Guns, Pain, Drugs, and Thugs

I sit in amazement as I type, that any human being can somehow muster the indifference to defend a policy that doesn’t halt the ludicrousness propagating repeated gun massacres of innocent children, young adults, and teachers in our schools.

Every day I am exhausted by the daunting cry from patients nationwide because of the politically popular trends to limit opioids, restrict doses, and mislabel legitimate chronic pain patients as addicts. I see misquoted and misleading opioid statistics that ignore real facts that the majority of opioid overdose deaths are from illegally imported fentanyl derivatives and heroin. Yet politicians and anti-opioid zealots either lack understanding of the bigger picture or choose to ignore the complexity. Meanwhile thousands of pain patients suffer, or worse yet decide that suicide is the better alternative.

Analogously many gun owners and politicians seem ambivalent to heightened gun control and limitations on assault weapons because it’s inconvenient. INCONVENIENT! Nonetheless, many innocent people are slaughtered at the hands of gunslingers that should never have access to these weapons. And I’m sorry to say that massacres have gotten worse since Dr. Fein’s Collective Bludgeoning post here in October 2015.

We know that prescription opioids have declined drastically by more than 50% since 2014 and are expected to hit a 20-year low by this year as seen in this graphic. Prescription opioid overdose data can be viewed in multiple ways at this CDC link.

Perhaps we should have the equivalent of prescription monitoring programs and urine drug screens in persons who carry guns, including a registry of where and how many ammunitions are purchased, and a continual updated database of ownership, and the equivalent of an abuse deterrent opioid – a fingerprint activated unlocking mechanism.

Gun carriers argue that their second amendment right allows “the right of the people to keep and bear Arms” and that these are invasions of privacy and INCONVENIENT.

At the same time, chronic pain patients that require long-term opioid therapy are forced by new and emerging standards of care to be monitored by state prescription databases, pee into cups, have limits on medication supplies, and limits on dosing.  Are these patients being cheated from their promise of “Life, Liberty and the pursuit of Happiness” by the Declaration of Independence since they are tormented every day by pain that is being controlled by the government, politicians, and managed care executives? Do you think weekly trips to the pharmacy for subtherapeutic opioid doses might be INCONVENIENT?!

Lucky for me, a close colleague in the pain world is a responsible clinician, responsible gun owner, and has two children that she loves dearly.  I asked her to make the comparison and comment herein. As you might imagine, because of the sensitive nature of both anti-opioid zealots, gun fanatics, and the overarching politics, Ophilia Pain, PharmD was a little “gun shy” at first. But, she rose to the occasion.  Here’s was Dr. OP had to say…

I am writing, not as an NRA member, but as a responsible gun owner (at least I think so).   My boys have always been hunters and I have a carry permit in our state.  I doubt I will ever use my handgun beyond the shooting range, but I know I could protect my children if I had to.  I will tell you that none of the firearms that I have used have been registered to me, and I never had to take an educational course to shoot them (I did have to take a class to get my carry permit).  My dad taught me “everything I need to know” when I was about 10 years old, but I suspect I am quite ignorant. By the way, I am 5’4″ tall and would easily be overpowered by > 95% of high school boys.

That being said, before you dismiss this blog, my wish is that organizations like the NRA and supporting members are able to learn from our failures in healthcare.  Let me explain – I work in a pain clinic and I have for many years.  Healthcare providers, in the truest sense, exist to take care of people who suffer.  According to data from the 2012 National Health Interview Survey (NHIS), 11.2 percent of American adults (25.3 million people) have experienced some form of pain every day for the past three months and more than 50 million suffer from “severe levels” of pain.  The wrong answer, but the one that was pushed on providers more than 15 years ago, was to use opioids, lots of them, because they are not addictive and millions of people are suffering.  Well, don’t we look foolish now?

Because we were not thoughtful we let opioid prescribing get out of hand and continuously stated that “the person who misused the medication is the one responsible, not me”.  Our pain management organizations and Pharma were standing behind their pulpits demanding “more drugs, not less”, just like NRA spokespeople have done this week with “more guns, not less” to keep our children safe.

What healthcare providers really needed to do was to have heart-to-heart conversations with our patients about what is appropriate pain management (ANY medication is only expected to provide about 30% relief) as well as taking personal responsibility in improving their own health (at LEAST 70% of the load).  Sometimes long-term opioids are appropriate, but most of the time, they just aren’t.  We believe that a prescriber should be able to order the best medication for the patient, but because we have not been globally responsible, providers have ended up with their hands tied and patients are suffering.  We left the government no choice but to step in to try to curb the rising death rates.  It appears that people who have been denied prescription opioids have now turned to the black market and illegal substances, which just shifts the problem to the street and out of the office.  If only we had been willing to care for patients holistically, but that takes a back seat to clinic schedules and revenue units.

The reason I bring this to you is because I ran some numbers on gun ownership and firearm related deaths, compared to opioid prescriptions and opioid-related deaths.  I was rather astounded at the similarities.  The association between firearm related deaths mirrors opioid deaths too closely to discount.  I searched for a common denominator.  The demographics of opioid use and gun ownership are very similar (rural and white).  The mental illness in those who use guns and opioids inappropriately is also closely linked, and certainly the emotion attached to the government “taking away” something that provides safety, or at least comfort, is very strong.

Here are some of the numbers I found from the most objective sources I could find.  I am not picking a side but simply want to see the numbers.

What I found was that gun ownership in the U.S. is approximately 300 million.
Opioid prescriptions written annually in the U.S. (2016 data) is approximately 214 million.

Annual gun-related deaths (including accidental) is ~ 31,500.
Annual opioid-prescription related deaths (including accidental) is ~ 33,000.  Note if included illicit (not be prescription) opioids the number is closer to ~60,000.

Some may say that automatic weapons can kill many people in a few short seconds.  I would also argue that dirty needles shared by several people in a community due to oxycodone and oxymorphone abuse, has caused a series of closely related deaths as well.

Two of the major differences are that opioids are highly regulated and guns have very little regulation. Opioids are prescribed at the discretion of a licensed medical provider and require a prescription to purchase.  Guns may be purchased at any retailer (Walmart is the biggest, and, conveniently, they have pharmacies too) without consultation with an expert to help decide which weapon (or maybe no weapon) is appropriate.  I’m not suggesting that there is cross over here (gun owners are also drug users), but both can be deadly.  Are there more numbers we need to look at?

I believe we have gone past the polarizing “we demand that we be entitled to 2nd amendment rights at any cost”, to showing how to preserve 2nd amendment rights responsibly.  An obligation to encourage the responsibility that the 2nd amendment requires.  It is very easy to say “guns don’t kill people, people kill people” but the fact is, people die.  I often say “drugs don’t kill people, people who take drugs inappropriately kill people”.  Same concept of innate personal responsibility, and yet people die, so obviously neither of our groups is doing a very good job at PR in the form of constant and consistent messaging about safety and responsibility.  I would encourage our 2nd Amendment defenders to do this before the government has no choice but to restrict those freedoms. More legislation is not going to fix inappropriate gun use, just as more legislation isn’t going to fix inappropriate drug use.  I’m not aware of any “abuse deterrent guns” but they would probably be as effective as abuse deterrent opioids. Building a wall just isn’t going to fix is either.  Our mental illness and irresponsibility are home-grown.  We have to find better ways to help people get a handle on their personal demons and make it a deeply personal responsibility to take care of oneself and one’s safety as well as those around us.  I feel deeply that if we are not part of the solution, we are part of the problem and I want us to be the leaders and the solution.

With respect,
Ophelia Pain

As usual, we’re happy to receive comments from zealots in either camp!

9 thoughts on “Guns, Pain, Drugs, and Thugs

  1. Ok. I’m dizzy reading all this. Good information to ponder and check up. I am a chronic pain patient. I have a high school education which I’m proud of. Raised a family and husband. Double proud. From Wisconsin. Since 1999 I have been on opioids for CONTROL of pain. It does work for me. Yes I went through the pysch testing, the biofeedback, even went off of them for 7months. Many of us do what is asked. Not to just get the medication but to find out if there is a better alternative. The reason for the meds and with that reason and what it has done to our minds body and heart is a lot to deal with. From where you were to now? Moments of Why me? or I never thought I’d be here, those are on top of the pain. Nothing you can do so resolve kicks in for reasons near and dear. The oath a new doctor takes, The Hippocratic Oath, do no harm, comes to me now. They swear an oath to do just the opposite yet are being forced to offer a dwindling suppply of remedies. Can we sue them? Or can we sue the Federal Government or better yet can the doctors do this for breech of that solemn oath they took that they are being forced to ignore? Well, they are!! At a high cost. Then there is the patient. Like me. Like so many. Guess what? I’m saying once again Why me? but for all of us. My injury occured helping an elderly gentleman so he wouldn’t get hurt. I would do it again. Another thing, I had two sons and a daughter to raise and they knew from the beginning the type of medications that was helping mom do what a mom does. I EDUCATED them on this type of medication. Never did anything go missing nor would it. So to those who loose children to these type of meds, I can only ask why? Raising children is hard but doesn’t mean give in. At some points you have to follow them, thats right because believing everything that they say is a fools paradise. You do this BECAUSE you love them. Let them scream they hate you. It will hurt some. But in the years to come, over a family supper you hear them say, Remember the time dad and mom. .and then. . thanks you two, we know why you did it. You can bet your bottom dollar this happens. So it all starts in the home. But now I have no meds because of this war on pain relievers. Now I can’t see my granddaughter at her competitions. And my familiy? They see me the way I never wanted them to. I never cheated like so many others don’t. I just did what I had to do with the help from my doctor and the DEMON medication so many are saying does nothing or kills. I guess anything could do that but for the people that were raised by parents in a home with love I can say that those people have commen sense and integrity that is strong. Thank God for families and the love it takes.

  2. I have been thinking about this very same thing for a long time, just because you have chronic pain doesn’t mean you give up your right to life,liberty and the pursuit of happiness. We who are in pain depend on this medication to live a somewhat normal life. Pain patients live under the constant threat of going in to there doctor one day and having there life completely upended for no other reason then the doctor fears the goverment. we are talking about people who did not choose to be in pain and are looking for some help, the majority are not junkies or addicts, they are regular people who need medication to be a productive part of society. If you make it so people cant even get out of bed anymore or sleep through the night, you are destroying people’s lives and families. also just not treating a person or handing them off to another doctor is just as bad. when you are in pain and dont have your medication being passed from doctor to doctor till some one takes mercy on you is just a horrible way to practice medicine.

  3. You”dthink that there would be a way for medical professionals to be good advocates for their patients. There”s been a fair amount of research regarding the long-term harmful effects of chronic pain on patients. The AMA should be able to work with the DEA to come up with a better way to help long-term chronic pain sufferers to be able to manage their protocols without being treated like criminals.

    1. I agree, I suffer from chronic pain all over. I take morphine, fentanyl patch, vicodin. For years Drs. Used me as a guinea pig. Tried me on several different meds. This combination works for me. I’m able to get out of bed. . There has been a couple of times I’ve ended up in Er. The Drs. As well as the nursing staff have treated me like a junkie. There was one dr. Who refusedo to treat me, comparing me to a drug addic. Even though I was crying in pain,my heart rate was over 140, my blood pressure was 160/130 . He laughed. A nurse once screamed at me because I couldn’t lay still, I was in excruciating pain, sobbing, tossing and turning. I have been a nurse for almost 30 yrs. And I’ve noticed that since the government, mainly DEA,CDC,FDA,ETC. Have stuck their noses into something they know nothing about, medical staff have treated people like me as trash. It’s been so difficult to get my medications. They are just making it more difficult for honest patients to obtain much needed pain relief. Drug addicts, criminals can obtain their drugs on the streets.I’m so afraid of the near future and what will become of honest people like me, that have actual diagnosis, that have no cure,but control their pain, symptoms, but because of our government have no access to much needed pain relief. I know we’re not supposed to wish bad things on others. But I hope these people, making decisions for us, to come down with severe pain, and be told, you cant have any pain meds, suffer!!! DEA,FDA,CDC,GOVERNMENT OFFICIALS, STAY OUT OF OUR CARE. LET US GET PAIN RELIEF.

      1. Thanks for your willingness to share your story about the abuse you’ve suffered at the hands of the Deep State (DS). They are the true criminals behind the so called, “opioid crisis” in America. Unknown to most citizens, the Deep State generated a document that they refer to as Agenda 21 and in which they’ve decided that their ideal world is populated by no more than five-hundred thousand people. What do they think ought to be done with the remaining 7.5 billion people? They say that the vast majority of earth’s population will simply be eliminated to reach their goal. This is the real reason ailing Americans are denied opioid medicines; they know pain sufferers cannot survive long without the help of pain medication, so they sent their cronies to be CDC committee members. The physicians from the (DS) on the “guidelines” creating mechanism of the CDC hold biases such as ownership of opioid treatment centers whose agenda is to “be there to help” the poor souls taking this type pain medicine.
        Until we Americans come together to address changing this garbage law, expect to see America overthrown from within as more and more needy citizens are denied medication, which will certainly reduce their mortality span.

  4. Here is an altogether sad history relevant to our enslavement of others in days past, present and future:
    “The real reason the Second Amendment was ratified, and why it says ‘State’ instead of ‘Country’ (the Framers knew the difference – see the 10th Amendment), was to preserve the slave patrol militias in the southern states, which was necessary to get Virginia’s vote. Founders Patrick Henry, George Mason, and James Madison were totally clear on that … and we all should be too. … In the beginning, there were the militias. In the South, they were also called the ‘slave patrols,’ and they were regulated by the states.”

    The vast disparity in the relative amounts of arrests, charging, and prison sentencing to this day where it comes to black and brown persons surrounding non-violent “drug (thought) crimes”, with a U.S. Attorney General who sees asset forfeiture (without any conviction), a still draconian and racist 18x sentencing multiplier for base (as opposed to salt) form of Cocaine, and private-sector prison system incarceration as a business opportunity for his and Trump’s invested revolving-door coworkers and fat-cat friends:
    … itself represents a perpetuation upon all persons of lesser means of criminal incentives and penalties.

    General Jefferson Beauregard Sessions III is a true modern day white supremacist and cultural dinosaur. In symbiosis with theocratically inspired and zealous revival tent carnival barkers like Kolodny et al chorlting agit-PROP, the DOJ gendarmes of the chemical-statist, life shattering police state happily perpetuate what is literally the Nazi Germany playbook:

    … “the widespread acceptance of notions of racial hygiene and genetic determination in both medical and policing circles made it easy for the state to increasingly marginalize drug consumers as asocial, psychopathic, or genetically deficient. New measures were taken to strengthen the existing policing and social welfare work against addiction. And new groups, such the ‘Imperial Committee for the Struggle against Drugs’ were created to bring the medical, policing, and political experts together in the war against drugs. Starting in 1935, the Nazi government created the ‘Imperial Center for the Struggle against Drug Crimes’ at the Prussian Criminal Police Office in Berlin, which acted as a central information-collecting office for drug crimes from the various district police offices. Drug users faced a number of possible sanctions, from conviction under the Opium Law to findings of mental and legal incompetence resulting in forced internment in a treatment or withdrawal center.”

    From: “Germans on Drugs: The Complications of Modernization in Hamburg”; Stephens; pp 16-17:
    This book is an interesting history of 20th century drug controls (see pp 13-41). Nothing new under the sun. All of today’s prohibitionist tactics that Kolodny-ites promote were implemented in Nazi Germany and continued after the end of WW II by the controlling British Military Government. The Brandeis – DOJ/DEA “playbook”.

    The most harmful “mental illnesses” (affecting many other persons, not just an individual them-self) start with these very snoops, snipes, ninnies, and nannies who zealously prey upon pain-treating physicians and pain-affected patients (to look busy while Fentanyls poison masses of people of whom they in large part evidently could not care less) – and those physicians who willfully abandon their patients’ interests and concerns and turn away from their pain and suffering in favor of their own convenience and financial comfort. Irrational reasoning and/or sadistic controlling tendencies are anathema to the entrusted role of physician (agent) exercising control over patients (subjects) – who left with only NSAIDs and Ethanol to mitigate their suffering may well tragically choose Firearms – all of which represent significantly more directly toxic and (annually in U.S.) deadly drugs and devices than do prescription pharmaceutical Opioids.

    “How can such paternalism on the part of the rulers lead to anything but infantilism on the part of the ruled?” (Thomas Szasz)

    I hereby petition the Rhetorical Court for a Restraining Order limiting their predatory, pernicious, and punitive powers over my mind and body, and the restoration of my natural human rights to ownership of property, self determination of quality and manner of life with dignity, to do with what I will with my mind and body in any/all situations where my activities as a competent adult do no tangible harm to others.

    Firearms are by design delivery systems of pain, damage, and death. Opioids are the very inverse of that. “For all the happiness mankind can gain; is not in pleasure, but in rest from pain.” (John Dryden)

  5. Appreciate your post ! Have been recently thinking along some similar lines regarding comparisons and contrasts between notable characteristics and effects of the use of Firearms (for the attempted infliction of pain, suffering, and deaths of other persons), and the use of prescription pharmaceutical Opioid medications (for the attempted relief from pain and suffering in the individual user only). Firearms are often toxic and deadly, while Opioids are rarely toxic and deadly. Firearms represent a vastly more reliable way for an individual to commit suicide than are prescription pharmaceutical Opioid medications. Ethanol leads to an order of magnitude more deaths annually, and NSAIDs lead to several time more deaths annually. “Toxicological burdens” should rightly fall upon these more deadly items so beloved to our culture obsessed with power, prejudices, violence, and theocratic moral pontifications – not Opioids.

    I am writing, not as a member of some particular advocacy group, but as a “responsible Opioid user”. I (eventually) taught myself “what I need to know”. Moderation and temperance where it comes to sensory and mood alterations are often not acquired early in life – however, there exists no meaningful or lasting way for legislators, bureaucrats, clinicians, so-called “therapists”, priests, or police-persons to force-feed any externally originated “objectivity” down peoples’ throats. Such is on it’s face but a fool’s errand. Those who sacrifice free will and human dignity to somehow evade personal responsibilities are misguided.

    People (in general) do not seek or enjoy pain and suffering (whether of physiological or psychological origins). They will endeavor by various means to feel a “sense of well-being” relative to their senses of discontent and discomfort. It is the responsibility of competent adults to educate themselves as to the possibilities as well as the limits surrounding chemical manipulations of sensory and affective aspects of consciousness and the human condition, and it is the natural right of competent adults to own their own mind and body – even where it comes to matters surrounding the deliberate ending of their (own) lives.

    A culture that dreads the mere possibility of an occasional fleeting sense of pleasure more so than the most severe and daunting pain and sufferings of it’s individual members is one that is wrongly convoluted and exploited by theocratic and/or totalitarian chemical statist regimens divorced from, and at odds with, the preservation of autonomy and dignity of competent adult human beings. No amounts of coercive and punitive psychological paternalism masquerading as “care”, scapegoating, and judgmental flagellations of self/others will prevent a culture from forging their own fetters with such futile endeavors. Physicians should rightly refuse to be conscripted (even under socio-political duress) into a servile army of phony “priests” and “police-persons” acting as weaponized pseudo-psychiatric agents of the State. Such rank conformism has nothing to do with the quality of life of patients – only with the quality of physicians’ lives.

    Firearms are bloody awful and deadly tools for tearing holes in human bodies (of other persons, or by choice, one’s self). Opioids, on the other hand, are an ancient and relatively non-toxic set of tools by which human bodies and minds can potentially be comforted and somewhat relieved from the pains and sufferings of human existence. In that sense, Firearms and Opioids are entirely non-equivalent things. The former puts and end to the possibilities for comfort and play in the lives of human beings. The latter, when judiciously utilized, can enhance the possibilities for comfort and play in the lives of human beings.

    The spirit of the demonstrable evil of the obsession with terminating the possibilities for comfort and play in the lives of human beings presently exists as a malignantly narcissistic, soulless cancer in our midst:
    “When I ask the prime minister of Singapore do they have a drug problem [the prime minister replies], ‘No. Death penalty’.” … “You know the Chinese and Filipinos don’t have a drug problem. They just kill them.” (Trump) … “But the president doesn’t just joke about it. … he often leaps into a passionate speech about how drug dealers are as bad as serial killers and should all get the death penalty.” … “Trump tells confidants a softer approach to drug reform – the kind where you show sympathy to the offenders and give them more lenient sentences – will never work.” … “He tells friends and associates the government has got to teach children that they’ll die if they take drugs and they’ve got to make drug dealers fear for their lives.” … “Trump has said he would love to have a law to execute all drug dealers here in America …”

    You are invited to gaze directly into the faces of such extra-judicial, totalitarian police-state madness:

    Speaking of “mental illness” concerns, I here propose that those who possess Firearms, and would ever consider using them in such utterly inhumane and unjust ways, (might perhaps, more justly) be prohibited from further complicating the potential deadly collateral damage surrounding their destructive psychoses by using various psychotropic drugs ? If societal limits are to be imposed by law, an enlightened society should concern itself with human activities that harm other persons, not one’s self. Vices are not crimes. I own my own mind and body – but I have no purview over yours when my natural rights are undiminished.

    Humankind has already wrecked the planet beyond reasonable repair, dooming ourselves and our young as the inhabitants along with the many creatures who had no part in such clueless myopic madness. To venerate wealth and power maintained by deadly armed force together with toxic NSAIDs, Ethanol, and environmental pollution while denying the legitimate interests, concerns, and natural rights of those who suffer in pain (of any origin) is anathema to all that I consider to be humane, just, compassionate, and reasonable. No law, rule, regulation or dictate should be followed that enforces such evil upon humanity.

    Referring to the above-linked CDC web-site, it appears that the (provisional) data differs from yours:

    CDC 12 Month-ending Provisional Counts of Drug Overdose Deaths, by Drug or Drug Class and Selected Jurisdictions (covering the 1-year preceding July, 2017) indicates significant proportional increases in Synthetic Opioids (Fentanyls and Tramadol) deaths (relative to all Opioids):

    Total (provisionally alleged to have been) Opioid caused deaths – 57,523 (100%)
    Synthetic Opioids (Fentanyls and Tramadol), T40.4 – 24,570 (42.7%)
    Heroin, T40.1 – 15,365 (26.7%)
    Natural and Semi-synthetic Opioids (Morphine, Hydro/Oxy-codone/morphone) T40.2 – 14,482 (25.2%)
    Methadone, T40.3 – 3,106 (5.4%)

    The forensic toxicological identification of Heroin requires detecting presence of the unique metabolite 6-monoacetyl-morphine (6-MAM). Any and all failures to test for 6-MAM have and will result in the misclassification of death as due to Morphine (adding it to “Natural and Semi-synthetic Opioids” prescription pharmaceuticals, instead). The result is the under-reporting of Heroin as allegedly causative while simultaneously over-reporting “Natural and Semi-synthetic Opioids” as allegedly causative.

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