduce overdose deaths by half.  The implication was that a 90 MMED dose limit should become a standard of practice for all pain management physicians.  Unfortunately, I believe that speaker was grievously wrong.

I would assert from wide reading and direct observation of social media, that CDC guidelines have already been directly responsible for at least hundreds of patient deaths in the past year.  In their present form, they are deeply and unfairly biased against opioid pain relief, scientifically unsupported, and vastly incomplete.  Of particular concern is that natural genetic variability of patient responses to opioids was utterly ignored by those who wrote the Guidelines.   Any physician training that is based on these Guidelines may be responsible for deaths among patients who hyper-metabolize opioid analgesics, and therapy failure among many more who are poor metabolizers due to polymorphisms in the expression of key liver enzymes.  [7]

[See “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 ]  These errors and omissions are well known among pain management physicians.  The Commission should consider recommending that the CDC Guidelines be totally rewritten by a qualified consultants group led by pain management physicians and supported by patient advocates and medical ethicists.  In their present form, the Guidelines are “unsafe at any speed.”

Thank you for accepting this input.

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 26 comments for this article
  1. scott michaels at 7:22 am

    Then we need to get millions of signatures and see who wants to be reelected. These pain magazines could help us but they arent. They can PRINT EVERY COMMENT FROM THESE SITES AND MAIL THEM OFF TO EVERY STATE AND FEDERAL LEGISLATER SAYING IF THEY WANT OUR VOTE WE NEED THIER HELP. 45 billion for.opioid epidemic. Lololol its a heroin epidemic. Give that money directly to the snakeoil sales people.

  2. Junior B. at 4:28 pm

    Thank you for attempting to help. I’ve been on pain management for over 10 years. I’ve never run out, never asked for an early refill, never failed a urine test, but I live with constant pain. I personally cut myself back and went from ER meds (duragesic 50 and Avenza 90). Not at the same time but both were supplemented with 3 x 7.5 vicoprofen a day. I found I could do ok on just the vicoprofen. I was on 150 a month. Then I went to Norco 10/325 at 120 a month. I’m now at 135 or 4.5 a day and am 65yo. I’ve come to the point of needing something a little more but in this government climate my doctor no longer seems willing to do anything more. I tried adding Cymbalta and it made things worse. The CDC guidelines also recommend pain clinicians not test for THC but they ignore that here in GA.
    I wrote all that to say this.
    Unfortunately, these politicians are NOT going to listen to anything any of us have to say. They have a public perception campaign going and will use it to further their power ad their control over us.
    We will be on our on. We are on our own now. It will get worse before it gets better… if it gets better. If you have a good doctor, stay with them. If you’re new to chronic pain good luck.
    Again thanks for trying to help. I’ve talked to my congressman and senators. I’ve written Whitehouse.gov.
    Government will do what it wants. Politicians do not care about you or me. They care about power and re-election. They use sensationalism like the “opioid epidemic” to their advantage. Our words are spoken into the wind. I’m sort to be so cynical but I’ve seen too much to not be.

  3. Emily Raven at 2:40 pm

    Take off the blinders BL. You can’t say something isn’t about us when what they do effects us directly. As for “making pain patients look like addicts because they can’t live without opioids” YOU are being part of the problem by not being able to differentiate dependance/addiction or the fact that some of us deal with things that result in cardiac collapse when our meds are stopped, yes it is that bad. A comment up about Medicaid not covering us… Gee now why is that, maybe because our flipping president is listening to parents that couldn’t parent and have to make themselves a victim of an inanimate substance that has been used for thousands of years and didn’t become a problem until this victim culture on top of the ACA giving tons of money to be made available for detox treatment? Give me a break.

  4. Connie Wagner at 4:10 pm

    These anti-opiate zealots in all levels of government seem to be blind, deaf and dumb when it comes to treating chronic pain. They choose to be this way because most of them have monetary investment in the treatment of addicts. Sadly even if they were to be in chronic pain they would not have to live with the stupid guidelines and now regulations that the rest of us are subject to! I thank those few people who are in a position to be heard that are willing to speak up! Most of our voices will NEVER be heard because we are nothing to the powers that be but a bunch of drug addicts complaining that we can’t get our fix! It’s wrong on so many levels but what can we do? There’s not a lawyer in the country willing to lose their lucrative jobs in order to help us. My medication has been cut by 90% in the last year and a half and I can barely function, I can’t even allow my wonderful husband of forty years to hold me anymore! To some that may not be of great importance but to me it is very important! Please someone listen to us! We aren’t addicts we are chronic pain patients who just want a chance at some relief!

  5. anonymous at 8:34 pm

    Dr Lawhern, as always I thank you for all your support for the chronic pain community! During a recent dinner party I ran into a physicist that works in the ER at our local hospital. We got into a very interesting conversation about the opioid epidemic and was very vocal that he wished that others wished the could spend a week in the crisis unit he covers. In the last year he has seen a huge increase in the number of chronic pain patients with failed suicide attempts or suicidal due to under treated pain. He mentioned that it’s outpacing the number of addicts that he is treating. Unfortunately the suicide patients fall into the “major depression” category so there is no good statistics on how often this is happening,

  6. BL at 1:13 pm

    Dawn T., Louisiana Medicaid does not pay for a Pain Management Doctor. Very few regular Medicaid Providers will prescribe opiates for chronic pain to Medicaid patients. Louisiana Medicaid does not pay for the management of chronic pain. Louisiana Medicaid does not cover alternative therapies.

    Louisiana Medicaid, as well as other State Medicaid programs, have limits and restrictions on opiates prescriptions. Beginning May 1, 2014, Louisiana Medicaid limited All hydrocodone containing drugs to 720 units in a rolling 365 days. For example, if a Medicaid Patient was prescribed no more than two tablets a day for twelve months, their hydrocodone prescriptions would be paid for by Louisiana Medicaid. If they were prescribed more, when 720 was reached and if it had not been a rolling 365 days, Louisiana Medicaid would not pay for the prescription.

    State Medicaid programs restricting and limiting the use of opiates for chronic pain began in 2010, thanks to Charles Grassley (R-Iowa). In 2010 he sent letters to State Medicaid programs inquiring about Medicaid Doctors that were high prescribers of opiates and certain psychiatric drug. In 2012, he sent letters demanding to know if the states had set up a way to identify and monitor Medicaid Prescribers that prescribed high amount of these drugs. If the states didn’t have a system in place, Grassley wanted to know why they didn’t. He also wanted to know what Disciplinary Actions were taken against Medicaid Providers that were high prescribers. Medicaid is a welfare program and paid for by taxpayers.

    Each State Medicaid Program determines their states limits and restrictions. State Medicaid Programs have to obey state laws. But, Rules, Limits and Restrictions State Medicaid Programs have only affect those that receive Medicaid and Medicaid pays the bill.

  7. Richard A. Lawhern, Ph.D. at 11:46 am

    Thanks to all who have commented thus far. I encourage readers to print out a copy of this article and to give it to their primary medical care providers with a request that they visit National Pain Report and comment as professionals.

    That being said, there is a lot of activity underway surrounding the FDA’s request to withdraw Opana ER from the market.

    I just posted the following comment to The Academy for Integrative Pain Management article, “AIPM’s Response to FDA’s Request to Pull Opana ER Off Market”. It is presently waiting moderation. Pain patients may also want to comment there:

    http://blog.aapainmanage.org/fda-pulls-opana-er/

    I am personally acquainted with a chronic pain patient for whom Opana ER has been a major savior of her life when she couldn’t tolerate other pain relieving medications. By taking Opana off the market when nothing else is available to take its place, the FDA may very well kill her.

    I encourage members and leaders of AIPM to take a MUCH more active public stance concerning the rank idiocy that is being forced upon chronic pain patients by the US government: CDC, FDA, DEA and I fear the President’s Commission on Combating Addiction and the Opioid Crisis. It is time for AIPM to publicly advocate for withdrawal of the March 2016 CDC Guidelines on prescription of opioids to adults with chronic pain. The Guidelines are demonstrably (and perhaps fraudulently) biased against opioid analgesics and the patients who have been stably and safely maintained on them for years. The Guidelines reflect weak medical evidence and unsupported opinion. And they dangerously ignore the medical science of opioid metabolism which renders any maximum dose limits totally inappropriate for poor metabolizers.

    In a spirit of outreach, I encourage your members to visit the National Pain Report and comment on a recent article there: “Warning to the FDA – Beware of ‘Simple’ Solutions in Chronic Pain and Addiction. http://nationalpainreport.com/warning-to-the-fda-beware-of-simple-solutions -in-chronic-pain-and-addiction-8833744.html

  8. Bruce at 4:58 am

    Thank you, Red. I am volunteering my services to the cause. Everyone knows what the issues are, so I won’t re-hash them, but just let you know that I am willing to do whatever it takes to help my fellow brethren in the chronic pain community. This is life and death.
    Bruce Stewart

  9. Scott michaels at 10:07 pm

    the cdc coukd take care of the desease kf addiction. pain management doctors can take care of ppeople in chronic pain that are dependent on high opioid pain therapy to monitor their oain and deoendence on the medication. there is no 1 dose that good for all. actually an addict shouLd not have ANY OPIOIDS. 1 pill is too many and a thousand not enough. the cdc knows this. they need to recognize 40 million of us are not addicts. we can become addicts because a hungry person will steal to eat. its natural that a person in severe pain that had successful treatnent taken away will naturally look for relief. if its bootleg pills or heroin they will try it. ITS HUMAN NATURE.IN MY OPINION AND MANY OTHERS, SINCE THESE GUIDELINES CAME OUT EVERY DEATH FROM HEROIN OR BAD PILLS IS THIER FAUKT AND SHOULD VE HELD CRIMINALLY LIABLE FOR EVERY DEATH BECAUSE THEY NEVER TOOK THESE PATIENTS LIVES INTO CONDIDERATION BEFORE THEY PUBLISHED THESE TORTOUS DR MENGALA TYPE GUIDELINES. YOU MUST FEEL SEVERE OAIN ON A DAILYBBASUS TO UNDERSTAND THUS

  10. Mike hause at 9:46 pm

    thank you. unfortunateĺy i believe these are deaf ears. my doctor cut my paim meds in half. it took my original dr 8 months to grt the dosage correct so i can live with minimal pain. i now live with a 6 to 10 daily pain scale, deoending on my activity. my life is aweful. with kaiser it was mandatory. i fought all the wAY to the ceo. i heard the same thing the high dose iwas is taking is no longer medically necessary. it was medically necessary for 7 years. even kaiser thought so for two years. then BOOM..NOTHING CHSNGED EXCEPT im older dthe stenosis is worse as are the other spinal conditions. .NOT ONE DOCTOR EXAMINED ME PROPERLY. MY PCP FEELS TERRIBLE BUT CANT LOSE HER JOB OVER ME. SHE IS FORCED TO REDUCE. THE BOILER PLATE LINE IS TELL THE PATIENTS THEY WILL DIE IF THEY CONTINUE AND ITS NO LONGER MEDICALLY NECESSARY. THEY SUGGESTED PHYS. THERAPY WHICH IVE DONE IN THE PAST AND INJECTIONS ALSO DONENIN THE PAST. EPIDURALS ACTUALLY CAUSED MORE PROBLEMS. THE KAISER EPIDURAL DOCTOR SAID IT ELECTIVE WILL COSR ALOT OF MONEY AND SIMCE ITS HAS NOT WORKED IN THE PAST IT WONT WORK NOW. HE SAID I AM COLATERAL DAMAGE. THIS IS NOT RIGHT. IS OUR COUNTRY JUST TRYONG TO KILL OFF THE CHRONICALLY PAIN PEOPLE OR CREATE MORE HEROIN JUNKIES. OPOID THERAPY WORKED GREAT FOR ME. I TOOK AS DIRECTED. NOW I HAVE TO MONKEY AROUND.EANING WHEN THE PAIN IS SUPER BAD I MUST TAKE EXTRA PILLS ON THOSE DAYS. THIS MEANS AT THE END OF MONTH I AM BED RIDDEN LIVIMG WITH MINIMAL MEDICATION. I KNOW NOT TO COMPLETELY RUN OUT OR ILL GET WITHDRAWLS OR END UP IN ER. WE TJE LEGIT PAIN PATIENTS ARE SUFFERING GREATLY BECAUSE GENERALLY YOUNG PEOPLE ISED THE MEDICATION TO GET LOADED. I HAVE MY WIFE GIVE ME MY MEDICINE DAILY. MAYBE IF THERE WAS A SAFE FOR PILLS THAT WAS FILLED BY THE PHARMICIST ANDNONLY OPENED ONVE A DAY THIS WOULD CONTROL PEOPLE TAKING TOO MANY AND AT THE SAME TIME ALLOWING HIGHH DOSW PATIENTS THE MEDICATION THEY NEED. I WAS FORCED TO GO FROM 3 80MG OXYCONTIN ER AND 30 oxycodone ir daily to 3x 40 er and 4 x 15 IR DIALY. I HAVE HAD METABOLISM TESTS THE MEDICINE GOES RIGHT THRU ME. i have never felt high. EVER!
    when i was in my 20s i smoke a ton of pot. I was a zombie. i was a good provider but i smoked and drank daily. i know what its like to be wasted. Its been 3o years since i smomed and 10 years since ive had a drink. id much rather be able to function and be pain free. todays weed is super weed and i want no part of it. i have stage 4 cirrohis so i wont touch booze.
    if opioid works for people we ahould no be ohnished because others abused the medication. NOBODY DIED BU JUST TAKING THEI MEDS AS DIRECTED. THEY.MIXED WITH BOOZE POT ZANEX ETC. PARTY DRUGS. INJECTING SNORTING ETC.
    WE DONT DO THAT YET WE ARE TREATED AS WE DO. I WOULD SOEAK IN FRONT OF ANY COMMITEE. I WOULD TAKE MY HIGH DOSE I FEONT OF ANY DOCTORS OR COMMITEES. GHEY CAN SEE I AM CORRECT. WE HAVE PEOPLE THAT HAVR NOT GONE THROUGH THE PAIN WE DO MAKING DECISIONS ALONG WITH REHAB HOUSES LOOKING TO PROFIT FROM MEDICARE AND INSURANCE COMPANIES. OUR VOICE MUST BE HEARD.
    YOU DONT GO TO A DENTIST TO SEE WHATS WRONG WITH YOUR FOOT. YOU GO TO A PODIATRIST. PAIN MGT DOCTORS AND PAIN PATIENTS MUSTUST MUST BE THE VOISES HEARD WHEN THESE DECISIONS ARE BEING MADE. THIS FAKE OPIOID EPIDEMIC IS THE HEROIN EPIDWMIC THAT BEEN AROUND SINCE THE OPIUM TRADE BEGAN IN THE 1800’S. WHEN THERE IS A LEGIT REPLACEMENT THAT IS NOT A SNAKE OIL WE CAN TALK BUT UNTIL THEN OPIOID PAIN THERAPY IS THE GOLD STANDARD WHEN THE DOCTOR IS HONEST AND THE PATIENTS HAVE PROOF OF THEIR PAIN BY MRI CT SCANS XRAYS ETC. I AM PERMANANTLY DISABLED MAKING 2K A MONTH. I WAS MAKING 10K A MONTH BEFORE MY.PAIN. I WAS TEYING TO GO BACK TO WORK BUT NOW NO WAY. I AM UNHIREABLE. I PUT TWO KIDS THRU COLLEGE. MNI NEVER WANTED TO HAVE TO NEED THEIR HELP. ESPECIALLY IN MY MID 50S. THE.PENDULLLUM SWUNG TOO FAR CAN WE PLEASE PUT IT IN THE MIDDLE WHERE IT BELONGS.
    MANY THANKS!!!

  11. Dawn T. at 9:23 pm

    Thank you for speaking out on behalf of all of us Mr. Lawhern. As a chronic pain patient who has degenerative disc disease, I have 9 vertebrae that are gone. Due to my weight and my back issues, I suffer from osteoarthritis in my knees, shoulders, ankles, etc.
    I never asked to be like this. My original back injury was the result of a drunk driver who struck my mothers vehicle when I was 12. Another rollover motor vehicle accident 15 years ago broke the end of my collarbone off and I was left unaware of the injury until years later. To late to repair the injury. I have had two surgeries since and no longer have the end of my collarbone. I cannot get a new shoulder joint as there is nothing left to attach it to.
    Due to things beyond my control, I suffer daily. Just last year I broke another vertebrae due to the degeneration of my spine. There is no putting jumpy dumpty back together again. My reality is I will someday be paralyzed from my condition.
    ( They told me I would be in a wheelchair by age 30. Knock on wood I turned 40 last year.)
    As I live in a state taking the “Opioid epidemic” to the top of extremes, I have already had my OxyContin removed. And by January 2018, I will no longer have any opiates for daily function.
    My states medicaid program has chosen alternative therapies like acupuncture, massage therapy, chiropractic care, etc.
    My primary doctor has found only one acupuncture clinic in my state that accepts Medicaid coverage, as they do not pay enough and are difficult to bill.
    With my condition, massage therapy and chiropractic care are not an option as they could paralyze me.
    I have had a pain contract and traveled 5 hrs round trip for the last 5 years to see my nearest pain specialist and receive my medications. I have had random and regular urine testing and pill counts. I have never broke the terms of my contract, failed the tests, or abused my medications. I have endured being treated like a criminal on probation or parole, to receive the medications that provide my mobility.
    I now am being forced to apply for social security disability benefits, as there is no hope of me working any form of gainful employment after the first of the year.
    My future is a painful place that I fear will paralyze me and kill me without my mobility.
    For those who do not know what it has been like to live the last 28 years in pain…. imagine the pain of childbirth, a broken bone, or an injury. And that pain NEVER goes away. That is my daily life.
    While I recognize an epidemic in America of drug deaths, I did not cause this and do not deserve to have my right to pain relief in my life removed because of the actions of others. And yes, the right to a healthy, pain free life is just that a right.
    Doctors swear to do no harm, (As my doctors have done by informing me that chiropractic manipulation is not an option as it can paralyze me) Now my doctors hands are tied and he can no longer prescribe me the medications that he has deemed necessary to my daily life and mobility.
    It is not only the patients right to care but the doctors right to provide care that is being taken away.
    Thank you again and keep up the good work.

  12. K at 10:15 am

    Thank you! Thank you! Thank you from all of my Heart for your advocacy, knowledge and help!
    Chronic, intractable pain is unfathomable. Not remotely comprehensible to anyone who does not have it. The reality of living with it is so incredibly difficult!
    Thank you for the link. All CPP need to speak up. The stigma and shame needs to stop.
    I feel the Government and Health Insurance companies have no business in the doctor, patient and treatment of any patient. But because they are intent on governing, they should do so responsibly with knowledge and care.

  13. Danny at 7:16 am

    Red Lawhern, I wrote to the commission. Like I knew it would, it paled in comparison to your letter, but that’s ok. The main points I made were the need for pain mgt doctors and pain organization representatives (and intractable pain sufferers) to address their Commission. I hope it accomplishes something. But, regardless, I feel like I did my part to try to help severe, intractable pain sufferers. Fingers crossed!

  14. Mike Daniels at 1:10 pm

    This war on doctors and pain medication is out of hand. As a pain patient it is extremely hard to get on needed pain meds and to stay on them.

    Gone are the days where people could just get pain meds.

    The doctors are not helping their patients anymore. It is because of the government’s failing to stop Heroin.

    Wait until someone you care about needs pain meds. I am sure that the rich and political will have no issues.

    You politicians have no damn clue about this problem

  15. Lexie Smith at 12:20 pm

    Excellent rebuttal! I could not agree more. Speaking from the perspectives of a nurse and a long time pain patient, humanity, morality and compassion are not being considered and known scientific facts are being completely ignored. The old adage about the fox being an unsuitable ‘advocate’ for the hen, most accurately describes this whole fiasco! How would our elected and appointed officials like having their own healthcare decisions made by people who have never met them and do not wish to know anything about them, have not even a passing knowledge of their needs and are doing it in secrecy, to boot?! This is so very wrong on so many levels and obviously, the participants are well aware of that fact, hence the secrecy.

  16. Mark G. at 10:10 am

    Very good article! I hope saner heads prevail in this problem. Punishing those who follow the rules will never result in a solution. It seems to me that anyone taking these meds for 6 weeks or more must attend a pain management specialist and be subject to counts, and urinalysis (UA) at frequent intervals. The patients compliance must be verifiable! I attend such a clinic and have never had a bad count or bad UA.
    I too have heard suicide stories. It is a frightening result of careless mismanagement by doctors frightened into violating their oath to “Do no harm”! Making people suffer by taking doses which had previously failed in not a solution.
    It is a sentence to a life not worth living! Since 1996 I have had one dose adjustment. I don’t want to take more! And, I also don’t want to take less and have to go back to my old life.

  17. Renee white at 10:09 am

    I agree I have lupus RA fibro mast cell disease no discs from L3-S1 I just had half the nerves on 1 side severed to help pain I’ve been on opioids for 10 yrs due to my pain I’m NOT in anyway an addict but if u took away the only thing I have giving me even a little relief I promise I would end my life and I promise u the suicide rate is going to go through the roof because of having to endure unbearable pain they also are going to go to the streets to buy anything to help them there has to be a way to separate the addicts and the true pain pts my dr yesterday told me if arthritis was an Olympic sport I would win the Gold I’m only 46 so tell me when everyone manages to take away our pain treatment what than I wrote Mr Christie of course he couldn’t take the time out of his busy schedule to even respond

  18. Kevin Mooney at 10:05 am

    Thank you for being an advocate for pain patients, and your open letter to the commission, we obviously need warriors against this propaganda facilitated by CDC and mainstream media.

  19. Carla Cheshire at 10:01 am

    I also listened to the first working meeting of the Office of National Drug Control Policy Commission on Friday June 16, 2017 and had much the same response. Those speaking as lay people were former addicts or had children who died from overdoses. There was no mention of Chronic Pain Patients or that these medications are life-savers for so many people and have been used for pain for 1000’s of years. They never seem to want to hear from us, the people who use these medications regularly and have a much better quality of life because of them. We don’t fit into their scenario and make their claims of the scourge of these drugs less believable. Bottom line that is why we are not given a voice.

    I wrote to President Trump after this meeting on the White House website. https://www.whitehouse.gov/contact/#page
    I am urging all of you to do the same. There is a limit on length.

    I also wrote to DemocracyNow! an alternative news source after their show June 7, 2017 featured Dr. Andrew Kolodny, co-founder and director of Physicians for Responsible Opioid Prescribing an anti-opioid zealot who believes they should never be used for long-term chronic pain. I asked that they do a show from the Chronic Pain patients point of view as their coverage was all one-sided.

    My next letter will be to AARP whose AARPBulletin, June, 2017 issue is titled: The Opioid Menace! How America’s Addiction to Painkillers Affects You. The 7-page Special Report is about addiction, abuse and how older Americans have become addicted to drugs they were prescribed for pain leading to some selling their drugs to make money to live. The article blames the “Opioid Crisis” on long-term treatment for chronic pain leading to higher levels of addiction and overdoses. Please.

    Not one word is about the benefits of opioids for pain relief, nothing about Chronic Pain Patients having a better quality of life from these medications. This report will lead to the undertreatment of pain and will have many seniors afraid to take pain medication after surgery as they will be scared that after one pill they will become addicts and possibly even criminals who will sell their medications.

  20. Danny at 9:37 am

    What a well-written and informative letter, Red! I will follow your recommendation and write to the Commission myself, but I fear that anything I write will pale in comparison to this. However, I hope that many others will write as well because this group needs to hear from us. We are the ones who will truly suffer if they don’t get this right. I, for one, cannot live with that outcome, especially knowing that I didn’t contribute my 26+ years of experience and, yes, expertise. Who knows better than us?!

  21. William Dorn at 9:36 am

    If the public knew the truth this genocide would end.These politicans will live to regret this crime against humanity when people die by the thousands because of these CDC guidelines.Its always been illegal drugs causing the problem.Has been for the last 50 years.I pray they listen before its to late.

  22. Frances Kramer at 9:10 am

    Thank you, Red, for once again speaking so eloquently and accurately in defense of the chronic pain patient. Just last week, we lost another of our TN warriors because of inadequate pain relief caused directly by the CDC’s faulty guidelines. We see so much about the opioid crisis on the news, but we hear nothing about the plight of the suffering chronic pain patients. I would love to see you represent us on a show like 20/20. Thank you for being a voice for us.

  23. BL at 8:54 am

    Richard A. Lawhern, Ph.D., it appears you aren’t aware of what the job of this Commission is and more importantly is not. Nothing is the Commission’s job description or the things they are to accomplish involves treatment of chronic pain patients. Unless they are focusing on chronic pain patients that became psychologically dependent on opiates.

    Blaming the current opioid deaths on the FDA, CDC, etc makes chronic pain patients that are prescribed opiates look like drug addicts that can’t live without opiates. This is a terrible disservice to legitimate chronic pain patients that always obey the rules and laws.

    “The Commission will function solely as an advisory body and will make recommendations regarding policies and practices for combating drug addiction with particular focus on the current opioid crisis in the United States. ”

    “the Commission shall:

    a. Identify and describe the existing Federal funding used to combat drug addiction and the opioid crisis;

    b. assess the availability and accessibility of drug addiction treatment services and overdose reversal throughout the country and identify areas that are underserved;

    c. identify and report on best practices for addiction prevention, including healthcare provider education and evaluation of prescription practices, collaboration between State and Federal officials, and the use and effectiveness of State prescription drug monitoring programs;

    d. review the literature evaluating the effectiveness of educational messages for youth and adults with respect to prescription and illicit opioids;

    e. identify and evaluate existing Federal programs to prevent and treat drug addiction for their scope and effectiveness, and make recommendations for improving these programs; and;

    f. make recommendations to the President for improving the Federal response to drug addiction and the opioid crisis.”

    Notification of a Public Meeting of the President’s Commission on Combating Drug Addiction and the Opioid Crisis (Commission)-
    https://www.federalregister.gov/documents/2017/05/31/2017-11230/notification-of-a-public-meeting-of-the-presidents-commission-on-combating-drug-addiction-and-the

  24. Paula Beanes at 8:40 am

    I worked in the mental health field for 14 years. If a person is addicted to opiates and not in treatment or no longer can get a prescription, they will find any other drug, such as heroin, (which is MUCH worse) on the streets. How does taking away needed medication help anyone? Stopping Physicians from prescribing NEEDED pain medication is wrong. Just wrong. Let the Physician do his job and monitor the patient so as to avoid addiction. I have been taking pain medication for over 15 years for several chronic conditions. I do not “crave” it. I need it in order to function at all.

  25. Sheryl M Donnell at 7:57 am

    Thank as always for your support of chronic pain patients and for giving us the website for adding our comments there too. It is so imperative wevstoo this death march on the Chronic Pain community.

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