Ohio Declares War on “Dangerous” Opioids

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I like Ohio, especially Cincinnati, Columbus, and Cleveland, the “C’s”.  I’m counting on Ohioan public health enthusiasts, patient care advocates, and the academic presence in Ohio to step forward and answer a burning question; Was the Columbus Dispatch article by Alan Johnson  specifically intended to be Deceptive, Deceitful, and Dishonest, or in a single word, Duplicitous?  In any case, the journal earned a “D” for media sensationalism, withholding or misleading facts, and potentially adversely affecting legitimate patient constituents from receiving opioid therapy by caring, but frightened, clinicians in cases where these drugs are appropriate and safe when prescribed appropriately with proper monitoring.  Even patients in pain are often frightened away from these medications and choose pain and punishment over comfort.   

In the article entitled Dangerous prescriptions fell in Ohio in 2013, reports show by title alone is deceptive.  “Dangerous” drugs include many such as warfarin (blood thinner), anti-inflammatories (NSAIDs such as ibuprofen), anti-cancer drugs (antineoplastics such as the platinols, vincas, anthracyclines. etc.), and many, many more.  I will admit that certainly opioids are dangerous if not prescribed carefully and correctly or taken as prescribed, but let’s face it; there are many intentional and unintentional overdose deaths from acetaminophen and antidepressants too.

The article states There’s fresh evidence that opiate painkillers are slowly losing their stranglehold on Ohio” [Johnson] as though Ohioan’s are winning a war of sorts, and gaining ground against the enemy.  It is reminiscent of the famous Franklin D. Roosevelt quote, “We have nothing to fear but fear itself”.  Even if the author’s statement were true and there was a war to be won on reducing the number of prescribed opioids; how many battles are lost to uncontrolled pain-related suicides, broken marriages from unbearable pain, psychological demise from depression and inability to work, and endocarditis (infection of the heart) or hepatitis C or death from Ohio’s heroin renaissance?  While Ohio lawmakers are smiling and patting themselves on the back, perhaps even more Ohioans are suffering now because of a real “stranglehold” from burgeoning heroin use and synthetic cannabinoids  (Spice), Kratom Alkaloids (Mitragynines) or Cathinones (Mephedrone, Methylenedioxypyrovalerone, (MDPV), and Methylone) which have become more popularized as prescription opioids have become less attainable for legitimate and illegitimate purposes.  But in general, the public does not keep track of these things, nor are they interested in this less familiar territory or the science behind the street chemistry.  “Territory” is the operative word because heroin, Spice, Kratom, and Cathinones have in fact established a less told “stranglehold”.   But, these dangerous Schedule I drugs don’t make such sexy media when one considers that 100 million Americans at any given time have chronic pain and most have in fact at least used opioids one time or another for short-term acute injuries or dental/surgical-related pain.  The familiarity with opioids is what helps sell these stories.

The Ohio Automated Rx Reporting System, as with other state prescription monitoring systems can be a wonderful much-needed commodity, but it certainly is not the panacea to “…a clear understanding of how vulnerable their patients are to an overdose situation” [Johnson].  What it does do however is to help monitor total opioid dosing and ensure, at least within state boarders, that subversive patients are not doctor-shopping from physician-dealers and multiple pharmacies.

“An Ohioan died every five hours from a drug overdose in 2011, the most-recent year for which statistics are available, according to the Ohio Department of Health. The majority were pill deaths.” [Johnson]  What we’re not told here is that 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. (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.  AND  McGinnis J, Foege WH. Actual Causes of Death in the United States. Journal of American Medical Association 1993;270:2207–12.)  Taking away tobacco won’t likely be a popular political move and would cost this county billions in revenue.

“Key to the new reports is the Morphine Equivalent Daily Dose. If that number is 80 milligrams or higher, which is the equivalent of 11, 5-milligram oxycodone pills per day, it is a red flag that the patient could be at risk for overdose or developing a dangerous addiction to painkillers. The MED Dose represents what the patient is receiving from all medical sources — doctors, dentists and other clinicians.”[Johnson]

Truth be told, morphine is about 30-33% less potent than oxycodone.  Why not journalistically be less misleading and say 80mg of a single oral morphine capsule, it is about equivalent to 60mg of a single oxycodone tablet or why not say about 6 oxycodone 10mg tablets daily is equivalent to about 6 morphine 15mg tablets daily.  These are more easily comprehendible truths, and put it more in perspective for the reader, but instead [Johnson] chooses to compare a daily morphine dose bundled together against several oxycodone tablets at small milligram strengths.  I suspect that has a professional journalist, Johnson knows this better than me.

“In the past, physicians could figure the MED Dose themselves by taking what could be a long list of drugs prescribed to a patient, calculating the morphine equivalent of each, and adding the total to see if the patient was at risk.”[Johnson]   Can they Mr. Johnson?  Let’s examine that…

Your statement assumes that the morphine equivalent dose (MED) is accurate and the sole reason for opioid risk and death.  The truth is that there are no standard acceptable MED’s on which to base Ohio’s or anybody else’s MED.  This was one of the FDA stated reasons for denying the recent citizen petition that requested a maximum 100mg per day MED for noncancer pain.  In fact, Quantifying Opioid Equivalence Disparities, on this website outlines a study to ascertain the calculation variability among several healthcare providers (including some identified from Ohio) when attempting to convert five different opioids to an equivalent dose of morphine.  These preliminary results were presented in a POSTER at the 2013 ASHP Midyear Clinical Meeting in Orlando FL.

A summary of findings include:

  • Based on average responses and standard deviations alone, there appears to be significant variation in opioid conversions within each professional type
  • Comparisons of average morphine equivalent doses between professions appears similar, with the exception of those identifying multiple professions and outliers
  • No official method exists that allows each of the five studied opioids to be accurately converted to another opioid, i.e. morphine

And, an earlier post of preliminary data, The Answer is Morphine 100mg Equivalent – Morphine Jeopardy, showed the same outcomes with a smaller group with huge disparities in MED based on various readily available resourcses.  Also, according to Webster and Fine, “Recent evidence suggests that the use of dose conversion ratios published in equianalgesic tables may lead to fatal or near-fatal opioid overdoses.” (Webster L, Fine P. Review and Critique of Opioid Rotation. Pain Medicine 2012; 13: 562-570.)

 “This is an example of how powerful a tool this has become for clinicians to take care of their patients,” said Kyle Parker, executive director of the Ohio Board of Pharmacy. He said while some doctors have complained about the reporting process, “it’s hard for them to ignore the bigger issue.”[Johnson]  Well, he got that right and Kyle Parker is correct…HARD TO IGNORE THE BIGGER ISSUE!  The bigger issue is outlined in yet another recent blog, Opioids, Media Deception, & Heroin: Are We Happy Now?

As always, comments are welcome and encouraged!

26 thoughts on “Ohio Declares War on “Dangerous” Opioids

  1. I like others here have been left in the ditch to suffer just because most Doctors either don’t really care what your problems are as long as they get their money, or are just afraid to do the right thing by their patient’s,A while back I suffered a bad fall ,already had problems with right hip needing replaced due to bone on bone wear, and after the fall broke a vertebrate an blown disc, and damaged my S-I joint, an with all this going on all at once could not get anything strong enough to do a bit of good (ie) tramadol..have hardware in left hip, right elbow, left forearm, left heel, an left ankle, from a head on collision in 2007 (no fault of mine) with all that they still look at you like your an addict or lie’ing just to get pain meds.all of this is documented in my medical records.still nothing.even had a doctor tell me that if I had cancer he could give me a stronger extended release medicine.over the last year I have put on 45lbs from not being able to get around to keep from gain’ing even more, my blood pressure has gone up.it seems they don’t want us to have a life with any quality to it.

  2. I live in Northeast Ohio, and I suffer from a symptomatic Tarlov Cyst at S2 ( a rare disorder that mainly affects women), along with herniated C5-6, T6-7, L2-3, and L5-S1.
    The pain is SO severe, I wake up long enough to catch my breath, then pass out. Or at times I’ll collapse if I stand up from sitting. Strain and exertion, basically performing normal tasks that others take for granted, like pulling my trash to the curb, affects the flow and pressure of the cerebrospinal fluid. I wake every morning with pain and pressure at the base of my skull.

    Yet I am treated with SUCH hostility and disdain by every doctor I see. Epidurals cause Tarlov Cyst symptoms to worsen, yet that is what doctors are “pushing” because they make a LOT of money from them. They do NOT care that I will be WORSE! Physical therapy will make my symptoms worse as well.
    Opoids, specifically Dilaudid, relieves the pain. But how dare I mention the name of a narcotic when I answer truthfully when asked “What takes the pain away?”.

    So I am forced to go to the ER when in intolerable pain, and my blood pressure spikes dangerously high due to the pain (185/116 is an example). I am screamed at and humiliated in front of other patients, and the staff, and forced to lie there for HOURS with no pain relief, but am always made to give a urine sample.

    I HAD a caring doctor, then he abruptly discharged me because he was SO afraid of the DEA coming in and inspecting his files. My Tarlov Cyst and herniated discs are well documented, but I am not permitted to have pain relief!

    These sadistic policies towards patients with chronic, severe pain are unconscionable. I wonder if the “Injection Mill” doctors are behind this propaganda about Opoids, since they make a LOT of money from injections as opposed to writing a prescription.

  3. Dr. Fudin,

    First i want to thank you sincerely for the battle you are fighting to win our (chronic pain SURVIVORS) war as well as the war for the prescriber of opioids for legitimate pain relief! I commend you and others like you, as fortunately my pain management doctor carries the same values as yourself when it comes to his patients. But I must tell you it has been a long haul for him. More on that later.

    First, I’d like to tell you about myself. I developed knee pain approximately 8 yrs ago ( I awoke one morning to find my left knee swollen to the size of a small cantelope) and had several consultations with doctors ranging from primary care, rheumatologist and orthopedic surgeons as well as having many tests, MRI’s, CT scans and X rays only to be told many different diagnosis’. I finally landed in the hands of a very gifted and caring surgeon who first performed a biopsy of my own cartilage (as the tests revealed deep cartilage “craters” and damage) and several months later had that cartilage reimplanted as well as more cartilage that a laboratory had grown from my own cartilage. This procedure is otherwise known as (hopefully correct spelling as it has been 8 yrs) autotogulous chondrocyte implantation. Unfortunately my body rejected that cartilage and instead of repairing smoothly it grew very string like only furthering my problems. In the end I had 7 knee surgeries. Some others were tibia tuberacle transplant where they broke my tibia bone, removed part and pinned it back together. Later that pin had to be removed due to complications. The end surgery was a patellar femoral joint replacement that was to end all pain as there would be nothing left to cause pain. I did all of these to avoid being thrown into the “opoid/pill popper/drughead” category. I ate ibuprofen by the bottle causing peptic ulcers, gastritis and a bleeding stomach.Again to avoid the stigma. After all of the above I was yet 3 yrs later still in CHRONIC pain and swelling beyond relief and was referred to Cleveland Clinic where I was diagnosed with RSD/CRPS (Reflex Sympathetic Dystrophy/Complex Regional Pain Syndrome. I was given 2 options for relief as I was 3 yrs in when a true diagnosis was made. If not treated withinthe first 3 months chances or remission are near impossible as I’ve learned. My two choices were a morphine pain pump or a neuro stimulator to be implanted in my body. I chose the stimulator. It failed to provide results of relief. I refused to go to a morphine pump so I set out on a journey to find a compassionate and caring doctor to help me. I had to finally give in and accept opiates!! I was very fortunate to find that doctor in Louisville, Ky. I felt that a prayer that I had prayed for several yrs was answered!! After becoming a valued patient of my hero he decided to move his practice to Indiana due to Kentuckys Pill Mill Law and it’s changes. This doctor had many awards aligning his walls along with a commendations from working with the DEA and other regulatory office to enforce the laws yet he was sick of jumping through hoops to treat his patients with true chronic pain needs! Did I state that RSD ranks higher on the McGill pain scale higher than non terminal cancer. I am sure you were aware of that but wanted other readers to know. At this point I was faced with the decision to follow or fall back into the draining and moral killing torture of looking for and hopefully finding another doctor who just might truly care as this doctor did. I finally decided to follow and low and behold he is now faced with the same “hoops” that he chose not to jump through in Kentucky! He is a man of true compassion, valuing his patients, and putting their needs and quality of life above all! He is now waging this same battle you are to hopefully end the war of the True Chronic Pain Patient VS. The Drug Abuser/Buyer/Seller.

    I commend you both for the courage and commitment it takes to stand up for what is right! You, the doctor knows what is best for YOUR patient and their needs to a quality of life, of love and of family! Not the ignorant and misinformed, and yes mislead bone heads that create and pass these laws! I beg them to walk in my shoes 1 week. I GUARANTEE they will reverse all of these laws that hurt the true suffers!

    Living in pain for the rest of my life and wishing you triumph,

    Melissa B.
    RSD Warrior and Survivor

      1. Dr. Fudin,

        Thank you! I did want to add that in my closing I state “living in pain the rest of my life”. It should have also included… controlled pain thanks to my hero, my advocate & my doctor.

        If you know him then you know my sweet words of him only touch on part of how truly caring and compassionate he is! He truly is one of a very chosen few. And you seem to fall into that category as well!

        Sincerely,

        Melissa B.

  4. War on this, and war on that: What is this country becoming? Who are these WAR mongers? Nevertheless, “Ohio, the torture state!” Great Blog!

  5. Johnson does citizens a disservice by printing what appears to be a press release for the governor’s office.

    The real story here is the politics of drug regulation. The questions he elides are the questions that matter.

    1) Where did (OARRS) originate: the Board of Pharmacy or the governor’s office “opiate action team”– whatever that is? And how does the BOP feel about the governor’s “opiate action team” point person announcing their new system?

    2) Where is OSMA in all of this and what really does “supportive” mean? Where did that quote come from anyway?

    Johnson writes: “The Ohio State Medical Association, representing doctors, said the group is supportive of OARRS”

    Does that mean that OSMA was one of the “44 organizations — representing physicians, dentists, nurses, pharmacists and a host of regulatory boards and professional associations — collaborated with the Kasich administration on the guidelines.”

    Or does “supportive” mean that OSMA accepts OARRS as a tool doctors have to use? Surely Johnson can get more than this bland quote? A few lines later the head of the Board of Pharmacy acknowledges that “some doctors have complained about the reporting process”

    So it sounds like the Board of Pharmacy and OSMA are on different sides. Johnson can learn all about OSMA by investigating its PAC:

    What about the Board of Pharmacy? How often do they take disciplinary action? Do they make those actions public when they do?

    Chain drug stores are also important to this change. It’s not clear from Johnson’s article whether they were among the 44 participants. They matter because they throw around a lot of money: National Association of Chain Drug Stores PAC, and Walgreens and CVS PACs (the latter two companies are now very worried about fraud I’d imagine). Does the Ohio money trail match what their PR reps say about OARRS?

    I’d bet that almost everyone quoted in Johnson’s article belongs to a professional group with a PAC that influences Ohio drug policy. I’d bet even more they are glad that Johnson focused on patients who have no power and no voice… just “problems.”

    Who am I? I have been a chronic pain sufferer for eight years. I have been able to manage and recover some quality of life with the help of well-informed doctors.

    Recently I moved to a different part of the country. I now live in a city known for world-class health care. But here patient care is hindered by state regulations and a prevailing medical culture that treats all patients as suspects.

    Johnson would hail this climate as a success. It is anything but. I spend hours and money I don’t have in a thus far fruitless effort to establish care equivalent to what I had before.

    I imagine many, many more patients suffer in silence, not knowing their rights and options.

    As a kind of empowerment, I have begun researching the intersections of the drug industry money, politicians and regulatory agencies in my state.

    Thank you for this blog. And thanks to Kristopher Blankenship above for your post.

  6. There are a lot of things we can fix , but we cant fix STUPID.
    For the most part people are good , but then we have people for whatever reason will never accept opioids for legitimate medical uses.

    I’m getting really tired of the ignorance about opioids , so much that I’ve thought about dropping out of these type blogs and websites that have to do with the legitimate medical use of opioids. But then that would be admitting defeat and I will never admit to being defeated by the ill informed.

  7. p.s. I have a severely disabled family member or I’d leave to go to a western state…Ohio is horrible and docs are not docs but scared rabbits. Police say If you aren’t doing anything wrong why run? so to docs I say the same. Docs? Why are you so afraid?

  8. Tell me if this is true or not Doctor but I’ve read alot and the truth is that the DANGER is antagonists. They eat opiods. Now I talked to a doctor at Cleveland Clinic…I asked what do you do when you have a patient with an emergency like accident or heart attack…they need emergency surgery and are on antagonists? she answered we put in a drug pump so we can get more opiods into the person to override the antagonist…you have to do this with a drug pump in order to get more opipods in…then they will have pain relief for surgery/acute pain. BUT…I SAID. I CANNOT have a drug pump or any unnecessary surgery as I’m allergic to antibiotics!!! So that is why I didn’t go with the drug pump to begin with…replacing batteries and fixing leads…surgery surgery surgery! So what would you do with ME if I showed up on antagonists and needed emergency surgery? NO ANSWER!!!! There IS no intelligent answer. Why are docs trying to push antagonists??? Cant the druggies snort those as well? God be with us…… .

  9. Ignorance. That is what this war boils down to. You hit on a good point, the information out there is so jumbled up together that even the ‘good guys’ get it confused. I am a member of two online patient support group(s) one for patients w/ connective tissue diseases and the other for sarcoidosis. The frustrating thing is that the very patients who can benefit most from using these medications (or DRUGS as described on tv and in print) are among the least informed. I can’t tell you how many times I have read posts from members describing having to ‘take on an addiction’ to Vicodin, Percocet, etc due to overwhelming pain. Example: Think of your church going 60yr old grandma here saying this! Enough times that I saved several sites w/ definitions describing the difference in dependence and addiction to my ‘favorite sites list’ for easy reference when responding and trying to educate them.

    . The US population, not the most informed or interested bunch in the world, cannot fathom someone needed MORPHINE or METHADONE every day because like w/ alcohol, only alcoholics drink every day, the logic therefor is anyone ‘needing’ opioids daily is an addict (regardless of the reason) How else do you account for family members worried about how much meds their dying parents/grandparents are receiving on their death bed. I wish it were as easy as having a few hearings or launching an education campaign. The things is it will be almost impossible to turn around over 100yrs of fear, repression, and discrimination (which most drug laws were originally based on) twice in one generation.

    I try to tell my fellow members that the difference is easy to see. How patients who take meds as prescribed are more active and participate in life where the same meds taken by addicts (Rx runs out the same week the got it) do the exact opposite. Instead of spending more time w/ loved ones and gaining a quality of life, they w/draw from life, family, and friends until their world revolves around the drugs to all exclusion. It is sad really. When you have the patients who can most benefit from these meds scared to death, the doctors scared to death, and the politicians counting votes and not wanting to appear soft on criminals, it adds up to an almost no win situation for those who play by the rules.

    A few years ago the drug war was all about meth, before that it was Oxycontin, before that ecstasy, before that cocaine. Recently, criminals (see pill mill owners, unscrupulous doctors, hijackers, professional patients, drugstore cowboys, etc; exploited the loosening of the ‘restrictions’ [both written and unwritten] on opioid medications to flood the black market. Once the powers that be plug this flood up w/ their dam, dong a marvelous job so far, they will move on to something else. Then we are left much like the debris after a news years day parade.. And it looks like that something else is heroin (for now). Bad thing about it is once the restrictions and brainwashing have been completed it will be near impossible to gain the ground won since pain was recognized as the 5th vital sign. Pain is now a taboo subject, to be danced around or utterly avoided/ignored. I am sorry to be such a wet blanket but as a student of history I am aware of the saying that one who does not learn from history is bound to repeat it. There is a good reason this saying is frequently used because it is so true. Not to get into it as it is totally off topic but there are just too many entrenched interests w/ a stake in this section of the drug war, they don’t use white flags either. The irony in all this hullabaloo over drugs is that citizens can purchase one drug just for kicks in two states but legitimate patients with documented painful injuries and disease states are left holding the bag. What is wrong with this picture? I’ll tell you what. While law enforcement can’t keep illegal drugs like heroin out of the most secure institutions In the country (see prisons and jails) they know they can stop the prescription epidemic. These DRUGS are traceable, the manufacturers (pharma) and ‘distributors’ (doctors) have too much to lose, and the patients are in no shape to fight back especially while in excruciating pain. Se we are all easy marks, unlike the bad guys who have nothing to lose AND oftentimes SHOOT BACK.

    Thank you Dr Jeff for all the advocating you do on our behalf. I think your blog along with Dr Levitt’s site provide an excellent vehicle to educating people on the facts in the face of so much rhetoric. Hopefully our posts will be more than just cathartic.

    KB

  10. This has nothing to do with Ohio. I was told that the pharmaceutical warehouse in Fla. who sends me my meds monthly, will not do it anymore. So, they told me, “We are sending you to a state of the art company in Arizona, it’s Walgreens.” I nearly fell on the floor……So, within one week, the drug Actiq, that I take, was confused with a Gall bladder treatment. They sent me a gall bladder drug. One strike. Then, after that was settled they argued with the office nurse that has written my prescriptions for a decade and two years…….They told her, he can’t be on that, he is on the patches……Well, the office nurse flipped at them, and an argument insued. So, I’m screwed pretty much. The doc will call back, but, you can’t get through to these people, and W/C is behind it…..Where is W/C? Well, they changed their addy. I can’t find them, the Dr.’s office can’t fine them. So, I know we will, but will my meds be figured out? I have my doubts. Walgreens has always been a nemisis. Cursed by a drug store. So, here i sit, scared to death……………………thanks Dr. Jeff, I know, not about Ohio, but, this old soldier is about to loose his temper………..

  11. I wish a panel of professional medical advocates could sit in on a hearing in Washington D.C. and make them listen to the facts about pain medicines and how they help people. The reps need to hear about what they have created for innocent citizens who live with chronic pain in our country. I bet that many of them only get their knowledge about pain from the newspapers articles and media reports, whether they are true or false.
    I think that a hearing will be the only way that US pain patient’s situation will ever get any better. I suppose that wouldn’t ever happen though.
    The media is killing us with their BS reports and articles when it comes to pain medicine. How are legitimate pain patients ever going to have their lives back? I hope the journalist who wrote the article gets a copy of this blog.

      1. Great blog, Jeffrey. You hit on a lot of the things that have bothered me as both a former editor and reporter and as a current chronic pain patient for a long time. I’ve written to the Dispatch about their inaccurate bias in these articles several times — and have gotten no responses — so don’t expect to hear back from Mr. Johnson anytime soon. The ego that drives these folks won’t allow them to admit they have an agenda (or have bought into a flawed one) in writing these stories.

        The one thing that has been consistently missing from these stories about overdose deaths in Ohio (which was the driving force behind the governor’s push to pass the draconian legislation that basically threw cold water on family practitioners and their willingness to continue prescribing/treating chronic pain patients) was this: a significant percentage of those overdose deaths (I don’t have the total, but I’m sure it was greater than 50 percent) were due to a MIXTURE of opiates and illegal street medications like heroin, cocaine, etc.

        This fact has been buried in almost every press conference, press release and official discussion that has taken place on why the state went so hard to reduce the number of opiates being prescribed in the state.

        While as a legit chronic pain patient I have NO problem with closing down pill mills and arresting doctors or pharmacists who abuse the system, the governor and the politicians took the easy way out: they basically used a shotgun where a slingshot was required, and the result has been the flood of heroin were are now seeing (and the deaths that go with it).

        Something you are probably also not aware of: when the governor’s office first wanted this legislation passed, it asked the Ohio Department of Health to review the proposal and take the lead on it. The experts at that agency told the governor’s staff that passing this type of legislation would end up putting a huge chill on the practice of medicine by legitimate doctors treating legitimate pain patients, and was not a good idea. The governor’s office ignored this sage advice, and the result has been that now basically no family practice or internist in the state will treat a chronic pain patient — we have all been forced to go to pain specialists. This means additional doctor’s visits and costs that simply aren’t necessary, as opposed to being treated by the people who have treated us for a long time and know our health issues better than anyone.

        Thank you again for writing this and I hope Mr. Johnson and others like him will stop being so lazy and start opening their eyes and their brains to what is really going on in this state; and stop just regurgitating the talking points that the politicians are providing to them.

  12. DocForThePeople, I completely agree with you! Pain patients are “surrogate targets” who are taking the hit for junkies. Dr Fudin, I do NOT find it helpful when you consistently equate illegal drugs with legit pain patients in articles and imply that legit pain patients are somehow behind the “Heroin Renaissance” or other illegal drug use when denied pain control measures. You have no DATA or FACTS to support this! I agree with DocForThePeople that apparently most legit pain patients simply suffer when denied, but again more data is needed. JUNKIES are to blame, not legit pain patients— these are 2 DISTINCT GROUPS!!!— and constantly mentioning them together only gives the impression that they are one and the same, which in turn perpetuates the War on Pain Patients. Perhaps it is time for a different tactic?

    1. Erika, I’m not implying that at all. I’m simply pointing out that there’s a shift. I am in favor of PMPs for monitoring. What I’m saying is that addicts will continue to use regardless of the paradigm shift. If there are less prescription opioids available they’ll use heroin or something else. I don’t think legit pain patients should need to suffer because of them, but I do think prescribers and legit patients can benefit from PMPs and validated risk tools. It’s shameful that reduced opioid prescribing is likened to a “better world” by lawmakers and journalists when in fact in some ways it is making things worse for legitimate patients.

  13. Among other issues, the Columbus Dispatch article epitomizes the reality that, while free speech is sacrosanct in America, there is no prepublication peer review to serve as a check against misinformed and/or deceptively misleading journalists. These days, anybody can say anything they want to… bona fide facts and fair balance are optional. Discussions of opioids have become politicized in the worst sense of the word, and patients do suffer as a result.

    1. 512 N, McClurg Ct.

      I agree with both Stew and Jeffrey on this. What is aching for some pointed thinking about what historically, presently, socially, economically, etc. is behind this. One of the topics rarely discussed about addiction rates now is how the history of our country over the last 15 years has created several catastrophes for Americans. Is there a correlation between what is happening, endless wars, government hyped constant fear, repressiveness and the destruction to the social fabric and illegal drug usage? Surely there must be. But I’m interested in why it isn’t addressed. We simply can’t study & discuss this issue in a vacuum.

  14. Doctor for the people , thank you because of this war on pain meds I have to take half of what I am to take daily. Now I am forced to sit out my so called golden years instead of enjoying them. I am in pain , my wife of 50 years couldn’t be more unhappy. Most all the things we did together the last 5 years has stopped. I know she is in pain to because seeing me just lay around makes her feel as bad as myself . Why you choose to hurt us because of junkies that don,t give a shit about anyone I will never understand. I have a great doctor. I take my drug test twice a year and do everything by the book. But ican’t get my prescriptions filled. I am treated like a drug dealer. No they are treated better.. Someone needs to speak for us and stop worrying about the ones that use our meds just for fun. We suffer and they party. They don’t have any trouble getting what we need just to live. Shame on all of you that have any part in what you are doing to us.maybe some day you will be in my shoes. I hope then you will know the pain you have put us through.

  15. The vast majority of chronic pain patients who take opioids for improving participation in life;s daily activities are in fact law abiding civilian citizens who are held hostage by their disease but use their opioids appropriately and do NOT overdose or sell. They are now being held as civilian hostages in this “War on Pain Patients”! The article from Ohio is another example of the glorification of the war on these hostages. The simple fact, to put a slight twist on Dr. Fudin;s revelations, is that the pain victim is now the civilian target of a war that is not of their choosing. The pain victim has become the surrogate target for those who are the true abusers, and they are generally young….and white. The majority of chronic pain victims are older, say 40 to 50. There is hard scientific evidence that the current war on drugs works. Indeed, the resurgence of Heroin and Heroin related deaths indicates full well that the use of surrogate targets has done little to stem the tide of illicit drug use and ensuing deaths. It has only inflicted undue pain and suffering on the civilian non-combatants while the illicit users have simply moved on to other substances. So far there are no statistics showing that chronic pain victims are leading or even participating in great numbers in the heroin ressurgance. The majority of pain victims, deprived of there relief of pain are simply retracting their participation in life’s activities as their pain escalates.

    The current war as chronicled by the Columbus article is glorifying itself based on the large number of civilian non-combatants they have taken out. In that context, the War on Drugs in the United States is a violation of the Geneva Accords. It is a violation of the human rights of the pain victim as set forth in the Helsinki Agreements on Ethical Research…..and given the fact that there are no SCIENTIFIC studies to show that the War on Pain Patients works to decrease overall illicit drug use, the War on Pain Patients is a grandly designed but uncontrolled medical experiment. May those who so violate the human dignity and rights of the chronic pain victim come to endure their just reward for violating en masse these human rights!

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