Is The Media Missing The Point On Pain Medication Dispute?

Is The Media Missing The Point On Pain Medication Dispute?

deaLeaders in pain management have increasingly been stressing that opioid abuse and its use for pain treatment are two distinct issues.

In recent interviews with the National Pain Report, two highly visible experts made that point.

Dr. Richard Radnovich, a nationally known pain medicine specialist from Boise, Idaho said, “The problem is that we have blurred the lines between 2 distinct problems: chronic pain treatment and substance abuse. The DEA is concerned with the latter. Medical providers just need to do a good job with the former: that is, show that they are using opioids for a legitimate medical purpose; and provide adequate medical care and supervision.”

Dr. Steve Passik, Vice President of Clinical Research and Advocacy at Millennium Health said, “Prescription drug abuse is a massive problem and we have to deal with it, but I’d also to see more consideration given to the person in pain in the dialogue going forward.”

However, over the past weekend, the emphasis of media opinion writers seems to be on the drug abuse and addiction side of the coin.

An op-ed written for the Tennessean by Terry Ashe, the executive director of the Tennessee Sheriffs’ Association calling the prescription drug issue in Tennessee an “epidemic”. He mentions the legitimate use of them only in passing.

And in Vermont’s Valley News, it describes New England as being in the grip of an opioid crisis—and talks about the importance of treating addicts—a noble gesture to be sure, but little about legitimate pain medication use.

And last week, U.S. Health and Human Services Secretary Sylvia Burwell addressed the issue of prescription drug abuse at the National Rx Drug Abuse Summit in Washington D.C.

“We’ve identified three priority areas where we can focus our efforts to have the most significant impact,” she said at the summit.

  • To provide the training, tools and educational resources that health care professionals need to make more informed prescribing decisions.
  • To increase the use of naloxone, a drug that reverses opioid overdose.  “We are promoting grant funds to encourage states to purchase naloxone and train first responders in its use. We are also encouraging the development of new products that can help reduce overdose-related injuries.”
  • We are using medication-assisted treatment to help lift people out of opioid addiction. … We’re also exploring bipartisan policy changes to increase the use of buprenorphine, which is used to treat opioid addiction.”

While the media and bureaucrats were focused on the opioid addiction angle, John Sandherr, a reader of the National Pain Report who is the father of two veterans, reminded us that patients—in this case his sons—need to be remembered.

“My two oldest sons are USMC Vets and both are left with 80% disability rating—the oldest has a bad back caused by training and the other son has combat related injuries. Both have now been denied pain meds that work but there seems to be plenty of antidepressant meds to force on both of them. Neither is depressed—pissed off– but not depressed.”

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Authored by: Ed Coghlan

There are 16 comments for this article
  1. LouisVA at 2:11 pm

    Paul Kemp said on April 14, 2015 at 10:00 pm that:

    “Opioids are by their nature addictive when taken over a long time period, as for one who has chronic pain.”

    Paul, this is simply not true and if the statement above was something you read, you are being deceived. Opioids are NEVER used as a first line of treatment but after having tried many, many therapies that were less drastic, and nothing worked, then I went on opioid therapy. I was titrated until I was comfortable back in 2010 and ever since then, my quality of life has improved to where I can do things that I had been unable to do for a long time. Addiction is rarely a problem in chronic pain patients. Perhaps you are confusing dependence and addiction, something that is commonly done. I am dependent on my meds meaning that if I suddenly stopped taking them, I would go through withdrawals. Addiction, on the other hand, is a loss of control to where a person continues to take opioids despite the fact that they are ruining their lives and addicts need an ever increasing dose just to feel “normal.”

    You also said:

    “Of course, MDs don’t believe our body can repair itself — that’s not what they were taught in medical school. I wouldn’t believe it either, except that I’ve done it — and much more without a doctor’s help.”

    I am happy for you that you were able to solve your own pain problems; however, not everyone is that fortunate. Many people are able to repair their bodies the way you have done but that is impossible once pain has been suffered for so long that it becomes centralized. When pain becomes centralized, the wiring of the nervous system and brain has been modified so that pain is the normal state and the body can no longer repair itself. My pain specialist, Dr. Forest Tennant, has determined that I have centralized pain as I suffered pain as a child up until I was 60 years old (I’m now 65). Please read the following to get an understanding of this condition. See:

    http://www.practicalpainmanagement.com/critical-necessity-diagnose-pain-centralized

    and

    http://www.practicalpainmanagement.com/centralized-pain-new-consensus-phrase

    Both of these articles were written by Dr. Tenant, a doctor that has worked with chronic pain patients for many, many years. His clinic, opened in 1975, is the oldest continuously operated pain clinic in the US. In addition, he started his career in addictionology but changed his focus upon realizing that many of the so-called addicts he was treating were actually chronic pain patients. Finally, we are all different and respond differently to different medications. If it were not for opioid treatment, I would not be alive today.

  2. BL at 2:19 pm

    Paul Kemp, addiction and physical dependency are not the same thing. There are a number of other medications that produce physically dependency that aren’t opiates.

  3. dave at 8:22 am

    Samantha- my issue with opioids is the great cost for diversion to society- $55 billion-every year-and though opioids do help a number of people-they are too expensive to society as administered currently. I would rather see opioids and other medications for people in pain available otc-and let us get rid of urine testing, which isnt reliable and costs $4 billion a year.
    The opioid economy has us coming and going- for it can either help you with pain or get you addicted and pay for salaries of DEA agents, drug treatment programs etc.
    Opioids are a capitalistic invention-and in that regard they serve capitalistic needs of the few.
    People in pain may not believe in cures for many reasons- but amongst those reasons are capitalists creating the lifetime pain patient who wont make the effort to find cures. Note well how in the 2011 IOM report they clearly state they don’t believe in cures. I believe intention matters-and if you’re not attempting to cure pain- well guess what- you wont cure pain. Ultimately, no one can prove that pain cannot be cured. Many people with intractable pain conditions- from MS, lupus, lyme, cancer, rheumatoid arthritis, migraines, rsd have been cured. Note well how science and the health care industry hasnt tried to do studies on people who have been cured and compare them to people who haven’t been cured- i wonder why…..
    In the ned analysis- there is no cure to the greed of capitalism- and greedy capitalism is behind using opioids to treat pain and the addiction that comes from opioids for pain- the opioid economy is over $70 billion annually in the U.S- and growing-whos calling for the opioid economy to shrink?

  4. paita at 7:00 am

    Reply to Paul K,,,do you believe their is a basic humane self evident truth,that no-one can physical feel your physical pain?????and if you don’t believe that,,then y????My belief is,,I cannot feel anyones physical pain,,,I can only feel my own physical pain,,,thus,,,a decent humane respect needs to be a self evident truth,,that since we cannot physical feel the physical pain of another,,,that as a civilized society no-one has the legal right to forced another human being to endure that physical pain by not giving them relief from that physical pain,,By you stopping your physical pain by whatever means u did,,great for you,,,but since u can’t feel my physical pain,,u don’t know what will work for me,,only I know what works for me,,and your method did not work,,but a decent humane respect should allow anyone to use what works for them,,,if u don’t agree,,,PLEASE tell my why????

  5. paita at 6:15 am

    Amen,,agree 100%,,thank u for exposing what is the truth,jmo,,

  6. Samantha W. at 3:32 am

    David, I agree with some of what you wrote, Yes the REMS is a joke, and more needs to go into physician education about pain, in all its forms, and there should be money going into research to find more treatments.

    But I don’t agree with you on everything. For one, opioid medications (along with a non-pharmaceutical list of strategies) do relieve my pain. Nothing is going to cure it until they can rebuild my CNS. And I believe that it is necessary and appropriate to use pain medication in persons that need it and do well on it.

    For another, maybe the reason that Alt. Therapies aren’t mentioned as much as is because they aren’t controversial! Sure, it needs to be incorporated into patients overall pain mgmt plans, but those therapies aren’t being attacked, threatened to be halted or otherwise politicized. In other words, not much to say there when speaking about the state of pain management policy.

  7. Samantha W. at 3:06 am

    “However, over the past weekend, the emphasis of media opinion writers seems to be on the drug abuse and addiction side of the coin.”…

    Correction. However, over the last *TEN YEARS* , the emphasis has been on drug abuse….

    This is its own epidemic. The demonization of pain medication as ONLY a tool for the addict and unseen as a tool for those of us in pain.

    And further, what **really** bothers me? A few points that don’t get mentioned much at all, and even most doctors do not consider them to be true, despite all evidence supporting the points below:

    1)Pain medication used in a person with pain RARELY leads to addiction without prior addiction issues.

    2) Physical dependence and tolerance AREN’T indicative of addiction. And they are NOT the same thing. (I have actually argued with otherwise intelligent Doctors about this)

    3) Death statistics that are used in these “media grabber” articles include stats that are almost always due to poly-pharms( benzodiazepines + psychotropics+opioids usually), along with illicit drugs and alcohol combinations, not just opioid pain medications all alone.It is rare that prescription opioids all by themselves are the cause of death.

    4)As well you have the problematic issue of suicides lumped into those stats, leading to a hugely conflated number of deaths attributed to opioid Meds.
    Also many times It’s not easy to distinguish death due to opioids vs merely death with opioids in the system particularly if the person taking them is already ill and is opioid tolerant.

    We really need to stop the headlines and political rhetoric that is determined to keep up the war on drugs through false information and scare tactics. There are certainly doctors that are pushers and need to be stopped. But there are many many many more that are so worried about prescribing that pain patients are left without relief, stigmatized and without a voice.

    I know many if not most people in this country have been touched by addiction. But if we’re going to start to control the problem, we need to work on the biggest issue: Alcohol. So many of these deaths are truly not caused by drugs alone but by the combined effects of drugs PLUS alcohol.
    Sadly too, is even addiction is overwhelmingly viewed as moral failure and not a medical problem, and we “treat” addicts not by sending them to a physician, but by sending them to prison.

  8. Paul Kemp at 10:00 pm

    Opioids are by their nature addictive when taken over a long time period, as for one who has chronic pain. There are other, much better options that can be much more satisfactory from the patient’s point of view. But opioids are where the money is for the pharmaceutical companies, so that’s what we’re currently stuck with.

    Another problem causing this epidemic of addiction is the fact that we have turned medicine into what is almost a monopoly, run and driven by the need for profits. They choose not to cure things — or let patients know they could rid themselves of complaints like osteoarthritis with inexpensive nutritional supplements — because there is more money in waiting until the patients are begging for knee replacements at $40,000 a knee. (The GAO should really get involved to curb this abuse of the public and Medicare fund spending, but they don’t.) Same thing goes for back problems, fibromyalgia, MS, rheumatoid arthritis, etc. So we depend heavily on opioid medication of problems my Naturopath can help me overcome with scientific nutrition.

    Of course, MDs don’t believe our body can repair itself — that’s not what they were taught in medical school. I wouldn’t believe it either, except that I’ve done it — and much more without a doctor’s help.

    My point is simply this: We, in the U.S. are getting royally screwed for drugs and services we don’t need. And, an increasing number of pain patients are finding a better way to eliminate the need for a supercilious MD to write them a monthly prescription, costing them a lot of money and trouble, and leaving them with a terrible quality of life.

    The medical profession are pricing themselves out of reach, but pain patients are finding natural herbal remedies that do a better job and leave them with energy and a clear mind to re-enter family and often work life, too.

    Will states ban herbal painkillers like kratom to force the patients back onto a deadly cocktail of opioids, benodiazepines, antidepressants — all to please the drug companies and their medical sales reps? OR will the states realize they can stop paying out so much money for drugs — or opiate rehab services — and just let the chronic pain patients buy their own kratom and whatever other self-treatments they find best.

    Educate yourself about this other option, kratom. Read the testimonials of pain patients who found a much better alternative to opioids. End the pharmaceutical monopoly of U.S. medical care. Start thinking outside the opioid box.

  9. LouisVA at 11:52 am

    Greg Evans said:

    ” I agree fundamentally with the article, but how to prevent addiction is the age old question.”

    I look at the problem of addiction and the use of opioids for pain patients as two distinct and different problems that need different answers. I have been using opioids for many, many years and am not addicted; however, I am dependent (also two different things). Dependency means that if I suddenly quit taking my meds I would suffer withdrawal symptoms. Addiction is a loss of control that causes a person’s life to be centered around drugs while causing harm to that person.

    Do not misunderstand, opioids are never a first line of therapy and I spent years trying many different things until I realized that I was getting nowhere before trying opioids. I am happy to report that my quality of life is excellent and at age 65 I am now able to do things that I could not do in my 20s and 30s.

  10. Paita at 11:33 am

    I have always said,,,no true chronic physical pain patient ever gets addicted to any pill,ever!!!!!!!!,,If carrots stopped physical pain,,then I’d eat carrots,,but they don’t,,it really is soooo simply,,for us true chronic physical pain people,,all we want is our physical pain stopped,,,thats it,,,,and like or not,,opiates work,,,opiates do the job at lessening chronic physical pain,,it really is that simple to us,,It is perfectly NORMAL human behavior to want to stop physical pain,,,it is a normal reaction to want relief from physical pain,,,not an addiction,,a normal humane reaction,to want to stop physical pain.,We don’t want to care about the media,or the d.e.a. We really do have enough on our plates,,,,but we are now forced to care about all that crap,,,because the demonization of all of us,our medicines,our doctors,that the Media has done,,,is now taking are abilty to stop our physical pain away,,forced torture,,,,The Media has done a great job for ,”our” government demonize everything about pain management,jmo,,,,but all of this has lead to taking our ability to simple live.away,,,..which is a godgiven right I believe,,We aren’t addicted.,,We don’t abuse our medicines ,we don’t sell our medicine ,we are the ones who are responsible w/our medicines,,We are adults,and as adults we know full well the ,”side effects”,,,Again its called a decent respect for humanity,,,jmo,,,and to allow anyone to suffer physical pain,,when the medicines are out there too lessen that physical pain,,, it is called forced endurement of physical pain,ie,torture.,and that should not be happening in a civilized world!!!!!As far as the children David speaks of,,,I have no children,,this chronic physical pain robbed me an my husband of 28 years of children..I decided as a responsible women in my child bearing years,, my thoracic pain,would simply be too much,,that going thru 9 month w/out medicine would be unbearable,,nor could I force a unborn child to endure the use of my medicine during pregnancy,,,I had the so-called freedom to make that choice.It was the responsible decision for me,,,,
    Personally,,I do not believe any of the governments data,,at all,,,The government lies ,,,a lot,,,I think they used the media to demonize everything about chronic physical pain,,,and in doing so,,,they legitimized there so-called ,”war on drugs,”,,,plan and simple,,All there ,”data” was designed to demonize our medicines,,thus their data is a lie,,,,,,,,,ok sorry,,my back I done,,,

  11. BL at 3:45 pm

    The media has a huge impact on politicians. The media is the one things that we all have in common, the general public, chronic pain patients, physicians, politicians, those who make government regulations, etc.

  12. paita at 2:54 pm

    One other very important part,,like Ed stated,,is the media missing the point,,,yes,,,Has anyone ever seen a head line say ,”Opiate’s cure physical chronic pain,,”,,or Chronic physical pain people find 100 % relief with the help of opiate medication,”,,,no,,,what we normal see,,,is,,”Opiate use for chronic pain causes abuse,” or Opiate physical pain people find relief with HIGH dosages of opiates,,,,,,always always there is some demonization involved of opiates or pain medicines,,always,,,,We forget the greatest president of our country needed medicine everyday to function,,yet he function brilliantly w/his medicines,,ie president Kennedy,,,Pain medicine needs to be viewed and written in the publics eye as exactly that,, ” MEDICINE”,, not some terrible drug,,blah blah blah,,,and in the beginning of pain management,,thats how they were viewed,,,simply as a medicine just like insulin,,,it was the specialty of pain management!!!!!!Doctors had taken educational classes to view our medicines as medicine,,it respected with dignity as a MEDICINE,,,,not some terrible drug,,but that all changed after 2004,,,the reason I believed is stated in my earleier post,,the D.E.A.,,, needed a job!!!!!

  13. david at 12:25 pm

    Members of the opioid economy- including Secretary Burwell- are stuck in a reinforcement loop- and believe and promote the idea that the problem with opioids can be fixed with education about using opioids or new and improved opioids or treatment with opioids. Did i leave out the word opioids?
    Secretary Burwell and HHS have failed to get doctors in numbers to get education in using opioids- and no funds have been used at HHS to educate doctors in pain care. When the FDA did a report on Opioid REMS- the report showed a failing grade of less then 20%- and that means opioid rems were poorly designed in the first place- as the government really doesnt care if doctors have education in proper use of opioids or not. There is no requirement to obtain education in pain care or opioids currently in the federal government. And obviously doctors dont care enough about the $55 billion in diversion, the still born babies from moms on opioids or overdoses or addiction- to get needed education in pain care.
    The Obama administration is well paid to promote the opioid economy-they have done a horrible job with diversion or pain management. They really don’t care about diversion-their plan to address diversion will make matters worse. Proof of such is that with opioid REMS- the fda had drug companies pay some organizations that were under federal investigation for their role in opioids teach doctors opioid rems.
    As for Dr Passik- who is part of the opioid economy- the public good would be better served by you calling for your colleagues to have needed education in pain care- and realize that opioids- even when they dont cause addiction are riddled with side effects and dont cure pain. Maybe Dr. Passik you should see with a vision to get beyond the great limitations of opioids and call for primary prevention and curative treatments, as well. And yeah my dorsolateral prefrontal cortex is methylated enough for that conversation.
    as for Dr. Radnovich- electrotherapies, dbs of the acc, aic, vpl, manaka acupuncture, intrathecal hydrogen,oxytocin, orexins, kreb cycle intermediaries, conopeptides, gabapentenoids, minocycline, rapamycin, cwit, eswt, ultrasound, hifu- funny how i dont hear you talking about those treatments for pain- oh i almost forgot your very much attached to the opioid economy and dont those allegiance biases abound. Its doctors and government failure to get beyond the opioid economy, the failure to take pain seriously that got us into this mess- and they wont take us out of the mess-they dont care about people in pain that much to make the effort.

  14. paita at 12:17 pm

    Its a ,”witch hunt,” out there now a days,,plain and simple,,and innocent people[us] always suffer& die in ,”witch hunts,”,,technical terms,,”group thinks,” are very very dangerous as we can see,,I truly believe since the government owns most media now a days,,not Ed’s THANK GOD,, but most media is owned by our government now a days,,As president Obama said himself,,u have to legitimize any cause for the public to pay attention,,Thru-out history we have seen ,”our,” government demonize anything that will legitimize their employment.Look at marijuana, us older folks remember the movie ”refer madness??The D.E.A. used the media,,because after prohibition the government was planning on firing the D.E.A, ,,they had no work for the D.E.A,. after prohibition ended,So Hoover,who was at the time,,the governments boss of the D.E.A,,needed something to stay employed by our government,,soooo they demonized marijuana and used the media to do it.,That is exactly what they are doing to our medicines now!!! I truly,sincerely believe after finding those government documents of the D.E.A,, getting their butts reemed for doing NOTHING and having no data to prove the use of the tax payers money to decrease the demand or reduction of illicit drugs,,the DE.A w/its new illegal freedom to have access to all our medical records & prescriptions saw us as an easy target …A perfect target to get their ,”data,” and to prove their worth..When tragic events in history happen,,its no 1 event that truly causes the tragedy,,it a series of little events,,that allow the 1 big event to happen,like the assault on all chronic physical pain people,,The D.E.A,,after their butt reaming in 2003 needed to prove their worth by numbers,data,on paper,,what better way to do it then with a computer,,,our computers!!They got access to the quantities of medicines being prescribed to all chronic physical pain humanbeings,,but the ,”label,” to many,,,used the media to demonize those number,and thus, us,our medicines and ours doctors,, so they can/have come back to their boss,the tax payers with numbers ,for fictional example,”,450,000 million oxycodones were prescribed in 2010,,since our ,”demonization ,” the prescription are now 240,000”,,,,they now have their data to prove their worth!!!,,The media,,I found here in wisco,,,if I commented on a Dr,Houlihan,the Dr,Ibsen of Wisconsin,jmo, in a good light,,they refused to print my comment,,ie,,how the D.E.A. uses the media,,,or these fictitious ##’s on O.D.’s or quantities,, All these so -called reports on O.D.s,,or quantities,,all these reports come from other government paid for organization, most in Washinton D.C,&,,Maryland,,,its all under 1 roof,,the D.E.A,,,H.H.S,,.N.I,H,,,D.O.J,,,there all together,,They use the media to get their propaganda out.jmo

  15. mar at 11:59 am

    They need to stop sensationalizing what is happening with the true drug addicts out in the world and concentrate more on how to protect those of us that NEED this drugs to be able to function at a low level with our daily pain. I am sorry , I know that drug addiction is a illness but it’s one that they choose to live knowing what might happen. With all the money they are spending on naloxone they could be spending it on finding cures or better drugs for chronic pain patients. We don’t like feeling drugged out, and seriously most of us live on very little pain medication not just because difficulty in getting it but also because we don’t want to be all drugged out every day. We don’t have a choice like a drug abuser does. Let our doctors treat us not fearing for harassment from the DEA.

  16. Greg Evans at 10:42 am

    The problem is that one potentially leads to another. I agree fundamentally with the article, but how to prevent addiction is the age old question. We at Pain Therapy Innovations believe that there are alternatives. http://www.acuknee.com