Kristen Mascia’s January 28, 2013 article in People Magazine, One Death Every 24 Minutes (Deadly Pills: A National Epidemic) although factual, is variously lopsided to healthcare providers that routinely treat chronic pain. After speaking with Ms. Mascia, it seems that her intent was not to sensationalize a serious problem that might breed fear in community and feed ammunition to media-starving politicians. Instead, I’m convinced her heart was in the right place to share a message that if not taken as directed, any drug could kill. That intent is admirable, although I believe was lacking in a recent Wall Street Journal article reviewed in a paindr.com blog, PROMPT Position Remains Unchanged.
True enough, prescription drug abuse is a serious problem that needs to be addressed. Panic, fear, and politics are counterproductive to addressing the problem − that only serves to fuel a fire which spreads across the field to innocent bystanders. The innocent that get burned are legitimate pain patients.
Let’s start with these three important take home points:
It is not okay to;
…drink alcohol with opioids.
…use someone else’s medication.
…take more medication than instructed.
The in-print and online versions of Deadly Pills: A National Epidemic includes 2/3 of one page outlining some “painkiller pill” (opioid) statistics and related deaths. But, it does not go far enough to objectively outline the whole [complex] problem. Five of the remaining pages include large color pictures of families that survived the deaths of their loved ones from opioid overdoses. I would have liked to see a few pictures of live patients writhing in pain and withdrawal because they were unable to obtain their opioids. I would have liked to hear about how families are destroyed because of poorly controlled pain that has caused job loss and failed marriages.
A follow-up article addressing much needed pain education among healthcare providers, the importance of stratifying risk in patients that are considered for chronic opioids, the harm to patients (and their families) that find themselves in withdrawal because they are unable to obtain an opioid refill for various reasons, the financial, psycho-social impact of poorly treated pain on patients, their families, and society, the absurdity of 20-40 Lortabs following a dental procedure (when NSAIDs work better and the Lortab ends up in a medicine chest someplace later to be confiscated by a teen), the black market that exists and what practitioners (and patients) must deal with in clinics to monitor patients (urine screens, serum analysis, and more), etc.
The article plays on emotions of the reader laying blame on the drugs. All three deaths discussed in the article are a direct result of behavior that is explicitly proscripted on the part of the deceased. I truly feel horrible for the families of these victims, as they are living with the tragic outcomes of their loved ones. I personally cannot imagine losing a son, daughter, or spouse to a drug overdose. I also suspect that if this blog finds its way to any of the families that interviewed for Ms. Mascia’s article, the truth herein will be quite hurtful; for that I am sorry.
Tragedies like this provide an opportunity to say that we (all of us, journalists, healthcare providers, patients, law enforcement, etc.) have a role in helping make sure we are doing everything we can to help make pain management safer.
Three cases given by People Magazine’s author Kristen Mascia;
1. A young woman (previously an athlete), age 28 recently married and pregnant. She took Lexapro, hydrocodone, and was “excessively drinking”. She died. [Drugs and Alcohol: There is a warning on all opioid prescription bottles that includes some permutation of, “CAUTION: Do not drink alcohol, drive or operate heavy machinery”].
2. A high school senior football player, 150 pound athlete, took 2 methadone tablets from his grandmother’s medicine cabinet. He died. [Although I don’t know for sure, I suspect the methadone tablet strength was no more than 10mg based on grandma’s diagnosis. A total dose of 20mg is high for an opioid naïve patient, but it strains credulity to believe that this didn’t involve more than two tablets and/or other substances in an otherwise healthy 150 pound male athlete. Also, taking someone else’s medication! All opioid bottles state, “Caution: Federal law prohibits the transfer of this drug to any person other than the patient for whom it was prescribed.” I think taking your grandmother’s drugs is covered by this.]
3. Forty year old firefighter post-injury now on prescribed Dilaudid and Celexa. He died of an “accidental overdose”. [I’m not sure what that means. Did he accidentally take a handful instead of the prescribed amount? This is where education comes in for the prescriber and patient; although we can’t prevent 100% of adverse outcomes, risk stratification in terms of co-morbid depression and other mental health disorders before and during opioid therapy is important and underappreciated].
Although prescription bottles are labeled with warnings and transfer is prohibited, we also know that folks typically don’t pay attention, are distracted, and don’t read all the labels. Is that all the patient’s fault? Pharmacies that rely on printouts to provide important drug information are copping out. Prescribers who don’t assess patients for alcohol and other drug use are dropping the ball.
Are opioids dangerous if taken other than as directed? You bet they are!
Dr. Scott Strassels said it well; “The challenge to policy makers, health care providers, patients, and law enforcement officials is to balance the need for appropriate pain management with efforts to reduce abuse and misuse, and to do so without resorting to fear or emotion.”1 His commentary was written in rebuttal to “Danger in your pill bottle” on the Cable News Network (CNN) Web site. (Seppala MD). The approach by Seppala was similar to what we saw in People Magazine.
Considering the numerous evidence-based pain practice guidelines in place, legitimate patients continue to suffer needlessly, outcomes overall are poor, and society pays a high price figuratively and practically because of suboptimal pain treatment strategies, resultant clinic and emergency room visits, hospital admissions, and readmissions.
Any real answer to this problem is multifaceted and needs to include education for healthcare providers, lawmakers, and consumers.
Articles such as the one that appeared in People Magazine could have a negative [fear factor] impact on patient care. “Pill Mills” are problematic and need to be squelched. Criminals involved in such activities need to be brought to justice, but patients have suffered needlessly because of knee-jerk reactions by lawmakers in various states. (See Dancing to the Pharmacy Crawl for Opioids and Kentucky’s Pharmacy Crawl. In some cases, we see sensationalized statements from politicians such as Senator Chuck Schumer speaking on an extended release formulation of hydrocodone: “It’s tremendously concerning that at the same time policymakers and law enforcement professionals are waging a war on the growing prescription drug crisis, new super-drugs could well be on their way, flooding the market… The FDA needs to grab the reins and slow down the stampede to introduce these powerful narcotics.” This blog on paindr.com addresses that well, [Hydrocodone: Potency, Popularity, Politics, & Practicality], as hydrocodone surely is not a “super drug” of any sort.
Here are some facts to balance out Mascia’s People Magazine article.
More deaths are caused each year by tobacco use than by all deaths from human immunodeficiency virus (HIV), illegal drug use, alcohol use, motor vehicle injuries, suicides, and murders combined.2,3 I don’t see anyone rushing to take cigarettes off the market, limit the number of cigarettes that one can purchase, or limit the nicotine intake from any consumers! But, this is on the table for opioids.
Every day, almost 30 people in the United States die in motor vehicle crashes that involve an alcohol-impaired driver. This amounts to one death every 48 minutes and the annual cost of alcohol-related crashes totals more than $51 billion.4
And finally with regard to opioids, see Policy Impact: Prescription Painkiller Overdoses. About one-half of prescription painkiller deaths involve at least one other drug, including benzodiazepines, cocaine, and heroin. Alcohol is also involved in many overdose deaths.5 In 2010, 2 million people reported using prescription painkillers nonmedically for the first time within the last year—nearly 5,500 a day.6
So there you have it. Isolated Police State politics and narrow-minded, draconian policy changes, across more and more states, is not the answer. Instead, it may fuel a black market or increase more dangerous activities such as injecting heroin as outlined in Pain Pills Wane – Heroin Moves In.
Telling the whole truth is less sexy media, may be limited by space constraints, and calls less attention to readers and magazine sales. Journalists – you are in a position to help or hurt. Publish the whole story fairly, even if it requires sequential articles, so that we can all work together for some reasonable solutions rather than pointing fingers. Let’s not blame the ground on a faulty parachute; instead let’s repair the equipment together.
References:
- Danger in Your Pill Bottle? (Journal of Pain & Palliative Care Pharmacotherapy, Vol. 23(4), 2009.
- Centers for Disease Control and Prevention. Smoking-Attributable Mortality, Years of Potential Life Lost, and Productivity Losses—United States, 2000–2004. Morbidity and Mortality Weekly Report 2008;57(45):1226–8.
- McGinnis J, Foege WH. Actual Causes of Death in the United States. Journal of American Medical Association 1993;270:2207–12.
- Blincoe L, Seay A, Zaloshnja E, Miller T, Romano E, Luchter S, et al. Injury Prevention & Control: Motor Vehicle Safety
- CDC. Warner M, Chen LH, Makuc DM. Increase in fatal poisonings involving opioid analgesics in the United States, 1999-2006.
- Substance Abuse and Mental Health Services Administration. Results from the 2010 National Survey on Drug Use and Health: volume 1: summary of national findings. Rockville, MD: Substance Abuse and Mental Health Services Administration, Office of Applied Studies; 2011.
Chronic pain is a debilitating condition, no matter what the cause. The vast majority of patients go thru months and even years of treatments that simply do not work. We all have tried so many different medications, OTHER than opoiods to relieve the pain we are in every day. We do NOT want to have to take these powerful narcotics, but alas, the medical research has not kept up with what we are going thru. Personally, i have tried over 8 different medications over the course of 15 months in an attempt to find ANYTHING that might ease my pain and allow me to function on some level of normalcy. For me, they simply do not work. I have also tried a “synthetic” narcotic pain medicine and i may as well have been taking a baby aspirin for all the relief it brought, which was NONE.
Law makers are so focused on the “abusers” of these medicines and what they need to do to stop them, that they have totally lost sight of who these drugs were designed to help. We are NOT looking for the next high. We do NOT get a buzz from taking these meds. We do NOT even get adequate relief in many cases from taking these drugs. Too many of us suffer every day because of the laws that have been passed in the last few years. Our doctors and pharmacists are afraid to prescribe and fill our medicines and we are the ones that suffer. Yes, accidents happen, but that is not confined to this particular class of drugs. You can OD on just about anything, even OTC medicines.
Before you can pass judgement on anyone surrounding this issue, ask yourself this…. if your mother, father, sister, child were in extreme pain every day but they are not “allowed” to obtain a medication that would allow them to function outside of the bed they are lying in, wouldn’t you insist that this medication be made available to them? That’s what it’s like…every day. Without these meds, patients become bound to bed rest and are suffering horrendously every day. I feel that there are more suicides from being unable to endure the pain any longer than there are lives saved by restricting addicts from getting them!
Karin, Thank you for sharing. You bring up some very interesting points, especially the risk of suicide versus chronic pain, as there was just a publication confirming the high suicide risk among chronic pain sufferers last week.
So true! I have been burnt,my spine is ruined,diagnosed with
PTSD.”wich is unbelievable to deal with “I have so much guilt
because my wife has to deal with ithis when I -fuck it,I have said enough! I am screwed and too old to ever see a change I. will be
dead before PRESIDENT TRUMP CAN SAVE US.my hope is that the folks who get hurt or are in the pain.I have will see these
Freaks put out of office and the sheep who go along with the
nitwits who have never been in this kind of pain are dead.
Yes I’m in that situation without my pain meds i cannot fuction properly the only way i can get pain meds is from a pain management specialist who are nickel and dimming to death or through the black market which when u take a pill u dont know if your going to see the next sunrise i should should have controlled over what i put in my system not someone’s else opinion im from tucson az if anyone knows of a general practice doctor who would ne willing to work with me please give me there name and phone # thank you and have a good day
Every day is a day in hell, I pray and beg god to take me from this earth because this life is not worth living through the pain.
I’m 28 and the doctors see me as too young to have serious pain so i get 90 hydrocodones a month, which barely take the edge off, I run out of medicinne every month and contemplate how to end my life, when i have plenty of meds I help alot of people, I make the world a better place, otherwise i just lay here while my bills and life pass me by.
People who dont need medicinne get it and sell it all and people like me suffer uncontrollably, I eat 2-3 goodies powders and 6+ asprin at a time and still hurt very badly.
The fda is racist against all people on drug managment and i’m feeling the pain from it.
Me and many more like me will die from suicide and nobody cares, but when they see what a drastic toll it takes on every community they will realize how important we are, in my good times i have cleaned up and made safe dozens of neighborhoods, fixed many computers, cleaned maany yards, taught alot of people about god. but in these hard times i see life as a joke and the jokes on me. I cant wait to die and leave this hell you call life. Hopefully the generations after me will recieve the pain managment they deserve.
FINALLY, a journalist tells the story the way it really is.
See FDA Action on Vicodin May Mean More Pain, Not Less Addiction or Overdose, by Maia Szalavitz in Times.
Up until the new laws kicked in in about 2 years ago I was being treated with a relatively conservative dose of morphine sulfate. Yes, I did work up over time from the bottom line conservative treatments; physical therapy, NSAID’s, Tens Unit and. even went to an “energy healer” at one point. However when the new laws started my the neurologist, fearing trouble from the state booted a huge amount of his patients that did not have an “objective” vs “subjective” neurological issue that was a clearly pointed to the cause of my pain My imaging showed degenerative changes, some narrowing in the lumbar spine, a small tear in the large muscle of my rear end and a small cyst in the same area. (It took me 2 years to get then to MRI the hip) I had sought out care for several years prior when pain became a steady companion if I walked for more than 10 minutes, stood for more than 10 minute. Pain would radiate down my thigh but was not sciatica. After a day of any extra activity it was guaranteed the following days would be more problematic than usual. Over the last 2 years I have not been on any opiate pain medications but have taken my doctors recommendation and have been seeing a pain management clinic and received injections for the hip and lumbar. After a few trials I do not get relief from the lumbar shots but some temp relief from the S1 injection. I’ve dropped down in to the same space mentally as I was the first few years while trying to discover the cause of my trouble and was not being treated for the pain. I am positive the last job I had which involved repetitive lifting, twisting, bending and walking while managing 40 lb boxes was the root of my troubles. I am back where I started but imaging shows even more degeneration. The depression is back, I stay home and do not make commitments to anyone except to make doctors appointments. And at this point with all that has taken place I do not expect to find any relief physically. But I do continue to see a mental health professional to attempt to not drop so low. But the truth is I’ve digressed as a whole person because I simply can’t function in any normal fashion. Not as a person, as a mother as a daughter and grandmother. As I sit here I have not left my house in 3 weeks. I’ve not even had a shower in days. I sit in a guarded near fetal position day in and out escaping through reading. No one there can fix my issues. I only wish those playing russion roulette with the lives of people like me could be in my shoes. I do not drink, I do not do drugs. I never abused my medications I followed every rule. I was on a first name basis with my pharmacist and used only 1. Initially I thought, well, okay…This is going to be okay. I was able to drop off the medicines without any withdraw problems and was just trying to do what I needed to do and take another direction. Now it’s clear to me and those who love me my quality of life has gone down the drain. I don’t know which way to turn. I did ask the doctor who has been giving me the injections if having some type of mild medication be a consideration and he prescribed a low does of anti depressant to take at bed time. It turned out it was the type the increased the serotonin levels and I was awake awake half the night and could not sleep. Something I have a hard enough time doing as it is. All I know is I don’t see things improving for myself or for those fortunate enough to still be treated. I also know that there are far more painful conditions than I have and I have to be thankful for this. At 48 years old I have no choice but to stay in the day because the to consider life and the limitations I have remaining as they are over the rest of my life is far to depressing to consider. Thank you all here for fighting for us and please don’t give up. I won’t either.
Keep looking for doctors in and around your area. I have neuropathic pain and I have not been able to find any neurologists able to help me. I have gone to at least a dozen. So I found a good pain management doctor. There are good ones out there. It just takes time. You should always ask a doctor for their opinion on opioids. If they say they wont prescribe them or only for cancer, then I’d go to a different one. It is my opinion that there are no absolutes in medicine, so you shouldn’t see a doctor who behaves as such.
Just this last month when I went to get my prescription refilled, my Walgreens denied my request and sent us on to another store. My pharmacist and staff know me by name, for heaven’s sake. The number of meds is so restricted, next time I won’t be a “good patient” and wait until I’m almost out. I thought I was supposed to wait until I was about 3 days from running out (that was the policy 60 days ago), but now it’s at least a week before they can fill it. I live in Florida (which was called the “stupid State” by my doctor last month). If it weren’t such a serious matter, I’d have laughed.
I realized we were in for trouble last year when I saw a TV commercial for rehab centers focused on chronic pain patients. “If you’re using a prescription opiate and would like help, call…” I turned and looked at my husband, slack-jawed! Seriously? I cannot imagine who funded that commercial, but the pressure to get “clean” was laughable. I almost died from Neurontin poisoning, so if “they” want to pick on chronic pain meds, that one would be on the top of MY list. Good grief!
By the way, Dr. Fudin, you are such an amazing advocate for us. What would we do without you? I appreciate your efforts so much. My earlier comment was addressed to the writer of the People article, not you. I think you know that, but just in case…
Good article Dr. Fudin. I cannot help but think that the massive growth in the injection industry is fertilized and cultivated by the war on use of opioids….and the adverse effects of the injections gets little press. How many patients I saw over the years who got worse after the injections and vowed never to have another injection….but no one tracks those adverse side effects. Now with the ongoing indolent evolution of fungal infections from contaminated steroids, the press seems to be ignoring the harm that has occurred in the people who have gotten injections rather than opioids. In fact since epidural steroids are given only to people with chronic back pain and some with acute pain, the targeted people are a statistically distinct subpopulation. I am not a statistician, but it seems to me that you could calculate a death rate among those with chronic pain. I bet the death rate for chronic pain patients is far greater from contaminated steroids than it is from opioids in that same population.
And where is the call for readily available intranasal naloxone that could easily drop the opioid death rate and enable the drug abuser (usually not a pain patient) to get appropriate treatment.
Treating surrogate patients by making it more difficult or impossible to get medications is not going to put a dent into the deaths of addicts who are by and large a distinct group of people.
I think this issue parallels the discussions on gun control. Do guns kill people or do people kill people? There is a real risk that people will over react and patients with legitimate needs will be denied the therapy they need.
Oh my Phil, you speak the truth. Like the post says, nor can we blame the ground for a faulty parachute (or plane crash for that matter). I definitely don’t want to get into a gun control debate here, but you certainly make a very valid point.
I was thinking the very same thing! Thanks for bringing it up…I didn’t because, like Dr. Fudin, I didn’t want a gun control debate. But it can be linked to every “right” we have (or had) as Americans. Thanks for your comment.
Dear Jeff, I am angry too. I think this attitude is reflective of our larger national problem of having now a bunch of entitled people who don’t take ownership of their problems and decisions and hence point the blame. This is now a ubiquitous mindset reinforced by government policy after policy after more policy. Sadly the liberal media hasn’t changed over the years nor do they care to. Sensationalism sells even when misleading. We need published tear-jerking stories of loved ones who committed suicide due to severe pain….marriages broken up when a spouse is so consumed by pain that intimacy and sex becomes nonexistent….MVAs caused by drivers distracted by severe pain…patients turning to illegal drugs due to limited access….famous people who battled pain…..patients have lots of fascinating but sad stories to tell…..not everyone cares to listen if it doesn’t support their own agenda. How did our country and the field of medicine fall so far so fast? How did an American’s hand go from proudly held over their heart, to being outstretched for free non-essential handouts, to pointing a finger at someone other than themselves….just in the past 20 years or so???
I imagine your saw the excellent outcome of US vs Roggow.
This was a victory for our country and those of us treating the most severe pain patients.
Thanks again for all you are doing!
Blessings,
Deb Tallio, MD
Kentucky
Couldn’t agree more. I do not understand why all the drug abusers, criminals, and drug addicts get passes from the media and society on their lack of personal responsibility. Why does the media and society think that it is ethical and good medical practice to sacrifice the lives of pain patients for drug addicts/abusers? Why are pain patients held accountable for people who steal, lie , commit medical fraud and do every dishonest thing imaginable to obtain pain medicines(which they intend to abuse)?
Drug addicts and abusers have choices. Chronic pain patients do not. Chronic pain patients cannot choose to not have pain. Drug addicts and abusers choose to break the law and they choose to abuse drugs. They should be held responsible for their actions. It is disgusting to watch how the media pampers them along with addiction specialists ( many of which are people with psychology or sociology degrees,not medical degrees). Drug addicts have far more choices and control over their condition than pain patients. Pain patients can’t avoid pain by “hanging out with right crowds.” Or going to meetings or youth groups. Pain patients can’t cause pain to go in remission by using behavioral therapy.
Hello. I manage a Non-profit that educates people suffering from chronic pain about how Opioid Therapy, as part of pain management strategy, can improve their health and quality of life by controlling their pain.
Quite a few of our Members are very scared that their state will enact laws , like Washington, that drive off Doctors for prescribing Opioids. Please contact your Senator and the FDA to inform them that you have a quality of life with Opioid Therapy. Or, if you cannot function due to not having Opioid Therapy. For more information visit: http://www.livinginpain.org/. I hope you find a pain Doctor with common sense.
Logical and sane. How absolutely refreshing.
Well done Dr. Fudin
Great read, spot on, I can’t come up with enough positive adjectives to describe it.
Along with Arachnoiditis, I have “failed back surgery syndrome” and have lived in pain for over 25 yrs. after having 4 spine surgeries, the last 2 with metal implants. I have a broken screw that impedes on nerves and causes extreme leg pain.
I have been taking opiates, responsibly, for over 20 yrs. My Right to a near to normal life,. by taking opiates, supersedes an irresponsible person’s Rights who take these controlled drugs for their own personal gain, either for a high or for profit. My legal, responsible behavior shouldn’t be taken from me, through no fault of my own, because of the crimes of another person that I don’t even know.
I do not feel bad or any sympathy at all for the people who pass away from abusing pain medicines. It is a well established fact that over 90% of all pain related deaths are related to mixing medicines/drugs or taking medicines that do not belong to you.
Some of the stories mentioned in the article are enough to make me pull out my hair and scream. Every time I fill my script I get stacks of paper with warnings all over about what not to do. There are even multiple warnings on the medicine bottle. It is unfathomable to me that someone would take hydrocodone for pain and then drink heavily. The alcohol warning is written in big bold letters on the bottle. Not to mention all the paper inserts warning against it.
How can anyone feel any sympathy or sadness for that? I don’t. All these cries for the government to do more and to put more restrictions on opioid pain medicines is tantamount to asking the government to prevent people from being stupid. There is no way for the government to prevent people from being stupid. People always find a way to do something stupid.
Every time the government intervenes and adds more restrictions, things get worse. The government bans marijuana and then people start using legal bath salts which cause all sorts of physical damage and can induce violent delusions and hallucinations. The government sets the drinking age at 21 and now teenagers are drinking hand sanitizer.
Thank you for another great blog post, Dr.Fudin! BOTH sides of this story need to be told.
“We got the bubble-headed-bleach-blonde who comes on at five
She can tell you ’bout the plane crash with a gleam In her eye
It’s interesting when people die –
Give us dirty laundry”
Don Henley – “Dirty Laundry” Lyrics
On another blog site I proposed my thesis that Pain Management Physicians were the new Abortion Doctors. I took a lot of heat for that from a veteran set of trolling MD’s. No, they told me. Pain physicians who wrote opioids/anxiolytics etc. and who did not focus on interventional pain management and surgery were in fact “pariahs”. Then the deaths from compounded steroids began to roll in…
I have gone toe to toe with the “moral majority” – anti-opioid folks. They don’t like it. And they have the influence to have my articles expunged from the internet [look me up “Tales from the trenches in the war on pain – parts 5 and 6 – GONE]. But we all go on…
Look, I pee test my patients ad nauseam – I have two labs sending their lab techs into my office 4 out of 5 days a week – both “fighting to get my urine!” And I rely on other patients, family members and even strangers to “rat out” my occult “bad” patients. And I go by my gut feelings as well…But until I have proof of abuse or diversion, I ethically must continue my practice of easing suffering in those who need it.
Please Ms. Mascia – contact me and I will try to explain what really happens regarding good pain management – and the seemingly inseparable and never ending battle between the amelioration of pain and the quixotic quest to root out and abolish abuse/diversion.
Thomas Sachy MD MSc. gapbm@hotmail.com
Thank you for standing up for us. I wish there were more, a lot more. There are too many doctors out there who deny the evidence supporting the use of opioids in chronic non-cancer pain patients. It is amazing how many doctors think these medicines work so well for years for people with cancer, yet somehow they won’t work for years on patients with similar painful conditions. I am always shocked and disappointed when doctors either disparage or dismiss the evidence. Doctors are basically scientists and for them to just flippantly dismiss great data is horrifying.
Keep up the good fight and know that chronic pain patients support you.
Dr. Sachy,
Another one of the good guys! So nice to see you comment here. I LOVED your “Tales from the Trenches”, on Updates. Gone? I’m speechless. I so appreciate your humor, and the fact that you call out the “bullies” (publicly) who would rather see all chronic non-cancer pain patients writhing in pain, somewhere where no one has to look at them. Your analogy about Dr.s who are willing to treat pain with opioids, being the new abortion doctors, is sadly, completely accurate.
You commented on another blog post last year when I was concerned about losing opioid treatment in MA, at the hands of BCBS. (link below)
http://www.psychologytoday.com/blog/sleeping-angels/201206/painful-bureaucracy-in-the-most-literal-sense
Your advocacy is truly appreciated!
Unhinged
ADDICTION is a DEADLY disease….
Drug addiction and alcoholism are medical conditions. We do not eradicate these by getting rid of the abused substances. If this country is serious about lowering the death toll of addiction, let’s force insurance companies to pay for treatment, aggressively fund drug & alcohol education in schools, and treat addiction as the HEALTH crisis it is.
Let’s start treating those who suffer from serious pain conditions, as human beings, who deserve respect, compassion, and quality pain managemt . Opioids aren’t right for everyone, and they are almost always the treatment of LAST resort for chronic, non-cancer pain. However, when they are the right treatment, and save someone from a life of daily, unrelenting, severe pain…..LEAVE IT ALONE. To deny responsible, legitimate pain patients access to opioid analgesics, it is sanctioning TORTURE. Anyone who disagrees, has never lived the torture of untreated, agonizing, constant pain….
There is LESS overlap between the disease of addiction, and chronic pain treatment with opioids, than the media portrays. There WILL be MORE of a correlation between the two, if we continue to sensationalize the “evil” opioid drugs, and continue to neglect and abuse legitimate chronic pain patients by denying them access to their medication because of it.
The kind of pain that requires treatment with opioid medication, cannot go left untreated, by simply denying patients access to this medication. People CANNOT live in debilitating pain everyday, and not seek alternative relief! That relief will come in two ways… The first will be (& it’s already happening), that untreated patients will seek out illegal means of obtaining pain relieving substances, and / or seek relief in alcohol. The second will come in the form of suicide.
This is where we are headed if we continue to punish legitimate pain patients, in the name of stopping the “epidemic” of opioid abuse. Those that are already abusing opioids, have the option of seeking treatment, or switching their “drugs of choice” when faced with short supply. Most will start using heroin or other substances to feed their addiction. What options does the person who lives with debilitating chronic pain face when they are cut off from these vital medications? A life of living HELL, or DEATH.
Another well written and articulated article by you, Dr. Fudin! It is important for society to get all the information about opioids. It is commendable that mainstream journalism wants to report on the opioid problem but as you addressed in your blog it is also important that the whole picture is presented. I do feel badly for those mentioned in the article that died or lost family members. However, I do see this as an opportunity to educate the general public about medication safety (including opioids).
There seems to be an overwhelming feeling by the public that if a medication is approved by the FDA and available at their pharmacy, then it must be safe for everyone to use. With this false sense of safety, people begin to believe they can: share their medications, mix medications with food, alcohol and/or other drugs they shouldn’t be combined with, and/or improperly store their medications. Unfortunately this is where we begin to get into trouble because the danger of medications is underestimated.
Opioids are not the only medications out there that require monitoring, need extensive patient education, and can be dangerous when shared with others. A few others off the top of my head that meet this criterion include Coumadin, numerous cardiology drugs (like Tikosyn, propafenone, amiodarone), psychiatric drugs (like Clozaril), and anticonvulsant medications (like phenytoin and carbamazepine). Granted people may not get the same feeling with use of these medications as with opioids, but opioids serve a purpose when used in the right patients and monitored properly. Just to point out that opioids are not the only medications that are misused or abused, I would like to bring up Seroquel (quetiapine). Patients abuse Seroquel (or Q or quell or Susie-Q) as it is known for its coming down and sedative effects, but there is not a rush to ban or limit this drug even though it is often abused on the streets or in jails. People will always find ways to misuse or abuse prescribed medications, but I think the best we can do to combat that is to continue to educate patients on medication safety and educate prescribers on proper prescribing and monitoring of medications.
Thank you for a great article Dr. Fudin!
Great article! These medications are life saving. For many people, they mean the difference between being bed-ridden vs. being a functioning human being. Anyone who takes someone else’s medication, or takes opioid medication along with alcohol or other drugs, is RISKING THEIR LIFE. Period. In addition to that, they are making the lives of people who live in serious pain, much more difficult. To blame doctors, and the people for whom this medication was intended for, is foolish. Contrary to popular belief, doctors aren’t handing out opioids like “candy”. People I know, who live with serious, diagnosed, pain conditions, are having a VERY hard time finding doctors to adequately treat their pain. Or, they can’t find pharmacies to fill their legitimate prescriptions. Because other people aren’t “playing by the rules”, the ones who are, are being punished. It’s a disgrace, and getting worse. Thank you, Dr. Fudin, for shedding light on the fact that when taken as directed, and under the care of a competent doctor, opioids can be VITAL, and life sustaining medications.
GREAT article, Dr. Fudin. You wrote everything I *think* every time I see various versions of this headline in print and on TV, and you did a way better job than I could have. I don’t understand why we pain patients have to be punished (or pushed to desperation–I’ve lost many fellow sufferers to suicide) because someone takes a drug incorrectly, ignores their Doc’s instructions, pharmacist’s printout, label warnings, etc. Most medications are potentially deadly if taken improperly–that’s why we have child-proof caps, right? Opioids are no different…they’ve been around forever, and taken properly are safer than many non-Rx medications (acetaminophen comes to mind). THANK YOU THANK YOU THANK YOU
I’ve seen 2 decades of pain sufferers come and go, it seems they keep coming no matter what.
Chronic pain will always be, how we go about treating it will change, hopefully for the better.
How can anyone deny a pain sufferer relief ,as it’s a doctors duty to do no harm.
I would think this means not to let your fellow man suffer when help is available.
I hope the FDA can see pain medication has a very important role on all that suffer from chronic pain.
I wrote down a set of things I do when a pain flare hits me. I have to constantly keep my hands busy
or stand up and pace for a while till the flare up subsides. I always stay a few steps ahead of my chronic pain. Sometimes I wish the chronic pain I have in my cervical spine would move to a different part of my body for a while. But I have accepted the fact this is my life and I do the best I can to survive.
I watched the u-tube video again called “ A Pain–Drug Champion Has Second Thoughts” with Dr. Russell Portenoy. This is the u-tube video that was grossly edited and did not reflect all of Dr. Portenoy’s comments or relay an accurate overall message. It saw a clip of Dr. Kolodny saying the point in which pain patients come to me the pain problem that they might have had is the least of their problems, not addressing the chronic pain issues but focusing instead on addiction alone. These are just my thoughts and not necessarily those of PROMPT. Dr. Fudin has done most everything in his power to make sure this petition by PROP does not gain any more attention; instead the PROP petition has stressed out and angered those already suffering from never ending chronic pain. These are people that are already in a bad situation ,why would the medical community want to make it any worse.
Andrew Kolodny and other “addiction specialists,” have a fairly big financial incentive for the rules they are proposing. A lot of them have some type of ownership of fancy and expensive rehab facilities. A lot of them have investments in companies that make medicines like Suboxone. They would stand to make millions of dollars if they were able to rip rug out from underneath the feet of chronic pain patients who rely on opioids for pain relief.
Dr.Fudin A dr on our side thats hard to imagin now days. I have suffered for many years. I had a good job as a engineer now on disabiliy. I had a good family dr who kept me comfortable and able to have a somewhat normal life. Untill a year ago he said he could not precribe opiates any longer. Then came the pain management drs who are more interested in billing medicare than taking care of me and my condition (they wont even listen to me). All they care about is there new expensive procedures that i have had before and do not work. the last straw was getting holes drilled in my back for a trail scs which was horrible. They win i am done. I will suffer the rest of my life thats what they want. Good luck doc you are going to need it.
Great article. I completely agree with your assessment of the situation.
I work 20 yrs in the HVAC field. Abuse of perscription medication is pretty severe. Co-workers will find doctors that are willing to prescribe medication to their custumers instead of treating the problems. Also if any co-workers know that somebody has prescribe medication, the worker will always be harass to share their meds with others.
C-bo; None of us are denying that opioids are potentially drugs of abuse, have a significant street value, and if used for recreational purposes are dangerous. It is shameful that the problems you mention exist, but they are real. This is exactly why education to prescribers, families, community, military, and journalists is so important. Thank you for your comments.
Dear Jeff, well said.
We who believe these are necessary medications seem to be in a minority now (as always, I suspect) and it is a shrinking group willing to take a stand for what we know to be right.
This article well have been well meant, but it is just another in a long line that makes ours and our patients’ lives that much more difficult.
Keep up the good work and the good fight
I am a legitimate pain patient with a chronic but eventually fatal genetic illness and I want to weigh in on this debate. Thank you, Dr. Fudin for a being an advocate for a balanced approach to this issue. The original article focused honestly on the impact to families left behind. How many readers consider the impact of chronic pain on families of patients who find it difficult enough to function on a daily basis? Will studies be done when those patients can no longer tolerate their suffering and die from broken hearts, or worse, by their own hand? Dr. Fudin, I’m one of the few blessed with a spouse who stayed with me when most walk away from suffering so severe. he had gout and seeing him in pain shed new light for me about the suffering families endure watching their loved ones in pain. We’re Americana, and we walk this life together with hope, faith, and inspiration. However, he watched me scream at the slightest touch on my worst days for almost two decades. I cannot imagine how much it pained him, but I’d say too much to gloss over the impact pain has on families.To think that we may have to go back there because people are either abusing their meds or stealing them isn’t fair to people like my husband who deserves a wife who loves and appreciates him so much. I pray that the FDA and DEA will consider US. We deserve the chance to live as normal a life as possible, don’t we? I had the misfortune of my pain practice dropping me after one doctor left and the next one got scared of future legislation and dismissed his chronic pain patients. Needless to say, when I found a hospital-based physician an hour away, he warned me that 3 pain doctors in one year puts a red flag on my case. I pray that your advocacy of a balanced approach will give credence to the idea that perhaps strict governmental regulation is not the answer. Doctors who are legitimate know what their patients need, and I would like not only to die with dignity, but LIVE with it, as well. Thank you.
Thank you so much for a balanced, unbiased account of what is actually going on. Pain patients are being penalized for the actions of ‘criminals’. It would be like trying to ban alcohol because of those that do not control themselves, and create tragedies because of their own choices to get behind a wheel, etc.
When will people wake up and stop blaming everything and everyone BUT those responsible for what they put in their own bodies. I am tired of being deemed a criminal just for the mere fact I need, not want, medications to just be able to function to some degree. We, chronic pain patients, certainly didn’t ask for these horrendous conditions, and we are being victimized again because of ignorance, over-zealous officials and media hype. It is just wrong. Thank you again. E11
Jeffrey, thanks for saying what needed to be said. The other side of this issue (the people in pain) need your (our) voices.
Dr. Fudin,
Thanks for giving us the true pain sufferers of America a place to go so our voices are heard.
No one can really know the life of a true chronic pain sufferer till it happens to you and I pray it never does.
Regards,
Mark S. Barletta
The night before, last night, the main stream media is saying, “Get off Opioids now”. Well, I’m all for it, and I wish I could!! Leave the Arachnoiditis patients alone. The one’s that are succumbing to all these overdoses are the one’s who play with these “VERY DANGEROUS DRUGS.” Hell, I have been the most faithful patient I can be. And, my pain Doc knows that. The bad name “opioid users”, con’t to use alcohol, or mix with other drugs. HELL, it’s like the “2nd amendment thing.” A bunch of bad names give we the people who are con’t staying to the direct orders of our doctors. I’m sick of hearing about the overdoeses. I’m an old RN. I know the dangers. BUT , by God, I have the pain, and the thing is, I know what works for me, and I will con’t . I’m never afraid of what I take, never. Why? I don’t abuse. I have proven it time and time again. JUST STICK TO THE DR’S ORDERS…………thanks Dr. Jeff, you have helped a hell of a lot of folks. I didn’t quite get you at first, (as you know, haha), BUT, your a hell of a guy. Your hear to educate, some of us are here to listen,,,,herb neeland,,,,,,,,,,,,,,,,,,,,,,doc
Agreed! As Dr. Strassels mentioned, there needs to be BALANCE. One sided descriptions, although powerful in sentiment, are not objectively representative of the full situation.
Dr.Fudin, did you happen to catch the article about opioids on NPR? It is somewhat similar to the other articles you listed. Here is the link for it:
http://www.npr.org/blogs/health/2013/01/23/169963431/painkiller-paradox-feds-struggle-to-control-drugs-that-help-and-harm
Sure did Andy. Thanks for supplying the link!
Thank you once again for hitting the nail on the head. I have the utmost sympathy for the families who lost loved ones – I wouldn’t wish that on anyone. But the truth is, these people were doing things they knew they weren’t supposed to be doing. Every decision we make has consequences, and sometimes, those consequences result in death. Is it fair to make millions of other people who need these medications suffer for the rest of their lives in misery? I think not. It’s time that people are held accountable for their actions and stop blaming everything and everyone else. I refer to the first case you mention, “A young woman (previously an athlete), age 28 recently married and pregnant. She took Lexapro, hydrocodone, and was “excessively drinking”.
While the full details will probably never be disclosed, where was this woman’s family while she was taking these medications and drinking excessively? What caused her to take those steps to begin with? Were there any signs of mental illness that were overlooked? Did she know she was pregnant at the time? So many questions that will probably never be answered, but let’s take these medications away from every law abiding citizen in the United States because if they mix them together and drink excessively, they will most likely die. I could slip and fall in the shower tomorrow with the same result, but I’m not going to stop taking a shower every day. Should we ban all showers and resort to bathing in creeks and ponds again? Where is the common sense? By the way, I used to be an athlete too.
I totally agree, Dr. Fudin, that there needs to be a balanced approach. Prescribing doctors and pharmacists that are filling these prescriptions need to educate their patients – and patients need to do their part, pay attention, and take their medications as directed. Don’t give uncle John one of your hydrocodone tablets if he has a toothache – that’s illegal. Make sure you tell the pharmacist and your doctor EVERYTHING you are taking, so you can be made aware of potential interactions. Actually take the time to read those little leaflets they give you at the pharmacy – you might just learn a thing or two, but again, ask for counseling with a pharmacist if you aren’t sure. I haven’t met a pharmacist yet that wasn’t willing to counsel patients on their medications – even if it is over the phone. If you aren’t doing anything illegal, (and you know if you are or not), then you don’t have anything to worry about.
The only way that this “epidemic” that the politicians and those such as Dr. Kolodny keep screaming about is going to go away is if doctors, pharmacists, and patients keep working together to initiate changes in the way these medications are perceived. In many cases, these are life saving medications. They don’t just allow chronic pain patients to ” lead more comfortable lives”, they allow them to live. Period.
Until you are put into a position to where you have to live with chronic pain every second of the day, for the rest of your life, you have no idea how much of an impact these medications make and how devastating it is to go from being able to function, to not being able to do even the simplest things. It’s maddening, it’s humiliating, it makes you feel sub-human, and it is totally preventable. Put the criminals in jail and leave the real patients alone – we aren’t doing anything wrong, and we don’t deserve to be treated this way. Stop blaming everyone for the mistakes of a few.
Ms. Maston.
Wow! You could not have said it any better!
Your paragraph 2 says it all.
Perhaps the day is coming when we will have to “call out” the foolish, the impulsive, the mentally ill, and the “holier than thou” in order to achieve the “balanced approach” and respect as patients/physicians/human beings that we all so desperately desire.
Tom Sachy MD MSc
Dr. Sachy,
Thank you for the encouragement. I just can’t help but feel that day is long overdue, and I pray it comes sooner than later. Since being diagnosed with a rare, congenital, PROGRESSIVE kidney disease in 2008, it has been nothing but a fight for me (and others with the same disease), to receive adequate care – with pain management being at the top of the list. I had 21 “good” years between my very first episode with this disease and the actual diagnosis, and I would give anything to get those years back. My health has been on a continuous downward spiral since my diagnosis. I am only 38 and I’m now considered disabled.
I am committed to bringing this rare disease, Medullary Sponge Kidney to the attention of the medical community so that they can see the truth about what this disease does to patients on a daily basis. That is a totally different fight in itself, and has proved to be much harder and exhausting than I ever realized; I refuse to give up though; too many lives are on the line.
Realistically, I know I will never be able to do the things I used to be able to do. I can’t be the athlete I used to be, I can’t run and play with my 6 year old daughter – I can’t even wash a sink full of dishes without having to sit down and rest several times. It hasn’t been easy by any stretch of the imagination, but I’ve accepted my fate.
What I cannot accept however, is the fact that I am continuously denied care that I know will improve my quality of life simply because some people cannot demonstrate self – control and follow simple instructions.
I cannot accept the condescending attitudes of not only medical personnel, but family and friends who think all opioid medications are “bad”, and if they know you take them, they immediately assume you MUST be an addict. According to them, there are only two types of people in this country – those who take drugs and abuse them at every available opportunity, and those who don’t. I cannot accept the stigma associated with opioid medications as a direct result of politicians and those like Dr. Kolodny who have a God complex and feel they have the right to stick their noses where they don’t belong..
I am so thankful that you and all of the members of PROMPT are standing up for what’s right, and I am proud to say that you are on “our” side. You are our light at the end of a very long tunnel – you give us hope; something the majority have lost. Please continue to keep doing what you are doing. We desperately need your level headedness and common sense in a world gone mad.
Thank you So much Mary !
So for the past 24 years I’ve been mistakenly taking life-sustaining medications for my never ending chronic non-cancer pain. Well you could have fooled me, otherwise I would have been paralyzed by pain all shut in my apartment and over weight from not getting enough exercise. As it is I’m able to grocery shop, clean my place, stay in decent shape all because the very medications public officials and government agencies say there is inadequate evidence to prove that they benefit me.
I don’t think I would be alive today if not for these same medications that have kept me as pain free as possible and able to live a decent life. So is the government going to restrict or take that privilege away from me, my means of being able to care for myself without a provider.
I hope all of you see what will happen if this gets any worse, if I where to be restricted the medications that help me take care of myself I would then need outside help increasing the cost to Medicare.
Mark S. Barletta
How about we all write the journalist from “People ” magazine who wrote the article and let her know what readers are comprehending from her article? Perhaps if she knew that people in pain suffer more with each article written negatively about pain medicines, perhaps, she would write another article telling the opposite side of the story. This is what happens 99% of the time. The readers always hear the fear factor side and not a word about how many people have disabling pain everyday. We could tell her how these articles are creating huge access issues for those who need opiates for pain relief and give them some of the examples of what Dr Fudin stated here. If she heard some of the stories about people in pain live everyday? It would shed light on the pain community in a positive way. Almost every article done by the most popular magazines and news papers are severely harming the care patients in the US recieving. Anyone else think this may possibly help us?
Thank you Dr Fudin for always telling the truthful real statistics and fighting for those who are in pain. America needs to hear why we have these medicines in the first place. They are useful for so many people. Your right about accidental overdoses. Hand fulls of pills were taken intentional, not by accident. I wonder if the economy has anything do with the rise in deaths resulting for pills, the easy way out. The government has kept many citizens living in horrible conditions since 2008 from the housing crisis, inflation, and no jobs. Possibly many people can’t stand it anymore. Of course, the government would never take the blame for that.
PA: There have been over 200 posts on the People Magazine website beneath Kristen Mascia’s article. Everyone certainly is welcome to post there, although since there are so many posts it may get lost in the shuffle. In fairness to Ms. Mascia, I believe she wrote about what she thinks was the most important issue. I’m hoping to work with some of these mainstream journalists to get the entire story out. Ms. Mascia’s agenda was to warn the world about opioid deaths, not to cover the issues that pain patients are dealing with.
A productive outcome would be to get her to write about the patient side of the equation. What she said is not untrue, but what people heard is less than half true. That’s why I dissected out each patient case, so that the “picture” was more clear. The photographs that readers saw were downtrodden families because of “bad drugs”. What they need to see is bad behavior on the part of the deceased with [when taken as prescribed], good drugs.
You are exactly right Dr.Fudin. Our opponents do not rely on lies to stir the public up into a frenzy. They rely on omissions, which are probably more dangerous and harmful then lies. It is easier to tell someone “you’re wrong,” than to tell them “you’re right,but….”. If you tell someone that they are correct, then they are probably less willing to listen to the second part of that statement.
You are BOTH “spot on” as usual! I truly appreciate the two of you, for being such intelligent, science- minded, tireless, professionals & advocates for patients who truly require the use opioid analgesics.
Another great blog post. It is SO frustrating as a pain patient, to read stories about “accidental” overdoses, when MOST of these fatalities involve using Opioids recreationally, and mixed with other substances like alcohol. My heart breaks for families who have lost loved ones in this tragic way, but we need to start having more conversations about addiction (the disease), and LESS conversations about “chronic pain patients” as the cause of this. Yes, patients need to take and store their meds properly, opioid use should be monitored, doctors need to use the tools available to them to ensure they are prescribing safely, and responsibly. Everyone needs to do their part to keep these medications from getting into the wrong hands, but I am SOOOOOOO sick of the discussions of the “epidemic”, viewing this ENTIRE class of meds as EVIL. Without opioids, my kids wouldn’t have a mother, because I can’t live every single day in AGONY from a condition that I didn’t cause, and that has NO cure!
I am becoming increasing afraid of my future & having access to adequate pain management. It is SO unfair that legitimate pain patients are carrying this heavy burden. Our lives are HARD enough, living with serious pain conditions. Today, I read an NPR article, where Dr. Kolodny (PROP), who knows NOTHING about pain, talked about chronic pain patients use of opioids, being at the heart of this “epidemic”. He is positively CLUELESS.
Thank you, again, Dr. Fudin & Dr. Leavitt, for being some of the few professional voices of sanity and reason in this mess. We NEED you now more than ever!
You are so right that criminal behavior is hurting legitimate pain patients. I have a birth defect in my kidney that causes me to have kidney stones multiple times a month. If anyone has ever passed a kidney stone they would realize that even though I do not have cancer, I need strong pain medicine several times a month sometimes for several days in a row. Without my Rx I would be in the emergency room repeatedly. The pharmacy I have gone to for years stopped “having the medicine in stock.” I only get some 2 or 3 times a year because I really ration it and try not to give in to the pain. Sometimes it is impossible. The pharmacies in FL are afraid to dispense opioids to anyone because of the DEA and the state of Florida. It is terrible to be in pain and be turned away by your regular pharmacy and spend hours going from one pharmacy to another being turned away like an addict.
Which part of Florida do you live in? Maybe someone from FFPCAN can recommend a pharmacy to you. Florida pharmacies have been hit very hard by the government in recent months. The DEA shut down a few Walgreens , a few CVS , Cardinal Health Distribution, and Walgreens Distribution center. Cardinal Health was one of the largest pain medicine distributors in FL. Hopefully, all of this nonsense will blow over. But, it seems unlikely given all the hysteria and panic over opioid pain medicines. The only thing we have going for us is the national media is more distracted by gun control and immigration. Maybe if we are lucky, that will be enough to make them forget about opioid pain medicines.
Good points, Jeff. The problem gets much more complex quickly. From what I can tell, there isn’t a whole lot of consistency in assigning causes of death. So, what happens when (as in the bulk of cases), there is more than one drug on board? Or when there’s a bad outcome and drugs are on board even if it is unlikely that they are involved (person is tolerant, functioning well, but is injured in an auto accident anyway) I think the opioid still gets blamed.
Scott
Good article, Jeff. Obviously, well-balanced journalism based on valid medical evidence does not sell newspapers or magazines. The real travesty is when government agencies and spokespersons sensationalize their data, as so often happens, and journalists accept such propaganda without adequate questioning.
Your parachute analogy at the end is quite interesting. There has never been a randomized, placebo-controlled trial of parachutes to prove conclusively that they are of benefit to the users. Yet, many public officials, government agencies, and gadflies seem quite willing to severely restrict access to opioid analgesics because, they claim, there is inadequate evidence to prove that they benefit patients with chronic noncancer pain. In essence, they propose an experiment akin to taking away life-sustaining parachutes from these patients and pushing them out of the airplane.
Thank you Stew. How did I know you’d figure out why I used the parachute analogy? You are spot on as usual!