The Prescription Drug Abuse Caucus – What Does It Mean to Chronic Pain Sufferers?

The Prescription Drug Abuse Caucus – What Does It Mean to Chronic Pain Sufferers?

From Washington comes word that a U.S. Senate Prescription Drug Abuse Caucus is being formed to raise awareness about the issue. West Virginia Senator Joe Manchin and South Carolina Republican Tim Scott made the announcement and are inviting other Senators to join.

PrescriptionsThat Senator Manchin is leading this isn’t a surprise. He spoke at the National Prescription Drug Abuse Summit in Atlanta in April and claimed that West Virginia has the highest mortality rate of overdose deaths – 29 people per 100,000 and said that “ninety percent of the overdoses are really coming from prescription drugs.”

This latest development is another example of what concerns some medical and thought leaders in the area of chronic pain – which affects 100 million Americans. Daniel Bennett, MD, DABPM, who is a practicing interventional spine/pain medicine physician from Denver, Colorado, is one of those leaders.

“What pain doctors and patients worry about is whether this emphasis on one problem- prescription drug abuse – is being undertaken at the expense of millions of people who need these medications in order to combat their chronic pain, living life as normal a as possible,” said Dr. Bennett, who also serves as chief executive officer of the newly re-launched National Pain Foundation.

Another is Richard Radnovich, DO, who runs a major practice in Boise, Idaho. He, like Bennett, participates in a number clinical research projects on new devices and drugs designed to treat chronic pain.

“I only wish there was a Senate caucus on the problem of chronic pain,” said Dr. Radnovich. In my practice I have patients that are suffering terrible chronic pain, yet because of anti-drug messages, like this one, are needlessly terrified of taking pain medications.

“The caucus’ work on the tragedy of opioid deaths should not impede the ability of the pain patient to get adequate care, or increase their suffering. More research needs to be done to quantify the problem. We need to identify who are dying form overdoses. Lumping all opioid deaths together with the pain patient along with the recreational opioid abuser, helps neither.”

While these two physicians expressed concern, a new voice in the battle against chronic pain was much less measured.

“From the view of the legitimate pain patient, this is all sound and fury, signaling terrorism,” said Terri Lewis, PhD.  “It is distraction and deflection from the very real problem of making sure that all people have access to the right health care.  It stigmatizes and reinforces faulty beliefs, codifying them into regulations designed to address the wrong problem, while diverting good money into the pockets of special interest groups.”

Lewis, whose father and adult son both fought lifelong battles with chronic pain, will moderate two panels at the International Conference on Pain Medicine in Chicago in June.

Meanwhile, anecdotal evidence from around the country indicates that access to pain medication is getting more difficult for people who have it prescribed. (Here’s a story from Western Montana.)

Senators Manchin and Scott say that 17,000 Americans died from prescription opioid overdoses every year.  That number should be looked at in the light of 1 in 3 people in the U.S. have a chronic pain condition (100+ million people); although terrible, the number of people who died from prescription opioid overdoses represent 0.17% of the people living with a chronic pain condition..

Manchin introduced the FDA Accountability for Public Safety Act earlier this year which would make it more difficult for new and generic opioid drugs to be approved by the FDA. (Here’s the National Pain Report story on it)

Follow Us on Twitter

@NatPainReport

@edcoghlan

@DrRadnovich

@tal7291 (Terri Lewis)

Authored by: Ed Coghlan

There are 13 comments for this article
  1. Kathrine McAnally at 5:38 am

    i honestly do not expect this to be read or given any empathy. But, writing my thoughts seems to help to get my thoughts in control. I am 63 and have had chronic pain issues for 50 years at least. All this to do about over abuse of opiads seems so ridiculous in comparison to deaths from smoking, drug abuse, drinking (including the innocent ones the drunk kills on the road), overeating, not exercising….. Well our quality of life can be controlled by our own choices in some areas. But I do not believe you will find one person who willing takes up “chronic pain”. We, like many believed in Christ’s time, did not sin to bring these afflictions on ourselves. Given a chose of a lifetime supply of opiads or a healthy body what fool would choose opiads. I can see the risk if dosing instructions are not followed; but isn’t that true of all drugs. I do not know what a drug high feels like. I am told if you are suffering the drug works differently on your brain. I am scared, so scared. I have fought a battle with pain for over 50 years and I am exhausted and angry. With all the progress in medicine why can something not be done to give us some quality of life in our old age. I would love to just go to the senior citizen center for example. Is research so behind or is our nation so uneducated about us we have become a PAIN to doctors and caregivers. Do the people who are in a position to help us ignorant of our needs or do they just want us to quit annoying them with needs they cannot understand. I think about another possible 20 years without any relief scares me. This is not living, this is simply enduring. And the worst part is not the physical pain, but rather the fact that we could help ourselves if we just tried harder. Why does my Mom, family, nurses, doctors….think I want to be in pain? Or. I should just try, as my mother said one day this week, try to get out more. Does anyone who does not have 50 years experience with this demon truly believe we can do better just by “trying harder”. Well, my “trier is too tried out to care anymore.

  2. Stephen M at 12:47 am

    I was reading the comments and after reading:
    “When that happens stigmatizing and marginalization serve as a justification by the medical system for failure to cure – it’s the patient’s fault. And if it is the patient’s fault they must be doing something wrong – that opens the door to entities like the DEA to assume this fundamental deficit is due to misconduct on someone’s part – the patient or the doctor. The DEA sees failure to cure as abuse of drugs which maintains the chronic pain problem rather than a model failure – after all legitimate doctors cure, don’t they?.”

    …and it reminded me of an episode of House MD. Cuddy was talking to House about the 100 million dollar donation/hostile take over and she starts talking about curing cancer and he replies “is the hospital getting our of the dull business of treating patients?”

    Chemotherapy has a 3% cure rate (although many more patients gain years because of it, aka treatment), but we don’t question that. Why? Because Medicine is about TREATING PATIENTS, not curing DISEASE.

    No one tells an ED patient their erection isn’t hard enough for Viagra
    No one tells a depressed patient that they’re not depressed enough for Prozac
    No one blames a diabetic who needs insulin instead of metformin (insulin being 2nd line & mimicking endogenous compounds, just like opioids)
    No one minds lifelong TREATMENT of diabetes
    No one minds lifelong TREATMENT of hypertension
    No one minds lifelong TREATMENT of hypothyroid
    No one minds lifelong TREATMENT of seizures
    No one accuses insulin users of being addicts for being physically dependent

    Why do we allow pain patients to be abused and discriminated against?

    NO pain patient will be safe until opioids and cannabis are 100% legal. I know that sounds radical, but until we realize that doctors aren’t supposed to be gatekeepers, patients will suffer. The War on Drugs must end. If opioids were over the counter, the price would plummet because you couldn’t gouge people and the overhead would drop. Without the high price, addicts wouldn’t need to steal to support their habit or inject to save money or ration their supply. The drugs would also be consistent, eliminating the guesswork and minimizing overdose risk. While there would undoubtedly be other benefits, just those benefits drastically outweigh any potential harm.

    Would more people get addicted? Maybe, but we tolerate 100s of millions of caffeine, nicotine, and sugar addicts because the societal harms are minimal and banning them would be worse. In my opinion, opioids aren’t very addictive for mentally healthy people, so they’re not magically creating addiction, the addiction is a manifestation of a mental health issue requiring treatment. How can we say that people who abuse drugs deserve more reverence than people in pain? Drugs aren’t anywhere near as dangerous as prohibition, but we choose prohibition.

    Honestly, I don’t believe that OTC sales of drugs (For strong concentrations that would be dangerous for an opioid-naive person a consultation with a pharmacist to make sure they understand the risks OR requiring a prescription for higher doses- although no daily/monthly limits and allowing EVERY doctor to maintain addicts) would increase overdose or addiction. Addicts currently have no supply issues if they have the money, so there is no reason to think that this would increase the number of users.

    Also, if opioids were OTC, many addicts could still be productive members of society (just like nicotine addicts, caffeine addicts, and some “functional” alcoholics).

    The money saved by ending prohibition could fund mental health and substance abuse treatment for EVERYONE who needs it and pain patients would no longer get punished for other people’s drug abuse.

    Opioids (or any drug) don’t cause addiction, addiction is a brain disease that becomes evident increased dopamine. People become addicted to video games, sex, exercise, and thousands of other things.

    If opioids are so addictive, why am I not an addict?
    I was abused as a child and teen, I was in foster care, and I have mild Asperger Syndrome, anxiety, depression, ADD, OCD, & cancer.
    I was put on high dose opioids.
    While on ultra high dose opioids, I endured extreme stress. Aside for the stress of being disabled and an IP (Intractable Pain) patient:
    *CYS tried to kidnap my daughter for federal adoption bonuses after a caseworker lied open a case to gain access to our house to steal my pills and my daughter was out of our home for many months while we cleared our names, which only happened once we finally got out of the hearing room and into the court room with a judge for TPR (Termination of Parental Rights)
    *I have been homeless
    *My wife got as ill as I am (EDS, scoliosis, IP)

    Until the REMS program was instituted on Actiq and my doctor got scared, I was on
    *Duragesic 450mcg/hr (changed every 48 hours)
    *methadone 45mg/day
    *oxymorphone 180mg/day as needed
    *Actiq 1800mcg lozenges, 4x/day as needed

    My wife is on a similar regimen, but without the Actiq or methadone.

    Neither of us have ever intentionally gotten high from our pain medication in the 10 years I’ve been on COT (8 years for my wife). I did, however, experience an accidental high ONE TIME in the past decade. I was having an extremely bad flare and hadn’t eaten for 2 days. I wasn’t responding to my oxycodone and my doctor instructed me to increase my dose. Still, no improvement. Thankfully, the 4 Actiq roughly every 6 hrs during the flare helped me intermittently. The flare was finally starting to lessen and my wife had made steak for dinner and I decided to eat some. That steak caused over 2 days worth (20 30mg tablets) of oxycodone to absorb and metabolize of once and I felt the “high” of oxycodone. Al that I can say is that, unless you are running from your life, there’s nothing that great about being “high” on opioids. While it was somewhat pleasant, the lack of control and the risks of abuse GREATLY outweigh the “high”.

    I’m also “high risk” because I’m a man and I’m 25

    No one I know has had problems with opioids and I personally know over a dozen IP patients on COT (Chronic Opioid Therapy) and I know hundred from support groups. The fact is that the vast majority of chronic pain patients don’t get addicted. That is because addicts get high and pain patients do not. Since dopamine, not opioids, cause addiction and the high, there’s no mechanism for legitimate patients to get addicted without abuse. Every pain patient turned addict always includes in their story a brief part where they mention that the pills alleviated some psychological pain or caused a high and they stopped taking them as prescribed.

    Addicts use opioids to escape life, pain patients use opioids to PARTICIPATE in life. Addicts and pain patients are NOT one in the same or in any way related.

  3. Bendybelle at 3:11 am

    So my big question is what can we, the chronic pain patients do. Write our representatives, and write them often. If you get a regurgitated, pre-printed answer then send it back, with your original letter, and revise it asking the questions that weren’t answered. Regular mail is given more consideration than email, so write, and Mail your letter. Or if you have really good speaking skills, and think you could eloquently get your message across call. I say that because I’m better by letter. If writing do make sure to look up the proper etiquette on how to address and end the letter, it does make a difference.

    But, outside of that – what can I do as a pain patient?

  4. Dennis Kinch at 2:25 pm

    I hate to always bring this up, but someone has to. Why, why why, are we so concerned with .017% OD deaths when there is 100$ of at the very least, 40 million people getting shabby care for pain diseases no one wants to research, name and treat, except the patients. You’re ( the people who run these insidious congressional investigation panels) just very lucky these same people are in too much pain to organize and start a campaign. You would be overrun, swamped with letters and emails. Is the under-treatment of pain not a real issue to you folks? Is the fact that 100% of the people I talked to, hundreds, including doctors, have horrendous stories about going through the gauntlet of the medical system, being called all kinds of names and labeled as lazy, drug addicts and losing what little they had to begin with.
    40 MILLION! 100%! C’mon folks. You got the power. We already went through this argument:
    Remember when Governor Deval Patrick of Massachusetts falsely claimed an “Epidemic of drug overdoses” in his state and declared it an emergency and then got shot down by his state’s Supreme Court? Too bad they already spent millions on committees and stuff. The pain patients could have used that money. They also found out that the numbers were being misinterpreted by the members and to the public. My guess is someone got a healthy check outta that deal.

    When you quote these numbers are you counting street addicts who OD and mis-prescribed OD’s? Will this bring the whopping.017% figure down? I hate to demean or make less of these people who died, I really do, but you’re giving me no choice. Do I need to bring up the number of suicides from under-treatment of pain and from those who just couldn’t handle the gauntlet? Do I need to bring up my own story which includes losing my kids and becoming homeless because a doctor falsified a Worker’s Comp report? Oh, there’s more, more to my story and thousands more stories worse than mine! C’mon guys! Why isn’t this a story or a committee or even worth some time in line, ahead of the OD deaths?

    How about the law in Colorado that doesn’t permit lawsuits on a case against a doctor that goes more than 2 years – from when the disease was first noticed? 2 years! I had mine for 10 before it was diagnosed, then 10 more of trying stuff. And every lawyer said the same thing, “Look at you, you look fine! No judge is gonna believe me when I present you and say your in chronic pain. And you’re such a nice person!” Think there was an insurance lobby committee involved in that?
    40 MILLION! 100%! C’mon!

  5. sharon sikand at 7:27 am

    The senators although well intentioned are failing to see the big picture. The overdose deaths I agree need to be further investigated as to conditions circumstances surrounding the individuals deaths on a case by case basis. Depression, isolation, unemployment lack of family ties personality disorders and addictive type personalities to begi with can all influence the statistics of these overdoses. One blanket rule may not be the best solution at all but a comprehensive investigation to all of the above would be better suited to formulate a more balanced resolutioin to a serious ongoing prolem across the Unites States. On the positive side communication is starting and it must be enhanced and both sides of the political poles need to contribute ideas, identification of issues with a reasonable, accurate, fair set of guidelines to replace antiquated protocols that have hampered delivery of patient care for very real chronic medical pain issues. Education of emergency room physicians and pharmacists to identify and address appropriately without character assasination of a patient who is on chronic pain medications is a start to helping to solve this problem. I look forward to this happening in the United States and feel strongly that all of us can do a better job of patient care with sincere effort and the educational tools it would require for improving patient outcomes.

  6. Aryana at 11:49 pm

    It is a failing model, and one that will likely be allowed to continually fail. I waited years to tell my doctor the pain I suffered daily, for fear I would be labeled a drug seeker regardless of the fact I out and out refused to take them, any if them, in the beginning.
    Applying for disability; spare me. It wasn’t even worth it, because even though fibromyalgia I recognized as a disability, the fact I could write was just too much. Yet, in the same token, I see an alcoholic on disability, still drinking that check, and here I sat, unable to even dealing wash my own hair.
    The whole system is broken, and will likely remain that way. Healing/curing people doesn’t make these senators money, the people that are constantly seeking care seem to make them money. Obviously, since neither one of those men holds any physician training, but can twist statistics around to suit whatever asinine need they *think* they have. Because they have no business regulating anything, because they’ve spent their lives being liars, and that is a tiger that doesn’t change its stripes. In my humble and sadly experienced opinion. They’re not helping Anyone but themselves, and this likely goes to getting votes from whomever yells the loudest. I am sick and tired of those of us that Do SUFFER CHRONIC PAIN being put on TRIAL FOR SEEKING HELP.
    Maybe when they start paying attention, and I mean REALLY paying attention it may change, but not likely. Unfortunately, I can’t dream of a day when this is possible, I’m too busy making sure I don’t fall/injure myself from a single moments inattention, because then I do pay dearly.
    Think they care? Nope.
    They’re busy furthering their Agendas, and make no mistake, any action taken that way, is always an Agenda.

  7. Janice Reynolds at 6:26 pm

    One error in the “death from opioids” “studies” (very loose term) is the data is frequently corrupt. Death certificates are not a good source of what someone has died from. Opioid toxicity may be listed when it was the disease process which actually was the cause of death, it may have been intentional. Frequently there are other medications and/or alcohol involved yet only the opioid is blamed. Data on deaths resulting from addiction to alcohol and tobacco are far more compelling but I guess not as sexy (plus there is the prejudice and disbelief in the legitimate use of opioids by those with persistent pain.

  8. Kellix at 2:32 pm

    Hell doesn’t surprise me West Virginia, their the worst and South Carolina, Who screwed up Florida so bad, these states. When Florida was having all those problems whenever they nailed pill mills, the people were from these states, and driving to take it back to their state not because they were in pain, because they wanted to sell the crap. Which leaves us real pain sufferers in the whole, because these assholes of the world. I remember when it happened in Georgia right after Florida shut down they tried to open up in Georgia, Georgia slammed the door so fast it wasn’t funny, but they always said the people you see in the parking lot are from South Carolina or Kentucky. Now these senators are going to effect the rest of us that are not screwing the system, and all. All I can say to those who did that, the one finger salute. Also I agree with the doctor that said that You cannot lump all people together who died from opoid deaths, that would add in Heroin and Fantynal, which is now on the streets. You have to have the numbers separated. Who died and how, were they a addict, or they a pain sufferer, not just lump them in a pile and say bad drugs. Its not like that, Its the laziness of government that won’t do the work instead of laying blanket kneejerk reactions to the problems.

  9. Stephen at 12:45 am

    Prescription drug abuse is a worklwide disaster! This problem is certainly underestimated and worst thing is that it is completely legal, any person can get in this trap. I had a terrible experience of struggle against the dependence of the close family member. Nowhere in the world there is no an adequate method of addiction treatment. We even risked to go to Kyrgyzstan to receive a treatment, where we eventually got an adequate treatment. Thanks God, we got over this illness, and thanks a lot doctor Nazaraliev.

  10. Terri Lewis at 10:00 pm

    If I may, I want to add to Ed’s concluding remarks. There is mounting evidence that the galloping numbers associated with chronic pain are correlated to persons who were recipients of medical harms, and who were left with injuries so severe that they now endure painful conditions that are secondary to their treatment and which cannot be ameliorated by the standard approaches. The disability statistics indicate that many of these are persons of working age, an increasing number are children for whom there are few if any protocols to deal with this issue, and even more are persons prematurely retired from the workforce because of this. This is not an old person’s problem. This is not a cancer problem. This is not an addiction problem. This is a problem that belongs to a medical model that has turned the art and practice of medicine into the drive through approach typified by drive through approaches to care. The medical model is failing this issue in profound ways. While drug abuse is a real problem, it is not the root cause of chronic paincare failure. And until we are looking at the evidence associated with the failure of this model to ‘cure,’ the person will always fail treatment. When that happens stigmatizing and marginalization serve as a justification by the medical system for failure to cure – it’s the patient’s fault. And if it is the patient’s fault they must be doing something wrong – that opens the door to entities like the DEA to assume this fundamental deficit is due to misconduct on someone’s part – the patient or the doctor. The DEA sees failure to cure as abuse of drugs which maintains the chronic pain problem rather than a model failure – after all legitimate doctors cure, don’t they?.

    The most adherent, conforming patient cannot be cured from their chronic health problem by the medical model. We need new definitions and new measures of success that have to do with how people live, not how they are not living.

  11. bill at 10:10 am

    nsaids destroy your kidneys, acetaminophen destroys your liver. chronic pain has nothing to do with it. opioids and synthetics there of are the only safe choice. weak minds are subject to addiction but physical addiction is easily beaten. for most of the population over the counter opioids are safe enough and better than alternatives.

  12. marty at 8:21 am

    I am a legitimate user for my chronic pain and an old woman so I have lots of it. I am tired of being made to feel like a criminal just to barely make it thru a day. I only take one kind of drug, but that is my choice because many of the others and combinations make me feel so bad. So I choose to take one that barely touches the pain but its better than nothing. I just have to keep living month to month praying they don’t cut my medicine like they have to so many

  13. John S at 8:18 am

    a picture of a big plastic bag filled with Rx bottles – why not hoist the Flag of ISIS.

    Last week I worked the election for a friend running for Judge. The Democratic party had their people telling voters who the party wanted in office. Its the same with Pain Meds now. It doesn’t matter that they work, what matters is that a few people are offended by them or perhaps suffered a tragedy in their family like an overdose.

    Now anything but pain meds for chronic pain patients.

    Thanks,

    John S