A Bridge Too Far (fetched)?
There is little doubt that ours is a polarized nation. We have elected, but constantly complain about, our “do-nothing” government wherein every disagreement leads to impasse. There is no longer such a thing as a civility in political discourse. Whereas disagreement and debate conducted with respect for one’s opponents’ views is central to a democracy, no longer do those on opposite sides of the aisle view the other side as their noble adversary – as ethical and patriotic as those on one’s own side. Both sides, it was once taken for granted, in the end want only what they truly believe is best for America and Americans. Instead, the other side’s positions are dismissed as extreme, crazy or simply disingenuous (disagreeing simply to stall and cause failure or garner attention). WE are the normal, ethical and thoughtful ones, THEY are crazy zealots.
Guns. Abortion. Healthcare. Opioids.
OPIOIDS???
Can people who believe that opioids are potentially helpful to a (sizeable) subset of those with chronic pain ever reconcile with people who believe that they are good for nearly nobody and worse are killing people? Two divided factions have emerged, as cantankerous as Democrats and Republicans, as Progressives and Tea Partyers, as diehard as the Boston Red Sox and the Yankees, as Left and Right, Oil and Water. Our government can be completely stalled and shut down even when leaders want to find compromise but cannot, because they have to hold together their coalition, but each have vocal constituents with polarized experiences and views. The opioid debate has similarities. The pro-Opioid and anti-Opioid movements are made up of professionals, lay persons and others with highly disparate views and experiences, not to mention loss and catastrophe.
Imagine trying to reconcile:
You will never see your child again because of a narcotic overdose
With
You will never see your spouse again because of suicide from unrelenting pain
Yet both sides really want one thing and one thing only, what is best for America and Americans with pain, addiction and suffering of all kinds. And what we have going for us is we have 30 intelligence quotient (IQ) points on the average modern politician.
Can’t we all just get along?
There are potentially over 100 million people in this country with chronic pain. If there is one thing we might be able to agree on is that any discussion of a therapy that is good for everyone is too stupid to have. And so too is a discussion that any therapy is wrong for all of them. Even if benefits were once overstated and risks belittled, intellectual dishonesty pushing in one direction doesn’t justify it pushing back in the other. Not when patients are squeezed in the middle. So while I can sometimes be militant and perhaps even intransigent, please pardon my passion, and for the sake of people, who are suffering, let’s attempt to build a bridge. Personally, the entire issue has been quite daunting for me in my practice as well as trying to balance that while combating some otherwise respected adversaries and supporting other ethical and competent pain practitioners. Let’s stipulate that we agree that prescription opioids are a Godsend to some, they can be the end of the world for others.
Imagine each day walking into your child’s bedroom knowing you’ll never see your precious son or daughter again because of sudden death from an opioid overdose. It’s heart wrenching so say the least, but not really a sudden death- it’s more of a slow death that includes anxiety, depression, humiliation, panic, and devastation for the victim and the family. The days, weeks, months, or years leading up to it will undoubtedly annihilate any family. The victim of addiction finds him or herself out of control, unable to function, and unable to work or lead any type of productive life.
Now imagine each day awakening next to your spouse, riddled with chronic pain unresponsive to any medication but opioids such as morphine or oxycodone. Heart wrenching to the family? Of course – it’s also a slow death that includes anxiety, depression, humiliation, panic, and devastation for the victim and the family. The days, weeks, months, or years leading up to it will undoubtedly annihilate any family. The victim of persistent unrelenting pain finds him or herself out of control, unable to function, and unable to work or lead any type of productive life.
People, WHAT ARE WE DOING? After almost two years of news reports, professional meetings, media blitzes, Big Pharma bashing, Tweets, and more, from with professionals including ethicists to psychologists, medical doctors, pharmacists, pain specialists, nurse practitioners, physician assistants, podiatrists, other various backgrounds, researches, and families that have lost their heart and soul to the death of their loved ones, we are no further ahead today than we were two years ago when PROP sent a petition to the FDA requesting prodigious changes to the allowable indications for opioids. Just days following, PROMPT countered with objections citing flaws in the basis for the request.
Smart practitioners, researchers, and writers from every corner of the United States (and Canada) have continued to banter around the various pros and cons of chronic opioid therapy all of whom have yet to produce a shred of indisputable evidence to support either position. WE NEED THAT EVIDENCE!
So here we remain two years later spending more energy fighting than trying to correct the problem together. We have two camps of zealots; those protecting the interest of families stricken by addition, overdose and death and families stricken by unrelenting persistent pain that virtually ruins their life to the point of begging for death.
We have reached a turning point where we must work in concert to attack both problems together. There are too many smart clinicians and families to spend more wasteful hours fighting. With this blog, I am calling on all victims and professionals to comment. Here we have over 100 comments from various pain patients telling us how horrible their life has been because of their persistent pain issues. We need also to hear from the families of those that have lost loved ones to overdose and tell how their mental anguish is just as, or more painful. We are a community – WE ALL HURT! We therefore must rise up together and understand each other’s issues to develop solutions instead of preserving barriers with PROP and PROMPT followers on each side of the pond.
Automobile insurers offer incentives for drivers to obtain discounts if they take “defensive driving”. Considering the risks of opioid therapy; perhaps “opioid drivers” (prescribers) should be offered incentives by insurers and state licensing agencies to obtain much needed education; perhaps pain patients should be required to attend risk opioid risk seminars (at the expense of managed care) to understand the world of addition; perhaps families of addicts need to hear from people who have had positive life-changing events from taking scheduled opioids. This should not be a punishment for either group of people – but instead it should be used to create a respectful understanding of each other’s world for the greater good of community, to allow opioid access where it belongs, and to prevent it from getting into hands where it doesn’t belong. Who will pay for this? I believe it would be a bargain for government, health insurance companies, and even Big Pharma. And I think a carrot approach must replace what heretofore have been only sticks.
Please let this blog post be the beginning of a community consisting of patients requiring opioids and those loathing opioids. With this information, perhaps we can promulgate an incentive for the professional pain and addiction practitioners together with families, to work with various government agencies, insurance industry, and Big Pharma to create solutions, study long term outcomes, and treat addiction as a disease with proper medical coverage without a requirement to be completely downtrodden and homeless.
LETS’ START WINNING SOME BATTLES BEFORE WE LOSE THE WAR. WE MUST COME TOGETHER AND EXPERIENCE EACH OTHERS PAIN WITHOUT THROWING DAGGERS.
EVERYBODY, PLEASE TELL YOUR STORY AND SHARE YOUR OPINIONS!
After many years of being turned away when attempting to make an appt with a spine surgeon and being told everything from you are not operable, when I say still able to walk to you are too high of a risk so we can’t accept you as a patient, it no wonder I needed to increase my opiate dose to attempt to live a normal life. At one appt, I was informed my dose exceeded the recommended amount and my break through meds were cut by 50%. During the two years after this reduction, my scoliosis accelerated but I was not provided any additional relief. Fourteen years after my failed triple spinal fusion, I was very fortunate to find a surgeon. I hadnan EBI battery surgically removed in December 2013, an emergency cervical fusion in February 2014 and my next surgery to fuse my lumbar and thoracic spine will be in a couple of months. As a widow and someone who lives alone, I was unable to convince my insurance company that I needed assistance after my cervical procedure. They commented that, “You’re only having a cervical fusion!” They gave no consideration that it is my lumbar spine and the hideous scoliosis that is at the root of my most severe pain. I spent three weeks unable to shower or change my clothes because I was in too much pain. I’ve been speaking with my insurance company about having assistance after my next extremely major surgery. I have also mention this to my pain doc. I don’t feel I’ve made much of an impression with anyone. I cant move forward with this major surgery I am ignored. With all of the studies done regarding opiate related deaths by abusers, are there studies of patients that are no longer capable of dealing with their pain that ultimately decide life is not worth living?
Dr. Fudin,
This post is wonderful, and I’m really glad to be part of a team of pharmacists in Pennsylvania that are providing care for the outpatient chronic pain population in our area.
There definitely is no cookie-cutter answer for all patients and providers here, but I do agree with some of the commenters about the importance of education for both.
For patients, we have developed a once monthly Multidisciplinary Pain Program (MPP) that is starting to build some “street cred” within our health care system. The chronic pain patients come up with their own goals and work toward those goals with their providers and MTM pharmacists. Part of this 1/2 day program has education for the patients on the addictive potential of opioids. I think this is a good start for tackling the problem from the patient perspective. It would be ideal if every patient that is prescribed chronic opioids were require to go this MPP, but just not practical. We also have an addiction specialist who specializes in chronic pain to whom we can refer patients that may be exhibiting signs of addiction. We also have patients see the specialist if they have a history of addiction, but most likely will require opioids to properly manage their pain.
As for providers, I definitely do see it being more difficult to provide effective education than to patients, just because there are conflicting opinions in family practice and pain clinics on the prescribing of opioids for chronic non-cancer pain already. For example, I work at a family practice setting, one day a week, where every doc has been influenced by their colleagues that methadone is inappropriate for chronic pain because of the risks involved with cardiac monitoring and high rate of overdose. This is a shame, and we have already held a presentation for the docs about the proper use of methadone in patients with chronic pain, but none of their opinions changed. As pharmacists, what more can we do here?! I think the answer here is…MORE EDUCATION.
Education is always the best answer regardless of which side of the camp we reside. As for parents who have lost loved ones due to addiction, my heart bleeds. I am a family member of a life destroyed by drug addiction. That said, instead of accusing the pain community, perhaps a better solution would be to learn about the risks of addiction so that further harm can be avoided, which by the way, applies to both camps. We should all be fighting, all of us on both sides of the fence, for better access to risk management, education, and facilities and programs that improve outcome. Fighting over politicized issues seems to cause nothing but gridlock. Even family members fighting against the use opioids are at an increased risk of developing some type of addiction, for all the reasons you mentioned Dr. Fudin. Well written, well received from a health educator and chronic pain patient who fights for the right of choice..
Amen Celeste. We need to make this happen!
Education is definitely the key. I’ve learned about opiates and pain receptors in one seeing with my pharmacist (is this Justin) than the four or so years that I have been on opiates. If it wasn’t for my wife, who works for a hospital, I’d never know about using methadone. Although I haven’t started switching over yet, I’m glad to see there is a light at the end of the tunnel. I’ll say another thing, neurological surgens don’t listen and automatically go into defence mode, when questioned and in my experience are hard to work with and have no interest in being a “team” player.
Thank you for this article, Dr Fudin. I know that innocent lives were lost when pill mills proliferated. But Florida has won that war – why are doctors and pharmacists being terrorized by government agencies into denying proper care to their chronic pain patients? These federal and state agencies can delude themselves into believing that their policies are saving lives but really, they have simply displaced the problem without addressing it. I believe that pain patients are dying because they cannot get their pain relief prescriptions filled. They are disabled yet are being required to do the “pharmacy crawl” after every monthly doctor’s appointment. Their chronic pain conditions are real, and yet far too many are being denied their medication. So some of them turn to street drugs for some relief and die of overdoses. Others kill themselves from the pain and despair. How can this situation be said to save lives?
Thank you and the others who care about life with daily pain. I did not want to leave the job I loved as a nurse. 14 surgeries and several mistakes have left me to 80 pounds and in tears over the quality of my life presently. Every 30 days a painful hour drive to pain clinic praying my damaged bladder will give the specimen in the bathroom where I am not allowed to flush commode or run water. Then hoping that the medication will be ordered that keeps me from dying from the pain. It is so hard with the failed fusion, sciatica, pheriphral neuropathy and bursitis in hips. The limited movements of not bending, unable to walk, sit or stand even with the narcotics for long. Then having my personal power taking away because in order to get the medication that allows me to bear the pain I must agree to the dangerous, useless painful injections that are not FDA approved. Refusal meant discharge with no medication. Then I must try to find a pharmacy to fill. I went to 6 in 24 hours begging for help. My usual pharmacy turned me down. I even asked to special order but was refused and lied to. I have required narcotics for more than 10 years. Not by choice but necessity. Now I am being discriminated against. Judged because I tried to find a pharmacy to work with me even pointing out that one would be safer to use the same facility. Then I read governor Halsom 17 point plan to make pain more of a patient problem in Tennessee on Tennessee.gov. under news. How anyone could make discrimination legal beats me. We are not criminals, the meth and heroin dealers do need arrested but our legislation forgets that. Better to make patients suffer, allow pharmacists to lie and deny you the medication that keeps you alive. Tennessee has the great narcotics monitoring programs and I have my sheet in the bed beside me. So I must wait to the hour and pray that it is filled. I have no patience for games unfortunately after years of sickness. I would love a life free from stress to enjoy my Kindle and grandchildren. I do not understand how needing to be medicated makes me a criminal with no rights or even legal assistance with these concerns. I would love to be normal but a cure doesn’t exist for nerve damage yet. Thank you for your concern and allowing me to know that perhaps others could understand what it is like not to be able to sit at a grandchild’s ballgame or not to be able to fix the bathroom floor from a very small disability check. Just to be free from discrimination and fear would lessen stress. It’s 2 am and I am awake, hurting because my medication was cut 1/3 because of DEA DECISIONS so I was told. Doesn’t matter that the medication doesn’t last 12 hours. Doesn’t matter that I can no longer shop, go on outings that doesn’t involve doctors. I have tried the tens units, the physical therapy and yes even the mediation for distraction, hasn’t stopped the pain yet.
We need petitions for the proper care of chronic pain. Like the ones that PROP have gathered and then we need to find a politician that would bring it to the floor for debate an discussions. Politicians look at numbers that will affect their being reelected,so lets see if we can get one going that involves both sides an get some signatures in numbers that will get their attention.
I agree with Timothy L. Howard here on this idea. We NEED a good petition that is supported by Lots of doctors and professionals who stand with the suffering pain community. I feel this is possibly one of the ONLY ways anything will ever change for us. This petition needs to address the DEA and how they are causing harm for innocent patients. Since these problems are now country wide now, it’s going to take something very BIG and very voiced loud to get this straightened out from the point where we are now. All in Washington D.C. needs to know and hear of what’s happening now days to the suffering patients since the pill mill idea has went over board. I would bet most of them have no idea! I hope and pray that this petition can happen and SOON. The little petitions that are done seem to never get heard loud enough or big enough, but if this one was voiced by plenty of healthcare professional behind it along with the American people who live in pain and those who watch their loved ones suffer every day, I think this one can work! What is all of your opinions on this one?? I haven’t heard anything else here that could work yet. This is it friends. Nothing is going to get better for anyone of us until everyone knows what’s happening in ALL the states these days. Anyone can end up with chronic pain from a ton reasons and we never know when that will happen. For many people,” It’s today”.. So no one is immune and will most suffer with no medicine to help kill the pain. Think about that for a second…
My pain medication makes my life more tolerable. I take it because I have to not because I want to. Addiction is a disease. My sister was a heroin addict for 10 years she started using drugs to forget her pain, her emotional pain. Maybe the key to all of this isn’t the restriction of pain medication to those who need it but a better mental health system for those who become addicted. In the 70’s the average stay of someone in a mental health facility was 6 months today it’s barely 30 days per year. If a pain patient feels as though they need help with addiction doctors also cut off the meds they need for pain. Whereas a heroin addict receives many months if not years of methadone treatment. The system is broken all the way around.
The longest journey begins with the smallest first step. The longest bridge begins with the smallest first brick. Both sides need to have compassion for the other. And your exactly right about pharmacists Dr chain my daughter is a nurse at Pikeville Methodist and two cousin’s that are Pharmacists.
Sorry meant to say Dr Fudin not chain.
I applaud your efforts on behalf of those in chronic pain. I know my days of getting by on Aleve are numbered due to the progression of my RA.
It makes me sad and angry when so many that I know think that every person taking pain medication on a daily basis is a drug addict, I hear them compare their experiences with after surgery pain and trying to make them understand that the pain from post surgical procedures goes away and chronic pain never does is daunting to say the least.
The one thing I don’t understand is why we don’t have the same constraints or concerns about alcohol? We hear constantly of the families whose lives have been torn apart by it due to addiction, or traffic fatalities, yet it is not at all difficult to get a hold of if you are under age or if you want to tie one on.
Why pick on a group of people who did not ask to be in chronic pain and can barely stand the life they have been sentenced to with their diseases?
I was even told that I should “offer my pain up”. my answer is “you first”.
If you don’t have to live with it, you have no clue what it is like for those who do.
What I am going to say is no different than so many others. I have been a chronic pain patient for the past five years. I have had four spinal fusions in that time that have left me permanent nerve damage. I live in a small town and pain management doctor are few and far between. When I transitioned from workers comp ins to Medicaid I lost my doctor I had for 4.5 years. I was on a high dose of pain medication and had to withdrawal abruptly while I waited to for the next available appointment with a new doctor. This doctor lost his practice right after I had my first appointment. Now I’m trying to get in the last doctor in my area. This transitioning has left my pain spiraling out of control. My family practioner can not keep my blood pressure or pulse at a level that is safe. Family practitioners do not want to write scripts for pain meds. They are afraid of the government crackdown on pain scripts. I live day to day in extreme pain, I rarely sleep. And there is no guarantee that the other pain doctor will accept new patients. The office says that they so many referrals that they have to turn over half away. Why? Because everyone is afraid that these scripts will end up on the street? Prohabition didn’t stop people from drinking alcohol. Those who want the meds will find a away. However those of us who have never broke the law is living in pain daily.
I am a RN. I have seen addiction and overdose. I have also seen people struggling just to survive a few hours with breaking down from excruitating pain. There is common ground that we can agree on, but first there needs to be some education. It’s so easy to pass generalizations then to see an individual.
IMO.. contracts are being broken left and right… the pt has a contract with the insurance company to pay for medically necessary medication.. the insurance company has contracts with pharmacies to provide/fill/bill these prescriptions. in the case of Medicare Part D or Medicaid.. the insurance company has a contract with CMS.. If the pharmacy has a contract with a wholesaler to buy medication from and the wholesaler rationed controlled drugs.. then the wholesaler has violated the contract with the pharmacy. If a valid/on time/medically necessary Rx is presented to a pharmacy for a covered drug by the pt’s insurance.. and the pt doesn’t get their medication.. it is caused by one or more parties violating their contract with another party in the transactiion. If the pt is eligible to be covered by ADA.. then a civil rights violation and discrimination under the ADA has happened.. which brings in DOJ.
It is my opinion that pain pills don’t kill people, people kill people. Its just like guns. My very best friend killed herself while she abused pain medications. She knew it was wrong to take as many pain medications as she was but her pain was so great that I feel she didn’t have a choice but to take more and more pain meds to find relief. She went to pain management and they wouldn’t help her get her pain from a severe disc degeneration of her neck under control. Her chin rested on her chest the disc were so bad and all they wanted to do was give her shots when she should of had surgery for it. Her family and myself visited her everyday to watch her for her abuse and after we left she would load up. I even took her medications away from her and gave her a days dose at a time. After I thought she had it under control she found someone who would sell her their meds and she just overdosed on them. It wasn’t an accident it was her choice.
I know it was her choice because I too am in severe constant pain. I’ve had four back surgeries so I know what real pain is all about. I’m stuck in bed everyday from constant chronic pain. For the last 14 years I’ve had just about every pain medication on the market, and alternative medicine so for anyone to say pills kill people just doesn’t really know what its like to live in real pain and how honest chronic patients deal with the DEA, doctor and pharmacy bull to get the right care we deserve.
First and Foremost, Dr. Fudin, I applaud your attempt to bring together these two polar opposite opinions in hopes of brainstorming for solutions agreeable for both sides of the spectrum.
I have read through the comments and seen a couple good suggestions and was happy to see a post from someone who sees the problem differently than most of us do. We need communication, desperately, good communication is key to changing anything; I also believe this is a good start on the communication level.
However, there are so many other levels which need to be addressed, for starters it was said Opioid prescriptions are risky no matter if taken properly or not, this is true, but shouldn’t the patient be the one to decide if they are willing to take that risk? The DEA and Legislators shouldn’t be stepping in and making that decision for them, since when did we lose the right to think for ourselves and make decisions regarding our medical care? I was glad to see it said that they didn’t want to take opioids away from patients already on them but the problem is….that is exactly what has happened.
People who have taken opioid prescriptions for 5 years or more, some were just released to their own devices or referred to a pain clinic, which takes weeks or possibly months just to get an inital appointment and also where the staff couldn’t care less about the patient, they only want to get them in and out as quickly as possible. I am sure we can agree on the patient/doctor communication, a doctor needs to spend more than 5 min with a patient in order to understand that patients needs; one poster had already mentioned that point so I won’t go into anymore detail about it because I agree with what they had to say regarding the patient/doctor communication.
I have to say that I don’t agree with any sort of registry containing people who are prescribed opioids, the reason is because these people have done nothing wrong, they are only sick and need treatment…so why should a doctor keep a registry on them? I also don’t agree with the KASPER system but I know that is not going to change because of it’s so called success. I don’t think we should have to give our personal information to a pharmacy clerk just because we have an opioid prescription, giving my SSN to someone shouldn’t be mandatory before I can receive a medication which my doctor says I need, and the pharmacist shouldn’t be able to deny my prescription just because they think I don’t need it or they think I fit some type of unauthorized profile they have made. These things need to be fixed as well, I do not feel a pharmacist has the right to over rule what my doctor says I need, especially if it is a prescription which I get monthly. Who gave them that right? Our Legislators did didn’t they? Legislators who also have never been to medical school and shouldn’t be allowed to say what medications I can and cannot have based on knowing nothing about my medical history!
We, chronic pain patients, go to our Doctors because we trust they know what is best for our illnesses, we trust they are doing what is in our best interest. I do believe if the patient has never had an opioid prescription before then they should be aware of ALL possibilities relating to the prescription ( I completely agree with that) However I don’t feel the pharmacist should be able to reject the prescription just because they don’t agree with it. This issue really bothers me, Pharmacists are not our doctors, they do not know our medical history or our medical problems so they should not be allowed to dictate what medications we need!
This could be easily fixed by the Legislators taking that power away from them and telling them not to judge people based on a backroom ‘made up” profile they believe certain people fit into.
I have so much to say but I don’t want to take up so much room on your page, but I will say one more thing…..Chronic pain patients are suffering daily because we cannot get adequate treatment, even if we receive an opioid prescription most times it is not enough to control our pain but we don’t leave our doctors because it is so hard to find another one who will even write an opioid prescription. Plus I have learned if you go into a doctor’s office knowing what you need and what your body responds to (as someone suggested) then the staff and doctors assume you are only a pill seeker and they will not help you at all. I was told anyone who knows that much about medications and what they need is a drug addict, not a pain patient. So I am very careful with what I say to doctors, even though I may know how my body will respond to a medication I am afraid to say anything because it seems to throw up a red flag with the doctor. At least, that has been my experience.
That could be fixed by educating the doctors to understand Chronic Pain Patients have been living with their pain for a long time and they know what their own body responds to and how it reacts to certain medications, just because they know about certain treatments and medications doesn’t mean they are only there seeking a certain drug.
Communication and Education…..two things we desperately need to help us all in this battle.
Charity,
Thank you for sharing your thoughts. While I do agree with some of your comments regarding pharmacists, there are certain of them that pharmacists, including myself would take issue with. Believe it or not, pharmacists are very highly educated clinicians regardless of the practice setting in which they have chosen to work. They teach at the college level to medical, pharmacy, NP, and PA students; they do clinical research; work in managed care; government; community; hospital; home care; and more. They attend college for 6-10 years (or more) for an earned doctoral degree similar to an M.D. degree, known as the Pharm.D. No, they are not medical doctors, but nor are medical doctors Pharm.D.’s (at least not usually).
“… the pharmacist shouldn’t be able to deny my prescription just because they think I don’t need it or they think I fit some type of unauthorized profile they have made.”
I agree with the last part of that statement, but certainly not the first. Hopefully like most, your pharmacist spends an inordinate amount of time speaking with prescribers all day to clarify, change, or suggest superior alternatives to your medication because of dangerous drug interactions, superior alternatives, or to provide a coverable option. In the hospital setting, much of the same occurs including chemical incompatibilities for intravenous mixtures, calculating amino acid calorie content and electrolyte balances for intravenous nutrition, neonatal dosing, special dosing adjustments due to kidney, liver, or other end organs dysfunction, and more. In 48 states they can prescribe and in many settings they see patients in clinics, order appropriate lab tests, and adjust medication therapies in the primary care setting and specialty clinics.
“… I do not feel a pharmacist has the right to overrule what my doctor says I need, especially if it is a prescription which I get monthly. Who gave them that right?”
Believe me, you should be happy they have that right to overrule a drug interaction or overdose if it affected you or a loved one! They do have that right, always have, and hopefully always will. I don’t agree they should pass judgement based on looks or some other parameters you mentioned, and I don’t deny they are missing important medical information, at least in a community pharmacy setting. In fact, I have advocated in support of your comments at Doctors Dole and Fudin on Walgreens Opioid Dispensing Policy.
“This issue really bothers me, Pharmacists are not our doctors, they do not know our medical history or our medical problems so they should not be allowed to dictate what medications we need!”
Dictate? You are correct. Doctors? You are incorrect. See Is there a [REAL] doctor in the house?
“Communication and Education…..two things we desperately need to help us all in this battle.”
For this sentence you are SPOT ON!
Dear Dr. Fudin,
My journey as a Pain Patient started when I was 24 years old. At that time I chronic debilitating headaches, the pain eventually radiated down the left side of my neck into my shoulder and left arm. I went to my Dr’s and was repeatedly told there was nothing wrong with me or I just had migraines, or it was my blood pressure or birth control pills. I went from a healthy weight of 125lbs on my 5’5″ frame to 100lbs. I was a gaunt shell of myself at 25 and wished to end it all. At that time I found a Chiropractor which gave me some relief which lasted until I was about 28. From 1992 until 2001 the pain got progressively worse , the headaches continued, they were with me 24/7 and the shoulder pain started to radiate down my whole left side and still no Dr listened. During the years mentioned above I self-medicated with alcohol. In 2001 I stopped self medicating with alcohol and found a program which works for me to abstain from drinking.
After the drinking stopped I felt sure that my maladies would go away as well, however they did not, they got worse. Again I went to Dr after Dr to get a Dx . It was not until 2007 that a caring Nurse Practitioner listened,really listened and sent me for a MRI. The results showed my Spinal Cord was compressed and the Dr surmised that it most likely had been this way for over 20 yrs. In 2008 I had my first Cervical Fusion. After a car accident in 2010 then being assaulted in 2011, I had my second Cervical Fusion. Because my condition went untreated for so many years I have permanent nerve damage, Fibromyalgia, Myofacitis among others. In 2010 the pain all over my body was too much for me and I went to my Dr and told him something has to change or I’m going to jump in front of a moving bus. At this point I had tried all alternatives available to me except for Opiod therapy. I had refused them (except for surgery) until this point because of my history with alcohol. I had a decision to make stay in pain everyday not being able to function normally or follow the course or treatment with Opiates my Dr recommended. I chose to to go with my Dr’s recommendation and have been able to function in daily life since then.
I give you this bit of background because I feel it directly correlates to your question” Do PainKillers Kill?”
Day in and day out I hear of the death/s of a loved one due to Opiod abuse. Any death directly caused by Opiates is tragic however the ones that occur due to Addiction are doubly tragic for me. There is a solution for those addicted but they have to WANT that solution, they have to WORK for that solution on a daily basis and sadly many are incapable of conquering the demons which cause them to compulsively abuse any medication or substance which takes them out of themselves. They continue doing the same thing no matter what the consequences of their actions might be. A switch gets turned on in their brains once they take that first pill which leaves them wanting more,more,more and more is still never enough for the addict. Yes, Pain Killers Kill. Sad but true. I have a deep and sincere empathy for all who have lost a loved one due to addiction. I have been in that same position more times than I care to count.
In spite of this sad fact there are many like me who are or have been punished by the actions of a few. There needs to be a greater understanding of how an addicts mind works by their loved ones, by Dr.’s and by organizations such as PROP, DEA FDA, state licensing boards,etc.It is my opinion that those who live with an addict or have lost a loved one to addiction avail themselves of a program such as Al-Anon along with all the agencies and organizations listed above. Become truly educated about addiction.
I should not have to live in fear every month that my medications will be reduced or cut off. I should not have to drive from pharmacy to pharmacy until I find one willing or able to fill my legitimate Rx’s. I should not have to submit urine specimens or pill counts at every Dr. visit. I shouldn’t be punished if I have done nothing wrong but as we all know this is not the case today.
As you said “civil discourse” is lost in today’s society. Each side against the other with no one willing to listen. I do hope a civil discourse will be opened between those who have lost a loved one due to an overdose and those who live with chronic debilitating diseases they did not ask for. We must come together in order to garner a solution which will benefit us all.
Sincerely,
Sonna M. Furtick
See link for more info;
https://www.facebook.com/pages/Opposition-to-Kentucky-HB-1-Reform-HB-217-aka-Pill-Mill-Bill/595049517218134?fref=nf
“We must come together in order to garner a solution which will benefit us all.” YEAH!
Dr. Fudin, I’m so grateful you’re advocating for us pain patients like this. You seem able to truly “grok” (http://en.wikipedia.org/wiki/Grok) pain, even though I assume you don’t suffer from it yourself, and that is extremely rare.
I agree the opiate debate has degraded into a kindergarten sandbox fight, with empty sound bites being flung by both sides, accomplishing nothing. We all agree that pain is bad AND addiction is bad, and the disagreement is how to treat one without ignoring the other.
The crux of issue seems to be in identifying addicts versus pain patients, and for this a doctor needs more than a 15-minute visit. It requires a good understanding of both the pain process and addiction, along with developing a deeper understanding of the patient than is needed for many other diagnoses and treatments. In addition, correct and clear documentation is essential to protect both doctor and patient when addictive drugs are being used.
I can think of a few things that we could all work on together to help reduce diversion and abuse:
1) Provide unbiased education for both medical personnel and patients
2) Evaluate patients in more detail to determine use versus abuse of opiates.
3) Build and use controlled substance registries.
Doctors:
Doctors need to demand better pain and addiction education, which will teach them about the critical difference between under-treated pain and addiction.
The anti-opiate media hysteria has resulted in the perception that all opiate users are addicts because the drug can be addictive, rather than acknowledging that only a few (2-5%) patients may become addicted. Addiction is in the person, not the drug.
Patients:
Because there is no objective method to determine pain, we must learn how to express ourselves and communicate our pain clearly in well-defined terms. By learning about the pain process, we can familiarize ourselves with our condition and learn its vocabulary. Understanding what’s happening in our bodies allows us to advocate for our needs, restores some feeling of control, and reduces anxiety.
To assist our doctors, I suggest we keep a detailed pain, activity, sleep, and medication diary for at least 2 weeks before an appointment to document the type, severity, and impact of pain in our lives. This will provide the evidence and background of our pain for them to work with.
Such a pain diary should be offered to any doctor managing our pain, instead of relying on our memory or just giving answers to specific questions. The process can be continuous (as I do it) or repeated at intervals of months and years to monitor pain much more effectively than merely asking for a pain scale number during an appointment. (It’s also a very effective tool to expose addicts or abusers.) This pain diary would be added to our medical record so the evidence is there for every subsequent doctor.
Legislators:
We need nation-wide registries for tracking controlled prescriptions.
This is the simplest and most straightforward solution to the problem of over-prescribing and diversion. Abusive doctors, patients, or pharmacists could easily be identified if records are kept and compared. This is not a matter of degree – extreme outliers become obvious in a scan of prescribing records. (See http://edsinfo.wordpress.com/2013/08/26/propublica-online-tool-prescriber-checkup-to-search-for-individual-providers-and-see-which-drugs-they-prescribe/)
The Lawyer and Dr fee’s that I referred to was fighting worker’s comp, so during those 6 year’s. It’s been 8 year’s since the accident that happened on my grandsons birthday. Thank you for the opportunity to post, never give up.
I believe that we need to take our emotions an put them aside and have logical an scientific discussions, who to know better than Dr Fudin an Dr Murphy that are well educated and been in the trenches through all this. And on the other side families that are suffering from the loss of a loved one. And mabey someone like me that’s well educated in physics, ( Master electro mechanical engineer) or at least I was. That’s lost everything because of lawyer an Dr fee’s with no help so that I could at least function and not live stuck in this chair that I have to sleep in
I agree with you Dr Fudin. This war between both pain patients that have had success with opioids and those who are totally against them has to come to some kind of truce. Nothing is changing for us and life for the pain patient is continually getting worse. Death will happen among this group of people if the suffering have no choices. Something needs to be worked out with all the smart adults from both sides of the isle here and the patients should be included in some of the decision making. I agree with informing the patient of all the risks and benefits BEFORE prescribing them opiates. It then should be the patients and the doctors decision to go forward with treatment. The government and the DEA need to give Americans with pain a choice even after educating them with all facts. I’m sure most pain patients had tried many other things to relieve their pain before going on opioids. It shouldn’t be the first line of treatment but for those patients who have been taking them for years with good results, they shouldn’t be yanked off of them just because someone else thinks they know what’s best for them. I still believe in American civil rights and people should have a right to choose on what works best for them. Education the key for all. I feel sad that some have lost loved ones because of one reason or another when it comes to medical treatment and medications. It’s also sad, that so many pain patients live in certain states that can’t get anything prescribed for pain that works, while in other states? You can get it prescribed but can’t get it filled. Isn’t this just as dysfunctional as it can get? Enough already. Let the patients and doctors do the deciding here without the DEA going after the healthcare professionals that are doing their jobs while trying to help people without causing them harm. Put the responsibility for the opiate treatment on the patient who agreed with it, AFTER they have been educated about the pros and cons and possible death. Many medicines advertised on TV, say they can cause death too but they are still prescribed anyway. WE need choices here and right now? There are not any for many people suffering today. JMO
I agree Donna (and thank you for your efforts in advocating for legitimate patients caught up in the crosshairs of this convoluted witch hunt).
In a ‘free’ country, what ever happened to OUR rights and more to the point, personal responsibility over one’s life decisions? American Adults make decisions every day that impact their lives both now and in the future. From dietary considerations (organic, GM food, supplements, vitamins, gluten-free, etc), choice of safety features in cars, guns, OTC and other non-scheduled meds, job training/educational selection, the list goes on ad infinitum. Why all the hullabaloo over opioid medication? [IMO the DEA needed a mission to legitimize its massive budget and bureaucratic infrastructure. While America has grown weary of the ‘war on drugs’- just google medical mj, outright legalization (WA/CO), and massive decriminalization (18 other states) so they picked an easy target, CPP and their providers. The problem with the DEA is that when their tool belt only contains one tool, most likely a hammer, every problem looks like a nail.
When one listens to the radio, tv, reads newspapers, etc why is someone always speaking FOR us. Where is OUR voice in this? IF, legitimate patients are at the center of this ‘Rx epidemic’ and its ODs, abuse, addiction, diversion, etc (I don’t believe they/we are) then why not call them (CPP) at truly random times (during/throughout the month)and have them report to a lab for a UDS?
Any simpleton can abstain from a drug for a couple days prior to an appt or take a few pills to show up positive for their meds. I contend that like most everything else in this country, the root of it all is money.
I say this as the ”game’ being played now is not only taking away pain relief it is pricing it out of the reach of many patients by forcing them to submit to repeated UDS despite no red flags or indications of diversion/misuse along w/ spiraling costs of abuse resistant formulations that are unnecessary (and at times ineffective) in most cases as pain modifies how the brain processes and experiences these meds] .https://www.youtube.com/watch?v=2FtyXc1QycQ
The immense cost of the new ‘abuse deterrent’ formulations change(d) historically cheap opioids into meds that are priced right out of the reach of those who need them most and who abuse them the least.
Despite being a patient in good standing of a PM clinic located on the campus of a major medical center for over 4 years now I am currently subjected to a UDS at EVERY SINGLE monthly appt!! This is despite the fact that I have never lost nor had my meds stolen, asked for an dosage increase (after initial titration stage), asked for specific medications, nor even missed ONE APPOINTMENT!!
I believe we have the tools available now to cut into the diversion of these meds, and it is working (almost too well if one considers the chilling effect on doctors). They include PDMPs, REMS, pill counts, closing ‘pill mills’, UDS, pain contracts, etc. Why not give them time to work?
One last point. Folks like Kolodny are quick to point out that CPP are being harmed more than helped by COT and the doling out of what he calls ‘heroin pills’ is out of control. What are the alternatives for those on COT to be then? Most of us ended up on opioids for pain after they have run the gamut of conventional approaches including PT, TENS, NSAIDS, diet, chiropractor, DMARDS (for those of us w/ INCURABLE autoimmune disease), injections and nerve blocks, acupuncture, the list goes on……………..IF these measures, that ARE quite helpful in a COMPREHENSIVE treatment program (I use several myself) were enough alone to fight our pain we would have never ended up on NARCOTICS (how our medications are called in the media to improve interest and ratings). Too many vested interests and too much money are involved in this fight to have a discussion based on facts and reason (unlike Dr Fudin I do not place much faith in a sit down discussion between the two camps and I wish that were not so).. The problem is that there are just too many groups on both sides with vested interests in keeping the playing field as it is. The Prison Industrial complex, the DEA, get tough politicians, the drug abuse treatment community (Kolodny-@ Phoenix House) grieving relatives out for revenge/lawsuits, Big Pharma (exclusive lucrative marketing of abuse deterrent formulations), etc. Common sense is often uncommon when big bucks are on the line.
I see stories like those of Tim Howard and Sheila Kim Purcell, and while they are sad, I find them inspirational as well. Because these two people, despite their own desperate situations, have chosen to help others also affected by the war on pain patients, I was so inspired by stories like theirs and became an advocate for people who cannot get adequate relief for their pain.
While my heart breaks for anyone who has known the overwhelming sorrow of losing someone so senselessly to an overdose of medication, my heart also breaks for those who have lost a loved one to suicide as a result of unrelenting pain. Those who were unable to find anyone to treat their pain due to new laws limiting the ability of the medical community to assist those of us who, due to no fault of our own, suffer incurable, barely treatable, constantly present PAIN.
While I feel very deep sadness for both groups, those who have lost a loved one to drug abuse/overdose, and those whose loved ones have taken their lives as they saw it as the “only way to stop the pain”, I see one major difference in these two groups. As I stated before, those of us who suffer from chronic pain, did nothing to cause our situations, and for the most part, we were receiving some treatment for our issues two to three years ago, before the onslaught of new laws that, for many of us, have stolen any hope we had for a productive life The main difference I see is that, while I did not cause or ask for my pain conditions, drug abusers/addicts were never forced to take pain medication they were either never prescribed, prescribed to under false and deceptive practices or procured in some other unnecessary manner.
In the spirit of this PEACEFUL communique, I will try not to dwell on the many ways drug addicts obtain their opioids, bit I will say the following. Because of the methods and results of drug abusers, chronic pain patients are now suffering a ridiculous amount of pain as doctors fear loss of license, reviews by state and federal agencies, and even the possibility of jail time. Pain patients are forced to endure extra medical appointments, pill counts (another trip to the doctor), drug screenings, and often they are forced to wait for long hours for the medication that will allow them the thrill of feeling good enough to just get out of bed.
So, my answer is yes, Painkillers, do kill. But it’s not that simple. I feel there is no way drug abusers are ever going to be stopped from their self-destructive path by keeping pain patients from getting their medicines. This has been proven true by the recent surge in heroin use. Drug addicts simply switch to whatever they can find to get their buzz while pain patients are left struggling and suffering with nothing accomplished but to complicate the lives of those who needed it complicated the least.
See Link for the following page:
“Opposition to Kentucky HB 1-Reform HB 217 aka “Pill Mill Bill”
https://www.facebook.com/pages/Opposition-to-Kentucky-HB-1-Reform-HB-217-aka-Pill-Mill-Bill/595049517218134
Kimberly,
With all due respect, I think that grieving parents are more concerned about NON-SUSPECTING addicts that became inadvertently “addicted” to opioids before they realized it. Sure, some may have participated at their own will, but perhaps some were not appropriately warned or didn’t realize they were addicted until it was too late. I have done some litigation against “pill mill” docs, and the situations with no regard to safety in some of these cases in simply unconscionable!
Whatever the reasons are, we all need to use our frustration and anger to work together for an amicable solution or at least brainstorm for ways to make things better. Fighting among all these groups is not helpful.
Dr.Fudin, I understand what you are saying and it is certainly not my intention to belittle anyone’s problems or use this opportunity to voice my frustrations, though, as you know, I have many. I have trouble, though, finding a way to comment on this subject without pointing out the simple truth that nobody was forced to take pills, once their problems with their pain issues subsided, these individuals continued to seek the medication in spite of their lack of need for it.
I was told the primary care center where I was a patient and had also worked for 27 years, would no longer be prescribing the pain medication I was taking nor would I be getting the sleep aid anymore.
I was told this was because of a new law designed to get rid of pill mills. I had never ever heard of a pill mill, so I was amazed, to say the least, that this could have anything to do with me. I was, nonetheless, cast out to find a doctor who would prescribe my pain medication in and “opiate shy” atmosphere (to say the least). After having gone for three years searching for another doctor, I was able to find a doctor to provide minimal pain relief.
I absolutely agree that the “pill mill” mentality is a disgrace to the medical community and a black spot on all of humanity. This is unacceptable behavior by all involved and it should be eliminated from the planet.
Without sounding accusatory, bitter or frustrated, I cannot say what I feel on this subject. It has caused me many problems and I, personally, have never been to a pill mill, nor would I ever go to one. It remains though, that I, along with many other pain patients are and will continue to be punished for the actions of these doctors and the patients that frequented their .
Until legitimate pain patients are no longer automatically viewed by groups with alternative opinions, as DRUG ADDICTS, I will find it difficult to see these groups as harmless adversaries.
See Link for the following page:
“Opposition to Kentucky HB 1-Reform HB 217 aka “Pill Mill Bill”
https://www.facebook.com/pages/Opposition-to-Kentucky-HB-1-Reform-HB-217-aka-Pill-Mill-Bill/595049517218134
Kimberly,
Your points are well-taken. But, an adversarial atmosphere is what I’m trying to avoid. An adversarial relationship is what is causing harm – let’s break down that barrier together!
Dr. Fudin,
Thank you for all you have done to help those of us in pain. Thanks you for reaching out to the Opposition Page seeking comments, for that I am truly appreciative. But, mostly, thank you for listening to me ramble on and basically whine about the issues I have faced, while you are trying to achieve a much higher goal. For this, I apologize. I am sorry for wasting your time and the other commenters’ time when I should have been concentrating on the task at hand.
That being said, I would like to say that I feel like there have been some interesting ideas within these comments I have read, but no obvious solutions. The thing we really need to get past, I feel, is, “are there really are two sides to this fight”.
What I mean by that is:
1) Do we all want fewer people to die from overdoses of prescription drugs? YES
2) Do we all want legitimate doctors who care about their patients and treat them as such? YES
3) Do we all want to be treated with respect by our doctors, the DEA and police? YES
4) Do we all want to know when a medication we are given is likely to cause adverse effects including the possibility of addiction? YES
5) Do we want all want to be treated with respect when we are ill and must take any type of prescription medication? YES
This list could obviously go on and on, but I think the point I am trying to make is that both “sides” of this issue may actually have far more in common than they themselves even realize.
See Link for the following page:
“Opposition to Kentucky HB 1-Reform HB 217 aka “Pill Mill Bill”
https://www.facebook.com/pages/Opposition-to-Kentucky-HB-1-Reform-HB-217-aka-Pill-Mill-Bill/595049517218134
I say yes to civility and building a bridge. We need to begin with Important ethical elements of transparency, full disclosure, honesty, respect and doing what is best for patients. This requires acknowledging: the molecular structure of opioids, potential dangers, effects on the brain and body, & although some pain patients may not experience harm in the short term, pain and addiction are not mutually exclusive. This is not about good and bad patients… we are all patients. Many patients have not been provided with all the information and therefore do not fully understand what is happening. The majority of our ARPO members’ loved ones experienced harm from opioid prescriptions for pain. We do not advocate for taking opioids away from patients already on them. We ask that before opioids are prescribed to patients who have never had them that they be given all the facts and tried less dangerous non drug alternatives. Patients have the right to know before starting a drug. They also need to know that therapeutic use can lead to misuse and harm. This is very important and one of the ways to help end the stigma surrounding how harm develops. Taking them as directed does not protect from harm. These are risky drugs not risky patients. Opioid mfgs. validate the drugs by deflecting the problem to the misuse of the drugs and demean and disparage the many who develop problems. An ARPO member’s son who recently died had been prescribed opioids for his back pain. He left the following note: At first it (opioid) was a life-line, now it is a noose around my neck. We need to keep in mind these are ‘controlled substances’ for a reason and yet they are the most prescribed. The U.S. and Canada are the top two per capita consumers of opioids and yet we still have people in so much pain. We need informed care not sales; and Big Pharma has centre stage here.
BTW I lost my only child, Michael, who was prescribed percocet for repeated bouts of kidney stones. Michael died from prescribed hydromorphone within two years of his first percocet prescription. He took his pills as prescribed and tried repeatedly to stop and could not. Three years later my father died. He had colorectal cancer. While in hospital his oncologist increased Dad’s opioid dosage. We (family) thought it was best for him but my Dad wanted to be lucid and did not want all the opioids. It was the opioids that stopped his breathing. It was 10 years yesterday that I lost my son… I advocate to prevent tragedies like mine and to help people who are in pain receive proper care. Michael had just turned 29.
Ada
Ada,
Thank you for your comments! Spoken from the heart, you are my new [cautiously optimistic] heroine. Please inform ARPO Board members (Pete Jackson, President; Ellen Arnold, Secretary; Sandra Kresser, Treasurer; Kirk Van Rooyan, MD). It would be nice if perhaps we could conference and brainstorm how we might move forward.
I personally am not looking to line the pockets of Big Pharma or anyone else for that matter. And, I think since opioid abuse has been around for centuries we can’t blame only Big Pharma. So, in the spirit of doing things right here as a collaborative group perhaps the government (and Big Pharma financially but otherwise HANDS OFF) could help financially spearhead a group effort for all of us to come up together with some direction moving forward. That could perhaps include a templated informed consent requirement for all patients receiving opioids beyond a certain length of time. Naturally that will not be the solution to these problems, but it could be a good initial start.
Yes opioids and illicit drugs have been around a very long time, what has not been around is the extent of iatrogenic harm caused by overprescribing (CDC) due to lack of transparency and misleading info provided to healthcare professionals and patients. The U.S. and Canada are in the midst of the worst drug epidemic in history. Let’s fix it.
Bravo Dr Fudin, very very well stated. I tore my rotater cuff and crushed my spine, C4 region Thoracic, an L2 to sacro joint. Now I have 7cm tarlov cyst in the nerve root .Ive done nothing wrong but destroy my body trying to save my coworkers life in a on the job accident at a oil well.He didn’t make it ,he died in my arms.I live a life in misery because I cannot find a Dr in eastern Ky that will treat my pain even with good physical evidence of my condition. Love reading your posts an I also will keep fighting to build that bridge. Thank you so very much for all you do.
Right on Dr. Fudin!
It’s like Stephen Covey says:
“Seek first to understand, then to be understood.”
Dear Dr. Fudin,
This is so nicely written. I truly hope that bridge can, & will be built. Soon.
I would like to say the scenario can also be used -what if it were your spouse that is no longer here because of addiction-. Truly heartbreaking to see an adult lose their spouse this way.
Also, the scenario can be used -what if it is your child with unrelenting pain that only responds to opioid therapy-.
When I heard my mother, on one occasion speak of me to my doctor, & on another occasion speak to the local branch of the DEA, asking why her daughter couldn’t get her medications filled, I was brought to tears hearing her description & observations of my pain. Her final question was ”what if it was your child?”
As you say, there are so many smart people, on both sides. I hope your plea comes to fruition.
Thank you for all of the hard work you do. It is very much appreciated, from many of us.
Carole
I wrote in my last post I was seeking out a new Pain Specialist but decided to stay with the doctor I’ve been seeing this past year. The pain pump has to be medically necessary before Medicare will pay for it and all other options like oral meds need to have been tried first. I found a long lasting pain medication that best keeps my chronic pain under control and have been successfully receiving good pain relief from this medication for 12 years now.
These past few months have been challenging , it seems the way chronic pain was being treated in the 1990’s was all wrong. Doctors would keep increasing the dose when the pain patient became tolerant. It was just a matter of finding what medication you could take with less side effects.
So this way of treating chronic pain is outdated and its like we’ve had a paradigm shift in thinking how to treat chronic pain. A paradigm shift is radical change in thinking from an accepted point of view to a new one, necessitated when new scientific discoveries produce anomalies in the current paradigm .
Now I’m being titrated downward to find a more appropriate or practical dose of medication . I don’t know what a Pain Specialist considers a moderate dose of the pain medication I take but apparently the dose I’m on is too high. As I titrate downward its not without a price I have to pay. But I have no other choice ,its either I do this or find another doctor ,but I just don’t have any fight left in me. So its either I do this and or risk being without any pain treatment all together.
All of what Dr. Fudin talked about is correct ,we must find a middle ground between pro-Opioid and anti-Opioid people. The way things are now we’re not getting anything accomplished ,all we’re doing is head – butting. Its time we understand what pain sufferers need to live a somewhat normal life. And keep these opioids out of the hands of people who might abuse them. Problem is some people don’t know the dangers of opioid medications and one drink of alcohol can cause respiratory depression causing death.
Its time we end this hate between pro-Opioid and anti-Opioid people. We achieve nothing by fighting amongst ourselves.
Taking away opioids from pain sufferers will send some to the streets and they will find heroin cheap in price. Then its just a matter of time when these pain sufferers overdose on heroin because their doctors stopped prescribing much need pain medication fearing the DEA.
Then we would have achieved nothing by making it difficult for pain sufferers to attain much needed pain relief , but sudden death from heroin.