Anybody following our blogs is familiar with the fallout that legitimate Florida pain patients are facing as a result of strict new regulations that did not account for the resultant negative impact to patients. This was outlined in detail in Dancing to the Pharmacy Crawl for Opioids and is also highlighted by many patient comments there and at Chronic Opioid Patients Speak Out Against PROP.
Here to review parallel issues in the state of Kentucky is Dr. Debora Tallio, who has nearly 20 years of experience in Physical Medicine and Rehabilitation. Her commentary follows immediately below.
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I read with avid interest your piece on the “Pharmacy Crawl”……unfortunately, more and more disenfranchised pain patients in Kentucky are doing a similar “dance” since the passage of Kentucky’s “pill mill bill” (HB1).
It should be obvious that drug addicts, drug dealers, and compliant pain patients are vastly different. Unfortunately, pain patients often get treated like there is no difference.
Drug addicts abuse drugs, and without proper medical treatment, sadly will likely continue to abuse drugs. Addiction is a complex medical problem and is a diagnosis unto itself. Addicts will pursue the easier course…..if they are not given adequate medical treatment to go into recovery, they will continue to seek substances to maintain their addicted state.
Adequate insurance coverage for addiction treatment and psychiatric services is lacking in our country. Unfortunately, many professionals confuse the difference between “physical dependency” (which is a physiological withdrawal response that occurs when chronic opioid therapy that is abruptly discontinued), “opioid tolerance” (more medication needed for the same therapeutic effect due to an adaptive mechanism and mu opioid receptor receptor up-regulation), and addiction (a psychological and physical craving to obtain opioids for a euphoric effect).
Then there are the criminals. Prescription drug abuse drastically increased after 9-11 when our border security increased. Traffickers and dealers are pleased that some criminal cohorts have a medical license to write for pain medications. “Pill Mills” are their gold mines. Opioids are just one example of substances that criminals traffic and sell….limit prescription opioids and other substances will be used and abused. In Kentucky, homemade methamphetamine labs are a serious problem, marijuana crops flourish, and heroin is on the rise. This is outlined nicely in a recent article by Dr. S.B. Leavitt at Pain Pills Wane – Heroin Moves in at paintopics.org.
Let’s look at the positive aspects of the FL and KY “pill mill bills”. Illegitimate pain clinics have closed. Drug dealers no longer have easy access to prescription opioids for diversion. Individuals practicing illegal medicine have lost their medical license. Addicts don’t have an easy stream of opioids to maintain their addicted state so maybe they will decide it is easier to just get help for their addiction. Physicians trying to practice appropriately but without adequate education regarding prescribing and monitoring opioids are now being made to get additional education. GREAT!
Now let us look at the unintended casualties of Florida’s and Kentucky’s “pill mill bills” and excessive regulations. The legitimate pain patients and the legitimate medical providers willing to treat patients with severe intractable pain are being treated as if they are illegitimate. Keeping up with all the “rules” has been onerous for medical providers…a burden that the politicians and certain Medical Boards are willing to minimize or ignore. Many legitimate physicians have refused to prescribe any controlled substances whatsoever because of the time constraints in monitoring and the fear of repercussions from the Board or law enforcement. Legitimate doctors are being “profiled” and investigated (including me) because politicians have appointed a “prescription advisory panel” who targets prescribers, with no correlation to the patient’s medical chart. Although I did nothing wrong, on the paperwork regarding my investigation I am called a “suspect.” Bullying is not allowed in our schools…why is it allowed by lawmakers and peer reviewers? The governor was quoted in a press release last year referencing the advisory panel: “The professionals I’m appointing know the difference between legitimate prescriptions and what constitutes a pattern of abuse.”
Well, if this is the case, why am I being investigated? The definition of “successful” legislation to some appears to be that minimal to no opioids whatsoever will be prescribed in the state of Kentucky for patients with chronic non-malignant pain. What a travesty!
Some politicians seem very happy to have facilitated a divide amongst medical providers….those who think opioids are detrimental and need to be federally controlled verses those who think there is a role for opioids when used appropriately but that more education and monitoring is needed. Like everything in life, there are risks verses benefits. Look at the large numbers of people who are hospitalized or die each year from complications of using anti-inflammatories…. Where is the outrage about this? In fact, anti-inflammatories are prescribed frequently by those who will not prescribe opioids in efforts to control pain.
There are thousands of people killed and disabled every year from motor vehicle accidents, yet we choose to drive our cars because the benefits exceed the risks. No medical provider in their right mind thinks that opioids are benign medications. Our job as medical providers is to evaluate a pain patient, ensure their diagnosis warrants the use of opioids and that opioids are only a part of a comprehensive treatment program, educate patients about the risks, use the dose appropriate to allow restoration of function, and monitor to reduce the risk of abuse and diversion. Given all we know about genetic differences between individuals, is it a surprise that different patients require different doses? Absorption, metabolism, receptor affinity, and excretion drastically vary from patient to patient. Why then the mindset that an arbitrary dose of opioid should help all people? The physician only willing to prescribe very low doses seem either more so concerned about their own quality of life than that of their patients or are too fearful of the medical board or the legal system to prescribe an optimal dose. How easy to only give a few Lortab® or Percocet® a day…..little risk of apnea, drug interactions, opioid-induced hyperalgesia….little risk of slander by peers for being a “drug pusher”….little risk of investigation by a medical board for running a “pill mill”. Wow, I want that kind of practice but that is not what I call true “pain management.”
Some politicians involved with the Florida and Kentucky “pill mill” legislation have not taken the time to look at all the consequences. Yes, illegitimate clinics and doctors have been shut down, but what about the legitimate ones? The legal system has mowed down a forest of animals, killing all the endangered animals just to eliminate a couple of rabid ones. Why would they do this? Politicians are supposed to care about ALL people in their state. Why not pass legislation which shuts down the illegal while protecting the legitimate. It appears we are well on our way to a big government takeover of medicine….quality care for deserving pain patients is being sacrificed.
Pain patients and medical providers who treat pain patients need to speak up now and speak up loudly. In Kentucky, the situation is urgent because the legislature meets in early January to decide about any possible amendments to HB1. Contact your state legislators and Medical Board. In Kentucky where I reside, the sites are www.lrc.ky.gov/Legislators.htm and www.kbml.ky.gov respectively. Let’s try to prevent the “Pharmacy Crawl” from sweeping our state.
BIOSKETCH: Dr. Debora Tallio’s primary clinical interest is treating patients with musculoskeletal pain and chronic pain. She completed a residency in Pediatrics at the Medical College of Georgia and a residency in Physical Medicine and Rehabilitation at the University of Michigan Medical Center. She is a member of several pain societies and is on the board of the Catholic Medical Association Guild in Lexington. Dr. Tallio is currently treating patients in Lexington and Irvine Kentucky.
i was going to pain clinic for 3yrs after 7yrs in severe chronic pain i was lucky to found female pain doctor who cared enough to write pain medication that really worked it didn’t make me high it took care of 3/4 of my severe pain i had 1yr of this they they said it was a pill mill and shut her down,icame to know alot of people like me i seen this doctor throw two know drug addicts out while being treated the rest of the patients i knew were get help also from pain so bad it made you want to cry,after 3yrs of being shut down i was told only 16 out of 3000 patients were drug addicts or selling their medicine when it first happen i heard on new 3000 drug addicts throw to the street,iknow of 5 real severe chronic pain patient that went there and die from not having their medication,i had to go to another pain doctor who told me everyone from clinic i was going too was being called an drug addict one medicine was taken away which i haven’t been right without it,the pain medicine i really needed was cut down to half the amount and half the mgs which was and is torture i went from feeling human to feeling like i’m dieing after months of telling doctor i was in severe pain he told me to shut up or leave i just took medicine which if i took right did nothing i need to be out of pain he fired me guess cause i woulsdn’t lie and say medicine was helping i was truly undermedicated in very severe pain i live in ky,i don’t drink or i just get moonshine, i don’t smoke pot or i just go to that but since i’m in severe permanent pain 24/7 and was given what they say is large amount it worked 120 30mg roxicets a month i took them every 6hrs they worked and gave me my life back but now they act like i murder someone when i ask or i’m an drug addict its on my rx record they know they are undermedicating me they want me to die i guess or don’t care if they did this in any other illness they would be arrested for murder its a witch hunt the real drug addict have gone back to street drugs as soon as they passed hb1 in ky its only torturing and killing person in severe chronic pain i’ve talked to everyone its like they said we’ll stop drug abuse of the few if wew have to kill all chronic pain patients,all i know they”ll have to answer here on earth or be in line will nazi’s for torture on judgement day were they are going is really hot.
Dr. Talio was without exception the finest pain mangaement physician I have ever had so it dismays me deeply that she has ceased practicing medicine as a result of being constantly harrassed by and in conflict with the people whose job it is to fulfill the legislative mandates. Never did she prescibe medicine without good reason and only after an exhaustive physical examination and in person interview did she prescibe medication of any type.
Dr. Talio is also held in high regard by her fellow pain management practioners including my current one, Dr. Harold Rutledge. ( To my dismay he too is now quitting the practice of pain management because as he says: “I now spend more hours filing reports so that I don’t loose my license than I do in treating patients….that is not why I went to medical school. I do not want to be a policeman, nor do I want to be treated as a criminal.”)
While I could go through my own experiences with pain and attempts to control to an extent that I can have a somewhat productive life, it is perhaps a better illustration of my situation to say that for years I was suicidal, coming close on numerous occasions to taking my life because living in horrific pain day and day with no end in sight was simply more than I could bear. The first physician who put me on medication effective with pain did far more than all the psyciatritic intervention I undertook in an attempt to keep living. Pain without end, without hope of improvement is torture and it is not surprising that so many people living with chronic pain choose to end their life.
For those legislators who think they will stop drug abuse by limiting the pain management options of legitimate physicians to legitimate patients I believe they are at best naive and at worse cruel. I would like to have those individuals live in my body for an extended period of time. I know their tune would change.
I regret that the actions of abusers of drugs, alcohol, tobacco and other controlled substances as well as those who choose “recreational drugs” has created a situation where in an attempt to solve the problem, the baby is being thrown out with the bath water.
Sincerely,
K. Casey
Nov. 15, 2013
HELLO THERE,
I ALSO WAS A PATIENT OF DR R. FOR MORE THAN 10 YEARS AND NOW THAT HE HAS LEFT BECAUSE OF THIS CRAZINESS GOING ON WITH DRUG ABUSE I AM MISERABLE WITH PROCEDURES I AM HAVING TO GO THROUGH ALL OVER AGAIN. THE NEW DRS DOESNT EVEN WANT TO LOOK AT MY FILES, THEY SAY THAT THEY ARENT DR RUTLEDGE AND THEY WANT TO DETERMINE WHATS WRONG WITH ME, EVEN THOUGH I HAVE BEEN TO SURGEONS VERIFYING EVERYTHING DR R. DIAGNOSED ME WITH. I HAVE NEVER FELT SO OUT OF CONTROL OF MY OWN HEALTH, I FEEL LIKE I AM NOT BEING TREATED AS A PATIENT ANYMORE BUT JUST A PERSON THEY CAN DO ALL THESE TESTS ON AND MAKE AS MUCH MONEY OFF OF ME WHILE THEY HAVE ME UNDER THEIR CARE THEN WHEN ALL THAT’S DONE THEY WILL COME UP WITH SOMETHING TO GET RID OF ME. I HAVE NEVER MISSED SOMEONE AS MUCH AS I HAVE DR R., HE ACTUALLY CARED ABOUT HIS PATIENTS AND HE UNDERSTOOD WHEN I WOULD TELL HIM I COULDN’T AFFORD A PROCEDURE AT THE MOMENT AND WE WOULD WAIT UNTIL A BETTER TIME WHEN I HAD MORE MONEY TO PAY. I BELIEVE THAT I’M NOT THE ONLY ONE THAT MISSES HIM AND HIS CARE THAT HE ACTUALLY TREATS PEOPLE LIKE A INDIVIDUAL AND ACTUALLY CARED ABOUT US. I HOPE YOU HAVE FOUND ANOTHER DR TO TAKE HIS PLACE BECAUSE I CANT FIND ONE SO FAR TO EVEN COME CLOSE. THANKS FOR LISTENING.
i’ve been in chronic pain 10yrs since this law been pass the medicine and amounts of have been taking away, i was given half of what i use to take and half the mg’s i’m 53 now feel like 90 have no hope of any kind of life woman asked me out i told i couldn’t cause i can barely move i have mri’s of fusion of neck left in great pain from permanent damage i would take an lie detector test i’m not an drug addict i’m just wanting my medicine back to where i can just do the basic things again not be in bed 24/7 waiting to die so i’d be out of pain,on judgement day those who are torturing real pain patints will be beside the nazi i don’t have to say where there going do i.
I was injuried trying to save my coworkers life on the job. Sadly he died in my arms that day 7 years ago. I ended up with my right shoulder crushed L-3,L4 tear with buldge complete loss from level L5 to S-3, That has also caused a 2cm tarlov cyst to form from the trauma to the nerve at level S-2,S3,oh and by the way they want to do a total knee replacement on my left knee. The surgeons tell me I am not a canidate for surgery due to the extensive damage and its a miricale i can still walk and i have no feeling in either pinkie or ring finger in either hand and live in Kentucky where i was getting treatment untill the PILL MILL BILL. Then i was told i was going to be in a lot of pain and no more treatment. One last thing i suffer from chroninc liver failure ,30% liver funtion, hepetitus which they called non alcholic steatohepatatic liver disease and i am treated like a drug addict even though ive never abused my meds and have been through all the therapys over the years and still cant find a dr that will treat me. So yes you are not alone in this fight and we do need to form a coalition or just lay down and die for them so they can enhance there political agenda, god bless and good luck.
The problem is worse than ever in Kentucky, yet another Legit Pain Clinic was shut down that now leaves 14 for the entire state. The passing of House Bill 1 aka the Pill Mill Bill has Doctors so scared they will write NOTHING, they will not even see you you. How do I know this I am one of them I have called over 200 Doctors and the minute they find out I have chronic pain I am told they WILL NOT SEE ME…..The one Doctor who did agree I will from here on out refer to “As the man in the white coat” agreed to see if ONLY after his office verified I had Ins..(Medicare) after taking thousands of pages of paper work in with me this is what he told me……I do not have epilepsy as My IQ is above 60 and I am not in a wheelchair, There is NO way I had a heat attack on March 9 of this year ( he was given hospital report) as I was to young, I do NOT and Could NOT have Fibromyalgia as there is NO such disease, I do not have Lyme disease (again he had proof in his hand) to make this long story a short one he REFUSED to write any medication I have been on before moving here, including Plavix due to sent in my heart , my high BP meds and my seizure meds’ and when I asked him what I was to to for medication and told him my concerns of withdrawal as I have been on Pain and seizure medication for over 20 years he said well come and see me in a month you have INS when I asked why he said I want to see if you make it through your so called withdrawals handed me my medical records and walked out……This is not MEDICAL CARE…..!!! Not sure what to call this But I did report the man in the white coat to the KBML in which he denied every word of it…..What he did not know is I audio tape My DR visits just in case I forget something the DR has told me ( Legal) in KY….Now I am awaiting a call or letter from KBML as to what they are going to do about his lack of EVEN GIVEN ME THE BASIC MEDICATION TO KEEP ME ALIVE….I was lucky I called my DR I had in another state before I moved here and he said I had t see him for him to help me so I had to fly to other state he was my DR of more than 7 years he listened to the tape was outraged to say the least and gave me my medication ion for 3 months only did blood work and told me my CA 125 number was very high and to get a DR ASAP when I get back home as its a test for Tumor maker for Ovarian Cancer well that was in Nov and still can not get a DR we need media attention to this problem and fast…….Thanks so much Dr. Fudin for allowing me to tell my story and Thank you for bring lite to this problem in KY
I don’t understand how they can justify going after legit doctors and pain paitents…when it’s so easy to catch abusers!!
It is the same the plan that has been used for decades. And it is a failure. They are trying to eliminate the “supply,” or “source,” of these pain medicines. It is the same strategy used for combating illegal drugs. This strategy never works though because there are just too many “supplies” or “sources”. Not to mention that there are not enough people to enforce this strategy.
The only sensible way to decrease the use of illegal drugs and the abuse of pain medicines is to reduce the desire some people have. This has been proven to be true. Portugal is the best example. Portugal has some of the lowest drug abuse/use rates in the world.
Not sure why countries have not adopted the proven and more rational approach to reducing drug abuse and the use of illicit drugs. It is a shame that there is such an easy solution and answer that nobody wants to implement.
The problem with the DEA is they have to produce enough doctor raids to show their on top of things even if its wrong. They must show their doing something with the money allocated to them each year.They must produce something and this something comes out of good honest doctors looking to make a living helping those in chronic pain finally find pain relief after exhausting all other alternatives. The bottom line is this gets us no where and proves nothing other than the DEA can do what they please when they want to do it to anyone at anytime. I’m putting myself at risk by writing this to all of you but I just don’t care anymore. Taking out good Pain Specialist for no apparent reason that treat chronic pain in suffering people for no good reason is just not right and to justify this as being okay is not okay with me and many like me. Along with the doctors that get their life and practice ruined for no good reason.
I think its time law enforcement steps back and takes a real good look at what their doing and the damage it causes good doctors, not to mention the people just looking for relief of their chronic pain. I understand the closing of Pill Mills and the Pill Mill Bill and putting a end to these illegitimate Pill Mills that was a plus for everyone including the drug dealers. But lets not mow down all legitimate practices and put innocent people back on the streets to suffer. Now we will see the reoccurrence of illegitimate drugs like heroin. Seems no matter what, either one the DEA, Medical Boards and Pain Specialist along with their pain patients all lose.
How can we bring this back together and see to it legitimate pain sufferers get the treatment they deserve. Can we please get back some kind of normalcy here.
The problem isn’t the DEA it’s the FDA. The FDA sics the DEA on this doctors who try and help us. I as a chronic pain patient am already being watched due to the fact my old GP passed me off to so many different doctors(specialists) that I am considered a doctor shopper. Guess why my old GP passed me off so many times, he was afraid of the FDA & DEA. But I trusted him to help me and look what he did to me. I now have a doctor willing to help me and as soon as the DEA found out I was seeing him they went to him and told a crock of bull about me being a doctor shopper. When I found out about this I was livid! I have done nothing but try to make my life livable and am condemned for it.
This needs to stop now. We as chronic pain patients need to ban together and fight this before it gets so bad pain patients start taking their own lives because they can’t find the help they need.
I have been in contact with another doctor that was shut down recently? He was absolutely legitimate. He had his office next door to a police station in Georgia. They raided his office twice and could not find what to charge him with so they made up something. You will not believe the stories of corruption within the DEA just to arrest doctors. Also, after talking with him several times? It sounds like a conspiracy is going on with a pharmaceutical company and the DEA. This pain clinic took care of many patients that didn’t write for a lot of name brand medicines or many high doses. They also,in the beginning, were treating patients from different neighboring states because those states didn’t have many or any doctors willing to treat pain. They stopped doing that and then was harrassed for something else that didn’t make sense. There were 6 doctors that worked there at different times that were certified in pain management. The day of the arrest a OB-GYN with certification of pain medicine happen to be working. Wouldn’t this doctor be a specialst for women with pelvic pain problems? If this is deleted . I will understand.
Why would this be deleted? It has to be approved before it is posted. So, I don’t think that will happen. Sounds like a somewhat common problem, unfortunately. These doctors are not alone. Do you have any links or articles about the situation. I would be interested to read about it.
This blog article is very good and says it all. I totally agree that Kentucky and all patients in every state
needs to speak up loudly and show your FACES!
They are changing the laws and now is when all legitimate pain residents need to be a apart of the law making process!
I cant count how many times I’ve read Dr. Debora Tallio’s story. I just makes me so frustrated I feel like I cant write another word. But in no way will I stop writing about the travesty like that of Dr. Tallio. If we don’t speak out to get the proper care of not just those in chronic pain but the special doctors that treat us that suffer from never ending chronic pain we will never come to a agreement or conclusion.
And to our government that runs this Country please stop ruining it and run it instead.
When Democrats and Republicans argue amongst themselves nothing ever gets accomplished ,maybe this is why this Country in in a recession ,no one wants to give in and make rational decisions.
I’ve been on a comprehensive treatment program for my severe chronic pain for 23 plus years and I know the risk. The proper use of pain medication allowed me to be a productive member of society again and for 3 years I lay paralyzed in pain on my couch thinking is this how I’m going to live the rest of my life.
In good time I found relief for that paralyzing pain and during that time found ways of dealing with it other that just medication alone. But if not for the very medications that got me out of bed I would not be writing this today.
I’ve been lucky, I have a family that cares and I’ve gone from the bottom to the top and I thank my maker for that. If we don’t all work together we will get no where,its takes all of us to make a difference.
So please lets put a end to the prosecution of good doctors like Dr. Tallio, she like other where just doing what they learned in medical school. Helping those in a bad situation get their life back ,is their sin in this. If so can anyone tell me how things have gone so wrong.
With Regards to all that suffer from chronic pain and their compassionate doctors.
Mark S. Barletta