New Hampshire; First in Politics and Pain…

New Hampshire; First in Politics and Pain…

Since the war on the “opioid crisis” started, it has been tough for those suffering from pain and those who minister to them. Public policies, or mis-interpretation of them, has led to a swing of the opium pendulum to an excess of abstinence. Many have been harmed in the process. Some have fought back.

There may be hope, though. For all those in pain or who will be in pain, especially those referred to as opioid refugees, one would have to look at the events of past few weeks as a sign of hope.

  • The FDA sent a letter to all doctors in the US informing them of the dangers of abrupt discontinuation of opioids and advised physicians against that practice.
  • The authors of the CDC guidelines, in response to pressure from various entities, published a clarification of the 2016 guidelines stating that: “policies invoking the opioid-prescribing guideline that do not actually reflect its content and nuances can be used to justify actions contrary to the guideline’s intent
  • The “Pain Management Best Practices Inter-Agency Task Force Report” was released calling for increased access to various therapies for pain

In the midst of all of this, something really big happened. A physician was held accountable by the New Hampshire Medical Board for harming a patient by abrupt opioid dose reduction to fit within a mythical dose restriction, and then, when the patient de-compensated, was discharged from the doctor’s care. His punishment was not big, but it was a punishment. Many of my friends all over the country have said:

“It’s about time!”

And it all happened in my home state. That does not really surprise me. We have a good medical board and one of the more patient and provider friendly set of opioid prescribing rules in the country.

So, I should be excited, correct? Up to a point, yes, but I can’t help but be overwhelmed by the hypocrisy of all of this. It is always dangerous to comment when one does not know all the facts. I know the facts in this case as reported, but there is usually more to the story and there are two sides to every story. With that said, it really stinks being a pain doc these days. No matter what you do, someone will say you are wrong and will pressure you to do what they want you to do. In such a circumstance, it takes a really courageous individual to do what he or she believes is right.

When the war on the opioid crisis started, those in power felt a need to do something. When one identifies a problem, the first step is to find someone to blame. And so, they blamed prescribers, pain patients, and pharmaceutical companies. In some states, individual physicians were held accountable in a very public way by policy makers, regulatory agencies, and the media. I find it ironic that several years ago, the same newspaper that published this news release, released the names of the biggest opioid prescribers in our state, an action that sent chills down the spines not only of those named, but also of those who could have been named.

For every action, there is a reaction, and in this case, the reaction was that many doctors in our state started arbitrarily lowering doses of opioids to fit guidelines, discharging patients for sometimes flimsy or fictitious violations of agreements, or just discharging patients, period, and getting out of the pain game. You can call it “covering your backside” if you wish, but the reality is those docs were very much afraid because the threat was not just medical censure, but also potential criminal charges.

So policy makers, convinced that the opioid crisis was simply the fault of those three groups, got their way. Prescribing plummeted. Predictably, those in pain suffered. Some died. It has not mattered what type of pain, acute, chronic, or end of life, all have been affected. What bothers me most in my dealings with insurers, regulators, and policy makers, they don’t seem to either notice or care. And they, at base, are the ones at fault.

To change behavior, nothing is more effective than putting someone’s head on a spike to scare those you wish to affect. That is how the war on the opioid crisis started. So now a new head has been put on a spike in an attempt to move the opioid pendulum. Should this doctor have been so publicly punished? Maybe not publicly.  At base, I do not believe that he was the only one to blame, or even the primary one. Still, this action draws our attention to those who have been harmed by such a myopic, un-balanced public policy, and that is important.

Every cause needs a sacrificial lamb to gain traction. For reasons both wrong and right, maybe we have our lamb. Let us share this example with those in power, so they too can see how their actions have harmed too many of our friends. Hopefully, they will choose a more balanced policy that reflects the needs of all. That is what we have been arguing about for more than twenty-five years. God speed.

David Nagel M.D. is a New Hampshire pain physician and an author. His book, Needless Suffering How Society Fails Those With Chronic Pain is an excellent read and can be ordered here on Amazon.

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Authored by: David Nagel, MD

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@Elyce o’Leary, it is neither law nor policy. The CDC simply gave it as suggested ‘Guidlines’ for primary doctors only to make them more aware of prescribing carefully. Period!
Others took that ball and created an Avalanche which quickly lead to disaster. The media is also to immensely blame for it. Maureen M.

JAnice

Has anyone seen the NPR article on how prescription opioids have killed so many ,? It’s like we’re back full circle what a disparaging bunch of jerks we have as representitaves….. After reading the article it was as if nothing absolutely nothing has made a difference. Like we’re dead in the water all over again.. So very sad.
May all that suffer from pain be healed. Much love and prayers to all.

Dr. Nagel, you seem to have such common sense and I don’t know why our government doesn’t have the same and as you mentioned the Physicians that you worked with didn’t have common sense. The arrogance overrides listening to what needs to be done. I love your book it is a must-read for every chronic pain person. I did a follow-up today with my hip surgeon and I continue to have hip pain. When I should be healed by now. All I got was patient blaming like well maybe you’re one of those people who come out of surgery always having pain or you have fibromyalgia. Not listening that this pain wasn’t present before surgery only after. I told the surgeon I had multiple surgeries and I have come out fine but this time I have not. Thank God for the physical therapist who found that the pain that I’m having is insertion of the adductor tendon is inflamed and he thinks I still have some impingement. But if it comes from the physical therapist maybe the physician will listen oh, I know he won’t if it comes from me . And that probably happened when they dislocated my hip joint. All I want is to feel better and have a future just like mr. Smith in your book. I have had this problem for so long and it’s just been labeled over and over. Now that I’ve gotten help but come out of surgery and didn’t heal up properly, again they the physician’s turn their back on me. It’s kind of like well they got their money you go home now leave us alone. That they tell you the risk of surgery but yet ignore it after it happens. They are so perfect that it is impossible for any risk to happen. And it didn’t happen to them and they don’t have to live with it I do, so why not work with me instead of against me. Such BS ! Just when I find Hope.

Glen

I think we all know that prescribed drugs did not create an epidemic. In reality it only exists because someone said so. People will do what they do until they can’t. Human Nature is to blame.Hedonistic people have caused the problem for pain patients. We don’t do opiates for pleasure but the morons that do created the “crisis”. Legalize drugs and smart people will use them when they have to and morons will overdose. They won’t have to rob you, they can go to Sheets and buy a pound of dope.

Just read laze comment. We are lazy? I got broadsided by a truck. Should be dead. I was a nurse. Now I help to care for 9e or.old father. Gaming the system?? I worked my butt off for wwears. before I could no longer be a nurse. I tried to go back for 9 most. Too much pain. I earned my SSI. The judge deemed me “untrainable” My bones are disintergrading. I dent know who wrote that article. But they know nothing!!! Its a whole lot of fun when you want show up for XMAS because you want walk. 😡

I would like to know something. Is the “tapering” of Opioid a ” Law or a “policy” set up by another group of people who monitor Opioid. I keep hearing “the law” says this amount. ” The law saysthat amount” What’s the truth. And you set up this no more than ’40 MMEt be given. Now I did get tapered only by 1 pill. Alot of others 2 pills. But my pain management Dr. knows I am pretty bad off. Yes,I do miss that 1 pill at bedtime to stay asleep without pain waking me. So LAW or made up POLICY?? Please reply.

Dear Dr. Nagel! It is so wonderful to hear from you again. Thank you for your informative post. I have let you know in the past that when your book first came out I immediately bought and read it and it was the beginning of understanding why over 4 yrs ago my pain mangagement had negatively changed. I’m still mismanaged and suffering more. My life has negstively changed and limitations have increased.
The NPR and you were the catalyst to my start in research and keeping up on the changes.
Your post gives me increased hope in believing that things may actually begin to change. Whether that colleague of yours was at fault or not… I’m rather glad to learn of his outcome.
Perhaps families and friends of the far too many who have taken their lives due to the negligence and suffering so many of us are experiencing…will get on the bandwagon in the name of God and their loved ones and tell the world about that disastrous suffering! Turn the tides!
Just as the families of addicts did that started this whole issue! which has wrongfully effected our community ever since.
We need to keep strong and be heard.
Keep strong in your practice and endeavors Dr. Nagel, we’ve never stopped needing you and others like you.
God bless you for helping us. Maureen M.

Holly

Dear Dr. Nagel, thank you for being you and writing the truth about this whole mess. Your one word said it all and the word I use almost daily when reading the opioid news to my husband. That word is hypocrisy. Bingo! Thank you!

Glen

No one has brought up (Lobbyists). There are existing agencies who might take interest. Not because they care, but for the money. We have thousands of pain patients who should either register as Lobbyists or hire an existing agency. One of these days a Politician might actually get elected saving the lives of Pain Sufferers,

I went to the library today to pick up Dr. David Nagel book needless suffering. I noticed a lot of the people that write on here or write articles recommend his book because it’s on the back cover. Ed Coghlan, Cindy Steinberg, Dr.Lynn Webster. I’m on the first chapter. But it is very disheartening and the view from other associates that Dr. Nagel work with that views chronic pain people as lazy, gaming the system. Says most chronic pain people are the poor, well that may be but it’s bc most have all worked extremely hard physically just like the gentleman you were talking about in chapter 1. Some of us are in the middle ground where we get very little help bc we do have some money but not alot. Dr. Nagel mentions Mother Teresa a lot, uses her statements. I was taught no matter what you do you work as as if you work for the Lord. I feel like a lot of Physicians game the system. Dr. Nagel even mentions guy in ch. 1 didn’t even need spine surgery in yet he ended up with five bc it made the doctors money. What a horrible thing to happen to this person by Physicians he trusted then continued to get placebos why the poor man suffered. What kind of monsters do that? That’s the devil incarnated. Dr.Nagel book sure does open your eyes. And it also breaks your heart. For those who have one.

Glen

There may be hope for some of the young and strong. My struggle started in 2013 when I moved to Florida from Pennsylvania. Both states had prescribed Vicodin since 2004. Not a problem and you could still go to a private doctor. Back then it cost 1/10th what it does now. (It was free for service connected Veterans). I believe it was insurance companies that inspired the inflated cost. They can pay $900 a month. Anything “health care” gets jacked up and soldiers never thought they needed supplemental insurance. VA had no reason to reduce my dosage and they did only because they could. They started us on Opioids and now are blaming us. Right now I am hanging on waiting for the “other foot to drop”. In 6 years they cut me off 3 times. If I move to another State I would say that my odds of getting opioids are zero. (Private or VA.) With insurance I would probably be okay but I won’t likely live long enough to get insured. There are probably thousands like me. Maybe some have even more pain. I would need surgery on both knees, both feet, and I think the nerve damage to my spine is way too severe to correct. Medication is all I have and eventually they will take that. The VA employees (but never once a Doctor) always “thanks me for my service”. Donald Trump is clueless but then his advisors don’t know or don’t care and trust me: no one has written or called Him more than me! I do get regular responses thanking me for writing.

Kris Aaron

“When one identifies a problem, the first step is to find someone to blame.”
Anyone who has watched the HBO series “Chernobyl” will remember that one of the first responses to the explosion was those in charge frantically searching for “accountable persons” – someone who could be blamed for the worst nuclear disaster in history.
It’s always easier and more effective to point fingers at a chosen few – whether they are responsible or not – than to locate the actual cause of the problem.
That all-too human urge has had dreadful, occasionally terminal consequences for pain patients. The fact that drug overdoses are almost always caused by users either consuming multiple recreational drugs AND alcohol or using illegal drugs of uncertain potency appears to be less important to authorities than finding a specific individual or group to heap blame on.
The result is people with damaged bodies forced to live with unrelenting pain or commit suicide while their physicians are being told how to practice medicine by law enforcement. This is no way to live and it’s no way to run a medical practice. America is not Stalinist Russia; fixing blame is not fixing the problem. Let’s stop pretending America is fighting a “war on drugs” and begin addressing the reasons people are driven to using recreational drugs.

Thomas Wayne Kidd

Thank you Doctor Nagel. I wholeheartedly agree. Something has to happen to stop this planned madness. Punishment should be pointed towards those in government who invented this so-called opioid crisis. Those trained to treat pain must be allowed to do what they have been trained to do. As a chronic pain sufferer for more than 30 years, and that being treated with Methadone, will not survive for very long if I should be suddenly taken off this medication. It has worked and continues to work. What has been done to Physicians and their patients is nothing less than wicked and evil! Thank you as again, and God’s blessings on you.

Chris

Do you think that some pain management doctors should look hard at themselves. Maybe seeing the same patients complain of the same pain every 28 days, year after year, has made them biased. Maybe some should take a break and practice anesthesia for a while. Some have lost their ability to be compassionate. It can’t be a fun profession.

Walter Strickland

Thanks Dr. Nagel for the above report.All your efforts are greatly appreciated.I would write more,but will be about the same as I have written so many times over the last couple of years.I will continue to support the CPP community by emailing and calling my state reps ,even though they never ever answer the emails or the calls.They know that we know what’s going on and they so not want to talk to us.

Anonymous1

This is the biggest National modern day medical/healthcare disaster of our time. Those in positions of “Power” that caused this disaster should ALL be held accountable. The DEA unfortunately are the biggest cowards there ever was taking down Doctors is easy & very profitable. DEA is running the show here…I was in Pharmacy the other day, I hear patient telling pharmacists her Buprenorphine RX is for Pain Only, Not addiction..The pharmacist is arguing with her that for Dr. To write Bupe for pain he needs an “X” behind his License # Pharmacists then says “Hold On a Moment, I will go call the DEA & walks off..I just about fell out of my seat. Seriously? Today the DEA’s daily job consists of monitoring Doctor’s prescribing habits & deciding which one to “Raid & Collect from next”. The practice of medicine without a license was at one time ILLEGAL in the U.S. Not anymore…The DEA does it every single day when they decide what opioid dose’s are considered “Excessive Prescribing” they need not see any patients medical records or even understand the basic principles of opioid metabolism & the variations. CDC set down a small arbitrary opioid dose “Limit” simple enough for DEA agents to understand & Government gave the power to raid & arrest any who dares cross that 90 Mg MME “End All Be All” of Opioid Dosing. We have Pain Management Specialists Anesthesiologists who are following CDC GL’s…90 Mg MME??? CDC GL’s were NEVER meant for Pain Mgmt Doctors especially Anesthesiologists to be following!!!?? They are extremely highly trained individuals & if anyone should be given ok to prescribe beyond 90 Mg MME they should. Until the DEA is called off the Dr.s this current nonsense will never change or stop. Dr.s are too afraid for fear of losing their liscense. Get the DEA out of Healthcare.

Ali

The Opoids drug epidemic is not new. Drug addiction and Opoids have been in America for decades and every decade the government needs a sacrifical lamb to slaughter. This time physician’s our heartbeat of medical care.
In this travisty of Injustice by negligence of duediligence to “first do no harm”.
Intractable Chronic Pain Patient’s have been ripped, stripped, labeled, profiled, loss of physician’s care, loss of medical care, dehumanized, bullied, and placed in a swirling hole of lost hope and committed silent Suicide’s. Silent suicides we will never know due to death certificate stating death by suicide and buried with loved ones not knowing the pain they endured with no hope.
Yes there is an epidemic but CDC, DEA, and FDA took there guidelines put them in place with NO educated knowledge of the profound travisty of Injustice by negligence of duediligence. They had there sacrifical lamb to slaughter.
COMPLIANT Intracable Chronic Pain Patient’s are the collateral damage from these government agencies guidelines.
This will go down in history as other travisties of injustice such as agent Orange.
The Opoids came in as a Trojan horse and has now become a fire storm that can never truly be contained. This has been decades in the making. Corrupt poloticians, cartels, no border control, and Presidents that signed deals with other countries
with no regard of the future of this country.
Addiction needs redefining for COMPLIANT Intracable Chronic Pain Patient’s for they are not addicts but using a medication to ease there profound pain.
What end will this come to? Where is the common ground?
One thing for sure we the COMPLIANT Intracable Chronic Pain Patient’s will not be silent.

Jody Hoffman

Why does it take a doctor getting his hand slapped by the medical board to put the fear in doctors about the way they are treating patients? Now that I have seen that a doctor has been punished for his actions, I am going to start a medical malpractice suit against my former provider, her actions caused me harm & has escalated my disease that I am now at the end of my life. To many people have died do to opiate termination & we have to make them all responsible

Rebecca Hollingsworth

Sorry, not sorry had to be done. Kudos to the cpp for standing up. I think we all know how he feels. I was on the same dose he was and mine are now at the “guideline” level and I’m in constant pain, cant work anymore, and its devastating. The doctor is not the sacrificial lamb, WE ARE! And I don’t want to be it anymore. It’s a start, but it needs to be more than 1 patient. I understand what the doctors are faced with, but most are still practicing and supporting their families. How many chronic pain patients are? And yes, the government stuck their nose where it didn’t belong and the situation needs to be remedied and quickly before we lose even more. One thing this did accomplish was to put a smile on my face today!

Laurie

All I can do these days is stream videos to take my mid off the horribleness in America these days.
So, I’m gonna go do that.
I start compulsory “pain management” in two weeks. My prescription will not be refilled until this mess is over. I don’t know what to do, there’s no help where I live and my neurologist has slammed me off my pain meds so many times, it’s beginning to affect my heart, I think.
He is NOT a good doctor in any way.
I’m going streaming now.
Bye

Gail Honadle

If you asked if I still trusted my Primary, I’d say NO. He won’t fill my scripts that any APN can fill. See the Specialist, Well I don’t see the Gastro but once every 3 yrs for a Upper Endo Scope for Barrett’s Esophagus which should be every year since it’s a Pre-Cancer. I have to double check all lab reports with my ENDO, because he lacks the Education they do and he steps on their toes with Lab work that he then can’t share as his computer system is not compatible with anyone else’s. Counters the Specialist orders. Talks to me like I’m 5 yrs old. I’m 71 in 5 weeks, I’m not Senile, in fact I’m a well read Patient who knows their health conditions and treatments better than he does along with med side effects. His assistant is typing notes into the computer, so he doesn’t have my history in front of him. I doubt he’s even read it.

Kerry

All looks good on paper, but when is the DEA and certain states medical pain management boards going to accept this.

Terri James

I couldn’t agree with you more. Ourselves, our doctors and the pharmaceutical companies have been put on a needless pedestal of disgrace. Yes there are always two sides to everything. This doctor was following suit just like everyone else, trying to cover his or herself from the harm that can be fall them as well. They have lives and families too. I wouldn’t want to see anything happen to my doctor. He’s a wonderful man with a family and has a heart unlike other doctors that I have come across in my lifetime. If blame is to be laid let’s lay it where it belongs and that is within our government. This entire situation is needless, ridiculous and totally uncalled for. Often times our government and its agencies try to fix something and in the meantime the very people they’re trying to fix are the ones that suffer the most and I do mean suffer. It’s disgraceful in more ways than one. I wish I could say more but as the author stated, one needs to be careful what one says. The. so-called good news of the past two weeks should have came shortly after everyone realized what they had done to the chronic pain patient. Now millions are suffering, many of them deciding to take their own lives instead of desperately trying to live with needless pain.

Debbie Nickels Heck, MD

Thank you for giving hope to so many who have wrongly suffered on both sides. I’d like to show this to the Dr who dismissed me from her practice because I needed opioids to control my pain causing my HTN but she called me uncooperative for asking for it when the specialist said I needed it.

Alan dean Thurman

my ability to work has been taken away needlessly. i going to write a book. How to screw over 50 million Americans. in the two years i have had no medication i have gained 85 pounds, my shoe size has increased 1 in(i have no shoes to wear) i have two t-shirt’s and three pair of shorts, i haven’t cleaned my house or car in two years. i sleep three hours a night(i have started keeping a record of that thru a medical app on my iphone. this policy has destroyed my health, finances and ability to provide. what genius thought of this policy, come election time we will send those in power a message.

Molly

As angry and disappointed as I have been, all stemming from pain, at my doctors over pain medication you are correct. Doctors have become the sacrificial lambs and I am sorry for that as a patient and a an individual. I too hope the right people are paying attention. It is a shame that we as patients have lost that relationship with our doctors. I want to say thank you.