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Countless published commentaries, blogs, and debates have covered the PROP (Physicians for Responsible Opioid Prescribing) petition submitted to the FDA in July 2012 this year.  Coverage of this topic is ubiquitous throughout this website and has become a familiar and popular discussion topic among our readers.  As well, the PROMPT (Professionals for Rational Opioid Monitoring and Pharmacotherapy) acronym is equally emblazoned throughout the Internet for their role in opposing the July petition and advocating for patients requiring opioids for chronic non-cancer pain.  PROP is comprised of physicians alone, while PROMPT maintains an interdisciplinary group of healthcare providers, many of whom also include physicians.

An unfortunate fallout of various published debates has variously become heated and often misdirected.  The whole subject of medically necessary opioid therapy has been grossly overshadowed by this ordeal, as both PROP and PROMPT recognize that opioid therapy is clearly not the only option for chronic pain patients.  In fact both groups agree it is often the medication therapy of last resort.  Unlike most therapies, opioids carry with them both therapeutic considerations (benefits and risks), psychsocial and highly political issues.  As with all politics, there is a very liberal LEFT and very CONSERVATIVE right.  Chronic pain patients come in both flavors; politically liberal and conservative.  But this is not about RIGHT or LEFT; it’s about RIGHT or WRONG.  A significant problem in politics, religion, science, or medicine often surfaces when we have zealots in one camp or another.

Exposition of PROP-PROMPT blogs, attached comments, and other published debate, should serve to remind us all that healthcare providers, at least initially, entered their respective fields with honorable intentions of healing.  I still believe this to be true, regardless of which camp our readers and healthcare providers fall.  To debunk any doubts that have arisen in the crossfire, one could easily upload copies of the physician’s Hippocratic Oath, The Oath of a Pharmacist, The Florence Nightingale Oath, and others.

As PROMPT members began to draft a Mission Statement, it became abundantly evident that this debate can’t only be about opioids; it’s also about risk stratification, mitigating risks, rational polypharmacy (not just opioids), interdisciplinary expertise, common sense, patient advocates, families, loved ones, behavioral health, psychotherapy, interventional medicine, rehabilitative medicine, alternative medicine, non-traditional medicine, and more.

During this whole process, it is no secret that contaminated intraspinal injections caused Multistate Fungal Meningitis and resultant harm and deaths to numerous patients throughout the United States.  That is an unfortunate and unanticipated outcome that should make any of us stop and think about what we do, how we do it, why we do it, the potential benefits versus risks, and long-term impact for our end user, the patient, and their loved ones.

It is with a heavy heart from the ongoing battle of PROP vs. PROMPT and much deliberation and dedication from PROMPT members that we finally developed a Mission Statement.  I believe it will be clear to our readers that the final product does in fact reflect concern for patients and fairness to those that care for them, regardless of the preferred medical camp.  But, it also demands that scientific validity and risk mitigation are essential components.

It is not just about opioids; it is not just about right or wrong;

To view PROMPT’s Mission Statement, click the link or continue reading below.  As always, comments are welcome and will be considered in future revisions of the PROMPT Mission Statement.




Who is PROMPT?

A diverse group of healthcare professional experts in pain management and patient care advocates.


To advance a universal inter-disciplinary, multi-modal approach in striving for effective pain management, including but not limited to, medically necessary opioids for chronic noncancer and palliative pain management and to advocate for appropriate Federal and State legislative strategies that improve outcomes and mitigate risks throughout the United States for all chronic pain sufferers.


PROMPT will,

1.         Promote valid, reasonable, scientific strategies to guide legislation and balanced policy that do not generate barriers for less traditional but validated therapies, interventions, and/or techniques, and medically necessary prescription opioid use otherwise intended to effectively treat and control chronic pain.

2.         Advocate for reasoned opposition to quash all non-evidence based proposals that threaten medically necessary opioid or other prescription medication access by requesting FDA or regulatory label changes or any other therapies that specifically lack scientific validity that   potentially impose unintended consequences to chronic pain sufferers.

3.         Support healthcare provider, public, legislative, and policymaker education.

4.         Encourage and support lobbying efforts at the Federal and State levels regarding the consequences of non-evidence based proposals, petitions and/or other similar proposals.

5.         Support ongoing dialogue and discussion with proponents of petitions to change the paradigm for which pain medications, including medically necessary opioids are prescribed, healthcare professional organizations, and other stakeholders to reach a consensus about appropriate medication use strategies and risk mitigation.

6.         Provide empathetic support and a channel of voice for those who have bereaved for family and loved ones, where acceptable medical therapeutics were employed, but due to adverse outcomes from interventional, medication, and/or modality-based treatments, unfortunate consequences occurred.

7.         Encourage implementation of tested, proven, evidence-based strategies, such as public health demonstration models for prescription opioid use that reduces mortality and mitigates untoward risks of opioids in Society – one such successful model is Project Lazarus of Wilkes County, NC that did not include FDA or regulatory label changes to opioids.

8.         Promote valid, scientific research into the safety and effectiveness of all prescribed treatments including but not limited to medically necessary opioid drugs.

9.         Support education of medically necessary opioid pharmacotherapy in chronic pain management into the curricula of all healthcare colleges, training programs, and organizations involved with delivering continuing professional education.

10.       Encourage education to the healthcare community regarding the role of law enforcement and opioid, misuse, and abuse in Society.

11.       Promote a workable and collaborative approach with law enforcement agencies and/or officials to abolish “pill mills” at local, regional, state, and national levels.



  1. I have been in non-stop pain for 22 years. I suffered a head and neck injury in 1990. I trained for a new career as a graphic designer and thrived even though I was in pain. in 2001 I had another injury that triggered fibromyalgia. Two years later I left work for the last time and am now fully disabled.

    When I dream I dream in pain. This is how relentless my pain has become. The only thing that makes life bearable is opiates. Without the mitigating factor of these meds, I would have to end my life.

    I am aware of the problems that opioid abuse has created in society. But I am not the problem, I am the patient and I take my meds because I need them. I do not use them to get high; they do not make me high, they lessen the pain.

    I have a visual medical report I created that illustrates what I live with better the words ever could. I’d love to share them with you and help in anyway I can in this fight.
    Karen Geer

    1. I am a pain patient and I agree with your sentiments. I would be interested in seeing your graphics if you would like to share them. I’m sure all of us on here could relate in some way. Opioids help me deal with the pain as well as cope with it too. It is a long difficult and often lonely road us pain patients must wander. It can be hard to to be positive. At least there are scientists and doctors working on new medicines and therapies for pain. I hope a lot are released soon. It takes forever for medicines to go from research to production. I’m also hopeful about genetic medicine. In the next few months, when the technology is completely in place, I am going to have my DNA tested and analyzed to see my pharmacogenetic profile. It will tell the doctors which medicines will work best for me and which will be worse. I can give more information if people are interested…

  2. A lot of people that suffer from chronic pain are afraid to post and let their voice be heard. Most are in fear of losing what little pain care they do receive. Its become a lot worse over the past 10 years. I make sure I say what’s on my mind even if it puts me at risk of losing my pain care treatment I don’t care. I would rather speak up and tell everyone what I think, how I think and my feelings about certain things. All of you that suffer from chronic pain need your voice heard, the more people that speak up and get involved the better chance we all get the correct treatment for the chronic pain we suffer from.
    Over the past 20 years whoever would have wanted me would have gotten me a long time ago,especially when I was involved with advocating for the suffering. I never really knew who I was writing or speaking to but had a lengthy intake on the people I helped.
    I made sure to get a MRI radiology report for that person before helping them.
    It seems its been a lifetime all the years that has past and I’m getting older now and have a better understanding of chronic pain and how best to deal with it.
    Now things aren’t half bad and I wish I still had my website I use to work on. But that was a good experience for me and it made me a somewhat wiser person.

    I hope all of you get the pain treatment you deserve.


    Mark S. Barletta

  3. Dr. Fudin, thank you for all you do to try to help patients who, like me, have been given a short time to live and want to truly LIVE until I die. I existed for 17 of the last 20 years. I’ve only had adequate pain relief for 3 weeks because someone finally gave me 24 hour coverage in 2 little pills. I use 1.5 pills of breakthrough meds a day (down from 4 a day without the 24 hour coverage), am on 3,000 mg of neurontin plus a boatload of other meds. I am looking into every alternative medicine I can find to help me endure should I be forced to become that writhing, teeth breaking from clenching in pain, not able to be touched person. I don’t have cancer, but the diseases and resulting side effects result in pain that is on par with end stage cancer when not treated with opiods. My MD geneticist said my genes are broken and my immune system “hates me.” He is right because I went to bed 2 night ago and woke up the next morning with an another exploded finger joint. It had bulged to the right and the tip of my finger points left!
    In an effort to find a multi-disciplinary approach besides PT, which injures me further, I am pursuing LAMININ, a little known molecule in the body that produces stem cells and gives collagen the green light. Next week I start the arduous process of seeking help from a PhD nutritionist to help me try to wean off as much medicine as possible, working with my MD, as I take Laminin in capsule form. . I have a boatload of meds to take daily and not an anti-depressant in the bunch. Despite my terminal prognosis I’m not giving up, just trying new things like magnesium oil for severe joint inflammation. Who would guess that Epsom salts diluted with water is a great topical pain reliever? Problem is it doesn’t last that long. Laminin was cited by a Canadian scientist in the early 20th century as a cure for systemic and genetic disease, as well as cancer. The government refused to fund his clinical trials., even when a member of Parliament with end stage colon cancer lived 4 more years using the laminin protocol. I’ve found a company that makes this compound and I’ll let you know what happens, ok? Interestingly, Laminine is shaped like a cross under electron microscope. Ebola is shaped like a cross with a dragon’s tail and the bottom. (Hello???)

  4. I want to thank Dr. Jeffrey Fudin for the hard work he has done and the group PROMPT he started to put a stop to PROP’s Citizens Petition proposal to the FDA trying to make label changes to opioids by making Pharmaceutical companies change the way they say their products should be used to help the sick and suffering of the U.S.A.
    Over the past 6 months the compassion Dr. Fudin has showed for suffering people on top of his regular work has not gone unnoticed.
    I think Dr. Jeffrey Fudin has gone over and above his call of duty as a compassionate doctor protecting and keeping in place the correct treatment of chronic pain for all that suffer on a daily basis. I also want to thank Dr. Fudin for stepping up to the plate to let PROP know the secret Citizens Petition they started was not going to be accepted by PROMPT and the people suffering from chronic and intractable pain.

    I have tried all of the alternatives from acupuncture ,epidural injections to my cervical spine.
    I tried Botox injections, traction, deep heat treatments to my cervical spine and many other treatments only to find 30 minutes later the ongoing chronic pain returned. I exhausted all avenues ,It was not till I was titrated up to a safe level of pain relief using a time released pain medication that I finally got my intractable pain under control. Its been 25 years now and I’m still receiving the pain relief I did from the very first day I found these life saving medications where the answer to my ongoing ,never ending moderate sometimes severe chronic pain.

    All surgeons told me surgery was not a option for me. I prayed for pain relief and I finally received it.
    So if we need long term proof that these opioids work and are safe and affective I’m a fine example as to why they do work, its now been 25 years I’ve taken opioids for my ongoing chronic intractable pain and I’m just as healthy today as I was before this treatment started, please know I do exercise 5 days a week and am on a special diet. I get stress test done each year to check my heart.
    I get blood test done each year to check my kidneys,liver and 19 other blood test to make sure everything is in check and they are. I’m 56 years old now.
    When I was 28 the roof of my car collapsed on the top of my head compressing my cervical spine causing permanent damage for the rest of my life.
    Now the use of time released opiates has given me my life back and I thank the Lord and the Pain Specialist brave enough that still treat my chronic pain.
    I hope and pray everyone that has not found pain relief soon get the relief they deserve. There is no good reason for anyone to suffer their life away, not when help is available. Thank you,

    Best Regards,
    Mark S. Barletta

    1. Mark,
      Thank you for your kind comments and all of the work you have promoted on Linkedin, blogs, etc. I do appreciate your kind words, but readers need to know that the PROMPT membership deserves a whole lot of credit as well for stepping up to the plate, advocating for the cause, and participating in developing this Mission Satement.

  5. PROP is not entirely made up of medical professionals although they like to advertise themselves as such. Pete Jackson and Betts Tully are not medical doctors. I’m fairly certain they are not any type of doctors. Also, PROP has many “members,” which they do not list. Most of them have probably signed the PROP petition though. Many of the signers of the PROP petition are not doctors or health professionals. I just wanted to point this out because PROP likes to hide behind the common image of a doctor that we all have. The image of doctors that our society has created is that doctors are intelligent, educated, and responsible authority figures. And many are. But, it is clear that many members of PROP hide behind this image as evidenced by their petition. PROP was hoping to pull the wool over the eyes of the public by basically saying ” we are doctors and we know what is best for everybody including pain patients.” Despite the fact that none of them are pain management doctors or doctors who even treat chronic pain.

    1. Andy,

      Thank you for your comments. I “unapproved” your comment at first because I needed time to validate certain of your accusations. I did allow the post in an effort to foster discussion and clarify certain points for you and our readers. Part of what you say is true, but part is untrue. For example, Pete Jackson and Betts Tully did not in fact SIGN the PROP petition, nor have they ever claimed to be doctors as far as I know. It seems that PROP has non-physician advocates, some of whom apparently are part of the chairmanship. From what I gather, PROP either has reached out to these folks or visa versa, but what is clear is that many of their non-physician advocates have either overcome an addiction problem themselves or have a family member that became an addict and/or died as a result of mis-prescribed opioids or misuse, or both.

      This is what I found;
      Betts Tully of Chicago, Ill.
      In an “OPIOID ANALGESIC AND RISK EVALUATION AND MITIGATION STRATEGIES (REMS) STAKEHOLDER MEETING”, Ms. Tully was a “patient advocate” in a round table discussion forum. This was memorialized in a document that can be found at
      To be fair, in that document Ms Tully is stated as saying ” So as a pain patient I can only give you what my experience is. I’m not a scientist. ”

      Pete Jackson or Arlington Heights, Ill.
      Mr. Jackson is listed on Novus Medical Detox Website at
      He is quoted as saying “My name is Peter W. Jackson. I am a biologist with the U.S. Environmental Protection Agency in Chicago. My wife and I reside in Arlington Heights, Illinois where we have raised two children. The smiling girl on the screen is my daughter Emily, a friendly, compassionate and high-spirited eighteen year-old girl who died from an overdose of OxyContin in August 2006 after she had taken one OxyContin pill offered to her by her cousin. This was her only encounter with OxyContin. She was just a normal 18 ½ year-old kid. She died three days before her first day of college. We used the money saved for her college education to bury her.”

      I will make Dr. Kolodny aware of this post and invite him to comment if he wishes.

      1. Readers,

        Dr. Kolodny graciously answered my request to clarify. Per his Tweet this morning.

        TWITTER: Andrew Kolodny@supportPROP @JeffreyFudin “PROP membership is not limited to docs. We’re open to anyone who wants to reduce opioid over-prescribing.”

        I can’t fault PROP for their position of having non-physician advocates. PROMPT has advocates too, but the difference is that our non-professional membership are “affiliate members” and are not listed on any official position pages or documents. Some of PROP’s non-physician advocates are listed as part of chairmanship on their letterhead.

        1. Also, as I mentioned in my other response, PROMPT does not claim to be only physicians in it’s name. The word “professionals,” is more inclusive and more accurate about the membership of PROMPT than “physicians,” is about the membership of PROP.

        2. It is a tragedy that a child or person dies from “one oxycontin”! Our children are most important to us. As I’m a parent too. Yet, I see people and “god forbid”, children , dying of so, so, so many things, much less than drugs or vehicle accidents.. Maybe, we should restrict or stop the use of vehicle! Vehicles not only kill by accidents, they also have long term effects on some peoples health, due to emissions! And scientifically proven that, they/vehicles , are destroying our planet.. even common sense can explain this ,to begin with! A billion vehicles. Think about it all, as we all should think about the pros and cons ALONG with life and death of our lives. As death is inevitable..

      2. Dr. Fudin, you are correct. I should have been more careful in my comments and I should have done more research on some of the topics. You are absolutely correct about the PROP petition being signed by only medical doctors.

        However, PROP does have an undisclosed “membership,” list. Anyone can join. I think it may be some type of mailing list or something, but I am uncertain about it. I would be interested to know what these “members,” get.

        Some of the “mistakes,” in my post can be attributed to semantics. The name ” Physicians for Responsible Opioid Prescribing,” implies that its members and ,more specifically, its board members are all physicians. Like I said, it is all semantics. I never stated that Betts Tully and Pete Jackson claimed to be medical doctors, but the name of their organization can be interpreted as implying such.

        Also, I have been aware of these anti-pain medicine “advocates,” for some time. while their stories are tragic, it is a mistake on their part to solely blame pain medicines. I have yet to see one advocate place blame and responsibility on themselves or loved ones. The bottom line is people are responsible for what they ingest or put into their body. Nobody has ever been forced to ingest pain medicines. Nobody has ever been forced to fill a prescription. These are choices that are made by people by their own free will.

  6. Well, to Jeff and all, regarding Prompt’s mission statement, it seems pretty fair. As long, and I hope I don’t sound like a broken record, but the folks that have this non cancer pain have to be taken care of as if they do have a terminal illness. HELL, we do. Like right now, so help me, I do. I have been in a flair of pain from the weather, moving around too much. After feeling better with the change of weather, it just turns around and bite’s you right in the butt. I read this, and see the , well, what we would call the “Liberal point of view” from prop, and I just wanna scream to the Heavens. It doesn’t help feeling so helpless. We Arachnoiditis patients are full of anxiety. Just so full of tension, that we will not have anyone to administer to our needs. Ya know? It’s sad, and I guess I’m feeling sorry for myself right now, but it’s just a horrible feeling to have a “Hopeless helpless feeling like this.” For the love of God, I know what this means. I was a Psych RN, and I have been in this business for so long. I have worked De tox and thought I knew everything about how opioids just destroy the body, and the teeth, and the liver /kidneys. Hell, I know. BUT, to get thirty minutes of relief, I will give up ten years of my life to achieve this. RELIEF!!!!!!!!! I don’t get relief from “Lyrica, Cymbalta, Neruontin”. How many Doctor’s, Nurses’ have heard this never ending “WHINE?” Well, I did, and now, I’m on the other side of the fence. 13 years of this. I thought I would never, ever be in this position. BUT, here I am, I belong to COFWA, and we take narcotics. Jesus, I think , like right now, how stupid this would have sounded 14 years ago, but we do need help.
    There is the criminal element, the pill mills, all this stuff that ruins “RELIEF” for the people who really need it. And here I sit, writing, pleading for prop to leave us the hell alone. It’s our decision to achieve relief any way we can, and for right now, it’s legal, and I’m a strong minded, and law abiding citizen. BUT, I can see how one would turn just the opposite, or put a gun to our brains, if we had to live in this hell all the time. I have done that some, within the last 13 years, and BY GOD, I can’t do it again.
    Well, thanks for listening to this ole “Medic/VN/Nurse”. I pray that we will have folks like “PROMPT” around to help. And the many COFWA folks who write letters like mine. WE are so tired of hurting, and now, “”BEING SCARED” of what might happen, if the powers that be, “DECIDE THAT THEY KNOW MORE THAN WE DO< and just FLIP US OFF". I'm truly scared, frightened. I pray for my brothers and sisters that we can achieve our little bit of pain relief, and have as close to a normal life as we can……………………….thanks to Jeff, and all the rest of you Prompt folks. "God bless'.
    Sincerely Herbert W. Neeland II,,,,"A real pain in the butt!!!"

  7. I fully support this mission statement. It is fair and inclusive of all parties. I have hope that those on the PROP side will see this, and join PROMPT. Thank you Dr. Fudin for alll your hard work.

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