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Op-ed: Chronic pain sufferers need access to opioids

https://www.deseretnews.com/article/865688783/Op-ed-Chronic-pain-sufferers-need-access-to-opioids.html

My 26-year-old daughter, Madison, is an extremely intelligent, articulate, creative and beautiful young woman. Anyone blessed with these attributes should be well on their way to a wonderful and fulfilling life. But Madison is suffering in ways that most people could never imagine. Diagnosed at 13 years old with Complex Regional Pain Syndrome, formerly known as Reflex Sympathetic Dystrophy (CRPS/RSD), an incurable and progressive chronic pain disease of the sympathetic nervous system, she lives every day in severe pain.

CRPS/RSD is ranked as the most painful form of chronic pain that exists today by the McGill Pain Index. With the advice of numerous physicians over the last 13 years, we have tried every possible remedy and every possible treatment. None of them worked. So many days, I can only hold her in my arms as she cries in agony. The only thing that eases her suffering slightly is her prescription of opioid medication. Yet the government, in a short-sighted effort to combat widespread opioid abuse, wants to take Madison’s lifeline away. She, along with many others in her situation, are apparently considered collateral damage.

Collateral damage is not acceptable. Our military does the best it can to minimize collateral damage on the innocent and unintended targets even if it means sparing the intended targets. This is supported by not only by our government, but by the international community as well. And it should be that way. It’s compassionate.

Why, then, is our government inflicting cruel and unusual punishment for innocent victims here at home? They are putting extreme pressure upon physicians, under the threat of being removed from their practice, to reduce and/or eliminate the levels of prescribed opioids to all patients. But there will be collateral damage to this. Tens of thousands of people who have chronic pain will suffer. For them, there is no relief without opioid medication, and for whom the reduction or the elimination of their medication will cause unspeakable pain and even death.

The United Nations Universal Declaration of Human Rights states in Article 5, “No one shall be subjected to torture or to cruel, inhuman or degrading treatment or punishment.” Medical doctors in the United States take the Hippocratic Oath that states, “I will follow that system of regimen which, according to my ability and judgment, I consider for the benefit of my patients, and abstain from whatever is deleterious and mischievous.”

How can we be in direct conflict to both the Declaration of Human Rights and the Hippocratic Oath, and cause immense suffering to those of us who are in chronic, incurable pain? How can we reconcile the fact that, as a country, we can show compassion and lend assistance to refugees, and send food and medical aid to Third World countries, yet allow our family and friends to be denied the medication they need to survive?

It is because we are only being shown one side of this story. What we are not shown are the millions of patients in the USA alone who, but for their opioid medication, would be left in constant and excruciating pain. Taking away their right to be treated for their pain is the real opioid crisis.

Sadly, there are thousands of people who die from the over-the-counter drug ibuprofen every year. There are tens of thousands of people dying from their antidepressants and benzodiazepines. There are hundreds of thousands of people who die from complications associated with anticoagulants. Although these numbers are tragic, we would not want to see the physicians associated with these prescriptions threatened. This, however, is exactly what is happening in the case of the opioid crisis.

This is not acceptable.

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Physicians Get Too Much Blame for Opioid Crisis, Some Say

http://www.medscape.com/viewarticle/885760

SAN ANTONIO, Texas — People looking to place blame for the nation’s opioid crisis too often point the finger at physicians, some speakers said at a reference committee for the American Academy of Family Physicians (AAFP) 2017 Congress of Delegates.

As communities across the country deal with the escalating opioid crisis, clinicians, public health officials, and the public are increasingly looking for answers, solutions, and — sometimes — where to place blame.

Several resolution clauses presented in a committee hearing Monday addressed shared responsibility and the need for education of physicians, officials, and the public on evidence-based prescribing. But the clause that caught the most attention directed the AAFP to mount a nationwide public relations effort to “dispel the myth that places blame on physicians.”

Some delegates who spoke against the resolution pointed to the large cost estimated for the proposal (more than $550,000 for a 12-month campaign). Others noted that changing minds would take time. And some simply said it was not a road AAFP should take.

However, the resolution passed the committee and was referred to the AAFP board on Wednesday.

Timothy Alford, MD, a delegate from Mississippi, which sponsored the resolution, said, “I can tell you we’ve got good physicians in rural America, right in the wheelhouse of what we do, where this problem is very pervasive, and they’re getting thrown under the bus by the press, and everybody else.”

David Hoelting, MD, a delegate from Nebraska, told Medscape Medical News, “Physicians, especially family physicians and orthopedists, are receiving the most pressure for prescriptions of opiates. A lot of this started as a result of the “fifth vital sign” program started around year 2000. First there was pressure to relieve all pain, then when addiction levels soared, we got the blame. The most serious problem now is that physicians are stopping narcotics to many of the patients abruptly, forcing them to resort to illegal street drugs, and risking overdoses.”

Jim Taylor, MD, an alternate delegate from Louisiana, said the issue has become a political football.

“The perception battle is one we’re losing. I think a half-million dollars is a very reasonable amount to spend on a national campaign to push back against those who actually push us into this.”

Other clauses in the resolution included asking that the AAFP to support appropriate and individualized pain treatment by physicians, educate family physicians in evidence-based pain management and prescribing, and educate government and law officials that a balanced approach is needed.

Clauses also promoted prescription monitoring and cognitive-behavioral therapy.

Domenic Casablanca, MD, a delegate from Connecticut, said those parts of the resolution are already being covered by current AAFP policy and launching the public relations campaign would take the academy in the wrong direction.

“Our delegation felt strongly there’s nothing to be gained in terms of making us look better by the PR campaign. It’s a multifactorial problem and we don’t want to lower ourselves to that level,” he said.

Dennis Dmitri, MD, a delegate from Massachusetts, said 2 years ago political will had turned against physicians, and physicians in the state were getting blamed for the opiate crisis.

It wasn’t until physicians sat down with government officials and legislators to work cooperatively with them, rather than defensively, on the issue that the tide turned, he said. That had a positive effect on the kind of legislation that was subsequently passed.

Dr Dimitri said the Massachusetts Medical Society launched a public relations campaign, but “not one aimed at buffing the reputation of physicians.” Instead it was aimed at educating the public about why there is an opioid crisis, how it could be addressed, how members of the public could be more careful about their own use of opiates, and how they could better interact with their physicians.

“That really changed the perception of physicians and the role they might play,” he said, “other than simply trying to say it’s not our fault.”

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Five myths about heroin

https://www.washingtonpost.com/opinions/five-myths-about-heroin/2016/03/04/c5609b0e-d500-11e5-b195-2e29a4e13425_story.html?utm_term=.616c93a6ee4d

1. Most heroin addiction starts with a legitimate pain prescription.

People who misuse prescription pain relievers are 40 times more likely to become addicted to heroin than those who don’t, according to the Centers for Disease Control and Prevention. Research also shows that 75 percent of patients in heroin treatment started their opioid use with prescription medications, not heroin. That sounds like pain treatment is at the root of the problem, and the CDC is targeting doctors with new guidelines aimed at reining in prescriptions.

But overwhelmingly, prescription-drug misusers are not pain patients. According to the National Survey on Drug Use and Health, more than 75 percent of recreational opioid users in 2013-14 got pills from sources other than doctors, mainly friends and relatives. Even among this group, moving on to heroin is quite rare: Only 4 percent do so within five years; just 0.2 percent of U.S. adults are current heroin users.

The proportion of patients who become newly addicted to opioid medications during pain treatment is also low. A 2010 Cochrane review — considered the gold standard for basing medical practice on evidence — found an addiction rate of less than 1 percent. A study of more than 135,000 emergency-room visits for opioid overdose found that just 13 percent of patients had a chronic pain diagnosis.

Further, a 2015 study showed that only 6 percent of those who received an initial prescription for opioids took the drugs for more than four months; the authors didn’t determine how many of those ongoing prescriptions were medically appropriate and what proportion were linked to addiction.

The real risk factor for opioid addiction is youth. Like 90 percent of all addictions, the vast majority of prescription-drug problems start with experimentation in adolescence or early adulthood, typically after or alongside binge drinking, marijuana smoking and cocaine use. Having a prior or current addiction to another drug is the best predictor of developing problems with prescription drugs — not pain care.

2. The best treatment for heroin addiction is inpatient rehab.

When the media covers addiction among the rich and famous, they almost always include an inpatient stay at a plush rehab center. Dr. Drew Pinsky’s “Celebrity Rehab” is typical of such programs. Like many who run inpatient programs, Pinsky rejects the ongoing use of anti-addiction medication (though Hazelden, the original model for the 28-day rehab center, began offering it to some patients in 2012 after experiencing record high death rates). Similarly, most drug courts and many state Medicaid programs also deny continuing access to the two best-studied maintenance medications, methadone and buprenorphine (Suboxone).

The position that residential treatment centers and their abstinence-only philosophies are superior to medication ignores overwhelming data and keeps families from seeking the best care. Let’s start with Dr. Drew’s patients: Nearly 13 percent who appeared on “Celebrity Rehab” died not long afterward; most had been addicted to opioids. While that may be an especially poor showing, research on more than 150,000 patients receiving treatment for opioid addiction in Britain found that people in abstinence-only care had double the death rate of those who received ongoing maintenance treatment. And other studies find that maintenance medication cuts death rates by 70 percent or more. Since untreated heroin addiction carries a mortality rate of 2 to 3 percent per year, the benefit is substantial.

This is why the World Health Organization, the National Institute on Drug Abuse, the Institute of Medicine and the White House drug czar’s office all agree that maintenance treatment — indefinite, possibly lifelong medication use — is superior to abstinence rehab for opioid addiction. While some argue that total abstinence is a moral imperative, dead people can’t recover. Sadly, only a small proportion of people with opioid addiction are currently in medication-assisted treatment — largely because of limits placed on it by misguided ideology, government policies and insurers.

The prognosis for heroin addiction seems grim because of the high mortality rate and because rehabs typically report relapse rates of 60 percent or greater. However, the odds of recovery are better than they appear.

Early evidence for this idea came from studies of Vietnam veterans, who, as young men, should have had particularly high addiction and relapse risk. Heroin and opium were cheap and easily available to American servicemen overseas; nearly half tried these drugs, and half of these soldiers became addicted. But upon returning home, just 12 percent of those who had been addicted relapsed within three years, and only 2 percent were still addicted at the end of the study — nowhere near 60 percent. Fewer than half got any treatment, and it didn’t make a difference in terms of who recovered.

This phenomenon, known as “natural recovery” or “maturing out” of addiction, is common with other drugs, too. Large population surveys show that most people who are addicted to alcohol or cocaine quit without treatment. The same type of study shows that around 60 percent of people who met the criteria for prescription opioid addiction at one time no longer do so — and one third of them never received any treatment. This research also finds that the average prescription opioid addiction lasts eight years; for heroin, the average is a decade. For alcohol, the average addiction lasts 15 years.

So why do heroin addicts appear so hopeless in the public imagination? Because people who quit on their own don’t show up for treatment — and so, while they are included in large epidemiological studies, they aren’t included in treatment research. This means that rehabs see only the worst cases, leading to an unduly pessimistic picture of recovery. Although opioid addiction certainly can be deadly, it doesn’t have to be — and those who struggle with it should absolutely seek help. Still, more research is needed to understand what people who recover without help can teach those who need it.

4. Tough love is the only thing that works.

The idea that people with addiction must “hit bottom” — or experience the worst possible consequences — before they can get better is prevalent among parents and policymakers. One drug court official told a researcher that “force is the best medicine” for treating addiction, and the 12-step program Al-Anon warns against “enabling” addiction by doing things like helping people avoid jail.

But research shows that the opposite is true. Like any other human beings, people with addiction respond best to being treated with dignity and respect. Programs that nonjudgmentally distribute clean needles, provide overdose-reversal drugs or offer safe spaces for injection do not prolong addiction; a Canadian study found that 57 percent of people who came to a safe injection facility to shoot up ultimately entered treatment . An approach for helping addicted family members that uses kindness, rather than confrontation or detachment, was found in another study to be twice as effective as a traditional confrontational “intervention” — and no studies show that harsh treatment or incarceration is superior to empathetic care.

Similarly, there’s no evidence that naloxone programs, which provide users and their families with the overdose-reversal drug, prolong addiction. But they do prolong life: The overdose death rate was cut by nearly 50 percent in communities that fully implemented these programs.

5. Whites have recently become the majority of people with heroin addiction.

In an article headlined “In Heroin Crisis, White Families Seek Gentler War on Drugs,” the New York Times recently claimed that “today’s heroin crisis is different,” because it is not “based in poor, predominantly black urban areas” and because use “has skyrocketed among whites.” NPR, the Atlantic and other major media outlets have run similar stories, often citing a study, published in JAMA Psychiatry, which found that 90 percent of new heroin users in the past decade were white.

What most of them omit is that the same study showed that whites have made up more than half of all heroin addicts since the early 1970s and hit 80 percent before 2000. In 1981, Newsweek panicked about a new wave of “middle-class junkies,” and in 2003, a Times headline read “Heroin’s New Generation: Young, White and Middle Class.” White heroin users are nothing new.

The reason for the misperception is political: Politicians from the first “drug czar,” Harry Anslinger, in the 1930s to Ronald Reagan in the 1980s have portrayed heroin and other illegal drugs as a black or “foreign” problem in order to justify tough policies. In the early 1900s, when heroin was sold over the counter without warning labels, the typical user was a white middle-class woman, and she was seen as a victim of unscrupulous manufacturers, not a criminal. After heroin became illegal and was framed as a problem of the poor and minorities, law enforcement began to predominate. Only now are policymakers beginning to recognize the failure of criminalization.

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CDC: Updated Influenza Immunization Recommendations for 2017-2018

It is recommended that flu shots should be given by the end of Oct because it takes a couple of weeks for full immunity to build up.  Conversely, there is new evidence that getting a flu shot “early” (Aug-Sept) that the effectiveness of the flu vaccine may have “faded enough” by the time of the peak flu season that the pt may be at risk of catching the flu.  Especially those pts with compromised immune systems (FM, RA, MS, etc) might be advised to get their flu shots in the last two weeks of Oct each year.

http://www.empr.com/news/flu-season-vaccine-quadrivalent-trivalent-acip/article/684558/

The Advisory Committee on Immunization Practices (ACIP) has issued new guidelines for the prevention and control of seasonal influenza with vaccines for the 2017–2018 season. 

For the 2017–2018 season, the following influenza vaccines will be available:

• Trivalent influenza vaccine (A/Michigan/45/2015 (H1N1)pdm09–like virus, an A/Hong Kong/4801/2014 [H3N2]-like virus, and a B/Brisbane/60/2008–like virus [Victoria lineage])
• Quadrivalent influenza virus (includes three viruses listed for Trivalent vaccine + additional B vaccine virus [B vaccine virus, a B/Phuket/3073/2013–like virus])
• Recombinant influenza vaccine (both trivalent and quadrivalent)

Due to concerns about its effectiveness, live attenuated influenza vaccine (FluMist Quadrivalent; MedImmune) is NOT recommended for use during the 2017–2018 season. According to Penn State College of Medicine researchers, influenza vaccination rates for the 2016–2017 flu season among children decreased by 1.6% (compared to 2015–2016 rates) after this recommendation was made. “We worried that there was going to be a huge drop off in vaccination rates without the nasal spray available,” said study co-author Ben Fogel, assistant professor of pediatrics at Penn State College of Medicine and medical director of Penn State Pediatric Primary Care. “We saw a drop off but I would not call it huge, which is reassuring.”

In general, routine annual vaccination is recommended for all patients ≥6 months of age who have no contraindications. Flu vaccine should be offered to patients by the end of October, if possible.

The major updates for this upcoming flu season include the following:

• A change in the influenza A(H1N1)pdm09 virus component from the previous season
• The availability of Afluria Quadrivalent (Seqirus), an inactivated influenza vaccine indicated for active immunization against influenza A subtype viruses and type B viruses for patients 18 years of age and older
• The availability of Flublok Quadrivalent (Protein Sciences), a recombinant protein-based vaccine for active immunization against disease caused by influenza A virus subtypes and influenza B virus in patients 18 years of age and older
• An expanded age range for FluLaval Quadrivalent (GlaxoSmithKline) to include use in children aged ≥6 months (previously approved in patients aged ≥3 years)
• Pregnant women may receive any FDA-approved, recommended, age-appropriate influenza vaccine
• Patients 5 years of age and older may now receive Afluria (Seqirus), a trivalent, inactivated “split virion” influenza vaccine
• While still a licensed product, the ACIP does not recommend use of live attenuated influenza vaccine

The full report, which includes guidance for influenza vaccination of specific populations (ie, children, pregnant women, older patients, immunocompromised individuals), and situations (history of Guillain-Barré Syndrome, egg allergy) can be found here.

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Congress Makes Progress in Destroying the Americans With Disabilities Act

www.rewire.news/article/2017/09/11/congress-makes-progress-destroying-americans-disabilities-act/

From literally putting their bodies on the line to save the Affordable Care Act to contending with a presidential administration that has demonstrated complete disdain for them, people with disabilities are facing unprecedented times. Last week, things went from bad to worse for us: Congress took significant steps in its efforts to destroy the landmark Americans With Disabilities Act (ADA).

As I have written previously for Rewire, Congress is considering the ADA Education and Reform Act of 2017 (HR 620), sponsored by Rep. Ted Poe (R-TX). If passed, this dangerous legislation would completely undermine the intent of the ADA and significantly harm the rights of people with disabilities.

Because of the ADA, businesses—such as restaurants, movie theaters, hospitals, hotels, and museums—must be fully accessible to people with disabilities. In addition, the ADA compels employers, as well as public and private entities including state and local governments, to provide reasonable accommodations to people with disabilities and prohibits discrimination based on disability.

Right now, if a disabled person faces an ADA violation, such as inaccessibility, at a business, they can file a complaint with the U.S. Department of Justice (DOJ) or file a lawsuit in court. Because there is no entity responsible for ensuring that businesses comply with the ADA, enforcement depends on people with disabilities to challenge violations.

According to a letter to the House Judiciary Committee last week by 236 disability and civil rights organizations, “H.R. 620 was not written in consultation with representatives of the disability rights community and it would create barriers to the civil rights for persons with disabilities that do not exist in other civil rights laws.”

Despite this strong condemnation, however, the House Judiciary Committee held a markup hearing on Thursday where it voted HR 620 out of committee. The final vote was 15 to 9 along party lines; all of the amendments proposed by Democrats, including additional damages if a business fails to make progress after 120 days, were rejected. The ADA Education and Reform Act of 2017 will now move to a full House floor vote.

In response to this appalling vote, the National Disability Rights Network issued a statement on Friday: “More than 27 years after the passage of the ADA, the committee’s vote was not an attempt to reform or educate on the ADA, but a blatant attempt by Congress to say that it is ok to discriminate against people with disabilities by not making public accommodations accessible.”

Disability rights advocates were not the only ones to release scathing remarks in response to the vote. Ranking member Rep. Bobby Scott (D-VA) issued a press release expressing his disappointment that read, “H.R. 620 undermines the goals of the ADA to create a more inclusive society and provide equal participation for all members of the community by removing incentives to comply with ADA requirements, placing the compliance burden on individuals with disabilities.”

Likewise, Sen. Tammy Duckworth (D-IL), a disabled veteran and wheelchair user, wrote on Facebook, “It’s hard to believe this legislation advanced in the House this week. 27 years after the Americans With Disabilities Act became the law of the land, the notion that businesses in this country need more time to provide people with disabilities access to their services is ridiculous and offensive.” Referencing the pro-ADA protest in 1990, she continued, “This vote is a disgrace to those who literally crawled up the steps of the United States Capitol so many years ago to secure the protections enshrined in the ADA as well as to all those who value liberty and justice for all.”

Other members of Congress, including Sen. Maggie Hassan (D-NH), Sen. Patty Murray (D-WA), and Sen. Bob Casey (D-PA), issued similar statements condemning the House Judiciary Committee’s vote and committing to oppose passage of the bill in the Senate.

Of course, many business representatives, including the International Council of Shopping Centers, are celebrating the House Judiciary Committee’s vote.

Throughout the years, based on a false belief that the ADA is being abused via frivolous lawsuits, Congress has introduced a number of “notification bills”—which shift the burden of enforcement further onto people with disabilities—such as HR 620. But their passage has never seemed so likely as now. Individuals must join the efforts to stop this assault on the ADA by contacting their members of Congress, signing online petitions, and most importantly, joining the disability community as we continue to fight this dangerous legislation.

Considering that the U.S. president’s real-estate properties have violated the ADA on numerous occasions, the bill is certain to be signed into law if it crosses his desk. Today it is the ADA on the chopping block; tomorrow it may be another civil rights law.

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Lady Gaga hospitalized for ‘severe pain’

http://www.foxnews.com/entertainment/2017/09/14/lady-gaga-hospitalized-for-severe-pain.html

Lady Gaga cancelled her Rock In Rio concert in Brazil Thursday after announcing she was suffering from “severe physical pain.”

The 31-year-old made the announcement on Twitter.

It was later confirmed on her social media that the pop star was hospitalized and is being watched over by “the very best doctors.”

The singer revealed earlier this week she suffers from fibromyalgia, a chronic disorder that causes widespread muscle pain.

Back in 2013, Gaga was forced to cancel several tour dates to have surgery on her broken hip.

She opened up about that painful procedure in her new Netflix documentary “Gaga: Five Foot Two,” which premieres Sept. 22.

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Figures reveal another increase in overdose deaths: Rates were up more than 20% in the first months of 2017 – showing efforts to control the epidemic are failing

http://www.dailymail.co.uk/health/article-4874540/Drug-overdose-deaths-20-2016.html

New CDC figures reveal another significant increase in drug overdose deaths – a bleak sign that efforts to control the epidemic are failing.

The number of Americans who died in 2016 and the first months of 2017 from a drug overdose hit 64,765, which is up more than 10,000 from the same figure from 2015.

Territories that had the steepest increases in overdose deaths were Delaware, the District of Columbia, Florida, Maryland and North Dakota. And only nine states saw their rates decrease from 2015 to 2016. 

The figures are consistent with the grim findings of recent reports that reflect the seriousness of America’s opioid crisis, which President Trump has deemed a ‘national emergency’.

Experts are blaming the rise on a lack of education about opioids and inaccessible treatment options.

They are also warning that the crisis is likely going to get worse before it gets better because – no matter what measures states take now to decrease drug overdose death rates – the epidemic has already taken effect.

New CDC data have revealed that the rate of overdose deaths in the US rose more than 20 percent from 2015 to 2016 despite preventative measures to bring the rate down (Source: CDC)

The CDC’s new report confirms that drug overdose deaths now kill more Americans than fatal illnesses such as influenza and pneumonia – which, combined, kill about 57,000 people – suicide, which claims around 44,000 lives annually.

Other CDC data have shown that the overdose rate for teenagers, specifically, is growing for the first time since the 2000s.

The territory that lost the most residents to drug overdoses in 2016 was Florida, where 5,199 people died from them between February 2016 and February 2017.

But the territory that saw the largest increase in overdose deaths between 2016 and 2017 was the District of Columbia, which saw a 128.8 percent increase. 

However, states that saw increases like these are not necessarily doing anything wrong in their attempts to help residents who are hooked on opioids, according to Dr Cheryl Healton, Dean at NYU’s College of Global Public Health.

‘That has to do with how long they’ve had the epidemic,’ Dr Healton said.

And, conversely, ‘just because the rate went down doesn’t mean [a state is] doing things right’.

She explained that it takes time for an epidemic to run its course.

Regardless of the measures a state is taking to lower its overdose death rate, if a large number of its residents got hooked before it started taking these measures, it is likely that a large number of them will die.

This means that even if a state’s overdose death rate is going up, it could still be making a strong effort to control it.

And one reason for a state’s overdose death rate going down could have simply been low population, Dr Healton said.

Dr Healton said that the spike in deaths is, in part, a reflection of a lack of education.

‘We are doing absolutely nothing to educate the American people broadly. There needs to be mass communication,’ she said.

She added: ‘The education curve has not happened and it needs to happen.’

Dr Healton thinks that a full-fledged anti-opioid campaign needs to be initiated in the US.

Another factor that contributed to this rise is dangerous marketing tactics, she said.

Dr Healton explained that pharmaceutical companies that produce prescription painkillers such as OxyContin label opioids as non-addictive when the reality is that they are highly addictive.

This confusion about whether or not they are easy to get hooked on has led doctors to over-prescribe them because they think they are harmless.  

Dentists in particular are to blame because they prescribe painkillers routinely after patients undergo minor dental procedures, Dr Healton said.

She added that doctors do this even when less-harmful and less-addictive medications exist that could also do the trick, saying: ‘We’re not utilizing other methods. They should try something else first.’

The price of painkillers produced by pharmaceutical companies has also contributed to the problem.

Dr Healton explained that after a person gets hooked on opioids – which does not take long – the doctor who prescribed the drugs to them will usually sense this.

When they do, they will stop writing prescriptions for opioids for the addicted patient, which will in turn cause the person to seek out the medications to satisfy their cravings elsewhere.

This leaves them with two options: paying at least $50 per pill for the medications they have been taking or turning to illicit versions.

Dr Healton said: ‘Providers stop prescribing. The pricing of opioids has driven people to street heroin.’ She added that heroin is usually 10 percent of the cost of prescription drugs, so it is the more attractive option.

And recent reports confirm this: the CDC’s new figures come on the heels of an analysis that showed that the rate of deaths caused by synthetic opioid fentanyl in American cities grew more than 600 percent between 2014 and 2016. 

Above all people need to realize that, if they are hooked, help is available, Dr Healton said.

She explained: ‘The most important thing is availability of treatment alternatives. Treatment is effective.’

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DEA Raid on Billings Doctor Brings Pain Wars to Montana

https://stopthedrugwar.org/chronicle-old/392/drnelson.shtml

The Drug Enforcement Administration’s (DEA) war without quarter against what it sees as corrupt, pill-dealing physicians who are fueling a crisis in prescription drug abuse came to Montana last month. But with the raid on Billings physician Dr. Richard A. Nelson, who has been treating patients with opioids for chronic pain from cancer, arthritis, and other conditions, that all-too-familiar narrative has been challenged. An uproar that has yet to die down has gotten the attention of local media and at least one US senator as patients complain bitterly of being left in the lurch and national pain advocates arrived to press for justice for Dr. Nelson and his patients alike.

The uproar began on April 20, when DEA agents arrived at Nelson’s West End office and seized his medical records and prescribing certificate. The DEA did not tell Nelson at the time why he was being raided, except to say that agents served an “administrative inspection warrant.” Nelson was not arrested or charged with any offense, although that could be coming. The agency was still keeping mum this week, with Denver regional DEA spokesperson Karen Flowers telling DRCNet only that “this is an ongoing investigation.”

Nelson, who has been practicing medicine in Billings since the 1970s, has a spotless record with the state medical board. He does not prescribe the controversial but medically accepted mega-doses of opioids that have triggered DEA investigations of other pain treatment physicians. But two of his patients reportedly died from drug-related causes in the last year, perhaps drawing the interest of the DEA. Nelson’s practice remains open, and the DEA returned his files 10 days later, but he now cannot prescribe the medications needed by his chronic pain patients. The practice limps along under the cloud of the DEA raid.

While Nelson and his newly hired legal team wait to see what the DEA will do next, some 75 of his patients have been left out in the cold. Without Dr. Nelson, said patient Glen Wilkinson, Billings pain patients are finding adequate pain treatment hard to come by. “I ended up with Dr. Nelson as a last resort,” said Wilkinson, who suffers from chronic pain related to two herniated and nine broken discs in his spinal column. “I had no place else to go. He’s a good, honest doctor, but now I am being denied medical care based on my affiliation with him. My primary care physician told me he wouldn’t see me again after I went to Dr. Nelson.”

Wayne Nott, a retired rock quarry worker from Bridger suffering from a variety of painful complaints, including arthritis, multiple lipomas, and varicose veins who also lives with a titanium plate in his neck, is another patient of Dr. Nelson’s who is having trouble finding a doctor to treat him. He told DRCNet he traveled more than a hundred miles to go to an appointment with a doctor who had agreed to see him, but when he arrived he was turned away.

“When I got to the doctor’s office and told them I had an appointment, the receptionist asked for my name, then told me ‘You did have an appointment, but you don’t now.’ She told me she got a phone call 10 minutes before I arrived saying not to treat any patients from Dr. Nelson’s office. When I asked her who had told them that, she wouldn’t say, but I know it must have been the DEA,” Nott said.

“She told me I had to leave the building,” said Nott. “She acted like I was some kind of psycho. People think that people who went to Dr. Nelson are junkies. I’m no junkie. I hate to even take the stuff I’m taking, but I have to for my chronic pain.”

The physician in question, Dr. Ahmed Madi of Roundup, refused Thursday to discuss his reasons for turning Nott away. “I’m not interested, thank you very much. Bye,” was his response to a DRCNet inquiry.

Nott has related his account of his encounter with Dr. Madi’s office in a deposition provided to Dr. Nelson. He has also since managed to find a doctor to care for him, but in a telling indication of the atmosphere of fear and intimidation created by the DEA raid on Dr. Nelson, he asked that that doctor not be publicly named.

“This is horrible, I don’t know how it could get any worse,” said Dr. Nelson’s wife, Jerrie Lynn, an acupuncturist who shares her husband’s practice. “This is just unbelievably sad for the patients. The DEA is telling doctors not to see our patients,” she charged, “and telling drug stores not to fill our prescriptions.”

While patients who spoke with DRCNet backed Ms. Nelson’s charge that the DEA is intimidating physicians and pharmacies, with some saying local doctors told them as much, it is a difficult charge to prove. DEA spokeswoman Flowers flatly denied it. “Absolutely not,” she said. “That’s false. If these people have medical problems, they should seek medical help. The medical community is obligated to help people who are sick.”

Several patients told DRCNet St. Vincent Healthcare had turned them away, but the hospital denied both being told not to treat Dr. Nelson’s patients and that it was turning them away. “St. Vincent Healthcare assesses and treats all patients on an individual basis. We follow guidelines and protocols for treatment based on established criteria. There is no policy or practice to refuse care to any of Dr. Nelson’s patients,” said Nancy Kallern, vice-president for patient affairs. “No,” the hospital has not received notice from any agency advising it not to treat Dr. Nelson’s patients, she told DRCNet.

“I have no reason to believe those claims are false, but the problem is in confirming it,” said Siobhan Reynolds, executive director of the pain patients and physicians advocacy group the Pain Relief Network (PRN), who traveled to Billings last week to meet with Dr. Nelson and his patients. “Every time a doctor says this to a patient, they also say ‘You didn’t hear that from me.’ The intimidation is complete,” she said.

“Everyone is getting into the game,” Reynolds continued. “Pharmacies are turning down Dr. Nelson’s non-controlled scripts and insurance companies are declaring the doctor’s demise, despite the fact Dr. Nelson is still in possession of an unblemished record with Montana’s Board of Medical Examiners and is still practicing.”

Typically in cases where physicians are accused of prescription wrongdoing, they are left dangling in the wind while DEA agents and prosecutors use their access to the media to paint a one-sided picture of pill-mills and Dr. Feelgoods. Reynolds was determined not to let that happen in Billings, and her strategy has paid off — at least in public relations terms. In the last two weeks, the Billings Gazette has run at least three stories on the raid and its consequences, with titles such as “In Search of Relief: Pain Sufferers Caught in Medical Controversy” and “DEA Accused of Targeting Pain Doctors.”

The third article was provoked by a very unusual event in Billings. Last Friday, after letters to US Senators Max Baucus (D) and Conrad Burns (R) were ignored, Reynolds and three dozen patients went to Baucus’ Billings office to seek a meeting after his office turned down a request for a meeting the previous day. Standing outside the building until a staffer agreed to meet with them, they protested the DEA’s nationwide pattern of going after pain doctors and its local impact, and demanded their representatives do something about it. “We want him to call for and help organize a Senate Judiciary Committee hearing on this issue,” said Reynolds. “We want to see an investigation into what the DEA has been doing, and we need the subpoena power of the Senate to get behind the veil and find out what is going on.”

“The feds and the state authorities can’t both be responsible for the regulation of Montana’s doctors,” said patient Gregg Wilkinson during the protest. “The medical board says Nelson is impeccable, while these Washington bureaucrats are saying he’s criminal. Somebody isn’t telling the truth.”

While Sen. Baucus was not present, office communications director Barrett Kaiser did come down to listen to patients’ concerns and promised to relay them to the senator. But, he told the crowd, it is hard to say what Baucus will do. The senator supports the justice system and has a policy of not interfering with criminal investigations or legal policies, Kaiser said.

It remains unclear what action, if any, Baucus will take. Kaiser failed to respond to any of DRCNet’s four calls seeking comment on the matter this week, and the office has made no other public remarks on the issue.

“Senator Baucus stonewalled us,” said Wilkinson. “Thirty-five people marched to his office, but he won’t even dignify us with an answer.”

“I’m watching people have their lives destroyed,” said Reynolds. “There are patients who were functional under Dr. Nelson who now can’t work or walk or even play with a two-year-old. The implications of this for these people are staggering. It is mind-boggling, but what is perhaps even more distressing is that their senators don’t seem to think it’s a problem,” said Reynolds. “They are stonewalling,” she told DRCNet. “I am just dumbstruck by the lack of concern displayed by elected officials here.”

Update: Late Thursday, Sen. Baucus responded — sort of — in a letter to Reynolds. Baucus reiterated his “policy of not interfering with criminal investigations” and did not address the larger question of the DEA’s aggressive behavior or the call for hearings in the Senate. But in a nice constituent service touch, he did contact the Deering Clinic in Billings on the patients’ behalf, which “has given assurance that all patients will be afforded the opportunity to be assessed by their staff for a continued pain management care plan.”

While that pledge is no guarantee of adequate opioid treatment for Dr. Nelson’s patients, the Pain Relief Network will be watching closely, said Reynolds. “We will be overseeing the care of these patients and will be providing the clinic with expert advice in the event they fail to treat patients appropriately.”

And while Sen. Baucus did not immediately acknowledge demands for a congressional look at the broader issues involved, his response was a first, said Reynolds. “This is a major step in the right direction. It’s the first time a US senator has acknowledged the humanity of people in pain,” she said.

While Dr. Nelson has the support of his patients, his colleagues in the medical profession have stayed largely silent or have been critical. The head of the Montana Medical Association, Dr. Joan McMahon of Lewistown, professed to be unfamiliar with the case and declined comment, saying only that “physicians have to follow DEA regulations.”

Dr. Bill Rosen, a specialist in physical medicine and rehabilitation at the Deaconness Billings Clinic scoffed at the use of opioids as pain medications. “Narcotics have never been shown to heal anything,” he told the Billings Gazette. “All you’re doing is putting a Band-Aid on a wound that will never heal.” While opioids may be appropriate in limited cases, he said, doctors are too quick to prescribe them for patients who could be helped in other ways. “People come in and tell me they are disabled by their pain,” Rosen said. “I say you are disabled from your inability to cope with your pain.”

Dr. Joseph Talley, a North Carolina physician whose practice was shut down by the state, found opioids useful for patients, but warned that doctors around Billings may decline to treat Dr. Nelson’s patients with them for fear of becoming a magnet for patients and ultimately the next target for the DEA. “An opioid prescriber will be swamped with patients, good and sinister, from near and far,” he told DRCNet. “As soon as the word gets out that a doctor will treat pain in adequate doses (which eliminates most doctors who prescribe at all) and will do so without making patients feel like dirty criminals (which eliminates all but a very tiny few of those remaining), the practice of those very few doctors will change drastically, and it will take on a form upon which the DEA can capitalize. He will have cars with out-of-state plates, desperate patients who couldn’t get an appointment milling around his door, and when he treats one desperate patient, he is likely to get 10 desperate calls from her friends, neighbors, and relatives wanting help themselves,” Talley said.

Unlike other prominent cases of physicians under the federal gun, Dr. Nelson was not prescribing massive amounts of opioids to patients, said his wife. “He doesn’t really go outside the guidelines,” she said. “He would prescribe maintenance doses and other prescriptions, but not the really high doses.”

“The DEA needs to be held accountable — at the very least it should be paying the medical bills for these people who have been adversely affected,” said Nelson. “People can’t function without their pain medications. Some have had to quit their jobs. One of our patients now has to have a person come in and care for him. And they are being treated like criminals when they go to the hospitals in search of relief.”

In the meantime, it appears that Billings-area physicians are already aware of Dr. Talley’s lesson and are staying away from opioids and patients who need them. “I was surviving on what Dr. Nelson gave me,” said Nott. “Now all I can do is lay in bed all day.”

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Editorial: Opioid lawsuits offer a quick high, quick letdown

https://www.abqjournal.com/1063312/opioid-lawsuits-offer-a-quick-high-quick-letdown.html

In this litigious world, New Mexico Attorney General Hector Balderas’ decision to join other states in suing Big Pharma over the nationwide opioid crisis makes a good headline. Ditto for the lawsuit from Mora County that preceded it and the one expected to follow from Bernalillo County. In fact, at last count the Washington Post had 25 states, cities and counties suing manufacturers, distributors and drugstore chains in connection with opioids, with more being filed almost weekly.

But it’s hard to determine how New Mexico residents would benefit from a far-from-guaranteed win.

While Balderas says the suit was filed to hold drug manufacturers and distributors “accountable” and to increase funding for opioid addiction treatment and law enforcement, it’s questionable that any money derived from it would actually be used for the stated purposes.

Remember when New Mexico won millions from Big Tobacco in a 1998 settlement agreement? The windfall, to an embarrassing extent, has ended up being a slush fund for legislative priorities that have nothing to do smoking’s impact. Tobacco settlement money has been used to balance the general budget, prop up the state lottery’s scholarship fund, cover costs for early childhood education – and the list goes on. Sure, some of that money from the “permanent” tobacco settlement fund pays for anti-smoking programs, but you get the picture.

Balderas contends opioid manufacturers “pushed highly addictive, dangerous opioids” on the public and failed to tell doctors how addictive they were. The suit also says drug distributors “violated their duties by selling huge quantities of opioids that were diverted from their lawful medical purpose,” thus causing an opioid/heroin/overdose epidemic.

Does anyone believe someone with a medical degree doesn’t understand opioids are addictive? Then again, suing individual doctor feel-goods who hand painkillers out like Pez is nowhere as promisingly lucrative as suing Big Pharma’s deep pockets. As for diverted opioids, how are distributors responsible for things they sell being stolen from people they sell them to?

And where is personal responsibility in all of this?

The suits also fail to mention that opioids have been around for decades, are highly effective painkillers many patients do use as prescribed, and New Mexico had a chronic heroin problem long before the current opioid crisis – largely because of proximity to Mexico and illegal drug trade routes.

Attributing the opioid crisis to manufacturers and distributors ignores the real problem – demand.

There is no denying that the widespread availability, and popularity, of opioids has exacerbated this state’s opioid addiction and overdose rates, and that more must be done to address the scourge. Reforms – including New Mexico’s Prescription Monitoring Program, which requires health care providers check a patient’s prescription history in the PMP database to block doctor shopping for drugs – are working. The state Health Department announced a 63 percent increase in providers using the PMP since last year and a 5 percent decline in opioid prescriptions.

Sure there’s a lure to joining major suits like this one: For a somewhat modest investment, the state or counties might eventually realize a windfall (nowhere equal to what plaintiffs attorneys will make by comparison). New Mexico gets millions annually from Big Tobacco.

In July, Balderas joined a lawsuit against six generic drugmakers, alleging they conspired to hike prices for a common antibiotic and a diabetes medication. More recently, he’s signed onto a suit seeking to block President Donald Trump’s attempt to scrap the Deferred Action for Childhood Arrivals (DACA) immigration program. While the former targets collusion and price gouging, and the latter is an immediate problem for about 7,300 DACA recipients here, this latest suit has a lot in common with the state’s opioid problem:

It delivers a quick high and a just-as-quick letdown.

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