How I’m Able to Work Again with Chronic Pain

By Crystal Lindell

How do I do it?

On my days off, I sleep for 15 hours, waking up only to eat and pet my cats.

I can’t get out of bed without Norco, morphine, Advil, 7-OH, and Tums.

And I have a super supportive partner who does all the house work, all the grocery shopping, and changes all the litter boxes.  

That’s the short answer for how I manage to work a full-time job outside of the home while living with debilitating chronic pain. It takes a lot of drugs, a lot of sleep, a lot of support, and a lot of luck.

I also eat the same meals nearly every day to make food prep and decision-making easier. And I make zero plans for days off.

I started working again in April – my first full-time job in over four years. 

Despite my years of experience as a professional journalist working in the corporate world, I took a job as a gas station cashier close to home. I was fed up with corporate culture and just wanted to see if I could even handle working full-time again in any capacity with my health issues.

I also needed health insurance and the gas station offered me that after just one month.

Now that it's been a little over three months, it felt like a good time to reflect on how it’s going.

To be honest with you, I absolutely love it!

I love going to work every day. I love interacting with the public and making friends with my co-workers. I love getting out of the house. And I have already been promoted to the first level of management, with hopes of continuing up the ladder.

But it has taken a major toll on my body. 

I wake up in so much pain that walking to the bathroom feels like I’m using muscles for the first time in years. And after my shifts, I only have enough energy to change out of my work clothes and get into bed. 

I really don’t know if I’ll be able to keep it up if 7-OH is officially made into a Schedule One controlled substance.

I really, really want to keep it up though. 

I want to keep working, being good at my job, and forming surprisingly deep connections with my fellow employees. I want to keep feeling productive and living like I have a purpose in this world – even if that purpose is just helping truckers get back on the road.

That’s because, despite all the stereotypes about people with chronic illnesses, I desperately want to work. 

In reality, it’s the people constantly trying to take away my access to opioids and 7-OH who want me to be unemployed and bed bound. 

They may soon get their wish if 7-OH is banned – a policy being pushed in the name of “protecting me.”

Protection I do not want and didn’t ask for.

If it happens, the anti-7-OH advocates and federal health officials won’t take any responsibility. They won’t even offer me health insurance. Instead, I suspect they will tell me to go out and get a job.

Illicit Fentanyl Use Twice as Common as Medical Use

By Pat Anson

Fentanyl has long played an essential role as a potent analgesic that can treat the most severe types of pain. But illicit versions of the synthetic opioid have been a scourge on the U.S. black market for over a decade, making it one of the leading causes of fatal overdoses.

The largest study to date has quantified how far those dual roles have gone, showing that illicit use of fentanyl is more than twice as common as medical use.

Analyzing urine drug tests for nearly 300,000 people who tested positive for fentanyl, researchers at The Ohio State University say 71.1% of them did not have a prescription for fentanyl, compared to 28.9% who had a legitimate medical reason for taking it.

“Fentanyl is a big problem, but we don’t actually know how serious illicit drug use is compared to medical use,” co-lead author Ping Zhang, PhD, a Professor in the College of Pharmacy at Ohio State said in a news release.

“Finding that illicit use has reached 70% among all fentanyl users is a surprise. And this is also a contribution of this paper. To make something that’s been a black hole visible to the healthcare system is significant.” 

Zhang and his colleagues, who published their study in the journal eClinicalMedicine, also found that illicit fentanyl users were three times more likely to suffer an overdose than patients who were given fentanyl in a hospital or were prescribed the drug. 

In 2023, over 105,000 people in the U.S. died from a drug overdose, with nearly 73,000 of those deaths involved synthetic opioids, primarily illicit fentanyl. That represents about 92% of all opioid-related deaths.

Until about a decade ago, the CDC counted all fentanyl overdoses as prescription drug deaths, a mistake that significantly inflated the number of overdoses attributed to prescription opioids. 

The misclassification of those deaths affected public policy. A CDC public awareness campaign, for example, focused entirely on the risks associated with prescription opioids, rather than the dangers posed by illicit fentanyl. When asked why it wasn’t warning people about fentanyl, a CDC spokesperson said the agency didn't want to risk “diluting” the primary message of its advertising campaign.

The Ohio State analysis found that illicit fentanyl users were younger, less likely to be married, had a higher concentration of fentanyl detected in their urine, and were more likely to have a mental health or substance use disorder.

Medical users of fentanyl were more likely to have a chronic health condition, such as cancer, cardiovascular disease, hypertension, and diabetes. They were also significantly less likely to overdose, abuse or become dependent on fentanyl compared to illicit users.

Geographically, Ohio had the highest proportion of illicit fentanyl users – 12.2% – followed by Massachusetts (10.5%) and California (8.8%). 

The number of fatal overdoses involving synthetic opioids like fentanyl peaked in 2022 at nearly 74,000 deaths and have since declined significantly. By 2025, the number of fentanyl-related overdoses was estimated at 38,084 deaths.

How Should I Carry My Prescription Opioids When I Leave Home?

By Crystal Lindell

Personally, I carry my daily dose of morphine and Norco in a Tylenol bottle whenever I leave the house. Just two or three pills rattling around in there, mixed with some regular OTC pain meds and a couple of TUMS thrown in for good measure.

I have been taking prescription opioids on a daily basis since 2013 and, like all long-term opioid users, I had to figure out how to store and travel with controlled substances.

A lot of guidelines you’ll get from your doctor about this seem to be based on the idea that anyone taking daily Norco must be spending all day, everyday in bed.

But if you have chronic pain, you know the truth: The whole point of daily opioids is that they help you get out of bed.

I take prescription opioids so that I can work, spend time with loved ones, and run errands.

In other words, I specifically take them so that I can leave the house. That means, a lot of the time, when I’m popping a pill with a bottle of water, I’m not at home.  

Unfortunately, this reality doesn’t mesh with some of the absurd rules a lot of pain patient contracts have. I’m supposed to store all my pills in their original bottles at all times. I also have been told that they will not be replaced if stolen.

As such, I can only assume that the people who wrote those contracts envision pain patients being bed-bound with a locked safe on their nightstand that they can only open when a dose is due. 

Because that’s the only scenario where it would make sense to keep all your pills in their original bottle. I highly doubt that my doctor actually wants me walking around Walmart with 53 hydrocodone pills rattling around in the original bottle, just in case I need to take a single pill before I get home.

That’s a massively high-risk situation. 

If anyone robbed me, they would walk away with almost a month’s worth of my prescription. And then, based on my pain contract, none of them would be replaced – even if I filed a police report. So I’d literally just be forced into immediate opioid withdrawal.

And I’m not exactly going to carry around a locked safe in my purse to keep the pills protected. That’s absurd. Anything that would actually keep the pills safe from a potential robber would be way too big to carry around with me as I browse the clearance section for pajamas.

Of course, this all means that if I ever run into legal trouble, a cop might wonder why I have a Norco pill in the Tylenol bottle in my purse. 

Some states allow for "reasonable repackaging" of medication into more convenient containers, like a daily pill planner. But state laws are usually more strict about controlled substances being kept in their original pharmacy container, because that makes it easier for the police to verify the medication is yours.

I fully understand that I could get in legal trouble, but I personally would rather risk that scenario than the possibility of a month’s worth of my prescription being lost or stolen during a trip to Taco Bell.

So yes, I keep some of my prescription opioids in a bottle that they did not originally come in. And yes, I mix them with other pills in that bottle. And while that scenario comes with some legal risk, I think it actually comes with much less personal risk. 

And, I will add, the rest of my prescriptions are always at home in their original bottles, safely stored in a very secure locked safe.

I’m not a perfect pain patient, but I’m not sure there’s any such thing. All we can do is all we can do.

How Pain Became Profitable

By Neen Monty

Why have prescription opioids become virtually verboten?

Is it safety? Partly. Evidence? Allegedly. The evidence is pretty thin.

But let’s not overlook the less noble explanation: research dollars, commercial opportunity, institution building and careers.

There is now an enormous scientific and commercial industry devoted to solving “the opioid crisis.” And that industry depends, at least partly, on maintaining a particular story: Opioids are dangerously addictive, fundamentally unsuitable for chronic pain, and urgently need to be replaced.

The United States National Institutes of Health launched its HEAL Initiative in 2018, nearly doubling annual funding for opioid and pain research from approximately $600 million to $1.1 billion. 

By 2023, HEAL had invested $3.2 billion across more than 1,800 research projects. That is an awful lot of laboratories, salaries, grants, publications and careers attached to an “urgent public-health emergency.” 

This does not mean researchers are gathering in dark rooms, twirling their moustaches and plotting against pain patients.

They don’t need to. The incentives do the work perfectly well.

Declare an existing treatment unacceptable and you create an urgent scientific problem.

Urgent scientific problems attract grants, investment, patents, clinical trials, prestige and promotions. They also create a potentially enormous market for whichever company produces the replacement.

That is not a conspiracy theory. It is an incentive structure. It's capitalism.

The Awkward Truth Behind the Sales Pitch

A recent Science article asks: “Can a new, safer class of pain drugs ever rival opioids?”

It sounds like another story about escaping the horrors of opioid medicine. But the headline accidentally admits something important: Opioids are extremely difficult to rival. That is why scientists are still trying.

If opioids were useless painkillers, as some modern pain rhetoric would have us believe, there would be no need for new drugs to “rival” them. Researchers would merely need to produce something better than useless. Apparently, this has proved surprisingly difficult. 

In 2025, the U.S. Food and Drug Administration approved suzetrigine, marketed as Journavx, as the first drug in a new non-opioid class for moderate-to-severe acute pain. It blocks NaV1.8 sodium channels in peripheral nerves, interrupting pain signals before they reach the brain. 

Its manufacturer, Vertex, is investing heavily in its commercial launch and development across further pain indications. 

Good.

We desperately need more effective pain medications. We need different medicines for different pain mechanisms, different bodies and different medical circumstances. We need options for people who cannot tolerate opioids and better treatments for people whose pain does not respond to them.

Research and development is good. Obviously.

But developing new analgesics does not require pretending that existing ones do not work. Nor does it require sacrificing the patients who already use them successfully.

How Dangerous Is an Opioid Prescription, Really?

We are constantly told that prescribing an opioid exposes every patient to an intolerable risk of addiction and overdose.

The actual numbers are much less theatrical.

A 2023 systematic review and meta-analysis examined 28 observational studies involving almost 24 million patients prescribed opioids for chronic pain. It found a pooled prevalence of:

• 1.3 fatal overdoses per 1,000 patients

• 3.2 nonfatal overdoses per 1,000 patients

That is approximately 4.5 fatal or nonfatal overdose events per 1,000 patients prescribed opioids for chronic pain. Not zero. Not irrelevant. But a very long way from the impression that catastrophe inevitably follows the first prescription. 

More importantly, the risk was not distributed evenly.

Overdoses were strongly associated with identifiable risk factors, including a previous overdose, current substance-use disorder, multiple prescribers, multiple dispensing pharmacies, higher doses, certain mental-health diagnoses and particular medication combinations.

In other words, “a person prescribed an opioid” is not one uniform risk category.

That should be obvious. Apparently, it needed a meta-analysis involving 24 million people to elucidate.

A stable patient taking one medication, prescribed by one doctor and dispensed by one pharmacy is not medically interchangeable with a person obtaining drugs from multiple sources, combining them with sedatives or living with an active substance-use disorder.

Yet much public discussion places all of these people into one ominous bucket labelled “opioid users.”

Not very scientific. Can you say bias? Stigma? Stereotyping? Profiling?

For a well-selected and well-monitored patient on long term opioid therapy, the risk of overdose is very, very low. That’s what the evidence says.

Many pain management doctors are keen to advertise “evidence-based treatment for chronic pain” without ever reading the evidence.

A Swamp of Addiction Statistics 

The estimates of addiction following opioid treatment vary wildly.

That is not because addiction is a mysterious force capable of changing its prevalence depending on the phase of the moon. It is because researchers frequently measure different things and give them similar names. What constitutes “addiction” varies wildly. 

And overdose statistics often include non-fatal overdoses. Or even overdose deaths where an opioid was detected, but was not the main cause of death.

Some studies only measure diagnosed opioid-use disorder. Others measure abuse, misuse, physical dependence, administrative billing codes, unexpected urine results, requesting an early prescription, or a vaguely defined “aberrant behaviour.”

None of these are the same thing. They are thrown together to inflate the outcomes. To keep the panic alive.

One 2018 meta-analysis reported an incidence of opioid “dependence or abuse” in 4.7% among patients prescribed opioids for pain. But the included studies used different diagnostic systems and produced a “substantial heterogeneity” of 99.78%.

For non-statisticians, that is roughly the scientific equivalent of throwing apples, wombats and garden furniture into a blender and reporting the average fruit content. 

Physical dependence is an expected physiological adaptation to many medicines, including opioids. I don’t believe it’s avoidable. It means abrupt cessation may cause withdrawal. This is a normal response to suddenly stopping a medication. By choice or otherwise. It is not addiction.

Addiction - or opioid-use disorder - requires a pattern of use that involves impaired control, compulsive use or continued use despite evidence of harm.

A patient who takes a medicine consistently because it relieves severe pain and improves their ability to function is not demonstrating compulsive use despite harm. They are using a medicine for its intended purpose.

Needing insulin does not prove an unhealthy fixation on insulin.

Needing anti-hypertensive medication does not reveal a worrying psychological attachment to blood-pressure control.

Needing anti-depressants to live a functional life does not show a pattern of compulsive behaviour.

But needing ongoing pain relief? Suspicious. Apparently.

What Happened When Opioid Prescribing Fell?

If opioid prescribing were the principal driving force of the U.S. opioid epidemic, we should have seen precipitous reductions in prescribing to be followed by a substantial drop in opioid deaths.

But that is not what happened.

U.S. opioid prescribing has been declining since 2012. The percentage of adults filling an opioid prescription fell by 31% between 2008 and 2018, while the national dispensing rate continued falling to 35.4 prescriptions per 100 people by 2024.

Meanwhile, illegally manufactured fentanyl spread through the illicit drug supply.

The CDC reports that approximately 70% of U.S. overdose deaths in 2023 involved illegally manufactured fentanyl. It states that illicit fentanyl entered the illegal drug supply around 2013 and subsequently replaced heroin as the dominant illegal opioid in the United States.

Even the FDA acknowledges that prescription opioids are no longer driving the opioid overdose epidemic. 

That sentence deserves to be printed in very large letters.

The truth that remains unsaid – and will never be admitted – is that prescription opioids were never the driving force behind the opioid crisis. Never. It was always about illicit drug use.

But prescription opioids are a much easier target than Mexican cartels and curbing illicit supply. Easy target, big wins, media headlines.

Who cares about the tens of thousands of patients who suffered and even died because their life saving pain medications were taken away? Very few.

Prescribed pain medication and illicit fentanyl are not completely separate worlds. There is some crossover. But most prescription opioid abuse is due to diversion. Yes, some people with opioid-use disorder were initially exposed to opioids through a medical prescription. But the vast majority of those already had a history of substance abuse.

And that crossover is very, very small. As can be seen from the major, large scale, systemic review already cited.

Stable therapeutic use, physical dependence, medication misuse, opioid-use disorder and exposure to an unpredictable illicit fentanyl supply are very different situations. Treating them as one big problem has not only failed to solve the illicit drug crisis; it has inflicted another crisis on people living with severe pain.

The Patients Who Spoil the Story

There is one group largely missing from the replacement narrative: patients for whom opioids work.

They are not getting “high.” They are not escalating their dose uncontrollably. They are not visiting six doctors or four pharmacies. They are not searching for euphoria.

They are searching for enough pain relief to shower, sleep, work, prepare food, and care for their children. To keep living a full and functional life despite moderate to severe pain due to disease or injury.

Some patients find opioids effective, but not remotely pleasurable. Many experience nausea, itching, sedation or mental fog. Others experience pain relief with few side effects. 

Individual responses vary, as they do with every other class of medicine. For every person, it’s a case of weighing up the risks and benefits.

Opioids have unpleasant side effects, but there are few things as unpleasant as living with constant, severe, pain. I’d prefer some itching and a bit of nausea than a knife twisting in every joint, and my arms and legs feeling like they are on fire. 

What would you choose?

In people with chronic low-back pain, research has shown that those with previous prescription opioid use got greater pain relief from morphine. But they were not more likely to feel “high.” In other words, stronger pain relief did not mean stronger euphoria.

But acknowledging those patients creates a problem.

If opioids are effective and acceptably safe for a properly selected and monitored group, then the scientific mission should not be to “replace opioids.”

It is “develop more choices while identifying who benefits from each one.”

Still very worthy. Still very important. Still very deserving of funding.

But we’re no longer talking about a “crisis.” Not quite as dramatic, and not as likely to receive that sweet, sweet funding for non-opioid alternatives.

Develop Better Drugs. But Stop Destroying Patients

To be clear, I am in no way saying that opioids are harmless. Opioids can have serious side effects. Patients need to be well screened and well monitored.

Opioids can cause adverse effects, physical dependence, respiratory depression, overdose and opioid-use disorder. Higher doses and dangerous medication combinations require particular care. Patients should receive honest information, individual risk assessment and proper monitoring.

Doctors are highly skilled and the very low overdose rate in chronic pain patients shows that doctors managed this risk very well. Right up until 2016 in the U.S and about 2020 in Australia.

But saying something “has risks” is not synonymous with “must never be used.”

I take many high-risk medications to treat my complex autoimmune diseases – medications that are much higher risk than any opioid could ever be. Yet taking that risk is allowed. Encouraged. Even insisted upon. 

Why are opioids singled out and denied when Xeljanz or Rituximab are much more dangerous?

It makes no sense. Scientific sense, medical sense or common sense.

Of course better pain medications should be funded. Safer analgesics is a lofty goal that should be celebrated. New treatments that are as good as, or even better than opioids, without opioid-related risks would be a genuine medical achievement.

But we should not be taking opioids away from those who need them, who have been stable and doing well for years, before those new non-opioid pain medications are available. That means leaving people to suffer needlessly, on the promise that something better is being researched.

Pain patients should not be treated like expendable research targets. They should not be forced to surrender their pain relief and functional lives to fortify the commercial and scientific case for tomorrow’s medication.

Develop the alternatives. Fund the research. Build the careers. Make the money, even. All good.

But stop denying people who need access to long term opioid therapy for any kind of quality-of-life. Put the risk/benefit equation where it belongs, where it is with all other medications – in the hands of the informed patient.

And stop pretending that scientific progress requires opioids to fail, along with the patients who benefit from them.

Neen Monty is a patient advocate in Australia who lives with rheumatoid arthritis and Chronic Inflammatory Demyelinating Polyneuropathy (CIDP), a progressive neurological disease that attacks the nerves.

Neen is dedicated to challenging misinformation and promoting access to safe, effective pain relief. For more information on chronic pain, the science, the politics and the lived experience, go to Pain Patient Advocacy Australia. 

You can also subscribe to Neen’s free newsletter on Substack, “Arthritic Chick on Chronic Pain.”

Why I Keep Quiet About My Use of Prescription Opioids

By Crystal Lindell

When I first started taking prescription opioids on a daily basis in 2013, I didn’t hide that information from anyone. I told my friends at church, my family, and even my then-boss.

I was in way too much pain to spend any energy worrying about what anyone thought about me or the pills I was popping.

At the time, I was still working in the corporate world. And I quickly began to see and experience the stigma that comes with opioids. It wasn’t long before every mistake I made and every emotion I had were blamed on the fact that I was taking Norco.

I still remember the time a man at work lost his temper on me. When I felt like I had the very appropriate reaction of sobbing at my desk, my then-boss immediately dismissed it to both me and the man who had screamed at me by explaining that I was “on lots of new medications.”

So, over the years, I have learned to withhold my pain medication use to new people. Sadly, this decision has only been reinforced by the fact that things have gotten worse over the last decade when it comes to opioids being a taboo. 

The media narrative that a 5 mg hydrocodone tablet is the same thing as a baggie of street fentanyl has caught on. Now, people who may not have even known what hydrocodone was in 2013 are hyper aware that it’s part of the “opioid epidemic.”

So, I hide my pain pill usage in real life. It may sound paranoid, but I have been undercover enough times to see the truth. 

When people think I’m healthy, they open up about how they really feel about opioid users. There are lots of comments dismissing us as lazy, saying things like, “Maybe he should stop getting high all the time” anytime they make even a small mistake.

I’m then put in the awkward position of having to decide whether to let it slide or defend them.

There’s a very strong part of me that wants to be the “good” opioid user. I want to show others what it looks like when people take opioids “responsibly.” I want to defend other people who take pain pills.

The problem is, once I admit that I use them too, I’m immediately moved out of the “good” opioid user category, because in their minds there’s no such thing. Going forward, everything I do would be seen through the lens of them thinking I’m high all the time.

It’s an impossible situation.

For now, I have found that the best way to navigate it in real life is to hide my health issues and my pain medication usage as long as possible. 

Yes, I write about all of it very openly online, and anyone looking for “dirt” on me would have no problem finding the truth. But most people lack such levels of information-seeking determination.

So, as long as I show up, seem alert, and come across as put together, there’s no reason anyone has to know that the pills I keep in the Tylenol bottle in my purse are actually prescription Norco.

South Korea Stops Sales of Trader Joe’s Seasoning Due to Opioid Contamination

By Pat Anson

A popular seasoning blend sold at Trader Joe’s is a bit too spicy as far as police in South Korea are concerned.

“Everything but the Bagel Sesame Seasoning Blend” is made with sesame seeds, dried garlic and onion, sea salt, and poppy seeds. 

Those poppy seeds come with “trace amounts of morphine and codeine” according to forensics tests, which is a violation of South Korea’s Narcotics Control Act. When not washed thoroughly, the seeds can become contaminated with opium alkaloids from the sap of poppy plants during harvesting.

While the amount of opium is minuscule, it’s enough to worry South Korean police, who recently warned the online marketplace Karrot to stop reselling the Trader Joe’s seasoning. 

The seasoning blend was banned in South Korea in 2022, but some South Korean tourists visiting the U.S. buy it as a souvenir and when they get home list the seasoning for sale on Karrot, often at inflated prices due to its notoriety.    

“Even if a product is legally sold overseas, it may be classified as a narcotic substance or a prohibited import in Korea, so particular caution is required,” a Seoul police official told The Korea Herald. "Not only sellers but also buyers can be subject to criminal punishment."

Karrot agreed to remove all listings for the seasoning blend on July 27, and its website now displays warning pop-ups when users try to list it for sale.

In 2019, the U.S. Drug Enforcement Administration classified unwashed poppy seeds as Schedule II controlled substances, claiming they were “qualitatively similar” to opioid pain medications. 

Poppy seeds that are properly washed and used as food are legal in the United States, but contaminated seeds occasionally slip through and cause trouble.  

Eating a muffin or bagel with poppy seeds is risky for someone about to take a drug test, since it takes only a few poorly washed seeds to result in a positive drug test for opiates. That could lead to a patient being dismissed by their doctor or an employer refusing to hire someone.

Some patients with poorly treated pain grow their own poppies and make a tea from the seeds to use as an analgesic. It’s a risky process, since it's hard to control the opioid strength of the tea – which has led to addiction and even some fatal overdoses. Potentially lethal doses of morphine have been found in some poppy seed teas.

The Center for Science and Public Interest (CSPI) has been urging the FDA for years to more tightly regulate poppy seeds by setting a limit for opiate contamination, but so far the agency has yet to set any guidelines.

“FDA is not advising consumers to avoid consuming poppy seed-containing foods. Although FDA is aware of some reports of consumption of poppy seed-containing foods being associated with negative health effects, FDA is particularly concerned about the misuse of poppy seeds,” the agency says on its website. “To date, FDA has received 11 reports of deaths purportedly associated with the consumption of homemade poppy seed tea.” 

New Non-Opioid Analgesic Works Better Than Vicodin

By Crystal Lindell

An experimental non-opioid pain medication appears to outperform a low dose of Vicodin for patients who just had tummy-tuck surgery.

Latigo Biotherapeutics recently published results from its Phase 2 clinical trial in The New England Journal of Medicine, looking at the effectiveness of their new analgesic, which goes by the name LTG-001.

Like other new non-opioid analgesics, LTG-001 works differently than opioids because it blocks pain signals in the body’s peripheral nervous system before they reach the brain. Opioids act on nerve receptors in the brain, where they can slow down breathing and have a “euphoric” effect at high doses.    

In the clinical trial, 343 patients with moderate-to-severe post-operative pain after abdominoplasty surgery were randomly assigned to four groups. One group received low-dose LTG-001; another took high-dose LTG-001; a third took tablets of 5 mg hydrocodone and 325 mg acetaminophen (Vicodin); and the fourth group received a placebo. 

The LTG-001 doses were given orally every 12 hours, while the Vicodin tablets were taken every six hours, for a daily dose of 20 MMEs (morphine milligram equivalents). Patients also had the option to request oxycodone if their pain was getting too severe.  

When researchers asked patients about their pain levels, they found that the high-dose LTG-001 had a 50% greater analgesic effect than Vicodin. “Meaningful pain relief” was also achieved faster with high-dose LTG-001 than with Vicodin (52 minutes vs. 83 minutes).

But many in the high dose LTG-001 group were not able to stay “opioid free.” In a press release, Latigo highlighted the fact that over half (52%) of the patients taking LTG-001 didn’t need the oxycodone “rescue” medication.

Another way to look at that statistic is that the other 48% of patients did not have pain that was well controlled and wound up using opioids anyway. On average, patients in the high dose LTG-001 group still needed 11 MME of oxycodone for pain relief.

Despite the lackluster results, company officials said the clinical trial was “an important milestone for Latigo.”

“The publication of these findings adds to the growing scientific understanding of non-opioid approaches to pain management and comes at a time when there is broad recognition of the need for additional treatment options in the context of the ongoing opioid crisis,” Neil Singla, MD, Chief Medical Officer of Latigo, said in a statement.

Based on discussions with the FDA, Latigo believes the study may serve as one of the well-controlled trials needed to demonstrate the efficacy of LTG-001 to support its approval as a treatment of moderate to severe acute pain, including postoperative pain. 

The company’s next step is to initiate a placebo-controlled Phase 3 trial in participants undergoing bunionectomy and an open-label Phase 3 safety trial. Latigo is also investigating LTG-001 as a pain reliever after wisdom tooth removal.

Last year the FDA approved a similar non-opioid analgesic, Journavx. Although it is only approved for moderate to severe acute pain, it didn’t take long for Jourvanx  to be used off label for chronic pain.  A recent analysis of prescription data found that Jourvanx is prescribed about 33% of the time for chronic pain. In fact, it’s prescribed more often for chronic pain than opioids are.  

The Stress of Being Drug Tested by My Own Doctor

By Crystal Lindell

I went for one of my regularly scheduled appointments with my primary care physician yesterday, and as soon as I got there the nurse plopped a urine sample cup and a new drug contract on the table.

I had not been drug tested in a while, and actually started to wonder if they had seen the light and stopped doing them. Alas, that was not the case. 

Drug testing causes stress and anxiety for patients, even when we’re doing everything right. It also erodes the patient-provider relationship and makes it harder to be completely honest with them about our substance use.  

And then they also have the audacity to bill you for the privilege!

The whole thing gives criminal probation vibes so strong, I half expected a police officer to show up and watch me pee.

They also don’t tell you in advance what they are even testing for – or how the results might affect your care. Like, will they immediately cut you off if you test positive for kratom? Are they even testing for kratom?

What happens if you get a false positive? Do you get another chance to take a drug test? And who pays for it?

Asking anything like that in advance only makes you sound super suspicious. 

Mostly they want to make sure you are taking the drugs you are prescribed, but beyond that you have to hope you haven’t accidentally taken anything that could make you fail, like poppy seeds.

Thankfully, I passed. And when the results showed up in MyChart, I saw that they did not test for kratom. 

In addition to testing for stimulants and opioids, they also tested for naloxone and naltrexone – which was strange. Naloxone is used to reverse opioid overdoses, while naltrexone is primarily used to treat alcohol and opioid use disorders. 

It seems odd that they would check to see if either drug was in my urine, and I have no idea how my doctor would respond if they had turned up positive. Would he think I was having issues managing my opioid use? Or perhaps hiding an overdose from him? I really don’t know.

But peeing in the cup is only half the stress. They also have a new patient contract I had to sign, which lists 21 specific conditions for my treatment to continue.

No. 14 reads in part: “I will not ask for early refills. I understand that lost or stolen prescriptions will not be replaced.”

It ends with, “I will report stolen medicines right away to my clinician and to the police. This report does not mean that my stolen medicine(s) will be replaced.”

I was surprised to see that stolen prescriptions might not be replaced. Even with a police report?

That’s very disheartening to read, especially since I recently had my cell phone stolen, so I know how easy it is for a theft to occur.

No. 14 also includes a demand that I keep "my controlled medicines in a safe and secure place, such as a locked cabinet or safe."

No. 18 gives them permission to conduct pill counts: “I authorize my clinician to order counts of my controlled medicines to check that I am taking them properly. I agree to bring in my medicines in their original containers to be counted.”

What if I get robbed on the way to the doctor? What then? I’m just completely screwed for the rest of the month? Am I supposed to travel with my locked cabinet or safe in this hypothetical situation?

Then there’s No. 11, which reads: "I may not use emergency or urgent care visits to get more controlled medicine for my chronic pain. If I do, my clinician may decide to stop prescribing controlled medicines."

Early on in my chronic pain journey, I would often have horrible breakthrough pain that was only resolved when I went to the emergency room. They would give me a shot of Dilaudid to get the pain back under control.

Apparently, I’m no longer allowed to do that. It’s not a huge issue for me these days because my pain is now well controlled and I have learned lots of ways to manage it. But my heart goes out to other pain sufferers who may not be so lucky.

The contract also specifies in No. 8 that, "I will get my controlled medicines from one pharmacy."

God forbid there’s a drug shortage or the pharmacist tells me they’re out-of-stock, an all too common experience. I can’t go to another pharmacy?

I have been with my primary care physician for over a decade now, and we have a relatively strong relationship. So if I ever actually needed exceptions to any of these rules, I would hope that he would be accommodating. But that's a lot of faith to put in a doctor, and it’s not something most patients can count on.

While I understand that opioid hysteria has led a lot of providers to respond with drug tests and patient contracts over the last few years, I think it’s time we got rid of them.

If you actually want to know if your patient is using forbidden substances, or if they aren’t taking all of their prescribed medications, the best solution is the one nobody wants to do: Build a trust-based relationship with them so they feel comfortable telling you themselves!

As it stands, with urine drug screens and intimidating contracts that feel like criminal probation requirements, the only real result is that patients will see their doctors as cops. And everyone knows you never, ever talk to cops. 

Short-Term Opioid Prescribing Should Be Tailored to Patient Needs

By Crystal Lindell

A new study has found something that every pain patient already knows: Opioid prescriptions “should be tailored to address individual patients’ needs.”

The research findings, which were published in JAMA, looked at how well opioids worked for 1,708 patients with short-term acute pain from a wide variety of conditions; from dental procedures and knee replacements to low back pain and cesarean sections.

The findings debunk common myths that many patients quickly become dependent on opioids and are unable to regulate their opioid use.

Overall, most of the patients used opioids for only a short amount of time – about 7 days –  and at low doses (10 MME). Only 10% of patients used opioids for 90 days or more, which is generally considered the threshold for acute pain becoming chronic.  

Overall, opioids were effective at relieving pain, with patients reporting a 55% reduction in pain on average. The median time to pain resolution was 20 days, although patients with low back pain or recovering from surgery took longer than that.

Most patients continued to use non-opioid pain relievers such as acetaminophen or ibuprofen, and also used ice or heat as part of a “multimodal treatment” approach.

About two-thirds of patients had leftover opioids. Interestingly, they were often patients with the longest-lasting pain conditions, which suggests they chose “not to continue using the opioids they had available” even when their pain persisted.   

Current guidelines from the CDC and FDA for acute pain recommend opioids only for severe pain or when non-opioid pain medications are ineffective.

Given the wide variety in outcomes and patient preferences, researchers say their findings demonstrate that guidelines for short-term opioids should be tailored to each patient. Most patients in the study were pretty good about moderating their opioid use. 

“Patients generally reported taking opioids on their worst pain days, in small amounts, for short periods, and in combination with other pharmacologic and nonpharmacologic treatments, with many patients limiting their opioid use to less than the amount prescribed by their clinician,” wrote lead author Molly Moore Jeffery, PhD, of the Mayo Clinic.  

“The findings suggest current guidelines for multimodal treatment and short-duration opioid prescriptions, if needed, will serve many patients but not all and that treatment should be tailored to address individual patients’ needs.” 

A recent study found that opioids are effective for many acute pain conditions and come with little risk. In a review of 59 clinical studies, researchers at the University of Sydney found that opioids were effective for “the vast majority of acute pain conditions,” with no significant risk of serious adverse events.

Banning 7-OH Will Ruin My Life

 By Crystal Lindell

When I got the news that 7-OH will likely be illegal in the United States within the next month, I was on a break at the new job I was able to get because of 7-OH.

I opened my texts to see a message from PNN editor Pat Anson:

“7-OH to be banned nationwide in early August according to DEA filings.”

He’s always been great at breaking news. 

When I saw the words though, I wanted to throw up. I started shaking and was overcome by a cold sweat. Then I fought back tears because I had to get back to work.  

I had to get over the shock and dissociate to get through the rest of my shift at the gas station where I work. I spent the next few hours legally selling customers cigarettes, beer, and lottery tickets. 

Then I went into my car and cried.  

7-OH has truly been a life-changing drug for me and many people I know and love.

I have intercostal neuralgia, which is nerve damage in my ribs. When you have the same thing in your face it’s called trigeminal neuralgia – which is colloquially called the “suicide disease” because so many people who have it kill themselves or want to.

As someone with the intercostal variety, I’m here to tell you that having that kind of pain in your ribs doesn’t make it any less horrible. I have long considered suicide as a potential treatment option.

For many years I was able to find some semblance of stability with a cocktail of opioid and OTC pain medications. I know how lucky I am to be among those who can still get an opioid prescription. But while the opioids have kept the suicidal-level pain at bay, they have never allowed me to actually live.

7-OH does that.

It’s not an exaggeration to say that it has given me my life back. It’s been even more effective than hydrocodone or morphine for me. It instantly treats my pain while also combating fatigue. 

Losing access to 7-OH will be devastating for me. 

I am worried I will no longer be able to work full-time, and that I will then lose the health insurance I only just got. Without work and insurance, I will be back to living below the poverty line, and relying on food pantries. 

But none of that has anything to do with why I think 7-OH should remain legal.

7-OH should remain legal because – as an adult – I should have the legal right to put whatever I want into my own body, and it is no one else’s business how I do that.

That’s it. That’s the only reason needed. Anything else is irrelevant.

This is a bodily autonomy issue. I should be the only one who controls my own body, especially my own medical decisions. 

Not to mention the fact that nicotine and alcohol are legal despite the fact that they are both very addictive and sometimes deadly. Why single 7-OH out? Especially considering how safe it is in comparison to those drugs. 

AKA Betrayal

What’s worse is the outright glee from some leaf kratom advocates, who think banning 7-OH will somehow let them be seen as the golden child.

I feel so betrayed by them. The American Kratom Association in particular pushed for this and they have made a deal with the devil. When 7-OH is banned nationwide, it’s likely that leaf kratom is next. It’s already happened in several states.

I will never again use a single kratom product from any of the companies that support the AKA.

For now, I plan to taper down and hopefully get off 7-OH without going into withdrawal. And I am going to look into different substances that may give me a similar effect. 

I’m also hopeful that the 7-OH manufacturers are working on new formulations of kratom alkaloids that will still be available after the ban. 

And I am clinging to the 1% chance that the DEA backtracks on this, as they did in 2016, after initially announcing plans to make mitragynine and 7-hydroxymitragynine illegal Schedule One drugs. 

I know we cannot count on that though.

Honestly, writing this column feels futile. I know it won’t do anything to stop the ban on 7-OH from coming. But I do feel it’s important to at least create a record of my objections. 

I want it plainly stated that a ban on 7-OH will be detrimental to my life, and to the lives of thousands of others who have found relief from this drug.

But how do I convince people to care about my life? Why do I even have to do so? Shouldn’t caring about other people’s well-being be something that comes naturally?

It’s degrading that I have to beg the world for pain relief. That I have to plead for a medication that allows me to live my life, work a job, care for my cats, love my fiancé, and aid my elderly relatives.

It disgusts and depresses me that we live in a country that would deny me those things.

I Hate When Doctors Insist on Physical Therapy for Chronic Pain

By Crystal Lindell

There is definitely an over-prescription crisis in this country, but it’s not about pills – it’s physical therapy referrals. 

While many doctors see it as an “easy” way to reduce their opioid prescribing, the only thing easy about it is how easy it is for them to write the referral and then immediately blame the patient for any lack of progress. 

In fact, I recently stumbled onto a discussion about physical therapy in the “Family Medicine” subreddit, where medical professionals, who’ve confirmed their credentials, were discussing just how much they love to push PT on patients and why. 

In the thread, a poster who claims to be a new physical therapist asked providers when they typically will prescribe it. 

A nurse practitioner responded with, "I only prescribe PT on days that end with Y." 

A physician's assistant said they prescribe physical therapy "as soon as [patients] open the door."

A medical doctor lamented, "I wish my patients took [physical therapy] more seriously because recovery for a lot of [musculoskeletal] and chronic pain takes work and they want the one shot fix."

Ironically, it really seems that it’s the doctors who are looking for a one-shot fix with their physical therapy referrals. As another doctor on the thread admits, they prescribe PT "for any pain, gait, chronic respiratory, chronic pulmonary, or weakness complaints."

As a long-time pain patient, the thread confirmed everything I assumed doctors thought about pain patients and physical therapy. But unless you’re recovering from a specific injury, like a bone break or surgery, physical therapy can be a huge waste of time and money. 

For patients, the reality is that physical therapy is a massive time commitment and a huge financial expense.

Way back before I even developed intercostal neuralgia in my ribs, I started having pain in my wrists, likely caused by years of undiagnosed Ehlers Danlos syndrome and typing for a living. The official diagnosis for me at the time was “tendonitis.”

As someone who writes for work, dealing with sudden wrist pain was causing me massive issues. There were days when the pain was so intense that I couldn’t even type up a column.

I was also younger and more naïve then, so at the time my only goal was to do everything my doctor told me to do. I genuinely believed that that was my best chance at getting better, and that he had my best interest at heart. 

So when he told me to take Advil and go to physical therapy three times a week, I happily agreed.

The only issue was that I had to miss a ton of work, use a bunch of gas to get to the appointments, pay for parking, and then also come up with the $30-per-session co-pay, which added up to almost $100 a week! Times that by four weeks, and suddenly you’re looking at a car payment, easy.

God forbid, you have a job where you can’t get time off during the limited business hours offered by physical therapists. Plus, there’s the issue of finding a babysitter if you have kids.

Maybe that’s not a lot of money to doctors, but to many patients it’s enough to put you into crushing debt and maybe even lead to you losing your job for missing too much work.

The worst part was that physical therapy did almost nothing to relieve my pain. The appointments themselves mostly consisted of the therapist massaging my wrists, which only helped in the moment. In truth, the most effective part was the wrist braces they gave me to sleep in, something my primary care doctor could have easily given me himself.

Many doctors seem to think that if a patient is “really” in pain, they will try anything to get better. And thus, if a patient is reluctant to spend a bunch of time and money on physical therapy, then the only logical conclusion is that they must be a drug-seeking junkie looking to get high.

But there’s a reason that pain medication, especially opioids, are so popular. They are known to be immediately effective, and they are very cheap compared to physical therapy. Plus, instead of forcing you to miss work, they actually allow you to go to work despite the pain.

Looking back, I do not think that I needed opioid medication for my wrist pain, so I’m not arguing for that. I’m just saying that I also did not need physical therapy. But, like many of the doctors on that Reddit thread, my physician had gotten into the habit of prescribing PT for almost anything. 

Unfortunately, that would not be the last time a doctor tried to push physical therapy onto me. It happened to me and my loved ones many times over the years. While I have seen it work for family members who had just had a major operation or an acute injury, I have rarely seen it help much with chronic pain.

Of course, there are certainly patients who have benefited from it, and physical therapy should definitely be an “easy” option for them. Unfortunately, insurance coverage of PT is often limited. My fiancé can’t get insurance to cover any more physical therapy for him, despite the fact that he does find the sessions to be beneficial for his chronic pain.

In essence, doctors will happily prescribe physical therapy, but that’s about where their concern ends. After that, you need to figure out the health insurance requirements, assuming you even have insurance. Then you have to come up with co-pays, transportation, time off work, potential babysitters, and the energy to go to PT appointments while also maintaining the rest of your responsibilities. 

That last one is something doctors often fail to consider. If you’re working one or more jobs, running a household, and trying to get through the week, adding in the time and emotional energy to go to physical therapy a few times a week can be almost impossible.

In short, there’s a long list of negative side effects that come with physical therapy. They start with the referral by your doctor. Physical therapy should not be used by them as a secret test that patients have to pass just to prove they’re not trying to score some hydrocodone. It also shouldn’t be used as a first-line treatment for patients who may greatly benefit from other treatments.

There were a couple people on that Reddit thread attempting to stick up for patients. One doctor said this: 

"To be fair, it's financially out of reach for many (most of my) patients. My low income patients can get 4 visits/year but finding a PT who can provide the low income service can be challenging. These same patients are getting a maximum income support of $1787/month (a 700 square foot basement apartment rents for about $1500/mo right now in our city, if you can find one).

Sometimes people don't make bad choices, they fail to have good choices to make."

The only problem with that response is that it still assumes that physical therapy is a “good” choice. As a patient, I’m not convinced that it is. In fact, sometimes it’s a bad one. 

A Fentanyl Vaccine Is a Horrible Idea

By Crystal Lindell

A few years ago, I saved a loved one’s life when he was overdosing on fentanyl.

His lips and fingertips were blue when I found him, and as I administered NARCAN (naloxone), all I could think at that moment was that if he was dead, I never got the chance to say good-bye.

It was one of the most traumatizing experiences of my life, and I’m forever grateful that my efforts to save him were successful.

Even with that experience, I’m here to tell you that a fentanyl vaccine is an absolutely horrible idea. And I pray that nobody I love ever takes it – even the man who’s life I saved.

This week, JAMA published an article about the current status of the fentanyl vaccine, which is in development.

In the article, Associate Managing Editor Kate Schweitzer interviews Collin Gage, a cofounder and chief executive officer of ARMR Sciences, which has begun early-phase human trials of a fentanyl vaccine in the Netherlands.

Schweitzer seems to think such a vaccine would be a net positive for the world.

"If proven safe and effective, it could become the first proactive pharmaceutical approach designed to prevent fentanyl overdose and, potentially, treat addiction," she writes.

However, as both a chronic pain sufferer and someone whose loved one struggled with fentanyl addiction, I’m here to tell you that this entire research project should be ended right now.  

First and foremost, my biggest concern is that such a vaccine would be pushed onto people who do not want or need it, including pain patients.

I can already see doctors having a policy where they won’t prescribe opioids unless the patient agrees to receive the fentanyl vaccine. They’ll claim the policy is meant to protect patients, when in reality, it would only cause them more harm.

The article even points out what those harms could look like. Schweitzer quotes Kathryn Frietze, PhD, associate professor of molecular genetics and microbiology at the University of New Mexico, who is one of many researchers working to develop vaccines against drugs of abuse.

Doctors, according to Frietze, have expressed concern about how a vaccine could complicate medical care, given that prescription fentanyl is a widely used medication for acute pain control and anesthesia.

“Can they increase the fentanyl dose medically if needed, or is it going to completely eliminate fentanyl as an option?” Fritze asked. 

Read that again. Do we really want to eliminate fentanyl as an option for pain control and anesthesia? This is a medication used in hospitals, usually on patients in severe trauma or undergoing surgery.

Do we really want a vaccine to make fentanyl ineffective for them? 

Do we really want a vaccine that requires more fentanyl to be administered?

In practice, either scenario could be disastrous, especially in an emergency situation where an unconscious patient would be unable to explain to doctors that they had the fentanyl vaccine.

The thing about fentanyl is that you have no idea that you might need it someday. We don’t usually know when we’ll need anesthesia or acute pain control.

That is particularly relevant in this situation, because the article quotes multiple experts who seem excited about pushing a fentanyl vaccine onto high-risk groups, such as college students and young adults, who are experimenting with drugs. They may not be aware that the counterfeit pill they bought or got from a friend has a lethal dose of fentanyl. 

“Overdose from fentanyl doesn’t just happen to people who are purposely taking fentanyl,” Frietze said. “People may be exposed without their knowledge.” 

So they want to go to college campuses and give students a vaccine against a very valid pain medication, when they have no idea if they will ever need it?

Schweitzer says a vaccine that specifically targets fentanyl could still allow for the use of other analgesics, such as morphine and propofol. 

As a pain patient, I’m skeptical about that. If a vaccine blocks the effects of one opioid, it may also dampen the effects of other ones.  

The other major issue with a potential fentanyl vaccine is a phrase coined by Richard Cowan in 1986: “The Iron Law of Prohibition.” That essentially means that when law enforcement targets a specific drug, the potency of other prohibited substances increases.

Or, as Cowan said, "The harder the enforcement, the harder the drugs."

If you give everyone fentanyl vaccines, people will just find even stronger drugs to take. And those drugs will likely be more deadly. It’s no coincidence that illicit fentanyl arrived on the black market just as opioid pain medication became harder to get. 

As such, a fentanyl vaccine could result in more overdose deaths, not less, as people seek substitute drugs that bypass the vaccine.

Gage’s response to that possibility is to call the fentanyl vaccine “a platform technology—one that we plan to adapt."

In other words, they will just make new vaccines for new drugs. But in practice, how long would it take to actually develop new ones? And how long would it take to get them to drug users, who are often difficult for the medical community to reach?

Trust me when I tell you that drug users and their dealers will move exponentially faster than any research and development team ever could.

In practice, the reason street fentanyl is so deadly is because it’s unregulated. Users don’t know how much they are taking or what is mixed in with it – and those two things make it more likely that the drug will cause an overdose.

The solution then is to offer drug users a regulated supply, which is what methadone treatment is. In a perfect world, if they really wanted to help fentanyl users, these researchers would be working to make methadone treatment more accessible.

Instead, they’d rather make it so patients can’t use one of the most effective pain and anesthesia medications on the market, while pushing them onto harder or less effective drugs.

It’s a bad idea, and I hope these researchers see the error of their ways before it’s too late.

Tell Me Who the Real Criminals Are

By Cathy Kean 

Close your eyes. Go back to the worst pain you have ever known. A broken bone. A car wreck. Surgery. Childbirth without relief. Stay there for fifteen seconds. 

Feel the desperation. The begging. The need for it to stop.

Now imagine never leaving that place. You feel that pain every second. Every day. No break. Not in sleep. Not ever.

That is my life. Millions of us live here.

There is something that helps. Prescription opioids do not erase my pain, but they turn down the volume enough for me to be able to shower. To work. To keep my home. To hug my grand child without screaming inside.

Then they took them away. They said it was for my own good.

Before my chronic pain worsened after the release of the CDC opioid guideline, I worked as a real estate agent and special education advocate. 

Now I cannot walk. I have lost my job. My home of 32 years is in foreclosure. Friends stopped calling. I need help to use the bathroom. My independence is a corpse they are still kicking.

And the final cruelty? The people who did this lied to you.

CATHY KEAN

The Lies Behind the ‘Opioid Crisis’

You have been told prescription opioids are killing America. In 2021, the CDC reported a 1,040% increase in overdose deaths involving synthetic opioids from 2013 to 2019. They said those deaths were largely caused by illicitly manufactured fentanyl.

Here is what they didn’t tell you in that report: For many years, CDC misclassified most of those overdoses as prescription opioid deaths, and those deaths were used to help justify the agency’s 2016 opioid guideline, which led to wholesale restrictions on opioid prescribing. 

Not until 2018 was the error quietly acknowledged by four CDC researchers. And that tens of thousands of illicit fentanyl deaths were misclassified for years as prescription opioid deaths. 

The error was so serious that in 2016 alone, over 15,000 deaths caused by illicit fentanyl were mistakenly attributed to prescription opioids. Millions of Americans were misled by these and other errors that inflated the overdose numbers.

The White House told you prescription painkillers were the enemy. The media screamed it. Meanwhile, the real causes – illicit fentanyl, heroin and methadone – were hidden inside the CDC's overdose numbers.

The Death Toll They Won't Count

Because of the CDC guideline, thousands of chronic pain patients killed themselves. 

Not because they wanted to die, but because they could no longer get the prescription opioids that made life bearable. The pain became more than they could endure. And suicide offered a way out.

Others died slowly. From heart failure. Stroke. Organ collapse. The brutal physics of untreated pain grinding a body into dust.

No one in power keeps track of those deaths or says a word about them. No government agency. No major news outlet. No one with a microphone stands up and says, "We made a mistake. We are killing innocent people."

Instead, they push Suboxone and “alternative treatments.” For money. Not thy fellow man.

We have lost our First Amendment rights in the doctor's office. If you speak up about your pain, you are labeled a drug seeker and abandoned as a patient. I would rather die at home than face contempt again in the ER.

What I Want You to Do

Now imagine those 15 seconds of the worst pain you’ve ever felt. Really do them. Feel that pain.

Could you live like that? For one week? One year?

I am not asking for your pity. I am demanding your understanding. Your voice. Your outrage.

We are not criminals. We are not drug seekers. We are not addicts. We are not statistics on a CDC spreadsheet.

We are mothers and fathers. Veterans who served you. Construction workers who built your cities. Nurses who held your hand. Grandparents who babysat your children.

And we are dying. Some by suicide. And some by the slow, grinding destruction of our lives and bodies.

So here is what I need from you:

Do not look away. Say our names. Help us get our lives back.

Because if you could spend fifteen seconds in my body — really spent them — you would not need to be asked twice. You would be screaming with us.

Cathy Kean lives in California. She is a grandmother of 9 and mother of 4. Cathy lives with intractable pain from a botched surgery, along with fibromyalgia, arachnoiditis, stiff person syndrome, lupus, Parkinson's disease and insomnia. 

Cathy is the creator and administrator of the Facebook pages Chronic Illness Awareness and Advocacy Coalition and Pain is Pain. She writes to give a voice to the millions of chronic pain patients who have been silenced, stigmatized, and left to suffer—and to ensure her grandchildren never have to ask why Grandma couldn't be there. 

A Simple Chart Destroys a Myth About the Opioid Crisis

By Neen Monty

There’s a simple reason the narrative around the “opioid crisis” falls apart when you actually look at the overdose data.

Because the data doesn’t show what they claim it shows. 

And that false narrative has been retrofitted to cover the deception and lies wrought by bad actors in the U.S. healthcare system.

The chart below tracking overdose deaths by opioid type tells two stories:

1. Prescription opioid deaths rose, stabilized, and then fell.

2. Fentanyl arrived… and everything exploded.

Those are not the same curve. Those are not the same problem.

There are two epidemics. And one deliberately blurred narrative.

In the United States, prescription opioid deaths peaked around 2012, at about 5 deaths per 100,000 Americans. 

Meanwhile, fentanyl-related deaths – almost non-existent before 2012 – began rising exponentially as illicit fentanyl entered the black market.

In 2023, they peaked at 22.2 deaths per 100,000 people. By then, overdoses linked to prescription opioids had fallen to 3.8 deaths per 100,000.

That means there are almost 6 times the number of overdose deaths caused by illicit fentanyl than prescription opioids.

Yet prescription opioids remain the target.

That “opioid crisis” curve?

That’s illicit fentanyl. Not pain patients. Not prescription opioids. Not doctors treating disease.

The Uncomfortable Truth

When overdose deaths skyrocketed, prescription opioid deaths were already flattening out and falling. That should have changed the narrative right there.

But the narrative stayed the same.

The explosion in deaths aligns with one thing: iIlicit fentanyl and its analogues flooded the U.S. drug supply with counterfeit pills of unknown, often lethal, potency.

That is why deaths surged, not because someone with intractable rheumatoid arthritis got oxycodone prescribed for their pain.

The numbers don’t lie. If the opioid crisis were really about prescriptions, the lines on the chart would look very different.

So why didn’t the narrative charge?

Because blaming illicit fentanyl means:

• Confronting illicit drug supply chains

• Admitting policy failure

• Acknowledging complexity

Blaming prescriptions is easier. It creates easy villains to target:

• Doctors

• Patients

• Pain medication

And it opens the door to:

• Restrictions

• Guidelines

• “Education programs”

• Entire industries built on fear

Who paid the price?

Pain patients. People with cancer, autoimmune disease, neurological damage, and severe structural pathology.

People who were stable. Functioning. Living.

Until they were cut off.

This was never about prescriptions. The chart makes one thing brutally clear: The U.S. overdose crisis is a fentanyl crisis.

Everything else is a false narrative. A fairy story. One designed to vilify people who are already among the most vulnerable people in our communities – the ill, the disabled, people living with severe pain.

It’s important to note that by the time Physicians for Responsible Opioid Prescribing (PROP) was created in 2012, prescription opioid deaths had already stabilised and were falling.

PROP was instrumental in creating the CDC’s infamous 2016 opioid prescribing guidelines. But there was no need to restrict opioid prescribing. There was no need for forced tapers that lead to suicides and overdose deaths. There was no need for dose ceilings that meant people’s pain was no longer treated adequately.

There was also no need for the fabrication of “evidence” that does not stand up to even a little scrutiny. Just read the studies that the CDC guidelines are based on. They do not show what you have been told they show.

But no one actually reads the studies. No one examines the data. No one questions. Doctors just blindly follow the guidelines. It’s hard to blame them when they face prison time if they don’t.

It has been ten years since the forced tapers started in the U.S. Six years since Australia blindly copied this failed policy. No one in Australia bothered to read the research. Australia just copied the U.S. guideline and allowed politicians to decide who gets pain relief and who does not.

Australia could see the policy going horribly wrong in the U.S. Yet it implemented those same policies and tortured Australian chronic pain patients the same way. The same is true for Canada and the UK as well.

This should never have happened.

Patients on three continents have been abandoned, left to suffer in agony day after day. Given psychological therapies for physical disease and injury. And no one says a word. 

I have contacted many politicians, journalists, and senior public servants in Australia.  No one will take this on. No one will right this wrong.

And the media continues to push a false narrative about an opioid crisis that does not exist. But it gets clicks.

It may be futile, but my life and those of many others depend on access to safe and effective opioid therapy.

And so, I will continue to fight.

Neen Monty is a patient advocate in Australia who lives with rheumatoid arthritis and Chronic Inflammatory Demyelinating Polyneuropathy (CIDP), a progressive neurological disease that attacks the nerves.

Neen is dedicated to challenging misinformation and promoting access to safe, effective pain relief. For more information on chronic pain, the science, the politics and the lived experience, go to Pain Patient Advocacy Australia. You can also subscribe to Neen’s free newsletter on Substack: “Arthritic Chick on Chronic Pain.”

What If Medical Marijuana Was Free?

By Pat Anson

Chronic pain patients in the U.S. who are curious about trying medical marijuana are often turned off by the cost. Depending on where they live and how much legal marijuana is taxed, an ounce of medium-quality cannabis costs about $250; a one-ounce tincture bottle can cost up to $80; and a package of edibles might range from $20 to as high as $60.

Consulting with a doctor and getting a prescription for medical marijuana costs $40 to $150, and getting a medical marijuana card from your state could be another $100.  

All of these are out-of-pocket expenses, since health insurers don’t cover cannabis, although that could be changing now that the DEA has reclassified medical marijuana as a Schedule 3 controlled substance, which allows for some medical use. That opens the door to insurance coverage, but private insurers, Medicare and Medicaid have yet to take that step. 

In short, medical marijuana is currently out of reach financially for many patients.

But imagine if it was free. Would pain sufferers benefit if the cost of cannabis was no longer an issue?

The short answer is yes, according to a small new study in the Cureus Journal of Medical Science.

Researchers at the University of Pennsylvania’s Perelman School of Medicine found 29 patients with long-term chronic pain who wanted to reduce their opioid use and try medical marijuana, but considered cost a “major barrier.” With advice from a medical cannabis pharmacist, patients selected from a variety of no-cost cannabis products and started on a personalized opioid tapering plan.

“To our knowledge, this is the first prospective study evaluating whether medical cannabis can be used as an alternative to opioids in patients with chronic pain for whom cost has been a primary barrier to access,” wrote lead author Franklin Caldera, DO, who specializes in Physical Medicine and Rehabilitation at Hospital of the University of Pennsylvania.

At the start of the study, the average daily dose of opioids for participants was 46.8 morphine milligram equivalents (MMEs). Most had been taking opioids for over a decade to treat chronic back pain caused by degenerative disc disease or lumbar radiculopathy.

After five weeks of daily medical marijuana use, the average pain score for patients fell from 7 (on the zero to 10 pain scale), to a little less than 6 – a 16% reduction. Participants also reported improvements in their physical functioning, fatigue, general health, social functioning, and emotional well-being.

Even more impressively, patients reduced their average daily opioid dose to 16.2 MME – a 65% reduction. Seven participants were able to completely discontinue opioid therapy. Researchers say the reductions were sustained after a five month follow-up period.

“The findings of this study add to the growing body of literature supporting the safety profile and potential therapeutic role of cannabis. These data may help inform future considerations regarding reclassification, which could reduce financial barriers to access and help destigmatize its use for pain management and other medical indications,” said Caldera. 

“When used under appropriate medical supervision, medical cannabis may represent an effective adjunctive strategy for reducing opioid use among patients receiving long-term opioid therapy.” 

An obvious weakness of the study is its small size. Participants also wanted to reduce or stop their opioid use, which may have influenced the results.

We know nothing about the dose or type of medical marijuana they consumed, since patients selected their own cannabis products, the dose, and frequency of use. Without a standardized dose and method of delivery, we don’t know whether vaping or smoking were more effective, or if tinctures provided better pain relief than edibles. That’s unfortunate.

Previous studies have found that medical cannabis can help reduce the use of opioids and other medications. A recent survey of over 3,500 cannabis users in Germany found that most were able to reduce their use of painkillers, sleep medications, anti-depressants and other prescription drugs once they started using medical cannabis.

A similar survey of medical cannabis users in Florida found that many who have chronic pain were able to reduce or stop their use of opioids. Patients also reported less pain, and better physical and social functioning.