Opinion: Oregon Health Authority Has It Wrong

Opinion: Oregon Health Authority Has It Wrong

By Richard “Red” Lawhern, Ph.D.

The fundamental errors which the Oregon Health Authority is trying to make policy can be traced to unproven or simply wrong assumptions around which the 2016 CDC Guidelines on prescription of opioids to chronic pain patients were based.  These assumptions were:

(1)  The US is said to have a public health crisis in opioid addiction and overdose mortality caused by physicians over-prescribing medical opioids to their patients.  Restrictions and enhanced oversight of medical opioid prescriptions are therefore deemed to be warranted to prevent further exposure of both patients and their untreated family members to such potential sources of addiction and death.

(2)  Opioid pain relievers are said to be ineffective for chronic pain, when used for months or years.

(3)  Safe and reliable alternatives to opioid therapy are said to exist and are declared preferable as substitutes for opioid therapy.

A fourth fundamental weakness of the Guidelines is expressed as a systematic omission.

(4)  The Guidelines are silent with respect to the practical impact of significant variations in opioid metabolism between individual patients, due to genetic polymorphism in six key liver enzymes affecting 90% of all prescription medication metabolism.

However, published medical evidence deeply contradicts all four errors in the CDC paper.

(1)  Data published by the CDC itself reveals that over-prescribing by doctors to their patients did not create our opioid crisis and is not sustaining it.  The contribution of medically managed opioid pain relievers to opioid overdose mortality is so small that it gets lost in the noise.

(2)  If opioids are ineffective then why are at least 1.6 million Medicare patients being maintained on doses exceeding the CDC guideline trip wire at 90 MMED — many of them for years?

(3)  If safe and reliable alternatives to opioid analgesics exist, then why have none of them ever gone through large scale Phase II trials required for certification by FDA?  And why have none of them ever been trialed as actual “replacements” rather than as adjuncts (additions) to usual therapy with analgesics?

(4)  A well-established literature on opioid metabolism establishes a very wide range of minimum effective dose that greatly exceeds the CDC 90 MMED criterion.  There is no one-size fits all patient or therapy plan.

The Oregon proposals basically lack medical and ethical support.  As discussed by Beth Darnall PhD, there are no published studies to establish any positive outcome from mandated tapering of legacy patients who are already stable with controlled pain. But there are multiple reasons for concern that patients coerced to taper may experience medical and psychological collapse.

The Oregon Commission is engaged in a fools’ errand that will damage thousands of patients — both those on Medicare and those on private insurance — by denying them the only therapies which actually work, in favor of outright quackery or unproven experimental protocols.

Richard Lawhern is Director of Research, Alliance for the Treatment of Intractable Pain and a frequent contributor to the National Pain Report.

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Robert Donahue asks “how can I rise and be heard?” And it’s a fair and meaningful question. One answer is this step by step script.

Telephone the offices of your Congressional Representative and Senators (also your State Assembly person and the Office of the Governor) and ask for an appointment to speak for ten minutes to the legislator’s healthcare staffer or the Chief of Staff of the office, by phone. When you are connected, speak from a prepared message:

“I am a constituent of Senator (Representative) so-and-so, and a chronic pain patient under treatment for multiple diagnosed medical conditions. I want the Legislator to understand that my life is being destroyed by misdirected government policy which has denied me the only pain treatments which work for me. By that I mean high-dose opioid pain relievers, among other medicines. I want your legislator’s commitment to demand withdrawal of the 2016 CDC Guidelines on prescription of opioids to adults with chronic pain, and to repeal of State laws and regulations on the same subject”.

“The Legislator and his staff need to know that doctor over-prescribing of opioids to legitimate patients did not create our opioid crisis and is not sustaining it. There is no relationship at all between rates of opioid prescribing and rates of overdose mortality — and published data from the CDC prove it beyond any reasonable contradiction.”

You may obtain further accurate information which should guide changes of public policy by looking up The Alliance for the Treatment of Intractable Pain on google. I urge you to do so immediately.

===========================
Be advised that the Alliance is in the process of re-hosting our website. But a google search should find our temporary information archive among the top ten hits, even as we are re-hosting the material to the new platform.

Regards,
Red Lawhern

As I have said before, this is NOT about proper care, it’s about the MONEY they save and redirect into other’s pockets. By denying care and medications, money not spent becomes money saved and then it gets split up as bonuses and more. Don’t believe me? Check out this recent article to see how much money can be made on healthcare and by DENYING healthcare. https://www.thelundreport.org/content/executives-oregon%E2%80%99s-coordinated-care-organizations-made-12-million-2017

Jessica

This is terrifying! I’m especially appalled by the lack of empathy, from a state that was once so concerned about it’s patients quality of life, that it boldly moved forward and enacted Death With Dignity laws! Laws that allow those with terminal illness and living in horrific pain, to end their lives peacefully and and painlessly..what happened??
And why should those living in severe and intractable pain, who don’t have terminal illnesses, be forced to continue living in pain until their bodies and minds finally succumb and they either die from complications or suicide!? I’d also like to know: Why is being forced to live in never-ending, unrelenting pain not considered a “terminal illness”? It will kill us eventually, one way or another.
Thank you Dr. Lawhern for your continued work and advocacy!

Pam

Thank you Red for your continued fight, support, efforts to get change made for those suffering. I am outraged and cannot believe this is happening…How the F*** can the government get away with this…medicare no less who are mostly seniors and the disabled and they know dam well too that by denying us our lifesaving pain medication where is that going to leave millions of suffering people who require these medications if we want any quality of life???? I’ll tell you where it leaves us……turning to the streets for relief when the pain becomes to much and a once functioning body is now going thru torture from the inside out, it leaves us desperate for relief even if for a few hours, it leaves us hopeless to the point many will take their lives to finally be free (many already have and continue to do so at alarming rates daily)…no more agonizing day in and day out no more drs, no more pill counts, no more being degraded and treated like something you are NOT, no more being drug tested like some dam criminal because we are sick and require a select group of medications, medications approved by the FDA for the treatment of chronic pain!!! That’s just some of the thoughts that run thru the minds of the suffering who are being abandoned by our drs. drs we trusted for years and put our lives in their hands and who are now turning their backs on us after showing us compassion for years and empathizing with us, we are now being looked at and judged as if we are only there to get a fix and after all these years the pain cant be that bad and we are no longer believed. The government and their sidekicks need a taste of their own medicine. They need to know what it feels like to be physically, emotionally and mentally driven to exhaustion , exhausted to the point of giving up when there is no hope in sight for relief from the raging hell inside our bodies !!!

Kris

Thank you for telling it like it is.

Very Good Presentation by Dr. Lawhern.

For all readers: be aware that I have just filed a formal petition with the Department of Health and Human Services, Centers for Medicare and Medicaid Services. I have demanded suspension of rule changes that will allow Medicare Part D insurance providers to require so-called “safety edits” at threshold levels of 90 and 200 MMED respectively, for any prescription that brings a patient’s daily dose levels above the thresholds. If you would like to endorse the petition, you may read it with its attachments at

http://www.face-facts.org/atip/.

Then you may send email (subject “Endorsement of Petition to Suspend Safety Edits Rule”, to these key officials:

Seema Verma, CMS Administrator

Shari M. Ling, MD, Deputy Chief Medical Officer, Center for Clinical Standards and Quality

Over 200 people have already endorsed the petition as originally submitted or by direct email, including at least four physicians who are Board Certified in pain management.

============================

Likewise, be aware that I have filed a formal complaint against the Centers for Disease Control and Prevention, with the Office of the Inspector General in the Department of Health and Human Services, on grounds of gross misbehavior, malfeasance and fraud in the process which produced the 2016 CDC Guidelines. I have been informed that the earliest I may be able to see the results of this complaint is early March 2019, and that I will have to file a Freedom of Information Act request to receive any documents generated during the OIG internal consideration of my complaint.

Feel free to clip and send this comment and the article above to your Senators and Congressional Representatives, after the election craziness is done.

I’m “all in” on this fight and I’m not going to give up — along with at least 400 of my colleagues and associates in the Alliance for the Treatment of Intractable Pain.

Hang in there, folks.

Anonymous

It’s absolutely appalling that this is even being considered. I have several very severe pain disorders and am living on the edge in fear of our government. “A nation of sheep will beget a government of wolves.” Our government is NOT supposed to be this powerful. This is not a democracy anymore. Our rights have been eviscerated and we are now living in a police state that rivals Nazi Germany. From police shooting and killing unarmed people, to widespread spying on us through our cell phones and computers, now to control of how much relief we get for pain.

I don’t know where it will end but I pray that God will intervene. I urge everyone to repeatedly email your legislators before this gets worse.

ROBERT BRUHL

Thank YOU RICHARD LAWHERN,,I come from a family of German trained Doctors.All passed now Except my brother Eye Surgeon,Im 73 yrs of age was hit by a Car that ran a stop sign while I was going 55mph on motorcycle,hit me broad side (T-Bone).got my left leg out of way,just in time needless to say broken bones spine injuries, now have arthritis all over parts of body.I have been under Pain management for 40 yrs,I have NEVER abused medication,I do NOT Expect to be Totally out of Pain,just dull it where I can continue with my life Opioids are the ONLY THING that have ever helped me and I take as little as possible. My Doctor died from cancer Now I cannot find a doctor that isn’t afraid of the Government.Im up right now because my back spine and neck is very painfull. I have little hope that the Government is going to do the right thing I wish they had to suffer every day like many now have to because of this BS war on Opioids Thanks again I’m tired try to lay down go to sleep……..R.B.

AMEN !

Stacy Cooper

Excellent, I wish I could print that out. I have tried everything and every type of opioid therapy and the best for me has been the Fentanyl pain patch. I had gastric bypass and that has caused absorption rate to be different from most people, I have HHT that causes aterialvenous malformations that bleed and so anti inflammatories and Nsaids will kill me. No I’m not healed by my pain meds, but they make my life manageable which is becoming not good enough and so they should be discontinued? Just wait till I can’t get out of bed, but what do they care?

Alison

All points covered in the article are spouted as facts with the Oregon Health Authority. When I attempt to argue for the medication that has given me a better life for almost 20 years now, it seems they have just made up their own set of facts. It is about as useful as arguing with a brick wall. I was recently told by one person that “opioids were never invented for long term use.”

As an Oregonian with chronic pain I am constantly filled with anxiety wondering if my life will soon be thrown into a living hell. Tapering and then eliminating my medications and replacing them with massage, yoga, or acupuncture will not quell the pain that always lurks behind the guardian of opioids. With opioid medication, I still contribute to society, live a pretty happy life and am able to support myself. I would think that the alternative of being unable to work and having to begin receiving disability benefits while trying to cope with the never ending pain would cost the state of Oregon more money….or maybe that just shunts me off to a federal rather than state program? I don’t know and I’m sick of thinking about all of it.

Jill

Dr. Lawhern, I also wanted to repost the fact that the new medical marijuana laws are making billionaires( according to news reports ) of John Boehner and political friends. I’ve come to believe this has been the push behind negative opioid media reports. Chronic pain patients denied opioids will flock in desperation to mmj despite its high cost making more politicians billionaires. Tough to fight that kind of power and greed.

Jill

Dr.Lawhern, what you write about are facts. Logic, common sense and facts seem to have no place in the ongoing vilification of opioids. Listening to the recent political ads with opioids still portrayed as evil, I’ve come to realize we’re losing this war. I continue to phone senators and representatives in my state but can’t get a face to face. Will try again after elections. Thank you for continuing the fight. God bless.

Holly

Dear Dr. Lawhern, thank you once again for speaking the Gods honest truth to all this chaos. Everyday I keep asking how can our government do this to us??? I have post traumatic syndrome pretty bad and the psychological part may be what does alot of us in. I am simply lost, and a week before my next pain management appointments the nightmare, tension headaches, etc. etc. begin. This past appointment is like a punishment for being ill. Now my Dr. wants a pill count! I have been 100 % compliant ! This [edit] is unbelievable!!

Barbara

I’ve been coming across more and more people everyday who suffer from chronic pain. It’s astounding how many of us there are. I think most of us keep quiet because of the stigma surrounding people who take pain meds. We are judged by others who have no clue what it’s like to live with chronic pain. And in this day and age we don’t want the wrong people to know we have pain meds on our person or in our homes for fear of being attacked and/or robbed. It seems like from the beginning no one has bothered to ask us, the chronic pain patients, how our lives are going. How we manage to function while being on medication. We hold jobs, raise families, live responsible,law abiding lives. We are not “high” all the time or overdosing. We have proven we can take pain meds as directed for many years and be just as “normal” as anyone else. There are millions of us. Yet no one wants to hear our stories. They just want to hear what the experts have to say. What they say DOES matter very much but what we say should matter more. Especially since there’s so many of us.If we could only get all our stories out there for everyone to hear. We contact our representatives, local and national media and no one is interested. We hold rallies and really don’t get the attention we should get. We need to find a way to be heard. Until someone comes up with a way to do that I’m afraid for all of us. We are many and our shear numbers should be enough. We MUST find a way. God Bless

Steven

Exactly!If any of us are to survive someone must do somthing.I am to weak with pain and just about had it. A stimlator and thats it.

Caregiver 24/7/365

When one clears his/her head, turns away from the frenzied and emotional knee-jerk rule making, it’s obvious that Dr. Lawhern has this right. Instead, we have “authorities” consumed by their misguided mission to an extent that people, real suffering people, people who wonder daily why/if they should continue on with life, are left to twist in the wind, tortured by intractable pain that can be partially ameliorated by carefully administered opioid meds.

I wonder how many of these “authorities” realize there are people (my wife is one) who have tried ALL the non-opioid meds and treatments. Her body chemistry and her hypersensitive nervous system renders them useless or worse, yes worse … sometimes suicidally worse, caught in hallucinations and critical imbalance (physical, psychological, and emotional) in reacting to non-opioid alternative meds. Shame on them for their “one size fits all” mindset.

The opioids help her. The “authorities” can take all their studies and place them in their anal cavities inasmuch as they do NOT apply in all scenarios. We have an involuntary multi-year lab experiment going on in our home, with my wife who is 79 and a PhD in genetics. She is scrupulous about the science of opioids, observes all the rules and precautions. She has a caring and skilled pain management doctor who is determined to help. It would be wonderful if opioids (or anything else) were more effective in calming the pain. But we have to listen to our bodies and do whatever can make life even a little more bearable.

Dr. Lawhern, you are a rare voice in the wilderness. But you are not alone in the wilderness — there are millions of us out here simply hoping against hope. Thank you from the bottom of our hearts.

Dr. Lawhern,

Please answer my question, the tl;dr of which is I that I want to know if you can, via guidance, help me help you help me & the rest of us in this community under siege.

1st, I share the main sentiments of the prior commenter—you hit the nail headfirst, but I fear the only audience to these exposures of government fraud is we ourselves who suffer from the life-destroying malady of chronic pain & from the government’s anti-scientific war of lies against us as patients.

So what can i do …

… to most “loudly”, effectively, and broadly speak truth to power on this evil. To expose this epic tragedy of misinformation & its use to legislatively & regulatorily cut off the most helplessly desperate of patients from access to the scientific treatments that have, till now, enabled us to live at least half a life?

I have no money, because I’ve been decimated by this solely political crusade by both parties (dressed up as your garden variety “urgent” health crisis of the hour in order to keep the coffers flowing at the agencies creating this false panic, no doubt greased by the right lobbyists & other “indirect”
beneficiaries of the massive government funding & propaganda that flows against us). So I have no voice, in our 1% society.

I have a very specific set of skills (queue Liam Neeson’s monologue from “Taken”), because I am an ex-Attorney who excels at research, argument, and writing, with a broad legal background. I also have an English Literature degree which left me with a penchant for both biting & subtle satire, as well as a passion for dynamically engaging writing. Note: This is being written very hurriedly, as I substitute teach a class.

So I know I have the capacity to wield mind and pen. To unearth and expose. But I’m no “influencer”. I too often am migrainous, or profoundly depressed—this war has cost my career, my family … I may even be evicted soon.

How do I rise and be heard?

Hayden

Totally agree with Mr. Lawhern. He is able to articulate the other side of the “opioid crisis” which heretofore is not being addressed as well as multiple, simultaneous substance abuse causing overdose. Pain management patients and responsibly prescribing physicians HAVE been accused of creating an “opioid crisis” through over prescribing by our physicians as well as unproven accusation of diversion and abuse by ALL pain management patients with our personally tailored, prescribed medication. Use of opiate medication through documentation especially now after forced tapering proves that opiate medication for millions of patients nationwide, is in fact effective and personally, very effective for decades well enough to help me continue to earn a living for my family and myself prior to an 80 percent reduction (in 8 weeks) in medication used for 7 years (23 years total of medication use) with my current pain management specialist, without even one milligram dosage increase. Our physicians, with their documentation of beneficial use has been challenged by the CDC and patients, ALL patients are being penalized for diversion which is and has been a crime. WHERE is ANYTHING like due process? Just forced, involuntary compliance being imposed causing physical and psychological harm has come to surface with the 2016 CDC “guideline” Just an elite handful of people have been able to cause devastation and even death by self infliction in many lives across the country. What seems to me completely insane is the consideration of further forced tapering and even total denial of the last effective medication for lifetime, incurable, continuous pain generation. CDC states approximately 9 to 11 million patients do in fact need opiate medication as the last, effective, available means for pain management but, refuse to amend or preferably abolish the 2016 “guideline” as worsened suffering caused by diagnosed disease, injury, and surgeon foul up continues. Further denial of meds?

Robert D Gephart

Many Thanks to you Dr Lawhern,
I greatly appreciate your hard work and well written replies to this nonsensical witch hunt the government is once again on.
Robert D Gephart
Licensed Psychologist Emeritus

cindy

How could any gov’t agency issue guidelines which oppose all fact? Trump’s EPA ignores climate science, as does FL’s state EPA under Rick Scott, but I would think that medical agencies at least would not deny science.

ANd, clearly no one involved in issuing them has a loved one with chronic pain.

Was this 90MME issued under Trump? If so, that would make since Sessions is trying to resurrrect the failed war on drugs, and his position on medical marijuana also is devoid of fact.

Two months ago, my pain manager told me that my mme of about 155 (i forget the exact number) was low enough that he’d fight to keep it. And I’d often been told that my dosage was quite low compared to other patients. Which made me wonder if I’d be more functional with a higher dose — instead of not only being on disability, but spending almost all my time sofa-bound and finding even taking a shower and loading the dishwasher to be a challenge most of the time. Of course, since I can’t stand up enough to cook, the dishes don’t accumulate as fast as they would otherwise.

But last month, he reduced me to meet the 90 standard so that neither of us would stand out from the norm. I’m terrified of what’s next.

I will try medical mj, but, it’s so expensive, and involves so much trial and error on my own, adding to the cost, since the doctors that can now get people licenses in FL have taken only a 2 hour class and know nothing about it. And there’s no guarantee it will work for my condition.

Todd

Well said Dr Lawhern. I am hopeful that your message gets out well beyond National Pain Report. So many people tell their stories about themselves but your message speaks to the heart of the matter and is the main issue that lawmakers and media need to be hearing and repeating and reporting. Great job! Thank you for being so thoughtful.

Dear Dr. Lawhern,
You sir, have most definitely hit the nail on the head while putting it bluntly with elegance. Wouldn’t it be wonderful if this was the topic of news that people watched versus the lies they are? Wouldn’t it be wonderful if those that didn’t have an earthly clue as to what chronic pain is could hear every word of your article? Since this drastic cut back occurred I’ve done my very best to adapt to the changes. Being tapered to one fourth of what I was taking has been anything but easy. Now with what little I’m allowed by law, I still struggle daily to maintain what I’m allowed while continuing to live my life with some sense of normalcy. To rid all of our medication, what little we have left, would be barbaric as well as ridiculous. I don’t know if Oregon is trying to make a name for themselves or what in this process but I pray that there are enough people like yourself with influence to stop this dead in it’s tracks. Often I wonder what would have happened a couple of years ago if every single doctor would have stood up to what was happening and said, “NO”! What would they have done? Fired every single doctor we have on the planet? I don’t think so. This crisis has gotten extremely out of hand as we are all aware. Please sir, if there’s any way humanly possible, please get your statements out beyond the National Pain Report. I often wonder at times if anyone except chronic pain patients read these articles that are on the National Pain Report. Thank you so much for what you’ve done. I’ve read many of your articles over the last couple of years. I pray these articles can and will reach deaf ears. Thank you so much. Respectfully,
Terri James