The Answer is Morphine 100mg Equivalent – Morphine Jeopardy

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The correct question is: How much of another opioid is equal to this?
LET’S NOT PLAY JEOPARDY WITH PATIENTS!

There has been much debate over the PROP Petition, asking the FDA to change the approved labeling for opioids.  One part of the request is that the maximum allowable dose for any opioid used in non-cancer pain be limited to 100mg of oral morphine per day, or the equivalent.  The question remains, are we able to pinpoint such an equivalent, and if we can, whose data do we believe?

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.)

In an effort to show the irrationality of such a rigid directive by PROP and to provide a real life teaching tool, I assigned a class of doctoral students from Albany College of Pharmacy & Health Sciences, the task of converting 5 different opioids to their corresponding morphine equivalents.  They were each tasked to select 3 different readily available resources and calculate the conversion to morphine 3 different times, for each of 5 drugs, using each of their 3 chosen resources.

Fifteen out of eighteen student participants converted the same 5 opioid drugs, 3 times and documented the lowest “equivalent” answer, the highest “equivalent” answer, and the average difference of their “morphine equivalent” in standard deviation.   Three of the 18 students double checked the references against all calculations and then pooled the data.  Sixteen unique reference sources were identified (listed below) by all students combined.  All students chose three references which mathematically allowed for 45 possible selections (i.e. 15 students x 3 choices each = 45 possibilities).  But, because some students selected the same references as others (which we would expect in real practice), 16 unique choices were made among all students.  Allowable conversion sources were textbooks, package inserts, online opioid conversion calculators, and primary literature.

The assigned drugs for conversion included Hydrocodone 80mg; Fentanyl 75mcg/hour transdermal patch; Methadone 40mg; Oxycodone 120mg; and Hydromorphone 48mg

CONCLUSION:  Using just 5 opioid examples, we easily demonstrated the different mg calculations that pharmacists or physicians, and other prescribers could arrive at when converting opioids from readily available resources for the morphine conversion.  To assign a random cut-off of morphine 100mg per day is an over-simplification and disingenuous.  The first summary table below shows the average calculated dose, the range in doses that were calculated from readily available reference sources, and standard deviation.  Summary graphs and charts appear below with the raw data.

SUMMARY

Convert From ↓ CALCULATED MORPHINE EQUIVALENT BY RESOURCE

Average
(mg)

Range
(mg)

Standard Deviation of Sample (mg)

Hydrocodone 80mg

88

67 – 144

20

Fentanyl 1800mcg as (75mcg/hour)

259

135 – 540

132

Methadone 40mg

103

50 – 160

33

Oxycodone 120mg

176

80 – 240

37

Hydromorphone 48mg

199

170 – 384

48

fentanyl

hydrocodone

 

 

 

 

 

 

 

 

hydromorphone

methadone

 

 

 

 

 

 

 

 

oxycodone

 

 

 

 

 

 

 

 

A special thanks to the 2013 Spring PHM 551 Pain Management Pharmacotherapy Pharm.D. Candidates
Bhullar, Rupinder Close, Jennifer Coppola, Kurt
Elias, Tamer Gardinier, Michaela Gray, Clarissa
Procopio, Joseph Shrivastava, Abhishek Squilla, Molly
Crachi, Nathanael Dabulewicz, Natale Durrani, Abu
Mirza, Maira Musco, Kenneth Pelletreau, Genevieve
Vargulick, Sonya Younan, Maureen  Yu, Julie

RAW DATA

 

Convert From ↓

CALCULATED MORPHINE EQUIVALENT BY RESOURCE

Brennan
(mg)

Kane
(mg)

Foley
(mg)

MedCalc
(mg)

McAuley
(mg)

Vieweg
(mg)

Fisch
(mg)

Algo
(mg)

Hydrocodone 80mg

80

80

80

80

80

80

120

144

Fentanyl 1800mcg as (75mcg/hour)

135

450

540

225

150

540

216

300

Methadone 40mg

121.1

50

60

120

60

160

120

Oxycodone 120mg

180

120

80

180

180

180

180

240

Hydromorphone 48mg

192

170

192

180

180

192

180

384

 

Convert From ↓

CALCULATED MORPHINE EQUIVALENT BY RESOURCE

Hamilton
(mg)

Mcpherson
(mg)

PrimCare Companion (mg)

Cupp
(mg)

Washington State  (mg)

Klimas
(mg)

UO S. Alabama (mg)

UO Chicago (mg)

Hydrocodone 80mg

120

80

80

66.5

80

80

80

80

Fentanyl 1800mcg as (75mcg/hour)

269.5

180*

225

180

180

270

270

135

Methadone 40mg

120

100

120

120

Oxycodone 120mg

180

180

240

150

180

180

180

180

Hydromorphone 48mg

192

192

192

186

192

192

192

180

 

*  Dr. McPherson’s text suggests various options depending on different resources and discusses conservative conversions versus less conservative conversions.  Data above represents the average (from a range given) by Donner and colleagues. (Donner B, Zenz M, Tryba M, et al. Direct conversion from oral morphine to transdermal fentanyl: a multicenter study in patients with cancer pain.  Pain. 1996;64:527-534.)

SOURCES IDENTIFIED        

  1. Algo. “Rapid Opiate Dose Equivalence Information”. Algo’s Research. <http://algosresearch.org/PracticeTools/NarcoticCalculator.html> (accessed 2013 Jan 30).
  2. Brennan MJ, Fudin J, Perkins RJ. “Opioid Calculator.” Practical Pain Management. 2013. <http://opioidcalculator.practicalpainmanagement.com/conversion.php>. (accessed 2013 Jan 30).
  3. Cupp M. “Equianalgesic Dosing of Opioids for Pain Management.” Pharmacist’s Letter 2012; 28(8):280801. <http://pharmacistsletter.therapeuticresearch.com/pl/ArticleDD.aspx?nidchk=1&cs=STUDENT&s=PL&pt=2&fpt=31&dd=280801&pb=PL&searchid=39410574&segment=4615> (accessed 2013 Jan 30).
  4. Fisch M, Burton A. Cancer Pain Management. 1st ed. McGraw-Hill. 2007 (table 2-4 and 2-5)
  5. Foley KM. The treatment of cancer pain. N Engl J Med. 1985;313:84-95.
  6. Hamilton RJ. Tarascon Pocket Pharmacopoeia: 2013 Deluxe Lab-Coat Edition. 14th Ed. Burlington: Jones & Bartlett Learning, 2013.
  7. Kane, SP. “Opioid Equianalgesia Calculator.” ClinCalc. 2012. <http://clincalc.com/Opioids/> (accessed 2013 Jan 30).
  8. Klimas L. “‘Death Tables’: ‘Notoriously Inaccurate’ Medical Reference Tool Could Be Killing Thousands”. Health. <http://www.theblaze.com/stories/2012/04/03/death-tables-notoriously-inaccurate-medical-reference-tool-could-be-killing-thousands/> (accessed 2013 Jan 30).
  9. McAuley D. “Advanced Opioid Converter.” Global RPH the Clinician’s Ultimate Reference. 2013. <http://www.globalrph.com/opioidconverter2.cgi>. (accessed 2013 Jan 30).
  10. Mcpherson, Mary Lynn. Demystifying opioid conversion calculations. American society of Health-System Pharmacists. 2013.
  11. MedCalc. “Opioid Medication Dose Conversions” 2013. <http://www.clinicalpharmacology-ip.com/Forms/Resources/calculators.aspx?fl=fl2&cpnum=0&c=297> (accessed 2013 Jan 30).
  12. MUSC Health. “MUSC Opioid Analgesic Comparison Chart”. MUSC Health. 2011. <http://mcintranet.musc.edu/agingq3/calculationswesbite/convchart.pdf> (accessed 2013 Jan 30).
  13. University of Chicago. “Principles of Pain Management/ Conversion Rules.” 2009. <http://champ.bsd.uchicago.edu/PalliativeCare/documents/Pallpaincard2009update.pdf> (accessed 2013 Jan 30).
  14. University of South Alabama College of Medicine. “Equianalgesic Narcotic Conversion Table.” 2011. <http://www.fammed.usouthal.edu/ControlledSubstances/EquianalgesicNarcoticConversionTable.pdf>. (accessed 2013 Jan 30).
  15. Vieweg WV, Carlyle-Lipps WF, Fernandez A.  “Opioids and Methadone Equivalents for Clinicians.” Prim Care Companion J Clin Psychiatry. 2005; 7(3): 86–88. <http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1163279/> (accessed 2013 Jan 30).
  16. Washington State Agency Medical Directors’ Group. “Opiod Dose Calculator.” <http://agencymeddirectors.wa.gov/mobile.html> (accessed 2013 Jan 30).

 

130 thoughts on “The Answer is Morphine 100mg Equivalent – Morphine Jeopardy

  1. Those guidelines were enforced as if they were laws. Some states went above and beyond the CDCs guidelines, while some physicians opted out of prescribing at all. This left pain patients without any recourse at all. At the same time, the continuous malignant language in mass media and marketing sites like this one, stigmatized, blamed and conflated all pain patients with craven drug addicts. Physical Therapists, as health professionals chose to use the so-called opioid epidemic for marketing their services, by misleading and cherry-picking information, to elevate their business, and increase profits. The tone of this article suggests they are utterly unaware of what their patients are dealing with. PT works fine for some conditions, especially post-surgical, or for rehabilitation after an accident. There is virtually no credible research on the various pain conditions, and in some cases, Physical Therapy can be dangerous or lead to further injury.
    Of course no research has been done on those issues. Another area where Physical Therapy has not been studied is when they postpone a surgery a patient needs. Patients who are vulnerable and desperate, turn to Physical Therapy to avoid surgery.
    In many cases all that they did was subject themselves to a year or more of appointments, frustration, and pain, and they still needed the surgery. They did not have access to real medical advice. No research `was done on this postponement, and further debilitation, due to trying physical therapy for a condition that can only be made worse. Desperate pain patients are reaching out on these sites. They were told by industry-funded advocacy groups to “Tell their story.” These patients should not have to plead their cases on sites like this or the CDC Website. Most are suffering horribly, like the one who commented above. Many of these pain patients had multiple surgeries, and some had infections and amputations. These are among the people who have been denied pain treatment, due to the misreporting of science, facts, and the advertising done by groups like this. There is no evidence that physical therapists can cure the ongoing intractable pain; these patients endure day in and day out. They start to sound insane because they don’t sleep. Their sleep is interrupted by their intractable chronic pain. They endure years of this, while sites like this ignore them. No amount of physical therapy, acupuncture, marijuana, or thinking good thoughts can relieve their pain. Health providers is using their distress to market their services. There is no mention of the criticisms of the CDC guidelines here, or the damage they have done. Clearly, Physical Therapists are unaware that some of their patients were denied pain care, a precise diagnosis, or were forced to undergo physical therapy, even though it would not cure their pain or also make it manageable. We have a conspiracy of silence here since the misery of these discarded patients can be profitable.

    Posted by Kathy Cooper on 4/16/2019

  2. Live in Killinois. Doctors had me on 40mg of Hydromorphone for 4 years after a failed back surgery. Everything was cruising along and then BOOOOM!!! These ass holes in Washington (and in my case Springfield) decide that because I am law abiding and not abusing my prescription I should be punished. Some crackhead junkie shooting heroin brought in by the CIA died and his dad ended up being a politician. So that sorry excuse for a human decided to make it his life’s mission to ruin as many lives as possible because he raised his kid to do whatever he wanted and it cost him his life. I finally found a doctor willing to help and I am now on 60mg of oxycodone. It doesn’t take care of all the pain, but it helps me to be able to move from room to room and get to the voting box where I try to get rid of these scumbags who enjoy watching us chronic pain patients suffer. I hope none of these FDA or CDC or DEA drug lords ever need opioids, but in the event they do I can’t wait to see them beg for pills and regret their ignorance and lack of compassion.

    Charlie Brown

    1. Charlie, While agree with many of your concerns, it is not appropriate to be name-calling to people that are addicted. Addiction is a disease, not a choice; nobody wakes up one day and says, “I want to be a junkie when I grow up.” And, the parents are not to blame. Many respectable good parents have lost children to a drug overdose. That said, it doesn’t give any politician a right to support laws based on a vendetta or personal experience over good judgement to the people he/she serves as a public figure.

  3. If you take the time to read this long rant. I want you to know its appreciated .
    No one else listens and I dont expect my fellow sufferers to want to listen to my problems , so thanks. My state recently legalized marijuana. Which is great for those pain sufferers who can use it. Unfortunately I cant use it and have been using the only thing that relieves my pain for the last 20 yrs, oxycontin.. There are addicts and then there are those people like me who are addicts because of a life saving need not a choice. My choices are oxy or death as far as I see it about my situation. I’m currently one of the many whose dr is scared and trying to wean me off of the only med thst has worked for 20 yrs. And i would rather die and take my chances at having a less painful life in whatever situation death may put me in than continue to live what’s left of my life as a pain ridden lump on the couch with no one to help care for me. Pain like this causes enough stress without having to worry if I will have the relief I have to have tomorrow. No one chooses this as their lifestyle accept addicts and there is no comparing an addict to someone true need for a medication. Ive nearly died from refusal to give me my meds just from the withdrawal. In a hospital yet. I was told by my government authorized pain dr that if I ever cannot get my meds I should go to the hospital or could die from the withdrawal. After a very serious surgery the hospital refused my pain meds and had to end up having my husband sneak me my meds in when he walked into the room to find me writhing on the floor in piles of vomit from not getting my meds. And nurses doing nothing accept to say they would not and could not let me have it. So much for thinking if I ever could not get my meds here at home I could go to the hospital to be taken care of. My husband a cancer patient who is also on meds for pain had a similar situation while having surgery to try to remove some of the cancer but after my hospital experience, found the best option was to arrange a meeting between his surgeon and pain dr to assure the surgeon understood my husband’s need for his meds. And that the nurses knew it also. Everything arranged to go on with the surgery and everyone including the nurses knew to give him his meds we went ahead with it. Only to find the surgery going on thru to the middle of the night and the nursing staff not passing the info on to the staff at staff change where the new nurses on duty knew nothing of it. When I found out a few hours later they weren’t going to give him his meds, it took my screaming threats down the hallways at 4 a.m. to get them to contact the docs involved and forcing the situation . We are NOT, we the pain sufferers, addicts by choice. We need it to continue to survive. There is no quality if life anymore. That’s not a good enough reason anymore to warrant pain relief. As far as the powers that be are concerned there is no reason good enough. So we continue to live with what we call a migraine toothache in our entire body 24/7 so the big hoo-has continue to make more money. It will backfire on them in the long run. Without us lining their pockets with pharmaceutical cash, they will be.
    S O L and more of their so called addicts like me will either die from withdrawal or choose life by choosing death. In looking back now it makes me so sad the reason I started searching on the web today was to figure out how much oxy I need to take to kill myself and in my own way choosing another form of life than the one I’m in now. I wont do it. I’d rather not commit the sin of suicide and choose to let them kill me. In their own way of course.

  4. This is so beautiful. Studies done in Israel have shown that good old Marijuana, god’s medicine, actually gives more pain relief than any of the opioids currently plaguing our society today.

    1. There are far more scientifically valid studies to show that the analgesic properties of marijuana are few and far between, but that there is benefit for very specific pain types. Just as a reminder, marijuana from the various cannabis species are no more or less “God’s Medicine” that opiates from the poppy or kratom from the mitragyna speciosa plant.

  5. THE MEDS PEOPLE ARE TAKING HAVE BEEN INCREASED OVER 10-20 YEARS. WOULD YOU RATHER WALK IN YOUR HOME OR A NURSING HOME? PEOPLE WITH SEVERE PAIN WOULD RATHER BE DEAD, I AM 76 YEARS OLD.. YOU WILL HAVE A LOT OF BLOOD ON YOUR HANDS, GOD KNOWS

    1. For my pain there is no comparision between Morphine and methadone,therte is a big difference in apples and grapes ,Methadone helps me 100 times as good as morphine ,except I don’t get the relief I need ,since the doctors cut me from 6o mg to 30 mg a day ,shame on Government telling sick people what dosage they can have,What ever happened to doctor patient relationship?

      1. My doctor put me on methadone 10 years 40 milligrams and now my doctor retired . Now most new doctor are scared of government .I rather go through pain than have somebody screw with me down road .new doctor still giving to me but don’t trust her. I been going down 5 milligrams a week now I took 5 milligrams yesterday and now going cold turkey so sick .pain craps and bathroom problems .

  6. What has the point of meds like zohydro or hysingla (abuse deterrent medication) if this 100mg morphine equivalent was/is the endgame of the gov?

    I’ve been I the same meds for 6 years, and since the start of 2019 is been literally hell getting my meds, from getting pa’ to in’s saying they only pay for a 30 day supply every 90 days, to me being required to pay hundreds or thousands out of pocket, then my doses literally being cut in half for no reason this month.

    I’m slowly considering street drugs over this insanity, then the crisis will be worse as no one will go to the er, deaths won’t be accurate as people will hide, you won’t really know what was taken cause it’s not regulated by a pharmacist

    It’s just going to get worse.

    I could function, now I can’t. And I hate my life.

    1. oc4pc@aol.com. Aww I hate you hate your life but I get it. I’m in constant pain since 2001. Thankfully I’ve never abused my pain pills and am on the same dose for years . Before this witch hunt began I was on oxy, fentanyl patches, percodan for pain . “ they” prescribed those back then. “ they “ didn’t know any better regarding addiction at the time. “They” didn’t know me that I would never take more than prescribed ( catholic school girl mentality) lol. Anyway those meds were taken away long ago, victims of phase 1 witch hunt. Recently my doses were cut down to that magic <100 mg per day ( phase 2 witch hunt) for EVERY body when we all know EVERYbodies BODY is different. Bodies don’t uniformly respond to pain meds. Pain comes in so many shades. Resulting in people wanting to die because constant pain can kill you just as sure as cancer. It only depends on the duration and severity. Pain destroys every aspect of your life. Imagine that migraine you get once in awhile. You can’t work, eat, do child care, laugh, ect. Now times that everyday for the rest of your life, and you get an idea what non stop chronic pains like. Most are incurable. Opioids are all we have. Are people equating pain as a character flaw? As weakness? More on that coming… but back to misconceptions on pain meds. I’ve never, God’s honest truth, have ever gotten high from my meds. In 18 years. But I can understand how one may have no choice but to go for heroin if the government were to take away the only relief I have thus creating a living death causing me to seek out more deadly drugs what the big wigs who make these rules don’t get is that they’ve never had to scream 24/7 in pain with no sleep or life. Nor have they watched their child do the same. ( chronic pain patients on opioids don’t get to be able to legislate but they should )
      And because SOME people abuse ALL PEOPLE are being punished. Chronic pain patients need their meds as surely as diabetics need insulin. Why aren’t they labeled addicts? Both illnesses, chronic pain and diabetics require meds. Even diabetics can od on insulin. My point being we shouldn’t all be judged or saved from ourselves. Most of us just want to take what we need to survive. So make non addictive pain relief already! I’d take cat food if it killed my pain. But they’re not interested in finding non addictive pain meds. For 300 years morphines been used. Now it’s a crisis. Everyone used it. It’s society abusing it for some reason we need to discern. In the words of one famous legislator “ what’s a little pain? Buck up!” Little?? Walk a mile…. why is the government in the biz of making laws about my deeply personal pain experience? No one forces anyone to take drugs. Better get alcohol and cigarettes off market too. They kill people too and don’t treat disease/ pain. And just as an aside they’re trying to legislate our wombs. Can’t control guns who kill our children, friends, well everyone, but interfere in my pain treatment. No one is forced to use drugs. Drugs have been around since the pharaohs and will always be. The problem to solve is why do so many want to escape reality so badly??
      Leave us legitimate chronic suffers to the care of medical PROFESSIONALS who prescribe on a case by case basis. I have idiopathic pain symptoms drs don’t even to this day know what or why they are. Because EVERYBODY is unique. You can’t treat patients the cookie cutter way.
      I’m sorry for the rant. I always hope someone somewhere will read this and think maybe patients should be asked what works for them, and they are not alone in this hellish journey. Stop blaming drs for doing their jobs by treating us with all they know to do. They’re compassionate. They don’t like suffering. Pills getting into wrong hands?? Blame those who get greedy and want more and steal . Or those who don’t lock up their meds. Duh. But please stop punishing we who can barely function because of the interminal pain we feel. We’d love not to have it, truly. It affects every aspect of our life. We only ask for a small period when we don’t want to gouge out our eyes in response to pain. We need to unite. Make our voices heard. Stop the torture and death by suicide when the pain gets too bad, and drs are too afraid to prescribe and we can’t take another moment of agony and know we will have to endure many more. That’s a real danger —-overdosing on pain and hopelessness. #chronicpainpatientslivesmattertoo
      I stand in support of you and feel free to contact me if you need to rant rave cry and bitch. I’m there with you and sometimes just talking bout it makes you forget bout it for only moments but it will. I as a veteran sufferer (18 years) could also offer you some tips
      Please hang in there. I’ve never met you but I do care
      Fox
      Best of luck

      1. Its a shame that a drug addict can get 120 mgs of methadone a day going to a methadone clinic, but I can only get 30 mgs of methadone a day for chronic pain at pain management, Pain managements centers used to manage our pain until the CDC said you have to go by the MME,thats bull shit, everyone don’t need the same meds or the same amount ,and every one doesn’t need Nuerontin, things must change,I would go to a methadone clinic in a heartbeat if I could afford it ,they don’t accept Insurances, I think I read that in 2020 Medicare will start paying for methadone clinics, please hurry up I am through living in hell,Sincerely,the pain doctors knows more what the patients need more than the CDC.

      2. This is so beautiful. Studies done in Israel have shown that good old Marijuana, god’s medicine, actually gives more pain relief than any of the opioids currently plaguing our society today.

    2. Same here I was on 6 a day 30mg oxy now 2 nothing else. I had 2 back surgetires last year I’ve suffered compou d shattered tub/fib wuth a case oststeomylitis. Shattered elbow by lateral carpal tunnel, barrettes disease (2 fonduplications), hyetal hernia, lust continues. Osteoporosis
      Etc. I had 2 part time jobs at one time 3 now I’m mostly in my house.my back surgeries were a waste and made things worse.

  7. What are some of your opinions about doctors being blamed for prescribing opioids? If a patient sells their prescription, is the doctor to blame? Same thing if someone overdoses. Is it the doctor’s fault? I’m reading about so many doctors being convicted. The government thinks doctors are the problem and this will solve the opioid crisis.

    1. the only fault, in my opinion, is the doctors cutting people off there opiate med because of the doctors fear of the ” college” . it is our media that wants people to think the doctors are to blame for everything else relating to opiates deaths. Media rules now days.

      1. I agree. I was in a bad car accident and prescribed 5 mg Percocets for a long time due to my bad injuries. But then all of a sudden the doctor says it’s been long enough and I should be fine and cuts me off. But was I fine no my pain was and is still there. So I 100% agree with this

    2. I’ll give you one… MY WIFE

      Unknown to me she was stealing a few of my Percocets a month, and YES, it’ll give you a high but for me that “high” only happened the first few weeks.

      After I caught her, she told me about some neck pain so of course, I told her to go to the DR and get her own pain meds.

      She went, and during our 20 year marriage she new EXACTLY what to say and do to not only get a DR to get her Percs, but another to giver her adderall. Spend an hour with me off adderral and you’ll know I have Hyperactive ADD… I zoom everywhere, and get nowhere. Nothing gets complete, I bounce from one thing to the next, adderral lets me finish one thing before moving on.

      I found out later she even used my analogy to explain me on adderall or off of it. It’s like having 50 20″ TV’s on full blast in my head but when I’m on adderall I see one 50″ HDMI screen, and 49 12″ black and white TV’s. While they’re still there, and I can hear the sound, I can ignore them

      But because she knew exactly what to say, the DR gave her drugs and then kept upping the doses until she was getting more than I was.

      She had neck pain from the phone LOL I had three ruptured disks L2,L3,L5, six surgeries on my right shoulder from playing baseball and in need of a new one, and a blown ACL, MCL in my knee… She has a muscle spasm from holding the phone in the crook of her neck.

      We were married for 28-years until her drug addiction that these DOCTORS gave her ruined it.

  8. I’VE BEEN BATTLING CANCER FOR ALONG TIME BEEN ON 80MG OXCIYCOTIN FOR TEN YRS. TODAY MY DOCTOR TOOK MY 80S AND PUT ME ON 100 MG MORPHINE SULFATE. AND ITS NOT WORKING VERY WELL FOR SHOULD I LOOK FOR ANOTHER PAIN DOCTOR.

  9. I HAVE BEEN ON OXYCODONE 60MG PER DAY AND OXYCONTIN 70MG. PER DAY I FELL AND BROKE MY BACK 20 YEARS AGO AND HAVE HAD 17 BACK SURGERIES, I AM 74 YEARS OLD AND HOMEBOUND FOR THE LAST 4 YEARS BECAUSE OF PAIN AND ONLY CAN WALK FROM ONE ROOM TO ANOTHER. MY WORK COMP. COMPANY IS MN. STATE INSURANCE TRUST AND JUST GOT A LETTER THEY WILL NO LONGER PAY FOR ANY OPIATES. ALSO, MY CLINIC AND DR WILL START JAN 1 TO GET EVERYONE OFF. MY CITY IS A MODEL CITY AND GOT LOTS OF MONEY BUT WILL NOT GO AFTER THE DRUG DEALERS AND PEOPLE ON HEREIN INSTEAD THEY WANT US TO KILL OURSELVES BECAUSE OF PAIN. PLEASE SEND THESE COMMENTS TO TRUMP.

    1. My life is a living hell. Thanks to a person I voted for and donated money too? Please tell me it isn’t so. I want to be dead. My life is awful they or he has ruined what little I had left to love. America my beautiful bounty given to me by my Lord in heaven please punish all the sinner’s that have put judgement days upon we pain sufferer’s. AMEN

    2. Joyce, Just wanted to say that I really feel for you.. I am in a similar situation as yours. Unfortunately, people like us & many others of us with valid chronic pain are being ” punished” & treated like criminals in a sense and it is SO wrong!!! You’re right more people need to send letters to our Congressmen & State Reps., etc. to get this handled to RIGHT way. However, I doubt Trump could care less!! I have absolutely NO faith in him..sorry, just my opinion!
      From, A an Ohioan with yrs.of chronic pain issues who USED to be staunch Republican as was my husband but, we did NOT vote for nor do my husband or myself have any use forTrump!! God bless you & I pray that things change for the better for all of us in this situation!

  10. I am done to talking to Doctors, my adult life when 18 right out the window, someone allowed to kill to friends 19 & 20 years old- driving an 18-wheeler truck plastered drunk, caused a head on collision, we did nothing wrong- my life ruined left to suffer torturous Pain due to the top of my spine rearranged and not right- my life from then on a daily fight with constant Pain. Then as I am losing my mind from more than ten years of Pain, they finally allow a Pain Doctor and two other Doctors to save my life and finally give me some what of a life- took another ten years to finally get to a working dosage. Then 13 years pass with no problem, but the United States, Maine, just step in and ruin my life once again I had to fight for- but they just punish me once again for other people’s wrongs I have nothing to do with- I don’t even know these people who I am punished for, nor the people who punish me.
    I am done with this so called United States Country- it can go to Hell!!! I
    I am being tortured once again by these so called nice people in this so called United States pit of the 2nd Hell.
    38 years and 8 months of daily Pain, and these so called people still frig with me- torture me- for what I have nothing to do with- GO FIGURE if you have the wisdom for it. A sly cruelty and evil is what it is all about. To pay their dues to their earthly god.

    1. Hi Richard,

      I totally feel for you and totally agree about this G.D. country. Why in the hell are our teeth and dental health NOT included in our health insurance?? Why are dentists allowed to charge 2500.00 for ONE root canal to save ONE tooth? Why is it that we don’t to buy, say, heart insurance, kidney insurance, liver insurance?? Are our teeth not a part of our bodies?? This has been the biggest scam going and for dentists to charge whatever the hell thru the roof outrageous prices to get help with sick teeth is just asinine! Anyway, I too have a terrible back, messed up spine, a vertebra that is slipped forward towards my spinal cord, scoliosis, a fracture, stenosis and arthritis and am in constant pain. The most my doctor will give me is 3 of the 10 mg. Hydrocodone and the only mfr. maker of these that pharmacies are dispensing is by Mallinckrodt and it’s the most worthless junk on the market. It’s like pure chalk or hardened flour there is absolutely no pain medication in them at all. I’ve tried taking 2 of them, nothing, take two more and still nothing. NOT even worth driving the 75 miles each way to get to the only doctor who will prescribe pain meds. OH and also get prescribed that crappy methadone,10 mgs. 2/day. I have heard this is the worst drug ever to try and get off of, so why is it they don’t have a problem prescribing this addicting drug that by the way is absolutely worthless against real pain!! Does not touch my pain. I have in a fairly good sized city and there are no doctors in it who will RX pain meds because they are all scared to death of our government! There is not even an opiate epidemic anymore, how could there be even legitimate pain patients cannot get medicine so why does the CDC keep the lies going? They included O.D. deaths in their statistics that were from people who died while intoxicated on alcohol and took opiates on top of that!! NOW that is some cowardly blatant lies they’re putting out there when they are including alcohol mixed w/ drug deaths under deaths from Opiates! The deaths are mostly from young people who just want to stay high. I hear so many of the parents of these young people who died or are addicted say “they became addicted after they broke their foot or had their wisdom teeth out” and they believe that B.S!!! When the doctor gives you enough pain meds to get through the worst part of your pain which is right after surgery or after teeth are pulled, like say 3 to 5 days worth, that’s it you should have NO problem stopping after that but they liked the euphoric feeling they got and they CHOSE to lie to the doctor and keep getting them, so don’t tell me that they did not have a choice because they did. Sure, you will feel tried and crappy after stopping them after taking them for 3 to 5 days but you will survive and it’ not withdraw when you’ve only been on them for that short of a time. I’ve taken them before after childbirth and had no problem stopping them when they were done. There are so many lies out there and so many gullible parents of these young people who actually believe their kid was automatically hooked after a 3 to 5 day duration of pain medication, no, not happening that is pure B.S! Now it’s the real chronic people with serious pain who are absolutely suffering because of these kid’s and their games. I’m sorry, but unless you’ve been in a serious accident like yourself or were injured in some way when you’re young there is no way you should be having any kind of muscle/skeletal pain at that age that would call for you to be on a regular everyday dose of pain medication unless they’ve got cancer. That was a problem too, doctors just writing scripts to young people without having any MRI or CAT scan test results proving they had something seriously wrong enough to warrant taking pain medication all the time. If someone has their MRI test results proving that they have a chronic condition there should not be any question in getting that patient relief and the government should NOT have any say in it! It is WRONG all the way around and NO excuse to let people suffer especially older patients. I am almost 60 and have clear results/proof of my chronic condition and I am left to suffer like you. Right now I am in near tears from deep down bone pain in my back and right leg and hip and that worthless Mallinckrodt crap is not even worth my copay to pick up. It takes up a whole day to go to my doctor 75 miles one way and before it was every 3 mos. now they want to see me every 2 mos, I cannot afford that B.S. I am on disability, you know, the money we paid into for 40 plus years of working and the amount always remains the SAME no matter how much the cost of living continues to rise every single day, they want us to starve to death too our wonderful government. NOT one decent cost of living raise in the 5 yrs I’ve been on it. I used to have no problem making it thru the mo. but my rent has gone up by 200.00 within this time and I used to be able to go to the grocery store 3 x a month, now only once and I am out of food after 10 days and practically starving and struggling for the next 20 to 23 days because usually your waiting 31 to 35 days in between checks. My elec is thru the roof too, a tiny apt and it’s 235.00 a month!!! The cost of living has gone up 3 fold or more but the amount of money I get remains the same but you better believe these rich b***ards in congress are getting HUGE cost of living raises. One yr they never gave a cost of living raise on SS because they said gas prices went down!!! Usually the most you get is 8.00 more dollars a month. This is just awful the way American citizens are treated, animals in shelters are treated and fed better than we are. This country is a real crap hole now. Other countries take care of their citizens with free medical and free dental healthcare. I am sickened by the way our government is run and now telling people suffering in terrible pain that you’re NOT getting anything to help with that pain because too many drug addicts have died. Just sickening!!!

      1. Yeah, I’m afraid you’re spot on. You used the word “chose” as in “They chose to..”. Well in the US freedom of choice and having to be personally accountable for that choice isn’t politically acceptable.

        If you look at the overdose deaths per hundred thousand, it’s really not that high. If I have to suffer in pain to drop first number, when a good portion made their iven choice to abide or combine their meds with alcohol, I’ll be pissed, and won’t suffer quietly.

        Then the Heroin. We can thank our government for that too. First make pain a vital sign, send make treating it a priority. Then change their mind. (Sorry!) People in pain are going to look for help and if Heroin happens to be the next answer, if you’re in enough pain you’ll do it.

        I fractured my pelvis from a horrific fall out a tree a few years ago. I was in shock and not experiencing much pain. I ITIALLY. I received ONE 7.5mg Vicodin Tablet. After screaming on. The X- Ray table, could I get an increase? NO. The dose was “on a table” and they were “scared of the DEA.” And the guy was a PA.

        I was in too much pain to make it out of bed to GO to the orthopedic surgeon. I noticed I could get strong pain killers from friends, but that would be a FELONY in FL. One Xanax pill on the floor of your car is a 5 year felony in this state. The prisons are not for conditioned. Peaceful non-, violent drug offenders lives are put at risk.

        So suffer from actually pretty severe pain OR risk a felony conviction, with the subsequent loss of your sacred constitutional rights, as well as your chance of being a good job. What would you choose? The answer INARGUABLY varies according to your perceived pain intensity. If it’s bad enough, death by fighting squash next week wouldn’t stop you from relieving your pain NOW.

        Note that this is the definition of TORTURE. Our Government is literally torturing us into breaking laws, and becoming felons. I caved. I was angry that I was forced into making such a choice.

      2. Sorry, but you should be lucky you get mallinkcrodt (sorry if spelling is wrong). They are the best ones in the market right now! I don’t think it’s the methadone that’s not helping, it’s probably the small dose. I am like you, on only 30mg a day of methadone as that is the max at all pain clinics in my state. The other generics of the 10mg methadone pills are horrible. Ascend is the worst and when I got it one month it though my into immediate withdrawal after one day. I was sick the entire month— whoever says all generics are the same is lying, they are not. I finally got back on the malli’s And I was better. Also, being on ascend was like water. Then, another month when I couldn’t get th malli’s I tried westward which was not good but better than the ascend. I still got sick and went through withdrawals once again. If you don’t believe me look up “Mallinckrodt methadone reviews” and you will see what I’m talking about as there have been quite a few web sites dedicated to discussing people’s experienxes with different brands of methadone and Mallinckrodt and Roxanne cane out on top. But, sadly, Roxanne was sold to westward so their pills are not the same as th Roxanne’s.

        1. Hi, I actually finally got off the methadone and am now prescribed Zohydro, which is a time released pain medication and it works better than the methadone. I don’t have any more problems with the Mallinkcrodt it actually works now! I truly believe some pharmacies were getting them off the black market and they were blanks because they did absolutely not ever help my pain. The last few mos. it’s been working fine, doesn’t take away all my pain but it’s better than nothing! I went through a couple of mos. of terrible hot flashes from stopping the methadone but thank God I was on a low dose and it wasn’t anything worse than that. I know someone who takes like 180 mgs. a day and has been for years and years. They also take 30 mg. morphine, 25 of those per day, yes, I am not exaggerating! I haven’t talked to them in awhile so don’t know if they’re still getting that much with all this crack down. They said that they were having a really hard time getting their scripts filled because the pharmacist was very suspicious of the high quantities this person is getting! I’d hate to go through the withdraws from all that! They’ve been on opiates for 35 years!

      3. Exactly!! We all get treated like criminals! End times people!! The only thing that really saved me from withdrawals and dealing with chronic pain from both shoulders replaced and 8 pins later , good old cannabis! CBD and cannabis works wonders but again this corrupt government keeps trying to down play that. They know once medical marijuana becomes legal all those hands in the cookie jar will dry up! They all get pay outs from big pharma and you cant make money off healthy folks! That’s why they push chemo that kills you instead of the cancer because you can make a killing on a dying person, why would they give you a natural plant that kills cancer cells!

        1. You are exactly right. Everyone that has posted on this subject needs to do some research on the subject before hand. Goodole what is the largest killer in the United States. You will find cancer, heart, kidneyvetc is top on the list. Willnthet ban smoking? Why? Tax revenue, that’s why. Out of the top ten killers if I remember 6 or 7 was related to diseases from alcohol or smoking. Also consider, if you can see clearly through the dust you will see that the media is playing this country like a cheap fiddle. They are doing more damage then the ATF, CDC and DEA who were supposed to monitor drugs. Well let’s just say they did a piss poor job of it. If a doctor crops up and starts writing hundred’s to thousand’s of high potency drugs, it stands to reason they weren’t paying attention. I live in Florida and have had 2 back operations (lamenectomy of L3,L4&L5) which did not sure the problem and a cyst removed off L5 which did work, cancer of the prostate and removal, planters fasciitis right foot, spinal stenosis, fibromyalgia, neuropathy, chronic pancreatitis, chronic hip bursitis and torn meniscus in both knees. I had a quality of life before the government took over when we see and take a dump. They dropped the privacy act that Obama put in place and the Eforce data base was put together which violates the HIPPA act. I’ll be 76 this year and useless as boobs on a warthog. I was always helping people (msinly older and vets) which I can no longer do. Now here’s the real catch, the accident I had in 1992 put me on disability in 2002 and my meds have been cut by 75% starting 3 years ago, like as if I’m really going to get better. There is no one in congress that cares!!! Not a damn one of them, you see, because they can get whatever they want when they want it. I write to my elected butt holes and all I get is a form letter. The last one I sent out certified mail tobboth party senators, congressmen and Mr Great TRUMP. I got a form letter from the whitehouse and and Senator Marc Rubio. Big deal, a real slap in the face. Check out all the congressman and representatives that got paid for the Net Neutrality Act by dropping it. They got paid in between $3,700 and $285,000 almost all of the 535 members of Congress took money from the lobbyists to repeal the Privacy Act. You can look it up by Google. I’m done ranting, I could go on, but everyone on the subject needs to do research, Google who your elected officials are and get to writing, calling or email. It’s all online, very simple!!!! If you dont then your not in enough pain!!!! As far as I’m concerned, cannabis is the only way out for some, not all.

  11. http://www.agencymeddirectors.wa.gov/Files/OpioidConference/SummaryPubComAMDGOpioidGuideline.pdf Wow i just read a bunch of these articles on people being weened of or completely cut off of there pain meds, I am one of those being weened. And i’ll teel ya i’ve been on pain meds for the better part of 20years i don’t know what i would have done without them, but i’m starting to feel the pain all over again with this crazy system our government came up with to cure the so called opioid crisis, can’t imagine at 61 i need to worry bout having a life, This will cause lots of problems among us chronic painers, Don’t we have rights where theres a way to fight this silly notion that taking something that helps me away from me will be better for me, lets take my high pressure meds and my blood thinners away lets see how that works or that antibiotic that kills that infection, i’m so disappointed in the DEA CDC for helping the drug dealers who will be swimming in there new found riches or the prisons that will be complaining of the over crowding, cause thats where this is going. Maybe lets work on getting the dealers off the streets and the punks who ruined it for those of us who are in need of this medication. Can’t believe you don’t see that. sometimes the obvious is blinding,you MORONS worried more bout yours SHITTY little jobs then the american people typical for this government, WISH ME LUCK YOU ALL as i’m but throught this brutal process in a serously weak attempt to try fixing a problem that you all are part to blame for. Wake up people look at what your doing…………………………………….

  12. http://www.agencymeddirectors.wa.gov/Files/OpioidConference/SummaryPubComAMDGOpioidGuideline.pdf Wow i just read a bunch of these articles on people being weened of or completely cut off of there pain meds, I am one of those being weened. And i’ll teel ya i’ve been on pain meds for the better part of 20years i don’t know what i would have done without them, but i’m starting to feel the pain all over again with this crazy system our government came up with to cure the so called opioid crisis, can’t imagine at 61 i need to worry bout having a life, This will cause lots of problems among us chronic painers, Don’t we have rights where theres a way to fight this silly notion that taking something that helps me away from me will be better for me, lets take my high pressure meds and my blood thinners away lets see how that works or that antibiotic that kills that infection, i’m so disappointed in the DEA CDC for helping the drug dealers who will be swimming in there new found riches or the prisons that will be complaining of the over crowding, cause thats where this is going. Maybe lets work on getting the dealers off the streets and the punks who ruined it for those of us who are in need of this medication. Can’t believe you don’t see that. sometimes the obvious is blinding,you MORONS worried more bout yours SHITTY little jobs then the american people typical for this government, WISH ME LUCK YOU ALL as i’m but throught this brutal process in a serously weak attempt to try fixing a problem that you all are part to blame for. Wake up people look at what your doing…………………………………….

    1. I see both sides of the coin.. My husband just had surgery and sent home with nothing but Meperidine 50 MG…. TOTALLY WORTHLESS…. Severe pain.. and he has NEVER taken pills. Blood pressure out the roof. Found some percocet finally and got him some relief. I am going to call the Dr today and either get a better pain med or drop him off at the emergency room… Damn I need some rest.

        1. I was prescribed Demerol 50 – 75 mg every 3- 4 hours for a tonsillectomy back in my early 20’s. YOW! Exceutiatingly painful at that age. If I had known… But Meperidene can be (AND WAS BIG TIME FOR ME) a very powerful pain killer, and it saved me hours of agony. 50mg was a little on the low side. Demerol stimulates opiate receptors that produce euphoria more than other alternatives. When I read this I knew they were right. I felt so happy, that the pain didn’t seem to be a big issue. IT WAS WITHIUT IT. INCREDIBLE. A recipe for abuse, and Demerol was numbet one for abuse by medical professionals. As everyone here probably knows, Demerol for chronic pain will be disastrous do to the buildup of toxic, seizure producing metabolites. Plus there are rinterdrug interactions unique to it. So goodbye Miperidine. It sure saved me though.

      1. AmyLou

        That is SO unacceptable to send someone home after surgery with NO decent pain medication, this has got to STOP NOW!! SO many are suffering terribly in serious pain and these S.O.B.s doing this because a bunch of absolute junkies took too many pills that they probably lied to get and had NO proof that they were in that serious of pain to get in the first place. I know a young woman who wasn’t even 25 who was being coached on what to tell the doctor to be able to get the pills,she had NO legit pain and she’d get them! She’d still get them after she took an MRI that showed she had absolutely nothing wrong! Another thing that pisses me off royally is the way dentists are allowed to charge such huge prices for taking care a part of our body that should be included in basic medical insurance, there is NO reason on earth that dental s/b treated like it’s not a part of our body. We don’t have to get heart insurance, liver insurance, leg insurance so why the hell are teeth treated like they’re not a part of a human body?? I had the worst abscessed tooth ache EVER and had no money, the whole side of my face was swollen like a tennis ball, could no longer endure the pain so I walked into the dentist office, clearly suffering terribly and was told that there was NO way I could get treatment w/o Money!!! OUR GOVERNMENT IS THE WORST, they do NOT care one bit about it’s citizens. This has to stop, stop making people suffer after surgery, stop making people suffer and die from toothaches because they have NO dental insurance and are on a fixed income, this is so unacceptable but they ALLOW it. I struggle every month not just from the chronic pain I have but because I run out of food after 10 days and guess what? I am NOT eligible for food stamps because they say I get to much!!!! LOL!!!!!

  13. my pain manager doctor just just dumped me too! It’s sad the government doesn’t realize we will go to friends and family to get their doctors to give them scripts and give/sell the pills to me. I could ask my younger nephews to “hook” me up. at age 65 on social security and afraid to go to the street by myself. I wish this government is forcing people to seek illegal opiate drugs just to be able to have quality of life. I really believe once a person is 65 yrs they should be able to get these drugs if they want them. We don’t have much time left. After all we paid our dues and have the body pain to prove it!

  14. I HAVE BEN ON DR ROSE S , LIST FOR 120 / 100MG MOPHIND PER MO, , BACK TO 300 FOR 38 YEARS AND GOV, HAS CUT ME BACK TO TO ALMOST NOTHING , I LOVE MY WIFE AND FAMLY I CAN’T LIVE LIKE THIS ANY MORE I NED HELP , DR JIM WEBB 928 758 3091 GOD BLESSS PLEASE HELP ,, ME HELP MY FAMILY

  15. I fell into this website accidentally when looking for an equivalent of Oxycodone compared to Dolophine I am being taken off of suddenly and fast and will not be given the real reason by my doctor. I’m curious to know what the correct equivalent is because the failure of a doctor that I see or physician assistant I should say has absolutely no idea what he is doing, not to mention he is the most inhumane sadistic physician assistant I have ever dealt with in my life. He informed me that all of his patients that are taking methadone currently will now be removed from it immediately. I am not sure but I believe from information I’ve gotten that one of his patients overdosed on methadone and therefore he wants all of the rest of his patients off of it. This same pain management office has trained me to always call my methadone medication “Dolophine” when speaking about it to other doctors or anybody due to the stigma attached to it. My pain management doctor most favorite statements are “I don’t care”, “It is what it is”, and “if you don’t like it go somewhere else”. But wait,,, oh yes that’s right,, I can’t go anywhere else because over the last six years that I have been seen by this PA, he never requested any medical records from me and all other pain management doctors I try to get into now obviously would like records of MRI, x-rays, and so forth and most of my records are over 10 years old. This pain management never even requested anything in the beginning . Six years ago when I started here they asked for one thing and I brought in one x-ray of my back and that was already two years old and that was it. So he knows I’m at his mercy because I can’t go anywhere else yet until I get a lot of stuff done to prove all of my chronic pain problems. In the meantime this is the most inhumane treatment I have ever had in my life and it’s scary because it’s like he is controlling my life in a big way. I will not get into all of the details of what he has done but its not what he’s doing to me by taking me off methadone but how he is doing it. He thinks that 60 mg of methadone per day (20 mg 3x per day) is the same as 20 mg of Oxycodone 4 times per day. My pain is not just one problem with one diagnosis but many. I have had all of my chronic pain diagnosed but due to the fact that I have no medical insurance because I had to retire early due to my chronic pain in the first place I don’t go to the doctor often for following up because some require surgery that I know I cannot have without insurance. Not all but some of my health issues can be fixed with surgery. My question is what amount of Oxycodone is the same or even very close to 60 mg of methadone? Also my doctor told me today that he could give me morphine sulfate? How much of that would be the same as 60 mg of methadone?

    1. The CDC names both methadone and oxycodone as stronger than morphine. Also hydrocodone is equal to morphine. Since morphine sulfate is weaker than oxycodone, I’d stick to the oxycodone if I were you. I do not, however, know the equivalent dosages between methadone and oxycodone. Since you were abruptly removed from methadone after at least 6 years, your body will go through adjustment changes even if you were given an equal dose of oxycodone. Some things that may contribute to feeling that the doses are not equivalent may be their half life, the mechanism of action, and the way they are digested and released into the blood, ie: in the stomach, small intestine, or large intestine; each of which will help determine how long it takes to start the pain relief. It could also simply be a matter of getting off one kind of med for another. The body can detect the changes and some may make you uncomfortable. I’m not saying I know, but with research you may be able to find those answers. Just as with pain medication, the same could happen with a patient who has acid reflux who changes (after 10 years) from say prilosec to zantac abruptly. There can be potential repercussions in the body. Yes, both help with acid stomach, but they do so with differing factors such as half life, mechanism of action, and which receptors are activated. In addition as is the case with pain medication, one medication may work better than another for different patients.
      A silly comparison could also be that someone with a tremendous liking for gummy bears suddenly has them taken away and is given jelly beans instead (with no explanation).
      We’ve probably all heard that digestion begins in the mouth, but before a jelly bean even enters the mouth, a mental state (feeling bullied) and an emotional one (but I want gummy bears, not jelly beans) have begun to affect one’s body. Once in the mouth gummy bears feel totally different than jelly beans in texture, taste, and even dissolving times. An aversive bodily response begins towards jelly beans where none existed before. This is mainly due to having the preferred candy yanked away. So right away there are differences in how the body is reacting. And like 2 different medications, the two candies may also be digested in the stomach and intestines at different rates or in some different way that will noticed by the body. This may sound silly, but IMO it a very real phenomena experienced by myself and many other people. Your reactions are real and should be respected by your doctor rather than telling you to just deal. When any doctor has no empathy for a patients responses to medications, he or she should not be treating people. To be a good practioner, they should be willing to honestly talk to their patients about the need for such a change and to explain medication equivalents truthfully.

  16. Same story different day. DEA, FDA, CDC, None of these agancies know what their doing when it comes to Pain Management & prescribing medications for relief. They put a 100mg guidline for morphine prescribed in a 24hr period, unless a cancer patient?!!? WTF is that about. Is my pain not as real as a cancer patient? Do i not feel pain in the same or similiar fashion? My pain is as real today as it has been since 1999 when i broke my back. From degenerative disc disease, ive gone from 6’2″ tall to just over 5’10”. Four inches shorter and.my spine pops and cracks & creeks when im able to stand or walk. And my pain isnt the same or as real as a cancer patient?!! My heart goes out to anyone in pain, whether its for a werk, or.constant for life. But total Bullshit is what these organizations have created. They say with a guideline that forces Drs to a 100mg limit will reduce opoid deaths. No guideline is going to stop the opoid medication abuser from taking as much as they need to get their high. However these people have gotten ahold of these meds hasnt anythjng to do with a guideline. If they are use to taking 200mg of morphine to get their fix or high, then that’s what their going to take.& no guideline or 100mg limit is going to make them take any less. Ive gone to the same Dr now for 15+ years. Not one early refill, and only 1 time have i called my Dr after hours. If you look up “The model of a Pain Management Patient”, in this Drs dictionary you will find my picture. Now ive made my way over the years due to tolerance, to 200mg MS Contin twice a day, with 8mg hydromorphone up to 3 times a day for breakthrough. I heard all.the OMGs from medical professionals, like a nurse or a PA or.NA that ive.come.in contact with thru other medical problems. And my.opinion of them is they aren’t very professional and should go and research pain management treatment before condemning someone. My Dr will even testify that on several occasions ive refused my breakthrough meds because i didnt need the entire prescription that month and or my pain wasn’t as bad due to my not having to take care of my 5 acres by myself because of winter, or because friends may of helped me more that month then they had done in the past.So i used less breakthrough and i let my Dr know tbat i didnt need as much or had enough to make ot abother month. Thats what the majority of us patients do, we’re not addicted, we’re dependent. Their is a huge difference. We dont take our meds to get high, or feel euphoria, we take our meds as prescribed to relieve as much pain as possible and still maintain a lifstyle thats productive and healthy!! Ive also after a couple yrs on the same dose of MS Contin discussed with my doctor tapering down a little to see how i related to the pain. And i was able to get down to 100mg MS Contin 3 times a day. And for the record, ive read a lot of these replys where some patient’s on long term pain management are taking the 4 to 6 hour pain medications. In the beginning i was prescribed in a similiar manner. And it wasnt until i was put on the longer lasting, 8 to 12 hour Continued release medication that i really felt much better. The short acting meds was to much of a roller coaster type pain all day and thru the night. I really believe that most ive read about here and elsewhere in the country would benefit from the Continued release 8 to 12 hr meds much better and feel better if they could get their Drs to see it that way or prescribe in that manner. But what really pisses me off like the rest of you is our alternatives!! We really have none other then these pain pumps installed in our bodies. Im not a fan and dont want it. But im now on 60mg MS Contin twice daily with 8mg hydromorphone up.to 3 times a day for my pain. Im not doing well at all. I ended up in the ER back 6 or 8 months ago when i was tapered to fast and experienced terrible withdrawal and my pain was excruciating. I even told my Dr how i was feeling when these symptoms first started and was ignored, i was told by one of the nurses who called me back, because i feel the Dr has totally lost what balls he use to have, the nurse says to me that the Dr said Benadryl will help with the withdrawal ??!!!!! Bullshit !!! I can say with certainty that 20 to 25% reduction per month is way to much for me at the dose i was on, and can say with certainty that most pain management patients would experience the same BONE CHILLING SHAKES, CHILLS, BODY JERKS, HEADACHES, AND THROWING UP because of feeling so sick and not able to hold down crackers let alone a peanut butter sandwich !! I probably had or have a malpractice suit if i was to.pursue it, and i can also tell you that when my Dr heard of.my Emergency room ordeal, that he didnt charge me one dime for my mnnthly treatment ar his office for 8 months or so. Why wasnt i charged ?? One can only imagine? One huge problem is these medical so called professionals, some say oppids or pain meds shouldnt be used, others say holistic is the only way. Too many Drs that dont have a clue about pain management giving oponions that aren’t relative and don’t apply. If they want to treat a patient a certain way, well they have a liscense to do so. But don’t give adivlce to organizations like the DEA, FDA, CDC, that only makes it worse for those Drs who And once a month i drive 80 miles round trip to see the Dr, im manipulated, treated, and all vitals are taken, all meds are covered, and about a 10 or 15 minute discussion on how my month was and how my pain was. I piss in a cup every month just like most other pain management patients, to make sure im takjng my meds and to insure my Dr i dont test positive for any illegal drugs or other drugs not prescribed by him. I know the DEA, FDA, CDC, and the rest of the morons that think they can fix this supposed opoid war know we patients that follow the rules and do all thats required by the Dr and laws, otherwise our Drs would of lost their liscense long before now, or ling before i made ot 15 years with the same Dr. And they want to crawl up these Drs @$$’s for some reason. I thjnk i have the DEA all.figured out. They have done their best im sure to fight and keep illegal drugs.from our streets. But now they figured out that if they find a Dr that has broke a rule, or in their minds hasn’t prescribed according to their “guideline”, they.can then Seize their Medical.Liscense, their business, their homes and bank accounts. This is what thw DEA is famous for. And their back in the headlines once again. Congratulations?!! They have.taken one.more Dr that follows all the rules, keeps their patients in as little pain as possible, and now their all.scared. Its pain pumps or the highway? Ive done my research on these pumps also. One Company in which my Dr has gotten in bed with has had recall after recall and just as.many deaths due to malfunctions. Even the FDA has fined this company millions for not recalling one of their pumps in a timily manner, and also for not fixing what was supposed to be fixed. Or they fixed or thought they could fix this.pump in a different manner than it should of been and it malfunctions. I also read this same.company has.millions set aside in an account for lawsuits from patients that had a.pump malfunction and or was killed due to overdose from malfunction. When this company makes billions for the Drs to sale their pump to a patients health care provider, they would just as soon pay millions in.fines and not worry about recalls and keep making their billions from the sale. The Drs now are also compensated, i can only imagine or guess, but im guessjng $10 to $25 Thousand per unit is their kickback to the Dr. The Dr also benefits from the.patient. instead of a monthly office visit, they now get the same office visits, but approx every 2 months an extra $250 to $350 for the Drs fee to refill this pump. I havnt had it installed yet, but from what ive read from the studies, they get a sort of surgical procedure fee, 15 minutes for the Dr to stick a needle into this device, withdrawal whatever meds are still remaining, then the refill with new medication. Ive read just the morphine or whatever they decide works best is around $100 per unit refill. So these Drs are now getting from.one patient an additional equivalent of 3.times their normal fee the patient use to pay for the normal visit. This is wrong and needs to be addressed before the next crisis is opoid Pain pumps legally used by Drs forced to abandon their old ways of prescribed pain pills, now killing patients forced to live in pain or have these possible malfunctioning pumps installed in their bodies, dieing from malfunctions!! What are we all supposed to do. I AM NOW ON A DOSE OF APPROX 25% OF.WHAT USE TO KEEP ME OUT OF EXCRUCIATING PAIN, TO A.LEVEL OF.PAIN THAT IS SO ANNOYING, SO TERRIBLE, THAT IM NOT ABLE TO LIVE A NORMAL.LIFE, OR FUNCTION IN.LIFE, TAKE CARE OF.MYSELF BY MYSELF, BY MY GROCERIES, MAINTAIN A LIFESTYLE. ON A DOSE OF 120MG DAILY OF MS CONTIN, 60MG TWICE DAILY. THAT I NOW SLEEP 2 TO 4 HOURS A NIGHT, NEVER LONGER THEN 2 HOURS AT ONE TIME, WAKING IN PAIN, FALLING ASLEEP IN PAIN, A.WALK TO THE MAILBOX IS EXCRUCIATING, STANDING, SITTING, FOR ANY LENGTH OF.TIME IS ALMOST UNBEARABLE !!! SOMEONE OR GROUP, ORGANIZATION, SOMETHING HAS TO CHANGE OR IM AFRAID TO SAY WHAT COULD HAPPEN .. IF. THEY WEREN’T BEFORE IM BETTING NOW THAT PHARMACIES ARE GOING TO BE A TARGET BY MANY INDIVIDUALS LEFT WITH NO ALTERNATIVES !! WHAT CAN THE PATIENT DO TO LIVE A NORMAL LIFE IN AS LITTLE PAIN POSSIBLE WITH LITTLE TO NO MEDICATION.THAT USE TO BE.PRESCRIBED AND WORKED TO HELP. KEEP ALL US LIVE OUR LIVES ?!?!

    1. out of all the things I have read about the subject your ass was not only on target and covered every base possible but I did not find not even one thing that you had written to not make sense true any person that suffers from chronic pain about nurses and other people that you have crossed paths with that give their opinion I call them morons not I’ve even had a pharmacist tell me that the medication that I’m on is way too strong and would advise me to go on a lower dose or they will be forced to deny me my prescription filled now I do understand stops with the pharmacist however, they are not doctors how could they possibly comprehend what someone is going through when it comes to this type of pain and everyone is different I agree which also should help people understand that some people will need more medication than others depending on the person I am one of those people that take my meds as prescribed and was also cut down but I had weaned myself down little by little so I do not blame the doctor however now that I told him it does not work as well he will not move it up this goes back to appraise you had mentioned about them not having the balls that used to have sorry to say that but they are all scared and I understand they have a lot to lose but once you are prescribed for chronic pain for more than a couple of months or like you said someone that will be in pain management for life let’s face it you will automatically be addicted however, there is a huge difference like you stated from being an addict to being a dependent I depend on my pain medication but I am not addicted to it however if I don’t have it I will feel withdrawals this is common sense then again those two words to not go together well it is what some would call in oxymoron which brings me back to the morons out there that think they can fix a problem but just make it worse thank you for your Insight I had a pleasure reading it and look forward to using some examples when having conversations about it

    2. The abusers have ruined it for us “obeying” patients. I have been on them for 20 years. MS Contin and Percocet for breakthrough. In those 20 years I have had only one increase and that was due to increased pain and disability from 2 more-car accidents. I too am the poster child for opiates taken properly. It has given me some quality of life. I pee in the cup monthly so how or why are we being penalized because they have now added the heroin overdoses to “imply this crisis” Do I think there is a problem?Hell yes! It is when people started taking fentenyl in pill form made on the streets. The way they are trying to “handle” that by cutting legitimate people in pain off their meds are only making those legitimate people who now can’t function or have a quality of life go to the street and going to cause a real epidemic! If it isn’t broken don’t fix it! Now they are going to try different meds to bring the numbers down to the magical 100mg daily quota. At what cost to those who need it to function? It took trial and error 20 years ago to get the right combination of meds. What will it take now? I told my doc I will be bedbound. Is that a way to live?

    3. I know you are in a lot of pain and I can relate, as I am too. But you should try to be grateful that your doctor didn’t lower you to just 90mg period. That is the recommendation by the CDC and it’s what many states, including mine, have enacted into law. I am only allowed to be on 30mg of methadone period with no break through meds. My friend was on 200mg of morphine twice a day and now with the new laws she has been dropped to 90mg total, 30mg three times a day. Hopefully your state will not enact these new laws but as time goes on, it seem to be going that way. Apparently NY will be changing their laws on January 1, 2019.

    4. You were spot on

      I have been taking pain meds for 15 years 6 shoulder surgeries from pitching, I ruptured my L2, L3 and L5 and that caused nerve damage down the leg my blown out knee is on so when my back feels good, my knee hurts, when my back is acting up my knee is fine LOL

      But when I arrived in Virginia NOT ONE DOCTOR wanted to accept me as a patient, I had to finally go to my back to my old SC doctor, so now I drive once a month 5 hours there and 5 hours back because the government would rather force patients that need pain management to jump through hoops instead of doing nationwide electronic scripts.

      But I also noticed any new PA’s my office gets they look at me like I’m a drug addict, and are shocked when I say some days I take 5 pills, some days I take three.

      They look like I just jump scared them or something.

      They’ll scream WHY? WHY?

      And I’ll tell them well yesterday I needed 5 because I cut my lawn and painted my house, today I needed three because I binged watched Game of thrones.

      MY GOD have these people ever heard of logic?

  17. Dear Doctor: I am a pain patient in a pain management program in the midwest.I have been at this particular program for almost 10 years now.I am on 60 MGs of Morphine 3 times per day and was on 15MGs of Oxycodone 4 times a day for break thru pain, now 10MGs 2 times per day.My conditions are Degenerative lumbar disc, lumbar facet arthropathy, and lumbar-sacral spondylosis to name a few.I have been in a pain program for over 35 years but in 2001 was beat up and also kicked and hit with clubs by six policemen while in their custody. And of course, was hospitalized as well.I have stopped my use of Valium which took a year and a half and I am learning to fly without them which is a day to day struggle for me at least! Now my doctor has enlisted the service of nurse practitioners who do his “dirty work'” of cutting down the pain medicine from barely acceptable level to below human acceptance.I am told they want a 30mg 3 times a day level and perhaps even lower after being an honest pain patient I am searching for narcotics on the street and must pay a dollar a milligram for Oxycodone I used to pay a penny for 300 milligrams for also forcing me to risk prison time maybe 5 years or more behind bars!THIS IS WHAT THEY ARE CREATING, FELONS! The real crime here is that an entire generation of doctors and nurses will be of the mindset that opioids do not work past a cerian level and that NSAIDs and Lyrica work just fine. Not until many prominent doctors come forth to capture a large media audience will this downward spiral of ignorance must be stopped and I am old and tired,I just want my medicine and to be left alone with my pain.

  18. Dr. Fundin,

    I am a chronic pain patient from a school bus rollover when I was a teen. Working with two Stanford-trained doctors, we reached a medication regimen that works. I’ve been stable on that dose for 10 years, and even voluntarily went down a year ago after changes in my daily activity (going to work rather than going to college) improved my pain. I have never been high from my pain meds – ever- and thank God for that regularly. However, the morphine dose I take means that I cannot live in Washington State.

    Like others, upon losing my insurance and switching to another, I am now subject to the “OMG” treatment once again. In ten years, I never had an issue with drug seeking, diversion, early refills or an OD. You can add in anything else negative associated with opioid prescriptions. My dose never did make my pain go away, but it decreased it to where it was tolerable, and for whatever reason it stayed that way. While I certainly experience dependence, I do not experience tolerance (or further tolerance?) which I have seen referenced so many times, and certainly not addiction.

    Like others here, we tried everything else first – prolotherapy, nerve ablasions, meditation, stress reduction, pacing – but the fact remains that the only thing that actually allowed me to regain a life and go back to work is morphine, *in addition* to these other things. Like others here, I have begged my spouse to kill me because I’ve been in so much pain. I’ve had to wait to get prescriptions, or go to another pharmacy, after pharmacists said that they were too near, or over, their “limit” set by the DEA. (However, being a well-dressed caucasian male I’ve never been flatly rejected by a pharmacist.) In the ER, I’ve had physicians scream at me, and delay treatment *they had already decided to provide* while they grilled me on the evils of opioids. Sadly, I knew more about the evils of opioids than they did, as I live them every day. (BTW – added an emergency amount of oral ketorolac, that combined with promethazine and my breakthrough dose of morphine has kept me out of the ER for 5 years.) I had a primary care physician literally turn white from shock when I told him my daily dose of morphine.

    The bottom line for me is that variation in biology is just being addressed – mostly in cancer therapies – but there is no money in developing new pain treatments, or even determining who benefits from what, as long as morphine cost $200/mo, but Lyrica costs $1800/mo. Why get another expensive treatment when opioids are so cheap? Yet, the people caught in the middle are pain patients. Echoing another person here – I wish every doctor in a medical field could spend a week with my pain. I guarantee attitudes would change, and efforts to alleviate pain in a safe way would once again get some focus.

    1. I’M 55 year old woman who has lived with pain all my life. By the time I was 10 I had substained 14 broken bones. I have a rare bone disease. I have osteogenesis imperfecta type 2. At the age of 50 I had exhausted every treatment know. I was put on a regimen of Oxycodone 30mg 4 times a day. I had my Dr. change the mg to 15 4 times a day. I’ve been doing really well with that. Aug. I went to get my.prescription to only be told that I was getting to much morphine equivalent. And could get my prescription. . I had to wait 2 weeks to get my medicine and I went through the most inhumane treatment I could ever imagine.
      The DEA NEEDS TO WORK ON GETTING THE PILL PUSHERS AND DOPE DEALERS AND LEAVE THE PEOPLE WHO HAVE DEBILITATING DISEASES ALONE GET IT RIGHT!

    2. Hello, I’m 60 years old and I raise in NW Washington.

      Wow!! You said it so well!! I honestly doubt if any of my physicians (pain management, primary care, GI, rheumatologist, ect) would be able to deal with my daily, constant excruciating pain that Im in a constant confrontation with any better than I am/do. Im positive that they’d convince one of their associates to speedily pull out their script pad and insist that associate to prescribe them 10 mg of oxycodone qid every 3 – 4 hrs daily not to exceed 4 doses every 12 hours. Yet, here I am! I had to resort to pain meds back in … my goodness! Back in 1998 when after a gastric bypass with waaaay to many mistakes and issues began causing me a myriad of symptoms which also led to 3 revision surgeries.

      FINALLY, having gained a bit more control over those past surgery ailments I was np longer taking pain meds, so from about mid 1999 up until around … eerr … spring of 2002 or possibly even 2003 when I began experiencing sporadic pain in my cervical spine accompanied by horrific headaches. At that point my primary care was beginning me meds to take as prn. I was only taking the (if memory serves me correctly it was) darvocet when I needed some relief, not on a strict regimen at all; my pain was new sunr my doctor and I worked as a well oiled machine together.

      Cervical pain began to increase to a level that it was affecting my quality of life and it was during this period that I ws referred to my first pain management doctor who was concerned with discovering the root cause of pain. I went through a series of very painful MRI’s because my doctor believed that I may have a Chiari Malformation. In order to confirm if that was my issue or not, could only be done with pictures. Chiari Malformation Type 1 was a good deal of my diagnosis plus spondolosys, osteoporosis, bulging disc, ysda yada yada! LOL

      This is when my long journey with a large variety pain meds began. That’s been so long ago plus 1 cervical spine fusion C5 & C6 and a discectomy in 2007. I’ve been a patient with uuhhmmm,
      I believe 4 pain clinics since the 1st one back in … err … 2003?

      Twice I had the strong desire to take a pain med vacation, so I did. It wasn’t easy, trust me! I got freaked out when I realized how much my pain meds had affected my life, body and mind. I also realized just how much relief I actually recieved from my meds once I had stopped them. Now, getting back into a new pain clinic wasn’t easy. I did find one and I was feeling hopeful thst this clinic would really listen to me, try to understand my pain. Sadly, that optimism didn’t last very long.

      Crap! Im sorry ya’ll, but like many of you, it just feels good to get some of my frustration out of my head and into print.

      Zoom up to fall of 2018!! Money current doctor at (once again) my new pain clinic here in northwest WA state … *sigh*

      First consultation visit with the doctor back in … September went very well. I felt as though this doctor truly cared about me, cared about my severe and chronic pain issues. I agreed that I’d be thrilled to find an alternative to pain meds if he had some good options for me. I agreed to trying injections of lidocaine into my cervical facets as he had explained that this really might be able to control my pain without meds. I (seriously) was really excited at the possibility of being closer to pain free than I had been for a good 15 or so years.

      I live off of SSD. SSD & Medicare Advantage are all I’ve got. Im so tickled that we’re actually getting a raise this year! But like someone else who posted on here said … our government is unrealistic when it comes down to who should be able to acquire government assistance (ie: food stamps & medical assistance)! I’m told that I am making to much money to receive any assistance.

      So, back to the agreement with my doctor regarding injections. I followed through on my first set of injections (which of course, is considered a “surgical procedure) even though I was told that for me to get the shots, I must pay $200 on the day of the procedure with a balance due of like $89 or in that neighborhood. After the procedure while I was sitting in recovery, I told the nurses AND my doctor that there’s no way that I can afford 2 – 3 more injections (these allow my doc to know which joints he needs to do the final treatment) plus the fact that I’m fairly certain that the final procedure is most likely more expensive. At my follow up appointment I was anticipating that the PAC (who I was now seeing) and I would discuss which pain meds would be my best option. I let her know that my last clinic I was on 150mcg Fentanyl every 48 hrs, 20 mg oxycodone for breakthrough every 4 – 6 hours as needed. She actually LAUGHED at me. In a’ll honesty, I should’ve just stayed with the last clinic, but 1 doc at that clinic told me that I had 13 ua’s that came out dirty (showed other drugs in my systrm), which both he & I know was a total fabrication! I hadn’t even been a patient of that particular clinic long enough to even provide them with that many tox screens PLUS my doctor (sadly, she left that particular organization) would have NEVER allowed me to remain a patient had I peed dirty. To this day I am still wondering why he had an issue with me.

      Anyway, I walked out of the office with no meds or scripts in my hand. I was told that the doctor wasn’t planning on writing me any prescriptions because I had been taking Kratom for my pain. I reminded the PAC that I told the doctor I was omitting Kratom from my meds. Kratom is amazing, but for me with my digestive issues from the 1998 gastric bypass, taking/drinking my Kratom tea I am frequently throwing it up. I walked out of my appt feeling embarrassed, humiliated and belittled. It seems that most offices that provide pain management treat us (the chronic pain patients) a’s though we are all addicts and that we all are liars.

      After about 2 weeks I wrote an email to his (docs) office telling snyone in thst office about my pain, the loss of the quality of my life, loss ood enjoyment. How deeply distraught and disappointed I feel. Once again I explained in detail about just how financially challenged I am.

      Saw him again yesterday. Started out bad. Due to my total frustration with any doctor these days in respect to my pain. I was angry about the way he was talking down to me, throwing in my face the fact that he did an additional 6 years in college to do what he does. He was being me le crazy … I had to sit like a child while this s.o.b. lectured me. I was SO HUMILIATED!!! And I say there … praying that he ws going to send me to the pharmacy.

      Well … he prescribed me 15mg morphine sulfate 2 per day. It is helping me though, as small a dose as it is. I have thanked God for keeping me strong enough to wait. Btw … the doc made me feel like I’m only one step away from being a “bag lady”. It’s very humbling to feel as though I must admit to just how poor I am since I was forced to go on Social Security Disability due to malnutrition which is one of the side effects from the botched up gastric bypass done back in September of 1998.

  19. I am going to be quite frank about this subject of 100mg of Morphine limit a day for Severe Chronic Pain. It is total Bull Shit! No person is going to tell me that 100mg is all you need for Pain, because I’ve lived it and it is total Bull Shit, LIES!
    I suffered with daily constant Pain for over 10 years, based on nothing, but LIES I was told about strong Narcotic Medicine and as to why I couldn’t use it for the Pain that ruined my life- and all thanks to an illegally drunk truck driver of an 18-wheeler truck, who caused a head on collision with the vehicle I was in and also killed my two friends.
    Right from the get go nothing worked for my Pain, but a high dose of Morphine. So how can this be, if all you need is 100mg a day, which I have also used far higher a dose than 100mg a day for the past 25 years with NOT one problem! Other than my Hell of Severe Chronic Pain, my health has been fine! I’ve passed all my urine tests, because I use Morphine responsibly!
    All I want is the best possible kind of life that I can have now, thanks to the severe injuries I endured due to a strangers criminal actions. I had a C1-C2 fusion, that is not exactly in place and ruined my life due to Pain. I also received a severe head injury- comatose for 2 weeks and three days, and another two weeks till first conscious of existing and far from up to par. I also received multiple head and upper body injuries, it has all ruined my life! I have also had to fight and suffer in daily constant Pain tooth and nail, just to have somewhat of a life! All for some other person’s criminal wrong doings. For which I have NOT at all been compensated for this Hell, but peanuts!
    And now after using Morphine responsibly for 25 years with NOT one problem, and they just step in and frig my life up once again- which I classify as Evil!
    And after 37 years of what I’ve gone through and lost, and I’m going to have people tell me about Severe Chronic Pain and what works- is beyond an insult to my intelligence!

    1. Thank you for stating my same problem, I ended up with an incomplete spinal cord injury which has caused severe lower back pain, paralysis of my left lower left leg neuropathy of both legs and no signal to my lower abdomen so you can imagine what it’s like to use the bathroom a daily nightmare.All of this from a snowmobile accident my first time on one my so called husband drove me and then he had to show off well we ended up airborne over a ditch it threw me off straight onto my butt and destroyed my back several broken vertebrae one that fragmented leaving me unable to work again I am a Registered Nurse after a 6 day stay in a trauma center and 6 weeks at a rehab hospital well the so called husband stayed the 1 st 2 years and then got himself a Girlfriend so much for in sickness and health. Then by April 2017 my Dr.started cutting back on my medication all for this bull and I had been stable on the same 2 meds and able to get around short distances with my walker well now I am back in physical Therapy and the same therapist had seen me 3 years ago and has noticed a tremendous increase in weakness. So I had been doing fairly well and was looking to try and do some kind of work with the ticket to work program the changes in the meds have caused a continuous decline in my overall ability. now that I have been alone since 2015 I can’t even possibly get out to meet anyone,I feel like I am stuck in my house day after day with no chance of ever having a special person in my life ever again. I can walk short distances with a walker but I have no way of getting my wheelchair out of the house to be able to go anywhere. The last time i went to the mall or down the road,to a country fair was at least 3 years ago. Life sucks all the way around and No one cares to even help I now have more pain,weakness and life is just hell not one person cares Thanks for listening

      1. I care, and god cares. I’m going through similar life long pain and mobility issues. During flare ups, I think nobody cares, and most people really don’t. So sorry

        1. oh David –
          seriously, what kind of god would be busy caring about people in severe pain when the same worldview generally assumes god assigns that pain?

      2. Sorry about your condition. I have great sympathy for you. I am an emergency room doctor and family practice doctor who has been attacked and even had criminal charges brought against me for prescribing medication for my patients. We are in a tremendous battle at this time. I’ve had several injuries over my lifetime with back pain ankle pain and so on however I do not take any pain medication and am enjoying life the best I can. I encourage you to look at my website. downtoearthmedicine.org Look particularly at the article dealing with earthing, as it is the most revolutionary healthcare discovery of modern times. My email is the same as my website except@Gmail.com and I would be happy to hear from you. I have no idea where this mess is going all I know is I’ve only seen one patient in the last 11 months unfortunately I’m at retirement age otherwise I would have a tremendous problem financially. I use alternative medicines and treatments where applicable and am available to come to wherever in the United States to lecture on both acute and chronic pain. Let me know how I may be of help.

      3. I’m in same boat to not as bad as you but going through them divorce part now we were together 13 years and marriage there last 6 now divorcing me sickness out there door me too.

    2. I was Diagnosed in 1972 with Leg Pertheas Disease… deterioration of Femur Head, bone on bone in hip socket which equates to : dual Sciatica, neuropathy, extreme night pain .tilted pelvis which = lumbar destruction. all that… Never took anything sans Ibuprophen till1995. I have had 7 knee surgeries, one which I caught a Staph/ mrsa infection in 2002, After 10 days of Morphine 10mg. every 2 hrs. I was DEPENDANT. NO SHIT?. THERE IS A CAR- USE EPIDEMIC…NOT HEROINE. Where I live , the Medical Examiner is FRUSTRATED that he has to LIE when he reports Opioid overdoses. Superiors want to use the term OPIOIOD, strategy is this; take away the legal meds, see how many we can let die from a drug that DEA allows into USA. jOB SECURITY ALONG WITH NOT ALLOWING MEDICAL MARIJUANA IN OHIO./ NO GROWING. VAPOR ONLY, AND ONLY FROM THE SELECT 24 STATE WIDE “CRONIES” I ASK, ” HOW IS THIS GOING TO HELP THOSE WHO MAKE $13,000 PER YEAR?

  20. I know a person who had several surgeries and many procedures where they were put under anesthesia. Well, that is to say they could not put the person under because the anesthesia did not work. They had to use extremely high amount that would have killed most people. The person woke up multiple times during the procedures. Then using anesthesia for dental sedation the nurse said they used 50 times more medication than normal. Now this person has a chronic pain disease and doctors are saying 100 mg equivalent is all they can have and doctors are scared that the federal government will charge them with a crime for not following guidelines. Just saying everyone is different and the government should allow states to set up practice guidelines. Everyone reacts differently to medications. This person is in extreme pain due to the government not allowing doctors to treat the patient properly. This is malpractice by the government. True story.

  21. Thanks for putting this together Dr. Fudin. It is sad to think That this is happening. Prop is just another extension of the temperance movement building on further prohibition in this country… and to be honest the 100 mg of morphine is absurd, and serves no purpose as you know. very little good could come out of this..What a lot of people do not understand is how a body process medicines,, their metabolic rate, time on the med.etc..And the side effects are another story. i would gladly give up my pain meds to get rid of the side effects, but there is absolutely nothing available to me that will help my pain. Ketamine is not used widely, the neuropathic meds like lyrica offer some help, but do very little to lower my daily pain level overall. This is just an attempt to force people to live under the standards that is acceptable to a few fundamentalists, not the mainstream. it is no different than a religious persecution from a small cult … but this time around the Government is becoming the enforcer. And to think the FDA is considering this drastic measure is absurd, shouldn’t they be looking for more tainted peanut butter?And to close , the conversion to morphine ratios most doctors do in clinic is absurd, they always fail to consider the oral bioavailability.. I am sure you are aware that it is very low, so when they convert to morphine they leave the patient grossly undermedicated, causing more pain and withdrawal.and lets face it. Morphine taken orally is not as effective as some other meds for sever chronic pain. The data shows that meds like duragesic transdermal patch helps control neuropathic pain like methadone. there really needs to be a better way to measure opioids for conversion and morphine is a poor choice to use as a standard…

    1. I know this post is 2 years old but I wanted to comment and say thank you to Dr.Fudin as well. I am so glad to see a DR. Finally stand up and say this is wrong! These patients are living in pain and need access to care that doesn’t include Rx limits that are absolutely ridiculous. I have said it many times before but I will say it again…Going by what the text books say is not anywhere close to what it is like to actually take the drug. Other Dr’s need to learn this tolerance, metabolism, duration of how long on a particular med these things all play an ENORMOUS part in how well the drug controls pain and given we are all individuals no one person is going to process it the same as the next. It is ludicrous and unfair to say ALL patients on opiates must be prescribed the same amount equivalent to 90 mg of morphine a day! What!!!??? This is pure insanity what is the world coming too? Do they have any idea the backlash this would cause? Because I do. And if it ever comes to this it will be a world I don’t want to live in. At what point do the pain patients get a voice? We go thru hell on a daily basis most of us don’t receive anywhere near the dose we should be on to control our pain taking our tolerance into account as well. We are treated like criminals with no voice. And being treated like lab rats while they lower our dose further & further and there’s nothing we can say or do about it we just have to live the hell everyday in silence and continue as functioning members of society and taking care of our children and families while we live in pain and withdrawal because someone who’s never seen the medications is dictating what our Dr can prescribe and what amount. The medical system has gone to hell with the rest of the world it is no longer a free country. Americans live in chains everyday. PROP needs shut down for good! We need to come together and stand up against these people once & for all.

        1. Thank you for taking the time to construct your article. I realize it’s currently 2018 and this fight has been going on for several years. Five years ago I moved my office failed to notify the regulatory bodies for the state I live in and they brought felony charges against me for simply taking care of my patients. Two years later the charges were dropped and I was placed on probation. After two years of a three-year probation they decided to reinvestigate and came up with ridiculous charges once again so I’m back in the same boat. I’ve only seen one patient in 11 months because I cannot take care of either acute or chronic pain patients anymore and now the state medical board has decided I don’t need a medical license. Very frustrating state of affairs and I do not have a good answer. I have seen the doctors step back and let big business and the pharmaceutical companies take control of the practice of medicine and fortunately I’m at retirement age however I did not plan on retiring at this time. I would like to see some possible way for the positions of the United States to band together and say enough of this ridiculous actions by state and federal agencies. Any thoughts or ideas would be appreciated

          1. I have more than a few thoughts for you and will help you in any way I can. Drop me an email if you’re still willing to fight

            Sincerely,

            Dr. Michael Farley

          2. Patient’s need to group and start sueing there doctor’s under several well
            known rules and oaths they have taken. It is there oaths to reduce pain and
            suffering in patients.
            Of course you would probably loose the torte’s but if you can prove damages
            of loss of income. Doctors would think twice, they would have to pay attorneys
            fees and really tie up there practices.
            If we could get some lawyers to band up I’m sure they could get contributions
            from tens of thousands of people
            Or sue the DEA oops, but there are laws and medical quidelines there TRASHING
            because they know were on our last leg.
            I will put in $100 just for a standard Boo letter to a doctor

      1. You are right my tolerance to meds and crazy, I have stage 4 pancreatic cancer just went through one year and chemo every two weeks now I have pain in my stomach nothing helps, im not 50 Mg’s of fenteynal 30 Mg’s of oxycodone and 100 Mg’s of methadone and my doctor thinks I just want to get high and I just want the pain to go away.

  22. I live in Florida. The pharmacies are refusing to fill any narcotic prescriptions except Lortab and now I hear FDA is trying to make those harder to get. They dont work anyway. I have just about had it as I can barely get up and walk anymore. I think it is nearly time to just end it. Just end it.

    1. I too live in Florida, I am not a pain management patient but I have a close friend that was injured in an auto accident, her injuries were further compounded by a Chiropractor, and an incompetent Orthopedic Surgeon who damaged her sciatic nerve while performing “injections” to relieve the pain, then dumped her as soon as the insurance money ran out.
      She has being seeing a legitimate pain management doctor for over a year, and the only thing that works is Opiate medication, without it she can barely walk, every month when she goes to fill her prescription she gets treated like a criminal by the pharmacist and usually has to go to several pharmacies to find one that has the medication in stock.
      People like my friend suffer enough as the medication does not completely take away the pain and their quality of life will never be the same.
      It is wrong for any group of people that are not experiencing this kind of pain to be dictating what people that are experiencing it should have available to alleviate it.
      If PROP gets their way they will cause much unnecessary suffering and possible deaths which they should be held accountable for.

      1. Mr. Holmes,

        I am so sorry to hear of your friends suffering. I too am a pain management patient that has tried everything out there to no avail. I have been taking hydrocodone for quite some time and it started to NOT give me the relief i need so i was switched to Oxycodoe. Now my new primary care doctor wants me off of that to try something new. I am being forced to see this doctor because i recently lost my BCBS health ins and can no longer afford to see the pain doc. I have heard that if you dress up and go inside for the prescription instead of dropping it off at the drive thru you are much more likely to get the drugs you are prescribed. That excuse about not having them in stock is BS…i have NEVER encountered that even tho i now am prescribed 120 doses a month. I also would stay away from CVS pharmacies as these are the ones that turn you away the most

      2. It’s nice to know that she has someone who understands exactly what she and I go through. I don’t have to deal with trying to find my medication but I am a chronic pain suffer and we would much rather have our life before all pain started.

      3. I agree entirely, David. I am a pain patient and have been for 15 years. I was treated like a criminal many times in those years by pharmacies in Michigan and New York. I know that this world, and this country in particular know very little about pain or pain relief. I expected that the professional medical people would be schooled about pain, but in my experience most are not. I have gone to three different pain clinics (in different states where I lived with my husband) and all 3 treated my pain completely differently. When I brought records from one pain clinic to another, the new clinic didn’t want to know how my pain was treated even if it was very successful. I began to realize that the pain clinics were just in business to make money, not to actually listen to the person with pain and work towards relieving that pain so that the person could live a better, more healthy life including healthful food prepared at home, exercise, and an active social life. I know when my pain is bad (often) I don’t prepare healthful meals (we just eat TV dinners), I don’t take my walks, and I stay at home like a hermit. It seems to me that the government (and that’s what it boils down to–FDA-CDC-DEA, etc.) does not want us chronic pain patients to be healthy, active, and contributing to society human beings. Frankly I think they wish we were dead. Get rid of us and build this sickening world of puppets and stepford wives and husbands that are like cookie cutter people. I know i have a lot to offer the human race despite being a pain patient. I’m a retired RN who is a mother, grandmother, great grandmother, and wife and my family loves me. I love to volunteer at hospitals. I’m an artist, I’m witty, and funny. Why would my country want me to suffer every day. Can someone help me understand this insanity? We need help.

  23. I just want to share my view on opiod medications. These medications are very important to healthcare and restricting them will cause many problems for people that need them. We already see this in some states like ky, where patients are suffering due to restrictions scaring doctors into not treating pain at all. Causing many people not to be able to work or do daily activities. Citizens need access to this treatment. Restricting medication is criminalizing good people!

  24. If the PROP suggestions are adopted it will mark the beginning of the end for me and so many others…already many friends are on a Memorial List, and my name will be added to theirs if I lose access to the only medications that have made my life bearable for the past 22 years. It seems patients like me are to be the final victims of the War on Drugs…illegal, recreational drugs are more easily and cheaply available than ever in my life, but the government wants to dictate what goes on between my pain specialist, and me. I’m not sure what my crime was, I certainly did not want to fall seriously ill at age 25, but I know already I am treated like a criminal, my name in a state database where anyone with access can see every date, type and amount of any controlled substance Rx I fill. Every year I sign away my doctor-patient confidentiality so that my Pain Specialist can continue to practice. But apparently that has not been enough. THANK YOU DR. FUDIN for all you have done for so many of us who can not speak for ourselves nearly as well as you have done for us. Words cannot suffice…
    Sincerely,
    Danya Zucker, B.A. Amherst College, EdM. Harvard University

  25. I have always said I would never wish my pain on anyone but I would give it to Dr. K. in an instant! I am a 52 year old female with Ehlers-Danlos Syndrome. I have known pain my entire life but it became unbearable 10 years ago. It took me another 5 to find a diagnosis and a doctor willing to treat me. Anyone who says long-term opioid therapy is not effective is lying because I am living proof! I look back and it as though my life only began 5 years ago, no coincidence that that is when I began using opiates to treat my pain.

    If I am forced to go back to life as I lived it before, dealing with unrelenting pain that could not be relieved by any other means (and I tried EVERYTHING prior to taking opiates), I don’t know that I could face it. While suicide is not anything I ever want to do, I spent at least 5 years of my life feeling as though I was slowly dying (and wishing it would just hurry up and happen) and now that my disease has further crippled my body and the pain would be even worse…

    I am truly at a loss to understand why the lives of abusers are more important than those of people who live with pain that cannot be “fixed”? Ehlers-Danlos patients are only one group of many that fall into that category. Most of us are respectable, law-abiding citizens who do not abuse our meds (we can’t take that risk because we need them to function) and we are being forced to fight for our lives when all we want is to simply live well.

  26. Pain management should be left up to the pain management doctors who have gone through specialized training with pain medications, not the FDA.

  27. I am not on morphine but do take medications for pain and the amount I get and need is determined by my doctor and myself. I am severely disabled. Without meds I cannot move at all except slightly in bed as the pain is so severe. Trips to t he doctor …I made but screaming…hardly could breathe normally as movement from breathing hurt so badly. So I understand. People NOT in pain cannot really understand. How long could I have lived staying in bed? I would have had blood clots in my legs….you figure it out. I wouldn’t be here I don’t believe if I couldn’t move some. I use a scooter for shopping and doctors visits unless their door is right by where I am let out of the car. Some days are worse than others. But I can move some and for ME that is enough. I am retired so don ‘t need to work every day. I know those who work must get up and move! they need more than I can survive on. How can someone who doesn’t know me, my condition, my pain, my lifestyle and financial well being…do I need to work…how much…NO ONE knows that but me and my doctor. So please the rest of you stay out of it. You don’t know what you are doing. There are as many limits to meds as there are patients. We decided at my age, stage in life, financial ability etc. what I needed to be able to do live and get by. You don’t even kn ow my name! How can you limit what medications I take?

  28. Jeff,

    I completely agree that the PROP recommended total daily dose of 100mg of morphine or morphine equivalents for the management of non-cancer pain just doesn’t make any sense on a number of different levels (individualized responses, pharmacogenetics, etc). Maybe we should ask PROP what opioid equianalgesic guide they follow and recommend?

    I hope the FDA and others presenting at the meeting this week pay attention to the tailoring needed for each patient rather than handcuffing prescribers. By the way, it is impossible to separate caner from non-cancer pain and mild to moderate pain from moderate to severe!

    Dave Craig, PharmD

  29. Dr. Fudin,

    Thank you for your tireless advocacy for patients who suffer Chronic Intractable Pain. For many years I suffered in silence as most of my Dr’s thought me crazy,They went to the “it’s all in your head school” I knew it wasn’t and manged to persevere until I found a group of Dr’s that listened to me and my complaints. It was at their urging I went to Pain Management. I tried many modalities, eventually had surgery to decompress my Cervical Spine not once but twice. This resolved some of my mechanical issues but it did not solve the damage to my nerves from years of being compressed.
    Along with this I also have multiple other conditions/illnesses which cause me chronic pain.I am so grateful for my PM team as they have helped me to find a combination of medications which allow me to function on a daily basis instead of being bed or house bound.. Without these medications I do not know how long I would be able to tolerate the misery my conditions bring,
    It is my belief that Dr,K and other behind PROP are doing it for the wrong reasons. If I recall correctly for at least one Dr. it’s personal.His daughter died as a result of taking medication which was not prescribed to her and mixing it with other things however this fact./s is not disclosed in the petition. This fact makes this Dr. biased in my opinion.All the facts need to be presented and I do not believe they are.
    There needs to be checks and balances in all things, for the benefit of society as a whole. however I and my Dr.’s should be the ones making my medical decisions not the authors of PROP not the FDA
    or the DEA.
    Respectfully,
    Sonna Furtick

    1. According to the PROP website, all it takes to join PROP is an e-mail address. However, there is one PROP founder who lost his daughter to drug abuse. Pete Jackson helped to create PROP and his daughter passed away from abusing oxycontin. Pete Jackson is not a doctor though. He travels to every hearing, committee, and event on opioids to tell her “story,” and to disparage opioid pain medicines as well as the companies that manufacture and sell them. I also believe that this is completely unfair and misleading. Pete Jackson is always blaming everyone else for his daughter’s tragic death instead of her and he acts as if all pain medicines do is kill. Last time I checked, humans have free will. Pills do not force themselves down a person’s throat. You will never hear him(Pete Jackson) say anything positive about opioids. He is on a crusade to get them banned for everyone, no matter what condition they have. It is very sad and cruel that he is using that tragic event to cause harm to millions of suffering patients across america.

      If you want links to verify the truth of what I wrote (basically letters and public testimony from Pete Jackson), just reply to me and I will provide them for you, as I’ve been asked not to include them here

      1. Andy,

        I read the link from Pete Jackson, seems he is blaming all Pharmaceutical Companies that manufacture pain medications for his daughter untimely death. I don’t have any children but I hear you never really over the death of a child. I don’t know all of what took place with Pete’s daughter and it must be tragic to the point of him never being able to live with the fact his daughter is gone. What I don’t understand is how can Mr. Jackson not have any compassion for all that suffer from chronic pain.

        Pete if your reading this, you know the never ending pain you have in your heart for lose of your daughter, if you could make that pain subside somewhat each day wouldn’t you do whatever it took. The never ending suffering of those that have chronic pain is something like your pain but its not mental anguish its real suffering of the human body. The medications we take for our never ending chronic pain subsides for a while and it makes life livable. I think its time you let go of the blaming game and deal with the fact whatever happen it cant bring your daughter back no matter how many events you go to . Telling your daughters story over and over is like putting salt in the wound of your lose. Do any of these stories of suffering people even touch your heart.
        I think its time you move on Pete ,your not only wasting your time, your not properly dealing with the lose of your loved one. I’m sorry this happen and I truly feel bad for you.

        Regards,
        Mark S. Barletta

  30. Jeff
    Excellent example of how one dose does NOT fit all and 100mg of morphine equivalent is a poor threshold. Great teaching exercise demonstrating that this arbitrary dose is a nebulous target and not a sure thing. The arbitrary 90 days never did make sense. Acute pain should not last that long and chronic pain is, by definition, not resolved by 90 days. It seems that all PROP has done so far is frighten providers and patients, and anger many in the pain management community.

    I believe the PROP authors did mean well but chose a rather rash approach, based on some soft epidemiologic data. They are all about safety, as we all are, but the approach is not terribly useful. Using high risk medications (blood thinners, insulin, opioids) is not for the uneducated or the faint of heart. We do not have enough high quality, multidisciplinary programs in the country to help the millions of patients with debilitating pain. Forcing patients onto a waiting list Medications are just one ingredient in the recipe of management. Pain management is so much more than a drug or a dose, regardless of whether it’s an opioid or a non-opioid. I had a patient in clinic today who was referred because her pain did not respond to opioids and her provider needed help with alteranative options.

    Are opioids abused sometimes? Yes. Are they overprescribed sometimes? Yes, Are they underprescribed sometimes? Yes There is no magic solution or a magic dose. I will leave out my opinion about appropriate dosing and management, but will say, as I have before, that putting prescribers in a “box” and making patients and providers feel defensive is not the answer.

    Thanks for the science – always refreshing and to the point!
    Lee

  31. Dear Dr. Fudin,

    I cannot thank you enough for your time and commitment to upholding PROMPT’s vision and I appreciate the work of your students. I am often criticized because I am willing to treat severe pain patients who need medication doses that are “outside the box.” Who constructed this proverbial box and what right did they have to decide that patients and medical providers treating pain needed to be in it? It’s bad enough if physicians try to define the “box” but worse still when non-medical politicians try to. Seems duplicitous for the government to financially cover CYP450 testing under Medicare and Medicaid yet deny the fact that patients metabolize medication differently enough to be clinically relevant. Arbitrarily selecting a maximum dose is not only frivolous, it’s absurd. Dictating a maximum dose will be hurtful and potentially harmful to many pain patients…..aren’t they suffering enough? I have no interested in being “in a box” that perpetuates ignorance and self-righteousness….I hope and pray that PROMPT can tear down its walls.

    Debora Tallio MD
    Lexington, KY

    1. Dr. Tallio,

      I couldn’t agree more with ” I have no interested in being “in a box” that perpetuates ignorance and self-righteousness….I hope and pray that PROMPT can tear down its walls.” You statement regarding CYP450 is very telling!

  32. I hope in writing this memo that it helps some of us pain patients get some support and not have all of us who are in dire needs of pain medication be pushed to the point of ending their life because they can not deal with the daily pain some of us all have.I have been taking pain meds for 8 years.In those 8 years my conditions continue to get worse.I live in Eureka Springs Arkansas.I had a doctor well 2 in a matter of fact that i seen for 4 years before they both was forced to quit their pratice because of all the regulations and that put a major hurt on alot and i do mean alot of people!I now have to drive over 1 hour one way just to get to see a pain management doctor and let me tell you I am tired of being treated like a drug addict and im sick of having to drive so far and the cost is unimaginable especially when i have 4 children and are no longer working.We are real people with real problems my pain is different every single day to the point sometimes where what i usually take barely takes the edge off.Recently I have had another doctor who once again closed his clinic this makes 3 doctorsand this time was the absolute worse!!!My scripts ran out last month and my regular doctor could not find me a replacement i was in a panic I spent my days crying thinking what am i going to do who is going to take care of me and my kids if i can not get out of bed?Well the answer is no one they rely on me!I started calling every pain dr i could possibly find.It took 4 months to finally find a doctor.Doctors have to have a referall and they are so backed up in request for new patients it takes 4 to 8 weeks sometimes just to be reviewed and thats if they have any openings or not.Luckily I was able to find a new dr but everyday I was in so much pain I just rolled myself up in a ball and cied and screamed into a pillow praying to god to make my pain go away!I had to make my last refill go for 2 months it was absolute hell!I hope I never have to go through that ever ever again and it hurts because i know of so many people who cant get to a doctor because there is none.This is becoming a major problem not just here but everywhere across the U.S.This matter is out of control all the FDA or whoever has this in their control are making thousands of people go through hell just to get relief of their everyday hell of a life of cronic constant pain.This needs to stop give the people a break and a fighting chance to be normal again!Please I beg you help us that needs our medication please get us new doctors theyb signed an oath to protect us and keep us safe and this has been taken from us.We need more doctors we need our medication we do not need to cry and suffer because of movie stars overdosing thats not our fault so why are we suffering for their mistake!!!!Its not right!Not right at all!Its immoral to make us suffer anymore than we do everyday we wake up!Its a nightmare!Please cut us some slack leave our doctors be please I beg you!I can not go through that again I just can’t do it!

  33. It is ridiculous to think that anyone can come up with a One Size Fits All mentality when it comes to pain medication. If you have never been in pain & relied on pain medication to function in your daily life then you have no business trying to define what is appropriate for someone’s pain control. Even if you have experienced pain, everyone is different.

  34. Thanks Jeff for writing this up. It’s kind of strange to me that after all the literature we have about the variability of opioid conversions and drug potency that a group of medical professions would propose such a rigid rule. If opioid conversions were more concrete and predictable I might be able to get behind PROP’s proposal, but the evidence and clinical experience I have had just doesn’t support their request. Again, thanks for all of the education and work you have put into this!

    Ryan Costantino, PharmD

  35. Every brain is different. We have an untold myriad of intertwining receptor genotypes, phenotypes, subtypes…you name it!

    There never has been a one size fits all brain, syndrome, treatment, medication dose, response to medication etc.

    Lets all wake up and do the right thing….

    We treating professionals and our patients and their families/loved ones will empirically figure out what doses of meds are required to ameliorate pain…

    1. Agreed. It is well known that opioid equivalency and the dosage of an opioid pain medicine required for adequate pain relief depends on one’s genetics and is therefor very much a subjective measurement. There is too much variability in human genetics to come up with a one size fits all solution like the maximum amount of pain medicines a patient should receive is 100 mg of morphine. I’m not sure why PROP even left that in their petition. I thought even Kolodny himself admitted it was arbitrary and had no scientific or medical basis. I suspect and hope the FDA will throw that request away immediately. PROP is guilty of many things and their feeble attempt to quantify subjective data is certainly included!

  36. This seems so ridiculously unattainable, to think it is an idea put forth by a scientifically based group really scares me. The data Dr Fudin has shared here clearly shows yet another vague set of instructions so that our medical providers are going to throw their hands up and say, “Too much trouble to figure out (in this case it’s actually impossible), guess we’ll just skip giving out pain medication.” At least that’s what they do in Kentucky. If things get tricky, just tell your patients they are no longer worth the effort.

    1. Not every member of PROP is a scientist. And a majority of its supporters are certainly not scientists. Although, the fact that so many medical doctors and health professionals read the petition and thought it was a great idea is quite disturbing. The members of PROP really make me think that the MCAT standards are too low. I think the MCAT needs to add some advanced logic and advanced mathematics sections. Clearly, the members of PROP lack the capability to reason. Why else would they propose and defend such a crazy and dangerous one size fits all solution? I am shocked and horrified that so many doctors and medical professionals would support such a piece of garbage petition with very little reason and scientific merit.

  37. I am becoming more and more TERRIFIED, that I may be, if this nonsense keeps going, given what amount to a death sentence. My medications, combinations of medications, are just enough to keep me from considering permanent solutions… what is scary is that o think this PROP group does know the potential harm on a large population, THEY JUST DON’T CARE ABOUT US. We are the ones TRYING TO LIVE, and they are chasing those that face no regard for life. .. insane.

  38. I am one of those chronic pain sufferers that are suffering because of over reaction of the DEA, bad publicity and worse. Doctors are afraid to help us by prescribing relief and even if we get a prescription we have problems getting them filled. I (along with en entire county) was cut off abruptly about a year and a half ago even though I was not addicted and my pain was not “cured”. My life is hard, I’m not able to do simple things like clean my house much less anything actually fun. There is no quality of life. I would not need nearly the maximum amount of drugs being discussed at this time for relief but I realize that I could one day since there is no good prognosis for my multiple problems. Somebody needs to remember that we are real people and not numbers or equations. Don’t let us suffer because a few abuse the very drugs that help us be normal.

  39. My fiance fell in a hospital while being treated for pancreatitis due to high triglyderides. This fall? Ruined his life. He WAS the MOST hard working, the HAPPIEST, FUN loving, ACTIVE man I have ever known. He loved life so much, and helped me do the same. He was always on the go, he made a good living and was giving me a beautiful life. Saltwater fishing, camping, hiking, traveling, going out to dinner, swimming in the ocean, going to antique shops, he loved life, and made me laugh every day, often. That ALL ended with this fall. Since this happened in 2001, we have lost everything. He is absolutely miserable and can barely stand to be in his own skin. He still cries almost every day and asks me why this happened to him, he never hurt anyone (which is true). Thankfully after he suffered for about 2 years (including a suicide attempt) we found a Dr. who actually helped him with pain relief medicine. No amount of medicine could ever let him have the life he used to , but at least after trying different medicines and different combinations, he was more comfortable. Since he stays in bed 23 1/2 hours a day, he finally was ready to work on building some muscle and stamina by doing exersizing in the pool at a park here. I had just made arrangements when last May, we went to his Dr. and she said she had no choice but to cut his dose….in HALF. Since then, we are almost back to square one. Then last week, the pharmacy called and said they would have to cut the one medicine that helps him the most…in half AGAIN. This is cruel and unusual punishment.. I can NOT understand how anyone could be thinking of denying people who are in excruciating pain….relief! WHY would you do that? Hasn’t he suffered enough? It’s more than 100 people deserve. And he doesnt deserve ANY of it! He was the sweetest man I had ever met. And now he is forced to live on disibility that barely affords a crappy apartment. He has to worry about how he will have enough to pay the power bill. He doesnt go out to dinner anymore. EVER! He only leaves the house to go to his Dr. appt. The permanent spinal cord and nerve damage, AND the coccyx bone that broke and grew back….backwards, has made sure that he will suffer in ridiculous pain for the rest of his life. He asks me all the time “what did I ever do to deserve this? Why doesnt God take me, so I don’t have to hurt any more WHY?” I am here to tell you, watching the person you love suffer this much and this long is more than heartbreaking. It’s pretty hopeless. It makes me sick to my stomach to think that there are people out there that actually WANT him to suffer this horrible pain for the rest of his life. WHY in the world??? I will never understand this, We should be treating the most helpless people with LOVE and HELP them the MOST!

    1. Claire,
      Reading this story is the most heartbreaking one I can ever remember reading. I started crying as you certainly explained with anguish what life is now like for you both. Maybe it is because I can too closely relate or because the imagery in my mind of your fiance’s suffering was too much for my heart to bare. I’ve been the patient who has many, many times shocked even the most seasoned of doctors and nurses, because they couldn’t believe the sheer number of complex health conditions I have. My friends, family, husband, pharmacist and even general practitioner have said many times they don’t know how I deal with this much. But, your story hurts me even more than my own suffering. Bless yours and his souls. May God be with you always.

  40. Jeff,

    Thank you to you and your students for demonstrating in a practical fashion what occurs clinically everyday – source material for equianalgesic dosing is far from standardized! I’m sure that folks from PROP will point to the experience in the State of Washington regarding the arbitrary limit of 100mg of morphine per day but where is the science?

    Another keep point to mention relates to pharmacogenetic differences in certain opioid metabolism. Depending on the phenotype of specific P450 isoenzymes patients may require much higher doses than “normally” expected. Many of these patients would then have severe limitations and a slim chance of reaching a dose that will provide adequate analgesia. (Dr. Brennan nicely summarized this science in the December 2012 supplement of J Pain Symptom Management).

    I have yet to hear any of the folks from PROP discuss what analgesic success will look like, especially for some of the patients that have posted about their long-term personal experience with chronic pain. How without these drugs on a long-term basis, with doses possibly higher than 100mg ME/Day would they be able to function from day-to-day?

    Jeff thank you for continuing to be vocal and to provide counterbalance to this irrational petition put forth by PROP.

    Jim

    1. If PROP brings up Washington, then I hope someone else brings up the collateral damage those laws have caused in Washington. Washington has seen an increase in suicides among pain patients as well as an increase in heroin overdoses. I wonder if the population in Washington thinks the trade off was worth it? PROP and groups like it are delusional. There is no perfect solution to drug abuse. I think the most moral solution is to allow pain patients to have access to their medicines and allow drug abusers to overdose and pass away. I value the life of law abiding citizens more than those of criminals. PROP’s petition basically indicates the opposite.

      I suppose one other solution would be to give drug addicts access to naloxone for free. That seems like the most agreeable compromise.But, it doesn’t seem like PROP and its supporters want to compromise.

      No matter how PROP frames the problem, it boils down to does society value the lives of law abiding citizens more than the lives of criminal drug abusers? Clearly, PROP thinks “no.” I find that immoral for so many reasons, but that is just my opinion.

    2. Jim,

      Thanks so much for mentioning this! Some Intractable pain patients have genetic metabolic defects & require higher-than-normal opioid dosages. My Intractable pain stems from a genetic disorder (Ehlers-Danlos Syndrome), and many of us in the EDS community have learned that often one genetic defect or disease begets another. Most notably in the enzyme system known as Cyrochrome P450. As people with rare diseases, we often share problems in our support community. One of the biggest, being the fact that many of us have a difficult time being anesthetised. Either we need a MUCH higher amount of anesthesia, or we wake up in the midst of procedures! (Many of us are also resistant to novicaine and lidocaine). A significant number of us require higher than usual opioid dosages for pain relief. There have been no longterm studies about this, but Forest Tennant, M.D. shared that MOST of his EDS and Marfans patients have defects in one or more of these metabolic enzymes. Thankfully, the doctor who treats my pain is aware of this! How many doctors are NOT?

      Obviously, I have to assume the PROP doctors are unaware of these (genetic) metabolic defects….. Either that, or they really DON’T care. When you have suffered most of your life with severe chronic & acute pain, finally make it to a geneticist who tells you what’s wrong with you, find a doctor to treat your pain (adequately), LIFE BEGINS AGAIN. It’s not perfect, but I can shower, dress, function, eat, SLEEP (finally), concentrate enough to read & follow conversations, have relationships, help care for my family & participate in life….. Prior to opioid therapy, I was SUICIDAL. I was underweight, depressed, didn’t sleep, couldn’t concentrate, showering was agony, getting dressed was too painful! This is what people don’t seem to understand…. we are talking about the difference between being able to take care of ourselves vs. being unable to complete simple tasks! Is that asking TOO much? What kind of “Doctors” would want me to go back to that “life” of torture?

      Guess what? I’m NOT. Whatever it takes, I’m NOT going back to wishing I hadn’t woken up everyday. It was SURVIVAL, not LIFE. So….if PROP’s ship sails, off I go!

  41. These MORPHINE EQUIVALENT charts prove that no one can figure out the true equivalent to 100mg of Morphine. There are so many variations. I take Methadone 2 10mg tabs 3x a day and just looking at the answers 100mg morphine equivalent are from: 50 to 160Mgs!!!! That is a huge difference! 160mgs would have me passed out. Some people couldn’t even find an answer for methadone because it seems to be the most tricky when it comes to equivalency. That is why the DOCTOR puts you on the lowest possible dose first (10mg x2 or x3 depending on the patient) THEN after trying the lowest dose the DOCTOR asks you what is your pain rating and if the number is low enough and that you are having a good quality of life and you can do daily tasks without additional pain. Daily tasks such as work, laundry, taking care of your children, etc… THEN if you say the pain is still present at a high level the DOCTOR raises the dose carefully. For the Methadone it would be 20mg x2 or x3 depending on the patient. And a week later the DOCTOR asks the same question. If you are down to a 2 or 3 and your pain was a 7 or 9 to begin with then you and your Doctor decide that you can live with a 2 because we all know that the pain never completely goes away and that is not what the medicine is for. It is used to dull the pan down enough so you can be a productive member of society. How does PROP, the FDA, and the Government know what your pain level is and how much is the right amount? 60mgs is perfect for me but Patient A might need 90mgs and patient B may only need 30mgs. This hurts the people that have a tolerance to pain medicines and need larger amounts in order for it to work the way it is supposed to. Why hurt those law abiding productive members of society to try to save a few criminal drug addicts when they are just going to switch to heroin anyway?! It just doesn’t make any sense. I seriously think the people at PROP are not on the same planet as the rest of us!

  42. this is a violation of our HUMAN rights!!! opioid medications are the same as any other type (diabetes meds, blood pressure meds, cancer meds, gastro, thyroid…etc etc). they were made for the purpose of helping people feel better! whether it be long term or short-term. just like any other medication, amounts/miligrams vary. each person has individual chemistry, therefore each medication, for whatever ailment it is, MUST be prescribed to meet that persons body and its INDIVIDUAL requirement. i am APPALLED that this is even being given a second thought! we live in a free country that gives us the freedom to think and speak for ourselves and unless we stand up for our BASIC human rights that are being threatened by this audacious proposal, we will loose those rights. it is unacceptable for someone other than your doctor or trained medical professional that handles your individual treatment to suggest what is best for you. would they take medical advice from a complete stranger? ESPECIALLY when its for the treatment that relates specifically to the patients quality of life??!! (pain, mobility, etc). how DARE the suggestion of being given the authority over someones well being be concidered?! what country is this again? and those that have fought and are fighting for our human rights and freedom are going to be treated like this??!! the elderly, terminal, disabled…all treated like this? i’ll make a deal with these ‘control freaks’, let me tell THEM how long and far they can walk (assuming they’re able), what they can consume that will be tolerable, when to sleep, what they can wear, how much interaction with others, (and all the other basic human function that people who dont suffer from chronic pain take for granted), while not knowing a thing about them, and i’ll let them do the same for me. until then, myself and many of the millions and millions of Americans that suffer from pain, will be heard. we will hold strong and fight for our BASIC HUMAN RIGHTS. worrying about pain adds to the pain. knowing you have the ability to help those in pain, and watching them suffer adds to the ignorance.

  43. I also agree with every poster here. The FDA and all government agencies need to stop listening to the negative stories of the media and the few family members of those who abused opiates and combined other substances that caused death. Pills don’t kill people. People kill themselves.
    Catering to addicts is what I call it. Most others feel the same. Why should we make it easy on them and HELL on pain patients? Alcoholics have to learn to live being around others that drink and suck it up and NOT drink it. Many of them succeed in doing that. What is the difference?

    First of all, I can’t believe that we are even having to worry about such a question. We need to moving forward to relieving pain and NOT allowing it to consume a human life.
    I have seen first hand what all this negative stigma has caused. Patients in Florida and Kentucky are living in hell every day since all this started. The anxiety is out of control!

    In these states and others.. Patients are not able to find a doctor willing to treat to them anymore, much less be able to get the medications filled by pharmacies. The FDA and the DEA have our pain management doctors and pharmacists in such fear they are refusing to treat these people anymore!
    Is this acceptable? Is this what they are trying to achieve here? Is this healthy?
    Not one size fits all. We have all heard that. Undertreatment of dosing is already occurring and many people including myself are suffering the conquences because of it. I’m not able to work like I want to and do all the things I used to do just a year ago because of all this mess. Limiting access to doctors and medications for these pain patients has caused so many people to go into such deep depression and panic. Does the government want us all to commit suicide? They sure are sounding like it. I believe that is just what will happen if this PROP petition passes. I know that many wouldn’t want to live, having to continue suffering, for what? What good will that achieve? No quality of life brings no reason to live. Just a bed ridden burden. So this the decision the FDA has to make.

    1. I agree donna.As dark as it sounds,Pain does create a major disturbance in ones quality of life 2 the point it affects every aspect of ones life.We are in Pain,We are not running around with smiles and a bounce in our step.it is depressing and does make one have 2 deal with living with pain.without access 2 pain relief our lives do become miserable and unbearable.a chronic pain patient is not cured by medications and soon as the medication wears off the pain returns.alot of us have a permanent condition that has no time limit…….I would like 2 hear what the solution 2 cure non-cancer chronic pain is if they remove the ability to obtain medication after 90 days….under the props petition they also are wanting 2 take away the moderate labeling for non-cancer chronic pain patients as a label for pain…Are they suggesting that if you do not have cancer that you can not have moderate pain?That is absurd,moderate pain is moderate pain whether caused by cancer or spinal injury,etc!….I also agree with you that this is attempt 2 stamp out the drug epidemic at the expense of non-cancer chronic pain sufferers!!…This attempt 2 deceive the public by labeling chronic pain patients as not needing opiate medications when surgeries have failed and all other means 2 relieve the pain has failed is down right cruel…..this is an attack on people in pain by saying that if you do not have cancer you do not have more than minor pain.the props petition is trying 2 re-write the definition of pain!!!I

  44. I am in chronic pain due to an auto accident. After the accident while the auto insurance was still paying for it I tried many methods of treatment to include chiropractic care, physical therapy, trigger point injections, massage and finally had epidural injections by an orthopedic dr. who in doing so hit my sciatic nerve. I now walk with a cane most of the time and can no longer enjoy life in the manner I used to. I am now a patient who goes to pain management to be able to make the best out of what’s left of my life. If it weren’t for medication I would be in bed suffering from horrendous nerve and disc pain. I don’t abuse my meds, I don’t sell them, and I like many others have a hard enough time getting my meds each month from pharmacists who stigmatize pain mgmt patients. Now I have to worry that my medication that enables me to get out of bed each day may be cut by some group (PROP) who wants to dictate how much medicine is in their opinion “the limit”. Every person is different, we all have different pain levels and thresholds, what works for me might not work for someone else and vice versa. And this group wants to put a 90 day limit on medication? Then what? This group if they get their way will hurt many many people and cause much suffering and agony where it is undue. As a chronic pain patient I suffer enough, who are you -PROP – to tell me how to treat my pain when you aren’t even my doctor and have never examined me? This is absurd to make legit chronic pain patients suffer because of what some addicts have done. I feel just like the “Retired RN”, I’m scared and I just want to be left alone. Please do not allow this proposed petition allow people like us to suffer more! Thank you for caring about us Dr. Fudin!

  45. Dr. Fudin thank you for pointing out and proving just one of the many errors that exist in the proposal to the FDA. I am one of the many people struggling to live each day with pain. I have been diagnosed with Rheumatoid Arthritis, Degenerative Disc Disease, and several other ailments. I am also a widow with two young children. I still work full time, and I have been blessed with a fairly lucrative middle management job and health benefits that allow me to afford my medications. I am currently prescribed Cimzia by self-injection twice a month, methotrexate (10 pills a week), sulfasalazine (3 pills a day), Folic Acid (once a day), prednisone (as needed), and Clonazepam (as needed). I am also prescribed oxycodone 6 times a day and without this prescription I would not be working. If I cannot work, then I cannot pay for any of my medicine or doctors. I don’t know if I could take care of my children. I would certainly try but before I was diagnosed I could barely walk. I found a medication that helps with the pain enough that I started having a life again. I even went back to school for my Master’s in Public Administration. I am a proud person who enjoys the life I have now, but as of late I am scared. Scared my life will be taken away from me. I am thrilled that there are doctors stepping up to help us. Please keep up the great work.

  46. This suffering must stop! Allow doctors to do their job without interference from Gov’t agencies that have NO medical knowledge of how to treat pain patients. After 4 spine surgeries, I am left with broken screws and a lifetime of pain. All I want is a better quality of life, the same as a diabetic and their insulin. It’s not MY fault that my medicine makes some people “high.” I don’t get high, I just get out of bed and move around a little easier. I have the Right to the pursuit of happiness, suicidal thoughts because of the lack of pain medication is keeping that Right away from millions of pain sufferers.

  47. Thanks for this article and thank you for the continued fight with PROP. We all know that the petition that PROP has submitted is way out there. I believe that Dr. K is out to make a name for himself and that is it. PROP members have never done any testing themselves to even suggest the changes they want made. I hope you are attending the FDA meeting on the 7-8th of this month to fight PROP. Arachnoiditis Society for Awareness and Prevention, ASAP, will be there! We have 7 min to deliver our requests and to fight PROP..Thank you for all you do to protect us that suffer every day!
    Becky

  48. I’m an old RN. I was injured in “99”, while admitting a gangbanger to my psych unit in Las Vegas. I’m not going into the whole W/C business, I’m just too tired. I finally after years of trying to get the right combination of meds.(I’ve tried all the antidepressants). I take 1200 mcg of Fentanyl/5times a day, and one “1600mcg fentanyl” at hs. These are the suckers. I take 60mg of methadone in the morning. This gives me 30-35% relief for the rest of the day and night, and this is all a combined per centage. I sit here and rock back and forth right now, scared. I’m an old Viet Nam Vet, and I didn’t think anything would make me afraid again. I was a medic there. BUT, I’m afraid of my government, and how they will take from people who have irretractable non cancer pain. I’m sick to death of reading about it, due to the fact I’m not a drug user by CHOICE!!!! HEll, my retirement is gone, all the money I saved while nursing is gone. I get ssdi, and I get a little from Uncle Sam. I think what I will do if these meds are taken away. What will I do? I get my meds through a company. I get them once a month. I have never, ever used more than I should or ran out early. NEVER!!!!! This has been years. I have been a good patient, and that’s not good enough. Hell, I detoxed patients. NOW, I’m on that side of the fence. I just want to be left alone, and whatever I’m taking be left alone, so I can at least visit my son and grand baby in Texas. It’s a six and a half hour drive, it takes me two days, “WITHOUT” meds. Then when I get there it’s a day to recover. Then, back on the road for a two day trip back to Arkansas. Six and a half hours, and It takes two days. I guess I’m just sick to death of hearing that the FDA is going to make changes. I’m scared, I’m really scared. And boy am I tired, not to mention the pain…………………….Thanks to Dr. Jeffrey F…………………Herb Neeland

    1. This past summer I wanted to see what it would be like to titrate off of the medications I take for chronic pain. All of this talk about what was coming up got me to thinking what would it be like to titrate down and off these medications. How would my chronic pain be , what would my life be like , could I survive. It took patients and careful titration and it took about 3 months to titrate down and off of a long lasting pain medication I’ve been taking for the past 6 years. I don’t recommend anyone doing this without your doctors knowledge. I’ve dealt with moderate sometimes severe chronic pain for 24 years now from a roll over car accident I had when I was younger, the roof of my car collapsed compressing my cervical spine. The root sleeves have lost their elasticity in my cervical spine and this is what causes my chronic pain.

      I had to let a friend hold on to my medications and for two weeks I went back to the way I use to suffer and it wasn’t very pleasant. I had to do this to see for myself where I was and if my pain was still as bad as it use to be. I believe I could survive without any pain medications but then I wouldn’t have a life. I went back to the old way of living and suffering day and night. Those 2 weeks reminded me of the way it use to be before I found help for my chronic pain.

      Its people like Herb that bother me the most, it would be evil to take away his medications and him go back to suffering. After all he served his Country why would anyone want to take away what makes him comfortable, the guy is scared and this makes me feel bad. I can take care of me but its people like Herb that bother me the most and there’s thousands upon thousands of people just like him. They are out there and their scared and don’t know what to do, this is very unsettling to make these people wait and leave them in limbo not knowing what will happen. And even worse it would be terrible to take away the very medications that help people that suffer from chronic pain and make them go back to suffering.

      So I’m making a plea and I’m asking that things be left as they are, don’t make all that suffer from chronic pain go back to the way they use to live in never ending chronic pain. You don’t know what life is like unless you’ve gone through it yourself, its demoralizing and being in chronic pain takes away everything you live for.

      I had to go back on the medications I take for chronic pain because my life was out of control, I couldn’t sleep, go to the grocery store and care for myself. It took everything I had just to get out of bed and get in the shower and even worse it took every ounce of energy to cook for myself and I had no appetite.
      So I’m back to normal now and I would like to stay this way. We that suffer from chronic pain that have a program that helps us with our chronic pain are not broken so we don’t need fixing.
      Those that abuse pain medication that don’t need them in the first place need to be fixed.
      So I ask please don’t fix what’s not broken and us that suffer from chronic pain will be fine.

      Thank you Dr. Fudin for giving all of us that suffer from chronic pain a place to go where our voices are heard. You’ve gone over and above your call of duty.

      Mark S. Barletta

  49. How is a pharmacist or physician to reconcile this? This makes no sense. You’ve proven the vast conclusions drawn from only 5 opioids. This is not even considering the patient or their pain. It’s hard for me to believe that any doctor would believe every patient’s pain will remit after 100mg dosing for 90 days. Also, the 100mg dosing doesn’t take into account a patient’s genetic factor. There are chronic pain patients with genetic defects that process medication vastly different. Genetic testing is a relatively new tool for the physician. Perhaps genetic testing requirements before a patient begins opioid therapy would be a more reasonable approach.

  50. unfortunately, when the government decides to do something, they usually have someone who they consider is an expert because they read a book. They should talk to real pain patients, those of us who deal with pain and problems on a daily basis. they should talk to the physicians who work on a daily basis to keep patients from delving into depression/anxiety/suicidal thoughts. the physicians, researchers, practitioners, pharmacist who help coordinate the field of pain management should be making the rules and regulations. Like with guns, one person dies and let’s ban guns. similarly with pain medication, we should harm and punish the legitimate users of pain medication for the sins of those who abuse and sell their medication. since when should the innocent pay for the sins of the guilty. quality research, like yours, has helped to increase the quality of life of thousands of pain suffers. last year i read an article entitled that someone died from oxycontin overdose. when you read deeper into the article, they also tested positive for heroin and cocaine. it grabs headlines when you write about something legal, not if they entitled it “heroin and cocaine overdose.” let’s punish those who abuse the medication and allow the innocent victims of pain to be treated properly.
    with their logic, if someone is raped, perhaps we should ban sex for everyone!

  51. For all doctors that try to come close to meeting the limited 100 mg of oral morphine per day or the equivalent it could do more harm than good because it’s a doctors duty to do no harm.
    There would be so much confusion that I bet this would lead to more underdoses or overdoses to those just needing relief of their chronic pain. This is why prescribing should be left to the experts in Pain Management and not that of what PROP thinks needs to be done. All pain patients I know where safely titrated up to a level of pain relief and their doing fine. Adjustments are made when necessary.
    Lets not cause more problems than we need, we must find a way to stop diversion of opioids and leave in place the treatment of suffering people that need no maximum milligram cut off. How do we limit what a suffering person needs for their chronic pain, everyone is different when it comes to finding their level of pain relief. We cant put one maximum allowable dose for any opioid for all that suffer, it will cause total mass confusion.

    Mark S. Barletta

  52. Dear Jeff,

    Thanks for this vey important post. As you are well aware, you and I have collaborated on an on line conversion calculator with your algorithms as the underlying methods for such conversions. You also know that in all of the conversions we recommended strongly to proceed with caution to prevent unnecessarily risky doses as drugs are rotated.

    The arbitrary doses selected by PROP are well below the doses needed for many patients suffering with chronic pain. And, the 3 month length of treatment course is equally unfounded.

    Those of us who along with our patients make up the community who must be affected if these changes are emplaced will necessarily need to decide how we will go forward under such an undue burden. This forum may serve as ground zero and I therefore wish to thank you Jeff for your efforts and leadership.

    Fellow posters to this sight, unite! Let us through our words and actions not go quietly into this fight. Be ready to address all who may be able to help in the event the FDA acts counter to our position.

    Mike Brennan, MD

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