It’s a Fentanyl Crisis, Stupid!

It’s a Fentanyl Crisis, Stupid!

Featured Image: TEDxABQ 2018 “A Working Parachute: spinal cord injuries, ketamine & comedy” which turned into a 9 min stand-up set! Photo credit Allen Winston Photography

In 2012, life was great: I proudly wore a white coat with a stethoscope around my neck and finally felt useful to humanity. Two decades earlier, as a stuntwoman, my parachute did not quite open, and I landed on my sacrum (tailbone) at 70 mph, crushing the sacral nerves. I had lost two inches of my spine, fractured several vertabrae, and would spend a year in ICU, hospitals, and a spinal cord clinic. I was left with traumatic cauda equina syndrome,¹ suffered from residual pain, and was left with a “sitting disability.” For my atrophied lower leg and foot muscles, I used leg braces, a cane or scooter and I sat on a padded office chair. I’ve schlepped pillows and camping mats with me ever since my skydiving accident. Frequently, lying down for a few minutes was the only way to deal with my disability.

Go to the profile of Kaatje Gotcha Crippled Comedy

Kaatje “Gotcha” van der Gaarden

As a Physician Assistant in primary care, I loved my job and providing a true provider-patient collaboration. I had ample opportunity to prescribe opioid medications. Responsibly, of course. In my toolbox, I had excellent interview skills, the State’s Prescription Monitoring Program (PMP), and a urine test. The PMP would let me know me if patients were doctor or pharmacy shopping, although it couldn’t take into account other states. A urinalysis would tell me if the patient was taking the opioids as prescribed, or diverting, or using other, illegal drugs, or medications that were not prescribed. Heck yeah, I even had my patients sign an Opioid Use Contract.

One patient’s husband worked for the Drug Enforcement Agency (DEA), and he told me one that opioids went for about 70 cents per milligram on the street, in 2012. However, I never assumed someone was gaming the system and tried to keep an open mind. Some patients did want me to refill their emergency room (ER) hydrocodone prescription, for complaints like a mildly strained knee. At that point, I would print out knee exercises instead. I always tried to understand my patients’ emotional and physical health and encouraged exercise and healthy habits (even if most days, I couldn’t prepare food so I ate LAY’S® Limón Potato Chips and gummi worms).

Another patient had just moved from Arizona, with a history of using 30 mg of MS-Contin, a long-acting morphine tablet, three times a day, plus another opioid, Percocet 10 mg instant relief (IR), one tablet every four to six hours for breakthrough pain. The patient was full-time employed, doing fairly intense labor, and was incensed when I wanted evidence of his “bad back.” The patient did not bring any records during his first visit, but he later returned with a lengthy health record — his pain deriving from five back surgeries, three of them revisions for the original surgeries.

I had never heard of “ultra-rapid” or “slow” opioid metabolizers² which affect adequate treatment, and still believed the Center for Disease Control (CDC) had society’s best interest at heart. The opioid crisis seemed far away, and I believed that did not affect my patients, or myself. Mistakenly, I thought there hardly would have been an “opioid epidemic” had medical providers only accompanied any opioid prescription with this warning: “Use your IR (instand relief) opioid medication when you truly have breakthrough pain, a 7–8 or higher, or it will no longer be as effective.”

Perhaps. But complicating matters was that opioid medications did seem to be prescribed for relatively mild to moderate pain, or in situations where acute pain would soon resolve. For example, to my patient with that strained knee, seen in a Colorado ER. In 1991, I’d fractured my lower leg above the ankle, after a car stunt gone awry, and wasn’t prescribed any opioid medication. The ER doc in Florida who applied the hot pink cast, from my toes to my knee, pointed me to a Walgreens to buy Tylenol (acetaminophen) for the simple, uncomplicated fracture.

Although I was in tremendous pain myself from the sky diving accident and crushed sacral nerves, I denied suffering from intractable pain. Yet I was battling worsening neuropathic (nerve) pain, as well as residual musculoskeletal pain from the sacral and vertebral fractures, on a daily basis. I made it through each workday by lying down on the exam table during lunch. Work gave me great happiness, but physically I had no energy left to cook, maintain friendships or even have a hobby.

That year I recall having to do five mandatory continuing medical education credits by the State on “responsible opioid prescribing.” This seemed ludicrous since I always looked at the PMP before going into the exam room. Especially with a patient that was on medications that fell under the Controlled Substances Act.³ As a non-contract employee, I also paid my own DEA license at $780 every three years for the privilege of writing controlled substance prescriptions. I was ticked off with the cost, but also with what I perceived as government encroachment on my medical decision making.

Sure enough, over the years, after the CDC Opioid Guidelines came out (which are voluntary, and not legally binding), I began to realize that there is no true opioid epidemic. There’s an epidemic alright, of people taking opioids with multiple medications and then adding alcohol and other illegal drugs on top. What we most certainly have is an alcohol epidemic, with 88,000 deaths⁴ annually, and this epidemic is starting to effect millennials. I blame those hipster beers with ridiculously high alcohol percentages, as millennials are dying of liver cirrhosis in record-breaking numbers.

Despite the ongoing alcohol epidemic, from 2012 to 2016, using opioid medication became synonymous with being a “drug seeker.” The “opioid crisis” narrative was perpetuated and fueled by mainstream media, whose culpability lies in using labels like “opioid overdose deaths” instead of the more appropriate “mixed drug intoxication.” True opioid deaths (opioid medications alone) range around five thousand deaths annually, according to Josh Bloom, writing for the American Council on Science and Health.⁵ New York City’s medical examiner’s office is unsurpassed when it comes to accurately determining cause of death: in 2016, 71 percent of all drug-related deaths involved heroin and/or fentanyl.⁶

Looking at the numbers, most of the so-called “opioid deaths” seemed to be people who did not take their medication as instructed, if opioids were legally prescribed in the first place. Seriously, because who cooks their Fentanyl patch and injects it? Not chronic pain patients, who need slowly titrated medication to bathe, cook, work, take care of kids, or go to school. Patients were indeed dying from respiratory depression, caused by taking legal or illegal opiates. But how many of those deaths are suicides? If patients with severe pain, on a stable regimen, are denied access, they may turn to suicide, or illegal opioids like heroin, now tainted by illegal fentanyl. That is not an opioid crisis, but another iatrogenic consequence of the “guidelines.” The Law of Unintended Consequences never fails.

How was it that the CDC took advice from an anti-opioid advocacy group, Physicians for Responsible Opioid Prescribing (PROP)⁸ in constructing the Opioid Guidelines? PROP had lobbied Federal officials and the FDA for years, to change opioid labels. When they were (mostly) rebutted, PROP got involved with the CDC, behind closed doors. The Washington Legal Foundation⁷ notified the CDC in 2015, as in their opinion, the CDC broke the 1972 Federal Advisory Committee Act (FACA) law. Washington Legal Foundation states that a Core Expert Group, advising the CDC, conducted their “research” and “Draft for Opioid Guidelines” in secret, without input from pain experts, pharmocologists, or patient groups.

Dr. Jane Ballantyne (current PROP President) was part of that Core Expert Group and is notorious for her anti-opioid stance. Another Core Expert Group member is PROP executive director, and founder, Dr. Andrew Kolodny, who refers to opiate medication as “heroin” pills and proclaimed that “oxycodone and heroin have indistinguishable effects.”⁹ Yet you oughtn’t compare a 5 mg tablet of oxycodone to IV heroin, without qualifiers on potency. Dr. Kolodny, an addiction expert, doesn’t even distinguish between “plain” heroin, and heroin cut with fentanyl, which is 100 times stronger than morphine. About 80 percent of fatal overdoses are now due to illegal fentanyl. By muddying the issues of opioid dependence, opioid addiction, and heroin use with either false or incomplete statements, PROP also does a disservice to people who are addicted to heroin or illegal fentanyl.

Research has found that 75% of heroin addicts have a mental health illness, and 50% have trauma from (sexual) abuse before age 16, something that gets drowned in Dr. Ballantyne’s simplified narrative of “continuous or increasing doses of opioids [… ] can worsen a person’s ability to function and his or her quality of life. It may also lead to opioid abuse, addiction, or even death.”¹⁰ Like many others, I argue that (illegal) fentanyl, and indirectly, profound loss of hope, is the main driver behind the current “mixed use overdose” deaths.

Dr. Kolodny was Chief Medical Officer of The Phoenix House, an addiction center, at the time he helped draft the CDC Guidelines. PROP also avoids mentioning the Millennium saliva,¹¹ or other DNA tests, to identify how individual patients metabolize opiate medication and that some are “ultrafast” metabolizers. PROP fails to mention opioid blood concentration measurements, no matter how imperfect.¹² However, no one doubts the conflict of interest: PROP Board members are involved with grants from the CDC, addiction centers, medical device companies to develop an opioid tapering mechanism, and even consulted with law firms investigating lawsuits against opiate pharmaceutical companies.

PROP was originally funded by Phoenix House, one of many addiction centers that prescribes buprenorphine. PROP is currently funded by the Steve Rummler HOPE Network,¹³ another anti-opioid group that lists Dr. Ballantyne and Dr. Kolodny on the medical advisory committee. Dr. Kolodny admitted in a 2013 New York Times article titled “Addiction Treatment with a Dark Side” that as a New York City Health official, he lobbied on behalf of the buprenorphine pharmaceutical industry. He was quoted as saying, “We had New York City staff out there acting like drug reps [with $10,000 incentives -KG].”¹⁴

Buprenorphine was the supposed miracle drug after methadone, but its known side effects include serious diversion, addiction, and possibly, lifelong treatment. Dr. Kolodny publicly promoted buprenorphine in various media outlets, despite evidence of buprenorphine overprescribing, pill mills, and overdoses. The true scale is not known, as most ERs and medical examiners do not test for the presence of buprenorphine. The CDC does not track buprenorphine deaths, despite a 2013 study¹⁵ that found a tenfold increase in buprenorphine-related ED visits, according to the Federally funded Substance Abuse and Mental Health Services Administration (SAMHSA). As “bupe” availability increased, so did diversion and overdose deaths.

Interestingly, that Dr. Kolodny promotes the idea that heroin and opioid medications are the same molecular compound. Actually, buprenorphine has a molecular profile¹⁶ that more closely resembles heroin, than hydrocodone. Dr. Kolodny indirectly claims that CDC “Guidelines” are effective, when the truth is that by the time PROP advised the CDC, prescriptions had already tapered off. This is evidenced in his statement as chief medical officer from a Phoenix House Q&A,¹⁷ dated December 2015: “It will take some time, but we’re already beginning to see a plateau in opioid prescribing.” Dr. Kolodny appears to take credit for a trend that had nothing to do with PROP, and he omits the fact that prescriptions are down since 2011, and yet overdoses are up.

Mainstream media occasionally, and accidentally, reveals the truth. CNN¹⁸ in 2018: “Fentanyl-related deaths double in six months; US government takes some action.” Then again, the echo of Dr. Kolodny’s statements, as reported by CNN: “The recent rise in popularity of these synthetics has been called the third wave of the opioid epidemic; the first wave was attributed to the overprescribing of painkillers like oxycodone and hydrocodone and the second to heroin. The drugs are all chemically similar and act on the same receptors in the brain.” Again, not one word about potency.

Few realize that when the CDC issued the Opioid Guidelines in 2016, there was inadequate research done ahead of time to determine the true cause of the rise in opioid-related deaths. There are no long-term studies on the effects of chronic opiate therapy. Very few, if any, pain management experts or pharmacologists were consulted to determine potential impacts on their practice. Neither veterans nor chronic pain patients were given a true opportunity to issue public comments to the CDC or any other Federal authority prior to the implementation of these new prescribing mandates. The CDC ended up targeting one of the most vulnerable groups, patients with intractable pain.

The CDC’s Guidelines also affect patients with cancer and patients who no longer receive cancer treatment because, unfortunately, both groups report similar pain levels. The guidelines allow the use of opioids during cancer treatment, but they are confusing when it comes to equally severe, post-cancer treatment pain. I fear this “opioid” crisis is far from over, and yet, trust me, this will go down as “reefer madness” in another hundred years. It is a manufactured tragedy that does real harm to patients with intractable pain. The “opioid” crisis also hurts human beings who suffer from heroin, opioids or other addictions by siphoning money, goodwill, and energy.

Few people realize that the CDC hired a PR agency to help sell the American people myths on the “opioid epidemic.” The agency, PRR, designed graphics to “educate” primary care providers that “one in four patients on opioids will develop addiction.” Even the National Institute of Health,¹⁹ another federal entity, estimates this to be 5 percent, not 25 percent. Another research team²⁰ concluded in Pain Medicine that opioid therapy for chronic pain patients (note: in absence of prior or current drug abuse) resulted in a 0.19 percent incidence of abuse.

The language used by the media as well as PROP contributes to misunderstanding; using words like addiction, tolerance, dependence, abuse or opioid use disorder as if they mean the same, directs the casual observer to bias. It’s clear that PROP never was an independent, neutral entity advising the CDC, yet they ended up dictating federal policy, based on flawed evidence. Dr. Ballantyne, Dr. Franklin, and Dr. Kolodny in Politico.com²¹ in March 2018: “We agree with Satel that the answer is not to force millions of chronic pain patients to rapidly taper off medications they are now dependent on (Italics mine). But then, neither is the answer to absolve overprescribing for pain.”

I’m not a linguist, but in that essay, PROP uses the word “addiction/addicted” 16 times, and “dependence” twice. The CDC could have ensured that patients with severe to intractable pain (no such distinction is made) would not lose access to their medications. And yet, that is exactly what happened. Stable patients on long-term opioids were tapered against their will, as the CDC “Guidelines” state it is undesirable to titrate above or equal to 90 morphine milligram equivalent²² daily (aka MME/day). But this was meant for opioid-naive patients, not those on long-term opiate therapy. Primary care providers, who were forced to follow these “Guidelines,” either stopped prescribing opioids altogether or forced patients to rapidly taper to below 90 MME.

Dr. Ballantyne is correct in her remarks that it isn’t realistic to expect zero pain levels, especially for acute pain that is expected to resolve quickly, like a sprain or an uncomplicated fracture. But people with severe to intractable pain are condemned to a world of suffering. Recall my patient with the five back surgeries? I wonder about him. He was working full time, on 180 MME a day, but in his mid-fifties, arthritis would worsen soon. My own story did not end well; I ended up with yet another spinal cord lesion, a benign hemangioma at chest level, which causes “central neuropathic pain syndrome.” My old cauda equina syndrome morphed into “severe, chronic adhesive arachnoiditis.” This is an incurable, intractable, progressive neuroinflammatory disorder whose pain is considered on par with having terminal cancer pain. Still, I try to make the best of it, see my essay, On Being Bedbound.

The CDC and PROP came for me: after using opioids exactly as prescribed, and less than 30 MME daily, my primary care clinic was forced to stop my opioid prescription, and that of all patients. I was not accepted in any pain management clinic, in an urban area of almost one million. Pain clinics here no longer provide “medical management,” yet perform epidural steroid injections ($3000 a pop), which may have contributed to, or worsened my adhesive arachnoiditis syndrome. I’m lucky to live in an urban area, where the academic hospital’s pain team took over my prescription.

But what about elderly and impoverished patients, or those in rural areas? PROP and the CDC claim primary care providers “overprescribe” and are responsible for most of the opioid prescriptions. But they fail to publicly acknowledge that pain management clinics no longer accept patients. This epidemic of undertreated patients will become known as one of the cruelest moves by a Federal agency on an already compromised population. I do feel for teenagers and adults who become addicted. Yet there ought to be a different, more sensible approach towards legitimate, chronic pain patients who need opioid medications, as well as people who develop a substance use disorder, who deserve our help and sympathy.

It is a conundrum of extraordinary proportions. At a time when managed care and Electronic Health Records dictate the length and quality of an office visit, there is less and less time to sit down and connect with a patient. Not just with chronic pain patients. Medicine and society would benefit greatly from the extra time clinicians deserve, to encourage exercise, eat healthier, lose weight, stop smoking and assess if a patient needs other support, like therapy.

In my opinion, it is loneliness, the feeling of not being connected to humanity in a meaningful way, combined with economic hardship, that leads to unhealthy lifestyle choices, as witnessed by the Rustbelt being hit hardest. Research shows that rats who were offered spring water or water laced with heroin, choose heroin. When those same rats were given ample toys, space, and other rats to play and have sex with, they did not choose the heroin laced water. That’s right, happy rats don’t need no heroin!

It cannot be denied that in previous decades, pain was both undertreated, and opioid medications prescribed for relatively minor, self-resolving aches and pains. Forget for a moment, the narrative that places blame on overprescribing, the opioid manufacturers, or the pharmaceutical distributors that, for example, flooded impoverished communities like those in West Virginia.²³ Forget all that, and focus on what is going on. Ultimately, patients with intractable pain pay the price of ignorance by scientists, journalists, politicians, and laypeople alike.

For this humanitarian crisis, there are no perfect answers. For example, as Red Lawhern, Ph.D. and prominent pain advocate²⁴ recently communicated with me (12/3/2018): “there is promise in genetic testing but hasn’t yet been fully reduced to routine practice and may not be covered by insurance.” Luckily my DNA testing was covered, on the condition it tested for depression. I also discovered that ketamine infusions help me most, but will leave that topic for my upcoming book, The Queen of Ketamine. Sadly, amidst the opioid paranoia, non-invasive alternatives like ketamine infusions aren’t mentioned for neuropathic or intractable backpain, which often has a neuropathic component. Research also shows that adding an anti-seizure medication to an opiate mediation provides better neuropathic pain contral, with less morphine²⁵.

In the end, I don’t think Tai Chi, Tylenol and Cognitive Behavioral Therapy is going to cut it for meningeal inflammation or other (neuropathic) pain syndromes. I believe the tide is turning. It will take time, and in that time, patients with intractable pain will choose to end their lives. But we are not alone, and it helps to know that courageous voices, notably the Alliance for Treatment of Intractable Pain, are speaking up for us. The print and online magazine Reason²⁶ has long been a voice of, well, reason. As Red Lawhern stated in a must-listen November 2018 radio interview,²⁷ “We must address underemployment, socioeconomic despair and hopelessness which are a vector for addiction. And end the War on Pain patients.”

Love, Kaatje

Kaatje Gotcha, model and stuntwoman-turned-Physician Assistant, found comedy, writing and advocacy after developing Adhesive Arachnoiditis. This spinal cord disease causes intractable neuropathic pain and leaves her mostly bedridden. Prior to that diagnosis, she’d survived a nighttime skydiving accident, landing at 70 mph. This caused Cauda Equina Syndrome; a subsequent lumbar puncture and epidural steroidal injections may have exacerbated her previous injuries.

Kaatje’s courageous spirit led to writing “The Queen of Ketamine,” available on Kindle in February. This is a comedic yet pragmatic memoir  on adhesive arachnoiditis, the opioid “epidemic,” neuropathic pain, dating with a disability, while offering hope and practical advice. Kaatje’s 2018 TEDx talk and book publication will be posted on her Facebook page, at www.kaatjegotcha.com and Instagram @kaatjegotchacomedy. Find her essays on Medium, and follow her on twitter.


  1. Cauda Equina Syndrome https://emedicine.medscape.com/article/1148690-overview
  2. Opioid Metabolism https://www.medscape.com/viewarticle/771480
  3. Controlled Substance Act https://www.dea.gov/controlled-substances-act
  4. Alcohol Epidemic https://www.niaaa.nih.gov/alcohol-health/overview-alcohol-consumption/alcohol-facts-and-statistics
  5. Opioid Epidemic Deception https://www.acsh.org/news/2017/10/12/opioid-epidemic-6-charts-designed-deceive-you-11935
  6. Overdose Deaths by Heroin/Fentanyl 71percent https://www1.nyc.gov/assets/doh/downloads/pdf/epi/databrief89.pdf
  7. Washington Legal Foundation and PROP https://www.forbes.com/sites/wlf/2015/12/15/cdc-bows-to-demands-for-transparency-and-public-input-on-draft-opioid-prescribing-guidelines/#c82eda135bc3
  8. Physicians for Responsible Opioid Prescribing http://www.supportprop.org/
  9. Dr Kolodny refers to “Heroin” Pills https://www.healthline.com/health-news/secondary-drug-industry-booming-amid-opioid-epidemic#2
  10. Dr Ballantyne’s Narrative https://www.statnews.com/2015/11/30/chronic-pain-intensity-scale/
  11. Millennium Opioid Metabolite DNA Test https://www.millenniumhealth.com/services/test-offerings/
  12. Opioid Serum Measurements http://paindr.com/serum-opioid-monitoring-wheres-the-evidence/
  13. Medical Advisory Committee https://steverummlerhopenetwork.org/our-team/
  14. NYT: Addiction Treatment with a Dark Side https://www.nytimes.com/2013/11/17/health/in-demand-in-clinics-and-on-the-street-bupe-can-be-savior-or-menace.html
  15. Sharp Rise in Buprenorphine ER Visits https://www.samhsa.gov/data/sites/default/files/DAWN106/DAWN106/sr106-buprenorphine.htm
  16. Heroin and Buprenorphine Molecular Profile http://paindr.com/heroin-hydrocodone-buprenorphine-prop-aganda/#comment-334500]
  17. Q&A with Dr. Kolodny, Phoenix House https://www.kolmac.com/2015/12/qa-dr-andrew-kolodny-chief-medical-officer-phoenix-house/
  18. Fentanyl, as Reported by CNN https://www.cnn.com/2018/07/12/health/fentanyl-opioid-deaths/index.html
  19. NIH Estimates Pain Patient “Addiction” 5 Percent https://medlineplus.gov/magazine/issues/spring11/articles/spring11pg9.html
  20. Pain Patient “Opioid Use Disorder” without Risk Factors 0.19 percent https://academic.oup.com/painmedicine/article/9/4/444/1824073
  21. Rebuttal by Dr. Kolodny and Dr. Ballantyne https://www.politico.com/magazine/story/2018/03/13/opioid-overprescribing-is-not-a-myth-217338
  22. Morphine Equivalent Dosing https://www.wolterskluwercdi.com/sites/default/files/documents/ebooks/morphine-equivalent-dosing-ebook.pdf?v3
  23. https://www.wvgazettemail.com/news/cops_and_courts/drug-firms-poured-m-painkillers-into-wv-amid-rise-of/article_99026dad-8ed5-5075-90fa-adb906a36214.html
  24. Red Lawhern, PhD and nationally known Pain Patient Advocate http://face-facts.org/lawhern/
  25. Combining epilepsy drug, morphine can result in less pain, lower opioid dose. https://www.sciencedaily.com/releases/2014/09/140915153613.htm
  26. Jacob Sullum, Reason journalist and syndicated writer https://reason.com/archives/2018/03/08/americas-war-on-pain-pills-is#comment
  27. “Unleashed” Matt Connarton Interviews Red Lawhern 11/28/18 https://www.spreaker.com/user/ipmnation/matt-connarton-unleashed-11-28-18

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Maureen M.

Dear Kaatje, Bravo! And thank you for such an incredible, informative and RIGHT ON writing! You consistently hit the nail on the head and I appreciate you.
I too have AA as well as other pain conditions but I cannot imagine all that you have endured, especially since your accident! And yet you’ve become a PA! How in the world I’d you do it? I’m an RN who became disabled and early retirement after my accident and subsequent 4 failed special me surgeries. I cannot even volunteer. You have incredible strength. God bless you and keep you strong, inspirational and ‘funny’! Maureen M.

Bill

Firstly, I can’t imagine the pain this Woman experiences on a daily basis. I hope I counted correctly, but paragraph 29, (“in My opinion…”) condenses the whole problem right to the core. Happiness, or even contentment are the places We all “pursue”. When I saw the suggestions that whatever committee wrote, I just about fell out of My chair. God Bless You Kaatje, and thank You for Your writing a sane perspective of the true problem.

Alan thurman

You 100% correct. Adding heron numbers into prescription pain overdose deaths is the first illusion. Let’s get true picture of the opioid situation. Take out the deaths caused by fentanyl place them in a file. Now let’s get to the bottom of this. Getting the real picture, is the first step. This, persecution of people in pain has ruined my life, ruined my helalth and is having a negative effect on my loved ones. No one cares until they are in pain, lawmakers and prescribers may empathize, but until that are wreck gives them out type of pain they will never care. Nothing garners votes line being tuff on drugs. Now, we can bye the ingredients to make meth at local drug stores, we can smoke weed.in 13 states, but if you need a pain pill, u will have to write congress, go thru six months of therapy (twice) and take naproxen’s (I call gut rot disease medication) to get a 5 mg Vicodin. I’m a 100 percent serious.

Cindy

I am even more angry at the gov’t than I was.
It’s so completely outrageous.
There are no words.

Christine Hawkins

Here is a new one for pain management patients vitamin infusions. Now doesn’t that sound like another way for pain doctors two make money not to mention I was offered a back brace at no cost to me this was at a pain management doctor which I was forced to see because a Walmart pharmacist called my online pharmacy and told CVS me Dr was not a reputable Dr and to deny all.pain related medication. That was 4 months ago
61 years old and I want to jump off a cliff.I am tired of injections surgeries. Now they want to put something near the spine that blocks the nerves to your pain.Reduction 35% decrease in opioids
great suicide has increased what about double that number. And yes fentanyl is the problem it killed my son. Xanax laced fiorinal Fentanyl.I live with that loss.

danya zucker

Thank you thank you thank you for this excellently researched and ultra-necessary article. I, too, hope you (or anyone with your permission) get it to as many sources of all types of media as possible. Some of us would not be alive without the medication we take responsibly to treat our pain.

William Dorn

We need people like you on the tv shows telling the true facts.

What a great article…so thorough and full of truth. I’ve been following this for years now….Kolodny, Ballantyne, PROP, et alerW8t, will have to account to their Creator for all the suffering they have caused, are causing. God does not look kindly on such things. Just my opinion. May they be stopped soon, by someone. Meanwhile, many more will take their lives. And these evildoers could care less. .

BXaFl

Got my cauda equina injury from a fall when the deer stand i was in, broke. It has left me with a “neuropathy” that my neurologist, and pain doctor both refuse to treat adequately. Their comments, “I never ever put anyone, with neuropathy, on “narcotics”..Then they give me tramadol! The neurologist claimed it was not neuropathic pain! Sadly, having had a graduate degree with Zoology and Human Anatomy majors and, minors in endocrinology and botany, a completed general surgical residency, and a Certificate in Pain Studies, from The University of the Pacific, in Stockton, my self esteem did not suffer. They assumed they were better educated than me!?

Jul

Another article and although well stated and concise, nothing will happen to check the DEA, CDC, MEDIA reports and other Governmental excessive OVERREACH. I like Williams’.statement, naming Chronic Pain as PERMANENT.
Our government is at such a chaotic crossroad that my hope and attempts to find a prescriber of correct pain analgesics, opiate analgesics, is at an all-time low. I/we have some excellent strategies for ending this horrid attack on Chronic pain yet nothing that’s cohesive.
National Pain rallies are scheduled for the 29th of January. This is a humanitarian CRISIS. Our government reps, Healthcare providers prescribers need to DO THEIR JOBS. The mental and physical hardship and suffering needlessly continues. Millions are at risk yet our voices continue to be IGNORED. This situation is DELIBERATE and many facts falsely stated. A committee addressing this abomination should be formed. Or an open investigation. Both.

Kolodney and prop new guidelines are that of biopsychosocial Network. Please look up the word biopsychosocial. This was done in 1977 and it was proven not to be adequate for diagnosing illnesses. And it was also discriminating against the patient because it can only be the word of the physician/ psychiatrist opinion of the patient. Does any chronic pain patient want to be put through more discrimination than then they have already faced. If you fill out HHS and give your opinion be sure to think about this biopsychosocial because that’s where it’s headed.

This is what all chronic pain people need to do is sign a document wanting Freedom of Information Act on the cdc’s secret meeting that they had that they come up with these guidelines. Does anyone know how to get this started?

Stacy Cooper

It’s an illicit Fentanyl crisis not a Fentanyl crisis. Please distinguish for those of us responsible Fentanyl pain patch users!!!

William

A further note – Dr Debbie Dowell – Senior Medical Advisor – CDC. She was the LEAD author of the 2016 CDC Guideline for Prescribing Opioids for Chronic Pain. Here is a recent quote from her.

“We have heard about suicides. We’ve heard the reports. The CDC guidelines are not a regulation or a law – it’s guidance for providers. It never made a recommendation to take people off medication involuntarily or to taper down involuntarily. It was meant to provide updated guidance about the benefits and risks of opioids for chronic pain so the the provider and the patient – together – could make decisions.”

She needs to be on every cable news channel and shouting this from the rooftops so that every doctor knows that it is NOT AGAINST THE LAW to treat a chronic pain patient.

L. Bennett

Dear Kaatje,
I cannot tell you how terribly these suspicious, penalizing attitudes toward pain medications have impacted the disabled community. And I’m just so surprised how easily the medical community has been intimidated and controlled. Doctors don’t seem to be made of the same stuff they used to be. Voices for patients, for people who are suffering, seem to be very quiet. We are ruled by the conceit of the healthy.

Notasheep

Wow. An extremely comprehensive, easy to understand and well written, concise article. THANK YOU!

Laurie

IMO, it’s all about keeping the drug wars going after they realized pot was going legal.
Keeping up the attack on the vulnerable and doctors who weren’t even given a voice.
The DEA LOVES this! and They are far exceeding their legal mandate as well.
It seems nearly everyone is suffering under this cruel administration

William

Thank you for the most comprehensive review of this “2ND OPIOID CRISIS”. We are the low hanging fruit that can be picked off by the DEA because we are legitimate and they can track us.
Thank you for calling out the MEDIA and their role in hyping this story every day, as well as Dr. Kolodny and his Cabal of anti opioid Drs.
The Media does not say one word about the Alcohol Crisis that you called out. Not only the 88,000 lives per year we lose to alcohol, but also, how many lives are ruined by “mean drunks” – broken homes, divorce, child and spouse abuse, etc, etc. Instead we promote drinking on TV and in our culture and name Stadiums after beer companies. I would say that alcohol has 100s of times more negative effect on our society than opioids.
My orthopedic Dr of 25 years just retired and I cannot find another Dr to fill my Vicodin script, 60mmg. I live in a metro area, 1.5M, and every pain clinic has now forbid their Drs from prescribing any opioids. My ortho refused to be bullied by what he called the pain nazis, but now he is retired and I am up a creek. The Drs I have met with will tell me that they will go to jail if they prescribe for me. If you are educated at all, you know that is a complete lie.
And what about the Physician’s Creed of “DO NO HARM”? Drs are causing immeasurable harm by forcing all patients off their scripts. It is IMMORAL and UNETHICAL to refuse to treat someone with permanent pain.
I really don’t know where else to turn as I don’t think there is 1 Dr left in my area that will stand up to the bullying of the DEA.
I’m so glad you were able to find another source, but I think most of us are just out of luck. Thank you again for calling out the real criminals, the CDC, DEA and the Drs hiding behind the government.

Miss Gaarden, have you ever sent your article here to the newspapers? I’m so sorry that you’re in the condition that you’re in. Excellent article. Also wonder why hasn’t any reporter looked into Kolodney & prop do a newspaper article on them. All of this has been fishy from the start. At least you’re getting help the rest of us are living in hell. Thank you for your insight into all this but unless you give it to the newspapers not many people other than chronic pain people are going to read it.

First thank you for yoir beatiful article and right on target too. I am also sorry for your pain. From first hand experience the government is killing the pain paient and I do not believe it is an oversite. This kind of Genocide by Suicide and on a mass scale yet hard to quantify, hard to prove had to be deliberate. If it were not the government would listen and chnge the policy. It could only be explained by a depopulation agenda.You say that a loss of hope is at the core of Suicde and you are right but that loss of hope is borne out of a loss of medicine and thus pain control. A Henious and Diabolical plan for the Intractable pain paitent made years ago come to it’s logical conclusion. I should know. With the promise of a most hideous end who would want that? My prayer would be that all ask Jesus into their heart.

Julia Heath

You go, girl! Love the healthy-spirited way you’re handling your life – and thank you for your courageous & optimism! From one former PA to another, let’s take a stand for the weak & ill, even when that includes us.

Sandie

Thank you for the truth, it is a Fentanl Crisis. Sad but the Government, CDC has No right to set guidelines on Pain Medication. They are causing so many of us that are in Pain, to suffer. Yet we all know if one of those people making these decisions was in the kind of pain myself and others are in, they would get the pain medication with No Problems. I have had over 30 surgeries. The last 5 were my Pancreas having a stint put in it. My pain is so bad, yet No Doctor wants to lose their License. I had a P.A. when I told him since I moved to a State that you have a right to die law and I refuse to have more spinal surgeries. He told me to keep that in mind. I have done physical therapy, injections that made me worse. A shrink that all he wanted was to get the Pain Doctor to send him more patients to screw the insurance company’s out of money. I have proof of all the things that cause my pain. MRI’S, CT Scans, X-Rays you name it I have it. All I know is if I could find a Lawyer that would go against those who made these decisions, as I feel like they have went against my Constitutional rights, and Pain Doctor’s right to practice. I am now bed bound most of the time. This crisis is not people going to a Pain Doctor! It is the Rich buying Doctor’s and those that are using street drug’s. Yet, those of us that have been on Pain meds for years are being called junkies or addicts. Yet I have not turned to street drugs or alcohol. I moved out of California and live in Oregon now. A state that makes it impossible for anyone who needs the pain medication. If you are Poor or on Medicare/Medicaid. Law makers are causing many people to feel that killing themselves is better than the Pain they live with every day. The CDC, DEA and those that helped make these Guidelines have done more harm than good for those of us that take our medications like prescribe. Have no Trust in our Federal Government Anymore! These new Guidelines are killing people in Pain.

Cindy

Great article, we all know this is true. Why can’t they figure out?

susan

Thank-you for your article. I am sorry for your pain. I have signed a contract with my PCP about Vicodin. Must be only prescribed by him. I signed it. I have multiple sclerosis and other pain issues with two back surgeries etc. I use them responsibility. Wish I didn’t have to take any sort of med. thank-you again. Susan

Kris Aaron

This is exactly the information we need! Pain patients can present these well-documented reports and facts to their local news outlets and campaign for a reporter to do a segment, broadcast or series on how government overreach is torturing chronic pain patients in the area.
Kudos and applause to Kaatje for her fine article and accurate reporting! Thanks, dear — we need you!!

E.S WILSON

This was a FANTASTIC Article! I wish THE WORLD could see & read it. She writes from Experience, Knowledge & Facts.
We need more of that & Less of knee-jerk reactions by those in Power, those who personify Agenda & those disseminating or falsely stating warped viewpoints as Fact from those who Gain from these dishonest and/or skewed Statements.

As a Chronic Patient for 17 years, due to vehicle accidents, not one of them my fault, & resulting 3 Spinal Surgeries (awaiting neurosurgery Cervical Spine, making 4th Surgery), I am at the lowest Level of Opioid prescribing
by a Supposed “Pain Practice” I have ever had. They write in infuriating, untrue things in their “medical” notes, do not “work” with the Patient & collect fabulous amounts of Money. These peoples’ Agenda as Demagogues, facilitated by the U.S. Government, is sickening.
I cannot function execpt to live in pain, and I do feel cut off from Society & from my normal duties, even enjoyment.

Congratulations on such a well written Piece!! It gives me Hope that I will be able to hold my head up & become part of Society again as a functional Human Being, not as a “Leper” looked down upon & talked down to, one day soon again!! PLEASE KEEP IT UP!!!!

Sue A Lewis

Awesome article!

Denise Morris

Beautifully done Kaatje! Thank you thank you for compiling this information and imparting an urgent message on this important topic.

Debe Kelley

Love your article. Thank you, and God bless you.

Pamela Lee

To the point, accurate discussion about the government, opioids, drug companies. Excellent recap about the individual in pain and the dead end maze they are forced to travel.
Thankful for my pain mgt. Group here in Calif. Pain management group in Oregon dismal.

Martha

Dear Kaatja – Wow! Such a powerful, thoughtful and moving response to the apparently “intractable” CDC & DEA, etc. Simply brilliant. Thank you, thank you, thank you for writing this. I can not type for very long as I have severe cervical damage from a 360° horse accident & typing causes severe pain for me. Thank you for taking the time to educate & illuminate the public.
This shoyld be mandatory reading for Congress, CDC, etc. But as we know….ha!
Stay brilliant & wonderful,
Martha

Katie Olmstead

Amazingly clear and accurate description of this disaster. Thank you. And I am deeply sorry for your pain. I look forward to hearing about your experience with Ketamine.

M Gate

Thank you for your insight! I too receive the slow acting 30 mg morphine & fast acting (was on percocet, now norco to try to get close to the 90mg . I’ve had 3 cervical surgeries, (rods & screws in the back of my neck & plates & screws in the front – fused C3-T1) I can work & try to deal with severe pain at the reduced meds but painfully. My previous pain mgmt DR, who I had been with for years reduced my meds by 30% in one fell swoop, no tapering. I considered whether I could live with the pain (thank god for my family & being finding another practice). My previous DR lied to all his patients by saying that his reduction was “LAW”, it is not. He just chose his backside over his patients. (I understand his need to to a CYA, but I do NOT excuse his lying to us-thank god the new practice increased my meds a little if not back to the original level). I have never abused meds I receive, nor have I ever “given away or sold” what I have. I need it myself & using more than needed on 1 day means not having enough to last the rest of the month. I just pray that we don’t have a disaster that prevents the Drs office or pharmacy from opening to supply meds on the very day you run out since they only give you enough to get through to that “very next” visit. (We are talking about living your life around being able to pick your Rx up in time to not miss a dose). Also, I too see that the new practice is trying to promote surgical procedures hoping to cut back my meds. Everything they are suggesting has been strongly ruled out by others so it is truly frightening that they would recommend serious surgeries & implants when the meds are working (enough to function, although painfully) & the implants are dangerous for my condition. I thank you…. ALL OF YOU who are trying to open the eyes of these people who don’t know what they are talking about or think they do.

Holly

Kaatje, Thank you so much for this article! What I don’t understand is this….. If The Washington Legal Foundation notified the CDC in 2015, as in their opinion, that the CDC broke the 1972 Federal Advisory Committee Act Law, why were they allowed to go through with it? And no one said anything??? I just don’t get it. I don’t get how they all know chronic pain patients are being treated like dirt, and are committing suicide , yet they continue with this bullcrap???
I look forward to reading your new book. I hope your pain is under control. Again, thank you for a great article!

Barbara Lampher

WOW! What an eye opening, well written article. Definitely one of the best I’ve ever read.
Thank you!

F.S.T.

Gosh, Katie “Gotcha.” What a detailed, wonderful post. The Doctor Kolodny, creator of PROP and I think a psychiatrist by trade, has single-handedly ruined millions of lives. How did this happen???

Then his attacks on intractable pain patients trickled down to us. I’m taking 80 mme, about half of what I need. I’m fortunate to have even that, I know; but I’m mostly bedbound now. My love of gardening is over. That helped me keep my sanity too. That’s quickly eroding.

I do not want to use a gun to my head but the idea is not as outrageous as I used to think, and that’s scary. The pain needs to be controlled, and it used to be. No thanks to Kolodny and his partners in crime. My God in Heaven, we are being treated worse than our dogs and cats!

God bless you, Katie “Gotcha” and all of us who suffer.

Gary Raymond

I agree. It is a Fentanyl crises. And a mental health crises among the CDC staff. The sadomasochists within the medical industry have been outed and enabled. Withholding
effective pain medicine is like starving a baby. The CDC must be held accountable for
each chronic pain victim who has committed suicide. An eye for an eye.

Kelly

Thank you for being an eloquent voice for those of us who are not able to express ourselves as well.

Debbie Nickels Heck, MD

Excellent commentary fully explaining in detail the horrendous manner in which a few unethical people can manage to weasel their way into the right places within government and gain the ears of vulnerable people and completely mislead them, bringing an entire topic down a slippery erroneous slope. But then it WAS during the Obama era when this all began. A perfect storm of lying about medical issues was upon us. Do recall Nancy Pelosi saying what was in the Unaffordable Nobody Cares Act couldn’t be revealed until it was passed. As someone stated at a medical meeting I attended, the only thing he’d ever heard of in which you didn’t know what’s in it until passed is a STOOL SAMPLE! The analogy applies well to everything PROP has to say, too.