Is it time to think OUTSIDE THE BOX in managing chronic pain ?

It is no big secret that the 3 largest drug wholesalers – who provides 80%+ of all the Rx meds to  pharmacies. They were sued by the 50 state Attorney Generals and others and did not even go to trial, but they agreed to pay BILLIONS in fines – while admitting no wrong doing – other than selling opiates and other controlled medications to pharmacies and they also agreed to REDUCE the amount of controlled meds that they sell to all American pharmacies going forward.  Around the same time, these same state AG & others sued the three largest community pharmacies (CVS, Walmart & Walgreen) and who also agreed – without admitting any wrong doing –  agreed to pay BILLION of dollars in restitution, basically for filling controlled med Rxs written by properly licensed prescribers – and also agreed to dispense FEWER Rxs for controlled meds going forward.

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Those agreements were signed in late winter – early spring of 2023, and they are now starting to show up as more and more pts that have a valid medical need for being prescribed controlled meds or being told that their doses have to be reduced and/or the pharmacy – that they have been patronizing for years -will no longer fill their controlled Rx medications.

Ambulatory PCA (Pt controlled Administration) pumps have been around for decades. They are very similar to what millions of type one diabetics are using around the world to help control their blood sugar. These pumps will provide pain pts many advantages:


* They provide a constant “drip” called a basal rate, the pt has fewer “ups & downs” in pain control, if their prescriber allows it, they can also provide pt initiated “pushes” to deal with break-thru pain and/or activity induced pain.

* Because the opioid is administered like a Sub-Q shot, the opioid avoids being partially by the stomach acid  – as in taking a oral dose – & the opioid goes directly to the cell receptor site – avoiding the first pass thru the liver and being metabolized and with it some loss of potency. Resulting in the pt typically needing only 20%-25% of what mgs they had been taking orally.

* Along with those fewer mgs/day, the pt should experience fewer side effects, like dry mouth, blurred vision, constipation and other side effects.

* the CDC dosing guidelines are directed toward oral doses, but regardless, the pt’s total opioid mgs/day will be reduced with a PCA pump.

The graphic above shows an example of a butterfly needle that would be connected to the pump and be inserted in the gut and taped in place and would be changed out every few days

The link below shows JUST ONE OF MANY PCA PUMPS on the market.  I am not recommending nor endorsing this particular PCA pump, it is just as a graphic illustration of what is available.

I am hoping that since injectables are mostly used by hospitals and surgical centers, that the DEA will be exerting less controls on the pharma production quotas for injectables and will hopefully be more readily available.

As oral opioid dosing forms become less and less available, this is a discussion that many pts will be forced to have with their prescriber.


Click to access Ambulatory-Infusion-Pump.pdf


3 Responses

  1. I wonder how much red tape one might have to go through to have a pump authorized by insurers such as Medicaid/Medicare? Then, there’s also the potential that the medically ignorant overseers will have a fit, somehow believing the medication would be accessed, and therefore, could be diverted. I think it’s worth looking into, don’t get me wrong, I am just considering everything that’s gone on up until this point and I really have to question whether we would ever even be ALLOWED to try this route without defective detectives thinking we are trying to beat them at their own game. Especially since they obviously seem to believe that no one REALLY needs “those” meds. Even still, it seems like it would be a worth a try. If a patient can’t get meds filled, there really aren’t many alternatives. Well, except for the one they’re promoting, which is going without. So, no reasonably decent alternatives. What a world we live in, when we are likely to see pushback on any move we try to make unless we give up. I fully and totally believe that’s what they would very much like us to do. If they could only grasp the concept of living a basic life with pain relief vs existing in a space, in agony, waiting to expire, perhaps they’d understand why that’s never going to happen.

  2. This is crazy! ALL of this crap & lies needs to STOP! Our govt needs to get out & stay out of our medical care!!! Its not like we’re not having to go through enough pain with our medical conditions. But now have to fight to get a little bit of pain meds to try & help us. Which the little, tiny bit some get barely helps now. We should not have to be subjected to having “pumps” put in us to get some relief. Or other crazy things that could make us worse or paralyze us. This has gone WAY out of control.
    If the gov’t, CDC, DEA/DOJ can’t see that the overdoses, deaths & suicides have dramatically increased & gotten way worse, since their Opioid Guidelines(of lies) & if that doesn’t prove the problems are, were & will continue to be from illegal street drugs, then I don’t know. They/govt need to quit using us for ways for them to profit & continue to hurt & kill us.
    Our govt is supposed to be our “leaders”. Therefore, they should have to go through years & years of horrible pain without any help from prescription pain meds, before they could even consider thinking about trying to make any changes to our medical/prescription treatments/care. Being a supposed “leader” means they should go first & they should be the one’s subjected to the torture we now are having to deal with because of them. Ya, sure, its easy for them to make changes when it doesn’t affect them in any way.
    Our gov’t is SO A _ _ backwards & corrupt, it isn’t even funny. Its scary!

    • You did not read the blog correctly, this is about having an EXTERNAL PUMP – much like a smartphone.. no surgery involved, just a butterfly needle inserted in your gut… It is basically the same/similar process that millions of type one diabetics use.

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