U.S. Chronic Pain Practitioners and Scientists Comment on Oregon Forced Taper Proposal

U.S. Chronic Pain Practitioners and Scientists Comment on Oregon Forced Taper Proposal

(Editor’s Note—This letter was submitted to the Oregon Health Evidence Review Commission (HERC) in advance of its August 9 meeting to consider opioid forced taper guidelines. People outside of Oregon are free to comment. To submit your comment of 1000 words or less, email them to herc.info@state.or.us as soon as possible.)

July 30, 2018

Dear Members of VbVS and HERC:

We are a group of concerned practitioners and scientists specializing in pain, addiction and epidemiology, and experts in public health law and policy.  We recently learned of efforts by the Oregon Medicaid Pain Task Force to deny coverage of opioids beyond 90 days for most chronic pain conditions and, effectively, to mandate the taper of current patients receiving opioid therapy. We believe that such efforts risk doing substantially more harm than good.

The Oregon proposal is the most restrictive in the country and is unsupported by current treatment guidelines related to opioid prescribing, including those issued by the Centers for Medicare and Medicaid Services (CDC) in 2016, Canada in 2017, the U.S. Veteran’s Administration, and professional medical associations.[1] While the CDC and Canadian guidelines ask practitioners to consider tapering patients to lower dosages, both expressly require a risk/benefit assessment. According to Tamara Haegerich of the CDC, the guideline does not provide “support for involuntary or precipitous tapering. Such practice could be associated with withdrawal symptoms, damage to the clinician–patient relationship, and patients obtaining opioids from other sources.” [2]  Under both guidelines, for patients with managed risks who experience a loss of function or an escalation in pain, tapering should cease.

Concerns regarding a Center for Medicare and Medicaid Services (CMS) proposal to permit denial of coverage of long-term opioid therapy above 90 MME—a proposal that is far less drastic than Oregon’s, which would taper patients to 0—prompted strong objection from architects of the 2016 CDC guidelines and leading experts in addiction and pain medicine.[3] Among their objections was the lack of evidence of benefit from compelled tapering and considerable anecdotal evidence of harm, ranging from medical decline to suicide[4]. In addition, the petition highlighted unintended consequences of recent regulatory limits on opioid prescribing, including the curtailed capacity of physicians to meet their ethical and legal obligations to patients and outright patient abandonment.[5] Oregon is a state that has sanctioned physicians for failure adequately to treat pain, including with opioids.[6] Well-intended regulations have resulted in over-reach to cancer patients and end-of-life care.[7] Recognizing these potential harms, CMS declined to go ahead with a hard edit at 90 MME.

Although the proposed coverage of modalities from CBT to aquatic therapy to acupuncture is laudable, such services should be offered alongside medication and procedures. Integrated care is the gold standard of pain treatment. According to the Academy of Integrative Pain Medicine, “For some patients, access to opioid medications to manage their daily pain is necessary; for others, nonpharmacological methods alone provide sufficient relief; and, for many, it’s a combination of both.”[8] No single modality is a “magic pill” for all patients. An across-the-board denial of opioid therapy for the huge umbrella category of chronic pain is as destructive as is liberally prescribing opioids for all types of chronic pain. While there is a paucity of longitudinal studies on the efficacy of opioids for chronic pain, your hearings recognize that the evidentiary basis for the alternatives you propose is no stronger. By contrast, there is a considerable clinical basis for an integrative approach that provides access to both options.

The denial of coverage to the Medicaid population, in particular, is likely to have a disproportionate impact on individuals with disabilities, on the sickest patients and those with multiple chronic conditions.[9]

Finally, curtailed opioid prescribing has not correlated with a reduction in drug-overdose deaths. Although prescribing has dropped every year since 2012, drug overdose deaths during the same period have skyrocketed as the crisis has evolved to feature heroin and illicitly manufactured fentanyl and its analogs.[10]  Even most deaths that involve a prescription opioid are polypharmacy[11] – often including illicit drugs, benzodiazepines and other CNS depressants, and alcohol – and most misuse is non-medical.[12] Until these realities are reckoned with, we will continue to see a rise in harmful effects. In conclusion, we believe that there is insufficient scientific evidentiary basis for the Oregon proposal and that denying pain relief to those who suffer most is likely to cause harm even with the best of intentions.

Sincerely,

 

Michael E. Schatman, Ph.D., M.P.H.

Director of Research and Network Development, Boston Pain Care

Department of Public Health & Community Medicine

Tufts University School of Medicine

Editor-in-Chief, Journal of Pain Research

 

Lynn Webster, M.D.

Vice President PRA Health Sciences

Past President American Academy of Pain Medicine

 

Robert Twillman, Ph.D., FACLP

Executive Director

Academy of Integrative Pain Management

 

Diane Hoffman, J.D., M.S.

Director, Law and Healthcare Program

Jacob A. France Professor of Healthcare Law

University of Maryland School of Law

 

Leo Beletsky, J.D., M.P.H.

Associate Professor of Law and Health Services,

Northeastern University

 

Daniel S. Goldberg, J.D., Ph.D.

Associate Professor, Center for Bioethics & Humanities

University of Colorado Anschutz Medical Campus

 

Travis N. Rieder, Ph.D.

Berman Institute of Bioethics

Johns Hopkins University

 

Kate M. Nicholson, J.D.

Civil Rights and Disability Rights Attorney

 

Jonathan D. Mayer, Ph.D.

Professor of Epidemiology,

Health Services, and Medicine

University of Washington

 

Stephen J. Ziegler, Ph.D., J.D.

Professor Emeritus

Purdue University Fort Wayne

Department of Public Policy

 

Terri Lewis, Ph.D., NCC

Rehabilitation Institute

Southern Illinois University-Carbondale

 

Dan Laird, M.D., J.D.

Medical Director

Flamingo Pain Specialists, PLLC

 

James Patrick Murphy, M.D., M.M.M.

Addiction, Anesthesiology, and Pain Medicine Specialist


[1] See, e.g, Joint Guidelines of the American Academy of Pain Medicine and the American Pain Society, http://americanpainsociety.org/uploads/education/guidelines/prescribing-opioid-pain-drugs.pdf; Academy of Integrative Pain Medicine, https://www.integrativepainmanagement.org/page/OpioidPositioning.

[2] http://annals.org/aim/article-abstract/2643843/changing-conversation-about-opioid-tapering, Dowell, Deborah, MD, MPH & Haegerich, Tamara, PhD, “Changing the Conversation About Opioid Tapering,” Annals of Internal Medicine, 167 (3), August 2017.

[3] Attached petition. Among its 220 signatories were persons who played significant roles in developing the CDC guidelines and faculty at major medical centers with expertise in opioid safety, addiction, pain, primary and palliative care.

[4] A VA abstract concluded that opioid tapering did not result in a drop in overdose mortality but a rise in suicide mortality.  https://www.wjhl.com/news/va-reps-to-discuss-impact-of-opioid-reduction-on-suicides-during-summit_20180123093420242/934066782.

[5] “Physicians prescribe fewer opioids despite their belief that they are causing patient harm,” https://www.bostonglobe.com/metro/2017/01/02/doctors-curtail-opioids-but-many-see-harm-pain-patients/z4Ci68TePafcD9AcORs04J/story.html.  As indicated in a related submission to your Task Force, a recent survey of 1985 patients with multiple chronic conditions conducted by Dr. Terri Lewis revealed harms of suicide and patient abandonment in Oregon.  In recognition of patient harm, British Columbia recently revised its mandatory prescribing guidelines on opioids to require that physicians continue to treat chronic pain patients who use opioids, https://www.theglobeandmail.com/canada/article-bc-doctors-cant-limit-opioids-or-discriminate-against-pain-patients-2/.

[6] Complications in Regional Anesthesia and Pain Medicine, 2d ed.

[7] See “Opioid limits hit hospice, cancer patients,” https://www.bendbulletin.com/localstate/6033839-151/opioid-limits-hit-hospice-cancer-patients; “Opioid Stigma is keeping many cancer patients from getting the pain control they need,” https://www.statnews.com/2018/07/06/cancer-patients-pain-opioid-stigma/.

[8] https://www.integrativepainmanagement.org/page/OpioidPositioning.

[9] See National Council on Independent Living, Pain and Opioid Task Force, Statement of Principles, https://www.ncil.org/wp-content/uploads/2018/07/7-20-18-Statement-of-Principles-on-Chronnic-Pain-and-Opioids.pdf.

[10] See https://www.aafp.org/news/health-of-the-public/20180425opioidstudy.html; Dasgupta, PhD, MPH, Beletsky, JD, MPH, Ciccarone, MD, MPH, “Opioid Crisis: No Easy Fix to Its Social and Economic Determinants, American Journal of Public Health, v. 108, n. 2, p. 183.

[11] Schatman, Michael, PhD, and Ziegler, Stephen, JD, PhD, “Pain Management, prescription opioid mortality and the CDC, is the devil in the data?” Journal of Pain Research. 2017; 10: 2489–2495, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5659223/.

[12] 2013-2014 National Survey on Drug Use and Health, Substance Abuse and Mental Health Services Administration (SAMHSA), https://www.samhsa.gov/atod/opioids.

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Authored by: Ed Coghlan

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Debbie Schlichting

This is to the post to Eddie. It’s clear to me that you do not go to a pain management doctor.If you did you would know that they are is very strict testing. Of course it does take honesty. I signed a pain management contract. I have been subjected to $2000 UAs. I am up front with any other doctor that I see. I suffer from chronic pain from a fall from the second story window. The impact from landing on my bottom fractured a vertebrae in my spine I am walking and I’m lucky that I am but the low back pain is excruciating. I also had a total knee replacement two years ago and it is worse than I could ever imagine. For those of us that are doing it the right way please do not insult us by comments such as you did. I have seen the same pain management doctor for five years. Oregon is now demanding patience be tapered off to nothing. So at this time I am considering another doctor. Just thought you might want to know another person side of the story thank you

Debbie Schlichting

I have been on opioids for the last 5 years. I have multiple chronic pain diagnosis and I am considered a low risk patient. So much so that I’ve never had an issue, I see my pain management doctor every three months. I haven’t had to do UA’s for almost two years and only have to have blood work. So I was blind sight d when at my last appointment I was told I was going to have to taper off from 90mm per day to nothing in three months and I have to see an addiction specialist so he can prescribe Suboxone. This doctor also happens to work in the same office as Dr. Stephen Dector from Kennewick, Washington. I live in Pendleton Oregon and I am outraged. My pain is so bad that I can’t sit or stand or do simple acts of day to day tasks. I wake up in pain and I am getting maybe four hours of sleep a night.Please note that my husband is also having to do the same. How can this go on? What right does Oregon have to dictate our medical care? We do feel he has abandoned us and I can only speak for myself but I can’t imagine having to live the rest of my life like this. I’m 59.

I really liked your tip to stay away from narcotics if possible, because they are hard to come off of. I was recently in an accident and pain management is very difficult; I hate the pain. I will be sure to ask my doctor about other ways I can manage the pain.

Eddie

I am an American who lives with chronic pain This war on opiates as the Government calls it is crazy. The doctors are scared to HELP chronic pain patients I understand there needs to be a few changes, but not throwing chronic pain patients to the STREETS. It seems logical that the DEA would look at the individuals who go only to pain management. I would bet that true chronic pain patients will have several other Doctors (Specialists) they see along with their pain Doctor . These are the ones that obviously NEED the opioids I know patients having to go to the streets to feel better and I know a couple of them have died or almost died. I have turned to vodka to get a little relief myself. Opioids actually help some of us to have days that are tolerable.
PLEASE STOP THE PATIENT ABUSE NOW!!!

Eddie StClair

I can not believe the treatment of chronic pain patients in our country. This war on opioids is absolutely wrong The people who suffer from chronic pain daily need the opioids We need to look at people who go to pain management doctors only. I guarantee you that the people that REALLY suffer from chronic pain have other Doctors (Specialists) they see regularly. I know people who are being FORCED to the street to get pain relief. THIS IS WRONG

LEAH

This article needs to be shouted from the rooftop! And we need more professionals to write articles like this. I hope someone sues for malpractice, inhumane treatment, fraud, and/or discrimination against disabled persons. The opioid crisis dumps street fentanyl and heroin in the same bucket as prescription opiates, chronic pain patients and cancer patients are NOT addicts or criminals. Drug addicts will find a different high, what are pain patients getting? Nothing. The government needs to stay out of my doctor’s office!

So, no proper pain management in Oregon, but suicide is legal.
What could possibly go wrong?

I have Ehlers-Danlos, a genetic connective tissue disorder with extreme chronic pain. No pain pills, I can barely move.

You do know how obscene your opioid rules are, right?

“Not all opioids are identical in abuse potential and likely
lethality, yet government statistics group causes of death in
a way that obscures the importance of identifying specific
agents involved in deadly overdoses. Searching the CDC
Wonder database reveals that the recent spike in deaths is
primarily due to illicit fentanyl. Targeting legal prescriptions
is thus unlikely to reduce overdose deaths, but it may
increase them by driving more users to illegal sources.”

http://www.jpands.org/vol23no1/lilly.pdf

John D. Lilly, M.B.A., D.O., practices family medicine in Springfield, MO.

Disclaimer: Any views expressed in this paper are solely mine and do not
necessarily reflect the positions of any business or organization with which
I am affiliated.
REFERENCES
1. National Institute on Drug Abuse. Overdose Death Rates. Available at:
https://www.drugabuse.gov/related-topics/trends-statistics/overdosedeath-rates.
Accessed Feb 7, 2018.
2. Centers for Disease Control and Prevention. CDC Wonder. Available at:
http://wonder.cdc.gov. Accessed Feb 7, 2018.
3. Gladden RM, Martinez P, Seth P. Fentanyl law enforcement submissions
and increases in synthetic opioid–involved overdose deaths—27 states,
2013–2014. MMWR 2016;65:837-843.
4. U.S. Department of Justice, Drug Enforcement Administration. Fentanyl: A
Briefing Guide for First Responders; June 2017. Available at https://www.
dea.gov/druginfo/Fentanyl_BriefingGuideforFirstResponders_June2017.

Susan

Susan

Please forgive me, Mr. Coghlan. While I extended a post of appreciation to all others, we cpp’s and pain advocates certainly extend our appreciation to you for making this publication possible! We always look forward to your great publications
Many thanks!

The rest of the state of Oregon is finally getting to experience what Douglas County has been doing since 2013. First they cut patients off opiates with no replacements, then begrudgingly allowed patients to have a “few” visits to the chiropractor or physical therapist. The local physicians organization, Douglas County Individual Practice Association (DCIPA) and CHI Mercy Medical Center of Roseburg basically control healthcare in Douglas County. They have refused to bring in any pain specialists after the last two left years ago. These providers use any excuse they can to cut patients off their pain medications. But what’s more appalling is the fact that they only seem to focus on the poor Oregon Health Plan and Medicare patients. For example, if a patient has chronic low back pain due to multiple surgeries (failed back syndrome) and has OHP or Medicare, they are tapered off rapidly and cut off their pain medications. If that same patient has a good paying commercial insurance plan, guess what? They get their medications most of the time! When adult patients have ear infections, OHP won’t cover antibiotics usually. But the doctors seem to be okay writing the antibiotic prescription anyways and telling the patient to purchase it themselves. But when it comes to pain medications that aren’t a “covered” benefit, they never offer to write the prescription and let the patient pay for it themselves. Double standards everywhere! Clinics and providers often lie to patients about the use of opiates and marijuana, claiming that it is ILLEGAL to prescribe the patient pain medication when they have a medical marijuana card or even test positive for marijuana use. The CDC Guidelines that they use to stop your medications clearly says not to even bother testing pain patients for marijuana. There is NO state or federal law that prevents a provider from prescribing pain medication to a marijuana using patient, unless they are an addict. These clinics and providers warp they guidelines and the laws to fit their desires and to benefit their pocketbooks, not to serve their patients. It’s a travesty that’s been happening for too long here in Douglas County, and finally the citizens of Oregon are starting to see the light when it begins to affect the whole state.

Alice

So many Heartbreaking stories. Because of this witch hunt many pain patients have been cut off cold turkey. My meds were cut in half after being stable on it 15 years. I’ve learned to cope but I’m never pain free now. I no longer am able to go to the flea market like I used to. I can’t stand in my kitchen long enough to wash the dishes, I have to do it in stages. If they ever shut then off completely I’m out if here. This is supposed to be the greatest country, yet chronic pain sufferers are treated like the disabled in nazi Germany! I hate this government. I’m so tired of jumping through the hoops. I wonder why I ever deserved to be treated like a second class citizen because of a severe injury.

Alison

As an Oregon resident, I want to thank all of you who wrote letters to HERC (especially under the time constraints and the tricky email address that took a web search to get to work). I’ve been fighting the Oregon Health Plan for the past two years about opioid restrictions and have felt very much alone and out gunned in this fight. After seeing the well researched and worded letter sent to HERC, signed by the many doctors from across the country, I feel so much better that it’s not just me against the world. Thank you, thank you, thank you! I hope someoneone the board will be open to listening.

Connie Woods

You just want us to kill ourselves
I hope you can sleep at night.
Nightmares are real

Jackie Wells

Glad someone is taking up for us chronic pain pts. Just bc we are on opiates mean we are addicted! !!

Cynthia

What an appalling idea that is heartless, discriminatory and has no place in a civilized society. These so called ” physicians” who have taken money from the state to taper patients off medically necessary medicines should lose their licenses. To offer patients relief and then take it away should be called what it is..torture. All parties involved should be sued and supporting politicians voted from office.

Dan

I honestly have to say. This is the most disgusting thing I have ever heard. I am from Connecticut I was in a severe car accident in 1991 and have had several back surgeries I have rods screws in my entire lower back is fused. I have been on pain medication since 1991. I do not abuse my medication I do not give it to anyone and I normally have extra at the end of each month. I take it only as needed. If Connecticut was to ever pass this law & make me stop taking my medication. I would be bedridden and in severe pain for the rest of my life I am only 46 years old. No I do not like having to take pain medication every day of my life but because of the medication I have a life. If they were to do this to me I would take my gun and put a bullet through my head is that what the United States won people who legitimately need pain medication and are not drug attic’s. You have to commit suicide because the pain is so severe. I hope they are stopped because this is against our rights as human beings and it is like they are acting like it is Prohibition again. It is my life my body I do not abuse my medication I take it as need it you do not hear about people on pain meds killing someone every 13 seconds like drunk drivers and alcohol is fine for anyone to buy. Hope my message help.

Cathy

The idea that anyone in constant pain is an addict has appalled me ! Thank you doctors for fighting back !

RGH

Thank you for understanding our challenges as chronic pain patients in 24-hour pain. I want to commend these doctors who will take on the system and stand their ground when so many others won’t. I can’t blame doctors who are afraid to lose their license when you read stories about the DEA raiding their offices and even taking some to prison. They don’t want to lose their businesses and years of schooling. In many cases having our federal government using a sledgehammer to solve a problem does make sense but not in other cases like this one. Like has been included in the many responses on this blog, most of those committing suicide do not fit the definition of a chronic pain patient. I know a study was done in Arizona about most patients who had committed suicide actually had 10 doctors or more that they had been Doctor shopping. If the government would look at the true statistics they will find that most chronic pain patients do not abused there opioids. Most of those who have committed suicide are younger then 40 in age and are involved heavily in either illicit drugs or alcohol or both along with opioids. I am 60 years old and have had 4 back surgeries along with about 30 epidurals and every other therapy you can think of. I have spent thousands of dollars on over the counter medicine, gadgets, as seen on TV products, and many other ideas that have been shared with me that might lower my pain. None have worked like oxycodone. Like most of you I hate taking prescriptions but it is in the only thing keeping me alive right now. If I could go off them today and eliminate my pain I would. I never dreamed that I would be in this kind of a physical situation but I am doing my best to cope and that includes oxycodone. Without it I who would not be alive. I hope and pray that the powers-that-be will very soon hear the truth and do what is right for people who only want to live without paying.

I am happy to see that there are Doctor’s who are willing to speak up about this issue. I currently have a torn Achilles tendon and I have to suffer daily because of the situation here in Ma and lack of pain medication. I cry almost every day and working is hard too. It creates a desperate situation and feels like a lack of care for an individual. It’s crazy to think that people who actually need the medications are denied access to it because of Heroin and the state’s desire for federal funding.

Ryan

I would have to leave Oregon. Maybe the ones writing this absurd guide need to be hurt so severely they can understand cronic pain. I never knew how pain could shut someone down from working and taking care of themselves and their home life until I suffered from my own back problems. My opioid pain medications help me fulfill my life. You’ll have to pry them from my cold dead hands filthy pigs.

Rene

I think that some people really need pain meds. The ones that are abusing pain meds are the meth users. I had 2 open back surgeries and yes I needed pain meds, so with this being said Dr’s can not just stop giving meds across the board. What if your family or families friend go through a similar thing. They would hurt real bad and they would suffer. You need to target the abusers not the ones who really need it. Thank you

Lee Husker

Thank God there are still some Dr’s who are willing to stand up for us, do the right thing when it can jeopardize r cuz great harm to their own careers. I was injured working Railroads. Starterd at 16 at 37 my nerves were shot coming down brain into neck, down shoulders n down leg. At 37 I felt 90. For 1st 3 yrs I refused to take any pain meds. But one morning I woke up n it took almost 60 mins for me to be able to move both arms in an upward position. This had been happening every morning for 5 yrs but never took this long n took so long to recover n the pain was intense. I’ve had a headache now going on the better part of 12 yrs. This headache is with me 24/7 365 days a yr. It’s either very minute or a full blown feels like you been stabbed with ice pick in middle of brain. Add to it I will vomit, be dizzy, vision blurred n just a general run down sick as dog feeling n it can last up to week at time. Before I was prescribed Fentanyl patches it was just a fact of life I had no choice but to deal with. Most times I thought of ways I thought would be the least painful way to kill myself n the least amount of trama I could find to help family cope witj what I was planning on doing. I love life, my family, trees, lakes n meeting new ppl, I want to live. But the problem is, at 6 ft 5 n 280 lbs I struggle with fact that this has defeated me, taken all of my will, dreams n hopes in life n brought me down to the harsh reality that this is now my life n it is not going to improve. Living in a hay seed state like So Dak, n add to that on a Native Reservation I am already behind the ball before taking anything. The life of some1who is on pain meds is no different then being looked at as the local drug dealer. I’m sure every single person who read this story has felt the same way n been treated the same way, prolly even worse then I have. Yet we all sit back and let the stigma dictate who n what others think we are. It’s just a sick circle that never ends, and everyday it takes away something, something I dont even know what it is? But its something taken from me n then plays games in my mind n puts me into this deep depression . Everything that at one time was important to me at some point in life doesn’t matter anymore, I dont smile very seldom laugh fact most times I have to make myself laugh. I no longer know who or what I am. Scary part? I no longer even care. Dr scared n… Read more »

kelly

P..S. I was a no taper patient. Almost had a stroke during withdraw after using opioid medication for 20 years. A patient willing to change medications only to be put back on a ridiculous low dose of opioid medication way under the 90mme. Yes doctors here in Maryland are trying to make big bucks of Suboxone. The doctor wanted $400 for the first visit and then it is $200 per month for the script and that is cash only. So I say to our government “why is this allowed to happen?”

Wendy

I’m adding my thanks to the professionals who understand the situation and took the time to address the committee in Oregon – the state where I live!

I have seen this day coming for a while now and am extremely grateful to not be tilting at windmills alone. It is my hope that the well reasoned letter/article will help swing the pendulum so that pain patients will no longer be punished.

In the end, the problem is one of addiction. That is made clear in your letter!

Thanks and thanks again!

kelly

All of these new laws made by our government just creating blanket laws and throwing everyone into one bucket. Senseless, barbaric, and inhumane. You can not lump drug seeking young adults into the same category as COMPLIANT disabled older individuals that have been in pain management programs that require pain medications to treat valid documented medical disease processes and chronic pain needs. How humane is it to take such a large group of people, deny them of medication driving them to the point of suicidal thoughts. I reside in Maryland and am fighting the battle. I refuse to be treated as an addict. I refuse to be denied medication that helps me have some quality of life. I refuse not to be heard, and I refuse to let my government tell me what they deem is necessary to control my pain levels. Stand up and start writing to local press and media. It has become quite apparent to me that our government is taking away our human rights under a disguise of proclaiming the great Opioid Crisis in America. You can not compare medications used to get high to the ones used in pain management. What we have is a healthcare crisis. People just cannot afford it. I can not tell you how many times I have heard the speech every doctor gives regarding pain medications. The very doctors that are giving the lecture have not even taken the time to get the education needed to prescribe Suboxone. A drug used in other countries that provide some pain relief for patients that has the property of naloxone to keep people from overdosing. Safe for patients and safe for doctors. A very limited amount of hours needed to get certified in order to prescribe. I have been going to a federal funded clinic that had a doctor prescribing pain medication. All the sudden he left and left all of us high and dry after years a pain management. I met with the Director of the clinic and from the horses mouth was told that the higher ups did not want him prescribing Suboxone to help people get off of the Opioid medications that the clinic themselves prescribed for years due to the stigma that is would look like a junkie drug clinic.We need to vote out the people making these laws leaving us debilitated, incapacitated, and frustrated. We are the citizens that put these people in office and we can take them out. We call this Democracy? How do you give quality care in a 15 minute visit?

gretchen lont

I thank the doctors for advocating for us, although they shouldn’t have to. If our government is so concerned about deaths, where are the screams for the deaths due to auto accidents, alcohol, etc…the stuff that more people die from than prescriptions? This is just another scheme for the greedy to make a little more money by lumping all pain patients into the addiction category and putting us all on Suboxone. As someone who has tried to take their life when my pain was untreated, I can tell you this is a bad, bad idea and I’m shocked they even have the balls to throw it out there. As for me I will either suffer or end my own life before I take Suboxone. Anyone paying attention will know that the CDC guidelines were made in secrecy and with false statistics. Time to get money out of medicine. And when did politicians start practising medicine? When did that become legal?

Why is there no attention to alternative pain management options. Some are very helpful, others not so much. Doctors suggest mmj, yoga, reike, massage, floating, aqua therapy, accupuncture…none of which are covered by insurance and as such not a viable option for a chronically ill person. If we can’t afford food, exorbitant premiums, deductibles, copays, legal medications how can we afford $75-$125 per session for the alternatives that get suggested? Answer: we cannot. So that leaves us with only one option, suicide. Most of us can not even afford $50+ per visit copays. We leave in torturous pain and cannot go to any ER or urgent care because we get put on the drug seeker list. In other words, we thrash around in bed sobbing, praying that we get cancer. Thanks to this misguided opioid war those of us in chronic pain have no choice but to end the torturous pain. If we had supportive family/friends and adequate funds we could get our homes vacuumed, real groceries not the food that no one wants and donates to a food bank, get proper treatment.

Terri McFarland

Thank you, Ed Coghlan, for sharing this, it gives me some hope as an Oregon chronic pain person. Oregon apparently lied about the cut off date for comments on this issue, didn’t surprise me in the least.

patricia datil

I am a chronic pain patient .i have been in pain management for about three years now .I have done every procedure that the doctor has recommended.I recently moved to wisconsin .The doctor at the pain management here has done many procedures.only to make my pain worse .when i started here i was on percocet 10 mg .within a few months they had altered my meds to norco 7.5 .i was short on my medication two times because i was in more pain and they lowered my medication .now they have put me on belbucca i told the doctor it is not working .they told me it takes time to work .so i am in alot of pain can not do anything .

Susan L.

It is ridiculous that this response needed to be written in the first place. Although I know many doctors haven’t viewed them as such, opiates should be a treatment of last resort. Sure, patients lie to get them, but that should NOT be the government’s or the doctors’ problem.

Rather than commit suicide when you can’t get your pills, get yourself thrown in prison: you can probably get “the good stuff” there. (I’m being facetious.)

mist

Thank You for writing in regards to Chronic pain patients and warning them in OR in what they are trying to achieve they are in fact causing more harm than good.

Carolyn Lord

Thank you, thank you, thank you and God bless you! Finally, some doctors with a backbone, willing to stand up for us. This letter is phenomenal! I also would have stated that denial of adequate pain control is a human rights violation as stated by the World Health Organization and other human rights groups. I wish you could all come to Maine and talk sense to our leaders, as Maine is now being investigated by Human Rights groups. I’ve also complained to the Dept of Justice regarding the rogue power they’ve granted the DEA in this opioid debate. As many others have stated, it seems that everyone is practicing medicine, except the doctors, who now have their hands tied. Again thank you, and I stand with you in this fight. Carolyn Lord, RN,BSN

Cynthia

HERC, thank you for your time and consideration. What you propose is absolutely barbaric. I live with chronic pain from the following incurable diseases: Scleroderma, MCTD, Lupus, Fibromyalgia, & severe DDD. In 2002 my pain got so bad that I was willing to try anything. It started with spinal injections, acupuncture, hyperbaric chamber, chiropractic services, water therapy, message therapy to no avail. In 2002 I started on my opioid treatment. Since my force taper in March this year I was stable on high dose opioids. I was able to care for myself, my 83 year old Mother and Mother in law. At 55yrs old and 4 months of force taper I want to die. My blood pressure is sky high, my sitting heart rate is 132. My EKG is showing murmurs and erratic heartbeat. I am now bed bound, a good day is me getting to brush my teeth. I was on 3 Medications for 17yrs (2 for pain) Now I’m on 12 different medications in which NONE HELP. All I wanted was to let nature take its course but I expected to do that comfortably with my pain medications. I was a cash pay patient paying approximately $375.00 for Dr visit and meds per month, now I’m on Medicaid and my government is paying over $4000.00 per month for Drs and Meds. Please consider the blatant fabrications told by the CDC in the first place. I believe that many lawmakers and policy holders are making money off the disabled, Veterans, IP and chronic pain patients while switching them over to Suboxone, Bupe and subutex. I here Drs are getting some kind of financial gain if they switch them to Bupe. My physicians are so scared they will loose their medical license. I see a Pain Management Specialist, the same one for 17 yrs. I’ve had the same pharmacy since I moved here in 2006. I have never called in early, I have obided by my pain contract, always passed my urine tests, and have never taken an illicit drug or drank alcohol for 17yrs. All I want is a better quality of life which has now been stripped from me. I want my life back, I want my meds back. I just want to be able to cook again, take care of my mother and mother in law but the only way to do that was on my high dose opioids. Please, I’m afraid if you pass this law, the ridiculous 90MME cap, (this is not 1 size fits ALL)! that we will have thousands of people committing suicide. I know I’ve certainly had those thoughts lately! Please stop this madness and stop punishing people in pain. You should NOT PASS LAWS BASED LIES & FABRICATIONS! Respectfully

Melissa Stringfellow

I live in Georgia and was just cut off by my oncologist . There is NO tapering going on they just take them away . This has left me unable to do the things I was able to do and I’m horrible pain . They’ve taken what little quality of life I did have away and also want to take my anxiety and PTSD meds and my gabapebtin . They don’t want law abiding citizens to have access but it hasn’t stopped the addicts from getting what they need . Someone has to help us before it’s too late .

Katie Olmstead

While I did write my own furious letter, this one carries a whole lot more punch. Thank you all for writing this. “Do no harm,” indeed.

Heather

THANK YOU!

As I scrolled down to see the number of physicians who had signed on, I was holding my breath… Yes. This is it. If they don’t listen to it, then they might as well vote to a hunting season on humans who are to be culled.

I’m viciously angry at the people who dare treat other human beings with such a lack of compassion. It’s indecent and it’s against International Human Rights Law!

THANK YOU to these doctors and for making the community aware that doctors can help us fight back! Thank you, Ed, for sharing this!

Angie

What can we do as citizens to help support this fight?

I am a Chronic Pain Sufferer. I have had 24 broken bones, 20 operations, have Chron’s Disease, Fibromyalgia, Migraines, Arthritis, and a myriad of other concerns. The V/A cut all Vets off Opiates, even the Disabled Veterans such as myself. If the private industry does the same to me, then I will be a Virtual Prisoner in my own house. The same sentence given criminals. I served, I got hurt, and now We are sentenced to a life of pain. I will not accept that sentencing. I’ll take the death sentence instead. Thanks for caring U.S.A. Less money to pay out, right. Win, Win for Our Government.

Bil Y Z

While OR is a very beautiful land that used to be, more or less, what is now called ”populist” by way of ALL the current terminologies ignoring the realities of the terminologies that had been accurate for decades, it has become, lately, a “Nanny state” where the state takes waaay too much control of each and every individual, almost always to the detriment of said dude or dudette.
What we can hope at this point is that OR will wake up and make the call to let the Doctors make the call for each and every individual for this class of drugs, and, for that matter, all classes of drugs.

Thank you.

Linda

Does this mean we now have a group of “experts” arguing FOR the guidelines? Isn’t that the problem in the first place?

Do they realize that the one and ONLY difference in Oregon is that Oregon wants to put its intentions in writing? And that many many other states are already mostly there. Other states have started with the physician groups and physicians by raiding practices and arresting people left and right.

Take a look sometime at the current list of physicians put out business and no longer able to practice medicine, by being raided. It is astounding! We already have a physician shortage….these guidelines, which most know are NOT guidelines, are doing critical damage to that aspect of things. Patients are already being forced OFF of their opiods all across the USA.

What Oregon wants to put in writing is already being done to patients everywhere. And worse. With no taper.

My fear is this group will inadvertently be pro CDC guidelines.

I’ll join the thanks…especially since I’m in the target state. I wish Oregon had learned something from banning sudafed a few years ago to “solve the meth epidemic.” Want to guess how solved the meth problem is in Oregon? Took the meth network a few months at most to shift to outside sources; meth rolls on.

Please, everybody write to the herc.info@state.or.us! Maybe if we can get ONE state to pause & actually use some reason over hysteria, the rest of the country will (may?) join in.

Beth Holden, MSSW

Prying pain medications out of the hands of chronic pain victims does not solve the pain problem or the opiate abuse problem. It does create immense and unnecessary suffering.

My sister’s husband has had multiple surgeries. He was a former US Marine captain and a tough guy. He needs opiates to control pain.

Here is an article for you to read and contemplate. A man whose pain medication was cut by 75% to achieve some bureaucratic goal committed suicide because his pain was intolerable. He left behind a loving family. https://amp.usatoday.com/amp/832086002

Or perhaps that is the unspoken goal of this new policy – encouraging chronic pain sufferers who are poor to commit suicide? Look to your souls if that is your secret, unadmitted desire.

Tammy

The Government, DEA, and CDC Guidelines are just plain dumb. Take me for example, I am 49 years old and suffer daily. I have had numerous surgeries without success. Should I ever decide to try and see how I would make it without my medications is impossible, due to the stupid laws. You see according to the way things are now, if I just wanted to try and see how I or if I could manage without my opioid medications, I would be put on Suboxon, or Subutex to relieve me of some of the withdrawals, this would tag me as being a drug addict and should I get older and ever require surgery again then I wouldn’t be allowed ANY OPIOID MEDICATIONS AT ALL. THIS LAW IS NOT ANYTHING ELSE BUT STUPID!!!

Sarah

Thank you so much to all of the professionals who took the time to provide a beautifully written opinion on the potential Oregon chronic pain crisis. As a long term chronic pain patient, I am watching with great trepidation as more and more non-medical personnel are getting in the middle of my relationship with my extremely well educated pain specialist. This doctor has given so much of my life back. In 2000, I spent most of my time in bed, crying with pain, unable to care for my family or do the simplest of tasks.Years of acupuncture, chiropractic, massage, facet injections, epidurals, a TENS unit, aquatherapy, physical therapy, etc. did not relieve the intractable, uncorrectable back pain I suffer from. However, carreful use of opioids, along with non-narcotic medicines, have enabled me to have a life again. After almost 15 years of palliative treatment from my doctor, I am terrified that these lifesaving medications will be taken away. It would be inhumane and unethical to remove opioids across the board, and not look at the individual when these decisions are made. I have no doubt that the suicide rates will skyrocket if these laws are enacted. I know because I was headed that way 15 years ago, before I found proper help from a pain specialist. There is a place for all the treatments that have been discussed, but those therapies (all very expensive, extremely time consuming, and generally not covered by insurance, by the way), if not effective, should not be forced on chronic pain patients.

Ed Humphries

As a pain mgmt patient for 22 yrs this is the most ridiculous proposal I have ever heard of! I have tried EVERYTHING and opioids are the only thing that has worked. I’m sick and tired of being attacked by politicians who just want a talking point and who don’t understand a darn thing about chronic pain. I want them to spend a week in my shoes. Degenerative joint disease and now Rheumatoid Arthritis. I have had 13 surgeries 4 back surgeries with lumbar fused 4 knee and a replacement 2 elbows and it goes on and on. Stay the hellout of my medical care. Listen to the EXPERTS on pain mgmt. I wish and pray I didn’t have to take opioids and the expense of it all but it’s the only thing that works!!!

Thank you to all of the Pain Management Specialists who have taken the time to use their expertise and experience to try to stop Oregon (and by extension other states – it seems that once one state starts a policy like Oregon’s others follow, no matter how bad and harmful that policy is) from interfering between the Doctor/Patient relationship and treatment. It seems like no matter where we look these days, the people being harmed by politicians trying to regulate opioids are the Pain Management patients who are NOT misusing our opioid medications! And we’ve all heard the statistics that politicians love to quote: 40% of all overdose deaths have some type of prescription opioid (or non-opioid such as benzos) in their systems. So why do we never hear the opposite: that 60% of all overdose deaths DON’T have any prescription opioids in their systems? Because it doesn’t fit with what they have decided is the problem.

I hope that letters like this one will cause Oregon to reconsider and abandon this horrific policy, but I am still fearful of the new regulations that Medicare will roll out in January 2019. Although not nearly as restrictive as Oregon’s proposed policy, it still interferes between us and our doctors in regards to our Chronic Pain treatment by regulating the MMEs in our treatment. No good will come from these reductions, yet the potential for doctor abandonment, patients switching to illegal drugs to get the pain relief they will be denied, and suicides by Chronic Pain patients who, after years of being able to control their pain and lead a somewhat more active life than they could without their Opioid medications, are suddenly either reduced or taken off their meds completely.

Us Chronic Pain patients are not the problem in the opioid overdose crisis, but we are being treated like it’s ALL OUR FAULT! I fear that things will get a lot worse for those of us who have found relief with opioids before they get better.

T J

We the people are losing our cival rights at the medical established level , just to satisfy an over zealous attempt of government coddling in a masked venture trying to make us think that they actually care about our well being. This veiled attempt at gathering votes at people in agony cost of living a.semi life of substance and quality.I am appalled at non medical beurocratic ​ politicians having a hand in my health Care , especially since it has done nothing but hamper my quality of life,and getting worse every month a with a mandated taper of meds that is now 85percent. I do not blame my doctor I know he is practicing with one arm tied behind his back.normallyi would edit this post but my back is really bad today and am just mad enough to make this far.

CathyM

Bless them ALL for writing this!! I’ve been drafting my response (I live in OR; not on Medicaid) but I get so rageful I am incoherent. Now I can refer to this comment to provide the data, and express my personal feelings and experience. I hope one or more of them can get to the meeting – it’s essential that this be stopped! I’m certain my Medicare provider will follow this immediately if implemented, given how overboard they went after CDC guidelines. A nightmare!! Thanks for sharing this with us!

Feeling ur struggle

I just want to know who gave the government medical licenses?? The people passing these laws have no idea what they are talking about.
Without medication I would spend my days in bed crying from the pain & be a total burden to society. At leasr with medication I am able to still hold down a job. Of course I have flares & still miss work more than I should but at least I am able to function most days. I have been to counseling, taken more epidural shots than I can count (which has weakened my already fragile bones,), done physical therapy, etc. It help’s sometimes & helped me try to put living in pain in perspective but it’s by no mean’s a real answer. These are simply tools that improve a bleak, sad & VERY HARD life I live. I have even tapered myself off for 6+ months & it does not get better…I ended up losing a job, back in bed wanting to die.
Where is the compassion for chronic pain patients? I guarantee if any of thesw people lived with my pain for a week they would completely change their minds.
My heart goes out to the patients in Oregon. I truly hope the suicide rate & OD rate from illegal drugs does not skyrocket. But I understand if it does because what else are they going to do? Nobody can live a lifetime feeling like this. It’s just very very cruel & uninformed.

Heather Maciel

Thank you so very much for giving us who suffer from chronic pain legitimately …a voice that is deemed credible and qualified by the boards that govern such things, unlike those like me , that are treated like pain medication gobbling junkies that will say anything for a “fix”.