Dancing to the Pharmacy Crawl for Opioids

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This week’s blog is dedicated to pain sufferers in all states, but particularly Florida that are expert at a new dance craze known as the “pharmacy crawl”.  Surprisingly in all my years as an experienced pain clinician, I had never known of this dance until a few weeks ago.  Unlike those of us that can easily learn a new dance because our good health and agility, the PAINFUL “pharmacy crawl” is limited mostly to chronic pain patients that are already stricken with a chronic pain disorder which by the way, makes it very difficult to navigate a limbo stick or dance the “crawl”.  This is one dance that most wouldn’t wish on their worst enemy.

Definition of Pharmacy Crawl:

First let’s break this down.  According to the Online Webster Dictionary
phar·ma·cy is the art, practice, or profession of preparing, preserving, compounding, and dispensing of medical drugs.  It is a place where medicines are compounded or dispensed.
crawl is to move slowly in a prone position without or as if without the use of limbs; to move or progress slowly or laboriously.

By these defined criteria, the chronic pain patients of Florida who may have coined the term are spot on!  The pharmacy crawl is a monthly (or more frequent) trek (to make one’s way arduously) to a Pharmacy in an attempt to fill their opioid(s) that were prescribed by a duly licensed provider for a pain syndrome that, if legitimate, would require continuous around-the-clock dosing of chronic opioid therapy.  Without a doubt, the licensed pharmacist should exercise caution with this (or any other medication) to determine that it is a legitimate prescription written by a duly licensed professional.  Also the pharmacist undoubtedly will review the RX for the correct dose, drug, patient, disease v. drug, and make an assessment of potential drug-drug interactions.

Florida is one of several states that had an overabundance of “Pill Mills” that were in business to maximize profits from drug sales in patients that were not legitimate in terms of a diagnostic disorder that would warrant the use of chronic opioid therapy.  The U.S. Drug Enforcement Agency (DEA) and the U.S. Food and Drug Administration (FDA) have often gone on public record saying that the intent of regulation in this regard is to mitigate diversion of controlled substances, but not to intervene or determine when a drug is medically indicated for a particular problem…and for the most part, as far as I know they adhere to that policy.

Until recently, Florida had one of the most pathetic Drug Monitoring Systems in the country.  Restated, the state of Florida had no such Drug Monitoring Program, the irresponsible fallout from years of political and regulatory negligence.  Ubiquitous Floridian Pill Mills were frequented by drug addicts traveling into Florida from various states (most notably perhaps Tennessee and Kentucky), the majority of which were run by corrupt physicians who in many cases partnered with corrupt pharmacists and non-medical moguls.

Writing on the new Florida Pill Mill Bill, Governor Rick Scott admitted, “This legislation will save lives in our state and it marks the beginning of the end of Florida’s infamous role as the nation’s Pill Mill Capital.”  That was correct, but then he went on to say, “The new law is as tough on illegal distributors and unscrupulous doctors, as it is fair to law-abiding patients and industry professionals.”  Governor, I beg to differ on your second point! And according to Governor Scott’s website, “In March, with the help of Attorney General Pam Bondi, Florida Department of Law Enforcement Commissioner Gerald Bailey and state and local law enforcement, Governor Scott launched the Statewide Drug Strike Force to begin turning the tide against criminal drug trafficking in our state.”  Well government leaders, I’m calling you out on your promise-while your intent may have been honorable, the outcome, at least in part, is unacceptable hardship to many legitimate patients.

Who was responsible for the Pill Mills, who stood to gain by squelching them, who are the heroes/heroines, who are the villains, and who are the victims?  Although there are lots of legitimate patients that are “crawling” from pharmacy to pharmacy each month, and no shortage of media coverage regarding the problems and successful demise of Pill Mills, there seems to be a lack of media attention toward the victims in all of this.

The Florida community at large stood to gain by eliminating the Pill Mills of Florida if they could virtually eliminate criminality associated with the illegal influx and outflux of controlled substances.  I support that and commend the politicians, regulatory agencies, and law enforcement officials who took long needed steps in the right direction!

Pharmacies stood to make a fortune filling these prescriptions-thankfully many of the corrupt pharmacy owners are in the slammer and others have had their supply chains cut off from wholesale distributors.  Heck, even some licensed drug wholesalers had their DEA licensed revoked!  For all this I admire the politicians that made it happen.  Kudos to you!

But make no mistake, politicians love to wave their flag and say to the world, “Look what wonderful me did by cleansing our state of corrupt wrongdoers?”  Do you see these same folks exploiting the fact that if their predecessors had done their job to begin with there wouldn’t be such a problem?  Are they waving flags emblazoned with photos of legitimate chronic pain sufferers crawling from pharmacy to pharmacy each month and spending a fortune on wasted gasoline in hopes to find a pharmacy that has their medication in stock, and if so, are willing to dispense these medications to a patient they don’t know?

Yes, Florida dignitaries, you have sent many criminals to prison, and rightfully so…please throw away the key and burn them at the stake if necessary…it should have been done years ago.  Any medical doctor or pharmacist who dare use patients to maximize profit at the expense of their well-being should be extradited for their corrupt behaviors.  But, the rapid fallout is legitimate medical doctors who have been threatened that if one of their patients overdoses, they likely will lose their medical license.  Really?  If unbeknownst to a parent, their child snorts cocaine and is arrested, should the parent go to jail?  Pharmacists have also been threatened and in some cases falsely accused of guilt until proven innocent; some have lost the ability to order controlled substances from their wholesalers; in many cases the supply chain cut-off certainly is and was legitimate, but in others, it may not be the case.

Yes, Florida Pill Mills were a mess.  Many of the clientele were nothing more than drug traffickers, others were hooked on opioids before even realizing it, and some were just plain thugs.  People made millions of dollars while the ubiquity of Pill Mills flourished in Florida, and although many [now in office] politicians had a legitimate concern, today their inaction and blind eyes towards innocent bystanders is unacceptable.  This includes patients suffering in pain chronically that are forced to dance the dreaded pharmacy crawl each month.

I suppose it’s more sensational for the media to cover the Pill Mills, associated corruption, and millions in criminal revenue than it is to cover the suffering patients, who by many, are simply written off as drug addicts themselves because that is an easier “pill to swallow” for politicians, their constituents, and perhaps state regulators.  But many voting constituents that are okay with this mess either because they don’t have pain themselves, don’t understand the complexity of the problem, don’t know a legitimate pain patient caught in the pharmacy crawl conundrum, or they are angry because a relative is an opioid overdose victim (self-inflicted or by accident).

I was delighted that the Wall Street Journal published an article on September, 27, 2012 to cover the patient side of this important story, entitled “Making the ‘Pharmacy Crawl’ – Wall Street Journal”.  Still, I don’t see any Florida dignitaries [yet] thrusting their tongues about to expose the pitfalls of their wonderful Pill Mill accomplishments or telling the world about the misfortune of “crawling” patients as a result of the rapid Pill Mill round up.  In short, although something needed to be done, it was very poorly thought out.

Those who initiated the Pill Mill Bill should have taken immediate but calculated steps toward solving the problem, but not overnight because state officials were in fact a part of the problem for years, and legitimate patients, medical providers, and pharmacists might suffer as a result.  I suppose it’s easier to take credit for shutting down the Pill Mills than it is to swallow one’s pride and admit there is significant unpopular fallout with poorly managed patient pain care.

Sensationalizing the shutdown of Pill Mills while at the same time ignoring suffering Floridians is unconscionable!  I hope that those responsible for the hardship patients are suffering today never have a significant accident requiring the use of chronic opioids.  Should any of you Floridian lawmakers find yourself in a situation forced to learn the latest rendition of the new “crawl” dance, I’d like to be playing in the band.  Florida dignitaries, PLEASE evaluate the problem and do the right thing-perhaps you or a family member will reap the benefits in the future.

24 thoughts on “Dancing to the Pharmacy Crawl for Opioids

  1. Dr. Pasha in Meridian Mississippi knew of a patient’s addictions now she is dead!! he was confronted by family and friends, he was going to drop her as a patient. however, somehow “changed” his mind, let her as a patient & kept prescribing pain medications to this patient; along with a few others (patients who’ve been “tagged” as over-takers) those patients are still living at this time. however the one particular patient, passed away from accidental over dose; because, of her addiction to pain meds. He was prescribing five different pain Meds to her along with vitamins and antidepressant and blood pressure medication! I don’t know how to report him anonymously!?! I used this doctor only two times & all he wanted to do was prescribed pain medication! I never went back to him!!

    1. As a specialist in chronic pain management, I can say two things to comment here. First of all MDs who prescribe in such a manner should be reported to their medical boards, as this was clearly unethical, at least in my state. Now, the great majority of good pain management MDs, do not do such things. As well as, there is a LARGE BODY of research that proves the following. 1. Offering opioid pain medicines in addition to other multimodal method greatly helps chronic pain patients lead more quality lives. The alternative: if moderate or severe chronic pain is not managed, a patient’s blood pressure can rise severely. Cause a major stroke or death. Again, well known results on much research, know by pain management specialists, like myself. And the rate of those patients who have chronic pain treated by opioids who ever have an issue with meds. ( addiction rates are less, this is one issue? ). A good deal of research shows the rate is less than three percent.
      The big problem with drugs, so called and deaths in the last few years, again by research, was cause by illegal drug users ( not chronic pain patients, ) using illegal Fentynal to get high. Unfortunately , it killed some of them. However, declaring a ” war on drugs, ” somehow became a ” war on chronic pain patients, ” who are already suffering a lot.
      The basic problems I see are : our government back then wanted to do something, YET the research must be understood and interpreted correctly before that could occur. Now, SURELY there are other specialists out there who can interpret the research.
      A lot can depend on which one lives in also. For example, in my state, it is both unethical AND ILLEGAL for an MD to not treat pain, acute or chronic. However, my best friend lives in a neighbor state without these legal and ethical protections. He is having a horrible time finding any treatment for his chronic pain.

  2. Posted by Dr. Fudin for Coonhound by request…

    According to the opiophobe zealots there DOES seem to be a consensus on what size opioid dose fits all. The problem is that size is 0 as in (zip, nothing, zero). I was turned away from having my methadone filled at Baptist Medical Center because I wasn’t using the right pharmacy (I was ‘awarded the privilege’of using only one of their 7 pharmacies to fill my schedule II Rx after 5+yrs as a patient there). The one I was supposed to use was out so instead of filling at one two blocks away I needed to come back Mon and drive another hour and a half out of my way.(it was 4pm Fri and day 32 on a 30 day Rx). Nothing pays like loyalty! I would hate to see how they treat people who just wander in off the street (their pharmacies are open to the public as well). What does this have to do with the topic? It could have sent me into pharmacy crawl mode which could be held against me because of profiling now being done on the disabled who fill Rx for opioids on their Plan D medicare insurance. Profiling?

    As torturous as the ‘pharmacy crawl’ has been for those disabled and in pain there appears there is going to be even MORE negative fallout that we could not foresee. As much as we would like to, or are under contract w/ pain doctors to do, use only one pharmacy, that has become near impossible for most. Unfortunately it can come back to haunt us as if we had done something wrong. Here is how:

    Information below from link: http://www.hematology.org/Advocacy/Policy-News/2014/3300.aspx

    Title: Potential Policy Fixes to Curb Medicare Part D Opioid Abuse
    Published on: October 22, 2014

    Medicare Payment Advisory Commission (MedPAC) is an advisory body to Congress.
    minus hospice and cancer patients the total number of patients prescribed opiates (counted are those who filled even just one Rx) equals roughly 10 million. Here are their findings on the 10 million opioid ‘users’.

    “The top 5% of opioid users account for 69% ($1.9 billion) of total spending on opioids. Users in this percentile, on average, fill twenty-three opioid prescriptions per year at a direct cost of $3,716 per person. 29% receive prescriptions from four or more prescribers, and 31% fill prescriptions at three or more pharmacies.

    Under authority granted by Section 6405 of the Affordable Care Act, the Center for Medicare and Medicare Services (CMS) has enacted changes that will go into effect on June 1, 2015. Physicians prescribing opioids to Part D beneficiaries will now have to be enrolled in Medicare, prescriptions ordered by unauthorized physicians will be denied, and Medicare enrollment will be revoked for abusive prescribing. CMS is also working to develop a tool that will monitor abuse by both prescribers and pharmacies.

    MedPAC discussed a policy proposal to utilize “lock-ins” for the distribution of opioids. A lock-in limits the number of prescribers or pharmacies that can issue a medication, and it can be utilized in many different ways. At-risk patients could be locked-in to single prescribers, or a single pharmacy could be locked-in to distribute all opioids within a geographic area (e.g., a state).

    While these policies might prevent opioid abuse, they could burden physicians and patients by limiting access to pharmacies for legitimate opioid use. Findings regarding the effectiveness of the coming 2015 changes will be analyzed by CMS and may be reviewed by MedPAC in fall 2015. Additional measures, such as lock-ins, will be considered after that time.” end

    Have 2 or 3 surgeries in addition to your PM doctor or PCP who normally writes your Rx? What about PM practices that use more than one doctor to write Rx for patients? I’ve had 3 write mine this year from the same practice? (too many prescribers for opioids) ? Pharmacy crawled a few months? (too many pharmacies used) You could easily be profiled as an abuser. Having my PM doctor allowing my surgeons to write for additional pain medication now doesn’t look as good as it did at the time. Switching main pharmacies and filling at two hospital pharmacies for surgeries may appear ABNORMAL and another RED FLAG. 5 doctors writing me an Rx in a year? On the surface it looks downright scandalous, OMG 5 doctors wrote NARCOTICS FOR ONE PATIENT!!!! That’s what scares me, these zealots never look much farther than on the surface.

    I wonder how all the addiction specialist psychiatrists sleep at night? They must know that there is much less ‘proof’ or evidence (reasoning against COT) of psychological disease(s) than pain conditions yet they write freely and unimpeded for large amounts of anti-depressants, stimulants, anti-psychotics, anxiety medications (now addiction meds) on nothing more than the patients report of symptoms? All of which have significantly longer and more severe side effect profiles including w/drawal syndroms than opioids; some like tardive dyskenisia being permanent. This seems a little hypocritical to me but that’s just my opinion.

    *Not sure how you revoke enrollment if physicians are not enrolled, am I missing something?

  3. I want to know is anyone in legislation fighting for us right now? I am unfortunately from Ky, also a chronic pain suffer for years and I am in the same boat as well. I just want to know how do we fight back and get the little bit of relief we can get . It is amazing the knowledge we have in this area, but we just stepped back in time totally disregarding the info we now have in this area. Which causes physical ,emotional pain, and causes social isolation due to the stigma. Guess we are not much removed from animals who hide when they are sick because they know they will be killed. People will loss there jobs become homeless and will become street wise to ease the pain or commit suicide to not have to deal with it.

      1. Although I sympathise with my fellow CP Floridians, please be aware that we are ALL experiencing the impact of our well intentioned (misguided) “law makers!” I’ve been in PM for many yrs due to multiple orthopedic problems. I was in a near fatal mva and left with a shattered pelvis (nearly 30 broken bones & fractures), and back related issues as a result of a crooked pelvis. I’ve also developed several rare illnesses & just recently had a tumor removed.
        I walked into my CP physicians ofc and left in shock!! He has no choice but to start limiting medications and possibly ending pt relationships due to the “watchful eyes” & “powers that be!” The doctors in my State are in fear of and have been warned: they will soon loose the ability to prescribe, BECAUSE; there is NO such thing as CP!!!!
        I blame myself for not staying informed & excuse me, for getting too preoccupied with my “struggle” of a (chronic pn’d) life!!! It was not enough for manufacturers to make some medications tamper proof, and never mind the state prescription databases, or urine screens and monthly doctor visits…..”they” are not going to be satisfied until our already (demoralizing, stigmatised) miserable lives are ruined @the expense of who, or what; Abusers and dealers!!! “The hell with the CP patient, right!” Through my recent research; I’ve become over-whelmed with the petitions and sites in regard to our current dilemma!! Where should we even begin….. @ the state level or? Please tell me where I can make the most impact, because my time is now limited & I’m nearly bed-ridden!!!

        1. I to have been in multiple high speed car accidents. At 20 yrs. old, while stopped at a red traffic signal light, rear ended at about 60mph ! Ten feet ahead of my mid sized car was a dump truck. Zero to 60 mph and back to zero in ten feet! But worse is 12 years later I was hit at 45mph while standing next to my car. I’ve had disc removed…phys.therapy of every kind. Tried ALL the medications. Chronic spine pain is my way of life and has only become worse. Opiod pain meds helped me. 120 mg of oxycontin and a few 5mg oxycodone for break thru pain. Occasionally mild muscle relaxer for cramping and spasms. Under Florida’s CRUEL AND IGNORANT opiod legislation I have lost my ability to live in pain any longer. I NEVER abused meds. I do not use alcohol or illegal anything. Nobody defended me. My insurance simply refused to pay at all…and now I have been forced to take gabapentin and I refused anti depressants due to repeated horrible life destroying failures at past attempts to comply with totally thoughtless legislation forcing anti depressants on an inoperable spine nerve pain condition. I’m 50 yes. old now and pain is like I just got run over again. One hit and run was horrible, but to be hit and run by FDA and legislation grouping me with abusers is honestly heart felt disgust and ashamed that this is my government. Dictators cause less harm. More it replaceable lives will be lost to suicide. . .as a human, unlike an animal, can choose to end their own intolerable pain when their leaders and representatives fail to do what is morally right and ethical. Forgive my government. As they know not what they do. God’s blessings, and unyielding strength to tolerate your pains, until we are allowed relief once again. Obama, Trump, Please help us all ASAP. Every minute hurts.

    1. I have a congenital hip dysplasia which i lived with without having to take any medications. When i became perm. disabled i began taking narcotics and was helped very much by them i followed the rules and was able to locate a doctor whom is very kind. when i had to move i found it impossible to find an md and now drive to her office some 400 miles away. It dose not make any sense. There is little concern that you will go without your next dose and get sick, it is so harsh and now i have only one choice …get over it .get over the fact the meds worked for you and learn to suck it up, thats the new therapy.

  4. How sad, and destructive….. I just noticed some Tweets on this page, Dr. Fudin. A David Juurlink seems to think the reason cancer patients are having a hard time getting opioids is the because chronic pain patients (who don’t “need” them) are taking them all. This is the kind of thinking that leads to further discrimination, lack of treatment, and more shame and blame on the chronic pain community. Lack of access to opioids for anyone suffering from serious pain, is a policy problem. We’ve taken enough abuse, blame, and neglect. Please don’t contribute to the problems people with pain are already burdened with. We are a group of people, who through NO fault of our own, have been dealt a lousy hand with serious, painful, medical conditions. We deserve as much compassion, respect, and treatment, as anyone else who suffers from severe pain!

    1. Nancy,

      Thank you for your comments! I cannot prevent people from voicing their opinions on Twitter, nor do I want to. Right or wrong, everybody is entitled to their opinion. I made three replies to Dr. Juurlink’s Tweets. One of those Tweets pointed out that of all opioids prescribed in the U.S., 2% are methadone. But, over 30% of all opioid overdoses are from methadone, a large part of which are presumably due to incorrect prescribing. Also, I have seen several incorrect determinations of death blamed on high blood levels of opioids without considering the level of tolerance in a particular patient. I’m quite certain that this anomaly at least in part may contribute to an overestimation of opioid deaths.

      Unfortunately, some doctors are convinved that use of opioids for non-cancer pain are the devil. Interestingly, two of the signatories on the PROP peition were authors with me on the 2009 APS AAPM Guidelines for use of chronic opioids in non-cancer pain, yet 3 years later they changed their mind. (See Chou R, Fanciullo GJ, Fine PG, Adler JA, Ballantyne JC, Davies P,6 Donovan MI, Fishbain DA, Foley KM, Fudin J, Gilson AM, Kelter A, Mauskop A, O’Connor PG,Passik SD, Pasternak GW, Portenoy RK, Rich BA, Roberts RG, Todd KH, Miaskowski C. FOR THE AMERICAN PAIN SOCIETY–AMERICAN ACADEMY OF PAIN MEDICINE OPIOIDS GUIDELINES PANEL Opioid Treatment Guidelines, Clinical Guidelines for the Use of Chronic Opioid Therapy in Chronic Noncancer Pain. The Journal of Pain, Vol 10, No. 2 (February), 2009: pp 113-130.) at http://health.utah.gov/prescription/pdf/guidelines/ASP.AAPMguidelines.pdf.

      Dr. Juurlink is also a signatory on the PROP petition. He is an MD and Medical Toxicologist in Canada. I’m not sure that any CANADIAN signature on the PROP petition to the UNITED STATES Food & Drug Administration is appropriate; it is just one more added irregularity in their petition. And for the record, there is another Canadian signature by one of Dr. Juurlink’s co-workers, Dr. Irfan Dhalla. I don’t know if either one of these doctors is a U.S. citizen, but I intend to find out, especially since the PROP letter was submitted as a “citizen’s petition”. How sweet would it be if that nullified their request?

      1. Thanks, Dr. Fudin, I appreciate your responses to his comment. It is frightening, as a patient, to see such damaging comments coming from a professional! I shouldn’t be surprised, I guess. The PROP docs are quite contagious these days. Not to mention the amnesia that most of them seem to be suffering from!

        I am going to share this blog with my support community (through the Ehlers-Danlos National Foundation – EDNF.org). Many of us rely on opioid therapy to significantly reduce BOTH the severe acute AND chronic daily pain we experience as a result of this devastating genetic connective tissue disorder. More and more patients are being denied access to opioids, abandoned by doctors, or have had pharmacies refuse to fill legitimate prescriptions (in a number of states). Our lives, and our futures are at stake.

        Thank you, Dr. Fudin, for drawing attention to the “other side” of the story. Some policy makers seem to think that because these consequences are “unintended”, they don’t have to address them. To people living with pain, they’re just consequences. Intended or not, they are serious, devastating, excruciating, consequences. Policy makers, the DEA, and others, need to know that they are being judged by their ACTIONS, not their INTENTIONS!

        What a terrible time to be living with pain.

      2. I have personally exchanged e-mails with Dr, Dhalla and after careful consideration of the plights of some of us “non-cancer patients” like myself who suffers daily from EDS I was assured that there are those of us which the need outweights the risks. here is his last e-mail reply to me:

        I do not believe opioids should be used only for those with cancer. I agree with you that in some patients with chronic non-cancer pain, benefits outweigh harms.

        Best wishes

        Irfan

        That was in November of last year, so unless he has recanted his position, he has agreed tha non-cancer pain might also have some instances where opiates are justified.

  5. Thank you, Dr. Fudin, for all of your support of chronic pain patients. I periodically make a file of articles, blogs, etc. on this subject and take it to my State Representative’s office in the hope of “educating” him and his co-workers on this problem and the resulting “Crawl Crisis”. I believe education to be the best way to resolve this issue, and you are a wonderful teacher. Again, Thank You!

    Most Respectfully,

    Karen Stateler

  6. My thoughts on this proposal from PROP,

    The proposal by PROP to the FDA got me to thinking what can we compare this to and it make any common sense.
    When my intractable pain started it was mild then moderate then it became severe.
    So after much thought I got to thinking lets compare what PROP is proposing to the food we eat.
    For the striking of Moderate Chronic pain from ever being treated, lets compare it to this.
    Okay lets compare Moderate Chronic pain to Medium Picante sauce , lets take all Medium picante sauce off of grocery shelves.
    I use to be in grocery sales and I sold Pace Picante sauce, the Medium sold the best, the hot was severely hot and I could not eat it, the mild was okay.
    Okay now we have angered a lot of people taking Moderate Picante sauce off all grocery shelves. Hence the striking of ever treating Moderate chronic pain.
    Eventually that moderate chronic pain will become severe if not treated in a timely fashion.

    Now lets go to allowing only 100 mgs of morphine a day and the equivalent to any one person that suffers from chronic pain.
    That’s like telling people that cant eat more than 650 calories a day. Do you all get what I’m trying to say. We all want things a certain way
    but most of the time we settle with the things we can get and be satisfied with that.

    Now lets change all labeling on food items and write on everything, If you eat this food in abundance it can cause obesity.
    Just like if you abuse opiates they will shut down your respiratory system. I don’t think a lot of people understand the anatomy of the body.
    People will abuse opiates, we cant stop it, all we can do is close these illegal pill mills and move on.

    Now lets but a limit on how much food you can buy to a 90 day period, after that your cut off of all food supplies, you must grow your own food after that.
    If your really poor and have no transportation you will have to go dumpster diving.

    This proposal PROP made to the FDA so far has only harmed people that suffer from chronic pain. Dr. Kolodny stirred a pot that didn’t need to be stirred.
    As if things where not bad enough for all that suffer every day from chronic pain now this. All the doctors that signed his proposal I thought your first promise as a doctor was the Hippocratic oath was to “first do no harm.” To promise to prescribe medicines to the best of your knowledge.
    I know one thing I would not want any of you being my doctor.

    I do not support this proposal by PROP.
    To regards to all that suffer from chronic pain.

    Mark S. Barletta

  7. Imagine waking up and being hit with the crushing pain of being under a steam roller and not being able to move until your pain medication “kicks” in. Then imagine you wake up like this every day. Then imagine it is day 28 of your pain prescription and it is time to take your monthly prescription to the pharmacy to get it filled. But you don’t know if it is going to be filled because it hasn’t been filled by any particular pharmacy in the last ten months. Just the stress of not knowing that pain relief will be there for you is enough to bring on anxiety beyond belief. Anxiety that raises your pain level even higher without you being able to do anything about it. And then on top of the pain and the anxiety, the fear of wondering, “When will I go into withdrawal?” The constant not knowing, “Will I have to go a day or three or a week in pain and still have to carry that prescription around town, all the while in pain and on the brink of withdrawal, and how am I going to do that, anyway?” Every 28 days. It’s insanity. Thank you, Dr. Fudin for speaking out for me and for thousands like me in Florida every day.

  8. Dr. Fudin.

    Thank you! Thank You! THANK YOU!!

    I live in Billings, Montana. As a patient at a pain clinic, I followed every dictum, rule, and suggestion. This year, Like HUNDREDS of others, I was rapidly cut off from the ONLY thing that has controlled my pain long term and then ignored. (I was on a stead dose for almost 4 years.) HUNDREDS. In one year. Does anyone believe for a second that all of those folks just “bot better’? Not hardly!!

    If I may, I would like to send a copy of your entry to my local media.
    Please GOD, let them HEAR us!!!

  9. Dr. Fudin;

    First of all, thank you from the bottom of my heart for all you do for us pain patient’s here in Florida, we are been treated like criminals just because we need treatment, and we have no one but Gov. Rick Scott, Pam Bondi and the DEA for this persecution. I was one of the lucky ones, that found a compassionate pharmacist, that is willing to order my medications monthly, but for one of me, there’s 6 that can not find their medications, and are going through withdrawals and pain, just because this State decided to “throw the baby with the bath water”!!

    Again, thanks for all you, and if you ever need ANY help, signatures, anything, please know that you can count on me.

    Sincerely,

    Millie Andreasen
    Miami, Florida

  10. Dr Fudin,
    I am so pleased that you wrote about what the real truth is in all this, especially in Florida. I have blamed the state for allowing these pill mills to run wild for several years. The state government let this happen and sat back and watched but did nothing until going overboard. Your comments are exactally what needs to hit the front page of all newpapers. I can only hope that Florida’s government reads this. I don’t know why journists don’t write the whole truth. It seems they jump around in the subject but never hitting on what really needs to be said.. The cruelty in these actions that the politicians are causing to innocent Americans in pain is uncomprehendable . I can’t believe with size of Florida’s government that they could not think things through before acting in a way that harms so many. It seems that chronic intractable pain and opoids have become dirty words in the households of Americans now days because of the negative, lopsided media reports. I hope with your help and the help of all other good doctors, patients, and organizations along with “Fight For Pain Care Action Network”, that we shall will win this war against pain care! We do need to be heard and understood. Thank you very much!

    1. FYI, I left a message with Governor Rick Scott asking him to read this blog. If he reads my message and follows up by reading this blog, he should see this REPLY. I hope for all the “paining” Floridians that he takes my message seriously.

  11. This pharmacy crawl issue is an utter disgrace. This is systematic, widespread, discrimination of the sick, disabled, and elderly. I suffer from severe Intractable pain that is managed with opioid therapy and other tools I use for pain relief. I would say I get about a 50% reduction in pain from my medication most days. Once a month, I go to my doctor and to my pharmacy to fill my prescription. Usually, on the day I do this, I don’t do much else outside of my home, because it takes a lot out if me physically. Just getting out of the car, walking down hallways, through parking lots, back in / out of the car, waiting for my prescription can be a tiring, painful process for someone who suffers from chronic pain. Thankfully, I have a wonderful doctor, and pharmacist, who are BOTH an essential part of my overall health & well being. My pharmacist was educated about my condition by my doctor, and I am always treated with respect, dignity, and care. I have never had a issue filling my prescription, and I know how incredibly lucky I am. I simply cannot imagine anyone trying to make my life MORE difficult than it already is! To deny essential treatment to people who have a legal and legitimate need for it is unacceptable. To force legitimate chronic pain patients to spend DAYS going from pharmacy to pharmacy to get their medication is a disgrace. It is a human rights violation in my opinion. Until you have lived with serious, unrelenting, incurable pain, you just don’t have a clue how serious this is. No one should have to live this way. I feel awful for the people suffering in Florida….those paying the price for the people who have already been run out of town. How is this good policy? Since when is it okay to allow human being s to suffer like this, when we have enough sense not to let our PETS suffer this much? Thank you, Dr. fudin, for drawing more attention to this CRISIS (it IS a crisis) that is devastating the lives of so many people. Something needs to happen before the suicide rate starts to skyrocket, or suffering people start being forced to “self-treat” by going to the streets, drinking themselves to death, or overdosing on heroin. People simply cannot live with this kind of pain and NOT seek relief. They shouldn’t HAVE to.

  12. Dr. Fudin,

    I appreciate all of your hard work, I hope all that suffer from chronic pain do not give up.
    This latest email I received from PROP is somewhat hard to imagine people can be so cruel.
    For those that suffer every day from intractable pain, chronic pain that cant be removed from the body with surgery, I pray they all find what best helps them with their never ending chronic pain. I think back on the ten years doctors made me suffer and for what. The answer to my problem was sitting on the pharmacy shelf held back from me because of fear of addiction.
    At what point in ones life does dependency really doesn’t matter when it helps a suffering person be able to live a somewhat normal life and them return a productive member of society.

    Its good all these illegitimate Pill Mills where closed down , but a legitimate pain patient should not have to suffer the consequences. I’ve been over this so many times in my life ,its starts to where it gets old writing about it. But I will continue to support all legitimate pain sufferers, I will also advocate for them. I sure hope Dr. K. feels like he is more a man today because leaving people that suffer from severe chronic pain to suffer even more is not what I call a leader. All of this that PROP started from the very beginning has been a utter amazement to me. I hope they have a feeling a great accomplishment on their half. Closing down Pill Mills was a good thing, its about time.
    To the pain sufferers that will catch fall out from this I hope and pray you can get the pain treatment you need and deserve.

    This pharmacy crawl you speak of just sickens me, no person here in the U.S.A. should have to suffer from severe chronic pain.

    Best regards,
    Mark S. Barletta

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