Surgeon General Warns About Painkillers in Unprecedented Letter to All US Doctors

Surgeon General Warns About Painkillers in Unprecedented Letter to All US Doctors

By Staff

Never before has a U.S. Surgeon General sent a letter to every doctor in America, but that changed on Thursday when Dr. Vivek Murthy wrote to nearly 3 million doctors asking “for your help to solve an urgent health crisis facing America: the opioid epidemic.”

As National Pain Report has extensively covered, the government has placed the lion’s share of blame for overdoses on “overprescribing,” leading advocacy groups to warn that restricting access to pain medicine puts pain sufferers at risk of being undertreated.

CNN reported that in June, the Surgeon General said in a speech at the Aspen Institute, “I’ll tell you that just a few months ago, I was in Florida for an event and I met up with an old friend who’s a cardiologist. He’s trained at some of the best institutions in the country, he’s one of the most compassionate doctors that you’ll meet. And I was having dinner with him and I said, “Can you believe that we were taught that these opioid medications weren’t addictive in our training?” And he put down his fork and he looked up at me and he said, “Wait, you mean they are addictive?” like he didn’t know.”

Perhaps, Dr. Murthy was exaggerating to truncate a point, as it seems highly doubtful that any physician in the United States does not know that opioids can be addictive and abused.  And, maybe, as the narrative surrounding prescription pain medicine begins to shift to counterfeit fentanyl and heroin use increasing as opioid prescriptions decrease, the government chose to find the front page of the papers in a different way – a first of its kind way.

Here is the letter.  You tell us what you think about it.

August 2016

Dear Colleague,

I am asking for your help to solve an urgent health crisis facing America: the opioid epidemic. Everywhere I travel, I see communities devastated by opioid overdoses. I meet families too ashamed to seek treatment for addiction. And I will never forget my own patient whose opioid use disorder began with a course of morphine after a routine procedure.

It is important to recognize that we arrived at this place on a path paved with good intentions. Nearly two decades ago, we were encouraged to be more aggressive about treating pain, often without enough training and support to do so safely. This coincided with heavy marketing of opioids to doctors. Many of us were even taught – incorrectly – that opioids are not addictive when prescribed for legitimate pain.

The results have been devastating. Since 1999, opioid overdose deaths have quadrupled and opioid prescriptions have increased markedly – almost enough for every adult in America to have a bottle of pills. Yet the amount of pain reported by Americans has not changed. Now, nearly two million people in America have a prescription opioid use disorder, contributing to increased heroin use and the spread of HIV and hepatitis C.

I know solving this problem will not be easy. We often struggle to balance reducing our patients’ pain with increasing their risk of opioid addiction. But, as clinicians, we have the unique power to help end this epidemic. As cynical as times may seem, the public still looks to our profession for hope during difficult moments. This is one of those times.

That is why I am asking you to pledge your commitment to turn the tide on the opioid crisis. Please take the pledge at Together, we will build a national movement of clinicians to do three things.

First, we will educate ourselves to treat pain safely and effectively. A good place to start is the enclosed pocket card with the CDC Opioid Prescribing Guideline. Second, we will screen our patients for opioid use disorder and provide or connect them with evidence-based treatment. Third, we can shape how the rest of the country sees addiction by talking about and treating it as a chronic illness, not a moral failing.

Years from now, I want us to look back and know that, in the face of a crisis that threatened our nation, it was our profession that stepped up and led the way. I know we can succeed because health care is more than an occupation to us. It is a calling rooted in empathy, science, and service to humanity. These values unite us. They remain our greatest strength.

Thank you for your leadership.

(Signed: Vivek Murthy)

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Authored by: Staff

There are 110 comments for this article
  1. scott michaels at 5:39 pm

    thats not my issue. kaiser is saying ALL patients are being weaned off. since kaiser is a provider and insurance co. i believe this is a huge conflict of interest. They stand to gain hundreds of millions of dollars by cutting the pain prescriptions. nor do i believe tbis is true. My ortgopedist just said the other day the state of CA I MAKING THEM DO THIS, WHICH IS AN OUT RIGHT LIE. CA IS ALLOWING DOCTORS TO DO THEIR JOBS AS LONG AS THEY ARENT STUPID AND OVER PRESCRIBING.
    next my pcp is awesome, shes just following the rule set by kaiser. she kNOws i should not be cut back but cant do anything.
    I have requested a pain management doctor out of kaiser. i have 2 things going for me. The closest kaiser pain clinic is 50 miles away and i dont have the transportation. she has set me up with a 1 time appt with the kaiser pain dr. only she can do the referral.
    I intend on brINGIng all mris reports and list of meds since day 1, along with the many other treatments and the metabolism test that prooves the meds go thru me like water hence the need for high dosage. none of the injections or epidurals or phys therapy ever worked. only the the pain medication. so they should either make an exception for me at.kaiser or refer me. if not i will hire an atty foe malpractuce and co flict of interest along woth the lack of care i did get wbile at kaiser. they only gave me the prescriptions withour actually seeing the doctor monthly as tha tlaw states. I will not take this sitting down.

  2. Tim Mason at 7:26 pm

    MA, only those that don’t get some relief from opioids have a CYP-2D6 deficiency. It sounds like you may have be caught in one of the exit strategies used by all pain management doctors. I believe there are about 6 maybe 10 of them. They vary from immediate dismissal by being involved in illegal activity with the prescription. Selling the RX. Not testing positive for the drug prescribed, etc. Even patient attitude is on the list. Several are minor and only call for a more watchful eye on the patient including call in for pill counts and drug screen. I am not suggesting you fit any of these. Perhaps you just need to move on to another clinic. Once the patient/doctor relationship is compromised it is best to move on. I have found this to be true even with primary care physicians.

  3. scott michaels at 5:15 pm

    thats what i said my dosage would be too much. what im saying is your dr. should get you off of oxy period. and they just plain old vicadin. you should necer get that type of reaction from oxy.
    sincr. you have fibro you should also ask about lyrica its non narcotic.
    also let you doc know my dad died of cancer. he never felt any pai. from it. i on the other hand have so many issues the pain i feel is equal to knife to being shoved in my neck and spine. Cancer is not always pain ful. and every patient
    different. 5 years ago maine was giving out pain pills like candy. now the pendulum swung to far the other way. we have injuredVETS living with extreme pain. BOTCHED SURGERIES and many other illlnesses that cause chronic pain JUST BECAUSE WE dont HAVE CANCER it doesnt mean our pain is not there. Because of maines disregard to people living with chronic pain they now hold the honor of the most suicides per capita because the peeps just cant live woth the pain and now the fastest growing heroin business and heroin overdose deaths. If the doctor there had the courage to fight back and lobby against the cdc guidine (which are not law. they are strictly voluntary). Legitimate patitients like yourself and others would get.the yreatment they need

  4. StevefromMA at 9:56 am

    Scott, not sure if you were writing to me in response to my 5 mg Oxy. Afraid it did knock me out, at 2.5 I’m still somewhat sedated with congestion, sore throat, significant abdominal pain side effects, modest pain relief, all similar to Tramadol. My PCP would say you are on massive doses of opiates;no M.D. in MA would prescribe those unless you were dying from cancer. My leg pains are fibromyalgia, have been around years before my med trials, don’t respond to neuropathic pain meds or opiates, which I seem to respond badly to. Everyone, especially with fibromyalgia, responds differently to meds.

  5. scott michaels at 7:09 pm

    tessa i find it hard to believe 5 mg did that to you. leg cramps are sogns of withdrawls.
    nor does this medication sedate. i have taken ot for 7 years and started with 30 mg 3 x a day no help. it wasnt until i was taking 80 mg 3 x a day did the medication take away the pain. mind you my pain is like a knife in my spine and neck.
    you may be allergic. i suggest talking to your dr
    and just try 10/300 norco= vicadin. or even.5 mg
    personally i believe such a low dose is does nothing for pain and thats how people get addicted. they take.more.and more without talking to dr. then stop cold turkey.
    back to the cramps. there is an otc med for leg.cramps very cheap but they work great.
    of you are having trouble sleeping dont take sleeping pill or valium. try melatonin or see of dr will give you a mild muscle relaxer.
    this is just more proof that everybody is different. this oxycontin just relieves my pain. so side effects at all. the only.problem.os wjen the dr.wont write the prescription until 2 days due for a refill than the pharmacy os out and i have to wait a week. Foe that reason i always save at least 6 to 12 pills a.month. going cold turkey will no doubt have me in the hospital by day 2. with extreme pain and withdrawls. These meds are stromg for those that are ot opioid tolerant and can get you sick. my deal is i am extremly.nontolerant to pain and overly.tolera the medication due to a very fast..metabolism. the medication goes right jass a 100%. my real paingt doc i had said i only.get.about 30 % of the medications efficacy. Agaim you may be allergic so see of your doc can.put you.on a hydro vs an oxy. or even a small dose of morphene. but get the leg cramp stuff its immediate relief.

  6. StevefromMA at 10:44 am

    Hi Tim,

    Still here. I finally tried 5 mg Oxy yesterday, fell asleep for two hours sitting at my dinner table. Couldn’t keep my eyes open. Unbelievable sedation, gradually woke up and it lessened over the next 12 hours but the really disappointing part was the pain relief,especially from the crushing and burning in my legs, was not great. Also, wonder if it intensified my middle insomnia somehow. So I took 2.5 mg this AM as a test. Much less sedation but still not able to drive, and, of course, even less pain moderation. I told my PCP I’d try it for a week. If I don’t end up using it, maybe the week’s break from Tramadol will reboot those receptors and Make Steve Great again LOL. I’m running out of pain meds to try and balancing sedation with modest pain relief is tough. I did not get any euphoria from Oxy that an acquaintance described, just like someone turning off ability to stay awake.

  7. Tim Mason at 6:05 pm

    Urine testing weeds out the undesirables, keeps honest people honest and protects the doctors and staff you are being treated at. At your pain levels you will not feel any high. Just pain relief. As far as the 1 to 10 pain scale that is just a reference point for the individual on a return visit. Its all in the book. Opiates have been used for 4000 years. Opioids are more recent
    These “contracts” and urine tests are ok with me.
    On a side note. Used to a farmer could purchase fuel tax free for his farm equipment. The fuel had a dye in it. Some farmers would sneak and use it in their vehicles. State Agricultural people would go around and check for the dye in the carburetors of the farmers automobile. If it was found the fuel was being used in the family sedan there was a fine to be paid.
    Same thing here, just a test.
    Good luck in your quest for pain relief.

  8. StevefromMA at 11:56 am

    Thanks for your notes, Tim. Others don’t seem to like the book as much as you do but I will check it out. I assume your pain is/was pretty awful to be on the meds you mentioned. I would say I have hit 9.5 a few times, fortunately not recently, mainly around 6-8 daily, bad enough to make just being around challenging and, aside from forcing myself to get up, go to supermarket, libe, deal with households tasks, plumbing disaster, etc., not able to do much. Certainly at upper levels of chronic pain you need very strong meds or a quick way out. My fear is of being in a fog for the rest of my life that makes me even less functional than I am now though for that two hours that Nucynta worked I was clear headed and would have driven. The side effects of constipation and exacerbating other problems, sorry for TMI, and maybe other side effects make me wary of opiates unless they make me essentially normal for a large part of the day. My new PCP is actually the one pushing oxycodone to ” improve my quality of life”. The pain management folks were pretty bad. Of course, being on opiates would mean here, DK if national law, I’d have to urinate in a cup monthly and have it tested to make sure I’m really taking, not selling it. That type of management gets me enraged and not likely to take opiates. Also, it seems that some percentage of folks find they need to keep increasing their dose just to stay even with the pain. My son has sent numerous folks to rehab for oxycodone as an HR person. Idk, I see my PCP Wed to address the pain question and other problems. It’s still astounding to me every day that three years ago I exercised 30 minutes daily and then biked six miles in the summer to a beach and now can’t bend down or walk around the block without a cane and am in bad pain after 30 years of just mainly low level annoyances.

  9. Tim Mason at 3:45 pm

    StevefromMA.”I have to decide whether to be in fairly bad pain all of the time or go on major opiates, a bad choice.”
    Steve, I am curious as to why you say opioids are bad. You have been misled. See Dr. Nagel’s book “Needless Suffering” page 248 thru 253. ISBN # 978-1-61168-889-4
    This book is only about $17 dollar from Amazon right now.
    Get the book. You will be glad you did.

  10. Tim Mason at 3:54 pm

    To Scott Michaels,
    One book you may want to check out and read. Needless Suffering by David Nagle MD. It just came out his year.
    I have a suspension that you are dealing with the wrong pain physician and may need to fire him/her or them.

  11. Tim Mason at 4:19 pm

    @StevefromMA. The NuCynata felt like “Cymbalta Light” with the headache (brain ache), I did not know it was intracranial pressure. I did not know it had a SSRI effect or I never would have taken it. I was already at 50mg morphine sulfate a day with Oxycodone 7.5 for breakthrough but the night pain was killing me and I would have to come home early almost every day due to pain and weakness.
    I am now on fentanyl patches and life is much better. They did not cut out my oxycodone.
    These pain management doctors will treat you right if you let them make the decisions. NEVER as for a drug by name. You will be labeled a “seeker”.
    Thanks for sharing your experience with the Nucynta. You are the only person that I have found that has tried it.
    Sounds like you have a good doctor.

  12. StevefromMA at 7:06 pm

    Funny, I tried Nucynta once last week on a day I couldn’t stand pain, unrelieved from my standard useless Tramadol. I’d gotten it for a week’s trial month’s on request from my now retired PCP. It nibbled around the pain and also spaced me out for two hours, then I was literally pain free for two hours, then it quickly faded. It was like a miracle for those two hours, as you said, zero pain for the first time in decades. I can’t justify taking it for only two hours relief, though. One of the potential side effects is increased intracranial pressure, makes me wonder if that was your headaches, though prescribers know a lot more about it than I do. Maybe it works longer for some people. My new PCP does not allow use of a med for intolerable pain even if I tell him I hold the Tramadol;he wants me to try oxycodone, a step up I am resisting despite the pain. I still have 13 emergency Nucynta and regardless of his treatment style, will certainly take one if I hit 9/10 again.

  13. scott michaels at 9:31 am


  14. Tim Mason at 8:51 am

    Have you tried tapentadol (NuCynta)?
    The is one of the best new drugs for nerve pain. (bring it down to Zero for most patients).
    It is worth a try. It is strong. I had a slight constant headache with it and stopped taking it.

  15. StevefromMA at 10:42 am

    Yep, am here, Cara, thx for your post. My state has MMJ and I have tried a number of commercial edibles and making my own, resulting in several ODs and one pain-free two hours but couch locked and unable to move. Titrating the dosage has been very difficult, with the line between pain relief and being immobilized thin or nonexistent so far. Have not tried vaping. I have found MMj to be a powerful drug and highly anticholinergic, making urinating for this aging Boomer with problems scarily difficult. Sorry for TMI but folks should know that you should treat MMj with the respect that you would show any other major med. I have not tried any of the commercial prescription MMJ products, am sure no one will prescribe for fibromyalgia though, as you note, my PCP is pushing me to try oxycodone, a scary option way more dangerous. I actually hope Big Pharma gets involved with MMj S they will come up with effective dosages and strains for us IMO though probably too late for someone my age. I have to decide whether to be in fairly bad pain all of the time or go on major opiates, a bad choice.

  16. Cara at 7:21 am

    This comment is to Steve, although I don’t know if you will see it.”My concern is about indequate pain research and why we haven’t found an effective, nonaddicting, minimal side effects pain med, something you think would be número uno for pharmacology.”

    Steve, there is an effective, non-addicting drug out there, and it is medical marijuana.(of course the big pharma probably won’t get on board, because it can’t be patented).
    I recently was put on medical cannabis, after being in chronic pain for over five years from a botched dental surgery. I have CRPS in my face(which I understand is pretty rare in the literature).Strangely enough, my younger sister has it in her leg and groin. I watched her become a horrible addict from the opiates that she was being prescribed.She is now red-flagged and cannot get the help that she needs. Why, the doctors don’t give out a timed lock box with the opiate prescription is beyond me.It could have saved countless lives(and families). I suppose it is too cost prohibitive.My sister was finally put on medical marijuana and is seeing a significant amount of pain relief.She went from being in a wheelchair on horrible days and a cane on her “better” days, to being able to do light housekeeping for herself, when our Mom can’t do it for her.It was because of her positive experience, that when it became legal in my state, I asked for it. I had to jump through hoops to get it, which I found ironic, because if I asked for morphine, they would have given it to me -no questions asked.My neurologist told me that “although I think that medical cannabis will help you, I am not about to start prescribing it at this juncture in my career”(although he did recommend it in a letter to my pain management specialist).So much for “Harm none.”
    In the past five years,I was put on every anti-seizure drug, and opiate known to man.I am highly allergic and/or experienced horrific side effects to everything that I was on. This is the reason that I was able to obtain m.m.
    In just one week of medical marijuana, I am feeling relief.The pain is still there, but I am dissociated from it.I strongly urge everyone on this board to ask their doctors about getting on it if they can.I was extremely suicidal from the continuous pain, and now I might have some hope.I have a friend who has MS,who also gets pain relief from m.m. My cousin in Canada used it for years for pain relief.Sadly for him, it isn’t an MS cure(at least it wasn’t for him), and he will be saying goodbye to this World on December 2nd, with the help of an assisted suicide physician.

  17. Tim Mason at 3:06 pm

    Very well put Matt. Doctors have lost their rights to “practice” medicine. Medicine now run by an Enforcement agency with a gun, badge and a car. I interviewed for a job at a local jail once. The Captain said I am going to offer you 10,000 more on top of the salary. I said: “Why in the world would you do that”? He said ” Because you did not ask for the three things every controlling person wanting authority asks for” -A gun, badge and car-
    Weakness and unprofessionalism and laziness has become the norm in all aspects of our business. It is how much money do I make and how good is your work-life balance. (How little do I have to work). I am not trying to insult the younger generation but this is what I see all over. I love what I do for a living, take great pride in my work and discoveries. It’s my hobby.
    If I were a practicing physician-I would be furious.

  18. Matt at 11:01 am

    The responsibility for surrendering their rights as practioners certainly doesn’t lie at the footsteps of the patient. A large portion of doctors are taking the path of least resistance by capitulating to government intimidation. Especially when I ask frank questions of them with their response completely recognizies how convoluted the guidelines truly are. This is no mystery or something open for conjecture. The lie is a Big one and nothing is logical about the way they are directing it, but make no mistake about it, there are more restrictive mandates coming down the pike for Phyicians in the future.

    A perfect analogy could be the government’s ongoing war on the rights of legal firearm owners. The gov is right now pushing another attack on semi-auto rifles that look evil in their eyes, along with a ban on magazines. If it were not for the grass roots fight for our 2nd Ammendment rights as law abiding citizens, our rights would have been stripped away along time ago.

    Our government will close hospitals. They will seek ways to make hospitals cut corners to conform to the rigidity of Obamacare. Reimbursements are already too low and the amount of “hoop jumping” has increased 4 fold.

    Anyone who believes this is an not an initiative to garner control and money at the expense of logic needs to readdress their thought process.

    Our rights as citizens to live a life of liberty and the presuit of happiness is unfortunately at the mercy of those who have been charged with are wellbeing.

    Any doctor who knows the truth and allows suffering to continue solely to protect their behinds, should not be surprised when their day of reckoning comes.

    It is their responsibility to stand united and address the futility of the prohibition of opioids as everything history has taught us. They are connected directly to venues to speak their views. They have the best opportunity to put a stop to this lunacy immediately. They just need to speak out against tyranny.

  19. Tamara Johnson-Scott at 5:14 am

    The ONLY things the DEA, FDC, and CDC are doing by creating this “opioid/narcotic” Epidemic is FORCING pain patients to SEEK OUT ILLEGAL ways to TREAT THEIR PAIN!!! They THINK there’s a PROBLEM now just WAIT!! The amount of SUICIDES are going to INCREASE with CHRONIC PAIN PATIENTS too, not being able to obtain their NEED MEDICATIONS!! “PAIN CAN/WILL DRIVE A PERSON CRAZY”!!
    SO by ATTACKING one “EPIDEMIC” these agencies are creating many other “EPIDEMICS” in its backlash!!! WAKE UP!!!

  20. Tim Mason at 2:52 pm

    I agree this could be a sordid attempt to affect a business model in the future. It seems a bit “far fetched”, however, that would be a great deal of effort for a far off pay back.
    I do not agree with your statement “Since being a doctor has come down to following instructions, why not do away with 2/3rd’s of the Doctors and replace them with equally efficient PA’s.
    PAs carry malpractice insurance but it is their “supervisor” or physician that that that the financial hit and disciplinary action by the State Board.
    Recently a PA diagnosed a female with a vaginal infection, prescribed what seemed to be the correct antibiotic. The next day the hospitalist made a call to the physician’s office stating that the misdiagnosis and prescribing put the woman at deaths door.
    While nurses may know a great deal more about functional pharmacology in most cases, they are not a replacement for a physician.
    Opioids are cheap. New, alternate medicine just out of the pipeline are not. The pharma drug rep pushes these new medications to recover development, stability study cost and clinical trials. Many of the new ones are not worth mierda..

  21. Matt at 10:15 am

    There is no need to inundate pragmatic thinking proponents of the Obama administration with statistical information, they are completely aware of the truth. They have intentionally propagated the lie that the epicenter of the opioid epidemic lies with chronic pain patients misusing their medication.

    It’s not difficult to extrapolate the reason with our nation’s deficit at $20 trillion and nearly 50% the country’s populous receiving entitlements. Now couple that with 2/3rd’s of the population going into retirement. Who is left to pay the staggering amount in benefits with the mean income down (inflation adjusted) and only 1/3 left with the responsibility? Is this situation contrived? Of course it is. Is it a conspiracy to eliminate the most vulnerable of us? Of course it is.

    Anyone who contrives the reason terminal cancer patients should be denied large amounts of opiate pain killers because of the possibility that they are at risk of addiction is so convoluted, it becomes impossible to retort or formulate an opposing argument.

    Doctors are at risk of having their entire practice micro managed by government bureaucrats with little to no medical background. One day when little Johnny comes in with a scrapped knee and the physician decides that a #5 bandaid is appropriate before consulting the healthcare plan “playbook” that instructs that a #3 bandaid should have been used. Sorry, no reimbursement, not to mention a letter of non compliance inserted into their file.

    Since being a doctor has come down to following instructions, why not do away with 2/3rd’s of the Doctors and replace them with equally efficient PA’s. Look at the cost savings to healthcare.

    If Phyicians don’t assert their rights to the Doctor/Patient relationship unencumbered by Big Brother’s interference right now over pain management, they will end up prematurely retired, unemployed and replaced by foreign Doctor’s willing to sign a contract with a hospital for $75,000 a year.

    Wake Up Dr. Who

  22. Tamara Johnson-Scott at 7:30 am

    I AGREE! The GOVERNMENT has NO BUSINESS in MEDICAL MATTERS! You are absolutely 100% correct there are basically 2 different outcomes that’s going to come from this “narcotic abuse epidemic” 1sto will be a HUGE INCREASE in SUICIDE amongst the TRUE PAIN PATIENTS that are being FORCED to SUFFER because they CAN’T GET THE MEDICATION THEY NEED and 2nd will be a HUGE INCREASE in STREET DRUGS being used to CONTROL PAIN which will lead to ACCIDENTAL OVERDOSES that’ll SNOWBALL into yet OTHER issues with whatever drugs etc… and the CYCLE starts over with “NEW FINDINGS”or “STUDIES THAT SHOWED” from the CDC, FDA, DEA, that blah, blah, blah!!! OMG we know your work is very important for our health but “DAMN!! You FORGET we’re only HUMAN and can only take a certain AMOUNT OF PAIN before you go “BAT CRAZY” and either HURT YOURSELF or THE ONES YOU LOVE MOST or worse BOTH!!! I’m beginning to wonder if sone thing “FISHYS” going on?!?! WHY else would you make people “SUFFER”? As it says in Bible 1 Peter 4:1-6; Since therefore Christ suffered in the flesh, arm yourselves with the same way of thinking, for WHOEVER has SUFFERED in the FLESH has CEASED FROM SIN, so as to live for the rest of the time in the flesh NO LONGER for human passions but for the will of God. For your time that is past SUFFICES for doing (you’ve “paid your dues” so to speak) what the Gentiles want to do, living in sensuality, passions, drunkenness, orgies, drinking parties, and lawless idolatry. With respect to this they are SURPRISED when you DO NOT join them in the same flood of debauchery on judgement day and they malign/slander you; but they will give account (lie about you) to him who is ready to judge the living and the dead which is GOD! So there’s a “positive side” to being sick I guess!!😉

  23. scott michaels at 7:46 pm

    The governments goal is to outlaw all pain medications, let everybody buy bad heroin off the streets, overdose and die. PROBLEM SOLVED AND LOOK AT ALL THE MONEY THE INSURANCE COMPANIES WOULD SAVE.

  24. scott michaels at 11:04 am

    un fortunately the only thing that makes national mew are the lies and innuendos.
    the latest example is hillatry clinton accusing the VA of handing out “bags of opioids” when asked about the suicide rate of vets.
    If they were just getting enough to handle their pain, the suicide rate would reduce drastically. VETS HAVE ALL BEEN CUT OFF OF THEIR PAIN MEDICATION SO THEY GO TO THE STREETS AND FIND BAD HEROIN AND FENTYNAL. THATS WHAT IS KILLING THEM.
    SOMEBODY OF STATUS MUST DECLARE THAT ALL OF THE STATISTICS ARE LIES. they also must have yhe courage to blame the dea for not doing their job of stopping the traffickers brining in heroin.
    Because the Govt and dea saw heroin on the rises they had to keep attacking us. They must help our citizens get the pain medication needed again and at the same time put harsher penalties for drug dealers of heroin and any homemade narcotic.
    only give drug addicts 3 trys at rehab. then jail. A year in jail with no visitors or contact with anybody that could supply them will sober them up. this so hard to figure out.
    Bags of opiates she actually said that. A vet cant get a bag of lunch from the VA. If they were handing out drugs like hillary says the vets would be without pain, but dropping like flies from overdoses, BECAUSE THEY HAVENT BEEN TAUGHT HOW TO TAKE THEM OR REGULATE THEM. GIVE THEM A WEEK SUPPLY OR A DAILY PICK UP LOCATION. JUST LIKE A METHADONE CLINIC, BUT THEY WOULD ACTUALLY GET GOOD MEDICINE THAT HELPS NOT METHADONE THAT DESTROYS THE BODY.

  25. H HEROLD at 10:38 am


  26. Jeremy Goodwin ,MS, MD at 9:38 am

    Statistics is my weak area. I have other strengths. This needs to reach more than the choir. Other newspapers need to understand and publish but the reporters on here are timid if very nice and knowledgeable. I have tried. There is a difference between making waves and presenting honest information in a respectful manner.

  27. Tim Mason at 7:05 pm

    Hello Dr. Goodwin.
    I asked for your email address via our blog but have yet to get a response.
    A fellow member of the American Chemical Society (ACS). He work for attorneys at the federal level all over the country fighting the injustice of State Agencies.
    I feel he is someone we could reach out to and help us put these poor statistical studies to rest. He is well know at the federal level and is highly respected.
    Use this communication to reach out to NP for my email address so I can give you his contact information. He may be at the next local section meeting and I will get a chance to speak to him personally.
    This could be a “door opener’ of us.
    Kind regards,
    Tim Mason

  28. scott michaels at 9:12 pm


  29. Tim Mason at 7:05 pm

    Dr. Goodwin,
    You put a lot out there. It was interesting see Russ Portenoy and his business associates-Big Pharma. It will be interesting to see how he validates his change of view on prescribing.
    It seems that Pain Management doctors are not allowed to “Practice Medicine” in the historical sense, only operate by a legalistic mandate laid down by pain illiterates.
    All medications have risks. We have become a nation of non risk takers. We did not get to the moon by not taking risks. (we did it with a slide rule an something less powerful than a Commodore 64)
    I think you hit the nail on the head so to speak. These entities making claims need a qualified third party statistician using a standardized set of variables. There are obviously many statistical reports being reported as factual. The sad part is they are put in all forms of media and no one his held responsible for this misinformation. Sad

  30. Robyn Blanpied, Ph.D, Major USAF, ret. at 4:11 pm

    My husband was captured and medically tortured by the Contras.
    He survived, but is in chronic pain. So he (and I) are being tortured by the medical corporate system.
    Running from specialist to specialist like the proverbial unwanted hot potato is stressful and exhausting. My life and his are both hellish as we struggle to find help.
    What is being taught in medical schools that MDs are so ill equipped to deal with pain? The dignity and professional standing of the medical profession is reaching crisis stage where they become specialized technicians, like the old Soviet Union.
    Ironically, Marx tried to warn us.
    If physicians can not lead the way, how can amateur patients?

  31. Jeremy Goodwin, MS, MD at 3:51 pm

    Dear Tim Mason,
    The article that you cited is a typical physician sheep-type rehash of the work of others. No original thought and minimal insight. I found this paragraph to be telling:

    “As the number of prescriptions goes down, the number of overdose deaths continues to rise. The Department of Health reported that 1,263 Tennesseans died from overdoses in 2014, compared to 1,062 in 2011. That’s a 19 percent increase.”

    It was not followed with any focused insight into a paradox that should make one, at a minimum, ask, ” Why would tat be so if the problem stems from overprescribing?”

    Interestingly, the chairman of the University of Tennessee’s Health Science College of Medicine’ Deoartmrnt of Addiction Medicine is a very forward thinking individual interested in expanding the range of treatments available for both addiction and persistent, intractable non cancer pain. I hope to join him in that endeavor.

    The stare’s stance on the opioid ‘epidemic’ is of some concern to me but maybe with a more balanced presentation of the generally misused and applied statistics minds will change. I don’t think that most clinicians see the big picture: the sociopoliticoeconomic one, and the lack of compassion and understanding of pain that is the hallmark of the average clinician needs to change for the level of care to advance.

    If you wish to communicate privately please ask the NPR staff for my email pointing to this response as evidence that I am offering it to you.

    Thank you for standing up for patients and helping to elucidate the incorrect conclusions too often reached by those who are less well informed and therefore more likely to be prejudiced one way or the other. There is no easy solution but the current guidelines are grossly misguided and incorrectly treated as standards of care for all practitioners and patients. They were not supposed to be that but the authorities knew that they would be taken as such and in turn they have started to believe it themselves. That makes the fight for a rational approach to improving care much harder to achieve. Fear gets in the way.

    I do think that most are genuinely looking out for the public’s safety but, like implicit racism, the lack of awareness of it and the lack of scientific training and intellectual rigour is the biggest barrier to progress.

  32. Tim Mason at 2:22 pm

    Dr. Goodwin, I would like for you to take a look at the link I have provided below. It is written by Dr. Keith Anderson from Memphis Tennessee.
    There are several hyperlinks in his story and many of them are full of misinformation.
    I am diligently trying to be proactive and be able to find the “root cause” of many of the fallacies that are rampant concerning prescription medications.

    Be for I rebut his article in the opinion section of the Chattanoogan I wanted you to take a look at his information. I was wanting to ask for a spreadsheet that they populate to come up with some of their ridiculous numbers.
    I sure could use your professional insight. His link is provided.
    Once again please read his article and then take a look at his propaganda

    All the Best,
    Tim Mason

  33. Steve at 10:21 am

    Interesting comments, will be interested in seeing if good M.D.’s like here and angry pts will be able to reverse political BS, tough to do. My concern is about indequate pain research and why we haven’t found an effective, nonaddicting, minimal side effects pain med, something you think would be número uno for pharmacology. I have sever FM pain, have failed all standard and nonstandard meds and treatments and failed first pain management doctor, real piece of work. I see second one next week but, realistically, am not sure what can address my varied severe symptoms. My Tramadol is useless, with nasty side effects, and a lone old Vicodin from wife’s dental work, only real opiate I’ve ever taken, had worse side effects and minimal pain moderation, would not be worth it. This is the 21st century and pain is an afterthought to doctors.

  34. HJ at 9:55 am

    I came across this today and think this is an important indictment of how statistics are being manipulated:

    “Scientists have been able to figure out illegal drug use by directly testing sewage water for cocaine and opioids.”

    Hey, but this cannot tell which opiods were legally prescribed!!! This is just one example how people with legal prescriptions who are taking their drugs as directed are lumped in with heroin addicts when it comes to statistical analysis. The statistics you hear on the news are similarly suspect. “Opiod deaths” may be a heroin addict on the street, it may be someone who used opiods to commit suicide, it may be someone who accidentally mixed alcohol and opiods. It could even be someone who died of OTHER causes, who happened to take opiods.

    I’ve shared this with PatientsNotAddicts, the National Pain Report and and Pain Network News. I hope my email doesn’t get lost in the shuffle

  35. Tamara Johnson-Scott at 9:51 pm

    Wonderfully written Mr. Mason! May I say on behalf of myself and ALL the other patients who are dependent on pain management, THANK YOU FOR LOOKING OUT FOR US!!😊😊 I believe you “hit the nail on the head” so to speak when you say the “LACK OF EMPATHY”….. it’s sooo much easier to SYMPATHIZE, almost 2nd nature, but to actually “PUT YOURSELF IN SOMEONE ELSE’S SHOES” Takes TRAINING, not everyone can do it so easily! I think the DEA/CDC/FDA members should ALL be required to take a class in EMPATHY and then SHADOW a family living with/in pain for a MONTH to really “SET IN” what they learned from the class!

    Why can’t the CDC/DEA/FDA be more like the HUMANE SOCIETY?? At least ANIMALS aren’t made to “SUFFER” like HUMANS are!!! 😳

  36. Jeremy Goodwin, MS, MD at 4:48 pm

    Dear Tim Mason,
    Thank you for your kind comments and professional observations.

    I have written to the chair of s department of Addiction a Medicine to see if he would be interested in a collaborative effort to expand upon the points raised, adding a statistician to re-analyze government statistics that have, in my opinion, been grossly misused.

    I feel for the many patients suffering in pain and fear as a result of non evidence-based generalizations and utterly ridiculous ‘one size fits all’ approaches to weaning their daily dose whether in need of it or not.

    Again, thank you for your support.

    Jeremy Goodwin

  37. Tim Mason at 11:13 am

    Doctor Goodwin,
    I commend you on your succinct style of writing. Your style is indicative of several things, one of which is your scientific intellect outside of mainstream medicine and that you understand the psychological, political and economic factors that enter into a complex equation.
    Also, you do not hide behind some alias or initial, indicating you understand what your are talking about and are willing to defend it.
    It appears that CDC/FDA/DEA and others have written articles and made claims that are not “peer reviewed”.
    As you mentioned The “Opioid Epidemic” is the biggest falsehood I have ever seen. How can a new reporter validate a story like this “Five adults found dead in a Chicago Suburb, each had a needle in their arm”. “This is solid proof that over prescribing “pain killers” has got to stop” Absurd!! This now becomes newsworthy and all the major networks carry it as well as well know afternoon “Talk Shows” where everyone goes home with a prize at the end of the program.

    The lack of empathy surrounding the pain patient is astounding.
    I have worked as an analytical research chemist my entire life. Twenty-five of those years in pharma. You write well. I can tell you have seen a lot as well.
    I feel these advisement board for CDC/FDA and others have put people in position of that do not have the credentials nor the experience to be there.
    Another thing that is obvious to me is that the new SG is nothing but a result of nepotism.

  38. Tim Mason at 8:52 pm

    Hazzy, No one here thinks Chronic pain is a joke. Just the opposite. I feel your anxiety associated with your problems. I, myself, have had two back surgeries, a spinal fusion using a polymer disc, screws and plate. I have had a total hip arthroplasty (need one on the other side now) and just got diagnosed via fresh MRI of moderate central canal stenosis, two compressed nerve roots and lots of painful scar tissue (perdural fibrosis)
    The bad joke is that people like us have been called pseudo junkies, low-lives, etc.
    What has happened is that a bunch of bought out members of the FDA, miss informed members of the CDC and testosterone infused members of the DEA (the ones that had three requests when they were hired 1.A Gun, 2. A Badge 3. A car have gone around and run amuck in medicine where they have not business medaling. (They actually need to be working on the drug smuggling cartels and such). But with so much danger involved in that work they have focused on the easy stuff, Physicians and sick people.

  39. Jeremy Goodwin, MS, MD at 3:54 pm

    We are short changing those in need of pain medicine as well as those needing modern addiction medicine. Recividism is often cited as the latter being a waste of time, but that is based on outmoded treatment program results. And the anti pain medicine movement is a shocking shirking of responsibility by clinician’s and the government both.

    The recidivism rate has to do with poor allocation of out of date treatment in most places based on concepts developed before we understood the role of neglect, abuse and trauma on the developing brain through its changes in body and brain chemistry as a chronic reaction to stress including PTSD— both complex and simple—and undiagnosed or misdiagnosed disorders , including complex PTSD, anxiety and depression….

    Those physical chemical responses to stress in the developing person who is neglected, abused and / or traumatised, activate and deactivate genes that in turn create miswiring and changes in normal wiring patterns between the developing frontal lobes and limbic system in the very young. The result is aberrant processing of exogenous chemicals with a lack of impulse control over the abnormal biological drive for more drug or ‘reward’.
    No substitute is in place in the lives of those affected as far as enrichment of their lives goes. Animal research supports the value of the latter in ignoring the once thought of ‘irresistible drug drives’.

    That reward-chasing behaviour peters out after a year or two and fear of withdrawal kicks in as the primary drive. A ‘high’ is only icing on the cake ( just like how minimum wage versus a good wage works in terms of making basic payments vs being able to enjoy a vacation).

    Three weeks of detoxification without the right long term and intensive support and means to reverse those genetic switches cannot reverse years of problems, both biological and psychosocial let alone spiritual. However, he brain CAN be rewired under the right program. There are too few being funded.

    That ‘opioid epidemic’ is a terrible political falsehood and exaggeration and really a reaction to demand for and need of by doctors who want to legally reject patients with intractable non cancer pain. They are too much work for the majority of clinician’s who have chosen to avoid the education needed to help them properly. Such patients are the orphans of medicine.

    The government goes by advisors who have irresponsibly lumped many subgroups together. This makes the headline-making data inaccurate and indecipherable. The conclusions cannot be utilised responsibly. There are problems within the system indeed, but not enough to mandate a stupid movement that is increasing the amount of drug cartel money and power while leading to suicide of patients ( and hounded by-the boards-doctors) out of desperation.

    Those who were functioning better on well monitored opioid therapy as PART of a multi-modal approach are not doing so well now. They are dropping out of school and the work place. It is a disaster.

    The street drugs originally moved from cartel-based to industry based, and more recently to a mixture such as counterfeit pills like ‘oxycodone’ made from fentanyl and heroin. Prince appears to have had access to them, and likely unknowingly. Many do.

    Why do you think that those without a history of addiction by their 30’s are extremely unlikely to develop the problems even on high dose opioids if that is all that works? Maybe their brains developed normally? No trauma or neglect when young? No abuse, or it was dealt with well? Possibly. There will always be exceptions but not as currently touted in this sorry movement.

    Without separation of these groups it is so hard to tell, but the ‘epidemic’ coincides with white people dying of what was initially illegally procured industry made meds, usually mixed with alcohol and benzodiazepines like Valium. It is safe to prescribe them together if taken as properly prescribed. There is the rub. Monitoring is necessary and QUANTITATIVELY so. And it isn’t a perfect system. What about guns? They shoot horses don’t they?

    87% of the deaths by overdose are NOT by those legally prescribed these medications and yet ridiculous cuts in doses across the board, and medical board persecution of clinician’s have raised clinician and patient anxiety , pain levels, and the likelihood of procuring that which works, illegally, given the increased pain and decreased function on low doses that were not based on patient behaviour or level of need but on policies and guidelines that have been MIS-ADOPTED as law when they were only intended as guidelines for family docs and others with insufficient training. This has damaged many.

    No one cared when most of those with addiction were black and on crack and other versions of speed, or when the white-based cocaine crowd appeared in the 90’s.

    The normal dosing range of pain medicines between individuals is 40x for the same level of pain due to receptor differences that are classically genetically influenced, the EPIGENETIC connection between nature and nurture, anxiety and other emotional disorders that may not even be mental illness but a normal reaction to an abnormal and prolonged stress and upbringing. There is also tolerance and the interference in metabolism caused by other medications processed by the liver and kidney.

    Why are pain pumps never addressed? Because they are not dealt with by most. It is but a delivery system. Ignorance and inconsistencies abound. And patients are not dying in an epidemic when well screened for addiction.

    Chemical dependence is REVERSIBLE. But we need to fund the treatment centers and get them beyond the AA model ( which does work for many but nowhere near enough).

    The articles published in the media and medical journals don’t go into these things properly so please be careful in using that media cliche of ‘opioid epidemic sweeping the nation’. There are indeed problems as there are with other areas of medicine. NSAID overdoses kill 16,000-17,000 a year. Indirect deaths from MI, stroke and kidney disease occur from NSAIDS too. They and other modalities often fail to alleviate pain PROPERLY and the level of expertise and attention to monitoring that or opioid use need not be draconian as currently implemented. It is a disgrace.

    But the bigger problem is the overreaction by the individual states that is now showing up as an unexpected by some but highly predictable outcome by others-means to actually killing people via suicide and desperation. And that is unconscionable.

  40. HAZZY at 10:48 am


  41. Tim Mason at 4:39 am

    Hazzy, Now that you have tried Cymbalta, keep the capsules, make a note of the side effects you had with it. Use a post-it note and rubberband it to the bottle.
    The next time you are asked “Have you tried Cymbalta”? show them the bottle and note.
    With that being said your doc knows you got an upset stomach, followed by a headache and sat for two whole days with your head in your lap trying to figure out what the hell just happened.
    Those SSRI type drugs are the pits. They will make me more depressed than an armadillo that has laid out on interstate 40 for a week.
    I report all my reactions to the FDA. They have a database for these things.
    Some medications simply cannot be improved upon. Valium and Xanax are two of those.

  42. Scott michaels at 8:12 pm

    wow look at all of these comments. maybe they should be pr in ted and sent to the SG.

  43. Tim Mason at 2:51 pm

    When I picture the figure of THE SURGEON GENERAL, I envision a person in their mid to late 50’s maybe 60 with years of experience in the medical field. A person who has seen it all so to speak. One that not only has continued his continuing education requirements in medicine but has been in the trenches. He or she would be an individual that has seen first hand the pain and suffering in both the patient and the family. I see a real surgeon. Perhaps one that worked on a Hospital Ship, or in a Surgical Field Hospital. A doctor that had been surrounded by fast acting intelligent nurses both male and female.
    I hate to say this but I believe we all got screwed by nepotism on this guy.
    I let a doc doing his residency take my gall bladder out a few years back and I know you have to learn from practice and have practical experience.
    I have been wanting the throw this in for a few days.
    People struggling in pain deserve a little better than this.

  44. HAZZY at 2:17 pm


  45. Mathew at 10:51 am

    Hello Dr. Stark,
    Well said! I found the “Take The Pledge” as condescending rubbish. Why would a Doctor wish to sign something that tells him/her we will monitor everyone of your movements (as if they don’t already)?
    You are correct about Gabapentin. For the 2 months I tried it, I experienced short term memory loss.

    It would be great if the Doctors who participate on the National Pain Report would sign a pledge to oppose the government’s attempt to eliminate your autonomy.

    Tim – Sorry for the wrong link, but sometimes I have multiple articles opened at the same time. What I said was pretty concise. We are considered disabled, therefore if someone like a pharmacist should take it upon themselves to deny filling your prescription due to their personal beliefs, they are breaking the law and subject to the American Disabities Act. Here is a link to the form –

    By redefining a disability as a disease, they are effectively removing select individuals from prosecution by discrimination. I hope that helps.

  46. Bruce Stark, MD at 9:27 pm

    The surgeon general letter is horrible, it’s so 2009.
    The CDC & now the surgeon general keep blaming us front line docs doing the hard work of treating chronic pain.
    They are as supportive as the DA of Baltimore & the mayor of NYC are of their cops doing the work on the streets.
    Take the Pledge…really? what am I in middle school?!?
    When Dr Murthy’s back pain kicks he will get only Lyrica and Gabapentin, this way he can be forced to retire when his brain stops functioning.

  47. Tim Mason at 2:18 pm

    “My point was to highlight the danger of Chronic Pain Patients being turned from a disability to a disorder. I have mention on several of my posts that one of the ways to fight this is to use the American Disabilities Act ”

    A spinal pathology, documented properly as well as several other diseases are disabling and a cause of disability. I am not sure what your are claiming.

  48. Tamara Johnson-Scott at 9:12 pm

    Reading the majority of responses I can’t help but FEEL for them ALL!!😔 I SINCERELY HOPE our Surgeon General takes the time to read at least a few! You can hear the “PAIN AND FRUSTRATION” they’re all going thru and dealing with as best they can! GOD BLESS ALL OF YOU!

    Going from working in the medical field to permanently disabled as a result of a “simple” Cholecystectomy that rendered my biliary junction damaged, known as Sphincter of Oddi Dysfunction! A LOVELY AFFLICTION **(sarcastically said) that renders suffers such EXCRUCIATING PAIN that they literally SCREAM FOR HELP and can NOT stop themselves from screaming until they get whatever it takes to STOP the PANCREATIC ATTACK!! That’s what the disease causes either it’s closed so tight that the pancreatic digestive juices get backed up or its open so loose it cause Crohn’s like symptoms or IBS symptoms so YAY for me!! NOT!!😲 Seeing first hand what all patients will do for a “FIX” as far as LYING and the stories they told (some comical) I remember thanking GOD that I wasn’t “sick”! WWWEEELLLLLL guess what?!?! Lol YEP KARMA GOT ME!!😯🤕🤒😷😢😭 Now I’M the “FREQUENT FLYER” in the ER!! That “NAGGING PATIENT’ my doctor HATES to see or hear from, etc…. Point is I’ve now gotten to EXPERIENCE BOTH SIDES of this narcotic/opioid dilemma! BEFORE I got sick I viewed patients seeking “pain relief” as ADDICTS that used the ER for DRUGS!! NOT anyone I’D EVER hang out with for sure!😤 BUT GOD SEEN HOW CLOSED MINDED I’D BECOME so he HUMBLED me by SHOWING me first hand what ALL SICK PEOPLE GO THROUGH day to day! I got the MESSAGE LOUD AND CLEAR😉 ALTHOUGH there’s an “Epidemic/Problem” with Pain Medicine in general YOU’VE FORGOTTEN ONE VERY IMPORTANT THING THERE TRULY ARE SICK PEOPLE WHO HAVE/NEED TO TAKE PAIN MEDICINE DAILY PERIOD!!! But the DEA has EVERY DOCTOR SCARED “SH**LESS” to prescribe PAIN MEDICINE that will HELP their patients!!


    THE PLEDGE/OATHE ALL Doctors take states “to do no harm” Takes on a new definition now! Now most doctors will say that they are “doing pts. no harm” by finding “alternative and some invassive” new ways to treat pain and WON’T re-prescribe or newly prescribe pain meds. Nieces that’s all fine and dandy if YOU’VE NOT BEEN ON THEM FOR YEARS however this is NOT a good idea AT ALL!! TRUST ME it’s already “difficult navigating” through the disease itself, trying to find that “NEW NORMAL” we’re told we have to do PLUS deal with the everyday STRESSES of life ALONG WITH ALL THE PAIN and now NO “INSTANT” RELIEF AVAILABLE because….🤔😲 OUR GOVERNMENT OFFICIALS DON’T HAVE TO SUFFER so it’s EASIER to “JUDGE” and “SENTENCE” EVERYONE who NEEDS PAIN MEDICINE as “ADDICTS LOOKING FOR A FIX”!!
    Well, they’re RIGHT about one thing True Pain Patients ARE “DRUG ADDICTS” only they HAVE TO BE of prescribed controlled pain medicines! 😊 PROUD TO SAY THAT’S ME!!! ANYONE/EVERYONE has the ability to CONTROL themselves when taking pain meds. It’s a CONSCIENCE EFFORT DAILY but can be done! So it’s NOT a matter of “physical addiction” AS MUCH AS IT IS “ENVIROMENTAL, SITUATIONAL AND MENTAL” Majority of “substance abusers” are either in/or have been in”situations” beyond their “control” OR the patient TRYING to CLAW their way out of the BAD ENVIRONMENT the live in OR the patient who got hurt and went from a 6 figure income to a now FIXED “3/4 less” income that is FULL OF RESENTMENT, the list goes on and on! I’m sure you could think of someone that is or has been AFFECTED by this “MEDICAL MERRY GO ROUND”!! Have pain patients be REQUIRED to meet with a Therapist, Psychologist or psychiatrist on a weekly basis the first 6-12 months in pain management in order to get their prescription, after that make it MANDATORY to meet at least twice a month if not more UNTIL the mental health professional feels comfortable with that the pts. overall mental health is “repaired” or “healed” enough that they can TRUST these patients to take their medication as prescribed and that they have a good Doctor/Patient relationship. This helps ENSURE the patients stays “on course with their treatment”😆
    When dealing with our ER Personnel/Responders there NEEDS to be a system in place (a universal health computer program) that links up by satellite where each patients file has ALL physical/mental health info as well as a TREATMENT PROTOCOL that has WORKED in previous visits allowing quicker treatment and for some (like myself) quicker/stat treatment not only means IMMEDIATE RELIEF it also means I WON’T have to be inpatient for 3-5 days! PLUS by linking up with all other hospitals makes it nearly impossible to SCAM DRUGS!! PICTURE IDENTIFICATION as well as a FINGER PRINT would ALWAYS need to be presented, IF REFUSED TO PRESENT IDENTIFICATION then the patient still gets treatment just WITHOUT any NARCOTICS for MINOR issues and EPIDURALS to NUMB PAIN! Only in EXTREME HIGH LEVEL emergencies would pain meds be administered by IV!
    The ANSWER is there staring you straight in the face, OPEN YOUR EYES!!!😨 DON’T MAKE PEOPLE SUFFER MORE THAN THEY SHOULD HAVE TO!!! Thats just IN-HUMANE!!!!!!!😔

  49. Mathew at 5:15 am

    To: TIM MASON,

    It appears the over reach of Big Bother has successfully had the petition taken down. Shame to see our Constitution shredded.

    To: GEO SIMS,

    Thank you for describing the location of the small print disclaimer located in the toolbox.

    The Substance Abuse and Mental Health Services Administration (SAMHSA) is a branch of the U.S. Department of Health and Human Services. The Administrator of SAMHSA reports directly to the Secretary of the U.S. Department of Health and Human Services.
    The U.S. Public Health Service Commissioned Corps is a uniformed service of more than 6,000 health professionals who serve in many federal agencies. The Surgeon General is head of the Commissioned Corps.

    The flow chart clearly shows that the Surgeon General authority encompasses all of the branches of HHS including SAMHSA.

    My point was to highlight the danger of Chronic Pain Patients being turned from a disability to a disorder. I have mention on several of my posts that one of the ways to fight this is to use the American Disabilities Act as a defense.

    In one of the National Pain Report articles entitled “Burnout”, an example of a pharmacist’s over reach of power was combated by a complaint to the ADA.

  50. Tim Mason at 7:26 pm
    These folks have a letter going out to CDC, FDA and several other State and Federal Agencies. You can sign the petition like I did and make a donation but it is not required.
    It looked good to me. Very good. It is Stop the Anti-opioid fiasco.

    I would like others here to check it out and let us know what you think of their letter.

  51. Mathew at 4:46 pm

    *I hope the moderator posts this as the last several have not.*

    After looking at a beautifully executed advertising propaganda tool, using a play with words to create a brand new disease that I did not have last month. The creative way they subliminally lie, I love the disclaimer the Surgeon General has placed at the end of his parade ~

    Nothing in this document constitutes an indirect or direct endorsement by the Substance Abuse and Mental Health Services Administration (SAMHSA) or the U.S. Department of Health and Human Services (HHS) of any non-federal entity’s products, services, or policies and any reference to a non-federal entity’s products, services, or policies should not be construed as such. No official support of or endorsement by SAMHSA or HHS for the opinions, resources, and medications described is intended to be or should be inferred. The information presented in this document should not be considered medical advice and is not a substitute for individualized patient or client care and treatment decisions.

    Also by classifying this as a disease, they no longer have to worry about the American Diability’s Act. We can no longer be discriminated against, they are merely treating our disease.

  52. Tim Mason at 4:44 pm

    Let Vivek Murthy know how you feel and what you have been thru. You can find him on FB. He is accepting comments on his decision. He is a 40 year old man, graduated high school in 1994. Has a degree in Healthcare management. I am sure the Surgeon General knows all there is to know about pain.

  53. Tom Keatings at 3:46 pm

    I have lived in constant chronic pain for over two years after a spine operation.The pharma companies have made a fortune from my suffering,I have become innured to so many prescribed drugs that I despair.Pregablin,DHC continnus,DHC instant,Diazapam,Tramadol,,,,all have worked for a limited time before stopping,its when they stop working that the judgement of those prescribing must be called into question,to simply increase the dosage or to recommend methadone to the patient cant be the answer.All my doctors seem to work under the misconception that I require 24 hour pain relief,I will settle for a few hours relief,its well documented that for spinal pain medical cannabis is a source of great relief,we are being treated as lab rats by these companies,I have been prescribed thousands in opiods,opiates and psychthropic drugs,my pain has not vanished for 24 hours ever since my op,those doctors claiming any drug can achieve this myth are liars,I,ll settle forvtwo hours pain relief from a spliff,far less harmful and does the trick,dismayed that so many chronic pain suffers embrace the lies and false claims made by doctors and pharma companies,multiply what its cost for one patient like me with spinal injury times the millions worldwide with chronic backpain,our pain is their profit and they flash then burn up,24,hour pain relief is a lie stop believing their lies ,turning us all into junkies.

  54. HAZZY at 2:23 pm


  55. HAZZY at 2:04 pm

    I would really like to see how someone with chronic pain, jumping around and playing with there grandchildren and even walking the dog !!! Without their Pain Meds. I went to my Doctor today and she told me there will come a day (AND IT IS SOON) that people with chronic pain wil only allowed to have 3 days worth of there Pain Meds, that is crazy, what happens say, you Broke your Hip, what is 3 Days of Pain Meds going to do, when a Broken Hip takes atleast six weeks to heal !!! These people that are Doctor Shopping and Buying off the streets make it really bad for us Chronis Pain Sufferer’s !!!!! My Doctor knows what meds i take and every month i get the same amount, im not selling them, because i need them. Iam a Disabled American Veteran, I fought 3 wars, and Im the one thats going to have to suffer along with other Chronic Pain patients.

  56. Jeremy Goodwin, MS, MD at 12:20 pm

    I have contributed a long comment near the beginning and have read most of the others.

    I think that it comes down to this: 1. It is a political movement that threatens the public’s health in ways that could have been anticipated had it been less reactionary and more carefully constructed without hidden agendas and a disgraceful bias against pain , addiction and other or intersecting issues that require careful, attentive care and that caseload should be shared to varying degrees by all clinicians where appropriate.

    2. The subgroups who have overdosed need to be separated and the cause investigated properly including an objective analysis of clinician’s’ behavior and prejudices that negatively affect their judgement. It is similar to what the nation’s police departments are now going through: reassessment and change to better serve and to protect ALL of the public, not just the wealthy and white.

    3. The draconian guidelines need to be put on hold and revised with a better balance of input and a less punitive air to them.

    4. Care needs to be multi-modal, integrative and interdisciplinary with better communication between all involved.

    5. More time needs to be allocated given the downward spiral that occurs as a result of negation, punishment and invalidation.

    6. ALL need care regardless as to whether or not the issues are intractable pain, addiction vs simple tolerance and only physical dependence.

    7. Unaffordable and non insurance covered therapeutic modalities need to be covered if they are to be prescribed and they, as well as controlled substances adjusted or stopped if properly assessed as being unhelpful or harmful

    8. Education and proficiency is needed by all clinicians where controlled substances are concerned. It is a shared need and responsibility to provide sincere and useful care.

    9. Recommendations for monitoring should be clear but non threatening and every visit urine testing, etc., deemed excessive , insulting, time and money wasting and counter productive. Trust and respect needs to be earned but it goes both ways!

    10. There ought to be statewide ombudsmen or women to handle complaints and the medical boards need to back off and desist from their threatening and counterproductive attitudes often at odds with their ‘how to’ publications and CME units.

    11. An apology and retraction is necessary with the CDC and FDA withdrawing leaving in place a more balanced federally financed and mandated guidelines group that can produce genuine, helpful guidelines that are not essentially veiled threats.

    This whole movement is as embarrassing as the Presidential election this time around. It can be stopped and the course altered. It has been a medical mob mentality that had driven an unjustifiable and reckless movement even though there are and have been genuine problems on both the sides of clinicians, patients and third party payers which can be corrected through research and reassessment of poorly used statistics and changes made accordingly and as quickly as possible.

    This conflict d it stands cannot be justified. It isn’t necessary and maybe the government could focus on the 16,000-17,000 NSAIDS-related deaths too as well as the 30,000-plus gun-caused deaths.

  57. HJ at 7:51 am

    Dr. Ibsen,
    I have deep gratitude for your advocacy on our behalf. You hit the nail on the head so perfectly. It is deeply affirming. To feel validated and understood makes my eyes start to water a bit. I am so tired of fighting, but it helps to know we are understood and we have advocates. Thank you.

  58. HJ at 7:47 am

    There is so, so much bias and judgement whenever “fibromyalgia” is on someone’s chart.

    When I went to physical therapy, I learned that the reason I had been to physical therapy a number of times without ever getting any type of heat or massage treatment, was that physical therapists were being taught that fibromyalgia patients will become “addicted to massage” and that they won’t exercise. The therapist that did the massage for me helped me more than anyone did. Without massage, I was working chronically contracted muscles and was seeing no benefit. It was frustrating and demoralizing!

    When I was “diagnosed” with fibromyalgia, they wrote the diagnosis in my chart and then didn’t tell me. The rheumatologist cc’d my primary care doctor in a letter, who then told me I was “just depressed” and that I should take antidepressants and stop arguing that I was tired and I hurt. I asked for a sleep study because I was so tired, the doctor disregarded my request. It took me 7 more years of rotating through sleep medications before someone said “oh, let’s do a sleep study” and found out I had sleep apnea. The sleep deprivation was amplifying my chronic pain and I was doing much better with pain after I was getting CPAP treatment!

    I learned that I had a fibromyalgia diagnosis after a car crash out of town that brought me to see my mother’s doctor who did the tender point exam on me. It was so strange, because I was there for the car crash, complaining of numbness in both hands and he starts pushing on random spots on my body and asking me questions about sleep (but I did hurt in most of the spots he pressed (!) and I did wake up feeling unrefreshed — more like I was being run over by a truck rather than actually sleeping!) I asked for my records from the rheumatologist that I’d seen months before at the advice of my mother’s doctor who said I needed my records to take to a doctor who was more local to me who could treat fibromyalgia.

    I may still have fibromyalgia, but I don’t see it as a primary complaint. If I manage my sleep apnea I have much less pain. Unfortunately, I do have osteoarthritis in many joints, along with cervical spondylosis and degenerative disc disease (tho the chronic pain-inducing issue seems to be annular tear in a disc).

    I saw a neurologist for the pain I was having in my lower back. He told me my pain was “all from fibromyalgia” and that I “needed to go back to my rheumatologist.” The rheumatologist said, “No, your pain isn’t all fibromyalgia. The records he sent me say you have a torn disc.” Frankly, the neurologist seemed to tune me out when I said I had fibromyalgia so I think he wanted to get rid of me.

    I have bone spurs, turf toe and plantar fasciitis in my foot. A podiatrist said there was nothing he could do because “(I) was going to hurt anyways” (because of my fibromyalgia).
    Some patients wouldn’t push a doctor. I said, “What if I had bone spurs, turf toe and plantar fasciitis and I didn’t have fibromyalgia. What would you do?” He said, “I’d write you a script for orthotics.” I was persistent until he wrote me that script. Until then, his advice to me was, “Try not to walk.” I got the orthotics and they help my foot pain AND now that I’m walking better, it took some pressure off my lower back. If I hadn’t advocated for myself, if I had listened, I would have been “trying not to walk.” Now, I walk for exercise.

    The bias against fibromyalgia patients is real. It has a real impact on our access to effective treatment. And then the doctors say we’re “whiners” and they don’t want to deal with us. Part of that is their own fault for failing to help.

  59. HJ at 7:01 am

    It’s so wonderful of you to generalize to us all and call us selfish. I find this very offensive but as you clearly were aiming for that effect, congratulations!

    There is such a thing as physical dependency. It is not the same as addiction. It occurs with anti-depressants, too, by the way. Are people who are depressed addicted to their medication? Does that mean they should stop taking it? It doesn’t just occur with opiods, so if you’re going to turn it into a moral argument, then you might as well argue that we should take Prozac away from people with mental health issues.

    The difference between myself and someone who is addicted is that I take my medicine as prescribed, I am well-monitored by my doctor, my medicine helps me work (instead of negatively impacting my life so that I am unable to work). The difference between me and an addict: The medicine improves my quality of life. An addict’s quality of life is negatively impacted by the medication. I have pain, I’m treating my pain with medication. If I had diabetes, I might treat my diabetes with insulin.

    If you can be productive without medication, then maybe you didn’t need it in the first place. But hey, you want to assume what works for you works for everyone, so I’m not going to pretend to think I’ll sway you.

    Going to work gives me a sense of purpose and I’d go so far to say it’s firmly incorporated into my sense of identity. Thank God I can still do it. I never take it for granted anymore. When I can’t do it, then I pray that I can find something else that I can still do that gives me a sense of purpose. I don’t have children or grandchildren. I like photography but it’s getting harder and harder to do. If a medication helps someone do things that give their life a sense of meaning and purpose, then there is a reason for the medication to be prescribed — appropriately.

    Oh, and about doctors giving young people prescriptions? Guess what? I started having chronic pain in my 20’s. Hey, I’ve got arthritis in my feet, ankle, knees, hips, shoulders, hands, degenerative disc disease and cervical spondylosis. But, I should “just exercise.” Right? The medication reduces my pain and allows me to be more active.

    My expectation, which you should be able to see in what I wrote, is to gain quality of life through the use of medication. It is not to be “pain-free.” I will never be pain free. Thanks to my medication, I can walk despite the osteoarthritis in my feet, knees, hips and degenerative disc disease. If you haven’t had pain that made it hard for you to walk, then you can’t put yourself in my shoes, so to speak. You cannot speak for me, so don’t try to lecture me and don’t you dare presume you can judge me. You don’t even have that right. And I owe you nothing.

    Just because you had an irresponsible doctor does not license you to judge others.

  60. Tim Mason at 6:30 pm

    OK. Here is everyone’s chance to be heard by the Surgeon General Directly and instantaneously!
    Post your comments on his FACE BOOK PAGE. YES. He has a Facebook page and a place to comment about his statements.
    Copy and past your statements. NO ONE HAS COMMENTED as of 9:29 EST

  61. Judith Bruno at 4:43 pm

    Please start asking some real questions like are any real drug addicts no longer abusing drugs with these policies because we know that Prohibition does not work?If you take away a drug addicts drug of choice, in this case pills, they will turn to whatever they can find. Those are fact! The country is so concerned over the raise in heroin addiction and you will find, that the raise is directly connected to these policies as they will and are turning to heroin and now our government is supporting the Drug Cartels who will get a drug addict anything they want just as the “Mob’s” did for alcohol. Did we learn nothing from history?

    Why is the life of a drug addict more important than the lives of those who are in pain? This is about quality of life, a life that is worth living. Suicides are on the raise and will continue when that life is not worth living.

    Why are politicians acting as doctors in the decisions of what is the best way to treat us?

    Mothers can no longer care for their children and bread winners no longer able to support their families. Who is going to pay for that care and where will that money come from? Who is going to care for those like myself who strive to stay independent and live within the boundaries of our disabilities but can no longer do so without the pain relief we need?

    Health Care in this country is going to fail under these policies and it must when doctors refuse to take on patients who are in pain, clinic are closing and good doctors can no longer treat their patients in the way they know is best without fear of prosecution? Who are they going to blame for this? Obama Care? Someone must be blamed for the failure of our health care system to deal with those who are in pain.

    Chronic Pain is a disability and we are being discriminated against because of those who will and do abuse drugs just like any religion or race who is discriminated against because of the actions of a few. We need someone to stand for us, talk about us, do something for us in this losing war on drugs.

    We are told that 13% of Veteran’s abuse drugs but what about the 87% who need relief from pain and now can’t get that relief? Chronic Pain can and does kill and those who can no longer deal with a life in pain 24/7 will take their own lives and Veterans are the most vulnerable after the horrors of war. America makes these Veterans and makes the pain they now live with and yet we are turning our backs on them and telling them there is nothing we can do for the pain they are in.

    Why aren’t pain patients given the same rights as others to decide what is the best care for their problems? Politics needs to stay out of our relationship between our doctors and the care we need.

    Please do your jobs, do it right, look into the problems these policies are making that no one will talk about because of the fear of supporting drug addicts but we are NOT drug addicts, we are patients who need help.

    Please look into the politics of all of this as we know the reasons behind this attack on pain medications after losing the war on Marijuana, which will become legal in this country, in order to validate their existence and the billions of dollars wasted in this losing war on drugs are now attacking those who are in pain. Look into the big pharmacies and the fight against them and yes, they need to be held responsible for never finding cures but only drugs that mask the symptoms to make more money but taking all of this out on those who’s only sin is that they are in pain, is not the right way to fight any of these injustices.

    Please, think of the quality of life of those who are suffering in pain and think of your families, your parents, your children and how you would feel if they were suffering in pain and told there is nothing that can be done.

    Help us, help the millions of American’s both Veterans and civilians alike who are actually being tortured because of these policies. Please look at all sides of this war on drugs and the dangers of drug abuse but remember, there are millions of us who need relief from our pain. They can’t fix the problems, can’t give us what we need to live with any kind of quality of life without the pain medications that are available so why are they torturing us?

  62. MichaelL at 4:10 pm

    Sorry, Cecelia,

    You need to become a little more well versed in the proper treatment of chronic pain, before you start making suggestions on treatment. Part of your “education” seems to have come from people that know nothing but eliminating pain medication as a proper treatment of chronic pain. Who are you to decide which patient “deserves” therapy? How could you possibly understand when you think exercise is going to work for everyone with fibromyalgia? Each patient is unique, and deserves careful evaluation before someone decides they don’t exercise enough, or are “too young” to receive therapy. My niece had a severe pelvic fracture, after an auto accident, before she was thirty. The nerves, of the lumbo-sacral nerve plexus, were damaged by the shattered bones of the pelvis that were torn apart. There is no cure for neuropathic pain, so far. You sound like you had someone willing to care enough to work with you, as a partner in you therapy.

    Why should anyone listen to you when you don’ even know the proper definition of addiction?! I have never seen a patient wanting to be pain free! Most people I knew were happy to be able to get off the couch, out with their families, enjoying activities that too many take for granted. It was rewarding to hear a young girl say, “I got to go fishing with my daddy last week!”

    You sound self righteous, bragging on how little medication you use. (It is a lot more than many people need!) You don’t even realize that the use of Xanax with chronic pain medications were linked to sudden death!? If your pain was adequately treated, you should not even need the Xanax. That seems to be a crutch you use! I know many people who weaned off of the pills, when it looked like they were going to be cut off. Tapering is possible. Addicts would not do that! You see, they have a compulsion to abuse the drugs, in spite of negative consequences of their use. I just can’t figure out why you need any pain medication at all! Maybe your doctor is still giving you too much medication! You must be one of those “irresponsible patients” that you mentioned in your comment. People have a hard enough time dealing with their chronic pain. They don’t need amateurs like you telling them that they are not getting proper medical care!

  63. Tim Mason at 3:33 pm

    Copy and paste the link above in your browser. This is the kind of misinformation Dr. Murthy is spreading. Many of the comments the readers make will make you angry.

    He tells a story about a man that is happy he got diagnosed with cancer because he knew he would be getting strong pain medicine.
    Judge for yourself.

  64. Cecelia at 2:43 pm

    Excuse me you all claim not to be addicted here? Why than would you be sick from a doctor tapering your medication down? Because you are in fact addicted. Let’s say you are taking 6 pills per day, 2 or 3 would be just for maintenance to keep you from withdrawal the other 3 or 4 would be for pain and that is exactly why tapering is not working for you. I know I have been through it and I can guarantee you that you are in no way suffering in pain more than myself. You are a slave of these pills as a heroin addiction is to heroin. In my post below I meant to post I was on 180 – 30 mg roxicodone, 90 – 80 mgs oxycodone time released and 120 xanax bars per month. This was pain management. When my medical doctor realized the amount of narcotics I was on her weaned me down slowly to 120 – 30 mg roxicodone and 90 0.5 xanax per month! He saved my life. This was irresponsible prescribing by pain management. I was in other pain management’s that also had me on similar amounts. The pain management doctors and irresponsible patients have caused these restrictions. It was tough but I remain at my dose of 120 – 30 mg roxicodone and 90 – 0.5 xanax per month by my medical doctor for 6 years now. Exercise eat right cut back and bear some degree of pain as no one can be pain free totalling. Do you realize if we kept going at these high doses of narcotics there would be none left for those in true need. You outlooks are very selfish!

  65. Mark Ibsen MD at 2:28 pm

    Here is what I just posted to Dr Murthy:

    Dr Murthy:
    Please do some of your own research.
    Read the IOM report on pain in America.
    100 million Americans in Pain.
    Your letter suggests that we can get out of an epidemic of heroin use by restricting access to legal helpful opiates for patients in pain.
    There is NO EVIDENCE that this will work, or even that there is an epidemic of problematic prescribing.
    There IS an epidemic of pain, and I beg you to re look at the issue, gather some reliable data, and follow the money.
    The CDC itself is vulnerable to a huge loss of credibility- promoting a set of “guidelines” that are based on low level evidence.
    Because of multiple factors, prescription opiate numbers have been decreasing for four years.
    Yet heroin use increases, and
    Doctors don’t prescribe heroin.
    Prohibition creates new black markets and cartels.
    Pain patients who need pain meds based on decades of governmental pressure to increase pain prescribing are being summarily dropped.
    This concentrates pain patients into clinics where more prescriptions are written, and these doctors are then pursued by DEA and state boards.
    2 of my patients have died since I stopped serving the pain population.
    Doctors are failing their patients by failing to adhere to their Hippocratic Oath.
    And patients are being abandoned

    Please read these books on the subject
    Pain in America by Judy Foreman
    A Painful Truth by Dr Lynn Webster
    Needless Suffering by Dr David Nagel.
    These blogs:
    National Pain Report
    Pain News Network
    Pharmacist Steve

    These are Human Rights Violations going on right under our noses.

    Please help us help our patients.
    Doctors know what to do.
    Regulators and agencies do not.
    Please help us preserve the precious
    Physician-Patient relationship.

  66. MichaelL at 2:25 pm

    “My mother” had “pain” from the dorsal column stimulator!

  67. MichaelL at 2:24 pm


    y mother had a stimulator and she had nothing but more ain, mostly in the site of the “generator” implant! They might work 30% of the time. But, they also could worsen the pain, as it did in my mother! I had one guy lie about using all forms of treatment before he wrote a letter to Medicare telling them that I had exhausted all treatments! He had tried nothing new, at all.

  68. Cecelia at 2:18 pm

    I would like to start by saying that I have been a pain patient for 30 years. I agree with much of this letter. Narcotics mainly by pain specialist definitely were being abused for many years. Pill mills over prescribing and patients who really should not have been on narcotics seems to have died down quite a bit recently. Patients were being prescribed long term narcotics for things like bad knees, simple back pain, hip pain, dental work ect. If you have a condition that can be fixed get the surgery done, bad backs fybromyaliga exercise is a big factor not just for the mentioned conditions but many more. We need to set reasonable guidelines to access to narcotics. Things such as cancer related pain, spinal fusions ect.should be exempt and still kept at the lowest dose possible as we will all have some degree of pain due to aging scar tissue. Narcotics are for non-curable diseases and trauma in which all alternatives have been exhausted. Things like eating right, exercise, physical therapy, corrective surgery and acupuncture should all be exhausted. At one time I was on 180 mg of roxicodone, 80 mgs of time released oxycodone and xanax bars per. month. In my many years of pain management I witnessed too many doctors prescribing to young people. That is needless. The problem is you build up a tolerance and when you really need a narcotic it will not work. Also I have read post about resetting receptors, never hearing of this I promptly investigated. To my amazement there was such a thing to keep doses at a minimum, if I had known this I would have requested it. We have drugs like suboxone and methadone to aid in resetting them. I definitely became dependant to the narcotics a slave to them just as a heroin addiction. Please people narcotics are for the incurable and by all means should be kept to a minimum. Eat right exercise and only take a narcotic if absolutely necessary we will all suffer pain as we age. Too many patients were selling their narcotics and most of them were older people doing this. Let us true pain patients help the Surgeon General in his well meaning fight.

  69. Candi at 1:25 pm

    Right at this moment I am in a pain management and treatment center with my adult disabled son to get his Spinal Cord Stimulator surgery set up. We gave been bounced from doctor to doctor in this organization due to poor office management and the continual issue of doctors leaving this facility. I helped my son fill out 2 forms with more than 25 questions on each that were to determine if he was an addict. We’ve been with this group for 8 months and he has to go through this procedure which I feel is ridiculous and demeaning. They ask about sexual abuse, friendships, family issues, happiness, low self esteem etc, etc. I told him that the facility was trying to determine if he was a person susceptible to opioid addiction. As his mother I feel so badly for him and having to suffer due to this entire political faux pas.

  70. Bill H. at 12:31 pm

    And so the saga continues. This time a personal letter from the Surgeon General, WOW!!! He is so concerned about the zillions of people who are dying minute by minute from the evils of opiates. Instead of “Reefer Madness”, it now should be called “Opiate Madness”. And that little personal touch about his fellow physician and friend, the cardiologist not knowing that opiates are addictive, PLEASE, spare me the garbage! Big Brother is here and flourishing! Does this Surgeon General realize that there is a condition called Chronic Pain Syndrome which encompasses fibromyalgia and other painful conditions, and that the FDA approved drugs such as Lyrica for the most part does very little in easing the unbearable 24/7 horrific pain? Those lucky few who do find relief with these meds are very fortunate, but for those like me who cannot tolerate the side affects, the oxycodones are the only meds that work reducing my pain greatly. Having to retire way earlier than I ever wanted to, I found that to keep my sense of purpose, I do volunteer work with other fibro patients, but on days that the flares are way too much, I can’t even think straight. My doctor cut my meds in half for the first month. I actually for the first time considered euthanasia as the pain was unbearable. The following month, I told my doctor how horrible it was for me, I actually needed a walker to get around whereas a cane worked before. She realized what she did, and raised the numbers of oxycodones to be 1/3 less than I was originally prescribed. She also retired soon after because of the governmental control (besides the opiates) where she can no longer practice medicine the way it should be done. I also have known of three cases so far within the last few months of patients with the Chronic Pain Syndrome committing suicide because they couldn’t live another day with the pain. I do not understand why all of this is happening, those who are prescribed the oxycodones are careful with the meds, not taking extras nor passing them out or selling them. We are viable people with a horrible condition, this is not our fault yet we are being punished (forget the addiction is an illness as it doesn’t relate to us) and treated like addicts going to pain clinics, not being treated with compassion, but with tough love! I cannot buy into this letter, it’s an insult not only to the doctors but also to us as well! If my new doctor trys to cut my meds back even further (I know my limitations), then I will send a letter to this Surgeon explaining what the feds are doing, and to let them know that they will receive a copy of my obituary when the time comes (not that it will do much, but who knows?)

  71. MichaelL at 11:13 am


    That is just plain blackmail! They are saying, “You come take our classes and pay us to tell you 90% of what you already know, and we will consider treating you like something more than an animal!” it sounds like a great way to get rich and screen out a lot of people that would be hard to treat anyway! It just sounds like they are there to make money off of the sick people.

  72. Dave at 10:43 am

    @ Signe. There’s a short and a long answer to advocating for oneself. Certainly, it begins with what your values, beliefs, ideals are with respect to pain care- which I refer to as “vision” and what’s your game plan- which I refer to as “plan”. And like Helen Keller wrote- It is a terrible thing to see and have no vision. Focus on a vision of a much better future and work towards that vision. Isn’t that an important part of life-regardless of being in pain. I think so. What are we without ideals and a vision.
    As the saying goes- people perish without a vision-and so its important to have one- or else you have no compass or no “true north”.
    As for a “plan”- that involves strategy and tactics. One needs to be careful, in this regard for we’ve heard stories of people being blacklisted by doctors. Complaints to medical boards can also backfire-but that doesn’t mean I am opposed to speaking up about being dissatisfied about ones doctor or to state board of health- its not just what you do but how you do it that matters. I always recommend, when possible, that people in pain have someone they know go to their doctors appointments with them. And I have gone to many on behalf of people in pain and had success in getting doctors to improve pain care. Sometimes, though, I have recommended changing providers.
    Its important when advocating to be honest and not overstate or understate. Its important to understate that the sorry state of affairs in pain care didn’t happen overnight and is not some aberration or oversight. Poor pain care is part of our invalidating and dismissive modern culture that views people in pain as serfs whose rights are determined by institutions and the powers that be. And so, just as with women’s rights, labor rights, animal rights- they are not given by modern society out of the goodness of their hearts- they are the results of serfs demanding and fighting hard for them to receive legal rights that free them from the bondage of serfdom. And so I believe, not in tweaking our pain care system- I believe it needs to be transformed by establishing people in pain as a protected class and afforded rights under strict rule of law. That would involve less professional domination in pain care and more medical consumerism. It is the modernistic professional/institutional model of pain care that has made people in pain dependent and subservient serfs without rights. To obtain such rights both federal and state laws would need to change-but failing that people in pain will remain subject to the arbitrary dictates of those professionals and regulations that are as disempathic and far removed from people in pain as the cdc opioid guidelines. So people in pain, in my estimation need to start a pain rights movement, join and create social and health justice movement organizations. People in pain need to have much greater social and political capital then they have now. They should realize we live in a world where big brother largely dictates pain care and the rights of those in pain. And while people in pain might have been born free- they live in chains-and the powers that be will make the chains heavier then before. And just imagine what may happen as the economic downturn comes and government implements more cost saving measures- who do you think will suffer- those with HIV/AIDS- or people in chronic pain?
    The longstanding neglect of people in pain by government and professionals has gotten us where we are today-and now, I am sorry to say- people in pain are burdened greatly by this terrible neglect-and if they want change and real improvement- don’t expect professionals or government to break their heads open to create the symbols of a new day for people in pain. Its up to people in pain to work alone and together, and it will be a terrible struggle, before a new day dawns for people in pain.
    People in pain can send $5 to pain care organizations-mark it for establish new rights for people in pain. They can continue to start and sign onto petitions, write to their legislators, medical boards, departments of health, insurers, dea, providers, the media, create videos, create and join social movement organizations. People in pain, need to do what they can- some can do a little- some can do little. But its foolish to believe someone else must stand up for the rights of people in pain- we all need to do what we can. We need an indomitable spirit to deal with pain-and a society that doesn’t care much for our painful burden.
    We can learn from past rights movements- the women’s movement, civil rights movement, labor movement, occupy wall street, animal rights movement. We have the great benefit of learning from past mistakes and successes. I read somewhere that pain is a fiery trial to endure patiently for something new to be born. We must find a way not only to endure our pain but a way to overcome a negligent and invalidating society. What other choice do we have? There are no quick formulas and fool proof methods to ensure success in pain care.
    I know its an uphill climb- but don’t stop- the view is beautiful at the top.
    Sweet hope be bold and thru all obstacles and thickets break-and though my heart is filled with wounds and care- Ill not despair- but one day soar into the heavenly air.

  73. Tim Mason at 10:09 am

    The Surgeon General just wrote an article in the Boston Globe. It shows what an uninformed person he is. Hard to believe he is an MD. But he is just 40 so go figure.
    What is even more disgusting are the comments.
    Check it out

  74. HJ at 9:43 am

    Someone said to refer us to pain management clinics. Problem is, the local pain management clinic told me I had to come back three times a week for three or four hours a day.

    I’m still working. I’d lose my job over this!

    I tried to get some individualized help rather than their “fibromyalgia class” that was that unmanageable time commitment and they said, “If you won’t take the class, we’re not going to help you.” I got turned away. I can come back if I can commit to the class.

    This is not fair for people who work. Having chronic pain is stigmatizing enough, but why should I have to sacrifice my job to get treatment? Isn’t the point to KEEP me employed?!?!

    Pain management is a broken system. It is not the answer. I see a physiatrist (a doctor of physical medicine and rehabilitation).

  75. Signe Topai at 8:42 am

    Right on Dave, I totally agree about pain patients needing t o get more involved! For those totally bedridden and at a 9 everyday , you have my prayers and a pass but for the rest of us still receiving our meds and functionally ( what ever that is with chronic pain), get going, get mad, educate yourself and get involved! Because if you don’t, we will be next ones to get a pass. So Dave, Thank you and please make a few suggestions were to start our journeys on advocating for yourself.

  76. Amy Hartmann at 7:56 am

    I don’t have a lot of additional thoughts or information to add here – but as a pharmacist, I am outraged by these “guidelines” – and not just the guidelines, but the fact that the government is (IMHO) far over-stepping their bounds in this arena. My personal experience with chronic pain is with my mother, who does not take opioids because she cannot tolerate them. However, from a professional perspective, I have pain patients EVERY DAY who can no longer get their prescribed medications from their local doctor. He has taken the guidelines as law (which is not uncommon, really), but if you used to get hydrocodone for pain and Xanax for anxiety, you are out of luck from him. He is referring you to a psych doctor now (so I guess its ok to take the Xanax – just not from him). Nor can you still get Valium for intractable muscle spasms from him – he says “just take another prozac, it will help”. These guidelines have relatively good physicians forgetting how to practice medicine and leaving a lot of patients in the lurch. And yet that same doctor will prescribe antibiotics with multiple refills….(that is a different rant though).

  77. pain sufferer at 6:06 am

    Why is this man who has no idea what chronic pain is asking docs to reduce the amount of pain meds prescribed? If he had any idea what it is like to live with it, I would think he would not ask this.
    Why is there a rise in people who need it? How about the degenerative diseases that are out there because our govt used us as guinea pigs to test out their great GMO products without OUR KNOWLEDGE! which now has created this pain issue for millions of sufferers.
    I have to be driven to my pain doc who is over an hour away. Even with all of the meds I am on, I can not comfortably drive myself that long to go anywhere.
    What will happen when we have an even higher suicide rate because people would rather die than suffer the pain? Why is the govt involved in this issue at all? They know and can identify each person who takes these meds. Why? Because the pharmacy tells them. Leave us alone you surgen general. You have no clue.
    Politics, big pharma, big brother are all in bed with eachother they all need to stay out of our business.

  78. Marty at 5:41 am

    Some here like to attack and belittle those who suffer while patting themselves on the back for all the good “work” they have done. IMO it is better to help someone up than kick them while they are down and trying to make money doing so.

  79. Jasmin Days at 7:57 pm

    I have had 2 lower back surgeries and all that happened is that without the meds that I get, I would not be able to walk like a normal human being and in constant pain. I have tried everything from epidurals to physical therapists, which made my back issue worse. Yes, maybe doctors in certain situations have given too many pills in one prescription, but that is not in everyone’s case.
    Shame on you for what you are doing to us!!!!!!!!!! Especially to the doctors that are afraid to so-called give us our prescriptions that we have been on for years. Refer us quickly to pain management clinics and be done with it!!!!!!!!!!

  80. HJ at 5:49 pm

    My work is a source of my personal identity. It gives me purpose. The day that I am unable to work, Lord help me. The medicines give me the ability to do things that give my life meaning. Does that mean I’m an addict? No, it sure as **** does not mean that. I pray that no doctor would confuse wanting access to medications that allow me to do things that matter to me with addiction.

    But, some will. Surely… there are doctors out there who don’t understand. DO NO HARM. Really, have a look at whether medications are helping patients live a better life, or if the medications have been causing harm and destructive tendencies.

    I’m afraid. Last time my job was in jeopardy, it was because doctors didn’t even tell me my diagnosis and wouldn’t treat it appropriately. I struggled at work. I planned to commit suicide. Then, by some bizarre intervention of (fate?), I met a doctor who gave me a diagnosis and a direction so that I could obtain treatment. Treatment that I DESERVED.

    I still deserve treatment. I’m frustrated because it’s hard to fight the system. I thought that I fought it once and was relieved to not face that burden again. But here I am.

    Take away my treatment, you take away the things that give my life meaning. I will most likely commit suicide. And it’s not because I’m addicted. It’s because I want to live my life despite my pain.

    Don’t think you’ll send your patients to therapists, either. The cost of therapy is prohibitive. I’m glad I went before there were high-deductible plans and outrageous copays.

    I would rather die than be forced to live with my pain when I know… I absolutely know… that I had a treatment that worked for me and it was taken away, and I am powerless to fight the system.

  81. Jonathan Gardner at 4:30 pm

    First of all I have cebrel palsy on my right side of my body from head to toe, which mades my right leg 2cm shorter than my left leg I have four blown discs , the rest are worn badly. I have nerve damage in my upper back and lower back and other problems due to CP. I am very careful and stick to my Doctor and state law rules taking my meds. My doctor makes us bring our pill bottle in at each monthly appointment to make sure I’m not taking any extra pills which I don’t mind also a pee test. I don’t drink or do any street drugs. I been going to the doctor since December of 2012 . Before I was taking pain pill I could only walk about 600 feet a day and the rest of the day I was lay down on my bed. Now I can walk with a cane 2 to 3 times a day 3.0 tens of a mile.

  82. Steve at 3:40 pm

    Like everyone else here, I greatly appreciate Dr. Goodwin’s advocacy. At what point did most American physicians agree to give up control over their patents’ medical care and hand it over to insurers and government? We must be attracting a different group of people to the profession. My doctor is retiring after 30 years because he was told he would have to reduce his pain med prescriptions by 80% next year. Most doctors here in MA will not prescribe opiates to anyone. Addicts get the front page, pain sufferers get the door and days full of misery.

  83. Dave at 3:23 pm

    Violet- such critical responsiveness- i knew i should have consumed an anaplerotic diet this morning to ensure my dorsolateral prefrontal cortex would be methylated enough for assertion and rejoinder.
    There are some of us working together to take legal action to improve pain care. We have not, as yet opened it up for all to join. You are free, of course to make your own petition- I created the American Pain Rights Act Petition in 2010-and yeah working n another book- Pain Care IN America- Cant Get it Right- and yes I do criticize people in pain for not being more active in improving pain care. There are very passionate and capable advocates- who have been working hard to improve pain care. But too many peoplein pain sit on the sidelines and wait for someone else to take the inititiative or excuse themselves because they are consumed by pain. And yeah Ive been in chronic pain and back. But i wont sit on the sidelines and wait for government or professionals or advocacy groups to take action. In the NAtional Pain Strategy- my cmments have a vision and a plan- whats your vision and plan to imprve pain care? I challenged the 80 who created the NPS t have as the main goal to lower the prevelance of all painful cnditions- and so I was successful(along with aother individual) I didnt wait for medical organizations or advocates to call for education in pain care in NYS- i got three bills in the NYS legislature- now doctors are required to have education in pain care. You dont have to be Longinus,Demosthenes or Lucretius to advocate for better pain care- you just have to care enough to make the effort.
    And yeah it is only painfully obvius that too many people in pain are cursing the darkness annd not trying to light a candle when it comes to improving pain care.

  84. H HEROLD at 2:16 pm


  85. george at 1:04 pm

    After 2 spine surgeries, herniated disc, laminectomy, 65 yrs. old, the meds
    prescribed keep my pain at bay. I have had back problems for some 50 yrs.
    If i am being monitored by my surgeons and my primary care MD, I think
    they know what is best for me and the maintenance I am on.

    I think to cut off senior citizens , or anyone for that matter should be against
    the law.

  86. Jo Dawn at 12:40 pm

    I had been carefully considering my comment as I read the excellent comments of others.
    (Special thank you to Michelle H for the contact info!!)

    Then I got to Dr Goodwin.
    What more was there to say? And I certainly couldn’t have said it better.

    I’d love to have a better pain doc. Unfortunately I have to drive over an hour one way to see the one I have. Then the next day drive 30min in the other direction to the pharmacy that has known me for 13 years and won’t give me problems.

    It is a true shame that in the land of the free, so many of us are afraid to try and find a better Doctor, because we might not find one and lose the one we had in the process. 😢

    All I can say is, hang in there, everyone. If you are using prescribed meds for a real diagnosis, don’t let others call you an addict. Use every chance you have to build on any relief your meds give you. Whatever that might be. Massage, hypnosis, talking to friends that make you laugh. Read books that take your mind off the pain, as much as is possible.

    I believe too many of these overdoses are intentional, from pain patients that couldn’t take this kind of crap anymore.
    Don’t give up!

  87. Amy at 12:37 pm

    My doctor told me that all people taking opioids for pain are selling them to make money and that is why all the American children are druggies. That is really upsetting to me. I never sell my meds and I can not take gabapentin or Lyrica. Those two drugs caused a serious reaction to me and make me insane. I’ve done aspirin until I have messed up my stomach and Ibuprofen until my stomach was permanently damaged. They didn’t help very much either so I was taking a lot to just be able to walk. I then went to tylenol until the doctor said my kidneys were dying from the drug. so I take the lowest dose of the hydrocodone to keep on going to my best ability.

  88. Violet at 12:30 pm

    “@ Dave” (when did it become so wrong to address people simply by their names?): Now the truth comes out – another book in the works. (I hope you also employ a very good editor; you’re going to need one.) I read on the other pain site that you are not a pain patient and wondered about your persistent presence.

    And quite frankly, your response in another section, where Pharmacist Steve advised that “it would take but a handful of advocates … to create a ‘legal war chest'” to someone who inquired about it irked me – “were [sic] working on it,” you said. Who is this we? Then, in practically the next breath you mention our need to donate. Who are we supposed to be sending the money to – you? If it existed, I believe we would have had our checks written months ago. Most seemed pretty excited about it.

    I have been meaning to ask that very question. If it is only that many advocates needed, why have they not yet banded together on our behalf to get it started?

    In addition, first you disparage the idea of reporting to medical boards (a practice I also happen to disagree with, for reasons I’m too angry and worn out to get into), yet days later, you essentially claim it’s a great idea. I take offense to being called morally and mentally lazy.

  89. Crystal Grieves at 10:46 am

    Where do I even begin? Maybe first I’m scared to death to go back to unbearable agony. I’ve already lost my job, friends, and many other things due to my medical issues.
    So now, I can almost guarantee I’ll have to find a new Pain Management Doctor. He’s already fed up with the government butting into treating people who need their meds.
    I’ve been on the same dose and amount for over 2 years. It’s just enough to help me be able to function at home, and I’m still in pain.
    I won’t be able to drive every month 1 to 2 hours one way for a new doctor. Especially when my husband is at work, and right now it’s a 5 minute drive, which I can handle on my own.
    I’m scared as what will happen to me. I don’t want to go back to being in bed for weeks and let alone the emotional state I’ll be in.
    So what then? This is politics, not medical. Deal with the addiction crisis, by calling it that. Throwing us Chronic pain patients into the mix is only going to cause more problems. I’m not an addict, I pass drug testing and sadly my insurance company doesn’t pay for those tests. I haven’t been approved for Disability, I’m still appealing since 2013, so with only 1 income, no assistance from any Government or Local programs, we barely get by. I’ve had to choose medications, drs co-pays, or make sure my son has what he needs. So yes I’ve had to suffer even more to make sure he is okay and fed, clothed, and try to keep the house.
    Where is the fairness? No I will not take that pledge, why would I or SHOULD I be part of something that will be devastating to me.

  90. Donna Rubinetti at 10:00 am

    Thank you Dr. Goodwin for your comprehensive and brave response to this post. Chronic pain patients need advocates like you. I suffer from a severe case of RSD/CRPS. I dislike taking opiods but do so on an “as needed” basis as prescribed by a board certified pain management physician. I am a mental health provider with extensive training and practice with the substance abuse population. There is a significant difference in opiod abuse, dependence and addiction (DSM V).
    I find it interesting that few people, lawmakers, health care professionals fail to menton the proven dangers of tobacco and alcohol. Those substances cause many more deaths than opiods, but they are acceptable.

  91. Kevin Byrne at 9:59 am

    I have been clean and sober for over 37 years. My addiction was and is on me, no one else. It is very discouraging to see this war against people in pain, waged by the press and parts of the medical establishment. Leave these poor people alone!

  92. Michele H at 9:49 am

    All of these comments r great but the surgeon general won’t see them. Take a moment and send them to him via mail or fax!
    VADM Vivek H. Murthy
    U.S. Surgeon General
    Fax: 240-453-6141
    Mailing address:
    Tower Building
    Plaza Level 1, Room 100
    1101 Wootton Parkway
    Rockville MD 20852

  93. Dave at 9:47 am

    @ Jeremy Goodwin being a government official or professional doesnt make one immune from human vices and is no guarantor of virtue. Professionals and government have suffered from denialism for sometime in pain care when it comes to their vices and lack of virtues- their excesses and deficiencie. The opioid debacle has revealed such-and now the private troubles of people in pain are public. And like professionals and government people in pain have their vices. They put too much faith in the market and government regulation. They now compalin somebody has to do something(but not them- no- not on their block or in their neighborhood). So government blames providers and providers blame people in pain and people in pain blame providers and government- its a viscious circle- Moe Larry And Curly and makes for theater of the absurd or Greek tragedy.
    Its time for individuals in pain to get off their behinds and realize their moral and mental laziness fueled the moral and mental laziness of government and providers. I know that some people in pain are making the effort- put too many are still sleeping. Like the title of my upcoming book reads- Pain Care In America- Cant Get it Right.

  94. MichaelL at 9:29 am

    I find it sad that any doctor would say that they were not taught that opiates were addictive! It is very telling of the intelligence level of US doctors! Having seen movies involving addiction since I was a young child, I cannot fathom such ignorance. That is, unless people, like the surgeon general, have no problem lying about that fact. There is no way in the world that I can believe any doctor does not know! What they will eventually see in history, is that the medical profession has forgotten that one of it’s most important function is to relieve suffering! Now we have doctors who think it is acceptable to lie to “win” this war against chronic pain patients, in the US! I learned about addiction when i was a young child! I learned , as a physician, that dependence was not equal to addiction. This change in definition of terms describing “drug abuse” are base on nothing more than emotion. Why would you punish patients, 95% of whom never become addicted? It sounds sadistic, to me! If the surgeon general wants to really help, he could work harder on preventing alcohol addiction, since it kills ore people , every year, in the US! But that won’t ever happen with alcohol elitists running the show!

  95. Kimberly Cornilsen at 9:02 am

    barking up the wrong tree! I think we as pain patients need to write this man! Does he know that drug users and sellers have no fear of being caught? Does he realize that Alcoholism ruins more families? Erggggg

  96. HOWARD H. HEROLD at 8:06 am

    Dear Dr Murthy: Iam 64 years old, ive been on Opioids since 1990, due to two failed Back Surgeries,one a Lamenectomy, 40%of Disc remove at L4/L5 and then a Fusion which has failed, so i have Two Surgeries that have had put me in pain for over 16 years, my Meds are not abused, i think alot of this opioid abuse is from Doctors not performing different procedures correctly, plus you have all these Doctor shoppers. What, you need is a name bank of people getting Opioids from different Doctors constantley. Now, im going to have to suffer more because of certain Doctoers and the people just wanting to get high. Thank you for your time.

  97. Maureen at 7:31 am

    Opioid are addictive without abuse!!! Very misleading and grossly negligent reporting. It’s because of this type of reporting that people continue to overdose and die including our Medicare patients. Is grandma and grandpa junkies and abusers? Get the facts and report the truth. Medicare injury and death from opioid overdoses are 3x’s higher that the marginaluzed population you continue to sensationalize. And remember, you need to be careful using the word abuse. Abuse is a behavior of ADDICTION. legally prescribed taken as prescribed. Reports like this allow this epidemic to rage on. Shameful.

    FROM This reader identififed a one-word editorial error that resulted in an unintentional and misleading statement. It has since been corrected. We thank this reader for pointing it out.

  98. Tim Mason at 6:54 am

    excerpt from Turn the TideRx dot org.

    Opioid Use Disorder & Overdose Risk

    Opioid use disorder, also referred to as addiction or dependence, is a medical condition that characterizes the compulsive use of opioids despite negative health and social consequences of continued use

  99. Lana Kirby at 6:33 am

    When will you acknowledge that 14 million Americans are suffering and dying due to your “war”? People are being abandoned by doctors afraid to write a script. DEA shuts down pain mgt facilities leaving 8K-25k chronic pain patients on the street with no medical records; nothing but a letter – and expect them to all find doctors without their medical records (which have been siezed). You’re putting these people out on the streets. If they can’t find a doctor, I suppose they’ll do EXACTLY what you want NOT to do. Go to the streets for pain relief. Why are you doing this to people? Don’t you understand these are severely ill and injured people. Why do they have to lose the very medicine that allows them to function. They pay their taxes; they don’t take more than prescribed; they don’t sell to the streets. NOW WE HAVE hospitals turning people away from treatment, only to fall to their deaths, handcuffed in the parking lots. We have Veterans committing suicide in the PARKING LOT of a VA hospital due to being denied care for PTSD. CLEAN UP YOUR GOVERNMENT AND DO THE RIGHT THING FOR THESE 14 MILLION AMERICANS SUFFERING & DYING AT YOUR HANDS.

  100. Joan Hamm at 6:28 am

    Did you take the time to tell Doctors not to I interfere with the medicines tested on each patient officially until the pain patient found help after months of suffering… Calling 911 regularly and screaming in pain u til they found medicines that go right to the damaged area and eases the the pain so on can function and not perish screaming in pain. These patients also had their doctors confer on 3 way calls to a Doctor wrote books on RSD CRPS and Scientists to confirm these meds work for real pain sufferers such as RSD CRPS… Cancer…. Fibromialgia. RSD pain can be worse than cancer studies found. If the government can come up with a real pain medicine that works is the answer…but not all meds work for each person. For example Ketamin shots do help most RSD CRPS patients BUT only if given quickly to the patient and treatments until pain gone. But education… Dr availability.. Travel to a Doctor Who Knows is educated by this horrible pain disease!!!! Many Veterans have RSD CRPS. Now if a Soldier has pain from an injury they now know to treat with Ketamin right away.. Hence your study list going down in size. But not for an ordinary Citizens who no one knows what RSD CRPS is!!! Pain is severe like Hard Labor or can be worse pain than Cancer. Pain medicines for these people who did all the right things to determine finally a name for the disease. P. S. So. Symptoms are the same for RSD CRPS varying differently in pain or injury degrees. It spreads it’s pain and attacks ones body when one is injured as small as a splinter. If anyone who has RSD CRPS receives a splinter its pain is 10 times worse than one who does Not have RSD CRPS!!!! If these victims of any severe pain disease is taken off or reduced which is finally proved to be okay so we can still do good in our lives and function you will be playing God and you will also be murdering those who are unfortunate to have these diseases who are finally receiving help. You need to go after the drug dealers who knows these pain abusers as you call your endeavors. Many drug overdoses are due to that and Improper follow up or plan not good for one who leaves a rehabilitation Center. Or improper meds given to these people who DO NOT have a real pain disease. You will be severely I injuring innocent people. You say time wll tell… Well time will tell and I do predict it will cause problems for unfortunate pain sufferers. And may cause lawsuits.

  101. Jud at 6:07 am

    “Years from now, I want us to look back and know that, in the face of a crisis that threatened our nation, it was our profession that stepped up and led the way. I know we can succeed because health care is more than an occupation to us. It is a calling rooted in empathy, science, and service to humanity. These values unite us. They remain our greatest strength.” Really?
    How about, “Years from now, we can look back and know that we, the medical profession and the scientists, put our energy, our brains, our money, our education, into finding a cure for chronic pain diseases, we ensured that surgeons and anesthesiologists did not make mistakes that led to Complex Regional Pain Syndrome, we did not dismiss a patient who complained of pain.” No? Nothing? Gee. Oh, no, wait, you did do something; you have a new disease, “Opioid Use Disorder”. And you still think the public will “look to your profession for hope during difficult moments”? Wow.

  102. Joanne O'Brien at 5:59 am

    I have been a Chronic Pain patient for well over a decade, and it has NEVER been my experience that any doctor I ever visited was willing to write a prescription for mass quantities of narcotics… not ever. When all my over-the-counter and alternative medicine therapies failed to handle the pain, I was only allowed a small quantity that wasn’t equal to the pain I was experiencing. Being a 61 year old woman, I developed yet another chronic pain condition (IC) whose cause is unknown, no truly effective treatment options, not immediately fatal, and yet so painful that it had me wishing for death. Despite begging the doctor for an increased dose to get through my last episode, I was denied additional medication. I suffered for another week with pain that would drive most people to the ER, but I was afraid to go to the hospital because I could be labeled “non-complaint” with the state narcotic contract I was forced to sign. During this episode, I broke three teeth from clenching my jaws involuntarily due to the pain. I wouldn’t allow a dog to suffer what I suffered during that latest two-week episode.

    Chronic pain patients are now being treated like drug-seeking junkies on parole. For someone who lived an upstanding life, was a public school teacher and had a management job in high tech, this is a hell of a place to find myself in old age.

    Instead of addressing the REAL causes of all these overdoses… illegal street drugs, especially illicitly produced Fentanyl … federal agencies and state government are harassing legitimate doctors and pain patients as if we were the problem We aren’t, and that’s why the overdose statistics show a RISE in overdoses, despite all the new prescribing restrictions. The real problem is far more complex than doctors writing prescriptions (and by the way, has anyone considered that the rise in prescriptions for pain medications is that baby boomers are now experiences arthritis and other painful, chronic diseases of aging, en mass?).

    Street drug abuser are driven to alter their realty using ANY drug available due to a complex combination of psychological and socioeconomic issue. In fact, recent reports suggest that cocaine is making a huge come-back, and illicitly produced Fentanyl has become a more desired drug on the street than heroin.

    I beg the medical community to stop targeting Chronic Pain patients and denying them compassionate care due to a misguided notion that they are the problem.

  103. Tim Mason at 5:54 am

    Dr. Vivek Murthy, is 40 years old. Graduated high school in 1994. He got his medical degree from Harvard and a graduate degree in Healthcare Management in 2003. Murthy’s main focus in medicine was (is) women’s health care.
    Dr. Murthy has only been the surgeon general for 2.5 years. Murthy is an Indian.
    Being an immigrant, he received $90,000 to obtain his graduate degree.
    Being an immigrant Murthy received preferential treatment and was nominated for “Doctors for America” (a society for physicians that were green card holders and became naturalized).
    “Doctors for America” has changed it name to “Doctors for Obama” in order for the president to build his legacy.
    Any ideas Murthy has concerning an Opioid Crisis being related to over prescribing in merely his ” OPINION”.
    Murthy may have a skill set in women’s health but he is not qualified nor does he have enough experience to advise the entire United States medical profession about Opioid Addiction being related to overprescribing.
    Murthy simply does not have the credentials to do such.

  104. Signe Topai at 5:34 am

    Hear, Hear…finally the affirmation that addiction is a disease and not a character defect! Yes, teach our doctors about addiction and the appropriate way to help those who are suffering! I would gladly render any urine sample or blood test to validate that I am not abusing my meds used to treat my Fibromyalgia and Myofascial TP Pain disorder! Doctors take a pledge to due no harm! Pain patients are seriously harmed and the quality of life diminished when Doctors take away opiates meds to treat their chronic pain. Those who have the philosophy that opiates should only been given after surgery have not lived day in and day out with relentlessly stabbing pain. I have had two surgeries within the last three years and I would due surgery any day of the week instead of having these two disability disease. Why? Because with surgery I would know the pain would eventually go away. And who is to say my pain is, if not worse, than that pain with surgery. It is a proven fact, those suffering with fibromyalgia feel pain differently than those not stricken with this disease. And yes, Doctors learn how best to treat my chronic pain. I have done the physical therapy, dry needle treatments the epidurals, cognitive behavior therapy and hydrotherapy . Their results are as unpredictability as this disease…..either making my pain better or worse! So, Doctors bring on the urine cups or blood test. If this is the starting point to screen out patients suffering from addiction and those legitimately needing opiates for chronic pain So be it! Please don’t take away the only modilty of treatment that controls my pain and gives me some quality of life.

  105. Pamela Hansen at 4:22 am

    This is a very sad day when all that has givin a piece of my life back now you want to take the only thing that truly helps. Shame on this Dr and shame on all Drs that listen to this Dr. Go after the ones the abuse it not the ones that take it like it should be.

  106. Jeremy Goodwin, MS, MD at 3:38 am

    I have had enough of this political movement! What do I mean by ‘political?’

    Oh, Thanks , Daniel.
    First, addiction, like prostitution and abortion, corruption and domestic violence will never go away. Neither will black markets. Fact of life.

    The pressure brought about recently on clinicians from guidelines that are given and taken ( as expected) as ‘law’ has resulted in chaos because those with legitimate chronic pain unresponsive to other modalities, many of them who were doing better on opioids when well monitored and compensated for by HRT, etc., and weaned whenever possible, have been targeted to the point where suffering and not just pain has returned.

    There are indeed many, many clinicians who misprescribe, do so too early and do not monitor and wean. They need remedial education but the patients also need better care. Neither is happening. This movement to restrict is a sledgehammer.

    And most of the alternatives that are known not to work well enough, or have already failed, are often scorned by western clinicians out of one corner of their mouth yet now recommended by them because it helps get the patient out of the office. These modalities are also very expensive and / or are not covered by health insurance. The patient in intractable pain pays the price or has to have the opioid dose increased when an integrative approach might prove opioid sparing.

    If appropriate, and if successful trials are made, intrathecal pain pumps are used but they are not subject to the same scrutiny of oral meds with enforced random drops in dose and yet they are merely a different delivery system. Why?

    There are, for the most part, so many with chemical substance disorders who use or have used street-accessed drugs for their habit. They have always been there. Only with a white demographic shift has anyone cared.

    Since Reagan, we have literally wasted $10bn a year on ‘the war on drugs’ because the requisite 65% of more drug interceptions by US forces has never exceeded 18% ! That is a total waste of funds that could be used for treatment, rehabilitation and education.

    Most clinicians do not understand or want to understand chronic non cancer pain and hence have not learned how to do so. They are capable, but they do put the effort into other spectrum disorders because the psychosocial aspects are usually beyond their training and sometimes even their ‘talent’. They do better with other things as do most surgeons.

    Time is also a factor but there are ways to collectively change that corporate and insurance-controlled system that compromises the quality of care. Concierge care is but one example. Interdisciplinary teams are another. National health insurance with more time allowed is yet another. They can coexist.

    Anyway, these patients are to most clinicians similar to those with personality disorders who are shunned by many therapists, psychologists or psychiatrists: they are orphans. They are not wanted.

    By a political movement, I am pointing out that unlike the far bigger problem of gun deaths or even the 16,000 a year NSAIDS-related deaths almost totally ignored, the deaths from OD of opioids, most commonly in conjunction with alcohol , benzodiazepines and other CNS suppressants do NOT occur on average with with patients properly prescribed opioids for intractable pain, at least for the most part . The government statistics put that number at about 13% of the fatal overdoses. The rest are mostly those with problems of addiction ( not just tolerance and physical dependence). They are procuring the drugs illegally but are important too.

    True, the number of Rx’s is too high, a correctable problem with non draconian education ( see The CA Medical Board’s excellent 2015 summary written by an addictionologist-pain specialist and the principles that are at odds(!) with their own, CDC’s and other such mandates).

    The chance to endorse and jump on the ‘opioid epidemic’ was too much to resist by too many, not only most practitioners who just want the patients to go away but even by the ex head of the FDA who, like the rest, lumped all the subgroups together in a NYT opinion piece to help create the notion of an OD epidemic that is now an unthinking term used by the press.

    There was never and still isn’t a decent separation of such groups or individual analyses of them. It is dreadful science, irresponsible and poor ‘art of medicine’, and a disgraceful misuse of statistics.

    So many drugs have had their time of fame on the streets. The worry arose when it was oxycodone, and even fentanyl patches causing death when overdosed where the manufacturing companies had gone straight to primary care clinicians who could not determine the problems with salespeople-level education and a few very biased sponsored talks attended. People died. Children died. It was wrong. Purdue Pharmacy has agreed. That company started it.

    Heroin and other cartel-based drugs then dropped in value on the street but went up again after across the board cuts were made leaving patients to fend for themselves. Many just suffered, and street addicts returned to the old drugs, new ones, and now fake OxyContin made from heroin and fentanyl. They died.

    Patients in chronic pain yet again were castigated and lumped in. The logic and publicity was and is but a political tool to show how tough some are on abuse and misuse, legal and illegally procured or otherwise. Medical Boards have hounded and still do so legitimate and responsible providers making them hurt their patients by intimidation.

    Addictionologists, pain specialists, ER docs and general clinicians and surgeons see groups that are all referral biased but they are all lumped in together by government agencies to come up with a political solution with stupid sets of formulae such as a maximum morphine equivalents taken out of context. The genetics of receptors, level of tolerance, tachyphylaxis, rate of metabolism and psychosocial factors, not to mention the slop factor in such calculations of morphine equivalents, result in a 40x range of dosing between individuals. You cannot treat them all as one.

    The restriction movement is political and not evidence or eminence based. A reporter, Kurt WG Matthies , has written on this too and I have mentioned some of these points in a recent chapter of mine currently in press. But most stay silent out of fear. I know so many pain docs, good ones, but even my sympathetic colleagues say little. And I don’t blame them. There is much risk involved.

    I have been attacked and illegally manipulated by a medical board (threatened) to signing under duress unread documents that bear no resemblance to what happened at a hearing resulting from an employee (not me) running rogue! It has hurt my career. It needs to be corrected but it takes time and will cost lots of money.

    So to speak out whatever one’s perspective is—not necessarily in line with mine—is dangerous from a career viewpoint. Even Russ Portenoy and Richard Payne have been silent. I am having to fight this at a very high up Government level and I don’t have the funds to do so!

    Therefore, I used ‘political’ to encompass these things in totem and, unfortunately, wrote this long response on my iPhone!

  107. Tessa at 3:34 am

    True patients in chronic pain will suffer needlessly. We have pain groups online, we talk about these new rules and how most are treated like junkies now and it makes them feel very uncomfortable even to talk their doctors whom they are supposed to trust and tell them intimate details if their life. Instead of the heroin addicts and pain killer people who don’t need them, they take pain meds to get high not to relieve their physical pain. Most People in chronic pain have already been Treated like test subjects
    Trying every other meds in the
    Book non narcotic. Then only did try the narcotic neds
    A physician has prescribed, no government should condemn
    Any chronic pain patient. I have talked to several people who said they never wanted to go back to that life where they can and move or go out because they hurt badly. They would rather die then go back
    To that life. Just thought some one should know what patients are saying. No one can help these people who are addicted to any drug, they have to pull themselves together, realize they have a problem and stop blaming everyone else for their problems. Ok was also told that some will go to Street drugs. The drug dealers out there are very Happy. No one can trust doctors any longer.