Let’s Reset the Discussion on Pain Management and Opioid Misuse

Let’s Reset the Discussion on Pain Management and Opioid Misuse

The headline is not mine. It is from a tweet this week from U.S. Surgeon General Dr. Jerome Adams who is the 20th Surgeon General of the United States.

“First we must acknowledge that we have a crisis of ‘untreated’ and undertreated pain in the U.S. and it can lead to suicide, self-medication with illicits and other bad outcomes.”

But Dr. Adams warns, “we have also have an overdose crisis in our country. It is now largely fueled by fentanyl, but there traditionally have been and still many are people who first become dependent due to opioids prescribed to them or diverted others to whom they were overprescribed.”

Dr. Adams made an important point for chronic pain patients.

“It can be and is true that many people benefit from opioids while others who are getting them are seeing more downside than upside. It is not an either/or. Examples of the latter are many patients (especially peds) getting dental extractions and most with migraines.”

“That’s why,” said Dr. Adams, “I highlight opioid alternatives where evidence suggests they provide as good or better risk benefit.

“I am not anti-opioids, “he said, while capitalizing NOT, “but am pro better pain management. I want to ensure those who benefit from opioids get them, and those who benefit from other meds get those.

Dr. Adams admitted that many chronic pain patients feel underheard and said, “I hear you”.

“Whenever I speak on opioids, I always discuss the need to protect chronic pain patients and not pull the rug out from under them.

We must not target the wrong people, he emphasized.

“We must stop swinging the pendulum to extremes and find a better balance between getting opioids to those who most benefit from them while minimizing for them who don’t. Opioids are both being over prescribed to some populations and under prescribed to others.

He continued, “We review the totality of data before taking official positions.”

He added “I hope we can work together to achieve better pain management for all those—acute and chronic paitnets—who benefit from opioids and those popuilations for whom there are reasonable and often better alternataives.

If you would like to respond directly to Dr. Adams on Twitter his handle is @Surgeon_General. Please include @natpainreport in your tweet to let him know the source of your inquiry.

If you’d like us to send him comments, please email me editor@nationalpainreport.com and I’ll forward to him and report on his responses.

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Authored by: Ed Coghlan

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Chris Ward

The judges are in with the doctors!

You all should see a lawyer. This is unacceptable by the medical community

Rose

I was recently at my pain doctor’s office to receive my prescriptions for my pain medication. I’ve been seeing with him since 2006. I eventually endured 2 more spinal fusions and finally a neurostimulator.. now for a total 5 back surgeries since age 25. I have 8 fused discs, spinal stenosis, adhesions, spondylosis, etc.. have had many epidurals, physical therapy, tried acupuncture, changing my diet, you name it!
Since my 4 and 5 surgeries in 2007 and 2008, my doctor and I have reduced my opiods from 120 mgs to 45mgs.I am highly motivated to take one 15mg. In the morning, and one in the evening. But somedays, I do have to take the midday dose..I do not like being on medications, but it helps me live somewhat of a semblance of life. My doctor is intelligent, caring, kind and just wants to help his patients.
On my visit, we discussed the current climate for chronic pain patients, and how this has effected doctors who are trying to treat patients.
He then began to tell me what is happening to him. He has been treating a patient for years who was in a terrible auto accident. He recently had to lower his dose of medications from 90mgs to 45mgs even though the CDC says differently. The doctor gave him his prescriptions for two months. The gentleman was very distraught, but the doctor told him his hands were tied. Within two weeks, the patient called him and pleaded to be put up to his usual dose he had been on for years. The man couldn’t handle the pain. Again, my doctor compassionately explained this wasn’t his choice, but the governments. The following month, the gentleman filled his prescription, ingested the pills and killed himself, because he cou8 not bear the pain!!! And now the government is blaming my doctor!!! This disturbs me greatly!

The CDC says these are just guidelines, the FDA says reduce slowly, and now I read your take on this, dear Surgeon General. Do you fault us for not believing!!

Molly K Canfield

“We review the totality of data before taking official positions.”
There…we are “data.”
Nothing more.

Jenifer Stevens

People are so ready to point the blame at the pharmaceutical companies, the doctors, somebody, anybody! The real problem which is always going to be an underlying problem no matter what the situation is that people make the choice to self medicate, to mix medications whether they be opiates, benzos, barbituates, etc. and they will do whatever they have to in order to get their fix. They have free will, as we all do. I certainly would LOVE to know what a pain-free day would feel like, but I can’t imagine what it would actually take to achieve that and it’s not worth it to me to find out. I feel I personally should have the right to have a tolerable level of pain I can live with, function with most days and that shouldn’t be too much to ask. Continuing to blame the manufacturer’s and allowing frivolous lawsuits will ultimately take away the only form of relief for a great many of us. If there was another option available that worked, brought my pain level down to a 6, where I am content to stay on a daily basis then I am all for it, but I have yet to find it. Punishing the chronic pain patients by eliminating the manufacturer’s is the completely wrong way to handle this issue. The chronic pain patients are taking their medications as prescribed, seeing their pain management physicians and are very, very rarely one’s who become one of the statistics. I can speak on both sides of this issue, I lost everything because my husband decided to self medicate and nothing would make him stop. It was ultimately his choice, his choice to lose our cars, have our home foreclosed on and lose our marriage of 18 years. He had the choice to get help and save everything to keep his family but he liked getting high more. That’s not anybody’s fault but his own.

Candace Simmons

No where in this discussion is the blame put on the pharmaceutical companies for pouring the opioids into our pharmacies and out on to the streets?! There is the real culprit in the opioid crisis! When will people start realizing that these companies run our government! It is all about the money and who has the most? The pharmaceutical companies!!! The DEA can’t even touch them! Who do you think is funding the opioid crisis to look at the Doctor’s? What a better way to take the focus off of them!!! Those of us who suffer from chronic pain will never get the care we need because we are nothing to them and we certainly don’t have the funds to go up against them!

David Becker

By working together- the Surgeon General means that the public should be more responsive to the beliefs and practices of government and not that the Surgeon General will make an effort to be more responsive to the public. As he has made no mention of such we can be sure he has no interest in hearing the dried voices of people in pain that are as mute and meaningless and distant as fading stars to him. He was trained in militaristic style to obey the commands of his educators and superioirs in governmnent and he has evinced nothing to indicate other wise. He is a lost soul like so many top down managerialists in government and health care who have not traveled free and far in search of real answers to pain. What virtues and what good does he claim ? He is just a go along to get along risk aversive careerists straight out of Orwells 1984- he has ducked and dodged every substantive question I have tried to raise with him- he sets a poor example for people in pain. He satands in the way of humanitas and his sense of immunitas from democracy or individualism in pain care demonstrates he and his ilk are underfit to serve people in pain or society. Prove me wrong, Mr Surgeon General- debate me in public and bring your paradigm bound evidentialists…..

William cox

Great to hear that someone like the U.S. Surgeon General acknowledges that some pain patients, especially chronic pain patients may actually need opiods as PART of their pain management… and that forced tapering of medication is NOT the answer. ..also or can be FATAL !!!

But !!!!
At this point, it’s ALL TALK…. we’ve heard before !!!!
OUR pain management doctors are scared of reprisals from state and federal agencies like the, FDA and DEA. They fear that their licenses may be taken and or their pain management practice closed…. as well as criminal and or civil prosecution.
Even though we have officials like the U.S. Surgeon General acknowledging the need for legitimate use of opiods, these, “witch hunts” continue.
I recently read an article on
a pain management practice that
pretty much sums up this misguided attack on opiod pain management and it’s patients.
The pain management practice in this story was sent threating letter by a governmental office of drug control. In the letter the pain management office was Sternly Warned that they ,even though they had complied with the CDC, 90mme suggested limits by lowering most all of their patients opiod medications to within the “suggested” parameters, they still had a very few that were over the , “suggested” mme. The letter went on to say that, “They (drug control agency) KNEW THAT THESE LEVELS OF OPIODS MAY BE “MEDICALLY NESSECARY”, but, that they should be aware that continuing to Perscribe higher doses may be cause for enforcement actions against them !”.
Did you get that ? The drug agency said, that they understood that higher doses may be “medically NESSECARY”, but to continue these doses (even if only to a few patients) could cause criminal and or civil prosecution. .. and or loss of medical license(s) and the entire pain management practice !!!
Wow. …would any one do that to, let’s say, heart or diabetes patients or any other medical conditions? Nope…words are great. .we need ACTION !!

Glen

I have been reading CDC Guidelines just now. Useless information stacked on top of useless information. They claim to not know the long term effects. Yes they do. I did find one study in there. In a 13 year study of 550 patients. One of them died of overdose. Good grief if you study any group of 550 people for 13 years, one of them is bound to die.

Maggie D

I’ve had multiple spinal surgeries, just about every procedure, injection, modality, therapy, including a implanted spinal cord stimulator and a intrathecal Dulaudid pain pump. I used to have morphine in my pain pump but it took more and more to get the same level of pain control. My pain management doctor weaned me down very slowly off the morphine in my pain pump and still that last quarter of a milligram caused me severe withdrawal. I had to take a “opioid holiday” to reset my opioid receptors in my brain. After 3 gruelling weeks of pain and suffering the doctor started my pump with microdosing Dulaudid. Now I have really good pain control. I take no other pain medications for breakthrough pain because what I do get is from over doing activities. A day resting is what’s needed. I don’t have to think about pain medication, it’s all programmed by my doctor. I love my Intrathecal Pain Pump. Plus I do not have to deal with the “looks” at the pharmacy. My doctors nurse fills my pump about every 90 days.

Dani

All we need are some really good pain clinics around my area and some good doctors. What we’re dealing with now, is just ridiculous.

Tricia Devlin

I’ve been in pain since 2002, following a bi-frontal craniotomy to remove a pituitary tumor. I have had many doctors, gone through 5 pain management programs, had many painful surgeries & procedures, have tried numerous opiates. For your information, the person taking opiates for chronic pain does not feel the ” high” sensation when taking their meds. No one in their right mind would OD on those meds either. You know when another pill will not help. This is where we suffer. We are constantly trying new ways to relieve the pain. No one wants to be on meds! The side effects & the toll chronic pain takes on your entire system can never be repaired! There are many people that need opiates! We are not addicts! My surgery completely changed my life! Living off disability isn’t “living” it’s surviving. Everyone with criticisms & blame need to experience what it’s like to hurt daily, and feel your control diminishing. NO ONE SHOULD HAVE TO SUFFER! It’s inhumane!

Auj Kalenic

I too am a bonified cancer survivor, arthritic/chronic pain sufferer. I’m 65 yrs old, take my pain pills as prescribed, go to pain management Dr. Never had a dirty urine, pay my $35.00 copay each month to Dr office,plus$47.00 copay for Rx each month, my point is that I should be able to get my pain Rx from my PCP, where it costs $0 per visit. I’m being punished on several levels and I did nothing wrong. I guess they did this false charges against Jesus too. It’s just unbelievable for those of us who are honest, but nobody wants to hear our stories.
I pray for healing for each one of us, til them be blessed!

Cindy

I am shocked that I just read that some doctors still easily provide lots of opioids.

In comments a few days ago to the Carolyn Hax Advice Column published by the Washington Post, the topic of opioids came up — (a lot of “off topic” items come up — regulars there discuss anything and everything) — and several people wrote how shocked they’ve been recently to have opioids thrown at them by their doctors, and blamed this behavior for the opioid epidemic.

These posts shocked me, and I wrote about all the problems of the pain community and how legitimate patients can’t get their needed meds to the point that many commit suicide, turn to street drugs, etc.

I don’t know the locations of these incidents, but they certainly shocked me and I don’t understand how this could happen.

Cindy

PS to Walter Strickland —

I ran out of allowed space in my first post —

I googled the law you referred and glanced at it and yes, it appears to be directed at fighting the opioid crisis — in making our lives harder.

So, it’s the opposite of what you contacted your Senator about.

So, it’s like I said in my first post a few minutes ago.

The only way to get the message across to people who are laser focused on the abusers, is to call and speak to someone in real time, and educate them and make sure they hear your words and understand our problems.

I was especially when one person I spoke to asked several times about the exact name of the HHS Task Force to make sure she wrote it down correctly.

Unfortunately, when I made my calls, I didn’t get the names of the people I spoke to and I didnt’ ask about follow-up. These were mistakes that I plan to correct in future.

For tips on making these calls, see the June 7 NPR entitled “Creating Policy Change from your Couch”.

I’d wanted to call since June 7 and wasn’t up to doing it until a few days ago. By then, I’d forgotten most of what i read on June 7 and decided I just needed to call and do the best I could while I felt up to it. If I’d delayed to refresh my mind, then I don’t think I would have been able to call.

Cindy

IN RESPONSE TO WALTER STRICKLAND’S BELOW QUESTION –

Walter, the same thing happened to me when I emailed Senator Marco Rubio about my problems as a chronic pain patient on a forced taper. Like you, I received a “canned’ response, which was all about his concern about the opioid crisis — the opposite of what I emailed about.

So, I sent a second email, saying that his reply was the opposite of my concern, and explaining again about forced tapers etc.

I got another reply about the opioid crisis; again ignoring what I was writing about.

So, finally I called his D.C. office, and spoke to a human being.

I also called my other Senator, and my Congressman, and spoke to live people. Next I’ll call my State legislators and Boards of Medicine and Pharmacy and anything else I can think of. And now the Surgeon General.

I recommend that you call. No one I spoke to had ever heard of the 2016 CDC Guidelines or the HHS Best Practices Pain Report issued on May 30 of this year.

I walked each person thru the history of the Guidelines, and the CDC’s recent statement and the FDA’s recent statement, and the HHS Task Force Final Report. I also described my own problems; and forced tapers and doctors being harassed etc.

AND, I described 2 stories I read here — one about the husband and wife who drove to a parking lot where she held his hand while he blew his brains out with a gun b/c he couldn’t live with his pain anymore after being cut off from his meds after years and years of being a compliant patient.

The 2nd story is much more important, especially when dealing with Republicans which I am in FL. The woman in NH who, thanks to opioids, had been able to own and operate a yarn shop; but then, after being cut off from her meds, had to close the shop and go on disability —- instead of paying taxes, this woman went on “the dole”. I think that appealing to the fiscal side of this issue is really important. The humanitarian side just isn’t enough.

Hope this helps.

Gail Honadle

Laurie, all these Forced Tapers were started under your Hero OBAMA. In the ACA, along with a ton of Hidden taxes.The Washington Post Blames Obama for Fentanyl Deaths – Hit & Run : Reason.com https://reason.com/blog/2019/03/13/the-washington-post-blames-obama-for-fen

https://infosurhoy.com/cocoon/saii/xhtml/en_GB/news-summary/obama-administration-gradual-to-reply-early-alarms-about-fentanyl-report/

Lisa Adams

That’s WHY… I suffer with Cancer. Yet, I suffer more due to internet down & pharmacy can’t fill your medications. Due, to ADDICTS misusing . Most of the Suicidal attempts have more than opioids in their systems yet opioids get ALL the blame. Maybe, their should be more HELP for ADDICTS & Alcoholism which has been killing folks for decades Yet, Alcohol NOT banned, limited, or even helpful to a health condition
It’s ALL about the 💰.Not about the patients best interests or something or someone would come up with right plan to HELP US who truly suffer in pain. Help the addicts who would use ANY drug to get High or DIE to get out of their miserable cycle of Abuse
I’ve never been short a pill count, get drug screened, yet Even knocking at death’s door …I’m suddenly made to feel like a criminal when Never Abused yet know REAL PAIN & Suffering. The Abuse is led by ins. Co. & Dear who go after the weakest & dying. Not the ones NEEDING help. Why, this stays such a Hot topic
I’m so glad I’m dying soon. So, won’t have to SUFFER much more… Would NEVER consider suicide as most… Wouldn’t Until, they Can’t handle their pain no more. It’s TRUELY SAD. Bann it ALL in toxicities reports & quit blaming just one medication when I bet ALL I own Death’s by just opioids is a very small %.Just an easier 🎯& more 💰💲 than TRUE Autopsy would reveal. Very Shady….

American

James McCay I was doing a little reaching on these same specialized opioid medications and the idea that an opioid like these can flood your receptors in such a way that it does not give instant gratification other than the much needed pain relieve so many of us need is truly fascinating. The idea that we could get actual pain relief and not have to jump through hoops and have fingers pointed at us while doing so is almost as fascinating and the the two ideas together would give me my life back so they probably can’t won’t happen, few would profit and there would be very little power and control of us at that point. NKTR-181 is one of those medications AT-121 is another one of these medications you speak of.

Laura steers

I am a chronic pain person. Who has been in so much pain I can’t even walk. I have been this way for 11 weeks and not one Dr. Will prescribe me pain meds. I am so tired of being in pain with no help that I dont want to live anymore. The only other choice I have is to try to get heroin and that is not something I want to do. This country is treating the opioid epidemic wrong and it is only going to get worse for people like me who truly need pain meds the only option is to get heroin which is easier to get than meds. So more overdoses will keep happening.

Dana Wirth

I have been on opioids since my first cancer surgery in 2003 and have never abused my medication or had any type of problem related to my medication until now. I was described as a stable, compliant, uncomplicated patient by my pain management doctor but then the walls started closing in on me.

The CDC with its squewed numbers and corrupt politicians convinced those with the power that people like me with chronic pain really didn’t need our opioid medication. We were part of the great “OPIATE CRISIS’, we needed to be saved from addiction and possible death. Some fool basically told us to take some tylenol and get over it.

What happened to our doctors? Aren’t they here to help us? The CDC took care of that by issueing their “Prescribing Guidelines” for primary care doctors to use when prescribing opioids to their opioiate naive patients, who had never used opioids before. This had never been intended for those patients like myself, on a stable dose for years. Almost overnight I found myself out in the cold with my prescription level at one quarter the level it had been. Given the circumstances it shouldn’t surprising that I was no longer “stable” with my pain was anything but controlled.
I am writing this at 2:30 a.m. because I was in so much pain. My doctor has given me no medical reason for cutting my meds, the only thing he says is it would be beyond his comfort level to increase my meds. What happened to my comfort level? I am at the point that there are too many days when I wonder why I do this to myself day after day Is help coming too late?

Beaux'

I say there are people like meself and 1000s of others who actually need pain pills to get through the day productily.. I think and support that anyone not of 21 yrs of age or older cannot get prescription or get any type of scheduled 2 or 3 drugs of any kind !! I think parents should do a better job of hiding them or not letting your kids see that you have a weakness or disability .. people have committed sins against themselves and others for these pills .. people di abouse them also .. but you can’t make the people suffer if not all the people are doing the same as others do !! There for should automatically be treated and respected for the power of resistance and showing no werkness for a drug to ruin yours mine or anyone I care about .. pills are not bad they are not the problem … The people controlling little people and then the people that have no control over there addiction again but their fault it’s the doctor’s for not telling them how this simple pain pills could take and or stop /ruin life’s without even wanting to …. Then you blame them and call them dope heads pull poppers and losers and such … Only loser is the one reading this and judging it !! Don’t give a two [edit] what you think or say about me … I’m mire real on my off days then any of you on your mist realest …. End quote !!

Heidi

While I appreciate his comments it comes too late. I suffer with chronic pain and had the rug pulled from under me. I was in my third year of college due to the ability to use opioids to control my pain and now I am in so much pain and treated with such disgrace I cannot complete my studies. So thank you for taking away my dreams and my quality of life. Animals are treated more humanely. Chronic pain sufferers have had their rights violated and I urge each of them to ban together and seek to file a lawsuit against the lawmakers that set themselves as the deciders of how much pain a human can endure and the mental anguish and suffering they have caused. Chronic pain sufferers are treated as less than second class citizens. It’s election time, don’t vote for those that show no compassion.

Katherine M Moriel

For me i feel like its going to be a case of too little. Too late because i dont feel i have the strength to wait much longer to see if we will ever really have the right and the option to have what we need to keep our pain tolerable. Thats all we are aking … Its all taking to long and i hate to say it but im exhausted and i dont think i can wait on hope and promises.

Glen

Honestly, I think that Surgeon General is sincere. The problem is that there is too much distance between him and us. In that huge gap are his staff, other government agencies, self righteous medical experts, large hospitals, crooked drug rehab clinics, and a large population of citizens who believe everything they see and hear on TV. It is the Media that created the Opiod Crisis. If someone (I’m too old, sick, and tired) would start a 501 c 3 Non profit, and collect enough to buy TV ads, you might have a chance. But as we know some one would stop it. Someone is buying time for all these “Rehab” organizations. (A new industry?) In the end it is always about money. Welcome to America! Join the Military see the World, get blown up in an Endless War, come home paralyzed and they can get your urine sample from your Leg Bag.

Alta Hanlon

I don’t believe there is an opioid crisis. I believe the insurance companies want pain patients pushed onto MJ which they don’t have to pay for. The truth is that a very small percentage of people ever die from taking their prescribed pain meds. The deaths are from mixing them with other substances, either to get a better high or because their pain is being under treated. The restricting has just opened up opportunity for the drug cartels to happily provide US citizens with they need or want. The root of the problem needs to be determined and dealt with instead of arresting doctors and forcing people in pain to suffer even more.

maxlet

Isn’t this the same jerk who was just crowing about a ‘study’ that ‘proved’ IV tylenol was as effective as morphine? How can anyone give credence to anything that idiot AG says? His speaking on behalf of pain patients would be a lot more useful if he didn’t come out with asinine statements like that.

And Richard;
Opioids ARE the answer for many people. If they don’t work for you, that’s unfortunate but applying your own situation to everyone is beyond ludicrous. Dormant?

Michael

RICHARD,
that’s your OPINION, because it is no more a FACT than the moon made of GREEN CHEESE.
“I”..(personalize)- have been in chronic pain for 39 YEARS, and for “ME” (Personalize),, in my OPINION….opoids DO work. It may be 2020, but the facts are that July 20 marks the 50th anniversary of mans first foot on the moon.. We should have a CITY ,,correction…several on the moon, we have the technology for it, but bureaucratic and political reluctance to fund the space program has resulted in ZERO. Same thing with research grants, federal, corporate / private funding for studies to find better pain control. So…until we find something better….In my OPINION…opoids are the ONLY answer now for myself, who has tried all other alternatives which failed. Try to remember, pain management is a personalized issue, no two people are alike, just like snowflakes.

Thomas Wayne Kidd

Sit you are so full of it! Reset the discussion? We are dying out here and you come off with more [edit]. I am so sick of these evil wicked people who care less what happens to the millions of chronic pain sufferers. Do something about this evil mess or just be quiet.

Glen

Many of us have State issued handicapped parking permits. (Lifetime for me). Any Doctor can sign off on them. State legislators could create a “form” to be filled out by a Qualified Doctor that is good for life (and many of us won’t need it long).Submit this and issue us a Medical Card allowing any licensed Doctor to prescribe opiates on the application we check the box that says , “Providers can not be held liable now or for future side effects, addiction, or overdose”.

Steve M

The pendulum has swung so far that my wife’s Medicaid HMO ruled that her post opioids were not medically necesary. She was in the hospital for three weeks and had two surgeries.

Laurie

Nothing will be done until we kick the republicans out of office, and maybe not even then. the DEA has the bit in their mouths and are profiting, along with others, off this (other) human rights abuse they seem so fond of.
It’s never been about pain patients prescriptions, which is exactly about all our awful Western medicine can treat, but they won’t.
I’m on my last prescription and have been abandoned by my doc who is a thug. I won’t be sorry not to see HIM any longer. all he did was bully me. I guess I wasn’t obsequious enough!
I’ve had my condition for 30 years and know a lot about it.
Now, I’m to go to pain management which will do nothing as I have tried EVERYTHING already.
I can’t tolerate going back to that pain. I just can’t.
And I’d better get some groceries before I run out or I won’t be able to walk around the store…I’ll be too sick.

Jeanette French

yes, we need to keep fighting for our rights !!!

Jeanette French

Good article I just read explains why they help people with Fibro now, at least they are Turing the tides slowly to better treat pain and allow those who need pain meds to get them. I have migraines and agree the pain meds did little for me, meds to help me relax, cold pack son the head constantly and dark room and no noise, and lots of rest made it last less time. An ER doc taught me how to manage them at home on my own, but it is hard for docs to understand what each person needs for their pain, they have to listen to the patients. I cant take migraine meds due to side effects so I know I have to wait it out, but at least I can do it in as much comfort as possible. Many people with chronic pain need this pain medicine to function, work, be parents, etc…it is slowly Turing around, recently I was in for pain in hospital and the doc still didn’t know it was illegal drugs causing the overdoses, still thinking it was prescription drugs, getting them into the current education is a slow process, but she did listen to me and I told her to do her own research and she would see.It is going to take a pong time to get back to pain being treated right, the biggest thing right now is to educate the docs who don’t have time to read the new results, they only have about 10 min with a patients and that needs to change big time, they dont have time to read a patients chart or anything, it is so wrong. And the current digital system needs to be overhauled, if they want to order Tylenol, they get a drop down menu of over 30 diff medications, it is insane, and no wonder they are always at their computers instead of facing us and listening to us. I wish someone int he media would do more articles on this digital health care system what was supposed to streamline everything and made a huge mess of it all. We ned to get back to where a patient has enough time with their doctor to talk to them and not be rushed and only do one thing at a time, we should be able to discuss more

James McCay

RICHARD- I’m a 30-year+ widespread medical professional (who still stays active advocating for the elderly/disabled pain patients in my area from bed w/laptop) and am now 52-years old. What’s your medical profession experience? Saying “Opioids are not the answer” just fuels the IGNORANT like the 2016 CDC “Guidelines” that became ORDERS (thanks to the overzealous DEA & other ignorance) to nearly every Pain Doctor in the country who REFUSE new patients! Please THINK before you type… 🙂

I NEVER GET THE SLIGHTEST BIT ‘HIGH” FROM my 270 mg of Methadone a day (it was 300 mg-360 mg a day) until my Pain Doctor became SO PARANOID by the DEA/CDC that he BROKE HIS HIPPOCRATIC OATH & ADMITTED THAT TO MY FACE by hurting all his patients!

I have Advanced Myasthenia Gravis (MG) which is basically Muscular Dystrophy and Multiple Sclerosis combined w/many more symptoms- with Hyperthymusism (XL Thymus Gland- all old meds are partially blocked & every post-2009 med is completely blocked- yet I often have OPPOSITE effects???), Degenerative Disc Disease (six discs in neck and lowest back all w/nerve damage), and Fibromyalgia. These are DEFINITE diagnoses, after being misdiagnosed from late-2001 until late-2006 seeing new Neurologists monthly for a year.

Everything is inoperable (MG)! I tried every injection more than once, every non-narcotic med more than once, NOTHING WORKED! Gabapentin helped a bit until MG became Advanced. Lidocaine 5% Patches helped a bit -INSURANCE WON’T PAY! So only Methadone keeps me from SUICIDE! NY State will target that soon.

In 1992, before I had any medical problems and was working in ICU/CCU- doctor friends were telling me that Big Pharma were working on opiods that will only specifically target areas of pain and will not have any “high” side-effects. I thought to myself “What a fantastic idea! I can’t wait until these Specialized Opioids hit the market!”. THEY NEVER DID ENTER THE MARKET & I NEVER HEARD OF FURTHER STUDIES! Why?

Judy Klingenhofet

I would like to address the Surgeon General regarding the fact that many health institutions are now going anti-opioid so far that they are leaving surgical patients and post surgical patients no options at all. Some are “experimenting” with unproven medications like Ketamine, and using Ibuprofen injections as their first options for surgical patients. These medications are leaving the patient in pain for many hours and sometimes days until they finally give them opioids, and some refuse outright to give them the appropriate opioids even if they are in terrible pain.

I was in the process of scheduling a needed surgery, a fix for an extremely large hernia, when I saw the pain management specialist. He told me they would not use opioids for any reason. They would use Ketamine and other medications. Even when I told him it would be my most painful surgery ever with the most painful recovery ever, according to my surgeons, of my many surgeries, he refused to even talk about opioids. My surgeons don’t prescribe any pain meds any more, that is what pain management is for, is what I was told. So what am I to do? This surgery would have been life changing for me, but as a Crohn’s Disease patient, I’ve had many surgeries in my 60 years and I know, because I remember the bad old days, what waking up without the proper pain control will be like. This is what is happening out there, and is totally inappropriate, and I would like to know what he plans to do about it. I’m not the only patient in this situation. I talk to people every day that are going through the same thing, and they are refusing potentially life saving surgeries because of this practice that seems to be taking hold of Hospitals all over the country. And we’re the lucky ones, the chronic disease patients that know enough to ask about pain management before it happens. What about all those people that are going through the trauma of surgeries, many life saving, or emergency, and have to live through this?

Barbara Sheridan

I hope with every ounce of my being that this statement can be taken as truth, and if so I give Dr. Adams my gratitude, my blessing and most of all my support in continuing an open dialog for the entirety of the pain med crisis because when we refuse to see all sides of any issue we are actually blind.

Sharon

To the AMERICAN!. You’ve missed it, the real cause of the opioid crisis! Drug addicts who buy from the drug dealers who get it from the drug cartels. They it to get high never knowing what they actually used. Drug overdoses and drug related deaths aren’t coming from your chronic pain sufferer until recently because the pain sufferer has unfortunately turned to suicide themselves from choice. That’s the difference between the drug addicts who use to get high and take the risk of dying and the person who choses to die because there is no relief. I’ve considered it myself when the pain is my life. I feel they’ve, THE GOVERNMENT,,.and can’t get their foot out…….!

Walter Strickland

Good day Mr. Coghlan.Thank you for this report.I am hoping will be goo for us in the CPP community.We will see,as I have become very sis trusting to most people in politics these days.My Texas senator finally responded back to me from an email I sent to him several weeks ago.I ask him his stance on the Chronic Pain patients issue.His name is Senator John Cornyn.He sent me an email about his views mostly on stopping the opiod crisis and some of the bills he helped sign into law in DC.The law —Patients and Communities Act—P.L. 115-271 is the signed into law bill I am having trouble understanding.Crom what I can understand,it is mainly about controlling the distribution of Opiods and mostly about ways for stopping the overdosing and how to help those who do overdose to be helped.I can understand this and I understand this has to be addressed and carried out.But I still don’t see the answer to my question to the Senator.Ed if you read this can you please clarify the meaning of this law.Was passed in 2018 I believe.

Rosalind Rivera

The doctor is absolutely 100% correct. I believe that it is those doctors that are overprescribing narcotics that need to be targeted, be held accountable and prosecuted to the fullest extent of the law. Chronic and intractable pain
sufferers such as myself should be given narcotizados Ca as warranted and not given narcotics on the prescribing s doctor whim and especially those doctors that are literally selling prescriptions for narcotics for self profit. My injuries are palpable and my doctor and myself have proof of that fact. Not only are their written proofs of my illnesses but also blood tests, c-rays and sonograms of the terrible damage results of my injuries and illnesses yet despite all of this I too am being unwillingly being targeted by my pain management doctor that witnesses my suffering on a monthly basis when I go for my monthly appointments. My pain meds reduction has caused me to become a crippled, home bound and extremely depressed not living but merely existing shell of the person that I was once a long time ago since these detrimental and suicide measures have been taken by the powers that be!

R.Rivera
Lucerne Valley, Ca

KatieK

Andrew Kolodny needs to be silenced. He is fueling a false narrative in this country and making chronic pain patients targets. There are now hospitals refusing opioids to surgical patients, pharmacies refusing to fill legitimate prescriptions from specialists and patients (millions) with painful diseases including cancer who are unable to access proper pain management. Those who represent the medical community and speak about opioids, like Jerome Adams need to be careful when speaking, posting and tweeting about the opioid abuse population. When legitimate pain patients are included, not excepted, they become targeted as part of the abusing population by doctors, hospitals, pharmacies and insurance companies. The DEA also needs to stop it’s raids and attacks on doctors offices which terrorizes patients and health professionals keeping them in fear of losing their medications, doctors and medical files, preventing them from getting help elsewhere. Patients and doctors mustn’t be unfairly treated. Entire families suffer physically, emotionally and financially.

Cindy

I had some trouble understanding part of this column and so checked Google for the actual tweet. (I’m not on Twitter.)

The tweet is 9 parts, and below I’m showing a few parts that I copied and pasted directly to clear up the meaning. There are other typos that I’ve left alone b/c the meaning is still clear.

But for anyone who wants to see the tweet itself, just google something like “Surgeon General tweet on opoids reset” and it comes up easily.

Below, I’ve capitalized the relevant changes that I’ve noticed from the above column:

Part 2 “……….We also have an overdose crisis in our country. It is NOW largely fueled by fentanyl, but there traditionally have been, and STILL ARE many people who first become dependent due to opioids prescribed to them – or diverted FROM others to whom they were over prescribed.”

Part 4: “….. Thats why I highlight opioid alternatives where evidence suggests they provide as good or better risk/benefit. Im NOT anti-opioids, but pro better pain management. I want to ensure those who benefit from opioids get them, & those who MIGHT benefit from other meds get those.”

While, as always, I am so grateful for Ed Coghlan’s hard work on our behalf, I also want to point out that this NPR column omits parts of the tweet which I consider extremely important —- where the Surgeon General says in Part 5 that he appreciates our feedback and in Part 8 that he tries to respond in real time on Twitter.

Thanks to this NPR column which alerted me to this tweet, I plan to contact the Surgeon General, which hadn’t occurred to me when I was contacting my federal legislators a few days ago as suggested by the June 7 NPR email.

I hope that everyone who is able to will contact the Surgeon General — a govt official who actually welcomes our stories.

Katherine Wolfe

You know, all this [edit] would be solved if we had pain medication that worked and didn’t get you high. What will it take to find them? Serious question, because if they won’t fund the research maybe we can.

The CDC and other regulatory bodies had and still have very poorly differentiated data on who overdoses on what. For example, Singer, (CATO Institute, Dec 2018) reported data that showed only (approximately) 13,032 people total had fatal overdoses on ONLY prescription opioids and he made no differentiation as to whether they were licit or illicit users of the prescription opioids. Singer used CDC data I believe, https://www.cato.org/publications/policy-analysis/harm-reduction-shifting-war-drugs-war-drug-related-deaths#full

Another example, Puja Seth (CDC, March 2019) ) estimated downward the total number of the number of fatal prescription opioid overdoses to about 17,000, again NOT differentiating whether the victims were licit or illicit users, https://ajph.aphapublications.org/doi/abs/10.2105/AJPH.2017.304265

BTW, tooth loss from many forms of prescription medications are a high risk due to “dry mouth condition”, xerostemia. Physicians should recognize this risk and treat the individual patients accordingly- there are products to treat this.

The overall balance of risks/benefits of long term opioid therapy appears to be positive for millions of Americans with chronic pain. Exactly how many of these patients have fatal overdoses has not been measured that I know of.

An “Integrated Pain Management Program” works best for many patients with opioids as a foundation or adjunct therapy, depending upon the individual patient and their unique life circumstances. We all have unique DNA and life experiences– redundantly, “one size fit all” just won’t work. We can’t save the lives of recreational drug users and outright addicts by harming innocent “responsible pain patients” as the CDC & FDA described in April & May press releases.

First Do No Harm.

Regulators and researcher have missed critical empirical knowledge by not surveying a healthy sample size of “responsible pain patients” to see how they don’t overdose after years and decades of use.

Richard

We are nearing the year 2020. The advancement and scientific study of pain meds have gone nowhere. I have been in chronic pain for 29 years. Opoids are not the answer and don’t know what is. Just don’t let yourself become dormant.

Signe Topai

Dr. Adams, Thank you for acknowledging the crisis of chronic pain patients. I suffer from Osteoarthritis in my spine, Myfascial Pain Disorder, Fibromyalgia, Endometriosis and Scoliosis.
I really want pain patients metabolism tested prior to be putting on medications, then our suffering would be shortened. We just want the pain to stop! Once diagnosis, which is another whole issue with problems, our access to treatment is limited either due to insurance issues or doctor’s fear to treat with opiates. Please, help us to fix that! I want my doctor to have solid research best to treat pain, the education, access to a variety of modalities to treat me! No more scare tactics, insurance hurdles or discrimination just because my illnesses creates unbearable pain! Dr. Adams can you image yourself or one of your loved ones crying with unbearable pain and your doctor, Urgent care or hospital turns you away? What our you going to due?
Every pain patient deserves to be treated individually. Whether that be opiates, antidepressants or other medications. Having our metabolism checked prior to treatment would insure we our put on the right medications. We just want the pain to stop or at least controlled enough to have some quality of life. Thank you.

Glen

We don’t need to “discuss the need to protect the needs of chronic patients” . There is no discussing and no referral to a Doctor that will prescribe. Period. They do not follow recommendations and they don’t have to. It is not always fear of losing a license. My VA Primary care provider sent me to the most qualified VA Specialists and decided they knew better. They had promised me that they would follow recommendations and then did not. It is now more important to reduce opioid prescribing than the lives of patients. NO DISCUSSION.

Terri James

Praise God for the Surgeon General! Finally someone who our government “may” listen to about this mess is speaking out.

Gail Honadle

But that is exactly what has happened. We are sold Snake Oil remedies, sent to Pain Clinics, treated like criminals, that in know way serve our health or Pain needs, run by staff not acquainted with our health issues. Many of us have more than 1 health issue. You say take OTC pain meds when they have horrid Liver, Kidney, GI, side effects and are good for 10 days ONLY. You can’t even differentiate between Illicit Street Drugs and legal Pain Meds, they are all the same thing in the Propaganda your agencies put out. Every commercial, every show now has a Anti-opioid message. Propaganda that exceeds that of WW 2 levels of Germany. We even see them in our doctors offices, Military Base Pharmacies. Cancer patients can’t get more than 60 mg or me of Pain meds. When often they need 150 mg. We are being Tortured because you can’t recognize the need for a Pain Med. 100 Autoimmunes all come with a 4 letter word PAIN. Post surgery you offer Tylenol in a dosage that will cause Liver and Kidney damage. That is NOT good Pain Management. When 5-7 days of Pain Meds would work.

Our doctors are SCARED to script more than 2 days of insufficient pain meds with no refills. I see 4 Specialist and a PCP, not a one will script a pain med. Though my health needs dictate other wise. It effects my Blood Pressure, my ability to walk, or even do common household chores. I’m luck to throw a sandwich together IF I can stand that long. Then the doctor drops more health bombs. You are Stage 3 Kidney disease, not but we aren’t sending you to a Specialist. Next bomb is Type 2 Diabetes. I’m already 1 point away. October will see it rise to full blown, and that is Autoimmune #5.

Take a walk in a National Park, WHERE IS THE MOTORIZED WHEELCHAIR I’d need? I furniture walk to get to the bathroom now, can’t get in the bathtub anymore. They YOU LIE about the number of OD’s, but don’t include the number of Heart Attacks or Suicides Intractable Pain causes. You’ve no study for it, VA Hospitals tell it.

Alan dean Thurman

two years and 7 months siting in a chair 20 hours or more a day. the opioid policy has destroyed me, your killing me, your destroying my health, home and hope. i could go into all of the problems i have had feting a pain doctor since my doctor retired 2 years and 7 mo this ago. how doctors now want me to go thru another round of physical therapy i have done that three times, i have go to the chiropractor i have done acupuncture i have taken other medications that have ripped my stomach wall into a bleeding ulcer, i have gained 85, i have no job, i eat old food from a food bank, i’m so fat my feet have flattened out adding an inch onto my shoe size, i have three t-shirt’s that fit, i want to thank for taking away my ability to function. when i say your killing me, i mean your killing me! i have worked 32 years, and would gladly work another 32. but now. i’m not sure i would ever work again. the opioid policy has destroyed me, YOUR KILLING ME!!!! is that plain enough????