2018 in review … what killed us

Today is 03/24/2019.. who will not be here tomorrow

2016 in review … what killed us

2017 in review … what killed us


6775 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



Here is the list from the end of 2016 if interested in comparing
United States of America
from Jan 1, 2018 – Dec 31, 2018 (6:27:30 PM)

Someone just died by: Death Box

Just the Data … Raw and Undigested

Abortion *: 1091318
Heart Disease: 613959
Cancer: 591325
Tobacco: 349779
Obesity: 306806
Medical Errors: 251295
Stroke: 133019
Lower Respiratory Disease: 142853
Accident (unintentional): 135967
Hospital Associated Infection: 98937
Alcohol *: 99937
Diabetes: 76440
Alzheimer’s Disease: 93482
Influenza/Pneumonia: 55192
Kidney Failure: 42735
Blood Infection: 33443
Suicide: 42746
Drunk Driving: 33787
Unintentional Poisoning: 31738
All Drug Abuse: 24989
Homicide: 16788
Prescription Drug Overdose: 14991
Murder by gun: 11486
Texting while Driving: 5985
Pedestrian: 4997
Drowning: 3913
Fire Related: 3498
Malnutrition: 2770
Domestic Violence: 1459
Smoking in Bed: 780
Falling out of Bed: 598
Killed by Falling Tree: 149
Lawnmower: 68
Spontaneous Combustion: 0
Your chance of death is 100%. Are you ready?

Totals of all categories are based upon past trends documented below.



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 v 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

Karon Shettler Paddock  committed suicide on August 7, 2013  http://www.kpaddock.org/


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  http://www.foxnews.com/health/2017/08/18/suspended-oral-surgeon-dies-suspected-overdose.html

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,”   https://www.cbsnews.com/news/florida-man-arrested-after-girlfriend-dies-during-alleged-suicide-pact/  

Steven Lichtenberg: the 32-year-old Dublin man shot himself   http://www.dispatch.com/news/20160904/chronic-pains-emotional-toll-can-lead-to-suicide  

Fred Sinclair  he was hurting very much and was, in effect, saying goodbye to the family.  http://www.pharmaciststeve.com/?p=21743

Robert Markel, 56 – June 2016 – Denied Pain Meds/Heroin OD  http://www.pennlive.com/opioid-crisis/2017/08/heroin_overdose_deaths.html

 Lisa June 2016  https://youtu.be/rBlrSyi_-rQ

Jay Lawrence  March 2017  https://www.painnewsnetwork.org/stories/2017/9/4/how-chronic-pain-killed-my-husband

Celisa Henning: killed herself and her twin daughters...http://www.nbcchicago.com/news/local/Mom-in-Apparent-Joliet-Murder-Suicide-said-Body-Felt-Like-It-was-On-Fire-Grandma-Says-442353713.html?fb_action_ids=10213560297382698&fb_action_types=og.comments

Karen Boje-58  CPP-Deming, NM

Katherine Goddard, 52 –  June 30, 2017 – Palm Coast, FL -Suicide/Denied Opioids  http://www.news-journalonline.com/news/20170816/palm-coast-man-charged-with-assisting-self-murder

https://medium.com/@ThomasKlineMD/suicides-associated-with-non-consented-opioid-pain-medication-reductions-356b4ef7e02aPartial List of Suicides, as of 9–10-17

Suicides: Associated with non-consented Opioid Pain Medication Reductions

Lacy Stewart 59, http://healthylivings247.com/daughter-says-untreated-pain-led-to-mothers-suicide/#

Ryan Trunzo of Massachusetts committed suicide at the age of 26  http://www.startribune.com/obituaries/detail/18881/?fullname=trunzo,-ryan-j  

Mercedes McGuire of Indiana ended her life August 4th, 2017 after struggling with agony originally suppressed with opioid pain medicine but reappearing after her pain medicine was cut back in a fashion after the CDC regulations. She was in such discomfort she went to the ER because she could not stand the intractable pain by “learning to live with it” as suggested by CDC consultants. The ER gave her a small prescription. She went to the pharmacy where they refused to fill it “because she had a pain contract”. She went home and killed herself. She was a young mother with a 4 year old son, Bentley. Bentley, will never get over the loss of his mom.


“Goodbye” Scott Smith: Vet w/PTSD committed murder/suicide. Killed his wife then himself today 11/27/2017


Pamela Clute had been suffering from agonizing back problems and medical treatment had failed to relieve pain that shot down her legs While California’s assisted suicide law went into effect a couple months before Clute’s death, the law only applies to terminally ill patients who are prescribed life-ending drugs by a physician. Clute wasn’t terminally ill

Kellie Bernsen 12/10/2017 Colorado suicide

Scott Smith: Vet w/PTSD committed murder/suicide. Killed his wife then himself today 11/27/2017

  Michelle Bloem committed suicide due to uncontrolled pain

John Lester shot himself on Jan. 8, 2014.

 Anne Örtegren took her life on Jan. 5  

 Debra Bales, 52 – Civilian – January 10, 2018 – Petaluma, CA – Denied Pain Meds/Suicide

 Aliff, Charles – Could not locate info!
He may be able to help! Charles Aliff – https://www.facebook.com/profile.php?id=100009343944744…

Brunner, Robert – Could not locate info!

Cagle, Melvin – http://www.objectivezero.org/…/The-Veteran-Spring-Why-a…


Harold Hamilton – http://www.dispatch.com/…/chronic-pains-emotional-toll…

Hartgrove, Daniel – http://www.legacy.com/…/name/daniel-hartsgrove-obituary…

Ingram III, Charles – http://www.pressofatlanticcity.com/…/article_b7a4a712…

Jarvis, Michael http://www.chicagotribune.com/…/ct-indiana-doctor…


Kevin Keller, 52 – US Navy – July 30, 2014 – Wytheville, VA

Kershaw, Sarah – https://mobile.nytimes.com/…/sarah-kershaw-former-times…

Kimberly, Allison http://feldmanmortuary.com/…/Allison…/obituary.html…

Lane, Keith – Timothy Shields
August 8, 2017 · Colon, MI I would like you too include Kieth Lane . US Army , Vietnam in country , combat wounded . He died recovering from ulcers surgery of a stroke and heart attack in Battle Creek VA medical center in Michigan .

Lichtenberg, Steven – http://www.dispatch.com/…/chronic-pains-emotional-toll…

Markel, Robert – http://www.pennlive.com/…/08/heroin_overdose_deaths.html

Miles, Richard – Could not locate info!

Murphy, Thomas – http://www.objectivezero.org/…/The-Veteran-Spring-Why-a…

Paddock, Karon http://www.kpaddock.com/

Denny Peck, 58 – Civilian – September 17,2016 – Seattle, Wa https://l.facebook.com/l.php…


Peterson, Michael – https://l.facebook.com/l.php…

Reid, Marsha – https://www.painnewsnetwork.org/…/daughter-blames…

Simpson, Jessica – https://www.facebook.com/photo.php?fbid=1616190951785852&set=a.395920107146282.94047.100001848876646&type=3&hc_location=ufi

Daniel Somers, 30 – US Army – June 10, 2013 – Denied Pain Meds/Suicide http://gawker.com/i-am-sorry-that-it-has-come-to-this-a…

Son, Randall – http://www.wpsdlocal6.com/…/woman-says-marion-va…/…

Bryan Spece, 54 – USMC – May 3, 2017 – Great Falls, Montana – Denied Meds/Suicide https://www.painnewsnetwork.org/…/patient-suicide…

Tombs, John – http://www.objectivezero.org/…/The-Veteran-Spring-Why-a…

 Jennifer E. Adams age 41 of Helena  December 20, 1976April 25, 2018


Jay Lawrence  March 1, 2017  on the same bench in the Hendersonville, Tennessee, park where the Lawrences had recently renewed their wedding vows, the 58-year-old man gripped his wife’s hand and killed himself with a gun.

suicide due to pain video  https://youtu.be/CSkxF1DMQws

Eden Prairie Aug 2018 handwritten note, which stated she “could not endure any more pain and needed to escape it.” http://www.fox9.com/news/charges-eden-prairie-man-helped-wife-commit-suicide

Raymond Arlugo  August 29th 2018   https://hudsonvalleydoctorskilledmybrother.wordpress.com/2018/09/14/suicide-over-pain-telling-my-brothers-story-because-he-cant/amp/

Kris Hardenbrook   Oct 2018   What is the difference between patient abandonment and a FIRING SQUAD ? – NOT MUCH ?

Robert Charles Foster,65 Nov 3, 2018 Chronic pain pt …SUICIDE BY COP https://theworldlink.com/news/local/crime-and-courts/suspect-dead-after-officer-involved-shooting-in-bandon/article_182bfafd-5e6d-539f-b366-0f9a00b7dc85.html

Lee Cole 04/23/2018   http://www.pharmaciststeve.com/?p=27825

Peter A. Kaisen  76-year-old veteran committed suicide (Aug. 24, 2016) in the parking lot of the Northport Veterans Affairs Medical Center on Long Island, https://www.nytimes.com/2016/08/25/nyregion/veteran-kills-himself-in-parking-lot-of-va-hospital-on-long-island.html 

Paul Fitzpatrick, 56 Oct 2018, kills himself blaming 20 years of debilitating pain caused by laser eye surgery  https://www.dailymail.co.uk/news/article-6445427/Canadian-man-kills-suffering-20-years-pain-laser-eye-surgery.html

Jessica Starr   Dec, 2018 failed Lasik SMILE eye surgery resulting in chronic pain

Paolo Antonio Argenzio:  Passed away on Monday December 10th 2018, from a self inflicted gunshot wound

Rory G. Hosking, age 50, honorable Army Veteran, passed away Feb. 9, 2019 from his struggle with chronic pain

Sonya White has passed away on Thursday March 7, 2019 at 30 years old

Danielle Byron Henry 10th June, 2017

Kelly Catlin, the 23-year-old Olympic cyclist with debilitating migraines committed suicide 16th March, 2019

Dawn Anderson was 53 years old, and a former Registered Nurse died on March 11, 2019 in untreated agonizing pain

I reserve the right of editorial censorship

It looks like the political “mud slinging” has already started – IMO – worse than the national election two years ago… I am taking a stand – in particular – against “slanderous name calling”  directed toward specific politicians, particular political parties and/or specific people.  I don’t mind political debate – based on FACTS… when the debate drifts off the road based on FACTOIDS, FAKE NEWS, opinions stated as FACTS.. is where I am going to draw the “line in the sand” and delete comments that go down that path.

While personally, I am not a big fan of our political/bureaucratic system.. IMO.. it is too self serving… Admittedly, politically I tend to lean to the POLITICAL RIGHT but that is because the Libertarian party is seemingly always kept in their place by our dominating “two party system”.

I have belonged to a national pharmacy association for 35 yrs… that promotes the saying “get into politics … or get out of pharmacy ..” If you don’t attempt to influence politicians… someone else will…. and IMO this saying applies to those in the chronic pain community and/or pts who are dealing with subjective diseases.  Legislatures, bureaucrats are doing things that are adversely effecting the quality of life of those pts.  As long as those being affected continue to lack unity and/or a large segment chooses to stand on the sidelines, whoever is successfully “bending the ear” of these politicians … they will continue to do so because they have  little/no concern about the consequences and/or collateral damage that they cause to those suffering and dealing with subjective diseases.

I am sure that the vast majority of my readers will understand and cooperate…those who try to challenge this policy…  It is THREE STRIKES and you are out/banned… and WORDPRESS gives me your IP ADDRESS attached to your comment(s)… Once banned, just posting under a different name – WILL NOT WORK !  Everyone needs to “play nice “

Lastly, please do not post anything promoting a particular vendor or any entity or person selling a product/particular service. Because some may perceive/believe that they have my endorsement which may or may not be the case. Anyone posting a link to a professional selling a product/service will be edited out

Image result for Play Nice in the Sand Box


Dr Mark Ibsen : unhappy about how a cancer survivor veteran loosing his pain meds

Under treatment of pain – ELDER ABUSE – plaintiff awarded 1.5 million by jury


Title: Fast Fact and Concept #63: The legal liability of undertreatment of pain

Author(s): Warm, Eric; Weissman, David E

It is well recognized that physician’s fear of fear of regulatory scrutiny (DEA, state medical boards), is a major contributor to the problem of under treatment of pain. A recent landmark lawsuit should be a wake-up call for all physicians that this type of practice poses its own legal liability. An 85-year-old California man with metastatic lung carcinoma spent the final week of his life in severe pain. Three years after his death his children sued his doctor alleging that the physician had failed to prescribe drugs powerful enough to relieve their father’s suffering. This was one of the first U.S. cases in which a doctor has gone on trial for allegedly under-treating a patient’s pain. By a 9 to 3 vote the jury decided that the physician’s lack of attention to pain constituted elder abuse, awarding the family $1.5 million (the amount was reduced to $250,000). To win, lawyers convinced the jury that under-treatment of pain was “reckless negligence”. Until recently, lawyers would have considered such a suit un-winnable. Given politically savvy aging baby boomers, as well as the preponderance of sound scientific evidence for the proper assessment and treatment of pain, we can probably expect more such verdicts. Here are some tips for how physicians can better protect themselves from charges of under-treatment of pain?

  • Review your own practice–are you currently meeting JCAHO standards? Find out at: http://www.jcaho.org and AHQR (a.k.a. AHCPR) http://www.ahrq.gov/clinic/cpgarchv.htm pain guidelines?
  • Improve your knowledge and skills in pain assessment and treatment. (Some states, such as California, now require mandatory pain CME).
  • Learn about and utilize your local consultation resources for pain management.
  • Improve your knowledge and skills in assessing substance abuse disorders; learn about and utilize your local resources for substance abuse referrals and treatment.
  • Improve your understanding of the drug regulatory system and how it functions- learn about the common triggers for regulatory review . Go to: http://www.medsch.wisc.edu/painpolicy/ for information about federal and state regulatory laws and regulations.
  • Become active in your hospital pain improvement efforts-check with your hospital QI department and their efforts to meet the new JCAHO pain guidelines.
  • Become active with your state Cancer Pain Initiative; go to http://www.aacpi.org/ to find information about your state activities.

Ideally physicians should not use the fear of lawsuits to help guide medical care, but evidence shows that they do. In a way, this attention on improved pain management may become a silver lining in the black cloud of our litigious society.


Stieg RL, et al: Roadblocks to effective pain treatment. Med Clin N Amer, 1999;83(3): 809-821.

Okie, S. Doctor’s Duty to Ease Pain At Issue in Calif. Lawsuit. Washington Post.May 7, 2001; Page A03

Crane M, Treating pain: damned if you don’t? Med Economics, Nov 19, 2001, pp 67-69.

Weissman DE, Doctors, Opioids and the law: The Effect of Drug Regulations on Cancer Pain Management. Semin Oncol 20(Suppl A): 53-58, 1993.

Gilson AM, Joranson DE. Controlled substances and pain management: Changes in knowledge and attitudes of state medical regulators. Journal of Pain and Symptom Management. 2001;21(3):227-237.

Joranson DE, Maurer MA, Gilson AM, Ryan KM, Nischik JA. Annual review of state pain policies, 2000. Pain & Policy Studies Group, University of Wisconsin Comprehensive Cancer Center. Madison, Wisconsin; February 2001.

Jacox A, Carr DB, Payne R, et al. Management of Cancer Pain. Clinical Practice Guideline No. 9 AHCPR Publication No. 94-0592, Rockville, MD. Agency for Health Care Policy and Research, U.S. Department of Health and Human Services, Public Health Service, 1994.

Acute Pain Management Guideline Panel. Acute pain management: Operative or Medical Procedures and Trauma Clinical Practice Guideline. AHCPR Publication No. 92-0032. Rockville, MD. Agency for Health Care Policy and Research, US Department of Health and Human Services, Public Health Service, 1992.

Copyright and Referencing Information: Users are free to download and distribute Fast Facts for educational purposes only. Citation for referencing. Fast Facts and Concepts #63 The legal liability of undertreatment of pain. Warm E and Weissman DE. March, 2002. End-of-Life Physician Education Resource Center www.eperc.mcw.edu.

Fast Facts and Concepts was originally developed as an end-of-life teaching tool by Eric Warm, MD, U. Cincinnati, Department of Medicine. See: Warm, E. Improving EOL care–internal medicine curriculum project. J Pall Med 1999; 2: 339-340.

Disclaimer: Fast Facts provide educational information, this information is not medical advice. Health care providers should exercise their own independent clinical judgment. Some Fast Fact information cites the use of a product in dosage, for an indication, or in a manner other than that recommended in the product labeling. Accordingly, the official prescribing information should be consulted before any such product is used.

Creation Date: 3/2002

Format: Handouts

Purpose: Instructional Aid, Self-Study Guide, Teaching


Training: Fellows, 1st/2nd Year Medical Students, 3rd/4th Year Medical Students, PGY1 (Interns), PGY2-6, Physicians in Practice
Specialty: Anesthesiology, Emergency Medicine, Family Medicine, General Internal Medicine, Geriatrics, Hematology/Oncology, Neurology, OB/GYN, Ophthalmology, Pulmonary/Critical Care, Pediatrics, Psychiatry, Surgery
Non-Physician: Nurses

ACGME Competencies: Medical Knowledge

Keyword(s): Addiction, Chronic non-malignant pain, Controlled substance regulations, Pain, Pain assessment, Pain treatment

Association of Tramadol With All-Cause Mortality Among Patients With Osteoarthritis

Association of Tramadol With All-Cause Mortality Among Patients With Osteoarthritis


Question  Is tramadol prescription associated with a higher risk of all-cause mortality than other pain relief medications among patients with osteoarthritis?

Findings  In this cohort study that included 88 902 patients with osteoarthritis, initial prescription of tramadol was associated with a significantly increased risk of mortality over 1 year compared with initial prescription of naproxen (hazard ratio [HR], 1.71), diclofenac (HR, 1.88), celecoxib (HR, 1.70), and etoricoxib (HR, 2.04), but not compared with codeine (HR, 0.94).

Meaning  Tramadol prescription may be associated with increased all-cause mortality compared with commonly prescribed nonsteroidal anti-inflammatory drugs, but further research is needed to determine if this relationship is causal.


Importance  An American Academy of Orthopaedic Surgeons guideline recommends tramadol for patients with knee osteoarthritis, and an American College of Rheumatology guideline conditionally recommends tramadol as first-line therapy for patients with knee osteoarthritis, along with nonsteroidal anti-inflammatory drugs.

Objective  To examine the association of tramadol prescription with all-cause mortality among patients with osteoarthritis.

Design, Setting, and Participants  Sequential, propensity score–matched cohort study at a general practice in the United Kingdom. Individuals aged at least 50 years with a diagnosis of osteoarthritis in the Health Improvement Network database from January 2000 to December 2015, with follow-up to December 2016.

Exposures  Initial prescription of tramadol (n = 44 451), naproxen (n = 12 397), diclofenac (n = 6512), celecoxib (n = 5674), etoricoxib (n = 2946), or codeine (n = 16 922).

Main Outcomes and Measures  All-cause mortality within 1 year after initial tramadol prescription, compared with 5 other pain relief medications.

Results  After propensity score matching, 88 902 patients were included (mean [SD] age, 70.1 [9.5] years; 61.2% were women). During the 1-year follow-up, 278 deaths (23.5/1000 person-years) occurred in the tramadol cohort and 164 (13.8/1000 person-years) occurred in the naproxen cohort (rate difference, 9.7 deaths/1000 person-years [95% CI, 6.3-13.2]; hazard ratio [HR], 1.71 [95% CI, 1.41-2.07]), and mortality was higher for tramadol compared with diclofenac (36.2/1000 vs 19.2/1000 person-years; HR, 1.88 [95% CI, 1.51-2.35]). Tramadol was also associated with a higher all-cause mortality rate compared with celecoxib (31.2/1000 vs 18.4/1000 person-years; HR, 1.70 [95% CI, 1.33-2.17]) and etoricoxib (25.7/1000 vs 12.8/1000 person-years; HR, 2.04 [95% CI, 1.37-3.03]). No statistically significant difference in all-cause mortality was observed between tramadol and codeine (32.2/1000 vs 34.6/1000 person-years; HR, 0.94 [95% CI, 0.83-1.05]).

Conclusions and Relevance  Among patients aged 50 years and older with osteoarthritis, initial prescription of tramadol was associated with a significantly higher rate of mortality over 1 year of follow-up compared with commonly prescribed nonsteroidal anti-inflammatory drugs, but not compared with codeine. However, these findings may be susceptible to confounding by indication, and further research is needed to determine if this association is causal.

Addiction now defined as brain disorder, not behavior issue

Addiction now defined as brain disorder, not behavior issue

Decades of research convinced American Society of Addiction Medicine to change definition


Addiction is a chronic brain disorder and not simply a behavior problem involving alcohol, drugs, gambling or sex, experts contend in a new definition of addiction, one that is not solely related to problematic substance abuse.

The American Society of Addiction Medicine (ASAM) just released this new definition of addiction after a four-year process involving more than 80 experts.

“At its core, addiction isn’t just a social problem or a moral problem or a criminal problem. It’s a brain problem whose behaviors manifest in all these other areas,” said Dr. Michael Miller, past president of ASAM who oversaw the development of the new definition. “Many behaviors driven by addiction are real problems and sometimes criminal acts. But the disease is about brains, not drugs. It’s about underlying neurology, not outward actions.”

The new definition also describes addiction as a primary disease, meaning that it’s not the result of other causes, such as emotional or psychiatric problems. And like cardiovascular disease and diabetes, addiction is recognized as a chronic disease; so it must be treated, managed and monitored over a person’s lifetime, the researchers say.

Two decades of advancements in neuroscience convinced ASAM officials that addiction should be redefined by what’s going on in the brain. For instance, research has shown that addiction affects the brain’s reward circuitry, such that memories of previous experiences with food, sex, alcohol and other drugs trigger cravings and more addictive behaviors. Brain circuitry that governs impulse control and judgment is also altered in the brains of addicts, resulting in the nonsensical pursuit of “rewards,” such as alcohol and other drugs.

A long-standing debate has roiled over whether addicts have a choice over their behaviors, said Dr. Raju Hajela, former president of the Canadian Society of Addiction Medicine and chair of the ASAM committee on addiction’s new definition.

“The disease creates distortions in thinking, feelings and perceptions, which drive people to behave in ways that are not understandable to others around them,” Hajela said in a statement. “Simply put, addiction is not a choice. Addictive behaviors are a manifestation of the disease, not a cause.”

Even so, Hajela pointed out, choice does play a role in getting help.

“Because there is no pill which alone can cure addiction, choosing recovery over unhealthy behaviors is necessary,” Hajela said.

This “choosing recovery” is akin to people with heart disease who may not choose the underlying genetic causes of their heart problems but do need to choose to eat healthier or begin exercising, in addition to medical or surgical interventions, the researchers said.

“So, we have to stop moralizing, blaming, controlling or smirking at the person with the disease of addiction, and start creating opportunities for individuals and families to get help and providing assistance in choosing proper treatment,” Miller said.

5 Secrets Your Doctor Will Never Tell You

5 Secrets Your Doctor Will Never Tell You

The inside scoop only a physician could tell you.


Medical privacy is very important in medicine and as doctors keep your problems confidential, they often also keep their problems a secret to the outside world.

Here are 5 secrets doctors don’t want to reveal and how knowing about them can protect you:  

Secret # 1:

Doctors often order medical tests, but they sometimes forget to look at the test results or they overlook suspicious details.

An example is Mark who went to see his doctor for a productive cough for the last 3 weeks. His doctor ordered a chest X-Ray to rule out pneumonia.  The radiologist commented that Mark’s lungs were clear, that there was no pneumonia, but he noticed at the bottom of the X-Ray, a suspicious area in Mark’s liver. He recommended an abdominal CT scan. Mark’s doctor only paid attention to the fact that there was no pneumonia and told Mark not to worry.  He gave Mark a treatment of antibiotics which resolved Mark’s cough.  One year later, Mark came in his doctor’s office for abdominal pain.  An abdominal ultrasound revealed a large liver mass which turned out to be a metastasis from colon cancer.  The cancer was too advanced, and Mark couldn’t be saved.  This was unfortunate because Mark’s doctor could have kept Mark alive by reading the lung X-Ray report thoroughly and by ordering an abdominal CT scan one year prior while the liver metastasis was still small and the cancer still treatable.

Similar cases are not infrequent: In 2009, L.P. Casilino (Cornell Medical College in NY) and colleagues found (Archives of Internal Medicine) that after reviewing the medical records of 5434 patients aged 50 to 69, physicians failed to inform patients 7.1% of the time. 

How can you prevent this from happening to you?

Always request a copy of all your reports especially your blood test results and your radiology reports (plain X-Rays, CT scans, MRIs, etc.).  Read the results yourself thoroughly and don’t be shy about asking your doctor questions if something seems abnormal.  If you have any doubt, run the results by another doctor to make sure that all that is abnormal is attended to.

Secret # 2:

Even the best doctor can make a mistake in treatment, prescribing the wrong medication or the wrong dose of the right medication.  This is especially true in hospitals.  

Giampaolo P. Velo of Verona University Hospital in Italy writes in the 2009 British Journal of Clinical Pharmacology that medication errors are common in general practice and in hospitals.  Velo mentions in the article that the range of errors attributable to junior doctors can vary from 2 to 514 per 1000 prescriptions and from 4.2% to 82 % of patients.

Henriksen and colleagues describe that in Denmark in the first 6 months of 2014, there were 147 mistakes in the prescription of anticoagulants (most often the dose was too high).  Out of those 147 mistakes, 7 ended in the death of the patient (who most often bled to death) and 83 gave rise to serious problems.  Henriksen points out that most medications errors happen when there is a hospital admission, a hospital discharge, or surgery. 

How can you prevent a medication mistake from happening to you?

Check with your pharmacist that the medication prescribed by your doctor is for your condition and that the dose prescribed is appropriate, especially if you are just discharged from a hospital.  If you have any doubt, don’t hesitate to give your physician a call or to get a second medical opinion.  

Secret # 3:

Even the best doctor can make a mistake in diagnosis:

Here is an example: Mary went to see her physician for acute diarrhea that had started the week prior.  Her physician diagnosed an infectious gastro-enteritis and gave her Imodium and Cipro.  Despite this treatment, Mary’s diarrhea continued for several weeks, completely debilitating her.  Desperate, Mary searched on the internet for the possible causes of diarrhea. She found that Magnesium could give diarrhea…. And she was taking high doses of Magnesium.  Actually, looking back on what happened, Mary realized that her diarrhea had started just a few days after her first Magnesium intake (which she was taking to decrease her anxiety).  She decided to stop taking Magnesium and within a few days, her diarrhea resolved. Her physician had forgotten to ask her if she was taking any supplements and had made the wrong diagnosis of infectious gastro-enteritis when in fact she was just having a side-effect from the Magnesium she was ingesting.  

Mistakes in diagnosis are common.  Doctors are pressed for time and when they see 30 to 40 patients a day are prone to make mistakes.

How do you prevent a mistake in diagnosis?

When your symptom continues for longer than you think it should, do your own research on the Internet, go back to see your physician and/or seek a second medical opinion. When your body tells you there is something wrong with it, trust what your body says.

Secret # 4:

Some doctors will not know about the latest research or about the best treatment for your condition:

Here is my own example:  The last few months, I have had incredible pain in my right ear when travelling by plane and landing.  I went to see my ENT (Ear, Nose and Throat) physician who diagnosed a Eustachian tube problem and prescribed a steroid nasal spray for every day use.  As the problem didn’t improve and I had to take an average of 4 flights per month (over 44 flights per year) I went to see another ENT who prescribed a high dose of an oral steroid to take before each flight.  This meant that I had to take a high dose of steroid at least 44 days a year with potential serious side effects, such as stomach inflammation, osteoporosis and cataract.  Unsatisfied with that answer, I went to see 3 more ENT in the USA and in Paris, France. Two of them (one in the USA and one in France) confirmed that the best way to resolve my problem was to take a high dose of steroid before each flight, the third physician (in France) recommended that, during landing, I use a little mechanical device invented by another ENT physician.  I ordered that device, which is a pressure equalizer used at the first sign of ear pain when landing.   As soon as I used the new device, my ear pain disappeared.  I had no need for oral steroid with heavy side-effects.  

How can you find the best treatment for your condition?

It is always advisable to get a second or even a third opinion (and in my case, fourth and fifth opinion) if you are not happy with the first one.  It’s impossible for any doctor to know all the latest treatments.  If the treatment you are taking for your condition doesn’t satisfy you completely, look for alternative answers.  Every week new treatments are discovered and approved by the FDA.  Some doctors will know about them, while other won’t.  My advice is to continue exploring options until you are completely satisfied.

Secret # 5: 

A lot of doctors are very stressed out and are sometimes burnt out, depressed and suicidal, which can lead to low professionalism.

Lisa Rotenstein, MD, MBA and colleagues (JAMA September 2018) extracted burnout prevalence data from 182 studies involving 109 628 physicians in 45 countries between 2001 and 2018.  Rotenstein found that 72% of physicians had emotional exhaustion and 67 % had overall burnout.

Maria Panagioti, PhD and Colleagues, published in JAMA Internal Medicine in 2018 a meta-analysis of 47 studies on 42 473 physicians aged 27 to 53 and found that “burn-out is associated with 2-fold increased odds of unsafe care, unprofessional behaviors and low patient satisfaction.”  This link was seen more in residents and in less than 5 years post residency physicians.

Burnout and emotional exhaustion can lead to depression which can lead to suicide especially since physicians have easy access to medications.

Louise B Andrew, MD, JD writes in 2018 that physicians have one of the highest risks of dying from suicide despite having a lower mortality risk from cancer and heart disease relative to the general population.  L. Andrew estimates 300 to 400 suicides by physicians per year, suicide being, after accidents, the most common cause of death among medical students.

How can you stop a burnt-out physician from giving you unsafe care?

Be aware that you only have 10 to 15 minutes with your physician (sometimes only 5 minutes) so be on time for your office visit. Then, tell your physician in one sentence what you are coming in for (this should include when your new symptom started, how fast the symptom got worse and what other symptoms are associated with your malady).  Also come prepared with the names and doses of all the medications you are taking.  If you have questions for the physician, write them down in advance of the appointment.  Preparing thoroughly for each appointment will allow your doctor to be more efficient and consequently to relax, de-stress and take excellent care of you

NACDS lauds bill to mitigate opioid abuse

NACDS lauds bill to mitigate opioid abuse


Legislation limits initial scripts to seven days.

ARLINGTON, Va.— The National Association of Chain Drug Stores Friday welcomed Senate legislation that would limit to a seven-day supply the initial prescriptions of opioids for acute pain —  a move that is consistent with Centers for Disease Control and Prevention’s (CDC) guidelines.

Steve Anderson

Sens. Kirsten Gillibrand (D., N.Y.) and Cory Gardner (R., Colo.) announced the introduction of the legislation, the John S. McCain Opioid Addiction and Prevention Act (S. 724), in a press release quoting NACDS president and CEO Steve Anderson.

“The seven-day limit for initial acute-pain opioid prescriptions is consistent with pharmacists’ recommendations from the front lines of care, their collaboration with law enforcement, and the needs of chronic pain sufferers,” said Anderson. “Six in 10 Americans support this measure, with only two-in-10 indicating opposition, according to a January 2019 Morning Consult poll commissioned by NACDS. This bill will help prevent addiction and help prevent unused medications from falling into the wrong hands. Our support reflects pharmacies’ longstanding commitment to serve as part of the solution.”

NACDS has noted that the opinion research reflects consistent support for this strategic approach across political ideologies, and that support is particularly strong among seniors. Furthermore, seven-in-10 voters support “advancing policies that leverage pharmacies’ role as working partners for stronger and safer communities _  such as working to address the opioid-abuse epidemic.” CDC notes that, for acute pain, “three days or less will often be sufficient; more than seven days will rarely be needed.”

The bill is consistent with one of NACDS’ priority public policy recommendations to help further address the opioid abuse epidemic. NACDS’ recommendations relate to initial prescription limits for acute pain; prescription drug monitoring plans (PDMP); drug disposal; and mandatory electronic prescribing.

The legislation would build on the SUPPORT for Patients and Communities Act (H.R. 6), enacted in 2018, which is consistent with all of NACDS’ recommendations and which was particularly helpful in requiring electronic prescribing for Schedule II through V controlled substances prescriptions covered under Medicare Part D to help prevent fraud, abuse and waste _ with limited exceptions to ensure patient access. The legislation also is consistent with the White House’s 2019 National Drug Control Strategy, which NACDS welcomed in February.

In addition to advancing its public policy recommendations, NACDS and pharmacies maintain longstanding and ongoing initiatives to prevent opioid abuse, including compliance programs; advancing e-prescribing; drug disposal; patient education; security initiatives; fostering naloxone access; stopping illegal online drug-sellers and rogue clinics; and more. NACDS’ Chain Pharmacy Community Engagement Report indicates that opioid abuse prevention stands as one of the top priorities for NACDS members among their community engagement initiatives.

We have all seen/read the “off the rails” proposed bill by Senators Gillibrand and Gardner and here we have the NACDS ( National Association of Chain Drug Stores… STRONGLY endorsing this lame opiate bill that many people will believe will do much harm … especially to those who will be the new chronic pain pts of tomorrow.

NACDS represents the 40, 000 odd chain pharmacies… that is about 60%-70% of all community (retail) pharmacies. Just another reason that pts should start supporting the local independent pharmacies  http://www.ncpanet.org/home/find-your-local-pharmacy  here is a link to find a local independent pharmacy by zip code

We have a serious and dramatically growing pharmacist surplus… it is reported that the 140 odd pharmacy schools are graduating 15,000/yr new pharmacists and the market place is claimed to only have a need for 10,000.  We have 5000 new graduate pharmacists looking for jobs that don’t exist. So these chain pharmacists are typically  being told that unless you do what you are told – by the chain employer – we have a “pile” of pharmacists’ applications that would gladly take their job.

Most of these new graduates have six figure student loans that and after to start repaying these loans at 6-9 months after graduation.

For those of who you say that you are being treated “wonderfully” by the chain store that you patronize, in reality you are only one corporate policy and procedure change or one Rx dept staffing change for everything that has been going wonderfully to GO SOUTH…literally OVERNIGHT.

A drug of abuse that costs society THREE TIMES the cost of the war on drugs and not a crisis ?

Why Alcohol Misuse May Be the Forgotten Addiction


In recent years, Americans have begun, justifiably, to recognize the complex public health problem of opioid misuse and associated overdose deaths as a national crisis. Unfortunately, as is often the case when a tidal wave of worry about a particular health issue engulfs the nation, other similar concerns are often swept out of public consciousness. 

Take alcohol misuse, for instance. Although alcohol arguably presents a greater threat to public health than opioid misuse, it has in many ways been overlooked in the recent national conversation about substance use disorders. 

Alcohol misuse occurs when a person drinks in a manner, situation, amount, or frequency that could cause harm to that individual or those around them. The data and statistics on alcohol misuse paint a clear picture of the continual threat alcohol poses, both in the United States and internationally.

In the U.S. alone, one in 10 deaths among working-age adults are due to alcohol misuse, and more than 88,000 people die from alcohol-related causes each year — making it the third leading preventable cause of death.

Alcohol misuse costs the U.S. nearly $250 billion per year in health care and criminal justice expenditures, lost workplace productivity, and other costs. Meanwhile, in 2016 an estimated 14.6 million American adults had alcohol use disorder.

Alcohol use disorder encompasses a range of symptoms with varying severity, from mild disordered use to addiction. Despite its prevalence and impact, only a fraction of individuals with this disorder seek or receive professional help, and fewer still receive behavioral therapies or medications that have been demonstrated effective through rigorous scientific research. In part this is because patients and their families don’t know the range of treatment options available, and don’t know how to search for treatment providers who offer good-quality care. 

Some might be scared away from seeking help, because they believe that it means having to “go away to rehab” or “quit drinking altogether, forever.” In fact, there is a broad menu of evidence-based treatment options accessible online and in person to facilitate different drinking goal choices and aid in decisions about quality of life, whether it is to reduce alcohol or stop completely. Some individuals will need life-saving, medically supervised “rehab-style” detoxification, stabilization, and to abstain completely. Others may be able to moderate their drinking at home, with the help of family and friends.

Source: bigjom/Adobe

The point is, finding out more about the variety of available options may surprise many people, and help them begin to consider and make healthier changes regarding their alcohol use.

The National Institute on Alcohol Abuse and Alcoholism (NIAAA), the world’s largest funder of scientific research on the health effects of alcohol, as well as the diagnosis, prevention, and treatment of alcohol misuse, recently released an Alcohol Treatment Navigator. Designed for family members seeking to find care for a loved one with alcohol use disorder, the Navigator spells out what they need to know, and what they need to do, to find good-quality treatment that meets their specific needs. 

The tool highlights five signs of quality to recognize — such as what credentials to look for in a qualified treatment provider and what specific types of counseling they should offer — signs that are consistent with scientific research and expert consensus on what constitutes quality care.

Other national nonprofit organizations, such as Facing Addiction, have also recently released tools to help individuals self-identify potential problems with alcohol use, and to help provide resources for individuals to find local care and treatment.

The more informed consumers are about their treatment options, the more likely they may be to reach out for help, and to have successful outcomes.

Learning to ask questions about treatment providers’ credentials, experience, therapeutic approaches, and costs is imperative regardless of the form of treatment being sought.

For family members, too, there is often a grave and enduring unpredictability that accompanies a loved one’s alcohol problem. There are now evidence-based options that can help partners and family members get the help they need for themselves, as well to help their loved one more effectively (e.g., the Community Reinforcement Approach and Family Training or “CRAFT” model).

While the tragedy of so many opioid overdose deaths continues to grab the headlines, it is easy to forget the many more millions of people and their family members impacted by alcohol use disorder. For these individuals, this disorder — especially in its most severe form, addiction — cannot be forgotten.

Now, more than ever, however, there is an array of evidence-based treatment and recovery support options available — at the click of a mouse, at the end of a phone, or through an office door.

Resolving an alcohol problem, whatever its impact, is very possible; in fact, very probable. Research has shown that most people suffering from an alcohol problem can and do recover. Also, just like many other disorders and diseases, the earlier someone begins to seek help, the shorter the time to remission. The important thing is to get started; do something positive, sooner rather than later.    

Change opiate regulations Emergency C.O.R.E.

cover photo, No photo description available.

There are people who make things happen, those people who watch things happen, & there are those who wonder what happened.

In the face of pain, there are no heroes.
~ George Orwell, 1984

There are people who make things happen, those people who watch things happen, & there are those who wonder what happened


video advocacy campaign project that we are forming. The website is: www.videoyourpain.com and once we get at least 50 to 100 testimonial videos from chronic pain sufferers to send us their 2 minute video testimonials, we are going to launch our COREUSA website and promote it to congressional members and committees, plus governmental organizations and officials plus political parties and leaders, not to mention the general public at large at well. We just need help from our fellow chronic pain sufferers to help promote it. Would this be something that you would be willing to promote? I also know you have a large following of email subscribers to your email newsletter, that would be a great place to help promote it as well.
I would be willing, in turn, to advertise your website and newsletter on the COREUSA website the minute it goes live.
Is this something you would be interested in helping us do?

Why doesn’t PDMP’s really work ?

PDMP do not work mailing because healthcare professionals (prescribers and Pharmacists) have no way of verifying who they are really dealing with… because they have not been granted access to some sort of on line official database to be able to validate a driver’s License or SSN.

There is a federal database for verifying SSN referred to as E-verify  https://www.ssa.gov/employer/ssnv.htm

However… While the service is available to all employers and third-party submitters, it can only be used to verify current or former employees and only for wage reporting (Form W-2) purposes.

Then there is the various state’s BMV driver’s license database… BUT… no state will allow a healthcare professional access to this database to validate the person/driver’s license presented with a controlled substance prescription. I have been told that states BMV that have been ask to allow healthcare processionals access to this database.. have been denied as an invasion of privacy…

Keep in mind, that these healthcare professionals are in charge of all the private personal HIPAA health information, and all the healthcare professional has to do is be able to verify the driver’s license presented against the graphic of the driver’s license as it was presented to a person it was issued to.

All the healthcare professional really needs is the pic, DOB, name and weight/height from the database.  If the pic and name on the driver’s license presented does match the driver’s license number on the one presented… why would a healthcare professional would prescribe or fill controlled substance for this person ?

The serious substance abuser/diverter will most likely have numerous fake ID’s allowing them to visit multiple prescribers and pharmacies every 30 days and will never show up on any PDMP report as being a doc/pharmacy shopper.

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