Today is 09/25/2017

2016 in review … what killed us

2600 Americans will die EVERY DAY – from various reasons


140 will be SUCCESSFUL – including 20 veterans

270 will die from hospital acquired antibiotic resistant “bug” because staff won’t properly wash hands and/or proper infection control.

350 will die from their use/abuse of the drug ALCOHOL

1200 will die from their use/abuse of the drug NICOTINE

1400 will contract C-DIF from Hospital or Nursing home because staff doesn’t properly wash their hands are adhere to infection control       80 WILL DIE mostly elderly.

850 will die from OBESITY

700 will die from medical errors

150 will die from Flu/Pneumonia

80 will die from Homicide

80 will die in car accidents


I am being completely weaned off my meds, & suspect I will kill myself with the amount of pain I am in, & will be by the time this is over (the wean that is). Already can’t function.

My husband committed suicide after being abandoned by his pain dr.

Please pray for me as I am on the brink of suicide! I don’t want to die but can’t handle the pain anymore! The doctor that I am currently seeing will not give me enough pills to last all month every month… I have to wait until Oct to get in with a pain management doctor whom I already know by others that I know sees this doctor that he will help me, need prayer to hold on until oct… I keep thinking of my family who needs me hear.

“We just lost another intractable member of our support group two nights ago. She committed suicide because her medications were taken away for interstitial cystitis (a horribly painful bladder condition) and pudendal neuralgia, both of which she had battled for years

D D., journalist and prescribed fentanyl patient for a dozen years joined me on air last weekend with her husband and spoke of her suicide plan should the only relief from constant agony be heavily reduced or taken away.

I was told last Friday that my Dr. will be tapering my meds again . When I told him I didn’t think my body could take another lowering he stated ” it wasn’t my
License on the line”, I stated ” no , but it’s my life on the line”!!!!! I can not continue to live this way . I can not continue to suffer in agony when my medications and dose where working just fine before and I was a productive member of society . I can no longer take this. I have a plan in place to end my life myself When I am forced to reduce my Medications again . I just can’t do it anymore .

On Friday at around 9 p.m. U.S. Navy veteran Kevin Keller parked his red pickup truck in the parking lot at the Wytheville Rite-Aid, walked across the grass and stood in front of the U.S. Veterans Community Based Outpatient Clinic next door.

Sick and tired of being in pain, he pulled out a gun, shot a hole in the office door, aimed the gun barrel at his head and ended his hurt once and for all.

As a longterm pain patient with a current unsupportive pain dr, I just thought I’d share the reality of the position I’m in right now…

I’m in very bad pain all the time for very legit and well documented reasons. My pain dr however never gives me enough meds to help me. He just keeps reducing them, which is causing me to be in even more pain and suffer so much more. My quality of life also continues to go downhill at the same time. I was just given a letter by him recently too about some study indicating an increase in deaths if you take opioids and benzos. It stated he’s no longer going to give pain meds to anyone who is taking a benzo. I take one, because I have to, for a seizure disorder, not because I want to. He told me to pick one or the other though, plus went ahead and reduced my pain meds some more. He doesn’t seem to care the least bit. I’ve looked hard and so far I can’t find another one to get in to see near me at this time, but I’m desperately still trying. Unfortunately, they’re few and far between here, in addition to the wait for an appointment being long. I’ve even called hospice for help. So far, they haven’t been of much help either, because I don’t have a dr who will say I have six months or less to live. I told them either choice my pain dr is giving me is very inhumane, so I’d rather just quit eating and drinking, to the point where I pass away from that, while I get some kind of comfort care from them. I don’t really want to though, although I do have a long list of some very bad health problems, including a high probability that I have cancer and it’s spread. Am I suicidal? No. Will I be if my pain and seizure meds are taken away. Highly likely. I never ever saw this coming either. I don’t have a clue what to do and the clock is ticking, but I’m still fighting for an answer. So far, I can’t find not even one dr to help me though. Not one. I know my life depends on it, but at what point will these drs let my suffering become so inhumane that I just can’t take it anymore. I just don’t know right now. It’s a very scary place to be in for sure. That I do know.

The patient was being denied the medicine that had been alleviating his pain and committed suicide because, “he couldn’t live with the pain anymore. He could not see a future. He had no hope. He had no life.”

I am a chronic pain patient who has been on fairly high doses of opiates for about nine years now. My dose has been forcibly reduced since the cdc guidelines. I moved to Oregon from Alaska and can’t find a doctor to prescribe my medication. I pray I have the strength not to take my own life!

Zach Williams of Minnesota  committed suicide at age 35. He was a veteran of Iraq and had experienced back pain and a brain injury from his time in service. He had treated his pain with narcotics until the VA began reducing prescriptions.

Ryan Trunzo committed suicide at the age of 26. He was an army veteran of Iraq. He had experienced fractures in his back for which he tried to get effective painkillers, but failed due to VA policy. His mother stated “I feel like the VA took my son’s life.”

Kevin Keller, a Navy veteran, committed suicide at age 52. He shot himself after breaking into the house of his friend, Marty Austin, to take his gun. Austin found a letter left by Keller saying “Marty sorry I broke into your house and took your gun to end the pain!” Keller had experienced a stroke 11 years earlier, and he had worsening pain in the last two years of his life because VA doctors would not give him pain medicine. On the subject of pain medication, Austin said that Keller “was not addicted. He needed it.”

Bob Mason, aged 67, of Montana committed suicide after not having access to drugs to treat his chronic pain for just one week. One doctor who had treated Mason was Mark Ibsen, who shut down his office after the Montana Board of Medical Examiners investigated him for excessive prescription of opioids. According to Mason’s daughter, Mason “didn’t like the drugs, but there were no other options.”

Donald Alan Beyer, living in Idaho, had experienced back pain for years. He suffered from  degenerative disc disease, as well as a job-related injury resulting in a broken back. After his doctor retired, Beyer struggled without pain medicine for months. He shot himself on his 47th birthday. His son, Garrett, said “I guess he felt suicide was his only chance for relief.”

Denny Peck of Washington state was 58 when he ended his life. In 1990, he experienced a severe injury to his vertebrae during a fishing accident. His mother, Lorraine Peck, said “[h]e has been in severe pain ever since,” and his daughter, Amanda Peck, “said she didn’t remember a time when her dad didn’t hurt.” During the last few years of his life, Peck had received opiates for his pain from a Seattle Pain Center, until these clinics closed. After suffering and being unable to find doctors who would help with his pain, Peck called 911. Two days later, Peck was found dead in his home with bullet wounds in his head. A note found near Peck read: “Can’t sleep, can’t eat, can’t do anything. And all the whitecoats don’t care at all.”

Doug Hale of Vermont killed himself at the age of 53. He had experienced pain from interstitial cystitis, and decided to end his life six weeks after his doctor suddenly cut off his opiate painkillers. He left a note reading “Can’t take the chronic pain anymore” before he shot himself in the head. His doctor said he “was no longer willing to risk my license by writing you another script for opioids”  (see attachment A for details of the problem as relyed by his wife Tammi who is now 10 months without a husband as a direct result of the CDC guidelines to prevent deaths)Bruce Graham committed suicide after living with severe pain for two years. At age 62, Graham fell from a ladder, suffering several severe injuries. He had surgery and fell into a coma. After surgery, he suffered from painful adhesions which could not be removed. He relied on opioid painkillers to tolerate his pain, but doctors eventually stopped prescribing the medicine he needed. Two years after his fall, Graham shot himself in the heart to end the pain.

Travis Patterson, a young combat veteran, died two days after a suicide attempt at the age of 26. After the attempt to take his own life, Patterson was brought to the VA emergency room. Doctors offered therapy as a solution, but did not offer any relief for his pain. Patterson died two days after his attempted suicide.

54-year-old Bryan Spece of Montana  killed himself about two weeks after he experienced a major reduction in his pain medication. The CDC recommends a slow reduction in pain medicine, such as a 10% decrease per week. Based on information from Spece’s relative, Spece’s dose could have been reduced by around 70% in the weeks before he died.

In Oregon, Sonja Mae Jonsson ended her life when her doctor stopped giving her pain medicine as a result of the CDC guidelines.

United States veterans have been committing suicide after being unable to receive medicine for pain. These veterans include Peter Kaisen,Daniel Somers, Kevin Keller, Ryan Trunzo, Zach Williams, and Travis Patterson

A 40-year-old woman with fibromyalgia, lupus, and back issues appeared to have committed suicide after not being prescribed enough pain medicine. She had talked about her suicidal thoughts with her friends several times before, saying “there is no quality of life in pain.” She had no husband or children to care for, so she ended her life.

Sherri Little was 53 when she committed suicide. She suffered pain from occipital neuralgia, IBS, and fibromyalgia. A friend described Little as having a “shining soul of activism” as she spent time advocating for other chronic pain sufferers. However, Little had other struggles in her life, such as her feeling that her pain kept her from forming meaningful relationships. In her final days, Little was unable to keep down solid food, and she tried to get medical help from a hospital. When she was unable to receive relief, Little ended her life.

Former NASCAR driver Dick Trickle of North Carolina shot himself at age 71. He suffered from long-term pain under his left breast. Although he went through several medical tests to determine the cause of his pain, the results could not provide relief. After Trickle’s suicide, his brother stated that Dick “must have just decided the pain was too high, because he would have never done it for any other reason.”

39-year-old Julia Kelly committed suicide after suffering ongoing pain resulting from two car accidents. Kelly’s pain caused her to quit her job and move in with her parents, unable to start a family of her own. Her family is certain that the physical and emotional effects of her pain are what drove her to end her life. Kelly had founded a charity to help other chronic pain sufferers, an organization now run by her father in order to help others avoid Julia’s fate.

Sarah Kershaw ended her life at age 49. She was a New York Times Reporter who suffered from occipital neuralgia.

Lynn Gates Jackson, speaking for her friend E.C. who committed suicide after her long term opiates were suddenly reduced by 50% against her will, for no reason.  Lynn reports she felt like the doctors were not treating her like a human being (Ed:  a common complaint) and she made the conscious decision to end her life.

E.C. committed suicide quietly one day in Visalia California.  She was 40.  Her friend reported her death.  “She did not leave a note but I know what she did”.  The doctor would only write a prescription for 10 vicodin and she was in so much pain she could not get to the clinic every few days.   We had talked many times about quitting life. Then she left.  She just left.

Jessica, a patient with RSD/CRPS committed suicide when the pain from her disease became too much for her to bear. A friend asserted that Jessica’s death was not the result of an overdose, and that “living with RSD isn’t living.”

Aliff, Charles

Beyer, Donald Alan

Brunner, Robert “Bruin”

Graham, Bruce

Hale, Doug

Hartsgrove, Daniel P

Ingram III, Charles Richard

Kaisen, Peter

Keller, Kevin

Kershaw, Sarah

Kimberly, Allison

Little, Sherri

Mason, Bob

Miles, Richard

Murphy, Thomas

Paddock, Karon

Patterson, Travis “Patt”

Peck, Denny

Peterson, Michael Jay

Reid, Marsha

Somers, Daniel

Son, Randall Lee

Spece, Brian

Tombs, John

Trickle, Richard “Dick”

Trunzo, Ryan

Williams, Zack

Karen Shettler Paddock  committed suicide on August 7, 2013 

Jessica Simpson took her life July 2017

Mercedes McGuire took her life on Friday, August 4th. She leaves behind her 4 yr old son. She could no longer endure the physical & emotional pain from Trigeminal Neuralgia.

Another Veteran Suicide In Front Of VA Emergency Department

 Depression and Pain makes me want to kill self. Too much physical and emotional pain to continue on. I seek the bliss fullness of Death. Peace. Live together die alone.

 Dr. Mansureh Irvani  suspected overdose victim

Katherine Goddard’s Suicide note: Due to the pain we are both in and can’t get help, this is the only way we can see getting out of it. Goodbye to everybody,”  

Steven Lichtenberg: the 32-year-old Dublin man shot himself  

Fred Sinclair  he was hurting very much and was, in effect, saying goodbye to the family.

Robert Markel, 56 – June 2016 – Denied Pain Meds/Heroin OD

CDC Launches New Campaign Against Rx Opioids

CDC Launches New Campaign Against Rx Opioids

The Centers for Disease Control and Prevention has launched a new marketing campaign to combat the abuse of prescription opioids – a campaign that completely ignores the increasing role of heroin and illicit fentanyl in the nation’s overdose crisis.

The Rx Awareness campaign will use videos, online advertising, billboards, newspapers and radio ads to increase awareness “about the risks of prescription opioids and stop inappropriate use.” The campaign will initially run for 14 weeks in Ohio, Kentucky, Massachusetts, and New Mexico, with a broader release expected as additional states receive funding through CDC programs. No estimate of the cost of the campaign was released.

“The U.S. Department of Health and Human Services (HHS) is committed to using evidence-based methods to communicate targeted messages about the opioid crisis and prevent addiction and misuse in every way we can,” HHS Secretary Tom Price, MD, said in a statement. 

The Rx Awareness campaign features “real-life accounts” of people recovering from opioid addiction or who have lost loved ones to a prescription opioid overdose.

“Prescription opioids can be addictive and dangerous,” a woman says in an online banner ad.

“One prescription can be all it takes to lose everything,” a man says in another ad.

Although addictive behavior typically starts during adolescence, the Rx Awareness campaign is targeting adults aged 25-54 who have used prescription opioids at least once either medically or recreationally.


“We learned that adults between the ages of 45 and 54 had not yet been targeted by a broad-reaching campaign. This information was reinforced by surveillance data indicating that the population with the highest fatality rate from opioid overdoses was non-Hispanic white adults ages 45–54,” the CDC said in an unusually detailed explanation of the rationale behind the campaign.

“We also found a need for communication efforts to deliver primary prevention messages to younger audiences ages 25–35, who are less likely to experience chronic pain but may be exposed to opioids for other reasons, such as having a sports injury or undergoing a dental procedure.”

The four states initially being targeted all have soaring rates of opioid overdoses, but in recent years most of the deaths have been linked to heroin and illicit fentanyl, not prescription opioids. 

The latest report from the Massachusetts Department of Public Health, for example, shows prescription opioids were involved in only 15 percent of opioid-related overdose deaths in the first quarter of 2017. Fentanyl was involved in 81 percent of the Massachusetts deaths and heroin in 39 percent of them. 

The CDC said heroin is not mentioned in the Rx Awareness campaign because it doesn’t want to “dilute” its primary message.

“The campaign does not include messages about heroin. Specificity is a best practice in communication, and the Rx Awareness campaign messaging focuses on the critical issue of prescription opioids. Given the broad target audience, focusing on prescription opioids avoids diluting the campaign messaging. Heroin is a related topic that also needs formative research and message testing,” the CDC said.

One of the video testimonials featured in the campaign is the story of Steve Rummler, a Minnesota man with chronic back pain who became addicted to painkillers. Rummler died of a heroin overdose at the age of 43.

His mother Judy, who appears in the video, founded the non-profit Steve Rummler Hope Foundation, an anti-opioid activist group. The Rummler foundation is the “fiscal sponsor” of Physicians for Responsible Opioid Prescribing (PROP), a designation that allows PROP to collect tax deductible donations using the foundation’s non-profit status. PROP founder Andrew Kolodny, MD, is listed as a member of the Rummler foundation’s medical advisory committee, as is PROP President Jane Ballantyne, MD.

The CDC said it developed the videos and other campaign material using a “mixed-method design integrating data from in-depth interviews and a quasi-experimental, one-group retrospective post-then-pretest (RPTP) survey was used to assess target audiences’ responses to campaign messages.”

In the other words, they did a pilot study. The CDC said most participants thought the campaign material was “attention grabbing, believable and meaningful.” Many also said they would share the video testimonials with others.   

“This campaign is part of CDC’s continued support for states on the frontlines of the opioid overdose epidemic,” said CDC Director Brenda Fitzgerald, MD. “These heartbreaking stories of the devastation brought on by opioid abuse have the potential to open eyes – and save lives.”

Healthcare professional DENIED CARE… PT DIED … charged with MANSLAUGHTER …

The nurse accused of withholding a diabetic inmate’s insulin is being sued over his death

A George County inmate’s estate is suing the county, the city of Lucedale and registered nurse Carmon Sue Brannan because he died in the county jail after seven days without the insulin that had been delivered for him.

The lawsuit filed in U.S. District Court accuses the county and city of “deliberate indifference” to the medical needs of William Joel Dixon, who lay overnight on a jail cell floor before Brannan realized mid-morning on Sept. 24, 2014, that he was dead, according to a sworn statement filed in the case.

Brannan is scheduled for trial Oct. 16 in George County on a manslaughter charge.

The jail had insulin on hand for Dixon, including one batch delivered by his mother and another fetched by a jailer from the glove compartment of Dixon’s car, records in the case show.

The car was towed after a Lucedale police officer arrested Dixon on drug possession, driving under the influence and child endangerment charges.

 Brannan called Dixon’s mother after he was arrested and talked to her about his diabetes and need for insulin, the lawsuit says. Brannan checked his blood sugar only once during his seven days in jail, the lawsuit says.

Witnesses from the jail have told investigators that Brannan claimed Dixon was “faking” his medical condition.

An autopsy determined Dixon died from diabetes.

The lawsuit seeks unspecified damages to compensate Dixon’s heirs for his death and punitive damages from Brannan.

Dixon was deprived of his constitutional rights to due process because he was denied medical treatment, the lawsuit says, despite exhibiting symptoms of illness for days. Before he lost consciousness, the lawsuit says, Dixon was unable to eat and was vomiting.

The lawsuit, which represents only the Dixon estate’s side of the case, claims George County has a policy or custom of prohibiting jail staff from summoning emergency medical assistance from outside the jail.

Anita Lee: 228-896-2331, @calee99


Pain never KILLED ANYONE… can just cause the pt to COMMIT SUICIDE ?

Prosecutor seeks to bar testimony at trial of doc accused of over-prescribing painkillers

Prosecutor seeks to bar testimony at trial of doc accused of over-prescribing painkillers

HAMILTON — Ravalli Deputy County Attorney Thorin Geist is asking a district court judge to prohibit physician Chris Christensen from presenting certain testimony or evidence at his upcoming trial on 400 felony counts, including negligent homicide.

In court documents, Geist asks Judge Jeffrey Langton to issue five orders in connection with the case:

• To prevent Christensen from presenting testimony from former patients regarding their medical experiences;


• To prohibit Dr. Mark Ibsen of Helena from testifying on matters that happened after April 1, 2014;

• To exclude testimony regarding an alleged extra-marital affair;

• To preclude Christensen from presenting information regarding jury nullification;

• To caution Christensen regarding his right against self-incrimination.

Christensen was arrested in August 2015 on charges that he allegedly provided hundreds of illegal prescriptions for large amounts of painkillers to his patients, including two who died from overdoses. His trial is set to begin on Oct. 19 before Judge Langton, and is expected to last 18 days.

Geist declined to comment on the case this week, citing the upcoming trial. But in court documents, he outlined the reasons behind his requests.

He wrote that Christensen has identified 28 former patients who would testify at the trial, with 21 of those being people he treated for “chronic pain syndrome” and for whom he prescribed controlled substances, including painkillers. The other seven patients were treated for “non-pain” conditions.

“None of the former patients were present when the defendant prescribed dangerous drugs to the victims in this case,” Geist wrote. “… The permissible scope of the former patient testimony is exceptionally narrow, and potentially inadmissible in its entirety as not relevant to the charged crimes and the victims in this case.”

Christensen’s attorney, Josh Van de Wetering, also declined to comment other than to say it will be “an interesting, challenging trial” that he’s eager to begin. However, he did address Geist’s motion in court documents filed Friday afternoon.

Van de Wetering, a former federal prosecutor turned defense attorney, opposes the first three motions, doesn’t object to the state’s request regarding jury nullification, and believes the caution against self-incrimination is “unnecessary and probably improper.”

The purpose of the testimony from former patients is to counter evidence from the state that suggests Christensen’s conduct was “so grossly negligent that he caused the death of two individuals,” or that he knowingly created a substantial risk of death or injury to his patients, or that his prescribing practice was far enough outside the norm that it constituted distribution of dangerous drugs in violation of the law, Van de Wetering wrote.

“They are expected to testify that Dr. Christensen was careful, knowledgeable, and caring,” Van de Wetering wrote. “They will testify that he did not encourage opiate use, but offered it as an alternative if appropriate.

“The relevance of their testimony is that it tends to suggest that Dr. Christensen is generally careful and therefore any error he might have made is just that: an error and not a crime.”

In regards to Ibsen, Geist writes that the doctor is being called as an expert witness who will testify regarding treatment he provided to 21 patients he took over from Christensen after April 1, 2014, which is the day a search warrant was executed at Christensen’s family medicine and urgent care clinic. Geist says that none of the patients was present when Christensen committed the alleged crimes.

“As such, Dr. Ibsen’s treatment of these patients is irrelevant to the issue of whether the defendant’s prescription practices were within the standard of a professional practice as applied to the individual victims in this case,” Geist wrote. “Their testimony is irrelevant and should therefore be excluded.”

Ibsen himself came under scrutiny by the state’s Board of Medical Examiners after a 2013 investigation began into allegations that he over-prescribed painkillers, and he shuttered his practice in 2015. He’s a longtime critic of how the federal Drug Enforcement Agency and the overall medical establishment have treated opioid addiction.

Van de Wetering writes that Ibsen’s testimony is relevant because he can can address whether Christensen’s prescription levels were appropriate for patients dealing with chronic pain, and should be admitted.


Geist also wants both prosecutors and the defense to be barred from presenting testimony related to an alleged extra-marital affair between Christensen and a former physician’s assistant he employed more than 25 years ago. Geist wrote that Christensen denies the affair ever took place, and Geist adds that the alleged affair is “entirely irrelevant” to the allegations in this case. The woman was identified as a witness for the state.

“Even if it were relevant, the danger of unfair prejudice to either party is substantial,” Geist wrote.

Van de Wetering agreed in part, noting that “This is a trial about a physician’s prescribing practices, not about anything related to his character.”

However, he said the former employee expressed a romantic interest in Christensen, which he rejected, and Van de Wetering expects to use that information in a cross-examination of the employee as “evidence of bias and motive to fabricate.”

The order prohibiting discussion of “jury nullification” asks that Christensen’s attorney be barred from explaining to the jury that it could return a “not guilty” verdict despite its belief that Christensen is guilty — in effect, nullifying a law the jury believes is either immoral or wrongly applied to a defendant.

Van de Wetering said he isn’t planning on raising that issue.

Giest also wants Christensen to be put on notice that if he testifies at trial, he won’t be able to plead the Fifth Amendment against self-incrimination. Geist writes that Christensen is facing potential charges in U.S. District Court for distribution of dangerous drugs and other related offenses.

“For example, during a Mirandized interview on April 1, 2014, the defendant admitted to taking prescription medication back from his former patients and to re-dispensing them and/or destroying them in violation of federal law,” Geist wrote. “The District Court should caution the defendant that he will not be able to assert his right against self-incrimination in the event that he elects to testify at trial.”

Van de Wetering called that statement a threat of federal prosecution from Geist “under the guise of protecting the Defendant.” He notes that while the federal government can bring charges arising from facts brought out in state court, even if a person has been convicted or acquitted, that it typically doesn’t do so.

“Nothing of the kind is needed or desired, or even really proper,” Van de Wetering wrote. “… Unless the state has information it is not sharing, this motion should be rejected. If the state does have such information, it should be required to share it.”

Survey: would you BOYCOTT CVS because of new opiate dispensing policy ?

CVS Health recently announced that it will limit new opioid prescriptions for acute pain to a 7 day supply. CVS pharmacies will also require that daily doses be no higher than 90mg morphine equivalent units for both acute and chronic pain. Customers must also use immediate release formulations before extended release opioids are dispensed. This policy, which is meant to reduce opioid abuse and misuse, will become effective February 1, 2018.


check here to take survey


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PROP Founder Calls for Forced Opioid Tapering

PROP Founder Calls for Forced Opioid Tapering

Have you or a loved one been harmed by being tapered off high doses of opioid pain medication?

The founder of an anti-opioid activist group wants to know – or at least he posed the question during a debate about opioid tapering with colleagues on Twitter this week.

“Outside of palliative care, dangerously high doses should be reduced even if patient refuses.  Where exactly is this done in a risky way?” wrote Andrew Kolodny, MD, Executive Director of Physicians for Responsible Opioid Prescribing (PROP). 

“I’m asking you to point to a specific clinic or health system that is forcing tapers in a risky fashion. Where is this happening?”

It’s not an idle question. About 10 million Americans take opioid medication daily for chronic pain, and many are being weaned or tapered to lower doses — some willingly, some not — because of fears that high doses can lead to addiction and overdose.

Kolodny’s Twitter posts were triggered by recent research published in the Annals of Internal Medicine that evaluated 67 studies on the safety and effectiveness of opioid tapering. Most of those studies were considered very poor quality.

“Although confidence is limited by the very low quality of evidence overall, findings from this systematic review suggest that pain, function, and quality of life may improve during and after opioid dose reduction,” wrote co-author Erin Krebs, MD, of the Minneapolis Veterans Affairs Health Care System. 

Krebs was an original member of the “Core Expert Group” – an advisory panel that secretly helped draft the CDC opioid prescribing guidelines with a good deal of input from PROP. She also appeared in a lecture series on opioid prescribing that was funded by the Steve Rummler Hope Foundation, which coincidentally is the fiscal sponsor of PROP. 

Curiously, while Krebs and her colleagues were willing to accept poor quality evidence about the benefits of tapering, they were not as eager to accept poor evidence of the risks associated with tapering. 

“This review found insufficient evidence on adverse events related to opioid tapering, such as accidental overdose if patients resume use of high-dose opioids or switch to illicit opioid sources or onset of suicidality or other mental health systems,” wrote Krebs.

But the risk of suicide is not be taken lightly, as we learned in the case of Bryan Spece, a 54-year old chronic pain sufferer who shot himself to death a few weeks after his high oxycodone dose was abruptly reduced by 70 percent.  Hundreds of other pain sufferers at the Montana clinic where Spece was a patient have also seen their doses cut or stopped entirely.

Spece’s suicide was not an isolated incident, as we are often reminded by PNN readers.

“A 38 year old young lady here took a gun and put a bullet in her head after being abruptly cut off of her pain medication,” Helen wrote to us. “Her whole life ahead of her. This is happening every day, it just isn’t being reported.”

“I too recently lost a friend who took his own life due to the fact that he was in constant pain and the clinic he was going to cut him off completely,” said Tony.

“I have been made to detox on my own as doctors who were not comfortable giving out these meds would take me off, not wean me,” wrote Brian. “Was a nightmare. Thought I was gonna die. No, I wanted to die.”

“In the end when you realize that you’re not going to get help and that you have nothing left, suicide is all you have,” wrote Justin, who is disabled by pain and no longer able to work or pay his bills after being taken off opioids. “I don’t want to hurt my family. I don’t want to die. However it is the only way out now. I just hope my family and the good Lord can forgive me.”

Patient advocates like Terri Lewis, PhD, say it is reckless to abruptly taper anyone off high doses of opioids or to aim for artificial goals such as a particular dose. She says every patient is different.

“There is plenty of evidence that persons treated with opiates have variable responses – some achieve no benefit at all.  Some require very little, others require larger doses to achieve the same benefit,” Lewis wrote in an email to PNN.

“It is an over-generalization to claim that opiates are lousy drugs for chronic pain. Chronic pain is generated from more than 200 medical conditions, each of which generate differing patterns of illness and pain generation. For some, it may be reflective of its own unique disease process. We have to retain the ability to treat the person, not the label, not to the dose.”

Patient ‘Buy-in’ Important for Successful Tapering

And what about Kolodny’s contention that high opioid doses should be reduced even if a patient refuses? Not a good idea, according to a top CDC official, who says patient “buy-in” and collaboration is important if tapering is to be successful.

“Neither (Kreb’s) review nor CDC’s guideline provides support for involuntary or precipitous tapering. Such practice could be associated with withdrawal symptoms, damage to the clinician–patient relationship, and patients obtaining opioids from other sources,” wrote Deborah Dowell, MD, a CDC Senior Medical Advisor, in an editorial in the Annals of Internal Medicine.  “Clinicians have a responsibility to carefully manage opioid therapy and not abandon patients in chronic pain. Obtaining patient buy-in before tapering is a critical and not insurmountable task.”

The CDC guideline also stresses that tapering should be done slowly and with patient input.

“For patients who agree to taper opioids to lower dosages, clinicians should collaborate with the patient on a tapering plan,” the guideline states. “Experts noted that patients tapering opioids after taking them for years might require very slow opioid tapers as well as pauses in the taper to allow gradual accommodation to lower opioid dosages.”

The CDC recommends a “go slow” approach and individualized treatment when patients are tapered.  A “reasonable starting point” would be 10% of the original dose per week, according to the CDC, and patients who have been on opioids for a long time should have even slower tapers of 10% a month.

The Department of Veterans Affairs takes a more aggressive approach to tapering, recommending tapers of 5% to 20% every four weeks, although in some high dose cases the VA says an initial rapid taper of 20% to 50% a day is needed. If a veteran resists tapering, VA doctors are advised to request mental health support and consider the possibility that the patient has an opioid use disorder.

Have you been tapered at a level faster than what the CDC and VA recommend? Let us know by leaving a comment below.

If you think you were tapered in a risky way, you can let Dr. Kolodny know at his Twitter address: @andrewkolodny.

CDC Releases More Faulty Research About Opioids

CDC Releases More Faulty Research About Opioids

A new study by researchers at the Centers for Disease Control and Prevention estimates that opioid overdoses have shaved two and a half months off the average life span of Americans – a somewhat misleading claim because the study does not distinguish between legally obtained prescription opioids and illegal opioids like heroin and illicit fentanyl.

The research letter, published in the medical journal JAMA, looked at the leading causes of death in the U.S. from 2000 to 2015. Overall life expectancy rose during that period, from 76.8 years in 2000 to 78.8 years in 2015, largely due a decline in deaths from heart disease, cancer, stroke, diabetes and other chronic health conditions.

But deaths due to Alzheimer’s disease, suicide, liver disease, drug poisoning and opioid overdoses rose, collectively causing a loss of 0.33 years in life expectancy – most of it due to opioids.

“This loss, mostly related to opioids, was similar in magnitude to losses from all the leading causes of death with increasing death rates,” wrote lead author Deborah Dowell, MD, of the CDC’s National Center for Injury Prevention and Control.

“U.S. life expectancy decreased from 2014 to 2015 and is now lower than in most high-income countries, with this gap projected to increase. These findings suggest that preventing opioid related poisoning deaths will be important to achieving more robust increases in life expectancy once again.”


Dowell was also one of the lead authors of the CDC’s 2016 opioid prescribing guidelines, which discourage physicians from prescribing opioids for chronic pain. She and her two co-authors in the JAMA study —  both of them CDC statisticians — do not explain why they failed to distinguish between black market opioids and legal prescription opioids, a dubious use of statistics akin to lumping arsonists in the same category as smokers or Boy Scouts learning to build campfires.  

They also fail to even mention the scourge of heroin and illicit fentanyl sweeping the country, which now accounts for the majority of opioid overdoses in several states.  

But Dowell and her co-authors don’t stop there. The say the actual number of deaths caused by opioids is “likely an underestimate” because information on death certificates is often incomplete and fails to note the specific drug involved in as many as 25% of overdose deaths. This is another disingenuous claim, because it fails to explain why the data on the other 75% of overdoses is faulty too. 

Epidemic of Despair

Other researchers have also tried to explain the disturbing decline in American life expectancy – which began over adecade ago for middle-aged white Americans. Princeton researchers Anne Case and Angus Deaton were the first to document that trend,  when they estimated that nearly half a million white Americans may have died early because of depression, chronic pain, suicide, alcohol and drug abuse, and other health problems – an epidemic of despair linked to unemployment, poor finances, lack of education, divorce and loss of social connections.

The evidence was right there for Deborah Dowell and her co-authors had they looked for it. The JAMA study found that over 44,000 Americans committed suicide in 2015, a 66% increase from 2000, and over 40,000 died from chronic liver disease or cirrhosis, another 66% increase. Opioid overdoses during that same period rose to 33,000 deaths. 

Which is the bigger epidemic?

As PNN has reported, the CDC ignored early warnings from its own consultant that the agency’s opioid guidelines were being viewed as “strict law rather than a recommendation,” causing many doctors to stop prescribing opioid pain medication. Chronic pain patients also feel “slighted and shamed” by the guidelines, and are increasingly suicidal or turning to street drugs. We’ve also reported that the CDC has apparently done nothing to study the harms or even the possible benefits the guidelines have caused since they were released 18 months ago.

Instead of going back in time and selectively mining databases to fit preconceived notions about opioids, perhaps it is time for the CDC to take a giant step forward and see what its opioid guidelines have actually done.

When “yes” sometimes means “yes”, sometimes means “maybe”, sometimes means “no”

Mexican cartels: ready to meet Americans’ insatiable appetite for illegal narcotics

Methamphetamine, also known as crystal methDEA: Meth making Illinois comeback via Mexican cartels

The Drug Enforcement Agency says Illinois’ meth problem is re-emerging and it’s not from domestic production. It’s coming from Mexico and one solution to combat the problem may be as simple as education.

DEA St. Louis Field Division Special Agent in Charge James Shorba oversees the southern third of Illinois, from Springfield down to Illinois’ southern border. He also oversees some of the Quad Cities, the states of Missouri, Kansas, Iowa, Nebraska and South Dakota.

 Shroba said there’s sometimes a “hyperfocus” on the significant problem of opioid abuse.

“I don’t know if it’s fair to say that we have a methamphetamine problem or an opioid problem, or a cocaine problem,” Shroba said. “Some Americans have an insatiable appetite for illegal narcotics.”

While the rates of overdose on meth don’t equal that of opioid overdose, “it’s still at alarmingly high rate,” Shroba said. “We forget that Mexican transnational organizations are the predominant producers of methamphetamine in the western hemisphere and they have an overabundant supply which has saturated streets all across America, in particular cities like Kansas City, St. Louis, [and] Fairview Heights.”

He said efforts years ago to curb domestic production of meth in makeshift labs worked.

“But as the government has enacted different legislation by, for example, placing pseudoephedrine-based cold medicine behind the counter at a pharmacy, it’s acted as a disincentive for individuals to make it themselves,” Shroba said. “Well, in steps the Mexican cartels.”

 The street price of meth indicates a saturated market.

“Between 2007, if you were going to buy a gram of 100 percent pure methamphetamine in the US market,” Shroba said, “that would cost you about 300 bucks. In 2017, that would cost you about $65.”

There’s so much meth out there from Mexico Shroba said “our information is the cartels are restricting supply, so that they can bring the price back up.”

Just like on a popular TV show, the DEA can pinpoint where the meth flooding Illinois streets is coming from “because of the minerals that may be in the water or the concentration of other elements that might be present in that narcotic allows us to pin it down to a particular trafficking organization that made it,” Shroba said.

There are some interesting ways to get the narcotic across the border to places like Chicago, Kansas City or St. Louis.

  “You’re only limited by your imagination,” Shroba said. “I’ve seen everything from trafficking organizations using semi-submersible submarines to fishing vessels, high speed boats that are stripped down, put extra engines and all they have gasoline and narcotics on board.”

Then, Shroba said, there’s the sad stories of people being used as human mules to carry drugs over the border.

Shroba said the DEA assists in busting the big time drug dealers.

“We target the biggest and baddest drug dealers that are there, that are bringing in significant quantities to places like Belleville, and Fairview Heights or Springfield.”

But, Shroba said, “We’re not going to arrest our way out of this problem.”

“We have to have aggressive education programs in schools,” Shroba said. “We have to invest in the right places.”

“It’s those new first-time users,” Shroba said, “or those individuals who are potentially the new first-time users that we have to get to and we’ve got to get to them when they’re in grade school.”


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