The Insanity of U.S. Opioid Policy

The Insanity of U.S. Opioid Policy

Over 400,000 Americans have died from opioid overdoses in the last two decades and millions more have become addicted. The numbers continue to escalate. This is because the federal government’s response to the epidemic has been the equivalent of closing the barn door after the horse has escaped, then injuring or killing many of the horses who haven’t escaped.

How the opioid epidemic started

There is considerable consensus in the medical community about when the epidemic started. Opioid addiction has long been a problem afflicting young people in poor, mostly urban communities. It was only after Purdue Pharma began aggressively marketing its extended release opioid, Oxycontin, to physicians, claiming it was safe to prescribe widely to pain patients, that the problem of opioid addiction began spreading to rural and suburban communities and began affecting people of all ages and income levels.

Purdue Pharma and other pharmaceutical companies claimed that the addiction rate would be a fraction of 1%. The most comprehensive study to date, a literature review that was published in the journal Pain in 2015, estimated the addiction rate of patients in pain prescribed opioids was 8-12%.

The U.S. is targeting the wrong population in the wrong way for opioid reduction

A rate of 8-12% for a serious complication from a pharmaceutical drug is extremely high, even when compared to pharmaceuticals in general, which often have serious adverse effects. That still leaves 88-92% of patients prescribed opioids who will not become addicted. Virtually all of those non-addicted patients, however, will become dependent on opioids. That means that their bodies will make an adaptation to ingesting the drug that will result in withdrawal effects if the drug is discontinued. They will also develop tolerance, which means that, because of their body’s adaptation to the drug, more opioids will be needed over time to achieve the same level of relief. Higher doses lead to a higher risk of adverse consequences from taking the drug.

Cindy Perlin

Prescribing an opioid to a new patient, even for acute pain, is like playing Russian roulette. While there are certain characteristics, such as being young, having a history of addiction or a history of emotional trauma, that can raise the risk of addiction, anyone can become addicted. It is impossible to predict who it will be. In fact, surprisingly, a 2015 study published in the journal Pediatrics found that, “Use of prescribed opioids before the 12th grade is independently associated with future opioid misuse among patients with little drug experience and who disapprove of illegal drug use.“ Middle-aged housewives and senior citizens with no prior history of addiction have also become addicted.

There is a group that we do know will not become addicted. That is the group of chronic pain patients who have been taking the drug long term, as prescribed, sometimes for decades, who show no evidence of addiction. This is a group of patients who believe that the benefits of their use of opioids, i.e. pain reduction, outweigh any negative side effects. That is also the group that has been most negatively and unfairly affected by US drug policy.

U.S. opioid policy has targeted physicians treating patients in severe pain for criminal prosecution

Initially, when the scope of the opioid problem was becoming clear, the federal Drug Enforcement Agency (DEA) began targeting “pill mills” for raids and prosecution. These are clinics that are run by doctors who prescribe large amounts of addictive drugs to people who are not their patients and who have no legitimate medical need for the drugs.

When those efforts failed to stem the tide of addiction, the DEA began targeting doctors who were prescribing large doses of opioids to their patients who had severe chronic pain. Even though these doctors were following standard medical procedures of the time, these doctors’ offices were raided at gunpoint and the doctors prosecuted as drug dealers. Their assets were immediately seized, depriving them of the resources they needed to defend themselves.

According to Linda Cheek, MD, who founded Doctors of Courage, over 1300 doctors have been charged, and close to 500 have served or are serving prison terms. Dr. Cheek was herself a victim of these practices. Those doctors who do not end up in prison often lose their licenses and suffer financial ruin. Dr. Cheek also reports that the targeted doctors tend to be minorities and/or practicing independently rather than working for hospitals. They do not have deep pockets to defend themselves.

When other doctors heard of these DEA raids, they were terrified. Many began refusing to prescribe opioids, often cutting their patients off abruptly, throwing these patients into withdrawal. Then, along came new guidelines from the Centers for Disease Control (CDC). These guidelines “recommended” that doctors refrain from prescribing high doses of opioids. Guidelines are considered “standard of care”, which doctors knew left them even more vulnerable. Even more doctors began cutting long term patients off from their medication.

Significant harm has been done to chronic pain patients by U.S. opioid policy

A study published in the Journal of Substance Abuse Treatment in August 2019 looked at Medicaid patients in Vermont from 2013 to 2017 who filled opioid prescriptions at dosages of at least 120 morphine milligram equivalents for 90 or more consecutive days and who subsequently discontinued opioid prescriptions. Half of the patients were discontinued in one day, with no tapering. 86% were discontinued within 21 days, which Is considered rapid tapering. 49% of those patients subsequently had an opioid-related hospitalization or emergency department visit. Although 60% of the patients were diagnosed as having a substance use disorder prior to discontinuation, less than 1% were transitioned onto an opioid use disorder medication.

Withdrawal symptoms after abrupt discontinuation of opioids can be very severe and include agitation, anxiety, muscle aches, insomnia, sweating, abdominal cramping, diarrhea, nausea and vomiting. While opioid withdrawal is not considered life threatening, the symptoms can be so unbearable that addicts will often do anything to get their next fix. Many pain patients who have been abruptly withdrawn from their medication are buying much more dangerous opioids, including heroin and fentanyl, on the streets. Treatment centers are reporting that 80% of new heroin users started with prescription opioids. Many other pain patients are reportedly committing suicide, driven to it by their unrelieved pain. It is rare that these patients have been offered other treatments for pain. Those who don’t hit the streets looking for drugs or kill themselves are left to suffer vastly diminished lives.

study published Aug. 29 in the Journal of General Internal Medicine found that patients on chronic opioid therapy whose opioids were involuntarily discontinued were three times as likely to die of an overdose than patients who were kept on opioids.

At the other end of the spectrum, in acute pain care, the official word from the medical community and most of government is that opioids are the best treatment we have for pain. Opioids are almost universally prescribed after an accident, surgery or many minor medical procedures, including tooth extraction.

A study published in 2019 in JAMA Network found that dentists in the United States prescribed opioids 37 times as often as dentists in England. The frequent use of opioids in dental care are despite the fact that studies have demonstrated that a combination of ibuprofen and Tylenol is as effective or more effective than opioids for dental pain. The National Safety Council has produced an infographic similarly showing that a combination of Tylenol (acetaminophen) and ibuprofen are effective for a larger number of patients than opioids.

Failure to prevent unnecessary initiation of opioids ensures a steady stream of new addicts that will continue to fuel the opioid epidemic.

There are safe opioid alternatives the U.S. government is blocking

There are other alternatives for treating acute and chronic pain, but the U.S. government is either doing everything it can to block them or doing nothing to make them more accessible and affordable

The federal government continues to block access to marijuana, listing it as a schedule 1 drug, which means it is a drug with high potential for abuse and no known medical benefits. This is despite the fact that a significant number of medical benefits of marijuana have been found. Possessing or using it continues to be a federal crime. Marijuana has pain relieving properties superior, in many patients’ estimation, to opioids. It is not physically addictive, so there is no withdrawal. And it is far safer than opioids. Marijuana has been in medical use all over the world for over 10,000 years and in that time not one overdose from marijuana has ever been reported. Furthermore, it can prevent development of tolerance and ease opioid withdrawal.

The federal government has also attempted to block access to kratom, another safe, potent pain reliever. Kratom is an herb that grows in Southeast Asia. Kratom is being used by many pain patients as an alternative to opioids. It is a relative of the coffee family and no more addictive than coffee. Besides helping with pain, it can also help ease withdrawal symptoms from opioids. The DEA has tried to have kratom classified as a Schedule 1 drug and the FDA is trying to ban It on the basis that a few dozen people have died of it over the last few years. All of the people who died while using kratom had other drugs in their system that could have caused the fatality or had consumed kratom from one contaminated batch.

When efforts to ban kratom failed due to activism on the part of kratom users, representatives of the FDA reportedly paid a visit to Indonesia, where 95% of kratom used in the U.S. is grown. The purpose of the visit was to try to get the Indonesian government to ban its export. As a result, the Indonesian government has announced a ban to take place in 2024, giving farmers time to convert to other crops.

The U.S. could be doing much more to make safer treatments affordable and accessible

There are other herbs and supplements that have been proven to help with pain, such as turmeric and Omega-3 fatty acids. Federal law makes it a crime for producers or sellers to make medical claims for these substances without first going through the FDA drug approval process. This process, which costs hundreds of millions of dollars, is beyond the reach of those who produce and sell these substances.

There are many other treatments that are safe and effective in relieving pain. For instance, one study found that acupuncture was more effective than injected morphine for pain. Low level laser treatment is another potent intervention for acute or chronic pain. Other alternative treatments that are safe and effective for pain include biofeedback, chiropractic, nutritional interventions, physical therapy, and much more. Health insurers refuse to cover these treatments adequately or at all, and the federal government has done nothing to require coverage.

A sane U.S. opioid policy

A sane federal opioid policy would ensure that all options for pain management were accessible and affordable for patients in pain and would encourage the use of the safest options first. It would give doctors more options for treating pain and provide education about those options. And it would protect those whose pain is most severe and chronic from any action that would increase their suffering.

Cindy Perlin, LCSW is the founder of the Alternative Pain Treatment Directory and the author of The Truth About Chronic Pain Treatments: The Best and Worst Strategies for Becoming Pain Free.

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Authored by: Cindy Perlin, LCSW

Cindy Perlin is a Licensed Clinical Social Worker and chronic pain survivor. She is the founder of the Alternative Pain Treatment Directory and the author of The Truth About Chronic Pain Treatments: The Best and Worst Strategies for Becoming Pain Free.

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mlang

The 8-12% seems, extremely high compared to what the overdose rate is for chronic pain patients. Most likely, that number comes from addictionologists who make their living treating addicts. They think all of us chronic pain patients, taking opiates, are addicts! Why not? when it makes them millions from from pushing “bupe”!

L. B

Thank you, Ms. Perlin. I am a disabled CPP who has taken opioids daily for 20 years. The only time I have struggled has been with the forced tapering I’ve endured in the last 3 years. I was agreeable to cutting my medication, after all, with narcotics less is better—always. But the tapering wasn’t about my health or functioning ability. My pain specialist was clearly under pressure, clearly under threat. And my doctor is a good doctor, a careful, conscientious doctor. I had trouble in the last round of 4 tapers & then I was dealt with as a Bad Patient. I was looked at as a Problem, & it didn’t matter that I had been in compliance for 20 years or that I’ve had 37 surgeries & am 100% disabled. My doctor fought for me, but he had to fight, rather than doing what he thought best for his patient of 12 years. I’ve written to all my congresspeople. It doesn’t matter.

Robert

THANK YOU DR. BOREL ! I do wish there were more Physicians such as yourself willing to speak truth. You cannot believe how it feels to have a Doc sound out in defense of Pain Patients.

Em Raven – Fantastic points!

Little over a month ago, the Mexican Navy seized 25 tons of Chinese Fentanyl intended for drug cartels and ultimately, the U.S. It is mind boggling when you consider just how much it truly is with 25 tons converting into grams at a staggering 22.7 million. Furthermore, with overdose potentially occurring by only a few grains, consider just how many counterfeit pills can be made with just a few grams of a drug over 50 times more powerful than Heroin.

I doubt if the illegal drug market gives a hoot over a genuine 5mg Oxycodone pill.

Barbara

I’m surprised this article even made it on here. After reading most of the comments, it seems others feel the same. It made me feel angry and sorry I wasted my time reading it. It DID make me wonder if you personally suffer with chronic pain.

Holly

Wow, more bogus info…..

This social worker doesn’t know her gluteus maximus from her olecranon process. Her “statistics” are totally false. Less than 1% of pts prescribed opioids for pain ever go on to addiction & they had addiction problems prior to their pain diagnoses! In the last 6 months, I’ve done extensive research using over 300 references on the numbers of deaths from debility due to rapid taperings, & suicides due to cold-turkeyings of pain pts including veterans in pain, as well as every aspect of this horrible holocaust against pts in pain due to the O..x..y..M..O..R..O..N..S in gov’t.
The OPIATE, MORPHINE & its semi-synthetic & synthetic analogs (aka Opioids) R
mainstays in hospital practice for all kinds of pain conditions. And this fool (sorry, bec she hasn’t a clue about many diseases requiring strong narcotics) says “don’t start with an opioid”.
Ever hear of Sickle Cell Crisis? That’s MORPHINE intravenously! STAT! Nephrolithiasis? (kidney stone scraping down the ureter) MORPHINE! I could go on & on about this person’s denseness about this subject. My research of “alternative treatments”–when opioids R the best & safest for pts in pain–shows if any work at all, it’s only DURING the physio, DURING the psychotherapy session.. then pain returns. Purdue’s OxyContin mktg has zero to do with addicts dying from adulterated fentanyl & fentanylized heroin. FDA’s extensive pkg insert
has full disclosure! Helen Borel,RN,BA,MFA,PhD

For all who found this so distasteful … it is obviously the author is using this site as a platform to sell her books to people who have mild to medium pain.

Em Raven

Opioid withdrawal IS LIFE THREATENING. Feel free to have a quick Google about all the people who have died simply from being in jail and left to “dry out” by the people running the places. These are mostly healthy people. If healthy people can suffer extreme hormone/electrolyte imbalance, seizures, heart attacks, strokes, etc do you *really* think a generally medically fragile population won’t?

Please stop the disinformation. It’s killing people. Literally.

Cindy too

Author:

A lot of statements that you cite as facts contradict information that I’ve read elsewhere.
Example – the % of people who take opioids who become addicted is FAR lower than what you cited. I’m terrible with numbers and dont’ remember the exact number, but it was around 1% I believe.
Also, your first sentence stating 400,000 OD’s doesn’t specify if that’s from Rx or illegal or both.
So, I agree with the many posts which question many of the statements in this column.

Robert

Now I understand what’s behind this. Cindy, I just visited your company’s website; Alternative Pain Treatment Directory.
For a mere $99 a year, medical professionals can have access to the growing market of abandoned chronic pain patients and receive the site’s list of marketing benefits designed to enhance their respective business.

Published By

Cindy Perlin, LCSW
A great marketing opportunity for alternative healthcare providers. #marketing #alternativehealthcare #chronicpain #chronicpaintreatment

Snake oil sales concealed as advocacy. Shame on you!

Eddy

I’ve been going to the same pain specialist for 15 years and during this time (by my own request) successfully reduced the original dosage by 75%. With the recent DEA guidelines I would never try to reduce my meds like this again because if I needed the higher dose it would never happen.

It would be beyond wonderful if the alternative methods had helped with my nerve pain. It’s anxiety-producing to live in fear that I might not be able to get my pain meds in the future. That’s no way to live.

Alan Edwards

I would like to communicate with the author personally. Or she should speak with Dr. Frank B. Fisher if the DEA has not harmed him again.

Acetaminophen and Tylenol absolutely does nothing for intractable, chronic, suicidal pain. The pain I have is such.

There are glaring errors in every sentence which need a stern rebuttal. High pain prevents any more pecking on this smart phone. You are wrong, wrong, wrong. Pain patients like myself used to be productive with the help of opioid medication. Now we are in wheelchairs. Going to the street corner? Addicted? Stupid? Intractable pain is a myth? Contact me and write a rebuttal of this FDA approved thesis. My email is known to the editor.

Kristen

Herbs and Supplements!Acupuncture more effective than a Morphine Injection!? Really??? Sorry that’s [edit] and we know it.I agree with Thomas Kidd,if you can’t do better than this Keep it.You are not helping the matter at all.

Plus,

Cindy, I know you contribute a good deal of articles that are of interest to the pain community.
You spend your time to the benefit of the whole group, which is appreciated.
But there’s something going on with this one that’s not evident to most readers.
It’s as though you are being coerced to parrot the long debunked myths concerning causes and cures. Nearly 100% of comments agree in general. Many are righteously angry at your reference to studies which are proven garbage and dangerous to essential health.

Please don’t take any comments personally. Please continue to contribute as you have.
Please don’t continue to be duped by the standard media drizzle and parrot it along, especially in your professional practice.

Thomas Kidd

This thinking has caused the fake opioid crisis. Educated people my eye! Foolish.

Thomas Kidd

More [edit]. If you can’t do better than this just keep
Silent. I’m so sick of the [edit] . I need my rights back as a disabled American.

Since people seem to be angry and some asking questions, I have a few myself. Why is it that those who have no earthly idea what chronic pain is are so easy to judge those that do? Why is it that we are looked down upon and made fun of? Why is it that those closest to us as well as those that have no idea what chronic pain is are the very ones that hurt us as badly as our chronic pain does? Even though some “say” they care why is it we still feel so isolated and alone in this world? We still have hearts and mind’s that function just fine. Minds that know what people are truly thinking, you know the old adage, “actions speak louder than words.” I was just wondering if anyone may know the answers to these questions.

I don’t like this article,.just sounds like a sales pitch for alternative treatment to opiates. Regurgitation of the opiate haters. People in intractable pain were first made to do all other alternatives before being allowed prescription of opiates. All this is doing is making people go to the dark web go to the streets and say forget the doctors BC no help there for unrelenting pain. CDC, DEA will be known for causing even more deaths. People are in the fight of their lives to get relief from this unrelenting daily pain. Their survival Instinct kicks in. Just like docs not wanting to prescripe except all they have to do is stick their heads in the sand and let us suffer. Fake news regurgitation. Although you look very nice in blue.

Margie

When you have cited statistics and/or studies, the source of the information is incomplete, if provided at all. Sources should be cited completely, to include the author(s) name(s), title of article or study, date/volume of journal in which published, journal name. I take articles that I read with a salt lick; I check citations carefully. As an LCSW writing on medical topics, it would behoove you to be much more careful about working with peer-reviewed sources. As a retired RN, I do not find your writing to be credible.

thetruespin

Another article claiming the absurd, “Acupuncture was more effective than injected morphine for relieving pain.” One study from the Fattouma Bourguiba University Hospital in Tunisia. Read the study and if you believe this I recommend we bring back psychic surgery.

Deb

Please don’t hurt me anymore than I already am. It’s devastating to be alive now during my chronic pain. I ask, why me? What did I do to deserve this? But in the meantime please don’t hurt me anymore than I am. Because I’m at that line. Pain is devastation. Please hear me, I’m fighting for my life and have to fight for my medication and worry. It’s a double whammy. I can’t even concentrate on how to fight my illness because most of my time is wondering if I will have relief toeven write this. God bless you all

Brad B

My Lord. Everyone needs to take a breath and go after the dealers lacing fake oxycontin with Fentanyl. Leave us chronic pain patients alone….

Cynthia

This article is all over the place. Ms. Perlin makes some good points, but, like many, she throws around the labels “addict” and “dependent” carelessly. Even describes responsible pain patients who are cutoff as seekers of “their next fix”. We don’t need anymore articles like this one…articles that attempt to rationalize and obscure the reality of many pain patients…THEY ARE SUFFERING EVERYDAY AND DONT WANT TO LIVE IN SEVERE PAIN., BUT THEY HAVE NO CHOICE. Dying is not an option for everyone…many have families and responsibilities . So it would be greatly appreciated if folks like Ms. Perlin, who want to put time and energy into writing an expose of some sort, would direct their comments to the people and agencies that have caused this tragedy, and help us fight against the horrific tyranny we endure every day. We already have a zillion articles like this one. They’re a dime a dozen.

As usual Ms.Perlin falls on the same talking points as the DEA using the heroin/fentanyl death rate to put all deaths from opioids in a lump sum. This is false and propagates a bias against those of us who suffer from chronic pain and get relief from opioid based treatment. This distortion of the truth, the failure to really look at the statistics that say less than 2% of people that get their pain relief from opioids abuses them or becomes addicted. The bigger problem is a society that has decided to criminize drug use in general instead of legalizing and controlling substances and treatment so people don’t die from their use of drugs. The drug war has been one of the biggest failures in American history, with trillions wasted and many unnecessary deaths. It is the single biggest form of crime around the world, as third world countries try to survive by supplying the world with the drugs people obviously want. The fact that people with chronic pain are lumped in with the illicit drug trade is an immoral attack on innocent people who through no fault of their own need medication to allow them to function. I feel sorry for doctors that are caught in the middle of this nightmare, but it is a nightmare that we can change as a country if we show compassion and a willingness to make our world a safer place for everyone.

Aside from the fact that I feel as though we’ve been made to look ridiculous once again, does anyone know if tumeric can really help with pain? I’ve been reading a lot about it lately, by no means is it a cure-all but from someone that is deathly allergic to Aleve and ibuprofen could it possibly help? At this point Epsom salts baths, ice, what have you if it helps one tiny bit I’m willing to try it. If anyone has an answer I would certainly appreciate it! Thank you and as always, prayers go up and out for all of you.

Jon

The dea and bullies just like them are killing more chronic patients
then the drugs how they can stop a treatment that a lot of people who need to live and feel ok is wrong. everyone has been affected but i can understand that when a pain patient kills themselves they get tired cant handle the pain anymore ..thats why they are on the meds to get relief then the bullies threaten our doctors i can see why the docs quit prescribing i would to. but now here is the but who takes care of us the D. E. A. Hell no eventhough they gonna stop the docs. shouldnt they pickup the slack? i have diabetic neuropathy. 4spinal fusions with hardware 2decompressions dont try to tell me a asprin is going to help the pain i havr had poising for taking to many asprin trying to get somekind if relief which didnt .i had a pain pump but my pain doc got scared now i dont i get 120 pills amonth which is better than nothing but not by much where does the madness end… Here is how its going to wind up dea will plant an agt in every office that prescribes opiates verify the patient the need ect then sign off on it go to other side if building aeach pill have a number you hand script they give meds you sign someone gets busted pill comes back to so and so once investigated put that person in detox cut from the practice once its proved to have been given or sold ect sorry for rant just things i need to spout …oh anf 9/10 articles are quoting people who take opiates even if they didnt die from them just cause they are on them they can use as puff material not slamming just i was in a hurry forgive grammer not pointing fingers or anything just a little of what i see hear and all

I just left my PC bc they have refused to give me opioids. I’ve had streak of bad luck, from my home being broke into, trying to move on my own & lastly I was
in a car accident. I still have tried my very best to comply with the crazy laws. I could have injections everyday and it still would not be enough for the pain I’m experiencing. I left telling her to make sure she put in my file she is refusing to treat me. Fuck her telling me it’s for my safety. I know my body and what it can handle more than her. It’s my body. I do apologize for my language but I am hurt and so much pain.

Terry

I agree with everything you said. The problem is we, chronic pain patients, are still struggling to have a normal life. Even if the CDC guidelines raised the morphine equivalent for chronic pain patients, the doctors will NEVER start prescribing opioids again. The fear of losing everything and going to jail is just too much to risk and I don’t blame them. I have an enzyme in my liver which makes me a rapid metabolizer, so I need twice as many pain pills as the normal person to be effective. Just another little tidbit the CDC overlooked. I was on 195 mgs of oxycontin daily before the “epidemic”, now I’m on 60 mgs. My ENTIRE life has been ruined. Medical marijuana is legal in my state but I can’t even try it because I will fail a urine test and my doctor will drop me cold. Just another little thing the CDC overlooked. As a chronic pain patient I just have to accept the fact that I’m screwed and my life has been forever changed for the worse. God bless all my chronic pain brothers and sisters. Stay strong.

Leo

I found your article initially offensive but then I realized it is just a half ass attempt to communicate a complex subject. I believe your intentions are to help but it just doesn’t. Consider a rewrite.

Paul Clay

I disagree on how this started, a point that has been ignored. In the late 90s through the late 2000s the government had the medical community add a 5th vital sign. This vital sign was (pain level) and the doctors were encouraged to treat pain which they did. The prescription problem for reasons of argument is over and has been over for years. After successfully taking opiods for 21yrs to function, they are now gone. I continue to watch the (Meth addicts) walking up and down the street visiting the local dealer. Those addicted get Suboxone for life while those that actually needed the opiods just get cut off. Yes, we could go get put on Suboxone for dependancy but most of us won’t be doing that as we do not want to be labeled (addicts). I used Ativan to deal with the worst of the withdrawal symptoms which lasted about 10 days. Thank God.

Alice La Plume

my problem with this is when i was withdrawel had numbness in all parts of my body left to be by myself and not being able to gert out of bed with out possible fall and warning from doctors if i fell i could die . keep it up you have turn and this government has turned it back on us . Especially when on it for 23 years and insane doctors not telling what there doing to your med . where are you all of you. i am not addicted i wont go to the streets to get my illegal drugs and passed for 23 years all the tests and still they scream and tell you to suffer. not only that they told me they wouldn’t help me why no insurance . So i call the insurance co. and they told me i had it . WOW this is doctors in Fitcburg Mass they go to Fitchburg University and scream at you they call these people NP nurse practionare really . no not with Marfans Syndrome they have no idear what they were doing I am tired of the corupt ness of Washington to get away with not stopping the drugs on the street and going after pain patients. They need to do there job. i am done this is allowed by Massachusetts ok so stand up for whats right for i see suffering for many years.

Cindy Calhoun

Ms. Perlin reading your article I became very angry. First of all you are using the 400,000 number of opioid deaths as if that number is prescription opioid deaths, you fail to qualify that the majority of those deaths are from illegal drugs or illegally obtained opioid pain medication. The alternatives you speak of, first off are not available to everyone, second these alternative treatments may help in lieu of access to prescription pain medication but by far they in no way can replace the pain relieving aspect of prescribed pain medication. The majority of people now living with chronic pain have tried many, many different approaches to managing their pain, if your alternative treatments worked, and they may for some but the vast majority of people this would only be in addition to their prescribed pain medication. This article I feel in no way is going to help the current climate of opioid hysteria.

Angie Heavner

One of the biggest problems I see again with every one of these “reports” is, they always say lower class citizens start the drugs first. Sorry that is very incorrect. Drugs have never been just a lower class citizen problem. Drugs affect every class and always have. Difference is you don’t hear about it as much with rich because they cover it up.
The problem is stop giving every single kid medications for ADHD/ADD. Not all kids are ADHD/ADD and those medications are a speed for kids not actually needing them. They are addicting.

Robert

Cindy,
I must take exception to your use of the quoted statement from the 2015 journal Pain that 8-12% of those who use opioids as being excessive. We know the real statistics for opioid use with chronic pain patients is negligible.

In that same year, according to the Substance Abuse & Mental Health Services Administration (SAMHSA), 1 in 10 Americans has a substance abuse problem. It would follow that the use of Oxycotin would not be the exception, nor excessive, but simply the norm.

According to their 2015 study, 24 million Americans have used illegal drugs. Out of those, 19.6 million have had a substance abuse disorder the preceding year, making 1 in 10 Americans susceptible to addiction.
I believe that it’s generally accepted that 10% of the population has a genetic predisposition to addiction to Alcohol, Tobacco, Gambling, etc.

Since breaking the human genome and identifying the 23 chromosome pairs of DNA, as an example specific to alcoholism, the three genes on chromosome 15 – GABRA5, GABRB3 and GABRG3 account for the addiction disposition of the estimated 15.4 million alcohol drinkers.

While I agree statistically misleading, Purdue would be a repeat of the 1874 discovery of Heroin which was to be far less addictive than Morphine.

As for dependance, it is necessary to understand that the remaining 90% is not one size fits all. After sustaining an injury that becomes chronic, our body’s natural opiate Endorphins, becomes overwhelmed and unable to deal with the pain generated. In the best case scenario, an individual would maintain the necessary physical activity necessary to produce endorphins and require the opium based analgesic to make up for the shortfall.

Additionally I believe that that physical dependence leading to increased dosages is not a Fait Accompli.
In my personal experience, 12 years ago when my Doctor established my dosage of Oxycodone, it remained static until the 2016 CDC guidelines changed the rules for all of us.

Gail Honadle

I’ve spent the last 10 months doing dental work. I had 10 lower teeth, that were damaged by the medications I have to take. Uppers he was not going to touch are still painful but no teeth missing except the Wisdom teeth. They were very painful, I had no molars to chew with. So opted for a lower denture. Removing 10 teeth at once is not the same as removing 1 decayed tooth. You need at least 4 days of a Pain Medication that is stronger than Tylenol. As a Stage 3 Kidney patient and a Gastro Patient OTC’s are not a way I can go. No one has designed a Ice Pack for the Mouth to sit on the gums. Then I developed bone spurs that had to be ground off. If that wasn’t enough the Entire Jaw had to be Re-sculptured. 2 days of 7.5 mg NORCO was not enough to handle 2 weeks of pain. The denture still doesn’t fit right, my upper molars while ground down to the fillings are still to Long and dig into my bare gums at night. There is no reason a brand new denture should need to be relined and Still not FIT.

And NO ONE has designed a Denture for Autoimmune’s who tend to react to chemicals and the Red Dye they use on the gums. Bubble Gum PINK is way to dark, I know to many people who wear dentures as I’m 71, their’s are very light pink, and sure are not Huge and ill fitting. Most dentist have given up their DEA licenses.

Deb

This report does nothing to highlight that many prescription opioid ODs included illegal drugs, and many of those overall opioid deaths were due to illegal drug usage, and the OD numbers were not separated out by drug.

Once again, when we don’t state and highlight the entire picture, we do ourselves a high disservice. By not highlighting the illegal drugs that are involved in ODs, the author leaves the assumption that ALL ODs are caused by prescription opioids, and ONLY prescription opioids. This is not uncommon.

In my view, this article which had great potential, falls short of detailing the entire picture. That’s the message we need to get out to turn the tide.

Thanks for letting me vent.

LMC

According to these numbers there’s an average of 20000 people dying each year from opioid overdoses.

If that’s the case than lets compare some numbers.

Smoking related deaths per year 480,000. Heart Disease related deaths per year 598000. Cancer related deaths per year 575000. Alcohol related deaths 88000 per year. I also found opioid overdose deaths at 70000 not 20000 but okay.

I am truly sorry for every parent whose child died from opioid medication that the child was prescribed by a doctor and was taken as prescribed by said doctor and died.

But I am just as sorry for the parents whose children die from alcohol, smoking and obesity each year because every single one of these deaths are and were just as preventable. And the numbers related to these deaths are far, far greater than that of opioids.

While I am sure they may be out there, I cannot recall one opioid overdose death that was solely caused by a prescribed patient taking the opioid as directed by their doctor and then dying from it.

Even though we can all agree that chronic pain suffers are being mistreated in this so called crisis, why can’t anything be done about it? I am one of the lucky few that a doctor can see my condition and I still get some medications for it. But so many other people are suffering and nothing is being done.

If this “crisis” is ever over do you think the focus will fall on another group of people? Not sure that I can anyone raiding McDonald’s because they caused childhood obesity with Happy Meals? Can you?

Melissa Lerner

You have left out key information. Chronic intractable pain patients have tried acupuncture, yoga,changing diets,injections you name it we did it before opioids. If we have been on them 10-20 years successfully why do we need to use Kratom or MJ? There are no long term studies on them. Some have tried & it doesn’t work for their pain. We have a medication that works for us why do we need to switch because others have abused it? Secondly, they government has made pharmaceutical companies change there formulas of opioids. We now have people getting sick on the medication. Nausea, vomiting, stomach pain & no pain relief. We are continued to be tortured. You are going to see a whole new level of addicts by taking away pain medication. Do you want pain patients turning to heroine or alcohol for relief? Because that is what is happening. Worse yet committing suicide. We need our medication, the old formula not medication that makes us sicker.