Opioids, Media Deception, & Heroin: Are We Happy Now?

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Is this the narcotic utopia we sought?
In the words of Urkel, Are we there yet? Did I do that?

To hear the media tell it, everyone using heroin in the United States today started with prescription painkillers. This is not even remotely the case but even if it were, it begs the question; were they bona fide pain patients genuinely seeking relief from pain professionals? Or were they people in a different kind of pain, whether they knew it or not, lying and gaming the system in an effort to get “fixed” or high?

If it wasn’t for increased opioid prescribing to treat pain, to hear the media tell it, almost no one addicted to heroin today would have gotten there. No doubt there has been an upsurge in the abuse of heroin unequaled since the late 1960s when Oxycontin didn’t even exist. At the height of heroin use in the early 1970s, the ranks of users rose to 600,000 as compared to 669,000 user’s today.1-2

Yet the media cannot leave the pain connection alone when reporting on any facet of this story. CNN, in reporting on the recent spike in overdose deaths stemming from the latest wave of analogue fentanyl finding its way into the heroin supply (a phenomenon that leaves a trail of deaths every few years), couldn’t help but make the world a little worse for people with cancer pain at the same time by referring to the drug as the “powerful narcotic used to treat cancer pain.” This is untrue. The fentanyl hydrochloride that generally finds its way into the heroin supply is brought to you by your friendly neighborhood drug cartel, not the pharmaceutical industry and is not the powerful cancer painkiller itself. It used to be called China White. Now it has been called Theraflu. Whatever the name, it is equally deadly though NOT the “powerful cancer painkiller”. What good would it do to report the facts and not scare the bejesus out of a few people with cancer pain while you’re at it?

One of those unfortunate people who succumbed to heroin overdose was Phillip Seymour Hoffman, the immensely talented and troubled actor, now gone at age 46. He died from ostensibly heroin alone on preliminary analysis (making perhaps, the typical mistake of the newly relapsed and recently sober, miscalculating his lack of tolerance into the equation as he used). Recently, nearly 30 people died in the Pittsburgh area when the heroin/fentanyl analogue combination surfaced there. Bless their poor tortured souls, all 669,000 of them. And bless the poor tortured souls of the 70-100 million people with chronic pain. They are also the victims of an epidemic. And they are suffering and dying too. How many have ended their lives because of pain? Whatever the number, without doubt a solid tenfold more have contemplated it.

The balloon has officially been squeezed. A combination of developments, some positive (abuse deterrent opioids; increased use of urine drug testing and prescription monitoring programs; better risk assessment and use of tools developed for that purpose; legitimate prosecutions of those running “pill mills”), some negative (humiliating pharmacy policies; unfair laws so burdening physicians that they abandon pain management with opioids; the unfair persecution of some legitimate members of the pain community), almost all of which have made the world a more hostile place for people with pain, has feasibly chased the opioid abusers (and some innocent non-abusing chronic pain sufferers on opioids) of the world out of doctors’ offices and into the welcoming arms of the drug dealers.

Then there’s the media…

Media driven sensationalized statistics, sometimes even quoted in some peer-reviewed journals have served to inaccurately legitimize misleading numbers, or HALF-TRUTHS.  For example, the claim that the “United States representing less than 5% of the world’s population, are by far the largest group of opioid users consuming 80% of the world’s supply of opioids” or “Americans use 99% of the hydrocodone available globally.”  We see these so often, we won’t even reference it.  The whole fact is that although Americans use 99% of the hydrocodone available globally, other countries choose not to use hydrocodone or it is not available. Dihydrocodeine largely is used instead of hydrocodone throughout Eurpoe for mild to moderate pain; hydrocodone in Canada is only available in cough and cold products, but not otherwise prescribed for pain.  In Australia, hydrocodone has been largely replaced by morphine.  THAT’S THE WHOLE REAL TRUTH!

But we want to ask – pain community/media/regulators/law enforcement – is anyone happy now? We know you’re not happy. No one who cares enough about people and aspires to become a doctor, nurse, pharmacist, psychologist, social worker, reporter, policeman, or regulator could be happy when people are addicted or dying.

We suppose the correct question is, “do we feel any more virtuous now that people are not dying from prescription medications at the same rate that they once were and are now dying from street drugs again?”

Let’s suppose the media was correct. Everyone out there currently using heroin used to be a user/abuser of prescription opioids. To hear the ostensible pundits, they’ve moved over because they want an “even more powerful high” (where do they find these guys?) or because heroin is cheaper. We think it’s because heroin is now more readily available. But whatever the reason for the switch, we view this as a missed opportunity. We, all of us clinicians, had them right where we wanted them – in doctor’s offices and various clinic settings. And they were in pain – maybe not the pain we thought we were treating but they were in pain nonetheless, even if they didn’t know it. They might have felt just as much of a rush fooling us and scoring their prescription as they did later when they crushed and snorted or crushed and injected or simply put a whole tablet in their mouth and chewed it or swallowed it. But they were hurting.

This is what happens when our solution to every drug problem we have is focused on the supply side. “Cut down access and addiction issues will be solved”. How many times have we made this same mistake?  As mathematically illustrated in the featured image, it’s become pretty clear that heroin usage is inversely proportional to illegal prescription opioid access; but, that doesn’t equate to or mean that legitimately prescribed opioids yields heroin usage.

And we had them RIGHT-WHERE-WE-WANTED-THEM, in our offices!

Had we not focused on cutting off access, but instead focused on the human being in the room; and if we had something to offer them, a vocabulary, and the training to present what we had to offer them in a nonjudgmental fashion to make them want to accept it, things may have been different today. If only our society had not made prescribers more afraid for their licenses and livelihood and not turned our relationship with these suffering people into an adversarial one…

So now heroin is the “it” drug again. Can we now offer help, state of the art help that is highly individualized scientifically (not philosophically) chosen treatments for each person?  And while we are at it, can we recognize that the pain clinic population has changed during this time?  We submit that the population of people with chronic pain is now using illicit drugs at a rate that is a fraction compared to that of the general population. We now have a huge range of tools to help stratify risk, manage risk and treat those who need and might benefit from opioids to help maximize benefits and minimize risks. So can we now stop further stigmatizing people with pain with prejudicial laws and policies? For that matter, could we stop stigmatizing people with addictions?  Could we stop stigmatizing everybody? Can we help…anybody? Can’t we just all get along?

To rephrase John F. Kennedy’s famous quote, Ask not what regulators and journalists can do for you (to lessen your burden of difficult patients), but ask what you can do for your patients.

No matter how or why, these patients found themselves on the wrong end of a potentially fatal syringe full of a potentially lethal drug. They should have had you at hello.  Instead, they are in cold place with nowhere to run except the street.

As always, comments are welcome and encouraged!

This blog was written by Doctors Jeffrey Fudin and Timothy Atkinson
Dr. Atkinson is a PGY2 Pain & Palliative Care Resident at the Samuel Stratton VA Medical Center, Albany NY.  This Blog was not prepared in his official duty as a government employee.

Authors & Urkrl

References:

1. Epstein J, Gfroerer J. Heroin Abuse in the United States. NHSDA 1996. Updated June 3, 2008. Accessed February 8, 2014 at http://www.samhsa.gov/data/treatan/treana11.htm.
2. Substance Abuse and Mental Health Services Administration, Results from the 2012 National Survey on Drug Use and Health: Summary of National Findings, NSDUH Series H-44, HHS Publication No. (SMA) 12-4713. Rockville, MD: Substance Abuse and Mental Health Services Administration, 2013.

 

34 thoughts on “Opioids, Media Deception, & Heroin: Are We Happy Now?

  1. I know this is a couple of years old, but a friend shared this on FB. Bravo!! Thank you for hitting the nail on the head. So many chronic pain patients across the nation are being treated horribly by their doctor(s) and/or pharmacist(s). Many have been recently abandoned by their doctors, forcing them into cold-turkey withdrawal (I know of two recent deaths directly related to this) or being weaned down to ineffective doses (even though they’ve been on the same stable dose for many years, even decades).

    States are passing outrageous “guidelines” (voluntary and mandatory, though we both know the ones that most doctors follow these “voluntary” guidelines because they have been targeted by the DEA and state medical boards for not following these “voluntary” guidelines. These are the same states that have seen huge increases in both their suicide rates and abuse of potentially-harmful substances with pain-relieving properties (large amounts of alcohol, street pills, heroin, etc).

    Those who are in constant severe pain, unable to access a doctor willing to risk their licenses, their reputations, their personal and business assets, and their freedom, will do one of two things – commit suicide or find a substance to help relieve their pain. Common sense tells us that humans can only take so much pain before they begin to crack. Those who’ve had to resort to finding pain relief on the streets are not addicts. They’re humans who can no longer take the physical suffering. We, as a society, would not dare treat our pets in constant pain this way nor would we allow anyone’s pets’ severe pain to be neglected like this (rightly so), so why do we, as a society, allow fellow humans to be treated with such neglect?

    Onto the subject of addiction – Addiction involves the compulsive, often uncontrollable, craving of a substance. It involves the use and misuse of a substance for the sole purpose of achieving a “high,” (non-legitimate medicinal reasons). It involves constantly consuming (or obsessing about consuming) more and more of a substance to keep achieving the same “high” as was achieved in the beginning. A pill, a drink, a plant does not “cause” addiction. Sex doesn’t “cause” sex addiction. Gambling does not “cause” gambling addiction. Shopping does not “cause” shopping addiction. The abused substance (or activity) is merely the symptom of something much bigger and more complex.

    Our mental health system is broken. So many of those afflicted with mental illnesses and/or disorders (including the mental illnesses that often co-exist along with addiction and/or is the underlying reason for addiction) can’t access the treatment they need. The treatments, including medication and counseling, are too expensive and not easily-accessible (esp for those living in rural area) for so many. Addicts are ill and deserve compassionate treatment, including different options that are tailored to fit them as individual patients. BUT the SAME is TRUE about PAIN PATIENTS, as we are also ill and deserve compassionate treatment, including different options that are tailored to fit us as individual patients.

    This government can’t continue to legislate addiction by restricting much-needed medications that help alleviate physical suffering. Instead of setting up an easily-accessible, affordable, solid mental health system all over this country that can help treat those afflicted with addiction and other mental health issues, our government has decided that imprisoning addicts and restricting medications for those who are physically suffering is the answer. Obviously, it’s not. History has shown us over and over again that this is not the answer. Why does this government continue to fail with their war on “drugs?” Because they fail to learn from history and keep repeating it even though it fails every time.

  2. Personally, I think the rise in heroin use is completely to blame on the scarcity of prescription meds. The difficulty and expense of obtaining and keeping a prescription for opioids is too much for the average patient…even if the patient is on the up and up. There’s just too many hoops to jump through and too many variables can get in the way. If EVERY prescribed drug and EVERY patient were put through these requirements, a whole boat load of people would not receive their daily medications.

    It is a matter of travel, money, sickness, and accuracy of lab work….not to mention we are forced to give up our privacy…. If there was wiggle room, it could be different. But, we are treated more stringently than some people on parole or probation.

  3. What a moving account of your frustration with the media, Dr. Fudin.

    One big reason the mainstream media do not care about the fate of people who get pain relief from opioid pain relievers for chronic, long term pain is that most reporters do not believe such people exist. Why should they? According to oft-quoted “experts” like PROP’s Jane Ballantyne, MD, “It (long-term opioid treatment) may provide comfort to people with refractory medical and psychiatric conditions, but it does not offer pain relief.” (See Amednews, Nov 14, 2011.)

    Therefore, people like me who get monthly opioid prescriptions by claiming they relieve our long-term severe, chronic pain must be addicts, criminals, or seriously delusional. If we lose our access to opioid pain relievers, who cares?

    Then there are reporters like Sabrina Tavernise of the New York Times and Sanjay Gupta of CNN. Gupta is the guy who hung the Doctor Death tag on Dr Webster, an obviously caring caregiver and contributor to this blog. Tavernise accepted without question PROP’s version of the FDA’s rejection of PROP’s petition for drastic limits on opioid prescribing, even though relying on PROP for complete, objective information on opioids is like relying on Fox News for complete, objective information about the Democratic Party.

    I believe that a necessary and honorable campaign to reverse a flood of misuse and abuse of opioid pain relievers has turned into a jihad against pain sufferers and the doctors who are trying to treat them with whatever works best. But I also believe that the tactic of feeding distortions and outright lies to popular media, even to achieve worthy goals, will eventually backfire. It always does, leaving egg on a lot of faces and reputations in tatters.

  4. I would also like to thank you, Dr. Fudin and all the other professional doctors for commenting on this blog posting as well. It’s nice to know that legitimate pain patients still have doctors on their side. It seems to be dwindling. The media does seem to influence our govt. and it has made it nearly impossible for innocent legit patients to get treatment for pain these days. Florida is still a hell hole when it comes to good pain management after the Pill Mill Bill – Crackdown. Our doctors are severely under treating now and the medicine is extremely hard to get filled. The suffering has increased and I have to wonder if people with pain here will ever get to experience a functioning life ever again without the worry they have each month. The stress of monthly Dr. visits and pharmacies are enough for many to just throw in the towel and begin the dying process. I hope something changes before it’s too late. The negative media is a huge part of this.

  5. This is one of the most truth filled blogs I have read, I actually got teary eyed because you are exactly right!! Why couldn’t they help people when they were right in front of them instead of focusing on the wrong things and kicking them out into the street, right into the arms of the dealers!! I have said multiple times that the Pill Mill Bill has probably created more criminals than it has stopped. I truly wish there were more medical professionals with the same common sense you have.

  6. Back in 2001 OxyContin was the first medication to finally get my chronic pain under control. It was like a miracle medication , finally after 10 years of suffering from chronic pain I found pain relief the way it was suppose to be. I tried alternative therapies and they did not work. Then all the negative media hype came out calling OxyContin Hillbilly Heroin . I thought what the heck are people talking about, this is a excellent pain medication when used correctly.

    All this negative reporting and all this negative hype is out of control. Now people that suffer from chronic pain are getting fed up with the negative hype about opioids. Some chronic pain sufferers that cant find pain relief from their doctor don’t know where to turn. We had things going in a good direction now things are getting further and further out of control. I saw how heroin destroyed a friend of mine , it was terrible to see this friend go from a descent guy to doing almost anything for his next fix. What he had was an addiction to heroin ,he had no chronic pain, but pain of a different kind, the pain of addiction. I got him in to a methadone clinic , I felt bad for him but there was nothing I could do to get him to stop , it was up to him to stop that madness. The disease of addiction is a terrible thing to see a friend go through.

    People suffering from chronic pain just want some type of normalcy ,after all ones life can become consumed by never ending chronic pain.

  7. Thank you so much for, as usual, seeming to read my mind when the mainstream media serves up ill-calculated conclusions that I *know* will spell out suicide for pain patients…for reasons you have already pointed out specifically. For now, I am one of those fortunate patients with an excellent pain specialist, a dedicated pharmacist, a supportive family. Yet because of phenomena like the post-Hoffman-death reactions, I know I live on borrowed time. I already miss more than one pain-patient friend who ran out of time. You are much appreciated.

  8. Here’s a nice late edition to this blog.
    The FDA Adverse Event Reporting System (FAERS) (formerly AERS) has a great schematic tool that trends heroin usage by age and gender (you choose). The trend graph at the top essentially shows change in heroin usage and related adverse events from 2004 to 2012.

    1. I do not see the usefulness of this graph or how it supports our position. Heroin use is up, and the peaks and valleys are more frequent…maybe suggesting a surge in availability???

  9. Dear Dr. Fudin,
    I am a Chronic Pain WARRIER. I am not a patient. I cannot afford to be. I have no health insurance and live off of roughly $12K per year.

    I have Fibromyalgia, Degenerative Disk Disease (L3,4,5 & C7), Arthritis, Chronic Migraine, Kidney Disease (frequent stones), Pernicious Anemia, Bone Spurs (feet and spine), and also have OCD and Panic Disorder. Needless to say, I know pain.

    It is becoming more and more difficult to not only get the prescriptions I need to function – and by that I mean, bathe, eat, and care for my child. I cannot work from the memory loss and tremors alone- the doctors do not want to prescribe enough narcotics to treat the pain… Just make it barely tolerable. Then, the pharmacies either do not have the medications, or they are outrageously expensive. (My Fentanyl patches cost from $20 each to $60 each depending on where I go. Ten patches a month =$600… That’s HALF my income!)

    I FIGHT “The System” every day, because they are making it harder on me, and easier for the heroin addicts and criminals. When the day comes that I can no longer get the medication I need – even though I have legitimate DISEASES that call for these medications – I will have a difficult decision to make. Shall I just let the pain and withdrawal kill me? Or will I become another “criminal?”
    I wish I didn’t know that day is coming.

  10. I saw the brutal fight on board the lifeboat in “Captain Phillips”. Wow, it must be pretty addictive, the writers thought it important enough to have a THING about it. Don’t know much about this article. All I know is, if they took my pain meds away with me being one of the arachniacs I guess I would settle for trying out for the new pot craze in Colorado/Washington. I was in Vietnam, and worked detox as an RN for many years, ironic huh? BUT, I would not put that tar in my arms. I have heard, and SEEN the horror with my own eyes. Over and over and over. I guess I would just curl up in a ball an die. NOT putting that crap in my arm/legs/feet/neck, etc. Seen it all…..One for instance. I watched a junkie who I just admitted to my unit a long time ago. He was heating his little rock of black tar in a PLASTIC SPOON. I said, “Hey, that just ain’t gonna work!” He looked surprised and said,,,,,,,”Damn thing is melting.” I walked over and just took it from him, and called the doc and had him discharged. Guess he didn’t wanna quit after all. Plastic spoon? Sheesh. lol

  11. Or you could educate yourself on the greed and corruption that surrounds the prescription drug overdose deaths “epidemic” deemed by the CDC. Big Pharma pays doctors to write medical books describing the under treatment of pain in the United States, pays to sit on the boards of the FDA while making decisions on admission of new pain pills into society.
    I have seen prescriptions written in broward county Fl for 308;30mg oxycodone, Xanax, and Soma repeating dosages every month to a 27 yr old with nothing wrong with him I have taken care of drug addicted babies and if you want to understand suffering talk to a family that has buried their child from this

    1. Stopnow, It seems that you are confusing/combining two unrelated issues. No doubt, the “pill mills” in Florida were a nightmare for sure and needed to be squelched and perpetrators that were involved need to be locked up and lose their licenses if they had one. I have reviewed several criminal cases in which certain prescribers and pharmacists did unconscionable things in terms of drugs and doses prescribed and dispensed as you outlined. Perhaps the lawmakers and politicians are in large part to blame for allowing things to get to the point that they did. To prevent innocent chronic pain sufferers from obtaining legitimately needed medications in particular cases is equally unconscionable. But, to connect these things to “Big Pharma”, the FDA, and expert opinions of highly regarded scientists in the field as you suggest, is short-sighted and naïve at best.

      1. Not every person addicted to opiates started out on a joy ride many were prescribed due to an injury and became addicted (it’s heroin). And you are wrong when you refer to the overdose deaths in the past tense. If you think corruption does not exist when there is so much money involved you are naive. There is a Senate Investigatipn on the matters I described. I ‘m sure you must know about the law suit won against Big Pharma by the State of West Virginia after it was proven that the drug they marketed as non addictive was in fact proven to be highly addictive and they knew it. Yet the FDA kept the drug on the market. Any physician who is prescribing opiates for their patient rather than alternatives for healing is setting their patient up for failure. The patient would be better served seeking another doctor. And there is plenty of studies to back up what I stating

        1. Stopnow, You really should “stop now” because you are incorrect. You say “…to opiates started out on a joy ride many were prescribed due to an injury and became addicted (it’s heroin)”. That simply is untrue…see OPIOID CHEMISTRY. With the argument you use, dextromethorphan in OTC cough syrup is “heroin” because they are both dehydroxylated phenanthrenes. If you believe you know the chemistry and pharmacology better than the rest of the world, please enlighten us with how you’ve arrived at the conclusion that prescription opioids are “all heroin” and explain why your theory defies science…then tell me what qualifies you to make this judgement.

          You say “And there is plenty of studies to back up what I stating”. Let’s see them!

          I don’t see anybody bashing drug companies for producing newer safer anticoagulants for treating atrial fibrillation, for new anti-rheumatic DMARDS (disease modifying anti-rheumatic drugs), new anti-virals for treating HIV or Hepatitis C, or for all the new anti-diabetic agents for treating diabetes. I also don’t see anybody bashing the companies for educating healthcare providers on the pharmacology of these drugs or their risks and benefits versus costs compared to other drugs. With no education and no marketing, to a significant extent many medical advances would remain stagnant; is this what you suggest should happen?

          1. Dr. Fudin,

            This is an issue that has bothered me since I have been stricken with several incurable conditions that are not adequately treated by non-opioid medications. Nobody has asked my father for a pill- count of his Plavix. My mother is never drug tested to be certain she’s taking her cancer medication.

            My life-partner must take diabetes, anticholesterol, and antihypertensive medications EVERY DAY of her life. She gets refills, no drug tests, no third degree from the pharmacist, but she takes them every day.

            I have the misfortune of suffering from diseases that require me to take medications every day that other people have killed themselves with. I don’t care if they’re considered “addictive” because, I still need them every day.

            If my dad, mom, or life-partner were told their medications are addictive, but without them they’re quality of life will diminish to nearly unbearable, would they care? Would they still take them. If you have to take a medication everyday, what difference does it make if it’s “addictive”?

            I have suffered for years attempting to deal with these conditions in other ways. Trust me, it’s a pain (pun intended) dealing with all of the unfair, unnecessary red tape (to put it kindly), if there was any other way to have any semblance of a normal life, I would much rather not have to fool with the whole mess.

            Thanks for your support for the chronic pain community. You are much appreciated.

          2. Because of people like you, I have stopped speaking for Pharma because I’m tired of the magniloquence from ill-informed “pundits”. To think that every clinician that is knowledgeable on a topic is “bought” by Big Pharma is credulous at best! You might be interested in Big Pharma: From a Marketing and Health Perspective as seen at this LINK.

    2. STOPNOW needs to thank his/her lucky starrs that he/she has never dealt with daily, disabling pain that hasn’t responded to multiple surgeries, countless specialists, over 20 non-opioid prescribed medications, rounds of PT, injections, injections, and even more injections, out-of -pocket costs for acupuncture, massage, and every other recommended treatment available!

      The ignorance and arrogance of the STOPNOW “thinkers” is hurting people who through NO FAULT of their own have been dealt immeasurable suffering… Yes, addicts suffer. So do their loves ones & communities. However, they have the power to put their disease into “remission” by seeking addiction services and having the strong desire to stop & turn their lives around. They have the ability to get clean, sober, and start new lives. It may not be an easy road, but it’s POSSIBLE.

      When you have a medical condition for which there is NO CURE, and opioid medication has kept you from blowing your brains out because of excruciating, daily, severe pain….there is no alternative. There is no “remission” for us. There is a bit of respite that allows functioning with symptom management.

      How DARE you act as though YOU have all the answers for things that you have NO CLUE about…. Get off your high-horse before you FALL & end up with an injury or illness that could tear your life apart. One that could require you to surrender to the fact that despite EVERYTHING else you’ve tried, opioids are the answer. Why should we suffer without relief for what’s left of our already incredibly difficult lives?

      Go educate yourself, and then get on your knees and thank GOD you are as clueless as you are about the consequences of living with an incurable medical condition that causes mind-blowing pain. I can promise you this much…. If you spent one day in my body, you’d be screaming for help & relief. You wouldn’t care WHAT worked, just that it DID.

  12. The above blogpost makes many good and important points. A great many Americans (and some healthcare professionals) seem to exist in a parallel universe wherein they believe that neither they nor their loved ones can/will ever suffer from chronic pain, or drug abuse or addiction, or require treatment with strong analgesics. Therefore, they stigmatize anyone who does fit one or more of those circumstances. The mass media fuel this false perception and resulting stigma, which is further echoed by misinformed politicians and other fools.

    However, implying that patients might be better served at the point of care for their physical OR psychological pain issues raises an important question: Will the current healthcare system in the U.S. reimburse healthcare providers for their investment of time/effort in more adequately treating such complex patients? Or, does the system favor prescription-writing and interventional procedures in the pain-treatment setting, rather than more laborious and careful patient assessments resulting in multimodal therapeutic approaches?

    1. Stew,
      It’s always so great to hear from you…a non-biased voice of reason and science, and always perfectly and succinctly articulated! Thank you once again for participating here!

  13. Dr. Fudin,

    I am so pleased that you presented this information. It desperately needed to be said… with logic, conviction, and common sense. Too often the “agent” is blamed instead of the disease.

    The drug should not be blamed.
    The patient should not be blamed.
    The disease should be TREATED.

    – James P Murphy, MD

    1. Dr. Murphy,

      It is SO important to me, as a chronic pain patient, to be treated as just that, “a patient.” My previous doctor had always treated me with respect all the way up to the very day he explained the entire seven-site facility would no longer be treating any patients with narcotics due to Kentucky’s new “Pill Mill Bill”.

      I am still upset and confused about what my role in this was. I did not sell or take drugs in an illegal manner. I never saw multiple providers or went to multiple pharmacies. How is my suffering going to stop a drug addict from overdosing on Drugs? I will never understand this way of thinking.

      Thank you for taking your Hippocratic Oath seriously. Thanks to caring doctors like you, I am feeling a bit better these days.

      Check out my Facebook Page:
      https://m.facebook.com/profile.php
      id=595049517218134&__user=100004736613852

  14. Drs. Fudin & Atkinson – thanks for shining light on the media’s “stretch” of the facts. Since Mr. Hoffman’s death there has been a lot of associations made between illicit & licit use (medically indicated or not) without much understanding of the complexities of addiction. It would be interesting to review the data about rates of addiction in countries like Africa or India where legal opioid availability is very limited or non-existent. The illicit substance may not be heroin but it maybe something as equally dangerous such as methampethamine, ketamine or some other easily synthesized synthetic compound.

    1. Khat

      From Wikipedia, the free encyclopedia

      Catha edulis (Khat, qat, or “edible kat”[1]) is a flowering plant that is native to the Horn of Africa and the Arabian Peninsula. Among communities from these areas, khat chewing has a history as a social custom dating back thousands of years.[2]

      Khat contains a monoamine alkaloid called cathinone, an amphetamine-like stimulant, which is said to cause excitement, loss of appetite, and euphoria. In 1980, the World Health Organization (WHO) classified it as a drug of abuse that can produce mild-to-moderate psychological dependence (less than tobacco or alcohol),[3] although WHO does not consider khat to be seriously addictive.[2] The plant has been targeted by anti-drug organisations such as the DEA.[4] It is a controlled substance in some countries, such as the United States, Canada and Germany, while its production, sale and consumption are legal in other nations, including Djibouti, Somalia, Ethiopia and Yemen.[5]

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