Did Chronic Pain Patients Help Elect President Trump?

By Pat Anson, Editor

Rates of opioid prescribing were significantly higher in counties that voted for Donald Trump in the 2016 presidential election, according to a new analysis published in JAMA Network Open.

Researchers at the University of Texas compared voting trends, census information and Medicare data for people who received opioid prescriptions for 90 days or more. Nearly 60 percent of U.S. counties that voted for Trump had an above average opioid prescribing rate in 2015. Counties with below average prescribing rates voted for Trump only 39 percent of the time.

The researchers cautioned that the study does not mean that chronic pain patients were more likely to vote for Trump. It’s more likely to indicate that economic, health and social problems that lead to opioid use – sometimes called the "epidemic of despair" -- played a role in Trump’s victory.

“Support for the Republican candidate in the 2016 election is a marker for physical conditions, economic circumstances, and cultural forces associated with opioid use,” wrote lead author Dr. James Goodwin, chair of geriatric medicine at the UT Medical Branch in Galveston. “This association is related to underlying county socioeconomic characteristics that are common to both chronic opioid use and voting patterns, particularly characteristics pertaining to income, disability, insurance coverage, and unemployment.”

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The researchers created a map (above) showing counties with the highest rates of opioid prescribing in dark red, while a second map (below) shows counties that overwhelmingly voted for Trump in dark red. 

The maps have similarities, but they don’t align perfectly or prove a cause and effect relationship between prescribing and voting. For example, while Trump won unexpected victories in Michigan, Wisconsin and Pennsylvania, where opioid prescribing is high, he also won in North and South Dakota, where prescribing rates are relatively low. 

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During the 2016 presidential campaign, Trump and Hillary Clinton both called for further restrictions on opioid prescriptions and expanded access to addiction treatment. Clinton also endorsed a proposed tax on opioid pain medication.

“Given that both candidates focused on opiate addiction as a major campaign issue, it is difficult to infer that opiate prescription rates are somehow linked with voting behavior based on the candidates’ respective campaign promises and/or platforms,” wrote James Rosenquist, MD, in an editorial also published in JAMA Open Network.

“These limitations aside, this article’s findings add to a growing body of literature showing the interrelationship between public health and society, including the all-important economic and political realms.”

The “epidemic of despair” was first documented by Princeton researchers Anne Case and Angus Deaton in 2015.  They believe that the reduced life expectancy of middle-aged white Americans is linked to substance abuse, unemployment, poor finances, lack of education, divorce, depression and loss of social connections.

"People who reach for an opioid might also reach for ... near-term fixes," Nancy Morden, PhD, a professor at the Dartmouth Institute for Health Policy and Clinical Practice, told NPR. "I think that Donald Trump's campaign was a promise for near-term relief."

Trump Calls for More Cuts in Opioid Prescriptions

By Pat Anson, Editor

President Trump is calling for further reductions in the prescribing of opioid pain medication and for some drug dealers to get the death penalty.

In a speech in Manchester, New Hampshire, a state hit hard by the overdose epidemic, Trump outlined his plan to combat the nation’s opioid and addiction crisis by cracking down on drug dealers, opioid manufacturers and doctors who overprescribe pain medication.

“We’re going to cut nationwide opioid prescriptions by one third over the next three years,” Trump said. “We’re also going to make sure that virtually all prescriptions reimbursed by the federal government follow best practices for prescribing. We’ll ensure that opioid addiction is not subsidized by the American taxpayer. The best way to beat the drug crisis is to keep people from getting hooked on drugs to begin with.”

The president did not spell out precisely how opioid prescribing would be reduced. His administration has proposed new rules that would make it harder for Medicare beneficiaries to obtain high doses of opioid medication by rigidly adhering to the CDC’s voluntary opioid prescribing guidelines. Under the Medicare plan, insurers could refuse to pay for opioid prescriptions that exceed the dose levels recommended by the CDC.

Opioid prescriptions peaked in 2010 and the Drug Enforcement Administration has cut opioid production quotas nearly in half over the last two years – which has led to shortages of pain medication at some hospitals and hospices.  

The president also said the nation “must get tough” with high volume drug traffickers.

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“The ultimate penalty has to be the death penalty,” Trump said. “Drug traffickers kills so many thousands of our citizens every year and that’s why my Department of Justice will be seeking much tougher penalties than we’ve ever had. And we will be focusing on the penalty that we talked about previously for the big pushers, the ones that are really killing so many people.

"Whether you are a dealer or doctor or trafficker or a manufacturer, if you break the law and illegally peddle these deadly poisons, we will find you, we will arrest you, and we will hold you accountable."

Trump said tougher border security was needed to stop the flow of illegal drugs and called for an nationwide advertising campaign to encourage children to avoid drug use.

“Spending a lot of money on great commercials showing how bad it is,” he said.

Last October, the president declared the opioid crisis a public health emergency, a designation that stopped short of the national state of emergency sought by his opioid commission. Critics have said the Trump administration has done little to fund or execute a coherent strategy to combat the overdose problem. 

Can Kellyanne Conway Solve the Opioid Crisis?

By Mark Maginn, Columnist

U.S. Attorney General Jeff Sessions announced last week that White House counselor Kellyanne Conway has been appointed to lead initiatives in the Trump Administration against the opioid crisis currently sweeping the country.

That’s right, President Trump’s former campaign manager and spinner of alternative facts has become the new “opioid czar” – although she is generally thought of inside and outside of the Washington beltway as someone as little acquainted with facts as her employer. 

Appointing a political shill who cares nothing about facts to such a high profile position strains credulity and places millions of pain sufferers and their doctors in jeopardy of more harassment and arrests.

KELLYANNE CONWAY (GAGE SKIDMORE PHOTO)

KELLYANNE CONWAY (GAGE SKIDMORE PHOTO)

Ms. Conway is a professional resident of what candidate Trump called the “swamp” he pledged to drain. And now this denizen of the Capital’s reptilian power structure is to be in charge of initiatives alleviating the opioid epidemic. 

This is a position that requires the ability to gather experts together in order to devise wise and humane policies to help those in terrible pain and those who become addicted to opioid drugs such as OxyContin and, of course, heroin.

To add gravitas to the strained credulity of this outrageous appointment, we have none other than “opioid policy expert” and the founder of Physicians for Responsible Opioid Prescribing (PROP) weighing in.

"It is a positive sign. She is a high-profile figure in the administration, showing the administration takes this seriously,” Dr. Andrew Kolodny told BuzzFeed.

It appears that in Kolodny’s brand of myopia, possessing a “high-profile” is evidence of seriousness. Kolodny perpetuates the notion that notoriety equals intellect, organizational ability and tact.

Those who applaud this sad appointment apparently do not take this so-called opioid epidemic with anything approaching the seriousness it requires. Conway’s appointment will likely lead to more of the same stupid drug policy of harassing pain doctors and jailing patients desperate for pain relief. No serious policies can be expected.

For example, after nearly a year in office, the Trump administration has failed to name anyone to head the White House Office of National Drug Control Policy. It also has yet to fund or propose a strategy for the overdose crisis, which President Trump declared a public health emergency in October. Does this look like an administration serious about the causes and treatment of drug addiction and drug overdose deaths?

Conway’s lack of candor and veracity is likely to lead to disastrous policies affecting millions of us. 

She infamously coined the phrase “alternative facts” in defense of then-Press Secretary Sean Spicer’s false statements about the size of the crowd at Trump’s inauguration. Conway later defended the President’s travel ban on mostly Muslim countries by making reference to the “Bowling Green Massacre.” She cited this fictitious terrorist massacre as evidence in support of the president’s travel ban on Muslims. 

The use of lies and half-truths by Conway should have been enough to disqualify her.

Can we believe that Conway will look to the ravages of poverty, the destruction of good middle class jobs, the collapse of education, the increasing wealth gap, and the epidemic of loneliness that I see in my office daily with patients suffering from various forms of depression and despair? No, certainly not. That would require long term financial commitment to jobs, healthcare, education, and housing.

Our current War on Drugs has led to the incarceration of millions of Americans of color. We now have more of our citizens in prison than any other nation. Yet Attorney General Sessions has created a new unit in the DEA that is solely charged with “investigating and prosecuting health care fraud related to prescription opioids.”

This indicates more law enforcement and pressure on doctors prescribing opioids for those of us who depend on these medicines simply to live. That is exactly the wrong policy. 

People of privilege like Ms. Conway and her boss, our President, are not capable of looking beyond their own wealthy horizons and seeing the lonely precincts of a depressed and despairing nation.

We need real, clear-eyed and honest people to bring us real, clear-eyed and honest help.

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Mark Maginn lives with chronic back pain. He is a licensed mental health and social worker who spent 18 months working in New York City with survivors of the 9/11 terrorist attacks. Mark now has a private practice in psychotherapy in Chicago, where he specializes in working with people in intractable pain. 

The information in this column should not be considered as professional medical advice, diagnosis or treatment. It is for informational purposes only and represents the author’s opinions alone. It does not inherently express or reflect the views, opinions and/or positions of Pain News Network.

China Denies Responsiblity for Fentanyl Crisis

By Pat Anson, Editor

China is disputing claims that most of the illicit fentanyl and related chemicals that are being smuggled into the U.S. and killing thousand of Americans originated in China. President Trump has said he would ask Chinese President Xi Jinping to “hold back the flood of cheap and deadly fentanyl” when he visits Beijing this week.

Fentanyl is a synthetic opioid 50 to 100 times more potent than morphine. It is prescribed legally to treat severe pain, but illicit fentanyl and its chemical analogues have become a scourge on the black market, where they are often mixed with heroin or turned into counterfeit prescription drugs.

“The evidence isn't sufficient to say that the majority of fentanyl or other new psychoactive substances come from China," said Wei Xiaojun, deputy director-general of China’s Narcotics Control Bureau of the Ministry of Public Security.

Wei spoke at a joint news conference Friday with the U.S. Drug Enforcement Administration. China and the DEA have stepped up their cooperation on drug control problems in recent months, with Beijing putting dozens of fentanyl related chemicals on its list of controlled substances.

“Once China controls a substance it has a dramatic effect on the United States in terms of lives saved,” said Lance Ho, who heads a new DEA office in Beijing.

DEA PHOTO OF counterfeit FENTANYL PILLS

DEA PHOTO OF counterfeit FENTANYL PILLS

"We did this even when there is no widespread fentanyl abuse in China," Wei said. "We were aware of the crisis in the U.S. and took the U.S. concern into consideration."

But an editorial in a Korean newspaper disputed the level of Chinese cooperation, claiming that China was using fentanyl in a “chemical war” against the U.S.

“Fentanyl is the nuclear narcotic that is killing thousands of Americans today and another example of China’s two-faced approach. The chemical, known as ‘China Girl’ or ‘China White’ on the street, may have some Chinese victims, but its true value is as a profitable opiate export that also destroys American communities and roils the U.S. political landscape,” said The Korea Herald. 

“Drug exports have allowed for the establishment of new Chinese-run drug cartels and distributors within the United States while untimely and tragic American deaths are recorded daily.”

According to the CDC, illicit fentanyl killed 20,000 Americans in 2016. A recent CDC study found that over half the opioid overdoses in ten states involved fentanyl.

Son of Fox News Anchor Overdosed on Fentanyl

The son of a former Fox News anchor overdosed and died after taking counterfeit prescription drugs made with fentanyl, according to reports.

19-year old Eric Bolling Jr. was found dead in his Boulder, Colorado apartment September 3. He is the son of Eric Bolling, who was recently fired by Fox News for allegedly sending lewd texts to several women.

The Boulder County coroner recently reported the younger Bolling had high levels of fentanyl, cocaine, marijuana and the anti-anxiety drug Xanax in his system when he died.

According to police, Bolling and a friend had gone to Denver the day before his death to buy cocaine and other drugs. They bought five pills that appeared to look like Percocet, a branded version of the painkiller oxycodone. Bolling, who had a history of drug abuse, took one of the pills and quickly realized it wasn’t Percocet.

ERIC BOLLING AND SON ERIC JR.

ERIC BOLLING AND SON ERIC JR.

“Eric took half of a percocet and the cocaine dealer took half of a percocet. Within a few minutes Eric and the percocet dealer started ‘panicking’ because they had a different reaction to the percocet than they normally do. Eric made the comment that he thought the percocet may have contained fentanyl,” investigators said in a police report obtained by TheBlast.com.

Bolling’s body was found by a girlfriend the next day. His death has been ruled accidental.

The DEA recently added three more fentanyl analogues -- ortho-fluorofentanyl, tetrahydrofuranyl fentanyl, and methoxyacetyl fentanyl  -- to its list of Schedule I Controlled Substances, chemicals that are considered highly dangerous and addictive.

At least 17 confirmed overdose deaths have been linked to the three drugs in Georgia, North Carolina, Texas, New Jersey, Wisconsin and Pennsylvania. The drugs have also been found in California, Florida, Ohio and Missouri.

The Justice Department recently indicted two major Chinese drug traffickers accused of manufacturing fentanyl in drug labs in China and selling it to U.S. customers over the Internet.

Trump Commission Seeks More Limits on Rx Opioids

By Pat Anson, Editor

President Trump’s opioid commission released its final report Wednesday, an ambitious list of over four dozen recommendations aimed at treating addiction, preventing overdoses, and further restrictions on opioid prescribing.   

“This crisis can be fought with effective medical education, voluntary or involuntary changes in prescribing practices, and a strong regulatory and enforcement environment,” the commission said in its report.

The president established the commission in March to give him a list of recommendations to combat drug addiction and the overdose crisis. 

“Our people are dying. One hundred seventy-five people a day, every day, are dying in the United States from this epidemic,” said commission chairman Gov. Chris Christie of New Jersey, one of five politicians who served on the six member panel.

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“If a terrorist organization was killing 175 Americans every day on American soil, what would you be willing to pay to make it stop? I think we’d be willing to do anything and everything to make it stop. And that’s the way we now need to see this, because this is an attack from within. We are killing ourselves.”

The commission’s 131-page report did not spell out how much money would be needed to implement the panel’s wish list of 56 recommendations.

Chief among them was to get drug makers and the National Institutes of Health to work together developing new non-opioid painkillers and addiction treatment medications.

“It is inexcusable that the major pharmaceutical companies in this country have stood on the sidelines during this crisis. And they have,” said Christie.

New Prescribing Guideline to Supplement CDC's

The commission is also recommending that a new set of guidelines for opioid prescribing be developed to “supplement” the guideline released last year by the Centers for Disease Control and Prevention.  It was not immediately clear if the new guidelines would replace, weaken or strengthen the CDC’s recommendations, or simply expand their use throughout the healthcare system.

“An updated set of guidelines for prescription pain medications should be established by an expert committee composed of various specialty practices to supplement the CDC guideline that are specifically targeted to primary care physicians,” the report says.

The commission recommended that federal regulators require patients to give informed consent about the risks and alternatives to opioid painkillers before the medication is prescribed to them. The panel also called for a new “national curriculum and standard of care” for opioid prescribers, and that pharmacists be trained to recognize and deny “inappropriate prescriptions.”

The commission urged the federal government to work with states to improve the toxicology data on overdose deaths by developing uniform forensic drug testing. Critics say the current data now being used by federal agencies is flawed or cherry-picked. 

“We do not have sufficiently accurate and systematic data from medical examiners around the country to determine overdose deaths, both in their cause and the actual number of deaths,” the report says.

No Limit on Opioid Supply for Acute Pain

The commission did not recommend that supply limits be placed on opioid prescriptions for short term pain, as many expected. Several states have already enacted 5 or 7-day limits on opioids for acute pain. The panel also did not endorse the development of marijuana-based medications, which many pain sufferers are now using as an alternative to opioids.

Most of the commission’s other recommendations deal with cracking down on drug traffickers and the illicit drug market, expanding the drug court system, and increasing access to addiction treatment.

Gov. Christie refuted criticism of President Trump for declaring the overdose crisis a public health emergency, instead of a national emergency. Only $57,000 in federal funding is currently set aside to deal with a public health emergency.

“The president did exactly what I asked him to. I wanted this to be a public health emergency because I wanted HHS (Department of Health and Human Services) to administer the funds, not FEMA (Federal Emergency Management Agency). No offense to FEMA. They’re busy with some other things and it’s not there area of expertise,” Christie said.

“Now it’s incumbent upon Congress to step up and put money in the public health emergency fund, so the president can utilize that. And that should happen without delay in the view of the commission.”

In addition to Christie, commission members include Gov. Charlie Baker of Massachusetts, Gov. Roy Cooper of North Carolina, Florida Attorney General Pam Bondi, Bertha Madras, PhD, a professor of psychobiology at Harvard Medical School, and Patrick Kennedy, a former Rhode Island congressman.

In its fifth and final hearing, the commission heard testimony from several people who lost loved ones to opioid addiction and overdose. The panel never asked for or received testimony from pain sufferers, patient advocates or pain management physicians.

Insurers Promise More Cuts in Rx Opioids

By Pat Anson, Editor

Less than two weeks before its final report is due, President Trump’s opioid commission held its fourth and final public meeting Friday – hearing testimony from top government officials and insurance industry executives about the nation’s worsening overdose crisis.

“Insurance companies are going to be a very, very important part of whether we will be able to stem the tide here or whether we’re not,” said commission chairman Gov. Chris Christie of New Jersey.

It was clear from their testimony that many insurers are planning to tighten access to prescription opioids even more than they already have.

Aetna’s chief medical officer told the commission the insurance giant was planning to reduce “inappropriate opioid prescribing” to its members by 50 percent within the next five years.  He did not explain what would be considered inappropriate.

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Aetna has already sent warning letters to hundreds of physicians and dentists identified as “super-prescribers,” urging them to reduce the number of opioid prescriptions they write.

“We’re now re-running our analysis and planning more aggressive interventions for those providers who haven’t improved their opioid prescribing habits over the past several months,” said Harold Paz, MD.  

The chief medical officer of Cigna said his company was close to achieving a 25 percent reduction in coverage of opioid prescriptions, a priority it set last year.

“That’s only the first of our goals,” said Alan Muney, MD.

Insurer Harvard Pilgrim said its coverage of opioid prescriptions has declined by over 20 percent since 2014.

“That’s not enough.  This feels like a balloon where you tap on one end and it comes out somewhere else. So it doesn’t mean we’re even close to solving this,” said Michael Sherman, MD, chief medical officer of Harvard Pilgrim.

Insurers clearly have the ear of the federal government when it comes to opioids. As PNN has reported, an obscure federal advisory group composed of insurers, law enforcement, and federal and state regulators has discussed eliminating opioid prescriptions for acute pain, as well as paying doctors not to prescribe opioids.

The Healthcare Fraud Prevention Partnership also wants access to the “personally identifiable and protected health information” of 57 million Medicare beneficiaries to see if they are abusing opioids.

Reducing Opioids a ‘Win-Win’

Labor Secretary Alexander Acosta said reducing opioid prescriptions was important to get unemployed Americans back into the workforce. He cited a recent study that found that about a third of unemployed men aged 25 to 54 were using prescription painkillers.   

“Reducing the amount of opioids is a win-win across the board. It’s a win for the individual who doesn’t want to get hooked,” Acosta said. “It’s a win for the insurance companies who don’t want to be paying for medicines that people don’t need. And it’s a win for the American workforce, because if we can get people back to work and paying taxes and participating fully, that’s a win for them and it’s a win for the country.”

Acosta cited no studies that might indicate how many Americans currently taking opioids would become unemployed or disabled if their pain medication was reduced or taken away. 

No pain patients, patient advocates or experts in pain management were asked to appear before the commission. No one from the pain community has testified during any of the commission’s public meetings, although thousands have submitted written comments.

An interim report released by the opioid commission in July focused on expanding access to addiction treatment and developing new ways of treating pain without opioids. Since then, the commission has increasingly focused on limiting opioid prescriptions. The final report from the commission is expected November 1.

The interim report also strongly urged President Trump to declare a national emergency to speed up efforts to combat the overdose crisis, something he has yet to do.  “We’re going to be doing it in the next week,” Trump told reporters on Monday.  However, there appears to be little consensus in the administration about what actions to take after an emergency is declared or how to pay for them.

"Everyone wants opioids to be a priority, but there's a lot of resistance to calling it an emergency," a senior administration official told Politico.