Reaction to New Massachusetts Medical School Curriculum Aimed at Stemming Explosive Rise in Opioid Misuse

Reaction to New Massachusetts Medical School Curriculum Aimed at Stemming Explosive Rise in Opioid Misuse

By Ed Coghlan

In an effort to address the opioid overdose crisis in Massachusetts, Governor Charlie Baker reached out last falls to the deans of the four medical schools in the state (commonwealth as they call it) and asked for their help in designing a list of core competencies needing to be covered during medical school to help combat prescription drug misuse, addiction, and overdose fatalities.

Working with the Massachusetts Medical Society and Monica Bharel the commonwealth’s public health commissioner, the schools developed a list of 10 competencies that will be introduced into their curricula beginning this fall.

The Safe Opioid Prescribing Curriculum is being overseen by Daniel Alford an associate professor of medicine and assistant dean for continuing medical education at the Boston University School of Medicine. The 10 core competencies, centered on 3 major areas, are designed to provide a broader, more comprehensive approach “to understanding the physician role in preventing, screening for and managing unhealthy substance use and prescription drug misuse in our patients,” Alford says.

For more on the curriculum, reads this article from the BU website.

Reading the story was Krissy Anderson, a 63-year old chronic pain patient who lives in Florida. The letter “inspired” her to write reporter John O’Rourke a letter reminding that the opioid overdose crisis addresses less than 5% of the chronic pain population.

She wrote: “For so many living with chronic pain on the pain scale between 6 and 10 every day, with whom opioid medications work very well, we are responsible with our medications, we do not go to the ER for early refills, we do not doctor-shop, we do not become addicted and we do not turn to heroin, which the CDC has made clear that we do.”

Anderson, a self-described activist who has written for the National Pain Report, told the reporter that the lives of chronic patients have been “ruined with doctors afraid of prescribing, pharmacies lying to us and refusing to fill Rx’s, and the public calling us “junkies,” addicts and abusers.”

She encouraged them to do more research and to read both the articles and the commentary on articles written by the National Pain Report.

“Suicides,” she wrote, “are rising fast as patients’ meds are taken away. Our armed forces have come home with chronic pain conditions, so please listen to VA patients also. The VA has done an extreme disservice to its members when it comes to healthcare.

If she hears back from O’Rourke she promises him that she will connect with patients who represent the 95% of the 100-million chronic pain patients that are not addicts.

If she hears from him, she’ll let us know and we’ll let you know.

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Authored by: Ed Coghlan

There are 37 comments for this article
  1. Michael Wagner at 10:59 am

    I have read all the comments on this subject, and I don’t know if this is in line with all the comments.
    I can see every state is different as WA state set up by the university of Wa. in which I went to one of there last meetings.
    The only Doctors left here prescribing opiates are the doctors that were already prescribing and working in there private self owned medical centers and do not take any new patients on, they send each patient to a specialized pain specialist each year to keep a back up doctor approving what he is prescribing, most all these are just moneys spent to keep them going.
    Pain opiate prescribing here is a joke but better than most states as every patient with the same exact problem ends up with the same drug, but one might get a small amount and others get more than double on up for the same exact problem .
    This is a small problem to what other states are going through.
    With all the pain problems I have on my last appointment, The Doctor after 11 months of getting all the injection money he could out of me, pushes me over to a 19 year old nurse of some kind .ell her my new problem and she goes to see the doctor and came back and said we can put you on this medication and I said that is one that is on the list of medications that I have interactions with. and have been hospitalized after starting that drug. I told her that I need to be seeing the doctor here until we get things straightened out. My back account has been hit very hard since starting with this pain doctor in March 2015.
    This is a small example of WA states problems with pain meds if they can not make a lot of money off you, doing injections they just push you aside to there lowest paid employee to take care of you each month. as more profits in it.
    I have to say it is all about the money.
    and these people making these new laws are in the same group of mentally that is going to take care of you people that don’t have a program like we do here I really do feel sorry for all of you in pain. Animal shelter’s take better care for animals than our medical system is and about to I n our cases.

  2. Richard Oberg M.D. at 9:00 am

    Thanks for the confirmation Jean and sorry for all you’ve been through. You spoke in a way only someone in healthcare and generally very experienced nurses do! Your story is tragic as we have a severe shortage (I know you know) of compassionate experienced nurses I’ve had the privilege to work with over my many years. It’s difficult enough to get through the rigors of becoming an RN, become familiar with ‘the system’, and then have it yanked away from you – I know many like you who invest a lot of themselves for the good of healthcare and are compassionate and honorable. As I’ve discovered health issues are ironically the worst way to have to leave healthcare.

    Everything you say is correct. Other ‘old school’ physicians from various specialties and I worked to try and limit (you can’t stop it unfortunately) this detachment from the patient and over-reliance on unnecessary testing which only runs up unnecessary costs. Some patients with family can be a challenge but I found it to be the exception not the rule and nurses were quite often where I’d go to find out ‘what was going on’- would you agree? From my perspective over 90% of problems between providers and patients are from lack of effective communication everyone feels they’re too busy to do yet is all that matters. I was always battling the same thing between surgical specimens/surgery and our PA’s (pathology assistants) and when you ultimately force people into face to face dealings it begins to humanize relationships and adversaries become friends. I maintained some regular patient contact doing fine needle aspirations of palpable lesions we set up to expedite diagnostics with one or two hour turnaround that helped everyone (I am cytopathology boarded also). Always expecting something painful and inevitably ending well, it was sad when they’d want my name and wonder if it’d be OK to see me as a patient which, of course, wasn’t possible.

    But everything is headed the way you say – more depersonalized and healthcare professionals becoming less and less satisfied with their jobs yet they seem to have a difficult time connecting the dots!! Now that bad disease has forced me out, I’m going to continue to advocate for patients and work to do whatever I can to change it and hope you will also. Good luck!

  3. BL at 9:31 pm

    My dearest friend lives in Boston and she is a foster mother to special needs children. She cares for babies that are addicted to heroin. She told me that the heroin problem is severe and everywhere. There have been times that we have been talking on the phone and I had to hang up because I couldn’t handle listening to those babies scream.

    My personal belief is that addicts have a choice to get help or not get help. Addicts have alternatives, chronic pain patients usually don’t. But, I can tell you that when you’re comparing chronic pain patients who can’t get their pain treated to addicts and addicted babies, chronic pain patients do not matter and this will not change. You also have to remember that the addicts and their families are vocal and visible about how opiates affect them. Unfortunately, chronic pain patients and their familes aren’t vocal and visible about how not having their pain treated affects them.

  4. David W at 7:42 pm

    I live in the western part of massachusetts, and here we are seeing more and more doctors and practices which are completely stopping prescribing opiate pain medications no matter how legit and documented the injury. My wife is going through went to closed and she had to find a new doctor as she needed to get back on her pain meds after she had our 3rd daughter, Only problem was when we started calling offices we found out almost every doctors office in the area said they were either not taking chronic pain patients or that they had a policy of not prescribing any opiate pain medications at all. We found a office that said they did prescribe them but it was on a case by case basis. my wife had back emergency surgery back in 2009 for her back which fixed the problem structurally but did not resolve the pain and nerve issues she was suffering from ( this originated when we had our first daughter and the person doing her epidural missed 3 times and caused instant damage ) she also suffers from Fibromyalgia and a yet undetermined hip problem where her hip keeps popping causing excruciating pain and extremely limiting her movement. When we went in to see the new doctor she told us that there was nothing she could do and that we should look into medical marijuana because in her own exact words “She does not believe in prescribing opiate pain medications to anyone no matter the age (my wife is 29) and it wouldn’t matter if she was 73 and had cancer she does not prescribe them for chronic pain period!!!” To which we were just like you have got to be kidding us, We then had to wait 2 months after getting a referral to Baystate Pain Management who said they did pain medicine management, once we got in and saw the assistant and he went through my wifes records and did a physical assessment during which her hip popped on him causing her severe pain ( he jumped a mile when he heard her hip pop) after this the doctor came in and started his speech about injections and how great they are and trying to pressure us into letting them do them for her even though they had no clue at all what is wrong with her hip ……. we then asked about getting her back on her pain medications which she had been on for years to help manage her pain only to be told they no longer prescribe pain medications anymore ! this is a Pain management clinic that now does not prescribe pain meds to there legit and well documented patients, we told them there was no way we were going to let them do injections as a screwed up epidural is what started this whole problem to begin with 8 years prior and especially since they didn’t even know what was wrong with her hip, we had to contact her primary care doctor again and get another referral this time to pioneer spine and sports physicians and wait another 6 weeks to get her in to be seen, when they called to confirm her appointment 3 days before it s supposed to see only to be told that as of Jan 31,2016 they were no longer providing pain management care for patients. now we are waiting yet again 5 weeks for her to be seen with yet another pain management clinic while she has suffered and been essentially bed ridden for the past 7 going on 8 months in agony because she no longer is on the Fentanyl patches she was on for round the clock pain and the low dose oxycodone for break through pain because it seems almost no doctors are willing to prescribe these anymore. They care not one bit the pain and suffering there patients are going through. Seems in this rush to stop opiate medication abuse that they are forgetting that these medications were created for a reason to begin with and that there are chronic pain sufferers with legit documented injuries who have never had any issues with abusing there medications who are now being hung out to dry.

  5. Jean Price at 5:48 pm

    Reply to Dr. Oberg….yes, you have me pegged! I worked in nursing (RN) previous to my first, then second back surgery. Then returned to work briefly in a non patient care position (the hospital felt I was too big of a risk to re employ) before my last, more extensive back surgery. The hospital was correct, I might add! I no longer could work in a physically demanding job, since I couldn’t even continue at a minimally demanding position. I have worked in many area of hospital care and seen many changes in policies, education, and patient care issues. As with any field, these have not always produced the desired effect. This is my concern regarding the education of our future physicians. I feel we have already replaced physical exams and comprehensive history taking with diagnostic technology…often to the detriment of patient care. Patients no longer have anyone to oversee all of their care, because it has been fragmented to specialists. (Certainly true of people with chronic pain.) So our new physicians will come into this picture needing the most up to date, comprehensive and multifaceted foundation to begin with. When we add in politics and the latest social trends and issues important to some senator, how will they ever be able to focus on the role that defines their profession….appropriate patient care for the individual in front of them?! I can’t help wondering how pain would change the parameters of concern for some of the non medical people, like the senator, who are addressing these issues of opioid use and opioid addiction and appropriate prescribing. If it would change it, then perhaps we need different mandates, different focuses to begin with. Doctors with experience have the most expertise to know what needs to be taught, not someone in politics. And looking at some of the lost patient care arts would be a better use of curriculum, I think! The old nurse and the pain patient in me speaking, I’m sure!

  6. Donna at 2:41 pm

    Holly,
    Thank you for sharing as a physician and as a pain patient. You validated my very thoughts on the subject. I have never stopped working for solutions to problems my entire life, but I don’t even know how begin with this one. And that is one of the worst part of having a chronic illness. The feeling of being powerless.

  7. BL at 1:43 pm

    I ran across this and thought it was interesting. You can go to the entire article by Googling Medscape 10 Ways to Say No to Patients — and Still Keep Them Smiling. It also backs up my belief that the majority of pain patients are having their pain adequatey managed. It is also a reminder that drs have pressures from things that we don’t consider. Tomorrow drs will be more intuned to these things than the drs that were educated before these things were a concern.

    Medscape February 17, 2016
    10 Ways to Say No to Patients — and Still Keep Them Smiling-

    “Indeed, a survey of 150 members of a state medical society (it was unnamed)—with over half of the participating doctors reporting that their compensation was linked to patient satisfaction ratings—found that almost half believed that pressure to obtain better scores promoted inappropriate care, including unnecessary antibiotic and opioid prescriptions, tests, procedures, and hospital admissions.[2]

    A study of 192 PCPs sought to estimate the effect of patient requests for medications on physician prescribing behavior.[3] Participants viewed two video-based scenarios: one of an undiagnosed “patient” with symptoms strongly suggesting sciatica, the other of a “patient” with already diagnosed chronic knee osteoarthritis (OA). Half of the patients with sciatica symptoms requested oxycodone; half requested something to help with pain. Half of the knee OA patients requested celecoxib; half made a general request for pain medication.

    The results showed that more physicians gave oxycodone to those patients who requested it, compared with 1% of those making no specific request.[3] “In both scenarios, activated patient requests for a medication substantially affected physician-prescribing decisions, despite the drawbacks of the requested medications,” the researchers concluded.[3]

    “The prioritization of the subjective experience of pain has been reinforced by the modern practice of regularly assessing patient satisfaction,” Anna Lembke, MD, a psychiatrist at Stanford University Medical Center, observed in the New England Journal of Medicine.[4] Patient rating websites have become very popular and may have a large influence, and doctors who don’t accede to patient requests may be rated poorly, ultimately affecting their reimbursement and job security.”

  8. Richard Oberg M.D. at 11:41 am

    Jean – what you’ve said is fine and relevant merely creating some discussion. Trying to have a conversation by reply, posts, or emails is difficult and will naturally get interesting due to how people read and interpret what is written and do it within their own contexts. We’re all different trying to find common ground. This is yet another thing Dave refers to that isn’t working in our favor right now.

    In your first reply here you made a spot-on statement that made me wonder if you weren’t a nurse. That short of a curriculum based on actually seeing and assessing pain patients (rather than just some didactic anti-opioid classroom stuff), not much good will result and you’d be correct. Interestingly, based on the youth vote in the current election cycle, there may be long-term hope yet. The media talks about them voting anti-establishment and physicians are a very independent thinking bunch who may ultimately reject what this post is about as cold and callous. I know I rejected many potential ‘mentors’ I thought were weird and callous toward patients.

    We physicians are extremely high paid professionals and are THE authorities in the patient exam room – it’s not some patient’s fault that they didn’t say or do the right thing and not get a correct diagnosis or be treated humanely. You can only have ONE authority in the patient room supposedly educated and who figures everything out. The patient is the customer and doesn’t direct their own care. I seriously doubt an expert bricklayer would care what some non-mason thought about his mortar mixture. Why does medicine – one of the most complex multi-trillion dollar professions in existence – have everyone thinking they not only understand it but can somehow make informed comments that are all equally valid? How this has become subverted in the pain management debate is truly astounding. And I agree Donna – the silence from those who know better is deafening. Despite physician independent thinking we’re very tribal and afraid of repercussions when stepping outside our professional ‘box’ as we have plenty to do and mostly aren’t interested in becoming political (I’m an exception).

    I’ve never seen physicians in my 30+ years in the profession capitulate like they have over this issue and it’s quite frankly cowardice. If pain management groups ‘stole’ someone’s patients permanently, you’d hear them howl bloody murder and their societies would scream outrage. In this political climate they don’t lose anything – patients or income – only some political liability they can now defer to chronic pain management physicians who have no intentions of treating their patients for anything else and will send them back. So it becomes a financial ‘win-win’ and care becomes more fragmented. Oddly most physicians will tell you fragmented care is BAD – how about that?

    Few people outside of medicine have any idea of the turf battles going on all the time with overlapping specialties – cardiology vs. radiology on who gets to interpret (thus profit from) test results, once nurse anesthetists vs. anesthesiologists (the latter now re-inventing themselves as pain management specialists, nurse practitioners vs. primary care physicians, optometrists vs. ophthalmologists, etc, etc. The notion of ‘well intended’ is overly simplistic and, unfortunately for chronic pain patients, has been hijacked.

  9. BL at 9:19 am

    Jean Price, there is nothing wrong with disagreeing. We all bring our education and work experience to the table along with our personal experiences. If we all thought alike, life would be very dull and uninteresting.. LOL

  10. Donna at 6:58 am

    Very well said Jean. I think a lot of people are simply frustrated that everything we say or do is suspect. That by saying we are in pain means we must be drug seekers. And that doctors seem to have gone mute in fighting for their right to treat patients—where is their outrage in all of this? My husband was just released from the hospital, and I made a complaint on the physician because he was a robot who didn’t once lay hands on my husband, called him by the wrong name, was unintelligible, gave him an incomplete prescription and then discharged him with simple order of self care. My husband has blood clots in both lungs and had also been vomiting with diarrhea. He didn’t eat while he was in the hospital. So he is home with me, not eating, while I’m in a pain flare and wheezing, trying to care for him. Doctors are lazy these days. Vent over. I know all of us are just so frustrated.

  11. Jean Price at 11:58 pm

    Apologies for helping sidetrack the comments off the subject of the actual article about med school curriculum! I will let BL have the last world on urine testing, and respectively agree to disagree. It’s good to have lively discussions, and I think the curriculum issue probably still has some who would like to comment. Guess any who want to comment on urine testing can do so on that post. Thanks!

  12. Jean Price at 11:35 pm

    Wow, I think we have lost the focus of this article, and I apologize!! I’ll let BL have the final say re:testing and I’ll respectively agree to disagree. Lively discussions can be helpful, but I added to getting us off track in the first place. Medical curriculums are important and don’t need to take a back seat to urine screening, so sorry folks!

  13. BL at 10:31 pm

    Richard Oberg M.D., the drug screens don’t see into the future. They can tell if the patient might be in trouble in the present. Drug screens nor any diagnostic tool should be a replacement for doctor-patient communications.

    You are correct about the number of things missed in airport security. But what is also of primary concern is what they have found before it was too late.

    It is interesting that you mentioned the medical school training. One of my daughter works for a state medical school in communications. They have various ways to teach tomorrow drs how to communicate successfully. When in clinicals and practice, the patient must also know how to communicate successfully. A lot of patients think that their drs are mind readers. You can have several patients with the same symptoms and impairments, but each are effected differently. So a patients thinking that because they told their dr certain things or because they have certain impairments, their dr should know certain things doesn’t work well. Saying you’re in pain doesn’t tell a dr enough. Drs also need to concentrate on the patient and not other things while they are with the patient. It seems that a lot of drs are so distracted with tyoing instead of writting their notes that they are consentrating more on that than the patients they are seeing. Does this make any sense to you ?

  14. BL at 5:19 pm

    Jean Price,Patients Bill Of RIghts For Inpatients in a hospital setting doesn’t apply to those that are outpatients and not in the hospital. You also have to remember the Patients Bill Of RIghts is not the same as the Bill Of Rights that are the first 10 amendements to the United States Constitution. Patients Bill Of RIghts are not laws. I have put two links below. One is from the Patients Bill Of RIghts from the Americal Academy Of Pain Management and the other is from the American Hospital Association. There are countless versions of the Patients Bill Of RIghts, but these are two examples. The one from the American Hospital Association states ” Tell your caregivers if you have concerns about your care or if you have
    pain. ” That is the only reference made to pain.in either one.

    Even though it is rare, there have been chronic pain patients that have taken opioids for many years and never had a problem and suddenly when a devastating life situation comes about, they abuse their meds. The drug screens are to alert the dr if this happens to any of us.

    Americal Academy Of Pain Management Patients Bill Of RIghts –
    http://www.aapainmanage.org/about/patients-bill-of-rights/

    American Hospital Association Patients Bill Of RIghts-
    http://www.aha.org/content/00-10/pcp_english_030730.pdf

  15. Richard Oberg M.D. at 5:08 pm

    I guess I’ve taken up my word space but I’d like to respectfully address some replies here. First to Donna – what Dave’s saying is an eloquent way to summarize what most of my posts are about – that the basic assumptions we’re all fed and supposed to accept aren’t correct, that there’s an unhealthy relationship between medical politics and politicians, and that divide and conquer (chronic pain patients are currently divided thus conquered) works if we allow it. We must fix this in ways other than anecdote stories that can be ignored and must understand what’s really going on most aren’t talking about.

    To BL responding to Jean I couldn’t disagree more (BL- your other posts are great). Medicine DOES NOT operate off the general premise that we do things to see into the future of anything not evident and functions quite the opposite due to false positive lab results and costs that are prohibitive. They’re also easy to misinterpret. This is some of the thinking Dave’s referring to. Life not being fair or convenient isn’t relevant to how ideal medical practice is performed unless you believe all patients are guilty of something until proven innocent.

    When I diagnose a case – no matter how complicated – I have no idea if I’m going to get paid or not – they’re all treated the same. Drug screens are a cover for lazy or inept practices and increasing reimbursement – most definitely if they’re done as ‘routine’ past one screening. I do agree with opioids coming with a lot of patient responsibility but criminalizing medicine (which is exactly what’s happening in many of these so-called practices) shouldn’t exempt them from behaving like a medical practice. Why otherwise would you need physicians there in the first place – just because they have a DEA number? The only thing I’ll say about the airport assessment is that many high ranking experts don’t agree with you – in fact, when ‘tested’ running bogus terrorists thru with things screeners were supposed to pick up the majority are missed.

    After college I spent 8 solid years in medical training (4 in medical school, 4 in pathology which is now 5), and once leaving training another 30 in everyday practice where I re-learned everything again mostly expanding on new technology/diagnostic terminology. Looking back, training years were like a ‘general foundation’ and the first several years out are a wake up call to how smart you only thought you were. Lay people often make the mistake of thinking they can understand simple answers that sound reasonable in their world but have absolutely no meaning in the physician training world few understand outside of it. And much of that is purposeful and misleading.

    I’d love to do a few guest posts (rather than long replies) if Ed is willing and help explain ‘the process’ by which people become physicians and why they react as they do – and why much of attributing a small slice of society’s complex ills on seemingly simple solutions are futile and can cause great harm at great expense.

  16. BL at 3:32 pm

    The previous Mass Governor, Deval Patrick tried to ban Zohydro when it first came out, but was unsuccessful.

  17. Holly Clowers, MD at 2:48 pm

    Lots of great points, here are some others:

    There’s good money in addiction treatment. Psychiatrists and pain management docs share the interests of addiction and chronic pain, although the two populations have very little overlap. Now suddenly all chronic pain patients are treated as if they are addicts. Addiction treatment was wide open, and now it’s self-referring!

    Pain is an inconvenience for providers. It requires a thoughtful, thorough history, a physical exam, maybe tests, and a consideration of uncommon diagnoses. Why else would patients with unusual diseases routinely need to see 5-10 providers (or more) before they finally see someone who remembers the disease they fit perfectly? It is much easier and faster (actually it’s mindless), especially if your patient is female, to give them a diagnosis of exclusion such as depression (depression hurts, remember?). If you add all uncommon diseases together they’re actually not uncommon at all.

    My unfortunate reason for being very familiar with this is the following. I am a physician with a number of serious medical problems including Ehlers-Danlos syndrome. It is quite painful. For years, before I was correctly diagnosed, I was told I was depressed because I had pain, without any real evaluation. I finally decided if my depression was that bad (i.e. I hurt that much), I needed serious help, and checked myself into a treatment facility.

    Treatment for mental health and substance abuse is combined in rehab facilities; regardless of why you are there, you are going to have to attend a lot of substance abuse meetings. In the very large, nationally recognized facility I was treated, the majority of providers were happy to share their history of addiction, and it did contribute to them seeing it everywhere. One of my roommates, a pharmacist in her 50s, had obvious deformities of rheumatoid arthritis you could clearly see from across the room which had been missed. No one wanted to hear about my pain there either, including the pain I was having from a spontaneous leg fracture I suffered while on the premises walking between buildings. I guess that was psychogenic also.

    I finally saw my husband’s rheumatologist as a patient or I likely wouldn’t have a correct diagnosis now. Interesting how suddenly everyone in hindsight seems to think it was obvious. The long road to getting a correct diagnosis, finding a primary provider willing to manage my pain, and two years of blessed relief before having it yanked away.

    Is this any way for the world’s most expensive healthcare to operate? Is this how patients with serious diseases including pain should be treated? Absolutely not, but it appears to be the new norm.

  18. Jean Price at 2:10 pm

    In reply to BL….I think being appropriately treated for pain IS on most hospital patients bill of rights, but I could be wrong about this. I’ve seen it on all I’ve ever gone to, so that’s what I’m basing it on. And although being given opioids isn’t a right per se, many of us have exhausted other avenues for better pain control without it. As for the responsibilities…those are a given, and I don’t think I would ever question that, or would most people in pain. And if we were unsure, it’s already spelled out in the contract we sign! But I’m seriously at a loss to see how this protects ME personally. A very small percentage of people in pain turn to addiction. So, although it might catch these people, I think the issue is more one of protecting the physician and it byes into the mindset that opioids and addiction go hand in hand with chronic pain. Iprobably didn’t come across in a way to express this or perhaps it seems like an understandable test for people like me who have used opioids for decades without once being noncompliant to the dosing and/or reason for use. I just think physician discernment counts for something, yet they are restricted in practicing this. Guess it’s merely my opinion. And yes, life is unfair and often inconvenient. For me, (again my opinion!), I think it’s I,portent to hold up these things when we encounter them…hoping for some change for the good. Thanks for helping me define this. No two people with pain are the same…we learn from each other, and hopefully become better equipped to live a meaningful, productive life with the reality of our limits. And also help those who come after us with the same treatment issues.

  19. Donna at 9:58 pm

    Dave–while I get the gist of what you’re saying, and definitely agree that telling our stories of pain is not an effective way to cause change (we need organization, statistical proof, and connections), I need some simplicity in your form of writing. Not trying to offend, just need what you want to convey to be a little less formal. I’m a nurse, but still a simple gal, with some difficulty in my cognition at times due to illness and age! Appreciate your comments!
    Thank you–Donna

  20. Donna at 9:25 pm

    Can I safely assume that there has been no outreach by the governor that medical students be required to have x number of hours in EFFECTIVE pain management with face to face clinical hours, or x numbers of hours in EFFECTIVE patient-doctor commuication?
    Pushing chronic pain patients out to the fringe again, this governor has totally missed the mark, and unfortunately will probably start a trend.

  21. BL at 5:02 pm

    Jean Price, just because a person hasn’t abused drugs before, doesn’t mean that they never will. Sometimes situtions occur and a person turns to drugs to cope with it. This is one of the reasons why the drug screens are done. They are done to protect the patients, the drs and the public. Life isn’t fair and it isn’t convenient.

    I don’t know if you have been on an airplane since September 2001, but everyone is treated as a potential terrorist. This is done for our protection and the protection of others. Receiving opioids for chronic pain is not a right, despite what some people may think. Receiving opioids for chronic pain comes with a lot of responsibility.

  22. Jean Price at 3:57 pm

    A reply to Patti’s comment….this article was really about curriculum for med schools, not urine screenings….but we’ve had a lot of articles lately, so that’s okay! But, I do take a little issue with your statement about going along to get along and especially your statement about not having pain if we are unwilling to have a urine screening. In relationships, when the abused person goes along just to get along, things usually tend to escalate…making it harder on the one who is abused. Although I too think it’s important to pick our battles, to me this battle is right at the core problem…..chronic pain being combined with addiction. I have submitted, unwillingly, to numerous urine screenings over the years with the same pain clinic. The first one, although it was humiliating, I could sort of understand why…they didn’t know me. After the years add up, I find it harder and harder to understand the why…and I think it’s important to hold up to our doctors, even though we can’t really refuse and still receive the medications that make pain more bearable. I don’t appreciate paying for this, or having my insurance pay, when I didn’t need the test for myself! So, being unwilling certainly doesn’t mean I don’t have chronic pain, or that I’m a drug addict. It means I am tired of being looked at as guilty until proven innocent…something so against what I thought our country’s legal system was founded on. And it means I am not considered more honest and compliant than I was the first day I walked in their door. So the issue of addiction wins over chronic pain here in the pain clinic, as elsewhere. Even just look at this page from the foundation…at least three ads regarding addiction but no ads for help controlling chronic pain or finding appropriate pain care!! And our med schools will follow right along, I’m afraid. The patients with pain, and some of the doctors, are caught in government and society’s crosshairs…and people with addictions aren’t being helped either. They just don’t return and will probably resort to illegal means to feed their habit. No one wins. Yet I feel we lose most of all. It may not change anything, but I always hold this up about the urine testing. And it seems our doctors feel coerced into this also. It’s not a choice for them, but a mandate to keep out of trouble. So sad…so wasted!

  23. Lynda Richardson at 9:21 am

    I think all of us in chronic pain need to write to this reporter flood him with patients using opioids correctly and make it important to him. Show him we are here and we are screaming at the top of our lungs for someone anyone to speak out for us! We are doing it right we don’t nor have we ever abused our medications. I would be happy to prove it. But no one wants to talk to me or anyone else that are taking their medications correctly. No one wants to hear about or wants to talk to anyone that’s had their lives improved! The media only want to put people that ruined their lives on T.V. commercials to promote their drug rehabs. There isn’t any money to be made showing chronic pain patients lives that are better because of opioids it doesn’t fit their agenda. I still wonder out of the few people that are abusing how many only started abusing because they weren’t getting the pain relief they needed? Because they had doctors that refused to provide the medication they needed to give them some sort of pain relief? I also wonder how many chose to O.D. on purpose with their medications to escape their pain not being relieved? How many chose to O.D. because they were under the threat from their doctors that they would be loosing their medications or being so reduced down to levels that would not cover their pain? How many O.D. on purpose because they just couldn’t go back to living in that kind of pain? They couldn’t go back to spending their lives in bed or on the couch living in misery. I am tired of the discrimination for taking prescribed medicine so I can have some semblance of a life without pain ruling every waking moment. It’s not some big party we are just trying to live like anyone else. This agenda being pushed is causing people to suffer needlessly. Its killing people its destroying families with this constant misconception about chronic pain and the people living in it. We have become the collateral damage in this war on pain medications being compared to drugs & Heroin. We have to fight back and get them to listen to us. So maybe if we flood this reporter John O’Rouke with our letters maybe he will speak out for us get us a commercial.

  24. patti b at 3:40 am

    If a person is not willing to get a UA in order to be treated and receive pain medications then they do not have severe chronic pain because those of us who do are unable to live with the pain. Personally, I am unable to stand, walk, sleep or live without pain management which includes opiates. I have tried dozens of non-opiate therapies, treatments, surgeries, injections and alternative therapies as well and while some help I still need opiates to be able to function. I am angry at the addicts that have caused this mistrust and have again made it difficult for people in pain to receive adequate treatments.

    The addicts that have taken advantage of compassionate doctors are the ones causing all the problems yet they are getting all the attention and the sympathy. There is nothing about the plight of people struggling with severe chronic pain 24 hours day – yet there are dozens of commercials and articles about addicts and their need for treatment. Chronic Pain is a disease as well and it destroys lives – the difference is most of us do follow the rules and we are being stigmatized and marginalized by the CDC & other groups that profit from filling the beds of the treatment centers.

    Chronic pain patients have learned to not rock the boat or cause problems because we so desperately need medication that we are used to being treated badly and unfortunately, we allow ourselves to be discriminated and humiliated in order to get our medications. However, having a UA is not the issue – we need to learn to pick our battles which at this time require going along to get along.

  25. BL at 9:35 pm

    Chronic pain patients that need opioid meds must remember that what we say “treating pain patients” and when others say “treating pain patients” , even though it is the same words, they don’t mean the same things. A dr can treat chronic pain without using opioids and still be treating chronic pain. Based on what I have been reading, the drs are being taught and encouraged to get away from using opioids for anything but cancer/terminal related pain. I hate to think about the ones after us that won’t be treated with opioids. Our generation may well be the last or next to last that has an option for opioids for chronic pain. It may be difficult for some, but for the most part chronic pain patients are receiving pain meds. It also seems that the vast majority of the drs that are doing the prescribing are older drs. Once those in medical school now are taught how sucessful (???) other methods are without the risk of addiction plus all the paper work and extra work the tighter regulations bring, it will be extremely difficult to find a dr that will use pain meds for chronic pain.

    A lot of people have blamed the President for the tighter regulations and they think that once we have a new President that it will get better. If you read where the candiates stand on this topic and how many of them have been personally affected by drug abuse of a loved one, you will realize that a new President is only going to make things worse.

  26. Richard Oberg M.D. at 8:21 pm

    I often wonder if data and reality are less a part of education than politics dictating events – notice the title is ‘response to governor’s request’. Sans that I doubt anything would have changed and perhaps we wouldn’t get Daniel Alford’s unfortunate opinion.

    I’ve called out CDC ‘statistics’ and it appears that Massachusetts isn’t much better. According to their ‘explosive’ rise in opioid misuse and being ‘in the grip of a public health crisis’ – they misquote their own published data for the state. Their supposed call to arms claims an ‘estimated’ 1,256 people dying from prescription drugs and, of course, heroin in 2014. This is really interesting since the Massachusetts Dept. of Health released a ‘Data Brief’ from April 2015 of ‘current confirmed data’ stating that opioid related deaths in 2014 were 600 confirmed and they used ‘predictive modeling techniques’ to estimate the cause of death for all cases not yet certified by the Office of the Medical Examiner. They then added an additional 408 unconfirmed totaling 1008 with the data further confused by ‘unintentional/undetermined’. So where exactly do the 1256 people come from they’re now stating on the BU website? Did they forget they’d already said 1008 (it’s official and online as a .pdf) and just make up more or perhaps annex Connecticut and I didn’t notice? Heroin is again incorrectly included presumably to boost the otherwise low numbers.

    Tennessee’s governor publicly stated he was going to ‘squash’ the drug problem (as quoted by the Tennessean newspaper) at the exact same time we lost our medications – coincidence? I presume he’ll squash poverty also since that’s better correlated with all drug abuse including alcohol in a high poverty state.

    I attempted to calculate true ‘poisoning’ mortality statistics for Massachusetts like I did for Tennessee since TN is the #2 per capita drug death state yet doesn’t call it an epidemic or even mention it for that matter in their state mortality statistics for 2013. The problem with Massachusetts is trying to find any coherent yearly mortality numbers compiled by the state which don’t seem to exist. The CDC does list the ‘top 10’ in Massachusetts and, using their data, would suggest a ‘poisoning’ mortality (I presume this is where deaths due to prescription drugs are) of at most 2.5% of ALL deaths – meaning 97.5% of people die of something else every year. More people died from the flu/pneumonia than prescription drugs there – would anyone guess that with the hysteria? Does 2.5% sound like a lot compared to 200%?

    I’ve taught family practice residents and many others about the misuse of statistics regarding lab results and how they can lead to wildly misleading interpretations especially with percentages, relatively small numbers, with a result of incorrect diagnoses. You know, like politicians do routinely.

  27. michael Wagner at 7:43 pm

    I have been a pain patient for now close to 30 years, The things us people in real pain, puts us in a group that we are being punished for everyone else’s problems, I don’t get enough to even loan a person a pill, and I want to have pain medication left at the end of 30 days. during these years I have had to go to different pain specialist during the good times when my regular Dr could write 3 months supply, at one visit. Now in Wa state all the big groups of doctors have given up on opiates and pushes us to pain specialist and each time you get a new pain specialist they all here want to inject you with steroids even if you have arachnoiditis, I have ended up with more pain because of the threats in a nice way, we inject you for $1400.00 a injection, and come back in a week for a follow up. more money.
    In less than 10 months I have had 6 injections my arms a so full of scabs , a side effect from too much steroids. Now they have done one RFA with a bad out come, I lost all the feelings in the left foot and ankle , on that follow up I said something bad happened on this RFA and they got very scared.
    I have noticed with these pain specialist that the DO doctors are the biggest problem with this drug problem and to much drugs hitting the street as most of them need pain people to support there income as there is not much demand for this type of a doctor. I know one DO that prescribes out of his office 360/ 30 mg’s of oxycodone a month to a man that can barely take a 5mg of oxycodone. He was sent to a pain specialist for a approval to keep the state happy, of course this doctor sends all his pain people to them to keep in good looks for the state and the DEA. You would think if they were on the up and up they would tell this doctor that this is way to much to be prescribing for a person that had one neck fusion in the mid 80’s and one shoulder rotor cuff surgery.

    I have had 5 back operation 3 neck operation, fused in 9 levels with adhesive arachnoiditis both shoulders, both elbo’s forget the 3 wrist operation’s. Nerve damage up the yang yang. and I get less than half of what this other man gets, where’s the balance in this prescribing, there is none, yet people like the DO’s I mentioned are the people making these laws and regulations. They Look like the political people we have in this country.

  28. BL at 5:49 pm

    There is an aspect that is never talked about and that is the number of drs that lose their licenses temporariily or permanetly due to chemical and/or alcohol abuse. My state has the info on drs that are have had their medical licenses suspended or revoked at the states medical board website. For the past few years, I haven’t found any drs that have had their license affected by irresponsible prescribing on Schedule II meds. But there are are more than a few that have had them affected by their own abuse of substances. I wonder what the medical schools are doing to address this problem. Some chronic pain patients may think that it doesn’t affect them, but it does.

  29. Dave at 4:03 pm

    Genteel erudition, expressing ones dissatisfaction with pain care and opioid availability- is all too little to change the powers that be. As there is no real transaction cost to those in power- they wont even bother to swat away such comments – as if they were from pesky flies.
    It would be more effective, in my experience , to act like epistemological police, and show their reasoning as false and the probative force of their evidence as lacking-and to, of course, have them incur transaction costs. As the practice of medicine is based on reductionism- on the economizing tendency- then by making it economically more expensive to engage in reductionism- then they will react. The best argument will only do so much to get the inurred to change- but drive up their costs in terms of time, effort,etc- then that is a force to be reckoned with.
    So far government has treated the voice of people in pain as some vague static that they have easily tuned out. It will take much more then people in pain realize to change the status quo in pain care. And frankly, as much as the powers that be have been negligent with regard to our pain care system- so have people in pain. But i dont seep people in pain understanding their role or the publics role in allowing poor pain care. So if people in pain remain morally and civily unrgenerate and hope that big brother will get religion in pain care- they will continue to be on the receiving end of poor pain care.

  30. Jean Price at 9:15 am

    I can’t help but wonder how much of their curriculum is devoted to assessing, treating and supporting patients with chronic pain?! The generalization of “an opioid crisis” starts any attempts to solve the real problem down the wrong road with the first step! The crisis is mental health and criminal behavior, not opioids. I suppose there are the rare cases of doctors who are innocently guilty of inappropriate prescribing habits. And there are a very FEW who may profit from intentionally prescribing opioids to be sold. But doctors who legitimately treat chronic pain with opioids when needed and the people who have chronic pain and use opioids consciencously to improve function and quality of life ARE NOT part of this so called “crisis or epidemic”!! Confusing this issue has disastrous consequences for those who live with pain. It’s abusive to them it’s inhumane, and it won’t solve the problem! In fact, the suicide rate is likely to increase out of the hopelessness and despair from the humiliation of being unfairly judged and the inability to bear their untreated physical pain. I can’t believe top educators and our government and healthcare system don’t comprehend this! It’s an incorrect, simplistic view of the increase in opioid use and suicides. If they would take the time to read the comments on this site from real people with real pain, perhaps they would at least question the validity of their mindset and regulations. And look for a better analysis and a better solution. When you define the problem incorrectly, you don’t stand much chance to resolve it….even if you care. I shudder to think of the doctor’s of the future being well versed in “safe prescribing practices to prevent misuse, addiction, and overdose”….yet clueless about how to appropriately use opioids as a lifeline for patient in chronic pain who are working to increase (or even just maintain) their level of functioning for a more productive and fulfilling life in society. Add to this no longer considering the treatment of pain as a component of care satisfaction for hospitalized patients who have pain….due to reimbursement being tied to these surveys…and it’s a bleak future, folks! I wish I had an intricate solution…but the only one I can think of is common sense!

  31. BL at 9:03 am

    Kristine (Krissy), I wonder if Mr. O’Rourke read the letter himself. The response sounds lmore like a standard response. Things like this are handled by assistances first to save the time of those that are busy. It is up to them to let the ones the letters are directed to know if things that would interest them come in. I may be wrong, but if this had been a letter from someone who had been affected by addiction, I’m willing to bet that it would have been important enough to get in front of Mr. O’Rourke.

    It doesn’t matter how many people we say die because they can’t get their pain meds, because there is no medical proof, ie death certificates. There is proof of the number of those that die from abuse. Human life will always be placed higher than ability to function as it should be.

    The old phrase “be careful what you wish for because you just might get it” came to my mind as I read this article. When chronic pain patients asks for things like pain management being taught more indepth in medical schools, what is being taught now iin not what we had in mind. It is going to get much worse for chronic pain patients and it won’t be getting better. We all need to be prepared for the future.

  32. SUSAN SHEFFIELD at 8:40 am

    Sorry for the typos in my post. Auto correct got me and I didn’t notice.. Mom should be non.

  33. Dave at 8:39 am

    6 years ago when I set out to help people in pain- I did not imagine things were going to get a lot worse for people in pain. But the terrible focus on diversion and misuse of opioids- cannot be called “balanced” anymore. It has become a cruel form of extremism writ large- and though I am not a big fan of opioid use- I cannot help but be disturbed and angered at how poorly people who use opioids for pain have been mistreated and dehumanized.
    The education that Dr. Alford is providing is heartless and a violation of principilism and the social contract. For his ears are dull of hearing and his heart has waxed dull-he forgets what and who pain care is supposed to be for. Though he wishes to present himself as reasonable- its just the banality of evil. People in pain are not Golems or moist robots to be relegated to civil and moral vagabondage by careless professionals- who lack basic knowledge in pain care- and have a heartless track record.
    I have seen the superficiality of Alfords curriculum and ideas on pain. As the poem goes- the worst are full of passionate intensity- and the rough beast -of poor and inhumane pain care- slouches toward Bethlehem to be born. The falconer-our health care system- can no longer hear the falcon- people in pain.

  34. SUSAN SHEFFIELD at 8:35 am

    This Is the opposite of what should be taught. Medical students should be taught that mom abused opiate use saves hundreds of thousands of lives. Untreated chronic pain has been proven to cause heart attacks and strokes without warning. I’ve never known 1 chronic pain patient to try heroine or sell our so needed meds, that’s ridiculous. Teaching how to educate the patients on how to use them correctly will reduce mis-use, not od’s. my understanding is that most overdoses occur when people mix opiates w alcohol. I’m glad I don’t drink but know a lot of people do, in pain or not. Without my scripts, I’ll likely due very young leaving my teen daughter without a mom. I have adhesive arachnoiditis which is incurable and can equal pain to stage 4 cancer, as well as cauda equina inflammation and a host of other. such as Occipital Neuralgia and Migraine. The CDC has their thinking totally backwards and as it is already happening, suicides are already climbing. This is so sad. I can’t see myself ever doing that or heroine. I’m only 46. My plan right now to deal with this massive disaster to patients like me is to try and get an early retirement and enjoy what quality of life I have left. We (chronic pain patients) need help! I’m terrified.

  35. Kristine (Krissy) at 7:40 am

    I just heard back from Mr. O’Rourke and this is what he said in his email:

    “Thank you so much for taking the time to write Ms. Anderson. Dr. Alford would agree completely that there are many people suffering from chronic pain for whom opioids have been a lifesaver. I appreciate you taking the time to share your story.”

    It was nice of him to write back to me, and nice of him to let us know that Dr. Alford would agree with me, but I had hoped he would give me some information on the questions and suggestions I provided. His polite response to me doesn’t appear to show any interest on his part to reach out to medical educators who could use patients and doctors in their educational settings, rather than actors, who he says will “play” the part in demonstrating how pain patients are becoming addicted to their prescriptions. performing drug-seeking activities and turning to street drugs.

  36. Michele Heitzman at 3:55 am

    I have been a chronic pain patient for 9 years. Been on multiple, dangerous, prescribed meds which all had horrible side effects. Then about a year ago, I found out about a wonderful plant called kratom! I’ve been taking it for about a year and have gotten off 12 medications by using kratom. It controls my pain so much better, without that drugged up feeling and without all the nasty side effects. But now, big pharm is trying to take this plant away from us because it’s taking money out of their pockets! Maybe you guys could look into kratom and find out the TRUTH about it, instead of all the lies the media tells. This plant is saving lives! Please look into joining the American Kratom Association and learning the truth about kratom! We need your help!