Rescheduling Hydrocodone May Have Increased Abuse

By Pat Anson, Editor

Four years ago that the U.S. Drug Enforcement Administration ordered the rescheduling of hydrocodone from a Schedule III controlled substance to the more restrictive category of Schedule II.  The move was intended to reduce the diversion and abuse of hydrocodone, which at one time was the most widely prescribed drug in the United States.

It turns out the rescheduling may have had the unintended effect of increasing the diversion and abuse of opioid medication by elderly Americans.

According to a new study by researchers at the University of Texas Medical Branch (UTMB), hydrocodone prescriptions for Medicare beneficiaries declined after the rescheduling, but opioid-related hospitalization of elderly patients increased for those who did not have a prescription for opioids.

"The 2014 federal hydrocodone rescheduling policy was associated with decreased opiate use among the elderly," said lead author Yong-Fang Kuo, PhD, a professor of Preventive Medicine and Community Health at UTMB.

"However, we also observed a 24 percent increase in opioid-related hospitalizations in Medicare patients without documented opioid prescriptions, which may represent an increase in illegal use."

Kuo and her colleagues say Medicare beneficiaries are among the largest consumers of prescription opioids. They speculated that opioid abuse by the elderly may be a coping mechanism to deal with poor health and depression, and that opioid diversion may be a sign of drug dealing.

“An economic purpose may relate to monetary gains from the diversion and sale to others,” Kuo wrote. “It is important for prescribers to understand that their elderly Medicare beneficiaries might be obtaining opioids from sources that are not documented in their medical records. There is a need for additional research on why, where, and how these Medicare enrollees are obtaining opioids.”

The UTMB research team analyzed a large sample of Medicare Part D enrollment and claims data from 2012 through 2015. Their study was published in the Journal of the American Geriatrics Society.

The reclassification of hydrocodone to a Schedule II controlled substance limited patients to an initial 90-day supply and required them to see a doctor for a new prescription each time they need a 30-day refill. Prescriptions for Schedule II drugs also cannot be phoned or faxed in by physicians.

In 2012, over 135 million prescriptions were written in the U.S. for hydrocodone products such as Vicodin, Lortab and Norco.  That fell to 90 million prescriptions by 2016.

Overall Opioid Prescribing Down

Hydrocodone isn't the only opioid medication to see steep declines in prescribing. The volume of opioid prescriptions filled last year dropped by 12 percent, the largest decline in 25 years according to a new report by the IQVIA Institute.  Opioid prescriptions have been falling since 2011, while dispensing of addiction treatment drugs like buprenorphine (Suboxone) and methadone have risen sharply.

“The U.S. opioid epidemic is one of the most challenging public health crises we face as a nation," said Murray Aitken, IQVIA senior vice president and executive director of the IQVIA Institute for Human Data Science.

“Our research and analytics revealed that 2017 saw new therapy starts for prescription opioids in pain management decline nearly 8 percent, with a near doubling of medication-assisted therapies (MATs) for opioid use dependence to 82,000 prescriptions per month. This suggests that healthcare professionals are prescribing opioids less often for pain treatment, but they are actively prescribing MATs to address opioid addiction."

All 50 states and Washington DC had declines in opioid prescribing of 5 percent or more in 2017, with some of the states hardest hit by the opioid crisis -- like West Virginia and Pennsylvania --  showing declines of over 10 percent. Nevertheless, the number of Americans overdosing continues to rise due to increased use of black market drugs like illicit fentanyl, heroin and cocaine, which now account for about two-thirds of all drug deaths.

Documentary Looks at Pain Relief as Human Right

By Steve Weakley

A new documentary calls pain relief a basic human right.  That is one of the tantalizing premises of “Hippocratic,” a film about the life of one of the pioneers of palliative care in India, Dr. M.R. Rajagopal.  

For over 20 years, Rajagopal has battled conditions that cause palliative care patients in India to suffer needlessly. Despite being home to most of the world’s legally grown opium, morphine and other opioid medications are often inaccessible in India to patients dying of cancer and other chronic illnesses.   

Rajagopal points out that the Indian Narcotics Act of 1987 reduced prescriptions of opiates in his country by 94 percent in just 12 years.  Under that law, even a minor mistake in prescribing opioids could send a doctor to prison for 10 years. 

“When you torture someone for political reasons, they can sign a confession and escape.  Here, (pain patients) don’t even have that option… they can’t fight back.  It’s a very one-sided war,” says Rajagopal.

In “Hippocratic,” Rajagopal points out that medicine and the profit motive compound the lack of effective pain care.  About 80 percent of the healthcare industry in India is privatized, and when doctors prescribe opiates they often steer patients toward expensive name brand drugs, when nearly identical generics cost only pennies.  He warns against unchecked medical profits and makes a passionate plea for universal health care.

The 88-minute film is most moving in the moments where it demonstrates the power of compassion as the primary purpose of treatment.  A four-year old girl, writhing and screaming in unbearable pain, is seen reaching up and kissing Rajagopal on his forehead after he administers her medicine.

You can watch a trailer for “Hippocratic” below:

In 2014, Rajagopal won an award for extraordinary activism from Human Rights Watch, a non-profit that has done extensive work on human rights abuses and the suffering of palliative care patients worldwide.

As PNN has reported, Human Rights Watch is now investigating the treatment of chronic pain patients in the United States.

“People we interviewed who didn’t have access to appropriate medications for their pain were essentially giving testimony that was almost exactly the same as the testimony we were getting from the victims of police torture,” said Diederik Lohman, Director of Health and Human Rights for Human Rights Watch.  “People were facing tremendous suffering that actually could be relieved pretty easily through very inexpensive palliative care and pain management.”

“Hippocratic” had a limited release in U.S. theaters last month, but can still be seen in New York City, Seattle, Fresno and a handful of other cities. It can also be rented online by clicking here.

Sessions Wants More Cuts in Opioid Production

By Pat Anson, Editor

Attorney General Jeff Sessions has proposed further tightening in the supply of opioid pain medication to punish drug makers who allow too many of their painkillers to be diverted and abused.

Under the proposal, the Drug Enforcement Administration – which is overseen by the Justice Department – must consider whether an opioid medication is being misused, abused or causing overdoses when it sets annual production quotas for drug makers.

“The current regulations, issued initially in 1971, need to be updated to reflect changes in the manufacture of controlled substances, changing patterns of substance abuse and markets in illicit drugs, and the challenges presented by the current national crisis of controlled substance abuse,” the DEA said in a notice to be published in the Federal Register.  

WHITE HOUSE PHOTO

“Under this proposed new rule, if DEA believes that a company’s opioids are being diverted for misuse, then they will reduce the amount of opioids that company can make,” Sessions said. "It’s a common sense idea: the more a drug is diverted, the more its production should be limited." 

The cuts in opioid production could be ordered even if a drug maker has no direct role in the diversion.

"If DEA believes that a particular opioid or a particular company’s opioids are being diverted for misuse, then DEA would be able to reduce the amount that can produced in a given year. These smarter limits will encourage vigilance on the part of opioid manufacturers," the agency said in a statement.

The public has only 15 days to comment on the rule change. Public comment periods in the Federal Register are usually between 30 and 60 days long, with some taking up to 180 days. Agencies are allowed to use shorter comment periods "when that can be justified."

"This shortened period for public comment is necessary as an element in addressing the largest drug crisis in the nation's history," the DEA said. To see the rule change and make a comment, click here. Comments must be submitted on or before May 4.

The DEA has already made substantial cuts in opioid production quotas, reducing them by 25 percent in 2017, followed by another 20 percent cut in 2018. This year’s cuts were ordered despite warnings from drug makers that reduced supplies of opioids “were insufficient to provide for the estimated medical, scientific, research and industrial needs of the United States.”

Last week the DEA said it would allow three drug makers to increase their production of injectable opioids because of shortages that left hospitals scrambling to find effective analgesics to treat patients suffering from acute pain. The shortages of injectable fentanyl and morphine are largely due to manufacturing problems, although some critics say the DEA itself is partly responsible.

DEA ‘Asleep at the Switch’

The proposed rule change was triggered by a lawsuit filed against the DEA by West Virginia, alleging that the current quota system “unlawfully conflates market demand for dangerous narcotics with the amount of legitimate medical needs.”    

“The DEA -- the agency tasked with effectively limiting how many opioid pain pills can be manufactured -- has been asleep at the switch and unwilling to recognize fatal flaws within its own system,” said West Virginia Attorney General Patrick Morrisey. The lawsuit was put on hold after Sessions directed the DEA to change its rules.

Under the proposed rules, the DEA would be required to get input from states, Food and Drug Administration, Centers for Disease Control and Prevention and the Department of Health and Human Services before setting opioid quotas.

Since becoming Attorney General, Sessions has been almost singularly focused on prescription opioids as the cause of the addiction and overdose crisis, even though about two-thirds of all overdoses are caused by black market drugs such as illicit fentanyl, heroin and cocaine. Less than one percent of legally prescribed opioids are diverted, according to the DEA’s own figures.

In February, Sessions said pain sufferers should “tough it out” and take aspirin, rather than turn to opioids for pain relief. "Sometimes you just need to take two Bufferin or something and go to bed," he said.

WHITE HOUSE PHOTO

Last week, Sessions visited a controversial memorial near the White House that features a wall of 22,000 engraved white pills -- each pill representing the face of someone who supposedly died from a prescription opioid overdose in 2015.

As PNN has reported, the National Safety Council’s traveling exhibit misrepresents the number of Americans who overdosed on pain medication. The CDC recently admitted that its methods for counting overdoses “significantly inflate estimates.”

More misinformation and half-truths are being published in the Federal Register to justify changes in the DEA quota system.  

“(Opioid) users may be initiated into a life of substance abuse and dependency after first obtaining these drugs from their health care providers or without cost from the family medicine cabinet or from friends. Once ensnared, dependency on potent and dangerous street drugs may ensue,” the notice says.

“About 80% of heroin users first misused prescription opioids. Thus, it may be inferred that current users of heroin and fentanyl largely entered the gateway as part of the populations who previously misused prescription opioids.”  

The notice is referring to a single but often-cited survey, which found that most heroin users in addiction treatment also abused prescription opioids. But experts say most addicts try a variety of different substances – such as tobacco, marijuana, alcohol and illicitly obtained opioid medication – before moving on to heroin. It is rare for a legitimate patient on legally prescribed opioids to make the transition to heroin.  

Dear AARP: Stop Picking on Pain Patients

(Editor’s Note: Last year PNN columnist Rochelle Odell wrote an article critical of the American Association of Retired Persons (AARP) for publishing a special report entitled “The Opioid Menace.” The report claimed that many older Americans had become “new opioid dealers” who were fueling the opioid crisis by “selling their prescription painkillers to drug pushers.”

AARP recently published a new bulletin, which focuses on how scammers are bilking Medicare for $60 billion annually. Once again, AARP claims that Medicare fraud "puts deadly pills on the street" and helps fuel the opioid crisis. In response, Rochelle wrote this open letter to AARP’s editors.)

Dear AARP Editors,

I received the AARP Bulletin and at first found your cover story on Medicare fraud interesting. Fraud is a major problem that will need patients, physicians and law enforcement to resolve. It causes healthcare costs to rise, which many of us on Social Security and fixed incomes can’t afford to pay.

As I got towards the end of the bulletin, my anger began to rise as I read "The Opioid-Medicare Connection." You claim that “shady doctors are writing bogus prescriptions for opioid painkillers” using stolen Medicare ID numbers and that “the pills are then sold on the street for huge profits.”

“The practice is shockingly common, and the impact is severe. For Medicare, it means covering the cost of countless millions of high-priced pills that never should have been prescribed. At the same time, prescription opioids are responsible for an estimated 95 overdose deaths a day in the United States,” the article claims, without ever citing a source for that information. 

It brought me back to last summer when AARP published "The Opioid Menace." Why is AARP constantly attacking opioid pain medication? Why do you continually write misleading information about opioids? Could it be dollar motivated? 

Then I read about AARP's survey on medical marijuana, which found that a majority of older Americans “think marijuana is effective for pain relief and should be available to patients with a doctor’s recommendation.”  I have to disagree with the survey findings. There are many of us who have tried medical cannabis and received zero benefit. It did nothing for my pain. 

Then it dawned on me, of course insurance providers such as AARP would like more patients to use cannabis. As it becomes harder for us to get prescription opioids, many pain patients are turning to cannabis, a treatment that AARP and other insurers don't have to pay for. How much will that fatten your bottom line?

I find it hard to believe stolen Medicare ID numbers play that big of a role in the opioid crisis. Prescriptions for opioid medication are tracked more than ever, with doctors, pharmacists and insurers having instant access to databases to see just how many prescriptions a patient is getting.

I have been on Medicare since 1997 due to becoming disabled by Complex Regional Pain Syndrome (CRPS). There has never been a time that I did not have to present a picture ID when picking up an opioid prescription. And if I was unable to pick them up myself, a friend or relative had to present my ID confirming it was indeed for me, along with my current address.

Please explain how the "shady doctors" you referred to in your article are able to pull off this "shockingly common" fraud and make “huge profits.” As in last year's Opioid Menace article, AARP uses minimal references to support these claims. It was interesting you referenced only one physician who did this, only one. 

Medicare just published a new rule starting in 2019, which impose new limits on high dose opioids and requires “high risk” patients to see a specific physician and use a specific pharmacy. Think of the money you can save now. More patients paying out of pocket for medical cannabis and prescription opioids being reduced or stopped. 

Whatever happened to AARP being there for us older Americans?

Rochelle Odell lives in California. She’s lived for nearly 25 years with Complex Regional Pain Syndrome (CRPS/RSD).

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.

Prominent Pain Doctor Faces Hundreds of Lawsuits

By Pat Anson, Editor

Imagine spending your retirement defending yourself against hundreds of lawsuits in courthouses around the country – all of them alleging that you played a key role in starting the opioid crisis and that you were indirectly responsible for thousands of overdose deaths.

“It is mind boggling to me and its frightening, actually. I don’t know how I’m going to defend myself,” says Lynn Webster, MD, a pain management expert and former president of the American Academy of Pain Medicine. “Right now, we’re just trying to keep our head above the water.”

Webster has been named as a defendent in so many class action lawsuits – along with Purdue Pharma, Johnson & Johnson, Endo, Janssen and other opioid manufacturers – that he’s lost track. He knows of at least 80 lawsuits but believes there are many more.

“I think it could be several hundred,” he says.

The latest one was filed this week by Salt Lake County, Utah -- where Webster lives -- alleging that drug makers employed him in deceptive marketing practices that downplayed the risks of addiction and overdose. Like the other lawsuits by states, counties and cities, Salt Lake County seeks to recover taxpayer money spent on treating addiction, combating opioid abuse and policing opioid related crimes.    

DR. LYNN WEBSTER

“Utah’s opioid crisis stems directly from a callously deceptive marketing scheme that was spearheaded by certain opioid manufacturers and perpetuated by prominent doctors they bankrolled,” the lawsuit alleges.

“Dr. Webster’s advocacy of opioids was designed to create a veneer of impartiality. But Dr. Webster was a forceful proponent of the concept of ‘pseudoaddiction,’ the notion that addictive behaviors should be seen not as a warning, but as indicators of undertreated pain. The only way to differentiate between the two, Dr. Webster claims, was to increase a patient’s dose of opioids.”

Until he retired from clinical practice in 2010, Webster operated the Lifetree Pain Clinic in Salt Lake City. The lawsuit makes a point of mentioning that at least 20 of Webster’s patients died from overdoses and that he was investigated – but never charged with a crime -- by the DEA and the U.S. Senate Finance Committee.

“Most of what they have in there, at least about me, is false. And I think I can prove that,” Webster told PNN.

A footnote in the lawsuit contains the curious but important disclaimer that “Salt Lake County asserts no claim against Dr. Webster arising from his medical practice. The claims against Dr. Webster relate solely to his participation, as a KOL and otherwise, in Manufacturing Defendants deceptive marketing campaign.”

'Key Opinion Leader'

KOL is an acronym for “key opinion leader” – a euphemism for doctors alleged to be so influential that they helped convince other physicians to prescribe more opioids. Webster and three other pain doctors -- Russell Portenoy, Perry Fine and Scott Fishman -- are portrayed in the lawsuits as KOLs who greedily accepted millions of dollars in payments from drug makers in return for their promotion of opioids.

“It's mind boggling to think how four individuals can be accountable for essentially brainwashing all of the doctors in the country to do something intentionally to make pharmaceutical countries rich. How can anyone think that is plausible? It’s crazy,” says Webster. “Most of the pharmaceutical companies that they’ve listed I never received a dime from.”

According to the Salt Lake County lawsuit, Webster was “handsomely rewarded for his efforts,” receiving nearly $2 million from opioid manufacturers from 2009 to 2013. Webster says that dollar amount is unfair and misleading because most of it stems from his work as a researcher. He is currently Vice President of Scientific Affairs at PRA Health Sciences, a clinical research company.

“If you’re a principal investigator in a research program that has contracted with a pharmaceutical company, that money goes under your name. But its money to conduct a trial. Not a penny of it goes to me,” says Webster. “I have received compensation for consultant work and advisory boards. My consultant work is because of my area of expertise. That’s not unusual. And I do not speak for a company’s product. I do not benefit at all because I personally have no shares in any pharmaceutical company.”

Since retiring from clinical practice, Webster has become an outspoken critic of efforts by the government and insurance industry to limit opioid prescribing -- which he believes have gone too far and unfairly punish pain patients, while ignoring the larger issue of illicit fentanyl, heroin and other black market drugs.

He's written a book, called "The Painful Truth" and self-financed a PBS documentary by the same name.  Webster also comments frequently on PNN about opioid related issues.

With so many lawsuits hanging over him, Webster’s financial future is uncertain.  He says he and his fellow KOLs could be bankrupted by legal fees before any of the lawsuits come to trial.

“We don’t have any big pocket that’s going to pay for anything,” he said. “If a jury decided to award money from us, they wouldn’t get any money, because there is no money. We would be all bankrupt by the time we got to court.”

Drug makers, on the other hand, do have big pockets. And during the 1990’s many of the same law firms now involved in opioid litigation helped win big settlements with the tobacco industry worth upwards of $200 billion.  That includes the law firm of Hagens Berman, which is handling the Salt Lake County lawsuit. The firm also represents the city of Seattle in a nearly identical lawsuit against opioid makers, in which Webster is named as a KOL.

Webster is also named in a string of lawsuits filed by the law firm of Simmons Hanly Conroy, which represents dozens of states, counties and cities. Simmons will pocket one-third of the proceeds from any opioid settlement,  which could run into hundreds of billions of dollars.

Simmons is well connected politically, having donated $219,000 to the re-election campaign of Missouri Sen. Claire McCaskill (D), who coincidentally released a report in February that's highly critical of patient advocacy groups and medical associations for accepting money from opioid manufacturers.

It is against these political, financial and legal forces that Webster must find a way to defend himself.

“The body of the allegations are inaccurate, misleading and irresponsibly paint a picture which ignores the realities of Dr. Webster’s compassionate commitment to alleviating suffering in his chronic pain patients,” Peter Striba, Webster’s attorney, wrote in a letter to the Salt Lake Tribune. “It is estimated that there are approximately one-hundred million chronic pain patients in our Country, and it is very telling that their suffering and their medical condition is entirely absent in the narrative of the Complaint.” 

Memorial Misrepresents Overdoses Linked to Rx Opioids

By Pat Anson, Editor

A provocative memorial to overdose victims makes its debut in Washington DC this week, where it is likely to draw more attention to opioid addiction and the overdose crisis.  

Modeled after the Vietnam Veterans Memorial, the National Safety Council’s traveling exhibit features a wall of 22,000 engraved white pills, each pill representing the face of someone who died from a prescription opioid overdose in 2015. To dramatize the point, a new pill is etched at the exhibit every 24 minutes, to represent how often a person supposedly dies from an overdose of pain medication.

Prescribed to Death: A Memorial to the Victims of the Opioid Crisis has already appeared in Chicago, Pittsburgh and Atlanta, and will be on display at President’s Park near the White House from April 11 to 18.

"We hope that putting a face on the statistics of the thousands lost to this epidemic inspires a greater sense of urgency among all stakeholders to continue their work to eliminate preventable drug overdose deaths," Deborah Hersman, president and CEO of the National Safety Council (NSC), said in a statement. 

NATIONAL SAFETY COUNCIL IMAGE

But like nearly everything else having to do with the overdose crisis – the exhibit misrepresents and exaggerates how many people actually died from prescription opioids, while ignoring the larger role played by illegal opioids and other black market drugs, which now account for about two-thirds of all overdoses.  

Twenty-two thousand people did not die from prescription opioids in 2015. According to revised estimates by the CDC, there were 17,536 deaths involving opioid medication that year. And some critics believe the actual number is even lower.

But that’s not stopping the NSC and the White House from promoting the memorial and its false statistics.

"The decision to bring the memorial to Washington is part of President Trump and First Lady Melania Trump's efforts to raise awareness about the crisis and to make us each part of solution," said Kellyanne Conway, counselor to the President. 

An NSC video shared by the White House on its Twitter account claims that “commonly prescribed pain medications are at the root of the crisis” and that “92,000,000 Americans were prescribed opioids in one year. 22,000 of them died from an overdose.”

‘Significantly Inflated’ Estimates

Where does the 22,000 number come from? It was not taken out of thin air or invented -- at least not by the National Safety Council. The NSC says it is based on CDC mortality data from 2015 -- when 22,598 overdoses were initially blamed on opioid pain relievers.

However, as PNN has reported, CDC researchers recently admitted that number and many other overdose estimates are wrong, because they included deaths involving illicit fentanyl and other synthetic opioids that “significantly inflate estimates.”

A more accurate number to blame on opioid pain medication, according to one CDC critic, is 16,610 overdoses – a number that has remained relatively stable over the last few years.  It’s also about 25% lower than the number of pills on display in the NSC exhibit.

When PNN asked the NSC to explain the discrepancy, we were emailed a nonsensical response by a spokesperson that only bends the truth further:

“The number of pills on the wall – 22,000 – represents the number of people who overdosed on prescribed opioids or prescribed fentanyl. However, some of the faces represent people who eventually overdosed on heroin. All of these addictions, however, began with prescribed medications.”

For starters, the notion that all addictions begin with prescriptions is -- to put it kindly -- misinformed. Toxicology tests also cannot differentiate between prescription fentanyl and illicit fentanyl, although the latter is now believed to be responsible for more overdoses than any other drug. And why would the faces of people who overdosed on heroin be included in a memorial to victims who died from prescription opioids?

The National Safety Council is a nonprofit that promotes itself as a "data-driven organization" focused on preventing unnecessary injuries and deaths. It was established by labor unions in 1913 to improve workplace safety but is now funded largely by corporations, including the insurance industry.

For several years the NSC has had an aggressive marketing campaign against the use of opioid medication.

"Opioids do not kill pain. They kill people," says NSC medical advisor Donald Teater, MD, on the organization’s website.

The NSC recently released a 32-page report called “Prescription Nation 2018” that calls prescription opioids “a gateway drug to heroin” that were "liberally prescribed, setting the stage for a flood of people suffering from opioid use disorder, overdose and death.”

An NSC analysis found that just 13 states and Washington DC have implemented adequate policies to prevent opioid overdoses, such as adopting prescribing guidelines and mandating prescriber education. The report says 29 states are lagging in adopting such policies and 8 of them are failing. 

The organization did not respond to a request for an interview. 

DEA Takes Steps to Reduce Hospital Opioid Shortages

By Pat Anson, Editor

In response to a growing number of complaints about shortages of opioid pain medication in U.S. hospitals, the Drug Enforcement Administration is allowing some drug makers to increase their production of injectable opioids.

The shortages were first reported last summer but have intensified in recent months – leaving some hospitals scrambling to find morphine, fentanyl and other injectable opioids to treat patients suffering from acute pain after surgery or trauma. The shortages are largely due to manufacturing problems at Pfizer, which controls 60 percent of the market for injectable opioids.

“DEA is working closely with the U.S. Food and Drug Administration, drug manufacturers, wholesale distributors and hospital associations to ensure that patients have access to necessary hospital-administered pain medications. These include certain injectable products that contain morphine, hydromorphone, meperidine, and fentanyl,” the agency said in a statement.

The DEA said it gave permission to three other drugs makers to produce the injectable drugs after Pfizer “voluntarily surrendered” part of its quota allotment.

“It is important to note that an increase in DEA procurement quotas to various manufacturers cannot alone prevent future shortages as DEA does not control the quantity or the speed by which manufacturers produce these or any of their products,” the agency said.

But critics say the DEA itself is partly responsible for the shortages. The agency may not control how companies manufacture drugs – but it has a big say on the amount. Under federal law, the DEA sets annual production quotas for each drug maker to produce opioids and other controlled substances.

Because of growing concerns about the overdose crisis, the DEA ordered a 25 percent reduction in opioid manufacturing in 2017 and an additional 20 percent cut in 2018. This year’s cuts were ordered despite warnings from three drug makers that reduced supplies of opioids “were insufficient to provide for the estimated medical, scientific, research and industrial needs of the United States.”

A group of 16 U.S. Senators – led by Illinois Democrat Dick Durbin – urged the DEA to make the production cuts. 

“Given everything we now know about the threat posed by opioids and DEA’s downstream efforts to tackle this problem, there is no adequate justification for the volume of opioids approved for the market,” the senators wrote in a September 2017 letter to then acting DEA administrator Chuck Rosenberg.

According to Kaiser Health News, shortages of injectable opioids have led to an increasing number of medical errors and left trauma patients suffering in pain. Some hospitals are rationing opioids like Dilaudid, and using nerve blocks, acetaminophen and muscle relaxants instead.

The DEA said it would make further adjustments to opioid quotas if they are needed and would “also consider other measures that may be necessary.”

More Americans Worried About Rx Drug Misuse

By Pat Anson, Editor

A recent study by the Centers for Disease Control and Prevention found that about one in four overdose deaths in 2016 involved prescription opioids. That’s a lot – but it’s far less than the number of Americans killed by illegal drugs such as heroin, cocaine and illicit fentanyl – which account for nearly two-thirds of all drug related deaths.

But a new survey shows that a growing number of Americans still blame the overdose crisis on prescription drugs.

The nationwide poll by the Associated Press and the NORC Center for Public Affairs at the University of Chicago found that 43 percent of Americans believe the misuse of prescription drugs is a serious problem in their community. That’s up from 33% two years ago. Only 37 percent see heroin as a serious concern locally.

The survey findings show that many Americans have a conflicted attitude about the opioid crisis and drug misuse in general.

For example, while over half (53%) believe prescription drug addiction is a disease that is treatable, a significant number (39%) think substance abuse is caused by mental illness. Forty-three percent think opioid addiction shows a lack of willpower or discipline, and nearly a third (32%) say it’s a character defect or a sign of bad parenting.

The stigma associated with drug addiction is strong. Fewer than 1 in 5 Americans are willing to associate closely with a friend, colleague or neighbor who is addicted to prescription drugs.  

"In the national effort to grapple with the enormous issue of opioid addiction, it is important to know the level of awareness and understanding of Americans who find themselves in the midst of an epidemic that is claiming growing numbers of lives," said Caitlin Oppenheimer, senior vice president of public health at NORC. "This survey provides important, and in some cases troubling, information."

Other survey findings:

• 13% of Americans had a relative or close friend die from an opioid overdose.
• 24% have an addicted relative, close friend, or say they themselves are addicted to opioids.
• Two-thirds say their community is not doing enough to make treatment programs accessible and affordable
• 64% would like to see more effort to crack down on drug dealers.

"The number of people who recognize how serious the opioid epidemic is in this nation is growing," said Trevor Tompson, vice president for public affairs research at NORC. "There is clearly a continuing challenge to ensure that what is learned about the crisis is grounded in fact."

The survey found that Facebook plays a dominant role in how Americans get their news – particularly about opioids. Of the 74 percent of adults who use Facebook, 41 percent say they have seen messages about opioids or deaths from overdoses. Fewer users of Twitter, Instagram and other social media platforms report seeing such information.

The nationwide survey of 1,054 adults was conducted online and using landlines and cell phones. The margin of sampling error is +/- 4.1 percentage points.

How CDC's Opioid Guidelines Killed My Mother

Sheila Ramsey, Guest Columnist

For the past year, I have been reading the heartbreaking stories being posted about the degrading and inhumane treatment of the elderly, critically ill and disabled persons by our government, healthcare institutions and physicians.

And all I can do is sit here and cry, thinking about the struggles that my mother went through for the last 25 years of her life. She was a diabetic for 40 years, had rheumatoid arthritis, osteoarthritis, degenerative disc disease, high blood pressure, depression and cystic lung fibrosis. These conditions caused her much pain every day.

She was placed on a low dose of hydrocodone 20 years ago. It did not completely erase her pain, but made it manageable to where she wasn’t completely bedridden.

Then in 2016, when the CDC came out with their opioid "guidelines," her doctor reduced her dosage three times. I watched her suffer immensely and she pleaded with him to raise it several times. He would not.

Her life became more miserable than before and her depression worsened. She even had to stop driving, relying on me and a few friends to take her to appointments and grocery shopping once a week. Which were the only times she got out of her small one-bedroom apartment.

In May 2017, her lung disease got worse and it was hard for her to breath due to panic attacks several times a day. Her pulmonary doctor placed her on a low dose of Ativan to reduce her anxiety.

JANET DIXON

As soon as her primary care doctor found out about that, he immediately gave her a choice of which illness she was willing to suffer from: panic attacks or chronic pain due to her many incurable illnesses. She chose the Ativan and he immediately stopped her pain meds. She then had to start using a walker instead of her cane.

In June 2017, she had a friend drop her off to see her lung doctor. While waiting for the elevator, she tripped over her walker, fell and broke her hip. She went into the hospital for surgery, caught pneumonia and had to be placed in a medically induced coma. She also had congestive heart and kidney failure. She was waiting on a lung transplant but did not make it. We had to take her off life support on October 25, 2017.

This was all due to complications from being in the hospital for a hip surgery that never would have been needed if she did not have to use a walker and had not been taken off pain medication! If her pain had been controlled, my mother might still be alive.

That’s why it angers me that our government is denying medication to patients that benefit from them. How in America can our lawmakers let this happen? I’ve written so many letters. I don’t know who else to contact or what else I can do to help all the people who have been brutally denied pain relief and subjected to humiliating and degrading treatment. Please if there is anything I can do to help stop this neglect, I’m all in.

I just want to let everyone who reads this to know that I feel for each and every one of you who is suffering, and I hope this ends soon. God bless you all.

Sheila Ramsey lives in Ohio. Her mother, Janet Dixon, died last year at the age of 69.

Pain News Network invites other readers to share their stories with us. Send them to editor@painnewsnetwork.org.

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.

Rallies Draw Attention to Suffering of Pain Patients

By Pat Anson, Editor

Hundreds of people braved the rain, wind and cold Saturday to take part in a nationwide series of rallies in support of people living with chronic pain and illness.

The “Don’t Punish Pain” rallies were organized by a grassroots group on Facebook and held mostly at state capitols in 47 states.

The primary goal of the rallies is to get the Centers for Disease Control and Prevention to change its opioid prescribing guidelines, which have caused many doctors to stop treating patients with opioid medication or to drastically lower their doses.

Although attendance was sparse in some locations, a dozen or more people gathered in Baton Rouge, Dallas, Little Rock, Annapolis and several other cities.

Some protestors brought an empty pair of shoes to represent people who were too ill to attend, those who have died due to poorly treated pain, and some who have committed suicide.

While the turnout may have been disappointing to some, the rallies were successful in attracting local media attention – shining a rare spotlight on the plight of pain patients and how many are suffering in an age of hysteria over opioid medication and the overdose crisis.

"We have gone so much to the other side that we are forgetting that there are voices of pain that need to be heard," Carlene Hansen told KIVI-TV in Boise, Idaho. "I've been on medications for 5-7 years and always take it as prescribed."

 "I think that a responsible doctor is going to do the right thing and prescribe the right medications for the right individual," Michele Thomas told the News Tribune in Jefferson City, Missouri. "Where I have a problem is when the government comes in and tells the doctor that they cannot prescribe what the doctor feels is the best medication."

“Doctors need to be able to treat their patients again,” Karlyn Beavers told WLNS-TV in Lansing, Michigan. "I have pain every day. Whether some days it may be light, some days it's heavy, but it's always there.”

The Don’t Punish Pain rallies were organized in the last few months on social media without support or funding from patient advocacy groups or pharmaceutical companies.

Since the CDC released its opioid guidelines in 2016, many patients say the quality of their medical care has gone downhill. 

In a PNN survey of over 3,100 patients on the first anniversary of the guidelines, 84 percent said their pain and quality of life had gotten worse. Over 40 percent said they had considered suicide and 11 percent said they had obtained opioids on the black market for pain relief.

CDC researchers recently admitted that they significantly overestimated the number of Americans that have died from overdoses involving opioid medication. A CDC report released last month found that most drug deaths are actually caused by illicit fentanyl, heroin, cocaine and other drugs obtained on the black market.

‘Don’t Punish Pain’ Rallies Set for Saturday

By Pat Anson, Editor

Dozens of protests are being planned across the United States this Saturday to draw attention to the plight of patients suffering from chronic pain and illness.

The “Don’t Punish Pain” rallies were organized by a grassroots group on Facebook and quickly gained traction in the pain community – where there is growing frustration over reduced access to pain medication and medical care.

“One day we were talking and decided we could have a rally. And it went from there. It just exploded,” says David Israel, a 30-year old Michigan man disabled by chronic pain.

Israel says the group is planning rallies in 47 states – mostly at state capitols – and has obtained the necessary permits. For a complete list of the times and locations, click here.

The primary goal of the rallies is to get the Centers for Disease Control and Prevention to change its opioid prescribing guidelines, which have caused many doctors to stop treating patients with opioid medication or to drastically lower their doses.

“There are millions of people that are being affected by this. Not only do we need to get the CDC to change but we also need to get help for the people who’ve been abandoned,” says Israel.

Israel was recently abandoned by his doctor and has been unable to find a new one, in part because of a disputed drug test. He suffers from hydrocephalus, a condition that causes spinal fluid to build up in his brain, leading to headaches and other neurological problems.

“I don’t have a doctor at all right now,” said Israel. “I need pain meds, but I don’t have any because there was a false positive last year that I proved was false, but the doctor said there was no such thing as a false positive. She dropped my pain meds overnight.”

Some patients have complained to PNN that the rallies are poorly organized and they don't know who to contact or where to get further information. Perhaps the best thing to do is to join their Facebook group by clicking here and see if the information has already been posted.

The Don’t Punish Pain rallies were organized in the last few months without support or funding from other patient advocacy groups. It truly is a grassroots effort, supported by volunteers like Rhonda Posey, a Texas grandmother who suffers from arachnoiditis, a chronic spinal condition.

“It’s been fun to be involved with it, but it’s been quite a job,” says Posey, who helped organize the Don’t Punish Pain rally at Dallas City Hall Saturday morning. She was unable to get a permit at the state capitol in Austin, possibly due to the stigma associated with opioids.

“We had to have legislator sponsorship (for a permit). And we reached out to probably a dozen people trying to get someone to sponsor us and nobody would do it,” she told PNN. “They probably didn’t want their name associated with something like that.  

“Dallas has been very nice. Someone will be there with us the entire time. They’ve been real nice about everything, so it’s worked out well.”

Posey has also been successful in getting some advance media coverage of the rally from local newspapers and from KTRE-TV.  Her group plans to bring 50 pairs of shoes to the rally to represent patients who have died from suicide or medical conditions caused by untreated pain. 

She and Israel say it is time for different tactics by the pain community. Just signing petitions and writing letters to politicians about how the government’s response to the opioid crisis is hurting patients hasn't been effective.

“Nobody’s got the guts to standup and say wait a minute, there are other people suffering. It’s not just people that are suffering form addiction. It’s not just the families who are suffering from people who have died from overdoses," Posey said. “What about me? What about the millions of chronic pain patients that are suffering? What about us?”

The Opioid Crisis Is Not Just About Pain Medication

By Roger Chriss, Columnist

The opioid crisis is no longer primarily about prescription opioids. Illicit fentanyl, heroin, cocaine and other black market drugs are now involved in more overdoses than pain medication.

However, the current response to the overdose crisis is still focused primarily on opioid prescribing. Arizona just approved  legislation to reduce opioid prescribing for injured workers. And President Trump has stated that he will push for a one-third reduction in opioid prescribing over the next three years. 

The ongoing media narrative reinforces this view. The crisis is blamed on prescription opioids, combined with manipulative marketing by manufacturers, pharma funded advocacy groups, and poor prescribing practices by physicians. Although these factors may have played a role in the onset of the crisis 20 years ago, the “opioid epidemic” has evolved far beyond that.

The National Institute on Drug Abuse summarizes the origins of the crisis this way:

"In the late 1990s, pharmaceutical companies reassured the medical community that patients would not become addicted to prescription opioid pain relievers, and healthcare providers began to prescribe them at greater rates. This subsequently led to widespread diversion and misuse of these medications before it became clear that these medications could indeed be highly addictive."

The Centers for Disease Control and Prevention says there have been three “waves” to the crisis:

"The first wave of opioid overdose deaths began in the 1990s and included prescription opioid deaths. A second wave, which began in 2010, was characterized by heroin deaths. A third wave started in 2013, with deaths involving highly potent synthetic opioids, particularly IMF (illicitly manufactured fentanyl) and fentanyl analogs."

CDC researchers recently admitted that they significantly inflated the number of deaths involving prescription opioids for years.  They also acknowledged in an “Annual Surveillance Report of Drug-Related Risks and Outcomes” that high dose opioid prescribing has been in decline for over a decade:

“Between 2006 and 2016, the annual prescribing rate per 100 persons for high-dosage opioid prescriptions (>90 morphine milligram equivalents (MME)/day) decreased from 11.5 to 6.1, an overall 46.8% reduction and an average annual percentage change of 6.6%. The rate leveled off between 2006 and 2009, then decreased 9.3% annually from 2009 to 2016.”

These trends are clearly visible at the state level. Maine’s Attorney General recently said “Fentanyl has invaded our state” and that most of the overdose deaths there were caused by multiple drugs. When pharmaceutical opioids were involved, most of the time they were “not prescribed for the decedent.”

FiveThirtyEight gave a detailed breakdown of drug deaths by state. In an article headlined “There Is More Than One Opioid Crisis,” Kentucky was actually found to have more overdoses involving gabapentin than oxycodone.

And in a recent Cleveland.com interview, FDA Commissioner Scott Gottlieb, MD, refers to the crisis as shifting “from a prescription-pill problem to one centered around deadly street drugs.”

In other words, prescription opioids have become only a small part of a crisis that now includes heroin, illicit fentanyl, and an increasing number of non-opioid drugs. In fact, we are fast approaching what will become the fourth wave of the crisis, one involving poly-drug abuse and overdoses, that will further challenge first responders, emergency rooms and addiction treatment facilities.

But still the response to the crisis has been focused on opioid prescribing. This may have made some sense a decade ago, when surveillance of the crisis was just starting. It made for good optics, but it was bad policy. Curbing prescribing is wreaking havoc with pain management, not only for chronic, progressive and degenerative disorders but also cancer and hospice patients. And it is not helping people who suffer from opioid addiction.

As Drs. Stefan Kertesz and Sally Satel point out: “Too many health care providers have started to see their fierce commitment to dose reductions as a badge of good citizenship, without any effort to measure the human outcomes of their own policies.”

Pain management expert Dr. Lynn Webster wrote this about the recently announced Medicare plan to reduce high dose opioid prescribing: “Such actions will not reduce opioid deaths related to heroin and illicit fentanyl which is the source of most overdose deaths. In fact the opposite effect may occur."

The opioid crisis will not be solved by focusing on prescription opioids. It is too late for that. Failure to recognize the evolving nature of the crisis will simply risk more fatal overdoses.  

Roger Chriss lives with Ehlers Danlos syndrome and is a proud member of the Ehlers-Danlos Society. Roger is a technical consultant in Washington state, where he specializes in mathematics and research.

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.

Medicare Finalizes Plan to Reduce High Dose Opioids

By Pat Anson, Editor

The Trump administration has finalized plans that will make it harder for many Medicare patients to obtain high doses of opioid pain medication. Medicare beneficiaries will also be limited to an initial 7-day supply of opioids for acute pain.

Under new rules released today for the 2019 Medicare Part D prescription drug program, a ceiling for opioid doses will be established at 90mg morphine equivalent units (MME).  Any prescription at or above that level would trigger a “hard safety edit” requiring pharmacists to talk with the prescribing doctor about the appropriateness of the dose. If satisfied with the explanation, the pharmacist could then override the edit and fill the prescription.

Under an earlier proposal that was widely criticized, only insurers could decide whether to override a safety edit – a requirement that would have essentially made insurers the final arbiters in deciding who gets high doses of opioid pain medication.

The new rules adopted by the Centers for Medicare and Medicaid Services (CMS) will still allow insurers to implement safety edits, but only at a much higher dose of 200 MME or more.  Insurers will also be given greater authority to identify beneficiaries at high risk of addiction and to require they use “only selected prescribers or pharmacies.”

CMS is also adopting a new policy that requires all new opioid prescriptions for short term acute pain to be limited to no more than 7 days’ supply. Several states have already adopted similar measures.

CMS says this “tailored approach” to opioid prescriptions was needed to address what it called “chronic opioid overuse” at the pharmacy level and to encourage support for the CDC’s 2016 opioid prescribing guideline.

“CMS believes it is important that (insurers) set expectations for prescribers to implement the CDC’s recommendations as a best practice through their provider contracts. PDPs (prescription drug plans) should also reinforce these messages through interactions with prescribers as an integral component of sponsors’ drug utilization management program,” CMS said.

“We also recommend that beneficiaries who are residents of a long-term care facility, in hospice care or receiving palliative or end-of-life care, or being treated for active cancer-related pain are excluded from these interventions.”

About 1.6 million Medicare beneficiaries met or exceeded opioid doses of 90mg MME for at least one day in 2016. The 90mg MME ceiling established by the CDC was only meant as a recommendation for primary care physicians, but has been widely adopted as a rule by other federal agencies, insurers, state regulators and prescribers.

'Cruel' Limits on Opioid Prescribing

"The 90 mg dose they set as a threshold for 'high' or overuse is flawed and not scientifically based.  It is totally arbitrary," says Lynn Webster, MD,  a pain management expert and past president of the American Academy of Pain Medicine.  "It is cruel to impose such a limit on people with involuntary dose reductions who have been functioning well without signs of abuse for years.

"Even the 7 day limit is misguided at best. The average length of time a person requires an opioid post-op involves several factors and include the type of operation, the genetics of the person and the type of medication. The literature states the duration of pain requiring treatment with an opioid post-operatively is 4-9 days for general surgery, 4-13 days for women's health procedures and 6- 15 days for musculoskeletal procedures.  This means half of the Medicare patients will receive less than half of what they will need."  

Over 1,200 people left public comments in the Federal Register about the Medicare proposal, most of them sharply critical of CMS.

“This is archaic medicine and does more harm than one can imagine,” wrote pain patient Henry Yennie. “The DEA, HHS, private insurers, and now CMS are pursuing policies and restrictions that will cause harm and suffering to millions of people.”

“I cannot understand how Medicare can be so uncaring about the pain people have,” wrote Mikal Casalino, a 72-year old pain patient. “Limiting the dosage to an arbitrary amount is not going to be helpful for individuals.”

A joint letter opposing the rule changes was also submitted by 180 doctors and academics, including some who helped draft the CDC guidelines. The letter points out that a steep reduction in high dose prescribing since 2010 has not reduced the number of opioid overdoses. And it faults CMS for being focused on reducing the number of high dose prescriptions – not the quality of patient care.

“The proposal does not consider adverse impacts on pharmacies, physicians or patients…and it will accelerate patient abandonment,” the letter warns. “The plan avows no metric for success other than reducing certain measures of prescribing. Neither patient access to care nor patient health outcomes are mentioned.”

CMS contracts with dozens of insurance companies to provide health coverage to about 54 million Americans through Medicare and nearly 70 million in Medicaid. CMS policy changes often have a sweeping impact throughout the U.S. healthcare system because so many insurers and patients are involved.  The new Medicare regulations will go into effect on January 1, 2019.

Doctors and Pharmacists Targeted in DEA Surge

By Pat Anson, Editor

The U.S. Drug Enforcement Administration has arrested 28 people and revoked the registrations of over a hundred others in a nationwide crackdown that targeted prescribers and pharmacies that dispense “disproportionally large amounts” of opioid medication.

For 45 days in February and March, a special team of DEA investigators searched a database of 80 million prescriptions, looking for suspicious orders and possible drug thefts.

The so-called “surge” resulted in 28 arrests, 54 search warrants, and 283 administrative actions against doctors and pharmacists.  The DEA registrations of 147 people were also revoked – meaning they can no longer prescribe, dispense or distribute controlled substances such as opioids.

The DEA said 4 medical doctors and 4 medical assistants were arrested, along with 20 people described as "non-registrant co-conspirators." The arrests were reported by the agency's offices in San Diego, Denver, Atlanta, Miami and Philadelphia.

“DEA will use every criminal, civil, and regulatory tool possible to target, prosecute and shut down individuals and organizations responsible for the illegal distribution of addictive and potentially deadly pharmaceutical controlled substances,” Acting DEA Administrator Robert Patterson said in a statement.

“This surge effort has demonstrated an effective roadmap to proactively target illicit diversion of dangerous pharmaceuticals. DEA will continue to aggressively use this targeting playbook in continuing operations.”

The DEA surge is the latest in a series of steps taken by Attorney General Jeff Sessions to crackdown on opioid prescribing. Last August, Sessions ordered the formation of a new data analysis team, the Opioid Fraud and Abuse Detection Unit, to focus solely on opioid-related health care fraud. 

Sessions also assigned a dozen prosecutors to “hot spots” around the country where opioid addiction is common.  Last week the DEA said it would add 250 investigators to a task force assisting in those investigations.

Although overdose deaths are primarily caused by illicit drugs such as fentanyl, heroin and cocaine, federal law enforcement efforts appear focused on opioid prescribing. Doctors and pharmacists are easier to target because they are already in DEA databases, as opposed to drug dealers and smugglers operating in the black market.   

As PNN has reported, the data mining of opioid prescriptions -- without examining the full context of who the medications were written for or why – can be problematic and misleading.

For example, last year the DEA raided the offices of Dr. Forest Tennant, a prominent California pain physician, because he had “very suspicious prescribing patterns.” Tennant only treated intractable pain patients, many from out-of-state, and often prescribed high doses of opioids because of their chronically poor health -- important facts that were omitted or ignored by DEA investigators.

Tennant has not been charged with a crime and denied any wrongdoing. Nevertheless, he retired this month due to the stress and uncertainty caused by the DEA investigation. About 150 of his patients now have to find new doctors, not a simple task in an age of hysteria over opioid medication.

In an interview with AARP, Sessions defended the use of data mining to uncover health care fraud.

“Some of the more blatant problems were highlighted in our Medicare fraud takedown recently where we had a sizable number of physicians that were overprescribing opioid pain pills which were not helping people get well, but instead were furthering an addiction being paid for by the federal taxpayers. This is a really bad thing,” Sessions said.

“It’s a little bit like these shysters who use direct mail and other ways to defraud people. They will keep doing it until they’re stopped. In other words, if we don’t stop them, they will keep finding more victims and seducing them.”

Living in Denial About the Overdose Crisis

By Ann Marie Gaudon, Columnist

Most of us know that denial of reality exists, but why is this so? How can humans with the ability to consider, evaluate, analyze and resolve complex problems ignore the facts? Even when ignoring the truth might lead to disastrous results?

Conceived by Sigmund Freud as a defense mechanism (to “defend” us against that which we do not want to feel), denial has been a concept for many decades. To over-simplify the premise, it’s a belief that something is either true or false when the facts say otherwise. Why would we do this? It’s because people experience a broad range of powerful emotions and intentions, such as greed, pride, revenge, fear, desire and a need for status – just to name a few. The have a strong influence over our ability to interpret facts.

When the Canadian government introduced the 2017 Canadian Guideline for Opioid Therapy, the creators were in denial. They ignored medical facts about chronic pain and turned pain sufferers into sacrificial lambs for people abusing illicit opioids. Patients and doctors tried to tell the truth but were not allowed a seat at the table with the so-called “experts.”

Chronic pain patients have never, ever, had their pain needs met and now they fare much worse. They are in more pain and experience more death and disability due to forced tapering and suicide.

Deniers yell loud and long that opioid pain medications are not effective, dangerous, addictive and will kill you in the end. Except that the evidence does not support that. Those with the worst pain have necessarily taken opioid medications to cope. It was their strongest weapon and were usually taken without danger, addiction or death. Opioids gave them effective pain relief that helped them regain function in everyday life.  Deniers will neither believe nor admit to this.

Let’s take a look at some of the strong influences which spur deniers to ignore the facts. We can see through many interviews and articles that McMaster University’s chosen group for creating the Canadian guideline enjoyed inflated reputations as “progressive thought leaders” who were “experts in pain management.” Add in the prestige and desire for status that comes from speaking engagements, media interviews, and more committees to participate in. Imagine the pride and prestige from conducting more studies (despite knowing little about the study area), and let’s not forget the enormous sums of monies paid to them by our government.

Greed, desire and a need for status can easily veto reality. So can feelings of morality and “doing the right thing” for people, while living under the fictitious perception that they are making positive inroads into addiction and overdose deaths while saving chronic pain patients from themselves.

In the real world, what has been the impact of the guideline on addiction? Nothing.

What has been the impact on pain patients? Devastation.

Most people can’t seem to figure out why the very same dreadful outcomes keep happening until they are knee-deep in it. Health Canada said this week that over 4,000 Canadians died from drug overdoses in 2017, the most ever. Most of those deaths – 72 percent – were caused by illicit fentanyl, not prescription pain medication.

Jordan Westfall, President of the Canadian Association of People Who Use Drugs, was bang on when he wrote in the Huffington Post that “it should shame this country to no end that our federal government is still afraid to see this epidemic for what it is in reality… What’s killing people is drug overdose and an apathetic government.”

May I add that what has never been killing people are chronic pain patients and their medications. Remorse and shame are powerful motivators for living in denial. Deniers continue to believe that punishing patients will somehow decrease the alarming rate of overdose deaths.

Chronic pain patients have always known the emperor has no clothes. It is a fact that all over North America prescriptions for opioids continue to go down, while overdose deaths continue to go up.  Does this suggest a statistically significant relationship between prescription analgesics and overdose deaths?  Yet the deniers continue with the same old agenda, despite the disastrous situation they have created.

There is an annoying little fact about denial. It doesn’t work in the long-term. Reality always wins out and when that happens, the next step for the deniers will be to place misdirected blame onto someone else. Count on it. It’s already happening. Doctors put the blame on the guideline’s creators and the creators reply, “No, no, no…it’s the doctors who have misunderstood the guideline.”

Here’s a message to the Canadian government and to the plethora of advisory groups, committees, response teams, et cetera and ad nauseam that are funded with taxpayers’ money to deny the facts:

When you are consistently creating the same disastrous outcome over and over again, you are in denial. And if this shameful situation continues, it will only lead to more suffering and deaths.

Ann Marie Gaudon is a registered social worker and psychotherapist in the Waterloo region of Ontario, Canada with a specialty in chronic pain management.  She has been a chronic pain patient for 33 years and works part-time as her health allows. For more information about Ann Marie's counseling services, visit her website.

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.