Beyond Opiophobia: A History of Opioids

Beyond Opiophobia: A History of Opioids

Before opioids, God created opiates, naturally-occurring pain-relieving substances that were derived from the opium poppy plant. Sun drying produces poppy latex which contains morphine, thebaine, and codeine.  In addition to their pain-relieving properties, opiates also produce a euphoria, a high, which often led to overuse and addiction.

Unfortunately, opiates also suppress breathing, and overdoses frequently resulted in death.  Due to these risks for addiction and death, the U.S. government stepped in and passed the Harrison Narcotics Tax Act of 1914 which outlawed opiates, legally referred to as “Narcotics”. The old Harrison Act later morphed into the modern Controlled Substances Act or CSA, first passed in 1970. Opiate sale or distribution is considered a crime unless prescribed by a physician “for a legitimate medical purpose in the usual course of medical practice”.

Dr. Jeffrey Grolig

Legitimate purposes included treating cancer and terminal painful diseases. Other legitimate purposes included heart attacks, pulmonary edema, sickle cell crises, battlefield wounds, acute fractures, and the like. Opiates were rarely used to treat long-term non-cancer pain due to valid concerns about addiction and dependence.

Physicians who failed to document a legitimate medical purpose or diagnosis were often arrested and prosecuted for drug trafficking, the crime for violating the CSA.

The synthetic opiates are known as opioids although this term is now used to describe both opiates and opioids collectively.  The first synthetic opioid was made from morphine in 1874 in a London lab. It was further refined to produce what is known as Heroin, a compound twice as powerful, and infinitely more deadly. The drug rapidly produced both euphoria and cravings which led to a user pattern of dependence, addiction, overdose and death. Heroin quickly became the Frankenstein of opioids, a creation gone so wrong that it has become little more than a curse that has left a wake of death, destruction and human misery that continues to this day.

The next two synthetics were created in German labs in the 1930s: Demerol and methadone. Methadone’s chief advantage was to produce far less craving. It has been used extensively in addiction treatment. Demerol proved an effective analgesic due to its quicker onset of action. By 1975, 60% of physicians prescribed it for acute pain while 22% prescribed it for long-term conditions.

Fentanyl was invented by Paul Jannsen in 1960. At 100 times the strength of morphine, it became a powerful medicinal agent used in surgical anesthesia. It made the World Health Organization’s “Essential Medicines List”. Unfortunately, due to its potency, it was also associated with greater risk for accidental fatal overdose.

The Reckitt & Colman Corporation sought to develop a synthetic opioid that retained the advantage of pain control “while shedding the undesirable side effects” of other opioids. In 1969, they succeeded in creating buprenorphine in the lab, a kinder, gentler opioid that many consider the safest ever made. One version, Suboxone, is used clinically throughout the U.S. and Europe for safer outpatient treatment of addiction with many advantages over methadone.

Another version, Butrans, is also widely used for the treatment of chronic non-cancer pain. Buprenorphine, although still dangerous if improperly used, has less potential for overdose death, respiratory suppression, cravings, withdrawal, and hyperalgesia. I have many patients who were able to ultimately taper off all opioids once they rotated to Butrans.

The two greatest drawbacks remain cost and education. Most physicians do not know enough about Butrans to select it. Opiophobia has created a public fear and stigma against all opioids. And Butrans is often not covered by insurance.

If the government subsidized buprenorphine in all of its forms so patients could afford it, millions could rotate off more dangerous opioids, and many lives could be saved-all without an increase in suffering-and all without involuntary tapers.

Get the facts now and give them to your doctor with the free Primer Flyer.  Learn more at ThePhysicianPrimer.com

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Authored by: Dr. Jeffrey Grolig

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I have taken Suboxone for my chronic pain for about 10 years now and it was a miracle for me. I stopped taking oxycodone and morphine on my own because I couldn’t take Suboxone with these in my system. My doctor in HAWAII couldn’t believe I did this at a friend’s home so someone would be with me. It was pretty bad but well worth it. As soon as I took my first dose I knew I had made the right decision. My all over body aches & pain were gone and I started to live again ! I only used half of what was prescribed unless it was a really bad pain day. And I have not increased my dose since doctor got it where it needed to be to take away enough of my pain that I could enjoy life again. Of course this was before the US FDA approved it’s use for pain and was only used to get off addiction to opioids.
Europe had been using it for chronic pain management for heat ! Why is the US always so far behind in medicine and theyyuses !!???!
Usually the trail leads back to money. It’s so often always about the money and I won’t even get started on how I feel about that. I don’t have any faith in the FDA

Hi Prince Charles Dickson PhD,
The most informative post you have shared on this page about the growing of drug problem But If the above is not scary, then listen to Dr Aliyu Abubakar of Ahmadu Bello University Teaching Hospital (ABUTH), Zaria, who in a paper he entitled: “Drug Abuse in Nigeria: Causes, Effects and Solutions”, said: “According to a recent study, 85 per cent of mad people in Nigeria are youths within the age bracket of 18-38 years.
Thanks.

csheltri

continued, but there brain thinks they do and so they continue to experience pain year after year, after year. But how many pain people do you know that don’t have any actual pain producing bodily process?
Then the term got mixed up with neuropathic pain which used to mean any pain arising from neural tissue. Then the word syndrome started getting attached to all kinds of other vague labels- “chronic pain syndrome”. which you don’t want- as you will be the first for a forced wean. I’m pretty sure the word syndrome is reserved for “pain in the arse” patients. Then the final kickaroo- taking pain medicine causes chronic pain! – the so called, all evil, HYPERALGESIA.
There are a lot of studies showing brain changes in people with long term chronic pain but the theory that those changes are the source of their pain is specious and can’t ever be proven. (There is some very important research involving repetitive shocks to induce “chronic pain” while receiving PET scans but I hope it isn’t funded with taxpayer money.)
They will never be able to induce years of severe disabling pain in a person, then stop and see if the brain keeps producing pain signals. They think mice and rats are telling them this is the case but I doubt it. No one who objects to this POPULAR theory will get published. And most front line physicians are only getting the readers digest equivalent of current research. They start tossing these terms around as undeniable facts. And even well meaning physicians will find these terms cropping up in conversations otherwise they might seem “uniformed”.
If you feel you are invisible, barely registering in the minds of many-it is because you have been slowing, quietly, seemingly innocently erased. Resist nagging doubts in the back of your mind, If you had horrible pain before you took pain medicine barring some pain sparring procedure, it will still be there. RESIST! And speak up. Make sure you are a pain in the arse!

Patricia

While I applaud the authors efforts to distinguish what he thinks of as a “good opioid” vs all the bad “opioids” he fails to mention issues patients must face if they wish to try buphrenorphine. The medication is clearly associated with the treatment of opioid addiction and even physicians who offer it to CPP patients often believe they are treating addiction not pain.

But my main concern is his assertion that it causes less hyperalgesia as I doubt he can actually provide evidence that this is the case. More importantly I take issue with the idea of opioid induced analgesia being a common occurrence that should be prevented. Has opioid hyperalgesia even been proven to exist? I might ask. In studies it occurs in less than 5% of rats or human subjects receiving repetitive shocks or some such. But when governments, insurers, medical providers want to get people “off drugs” all the sudden it happens to 95% of all CPP patients. Because getting people “off drugs” is what it’s all about. Its about negative (and flawed) perceptions of somebody else’s lifestyle. In this case, people who take pain medication.

It is my assertion that we have returned to the dark ages where we are subjected to the authoritarian rule of a few “experts” (CDC, DEA, etc) fueled by fear mongering and demagoguery. And much of the general public believes that if some study said so it must be true, right? NOT!

Don’t take this seriously, but if I meet the person who coined the term “chronic pain” I would shoot them on the spot. Because thats how it starts. A fairly useless vague label which de-individuates and de-humanizes. It used to refer to persons with pain lasting over 1 year, then it was 6 months, now it is 3 months.

Once the actual person was removed it was so easy to take the next step: “centralized pain” which was a theory that CPP patients don’t have any active bodily pain producing processes
Continued next post

#1. Regarding the establishment of the DEA:

“The Congress of the United States enacted into law the Controlled Substances Act (CSA) as Title II of the Comprehensive Drug Abuse Prevention and Control Act of 1970.1 The CSA serves as the legal foundation of the government’s fight against drugs of abuse. This law consolidates numerous laws regulating the manufacture and distribution of narcotics, stimulants, depressants, hallucinogens, anabolic steroids, and chemicals used in the illicit production of controlled substances…

The Drug Enforcement Administration (DEA) carries out the enforcement of the CSA. Established in 1973, the DEA is the federal agency responsible for the implementation of regulations related to the CSA.2 It replaced what was known at the time as the Bureau of Narcotics and Dangerous Drugs (BNDD). Currently, the DEA is a unit of the Federal Bureau of Investigation within the Department of Justice. Although the federal BNDD has been eliminated, many states continue to have their own drug enforcement agency, with laws similar to federal statutes and regulations and known by the same name.”

Van Dusen, VV, Spies, AR. An Overview and Update of the Controlled Substances Act of 1970. Pharmacy Times. 2007; February 7. Retrieved from http://www.pharmacytimes.com.
https://www.pharmacytimes.com/publications/issue/2007/2007-02/2007-02-6309

#2. Regarding the statement that few physicians were traditionally willing to prescribe opioids for chronic non-cancer pain:

Alon E, Jaquenod M, Pasch T. Opioids in treatment of chronic noncancer pain. Praxis (Bern 1994). 1998; Feb 25;87(9): 300-4.

Kris Aaron

Along with the history of opioids in America, I wish Dr. Jeffrey Grolig had mentioned the terrible damage done by Harry Anslinger. Anslinger was a Prohibition agent, and determined to stamp out the “curse” of alcohol. When that failed with the end of Prohibition, he was facing unemployment until his father-in-law, Andrew Mellon, who was also the Secretary of the Treasury, decided he didn’t want his little girl’s husband standing in the bread lines.
So Andrew Mellon (of the billionaire Mellons) had a word with J. Edgar Hoover, and Harry had a new job! His goal was to eradicate all opiates from America — nobody needed to avoid pain, because it just wasn’t that bad, or so he insisted. Opiates were only good for intoxication, and that was not the American Way, according to Harry.
It helped that America was in the depths of both the Depression AND the Lynching Era, a time when blaming people with darker skin for all the country’s woes was in vogue. Harry told anyone who would listen that when dark-skinned men got into narcotics (including cannabis), no white woman was safe. Thus was born the Federal Bureau of Narcotics, which later became the Drug Enforcement Agency.
For generations, the agency has depended on fear-mongering and incorrect information to keep funding rolling in. Few experienced pain specialists would ever agree that “Opiates were rarely used to treat long-term non-cancer pain…”
Several of us reading the article are living proof that opiates DO control non-cancer pain without causing addiction. I’m interested in seeing the documentation behind the author’s conclusions.

Hello Dr Grolig,
It is good to see your postings, and am reading them with interest. I worked with you in Northern California as a RN at rehab as a float nurse that for a while went there often. It was in the early 90’s. I have ended up with a neck injury that was initially diagnosed as depression. I found that ironic as most who worked with me commented on my positive disposition and smile. Just because I injured it doing hospice for my mother doesn’t mean I believed it was a bad thing. For all, there is a time to die. Having cancer with mets and being bedridden for 17 days, it was my mother’s time. If you recall a young brunette woman I befriended who was left a quadraplegic that also had a history of CP, you may recall me. I too am brunette with freckles.
Anyway, I didn’t get any scans for months, and I had moderate spinal cord compression with bilateral severe foraminal stenosis. Surgery was not done until the 6 month point. I now live with daily pain. There is not a way to please everyone, or to have everyone understand your message. Keep it up though! Currently due to the CDC & DEA pressure on doctors I was cut off my opioid pain medication a short time ago. Kratom has given me fairly good relief, yet it too may soon become illegal. I have faith something will work out. Patients like me need doctors like you. I am on the search again…
Thanks for all you are doing.
Kerry

Dear Readers:

I wrote the above article and would like to address some of the comments. To those of you who think I am not a pain specialist, or am a stockholder in Buprenorphine, or am paid by PROP, I am none of those.

However, I am a board-certified Physical Medicine & Rehabilitation Specialist, and I have devoted the past 28 years of my career to advocating for and treating chronic pain patients. I founded and directed the first multidisciplinary Functional Restoration Program (a type of pain clinic) in Northern California in 1991. Our clinic helped change the lives of many hundreds of pain patients from 1991 through 2000. I became incensed and angry at the injustices done to my patients by the California Worker’s Compensation system.

I became as angry then as most of you are now. My angry letters did no good. I decided I needed to learn more effective ways of exacting change within the system. While treating pain patients by day, I attended law school at night to become a better advocate for pain patient rights. I graduated night law school in 1997 and I passed the bar exam.

In the above article, I was simple trying to point out that all opioids cannot be condemned with the same brush as the CDC has done. I didn’t mean to suggest that Butrans works for everyone.

Let me say that by me helping your physicians legally not fear prescribing opioid medications, I am really helping you, the pain patient, retain access to these necessary medications. If physicians refuse to follow CDC guidelines, or to document properly, they will be made examples of, and you will ultimately lose. Law school taught me how to work for change within the system rather than simply vent my anger at injustice. I helped block AB 1998 in California last spring where the initial proposal would have limited opioid prescriptions to a 3-day supply. The 3 day rule was eliminated following a campaign on change.org.

I appreciate your feedback. I am on your side.

Robert Marshall

Warning: This posting contains many factual errors and many opinions of the author, stated as facts. In addition, the author is not an anesthesiologist and has not completed a pain management preceptorship. He is an MD and attorney who is marketing guidebooks that are supposed to keep other MDs that “must prescribe narcotics” from suffering run-ins with the DEA and/or regulatory bodies. Among other things, he advises: 1. Periodic dosage reductions and 2. Compliance with CDC protocols. His website headline reads: Prescribe like a lawyer. I can think of nothing that disqualifies an individual more to advise chronic pain patients than to trumpet that headline.

Holly

Push that Buprenorphine! HMMMMM Is PROP paying you? Jeff I do believe MANY of us know the history of opioids….IMO this “knowledge” that you write is just to make u look smart and to push Buprenorphine on everyone as the miracle drug for all chronic pain patients. You know nothing more that so many of us that are suffering needlessly everyday! As a matter of fact I am certain we know much more! Why? Because we are the ones suffering and have already taken and tried soooo much to relieve our pain!

Rich Reifsnyder

Good Morning, I call the whole Charade Bull(edit)Phobia.Iam Disabled,6 inch stainless steel rods in lower back,severe nerve damage,failed fusion,degeneration of spine,bulging disks in neck and lower back,no more Surgeries!I have been stable on Opiod Medication since 1998,my Quality of Life was decent with some pain from the severe nerve damage in lower back.And by the way I was diagnosed with anxiety and take a Xanax when needed and Iam not dead yet from an OD,now let’s do the math,20 years not dead!Iam 61 and take my Opiod Medication responsibly and it is used as a tool to control my pain and give me a decent Quality Of Life.That changed in 2016 when that ******* psychopath from PROP helped with the Fictitious Opiod Guidelines And Robbed me and 50-100 million Wounded Veterans and Intractable Chronic Pain Patients of our Quality of Life.There is a label on the Opiod Medication Bottle that tells you how to use responsibly.I take my meds responsibly and in 20 years Iam not dead,Iam being tortured and in severe pain from forcibly decreased my Opiod Medication by 63%-160mg/day to 60mg/day.The weird thing is that all Pain Patients at this PM clinic I talked to all get 60mg/day.The MME chart states 60mg/day oxycodone=90MME-Morphine Equivalent.Iam an adult if Iam going to OD and Die from my Opiod Medication that’s my fault I didn’t take it responsibly as label directed on the bottle,not the doctors fault.When used properly and responsibly this fictitious 90MME number is totally ridiculous since everyone metabolizes Opiod Medication differently,”one size doesn’t fit all.”A prescription of Opiod Medication,I don’t care how many pills are prescribed,when used responsibly like the 50-100 million Intractable Chronic Pain Patients and Veterans that have been taking and stable for decades with a decent quality of life,why would the CDC disrupt stable pain patients and cause misery for millions and thousands of suicides?

Hayden

I simply don’t need any more information about what might help me with my 25 year pain management issues. Been there, done that. I have been on the same opiate medication for over 20 years owning and operating my business I started at 23 years old as a home builder but, unfortunately it takes more than 90 mme to effectively manage the pain from multiple spine surgeries. Surgeries complete with screws and plates. With the “life saving” CDC misguidedline we, my wife and I have lost our business, our life savings, ANY family or friend socializing and am lucky to get any sleep. I simply suffer until I am so exhausted and fall into sleep because my body can not stand the constant pain AND exhaustion. I reduced the dosage of medication myself 8 years ago and have not increased or “asked” for any other medication or higher dosage yet I was further reduced to an amount of medication that is impossible to “take as directed” and be able to function at anything. This misguided attempt to stop drug abuse has ruint millions of lives. Insanity. I’m tired of calling and writing my state politicians and the medical board who tell me that the “guideline” is saving lives. [edit]! I have NEVER failed a double urinalysis, pill count and my pain management doctor still documents that he does not feel I was at ANY risk before the “guideline”. Dot/gov simply will NOT accept the facts that have been presented referencing pain management patients and pain management physicians as being diligent in their prescribing. I would guess millions of PMP’s can provide documentation about our use of opiate medication and the benefit and success of it’s use but we, the patients started this “opioid crisis”. Walk in our shoes just for a few days and EVERY “expert” would change their minds about opiate use in an effective dosage. It makes life seem hopeless when the “experts” and panels of “experts” who have NEVER endured never ending pain yet they know what Is best for all patients. Sad!

Johns Hopkins says in the United States medical errors are the third leading cause of death more than cancer and heart disease. Medical errors kills 250,000 people a year. John Hopkins says the CDC inaccurately documents this Factor. So again the CDC describes cause and effect situations inaccurately. This history lesson about opiates is interesting but how do we know it’s accurate as far as what is best to use for pain? Has long-term studies been done other than that of addiction treatment clinics? And why should we hand out information to the Physicians because they don’t listen to patience and how do we know what we’re giving is important information. We are only patients Physicians don’t want to have us educating them from a sheet of paper. They would find this insulting and patients would pay the price for what the physician perceives as an insult. We’re not even allowed to talk about our pain or ask for treatment for it and when we do we’re looked as drug Seekers. PCP told me he couldn’t do anything about it so for me to never bring up the conversation of pain. People who have fibromyalgia are denied pain treatment even though they have other diagnosis that would be in need for pain treatment. Yet as a single qualifier having fibromyalgia disqualifies a person for pain treatment and other diagnosis is ignored. Physicians are doing guesswork at what fibromyalgia is or cause of so without a definite diagnosis what fibromyalgia really is Physicians are denying pain treatment and just giving it a fake name because they feel that people are faking even though MRI prove differently.

Red Bird

Thank you Justin You said exactly what I wanted to say . BUTRANS is a PAIN patch only buphenorphrine its not suboxone which also has naletrexone. I’ve been on BUTRANS about 7 years for chronic pain. PM gives me up to 2 1/2 Hydrocodone but there are zero cravings and I wake up in less pain than I used to as you wear it 7 days. It has a ceiling effect so you get used to it once you plateau no high just less pain.
If you have chronic pain no reason to come off them but different strengths could be weaned. My insurance covers. I tried the generic it seems to have less sticky and was a pain. I’m paying $15 vs $7 . BUTRANS offers coupons at times. Yes like a opiods respiratory depression is a Risk so Dr should start on lowest dose. Is it perfect? No but I feel safe and I know I won’t be addicted as in craving etc.
It’s worth a try instead of complaining. I guess it’s not for everyone but best for me although at times I still get intense pain but it keeps me working. I don’t do much else but I need to. no choice.

Steve M

buprenorphine binds to receptors so strongly that the patients are able to stop using their real opioids because they no longer work. Bup is a mixed agonist antagonist, it blocks most other opioids (like Narcan). The only difference is that if you keep the dose low enough (which BuTrans does), it will also activate the opioid receptor.

Bup is known to cause withdrawal in opioid tolerant patients.

For those not getting relief from normal opioids, you may want to consider asking your doctor about an intrathecal pain (Medtronic SynchroMed II or Flowonix Prometra II).

Steve M

The UK uses Heroin to this day without problems. Your understanding is Elementary and narrowly focused, at best

Steve M

Wow, so much wrong information here, I seriously don’t know where to start. Please don’t take anything from this article as gospel… although it’s about as fact based.

I had been misdiagnosed with super tolerance when in fact time and neuropathy was taking its normal hell on earth course. I proved it just in time for the one size fits all. No more opiates for any one. The world renound Dr Tennet 2nd opinion was that ‘Buprenorphine is [edit]’. They offer us junk because that is all that fits the adgenda. The CPP is and was not diverting medicine because we dont have enough for ourself. Now we die.

ecanarensis

It gets really tiring, trying to explain to supposed medical professionals that no one drug works for all people. Buprenorphine isn’t a miracle drug that’ll cure all people with any pain, and saying so is the height of irresponsibility. Also, the idea that somehow switching to Bupe will lead to everyone no longer needing any pain relief is, frankly, nuts. What, it cures the source of all types of chronic pain?? I don’t think so.

And honestly, I’m also getting monumentally tired of this guy’s commercial “articles.” He has some good points at times, but they all end up with him pushing his pamphlet/book/etc. I now have to wonder if he has stock in buprenorphine.

Yet another doctor pushing this toxic [edit]. I can say this since I was put on both forms of it. I can only speak on my behalf on how horrible I felt when using it. I lost my PM doctor July 2018, and my nightmares started trying to find another PM doctor in a rual area is next to impossible. Even trying to find a decent GP is hard. . I’m a patient at Stanford and I inquired about finding a PM doc, they said good luck if you can find one. Ended up having to see my heartless GP, not even willing to look at one page of my 500 plus pages of medical records. He immediately labeled me a drug addict and the only thing he would put me on was this overrated medication. I had the reverse reaction to this medication and the severity of my side effects I called the FDA. They said anyone that has this type of bad reaction needs to be taken off of it. Yesterday I had my last appointment with this so called doctor and he said don’t think of asking me to change your medication. That I needed to go into drug rehabilitation for my addiction. I’ve had 17 surgeries. trying to avoid another neck fusion as well as another back surgery. Not to mention all my other health issues Lupus etc. How can any doctor try to dictate how you feel? It angers me when I ask if they have ever experienced chronic pain? Why didn’t you bring up on how expensive this crap is? I don’t get it insurance companies are willing to pay around $1300.00 a month for this [edit]. But not willing to pay around $140.00 a month for my oxycodone that helps me cope with the pain. I feel like we as humans have no say anymore. So I’ve had to resort to going to the streets for medication. It’s either that or I’m going to end my life.

Larry Feldman

Between weaning myself off oxycontin/percocet and beginning Nucynta 8 months later, I tried
two separate times to use Buprenorphine. It did nothing for the pain, but was a great source of nausea & reflux. That was 10 years ago. The amount of Nucynta I use has remained steady, and I’ve never asked for additional narcotics for breakthrough pain. Unlike those who foolishly abused their prescriptions, I realize, as do most responsible pain patients, that a certain amount of pain is unavoidable.

Joseph Lane

The author of this article is so wrong on so many counts. To lump all patients together and to state as fact that Butran/Suboxone is a viable replacement for an opioid that has been working for a CP patient is misleading and a show of hubris gone wild. I am astounded that the National Pain Report published this paper. Who on earth gave the author the power to decide that one opioid is better than another for every patient, he definitely did not divine his ideas from any study or real world applications. To write this article under the guise of opiophobia is outrageously misleading.
I am bone-weary of reading articles that are written as fact while based on nothing but personal preference. The fact that the author (and other so called experts) talk about a chance of death through overdose due to respiratory suppression, is ludicrous. There has been no reported over-dose death due to respiratory suppression in any CPP taking their medication as directed, respiratory suppression is found in over-dose deaths due to ingesting street drugs like Heroin, Fentanyl, and other illegal drugs. The fact that people have decided to take away my ability to choose taking a medication that controls my pain because of the off chance that I may die, is not only alarming but also ignoring my right to choose. In my case, the small chance of an opioid accidentally killing me (no matter how it may kill me) is a far lesser fear compared to having to live the rest of my life in severe pain along with the added inability to be a useful member of this society.
I used to think it was terrible when I would read about other CPP’s saying that they wished that same pain that they were experiencing on their doctors. I no longer think so and wish the same on all politicians, mental health care workers. doctors, and any other person that holds and preaches the belief that people in pain are better off suffering and should be “spared” the evils of opioids.

I just ordered the Physician Primer, I am truly hoping it gives me enough knowledge to share with my NP so maybe she will actually treat my pain. I’ve been suffering for many months now and can barely use my left arm. She wants me to get a MRI and it’s the beginning of the year and I’m on Medicare so only allowed so much per year. I don’t want to do it, because I don’t want to lose my home. If I’m not compliant then they really won’t help me. I am in so much pain spend most of my days and nights sitting and crying. I absolutely hate my life. Going without sleep hasn’t helped. And I’m still praying, god please don’t let me wake up.

To All:

I offer readers of National Pain Report a 50% discount on the Pain Patient Handbook on my website. http://www.thephysicianprimer.com

Simply put in this coupon code when ordering: 47PAINREPORT.

What developed in parallel with the Reagan Administration’s escalation of the Drug War, was a sizable body of scientific research done at, or funded by, the National Institutes of Health. Two NIH labs took the lead: the National Institute of Mental Health (NIMH) and the National Institute of Drug Abuse (NIDA). All of this research yielded an inconvenient truth: Long before opium poppies appeared on land, the fishes and plants of the sea were already secreting morphine and thebaine.

NIDA research proved that morphine and nitric oxide run the controls on mitochondria, the nanoscale furnaces in every living cell that react oxygen with food to provide energy. Without morphine, no living thing on God’s Green Earth would be able to keep from burning itself up from uncontrolled metabolism.

Since morphine is normally present in all of us, from the moment we are conceived in the womb, “drug-free” living is impossible.

The disease of addiction is not caused by exposure to morphine. If it were, everyone alive would have it.

We don’t prohibit peanut cultivation, to protect the people who are disabled by peanut allergy. Instead, we warn them that this allergen is present in food, so that they know to choose something safe for them to eat.

Addiction must be viewed like every other disability. The person who develops it needs treatment for withdrawal, once they recover from whatever condition required them to be treated for pain. Addiction is a complication risk, when people who have the addiction gene suffer injury requiring pain treatment…exactly as infection or blood loss are complication risks in injury.

The CDC Office of Accidental injury Prevention needs to pay closer attention to preventing the injuries that cause disabling pain, if it is to prevent all the complications of injury, including addiction.

After reading this article this morning a rage came over me. I’ve been put on both and the side effects are never brought up why? I lost my PM Dr. In July 2018 do to cancer. And my nightmares began trying to find a doctor is impossible living in a rural area. Forget trying to find a PM Dr that is impossible anymore. I had to resort to seeing my GP which labeled me a drug addict without even looking at one page of my 500 plus pages from my PM doctor. I informed him that I react violently to anything that has buprenorphine in it. But since he labeled me a drug addict that’s all I was going to get from him and that I need to be admitted for my drug addiction. I’ve already had 17 plus surgeries and trying to avoid another neck fusion, and back fusion. I’m even a patient at Stanford and can’t find one that will prescribe anything other then this poison that I’ve been taking. So my last resort for any pain relief is going to the streets or ending my life. That’s crossed my mind too many times. I battle extreme depression and being bipolar combined with chronic pain can and does push people to end. When I have to sit and beg for help then my cry turns to rage. Why our these damm doctors trying to say they understand when they don’t. Yesterday I had asked my idiot doctor how much do you do about this medication and how many deaths have occurred from it? He could not answer any of my questions because they only go by what they are given. It’s a damm shame that a patient has more information then the doctor does.The doctors don’t give a damm if you live or die. FYI I had to contact the FDA because of the severity of my side effects. So if your doctor does recommend this poison be mindful and remember how expensive two boxes can go for the cost for 60 strips was almost 1,300.00. But yet insurance companies won’t pay out 175.00 for my oxycodone for a month supply. Insurance companies are idiots as well they don’t know other than what the DEA and CDC are pushing.

Maureen M.

I find this to be an excellent breakdown of the history of this medications. Thank you. A pain management doc I had 3 yrs ago was beginning to talk with me about trying Butrans, but then he left the group I go to. The doc I see there since then avoids every mention I make of trying something new and different since I have been on Norco for 14yrs now. I’m stuck! Oh well, dare I complain. At least I continue to get something.

Tammy Cole

Thank you! I learned so much in this post about the different medicines the cause and effects as well as there orgins. It seems to me that doctors are just tapering patients off their pain medications and not giving any other options, your post makes me hopeful that there are options to help with our pain management opiods never took away my pain, just allowed me to function better with the pain. Now if know I can ask my doctor if any of these alternative drugs would be an option for me instead of going back to being bed ridden.

Tess

What needs to be said is this article is again saying how scary and dangerous pain meds are!!! This is simply not true!!There are thousands of pain patients not addicts that have been on same dose stable pain medication for years without any problems! And they are able to partake in like because of them..Why should a patient with rare incurable painful diseases that has tried most alternative treatments have to switch yet again off something that works for them because of other people action or fears?We all should have a right to say what is put on or in our bodies! As long as we are not hurting anyone else .I’m sick of antiopiate zealots telling patients what they think is best for their lives and treatments! If someone is on stable pain meds and functional then leave them alone! Patients are NOT lab rats

William

Why not issue chronic pain patients a card allowing them the medicines they need so it would be easy to tell legal patients from illegal ones. It is clearly illegal drugs causing the problem in this country so why is the government punishing pain patients.

Sir, with this opioid Injustice in place you don’t give your doctor anything except respect! Why go from one opioid to the other? This I don’t get, especially after reading about Butrans, they are extremely hard to stop taking. It’s no wonder they don’t prescribe them! This whole thing is absolutely absurd. Just go from one to the other in a country that is already unstable not to mention downright evil. Say our doctors do prescribe this, then what? Have it taken away as well, leaving us worse off than if they would have left us alone in the first place? We are NOT addicts, we ARE chronic pain patients with legitimate chronic pain problems or we wouldn’t have been taking our life saving opioids in the first place because our doctors would not have prescribed them to begin with! Before this opioid injustice started there may have been a few shyster doctors here and there but for the most part our physicians we’re helping us live our lives the way God intended, and doing a damn good job I might add. In my mind I always thought that’s what a doctor was for was to help you. Now they can’t! We shouldn’t have to taper due to the ignorance of our government. This whole thing has been so blown out of proportion it makes me sick. Everyone knows what’s best for us except for us. Now we’ve got Medtronic’s predicting to make billions by 2024, acupuncture wanting to make a debut, and books for sale as to how to prescribe like someone who’s in another profession, just to name a few as of late. Seems as though everyone not only has an opinion but also a solution. What about us? We know out own bodies and what they can handle and what they cannot, although we no longer have an opinion, a voice or a solution! We’ve been grouped together like a herd of cows and yes we have been put out to pasture. Point Blank! Enough said.

To All:

Before you all beat me with the Suboxone stick, please know that I am a pain specialist and treat ONLY chronic pain patients. Butrans patch is used for PAIN. Suboxone is used for addiction. You don’t have to go back to the clinic every day or every week, and you are not branded an addict. Many who have been on Fentanyl patch 25 mcg find Butrans 20 mcg works just as well or better. Many who have been on Norco or Percocet four or five per day find the same pain relief and quality of life with the Butrans patch.

Dr. Jeffrey Fudin, a colleague of mine, is also a strong pain patient advocate, and you can read what he says below too. Buprenorphine is used to treat chronic pain, and the form I prefer is Butrans patch. It has worked fantastically well in dozens of my pain patients and many have been on it for years. It has been covered by some worker’s compensation carriers, and some of my patients’ Medicare plans. Please read the following two articles for yourselves:

#1. Likar, R. Transdermal Buprenorphine in the Management of Persistent Pain-Safety Aspects. Ther Clin Risk Management. 2006; 2(1): 115-125.

#2. Fudin, J. Painfully Buprenorphine (Guest Blog). Paindr.com. 2016; Aug 14. http://www.paindr.com

Terry

Really interesting stuff, unfortunately I’ve still been cut to the bare minimum amount of opiates for my chronic, intractable pain. In the past 10 yrs I’ve been prescribed 195 mgs of oxycodone and oxycontin daily, my life was great, I was never hindered by any of my 20 different chronic pain conditions. Now it has been lowered to 60 mgs daily and I can barely get off the couch. It’s not that I don’t appreciate the opiate history that you’ve laid out but it really doesn’t help me, it’s like showing a drowning man a picture of a life jacket. And I’m truly not trying to be a jerk. We complain a lot about the unfairness of the “opioid epidemic”, we bitch and moan, we tell our sad stories and console each other, but we need solutions and we need them fast! I’ve written to my elected officials at least twelve times and have only received one response, in a standard form letter. Somehow, and I don’t have the answer, we need to get the public on our side and find someone with some clout and a voice, to speak on our behalf, be our advocate, nobody is going to listen to a bunch of crazed, drug addicts just looking for a fix. John Q. Public only believes what he hears on the news and there isn’t one person with any notoriety to represent the chronic pain community and their desperate cries for help. Somehow we have to get the REAL statistics out there in the news, for example, 98.8 % of all opioid overdoses are from heroin and fentanyl and 1.2 % are from legitimate prescriptions. I’ve been racking my brain trying to find solutions before it is too late. If anyone has any ideas along those lines, we desperately need an idea for a well known public figure to advocate for the chronic pain community. Here’s your homework, EVERYONE send emails to their elected officials explaining our plight, you never know where help will come from. Let’s have a forum with ONLY ideas on how to help us. Let my response be the kick off. Maybe Ed will allow me to start the conversation. God bless.

Jody Hoffman

I had no idea that Suboxone was created in 1969 or that it even existed until our so called epidemic. Our government has billions of dollars set aside for rehabilitation of addicts and they should give the Suboxone to anyone who requested it. We have had methadone programs in major cities since the 1960s for addicts why not create a program to help everyone that needs it and stop talking about it. Fix the problem

Heather

As for your input, it’s also unwelcome in my mind. These other “safer” alternatives will mean I go to an addiction clinic once a week when I’m NOT ADDICTED. There is no medical justification for what you’re suggesting and you’re as bad as the rest of them.

When doctors forget that they’re dealing with REAL PEOPLE who have REAL NEEDS and REAL OBSTACLES and who amidst this may still be trying to hold a job or be part of a family… Then you might as well throw your so-called “Hippocratic Oath” out the danged window, you HYPOCRITE!

So many people are trying to tell us what to do, what’s best for us… so many people will make money off of what they suggest to us. Do you know how ridiculous this all is?!? I had a dental appointment and the dentist told me he was reading a book “Ohio” about a small town affected by the drug crisis and that he has a friend who writes for medical marijuana and I should go see his friend.

Look, I never even ASKED him for his opinion, I didn’t need or ask for any pain relief at the appointment. I had a filling done and was not in pain during the procedure. Yet, I get his opinion.

You know what they say about opinions… Just like … Everybody has one.

Nevermind the stigma that already exists with addiction meds, down the line, those will be bad for us too, they won’t be safer and they’ll also be taken away. Everyone has an agenda and there are a lot of shysters getting involved.

My opinion and my needs never mattered so I’ll tell you how it is! I’m such a freaking “non-person” in the midst of all this, and all I’m trying to do is to take care of myself. That’s what’s sick… So think about that.

Gary Raymond

Jeffrey, What is the sense in giving literature to my doctors? They will only hand me a reference for rehab. They are acting scared to death of losing their license and they are probably being paid to deny opioid treatment. If we do successfully BEG for effective pain relief prescriptions, then we must deal with the pharmacies that have been empowered to lie about their stock in order to protect their buttocks. I have never known a stable pharmacist and now they are able to exhibit their personality disorders and dictate our healthcare, of which they know nothing. After more than 2 years, why are prescription opioids still on the streets? The manufacturers and chain pharmacies are allowing crates of opioids to “fall off the back of their trucks”. Our government has turned upon the most weak in our society. Similar to a feline cannibalizing its defective litter. Survival of the fit? Or, survival of the mentally ill?

Heather

I had a neurosurgeon resident tell me that I need to prepare myself to stop taking tramadol – that it should be in the back of my mind, “no, the middle of (your) mind.” I have osteoarthrits in my feet, ankle, knees, hip(s?), SI joints, degenerative disc disease, cervical spondylosis, arthritis in my left shoulder (and possibly a rotator cuff injury), and in my hands. It’s likely also in my jaw (TMJ) and at least one if not both of my elbows. I’m 39 years old. I also have fibromyalgia. A gastro doc looked at my chart and asked me, “How are you still working?”

“The meds. The meds help” It was all I could croak out, feeling quite shocked. I have other chronic illnesses as well (including possibly narcolepsy, certainly excessive daytime fatigue and fully-treated sleep apnea with full CPAP compliance – AHI of less than 1).

The meds work. Why is it no longer justified… for me to take tramadol?

I’ve been urine-tested by a physician’s assistant who saw me when my regular doc couldn’t. There’s been zero indication of abuse or diversion.

I’ll fight like heck because as I see it, losing my medication is also stealing my ability to earn a living and if I don’t fight for that, then what do I fight for?!?! It’s also my quality of life.

My mother was disabled by aggressive osteoarthritis in her 50’s. I saw what it was like for her to get disability. She never lost insurance coverage because she’s married and covered under my father’s insurance. I’m single… If I can’t work, then I can’t afford insurance and with all my other health issues, it would be a slow downward spiral to death. No, I’m not “depressed” — I’m realistic. I’ve had asthma attacks and those inhalers are NOT available as a generic. That would be a terrible way to go.

Thankfully, my physiatrist can still prescribe the tramadol for me, and the neurosurgeon is only consulting for a pituitary cyst. He has no idea what he said to me… how terrifying it was. ZERO idea. That’s what we’re up against.

LMC

Have any in depth studies been done about the side effects of Buprenorphine/Butrans? Although I have read some individual horror stories from some users (in reference to reactions) and, as with anything on the internet, fact vs fiction is hard to interpret for the regular layperson.

Danielle Betz

This medication, Buprenorphine, is the single hardest opioid to come off of. They are finding it absorbs deep into bone marrow and lingers so long that it almost appears as if it was designed to make all users permanently dependent. Yes, this is a better alternative to heroin and Fentanyl, but it’s a living nightmare to come off. Some never do.

Sandra

In the UK, and myself personally have been prescribed a low dosage of slow release morphine sulphate capsule called zomorph for chronic pain, taken every 12 hours this does not create the initial euphoria and crash that some others do or liquid oramorph does, but with some other pain medication does help keep the pain at bay a little. Also despite still having some pain with the slow release I do not feel I actually want to take more.