The Other Opioid Crisis: Patient Abandonment and Denial of Treatment

By Georgia Carroll, Guest Columnist 

I am a patient advocate and pain sufferer. I have the usual pains associated with rheumatoid arthritis, a bad knee and a few bulging lumbar discs. But my personal story is nothing compared to what most of the patients I work with are going through. 

I represent only a small fraction of the tens of millions of patients across the U.S. who have been abandoned by their doctors and denied treatment for the pain caused by diseases, injuries and mental health conditions. They are the unintended victims of efforts to curb opioid overdose deaths, even though studies show less than 2% of overdoses involve prescription opiates written for the deceased.  

Leaving these patients without medical care is inhumane and only exacerbates the opioid crisis, forcing some to turn to the street for relief. The victims of this abuse have been crying out for help since before 2013 and nothing has been done. They have been left to suffer, deteriorate and die. Lack of action to protect these patients has elevated the opioid crisis to a self-fulfilling phenomenon.  

Frankly, I was ignorant of how bad the situation was until a few months ago, when our doctor was arrested. For the last five years, he and I have been focused on teaching patients to integrate alternative therapies into their treatment regimens to help them reduce opioid dosages and frequencies.   

Now it is in my backyard and we are the victims, because no one gave a damn about 50 million suffering souls.

We are not drug addicts looking for the next high. We are medical patients who need doctors to responsibly prescribe the opiates we need for relief.

GEORGIA CARROLL

None of the legislation passed in recent years does anything to protect doctors from ill-conceived prosecution or their patients from being abandoned. The Department of Justice, DEA and local law enforcement have not been able to effectively diminish the availability of street drugs, much less stop their distribution. So they misinterpret and pervert the CDC opioid guideline to make their own rules for investigation and prosecution of the “low hanging fruit" of prescribers diligently treating their patients.

Physician intimidation is unacceptable. Patient abandonment is unacceptable.  

A case in point: The doctor of most of the patients for whom I advocate was arrested and the clinic closed without warning last November. The staff were threatened and intimidated, and medical records and computers confiscated, including the external hard drive backup.  In a flash, the doors were locked and 7,000 patients were abandoned with no recourse and no source for prescription refills, even blood pressure and insulin, much less chronic pain, panic attacks or depression. 

It took 10 days for the local district attorney to return the backup drive for patient records. It was blank, completely scrubbed.  We asked the DA to make medical records available to the patients so they could engage new physicians. They refused. Not their responsibility. "Clinic should have had backup," we were told. 

On day 73, after many letters from patients and doctors requesting the files and two street demonstrations, they finally agreed to download individual patient's records to a disc, on request, to be picked up at the DA's office in person or by a representative. 

Doctors and medical facilities across the country are refusing to write prescriptions for opiates to anyone, for fear of suffering a similar fate.  Instead, they are pushing patients to expensive and repetitive injections or surgery.  

Our doctor has been "flagged" by other local doctors, who refuse to even see a patient with his name on the medical files or prescription, even though he is highly respected by most of them. Call it "Not Me Next Syndrome."

The hundreds of patients I work with have now been without effective pain and mental health disorder medications for over 120 days, with no relief in sight.  They have been through the agony of withdrawals unassisted. What recourse do they have?  Continued debilitating suffering, accelerated physical and mental health decline, street drugs and the ultimate relief of suicide.  

These are the calls I receive almost daily. How would you advise them?  How would you manage your symptoms or those of a loved one?  How would you cope?  

Several states have begun to introduce bills to protect doctors from prosecution for doing their job and patients from being cut off cold turkey from their prescribed opiates. But these individual state efforts are inadequate given the number of patients across the country already affected. Patient abandonment and denial of care is now a national public health epidemic and demands immediate, emergency action. 

Georgia Carroll lives in Texas.

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

How to Scrub Up, Stock Up and Hole Up During Coronavirus Pandemic

By Roger Chriss, PNN Columnist

The coronavirus pandemic is now a national emergency. The CDC has a web page specifically for high risk populations, which is older people and those with chronic health conditions. The key advice is to scrub up, stock up, and hole up.

But stocking up on medication (particularly opioids), scrubbing up hands in splints, and holing up safely are going to be hard for people with chronic illness. Here are some useful suggestions.

Stocking Up on Meds

There are ways to stock up on prescription medications and some states are helping. The Washington State Department of Health has asked all insurance companies to allow people to get a one-time refill of their prescription medications before the end of the waiting period between refills.

However, the agency’s website notes that: “Your insurance company may have limitations on refills for certain drugs like opioids.”  

NPR reports that pharmacies may also be able to help, so a talk with your pharmacist may be worthwhile.

Scrubbing Up With Physical Limitations

Scrubbing up is essential, of course, but the need to wear braces and splints makes this difficult for people with Ehlers-Danlos syndrome, arthritis and other health conditions. Cleaning wrist braces is a challenge. One way to reduce the need for cleaning is to minimize use when out, or to use braces that are more easily cleaned.

Another trick is to eschew braces when out and rely on snug winter gloves, which can be easily washed once home. Late winter is often a good time to stock up on gloves because of end-of-season sales. And such gloves may be adequate for stabilization in people with less serious disease.

Of course, it is also important to keep your hands away from your face. People with mobility issues may be in frequent contact with what the CDC calls “high-touch surfaces in public places” (think railings and banisters) in order to maintain stability and walk safely. Hard-hit areas like Washington State are already encourage or require regular sanitizing of such surfaces, but extra caution is required.

Holing Up Safely

Holing up may be something people with chronic illness are well practiced at. But there are important differences because of the coronavirus.

In an article about elder care, STAT News suggests that seniors limit visits with people who may be sick and rely on digital communication instead.

Max Brooks explains why that’s important.

A message from me and my dad, @Melbrooks. #coronavirus #DontBeASpreader pic.twitter.com/Hqhc4fFXbe

— Max Brooks (@maxbrooksauthor) March 16, 2020

But to “hunker in a bunker” safely and sanely for weeks requires more. Hospitals and clinics in coronavirus hotspots are already limiting elective procedures and delaying routine care. Staying safe at home while holing up is key.

This means avoiding triggers that can cause exacerbation, as well as activities that impose undue risks. So no home improvement projects, experiments with new recipes or supplements, tests of new fitness activities, or major changes in daily routines.

Of course, things will go wrong. CNBC reports that 54% of Americans are not financially prepared to handle a contagious disease like coronavirus that may limit their ability to work for a few weeks. CNBC suggests phone consultations, telehealth, and avoiding ERs.

Some states are moving to improve access to health insurance in this critical period. Massachusetts and Washington State have both added a special enrollment period for their Affordable Care Act exchanges for people who need health insurance.

As public health authorities issue more general recommendations, people with chronic pain disorders will need to be mindful and take extra precautions on how to stay healthy and functional in the face of the coronavirus. Resources like the ones listed above may help fill in the gaps during this difficult time.

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.

Do Smartphones Cause More Headaches?

By Pat Anson, PNN Editor

People with headaches who use smartphones are more likely to use more pain medication, but get less relief from the drugs, according to a new study conducted in India.

Researchers surveyed 400 people who suffer from a primary headache condition, which includes migraine, tension headache and other types of headaches, asking them about their smartphone and medication use.

The smartphone users were more likely to take pain-relieving drugs for their headaches than non-users, with 96% of smartphone users taking the drugs compared to 81% of non-users. Smartphone users took an average of eight pills per month compared to five pills per month for non-users.

Smartphone users also reported less relief from pain medication, with 84% gaining moderate or complete relief of headache pain compared to 94% of non-users. The study findings were published in the journal Neurology Clinical Practice.

"While these results need to be confirmed with larger and more rigorous studies, the findings are concerning, as smartphone use is growing rapidly and has been linked to a number of symptoms, with headache being the most common," said lead author Deepti Vibha, DM, of All India Institute of Medical Sciences.

The study has limitations. It only examined people at one point in time and did not follow them over an extended period. It also relied on people to self-report their symptoms and use of pain medication.

While the study does not prove that smartphone use causes headaches or greater use of pain medication, it does show an association.

“There is a great deal of speculation among the lay population regarding the effect of computers and mobile phones on ailments such as headaches and neck pain. However, although there are anecdotal stories suggesting a link between technology use and pain, there is little evidence of either a definitive relationship or data absolving mobile phones or computers from a link to recurrent pain,” wrote Heidi Moawad, MD, of Case Western Reserve University, in an editorial accompanying the study.

“Smartphone users may rely on the devices for many hours per day -- while on the go, resting, or working -- which puts a strain on the eyes, neck, and back. As people are becoming more dependent on these devices, it would be worthwhile to know whether using smartphones could lead to health problems.”

A 2017 study speculated that high energy visible (HEV) light – also known as blue light – emitted by smartphones, laptops, desktop computers and other digital devices could contribute to headaches by causing eye strain. Blue light has a very short wavelength that penetrates deep into the eye.

A nationwide survey of nearly 10,000 adults by The Vision Council found that about a third had symptoms of digital eye strain, including neck and shoulder pain, headache, blurred vision and dry eyes.

More information about blue light can be found at BlueLightExposed.com.

Bunny Boy and Me: A True Story About Chronic Pain and Unconditional Love

By Pat Anson, PNN Editor

When most people think of therapy and support animals, a dog or cat immediately come to mind. But after years of struggle with chronic pain from lupus and fibromyalgia, Nancy Laracy needed a different kind of animal.

“Our family had been through so much that I felt we all needed a family pet other than our lizard. And because my husband was allergic to dogs and cats, we settled on a rabbit,” Nancy explained.

She adopted a baby red satin rabbit, a breed known for its calmness and sociability. “Bunny Boy” quickly became part of the Laracy family and would have a profound effect on Nancy’s life. She wound up writing a book about her furry friend, “Bunny Boy and Me: My Triumph over Chronic Pain with the Help of the World’s Unluckiest, Luckiest Rabbit.”    

“Little did I know that Bunny Boy would become my third child in so many ways and that he would be the perfect therapy for my pain,” Nancy told PNN. 

“I had tried acupuncture, massage therapy, chiropractic, mainstream medicine, slept on a magnetic mattress — just about anything. But it was Bunny Boy who took me away from my pain as he slept with me, snuggled with me, and grew to know when I needed him the most. When I had his warm body on mine, I could feel the muscle pain lessen and of course the stress as well.”

Nancy started taking Bunny Boy to her doctors’ appointments, where he had a similar effect on other patients.

“I would see the positive reaction of the patients in pain, sitting in the lobby while we were there. If only for a short time, Bunny Boy would run around, jump on their laps when they allowed him to, knock the magazines all over, and make the patients laugh and smile,” she said. 

In a cruel irony, Bunny Boy got sick and was diagnosed with a similar autoimmune disease, and needed multiple surgeries for a severe jaw abscess. Most rabbits don’t respond well to painful invasive medical procedures, but Bunny Boy was a plucky hare with a strong will to live.

“I provided that same comfort to Bunny Boy as he underwent numerous surgeries and treatments that normal rabbits don’t survive, but he survived due to the strength and love he received from me and my family,” Nancy said.

“The vets who cared for him eventually called him ‘Iron Bunny’ and said to me over and over again that he was only surviving so many things due to our bond which formed in sickness and in health.”

Bunny Boy not only survived, he helped pioneer a new medical treatment that Nancy credits with saving her life, which she discusses in her book.

Bunny Boy lived a long life for a rabbit – nine years – and Nancy went on to adopt a new rabbit that she named Muffin, who also became a therapy animal.

“I started first by visiting nursing homes to see if she had the right temperament. Not only did I visit the patients in their rooms, but they wanted me to visit the patients in physical therapy and it was amazing how Muffin could help the patients increase their physical therapy programs, simply by sitting on their laps during some of their exercises,” Nancy said.

“For arthritis and fibro patients it is important to keep moving at some level and having pets helps us do that. For me a bunny was perfect because I believe it would have been too difficult for me to walk a dog that dragged me or walk a dog regularly period. A bunny is litter trained, doesn’t have to be walked, and they are equally as endearing and social as a dog or cat.”

Bunny Boy and Me is featured in PNN’s Suggested Reading section, along with other informative books on chronic pain and pain management. Nancy is donating all proceeds from her book to charity.

People With Chronic Pain Must Prepare for Coronavirus

By Dr. Lynn Webster, PNN Columnist

The new coronavirus, COVID-19, is real. It is not a political fabrication and it is not a hoax. Its dangers have not been exaggerated. With over 1,300 confirmed cases in the United States as I write this, we are now in the acceleration state of the pandemic.

In Italy, there were only three confirmed cases of coronavirus less than a month ago. Now there are over 12,000 cases and 827 deaths. The Italian government has ordered all shops, bars and restaurants to close, and a nationwide lockdown prevents 60 million people from traveling outside areas where they live.

What History Teaches Us About Pandemics

Although the trajectory of this coronavirus is difficult to predict, we can look at the history of other viruses to know what might happen in the U.S.  

Within a week or two, there will probably be tens of thousands of Americans who have the coronavirus. Most likely, the virus will remain a threat for at least a year. We almost certainly will not see a vaccine before then. By the time we have developed a vaccine, the virus will have infected millions of Americans and will probably have mutated in unpredictable ways.  

As I wrote in a previous column, the people with an increased risk for severe symptoms and possibly dying of COVID-19 are seniors and those with chronic illness. Of course, people in chronic pain are part of this high-risk group.  

The lethality of COVID-19 was initially reported to be about two percent, but the World Health Organization now estimates the overall fatality rate to be 3.4 percent. For people over age 60 or with underlying health problems, the rate is even higher. 

We still don't know how many people have been infected, so it is impossible to know the true rate of mortality (the number of deaths compared to the number of people diagnosed). As we improve our ability to test for the virus, hopefully we will see the rate of mortality decrease, although the number of deaths will continue to climb.  

The 1918 Spanish flu infected one-third of the world's population. Even though the pandemic lasted only 15 months, it still killed between 50 million and 100 million people worldwide. An estimated 670,000 of them were Americans. Adjusted for population growth, that would be more than 1.8 million Americans today.  

Just ten years ago, the H1N1 swine flu virus infected 60.8 million people worldwide. Up to half a million lived in the U.S. and 12,469 of them died. The swine flu spread slowly compared to coronavirus. In April 2009, a 10-year-old boy in California became the first American to test positive for the H1N1 virus. By October, President Obama had declared swine flu a national emergency.  

One of the takeaways of past pandemics is that we must recognize the speed at which a virus can spread and the importance of preparing as early as possible. 

It's Essential to Plan for the Coronavirus 

Every person in the United States should have a plan in place for dealing with the coronavirus. In the best-case scenario, our lives will be relatively unaffected. But we would be remiss to count on the best outcome. Wishful thinking won't help us. Preparedness may. 

One of my colleagues told me that during Hurricane Katrina, hundreds of patients in the Mississippi area with intrathecal delivery systems for conveying pain medications to the spinal canal were unable to be seen by their physicians. Many of the pumps ran dry during and after the hurricane because patients could not reach their doctors or the doctors could not obtain medications from the a compounding pharmacy. Patients experienced a tremendous increase in pain and many were forced into severe opioid withdrawal. 

Pain patients weren’t the only ones who suffered. Intra-abdominal pumps delivering insulin also ran dry. Thousands of patients experienced insulin withdrawal or diabetic coma. Many people with complex medical problems, including cancer, could not receive life-sustaining therapies. Some people died. 

Questions To Ask Your Doctor 

Think of COVID-19 as another natural disaster, and anticipate the same potential problems. Begin your planning immediately by talking with your doctor. Some of the questions to cover are: 

• In the event of widespread sickness and quarantines, will the doctor’s office be open?

• Can you get medicines delivered if you are not able to leave your home?

• What if your doctor is ill? Will they have someone who can fill in for them?

• How much medicine will you need to ride out a community-wide quarantine?  

Some experts recommend stockpiling additional medication in case of an emergency.  Ask your provider how they feel about that. 

How long can you last if there are supply problems and your doctor, nurse practitioner or pharmacist can't get your medication? What are your options? You may need to go to a different doctor. However, that can be problematic because fewer doctors are accepting new pain patients.

Also, if you do need to find another doctor, the prescription monitoring database may show that you have obtained medications from two or more different providers. You may be labeled as a doctor shopper. Ask your doctor how to avoid this problem. When meeting with your provider, be transparent about your concerns. Avoid panicking.

If you are infected, the virus may affect your ability to breathe. Opioids can add to breathing difficulties caused by viral infections, so be prepared to reduce the amount of your medication. Discuss with your doctor how to decrease your dose to remain safe.  

Be prepared to ask your doctor the right questions and come up with a plan together. Think of coronavirus as a serious threat, but trust that you can prepare to mitigate the harm.  

This is like war. But the invader is not a human enemy. It is an enemy of humans. It is an infection.

Lynn R. Webster, MD, is a vice president of scientific affairs for PRA Health Sciences and consults with the pharmaceutical industry. He is author of the award-winning book, “The Painful Truth,” and co-producer of the documentary, “It Hurts Until You Die.” You can find Lynn on Twitter: @LynnRWebsterMD.

Opinions expressed are those of the author alone and do not reflect the views or policy of PRA Health Sciences.

Avoiding Coronavirus: Lessons Learned From People With Weak Immune Systems

By Anna Maria Barry-Jeter, Kaiser Health News

Andrea Amelse knows hand-washing.

For the past eight years, she’s been washing her hands pretty much every time she passes a sink. When she’s near a bottle of antibacterial gel, she uses it. She makes a point of avoiding people with contagious illnesses, even though it can be uncomfortable to ask to work from home or miss a date with friends. And she makes sure she gets plenty of sleep, not always easy at age 25.

Amelse was diagnosed in 2012 with lupus, an autoimmune disease that makes her vulnerable to infections. She’s since developed pulmonary arterial hypertension, a condition that requires intravenous therapy via a central line to her heart. Both illnesses place her at heightened risk for viral and bacterial illnesses. So, she has adapted as a matter of survival, taking to heart long-standing axioms on what constitutes good hygiene.

As the highly contagious new coronavirus continues its spread through the U.S., the general public could learn a thing or two from Amelse and the millions of other Americans with weakened immune systems who already live by rules of infection control.

Whether it’s people who had recent organ transplants, people undergoing chemotherapy or people with chronic diseases, America has a broad community of immunosuppressed residents who long ago adopted the lifestyle changes public officials now tout as a means of avoiding contagion: Wash your hands, and wash them often. Don’t touch your face. Avoid that handshake. Keep your distance from people who cough and sneeze.

Amelse doesn’t follow the advice perfectly — of course she touches her face sometimes.

“You do these things unknowingly, so forcing yourself to break these habits can be challenging,” she said. But the incentive to keep getting better is there. “If you get a cold and you give me that same cold, you might get it for a week. I’ll get it for a month.”

Even with her dedication, COVID-19 is proving a daunting prospect to face. And she has a stake in Americans adopting these habits because, while the disease is relatively minor for many people who get it, it can be life-threatening for people with preexisting conditions.

Amelse works at a health literacy startup in Minneapolis that helps patients with complicated diseases learn about their illness. She knows a lot about health and how to prevent infection. Still, the threat of COVID-19 is unnerving, for her and her doctors.

Stockpile Essential Supplies

With a virus so new, official guidance on what people at heightened risk should do to steer clear of COVID-19 is limited. But the Centers for Disease Control and Prevention recently said the virus seems to hit hardest in people 60 and older with underlying health concerns. There is also concern for younger people with limited immune systems or complex diseases.

Health officials are asking those at risk to stockpile two-week supplies of essential groceries and medicines in case they need to shelter at home; to avoid crowds and heavily trafficked areas; to defer nonessential travel; and to track what’s going on in their community, so they know how strictly to follow this advice.

Infection control always follows a similar set of principles, said Dr. Jay Fishman, director of the Transplant Infectious Disease and Compromised Host Program at Massachusetts General Hospital and a professor at Harvard Medical School. The most important things for people to do right now are the things he always recommends to his organ transplant and cancer patients. Again, think hand-washing and avoiding spaces where sick people congregate.

Still, the recommendations aren’t one-size-fits-all. Some people are born with stronger immune systems, and immune deficits exist on a spectrum, said Fishman. How strict people need to be to prevent illness can vary depending on how susceptible they are.

Avoid Crowds

Recommendations also need to take into account what people can and will do, he said. Children, for example, are among the greatest germ vectors of all time, but Fishman doesn’t ask his patients with grandchildren to stay away from their young family members. “We did the transplant so you can see your grandchildren,” he might tell them.

Similarly, avoiding crowds and staying away from sick people is easy for some but can be all but impossible if you work in food service, for example. Find ways to avoid the risks and reduce them where possible.

Though there isn’t great research on how well transplant patients and others manage to prevent infection, Fishman said many of his patients don’t get sick any more frequently than the general population, despite their vulnerabilities. But when they do, the illnesses tend to last longer, be more severe and put people at higher risk for additional infections. He counsels patients to be vigilant, but also to live their lives and not be ruled by fear.

Dr. Deborah Adey, a transplant nephrologist for UCSF Health, echoed Fishman, saying she likes to find ways to help her patients carry on with their lives. A patient recently asked if it was OK to fly to Salt Lake City, and she suggested they drive instead.

Gauging the risks can be tough. Amelse was relieved when a major health conference she was scheduled to attend recently in Florida was canceled at the last minute. She wasn’t sure it was safe to travel, but it also was unclear how to categorize an important work trip: Was this essential? Nonessential?

Adey conducts follow-up appointments via teleconferencing where possible, to keep her patients out of medical facilities. Hospitals are, by design, places for the sick, and people with compromised immune systems are generally advised to avoid them and the viruses and bacteria potentially inside.

That matches advice from officials in California and other states, asking people to stay out of emergency rooms unless absolutely necessary. They are asking people, when possible, to call ahead to their doctors and stay home unless an illness is serious.

Good Hygiene

And, similar to what public officials are advising the general population, Adey does not recommend that her patients wear face masks when out in public or even at the clinic. “The only people I would recommend is if they’ve got a lot of close contact with the general public, and they can’t afford to be off work.”

While much has been made of the hoarding sprees for face masks, the empty hand sanitizer shelves are equally frustrating for Amelse. Every 48 hours, she has to mix and administer drugs she places in an IV that goes into her heart. Everything must be sanitized, and she typically gets monthly shipments of antibacterial wipes and sanitizer. If suppliers run out, she’s worried she’ll have to go to a hospital to have the drugs administered — exactly where her doctors don’t want her to be.

Officials are desperately working on a vaccine for the coronavirus for use in as little as 12 to 18 months. But many vaccines are made from live viruses and can’t be given to some immunosuppressed people.

Given the risk COVID-19 poses for people with compromised immune systems, the government needs to stress how important it is for everyone to follow good hygiene protocols, said Fishman. “The worst thing we can do is downplay it.”

And for those just getting up to speed on preventing infections, Amelse has advice: “Viruses don’t pick and choose; they will latch on anywhere,” she said. Even if it’s not a serious illness for you, “there are people in your life that you can infect. You have the obligation and the responsibility to take care of your loved ones.”

Kaiser Health News is a nonprofit news service covering health issues. It is an editorially independent program of the Kaiser Family Foundation, which is not affiliated with Kaiser Permanente. This story was first published on California Healthline, a service of the California Health Care Foundation.

Tweet Led to Dr. Kline Losing His DEA License

By Pat Anson, PNN Editor

A complaint from a woman in upstate New York launched the investigation that recently led to a North Carolina doctor losing his DEA license. Julie Roy doesn’t know Dr. Thomas Kline or any of his patients, but claimed he was dangerous and that “someone can die” because Kline believes opioids are rarely addictive.

Kline surrendered his DEA license to investigators with the North Carolina Medical Board last month.  He is still able to practice medicine but can no longer prescribe opioids and other controlled substances, leaving his 34 patients in medical limbo. All of them suffer from chronic pain and rare diseases that other doctors are increasingly unwilling to treat because they fear coming under scrutiny for opioid prescribing

“I do feel bad for the patients that were affected,” Roy told North Carolina Health News, which first reported on her role in the Kline investigation.

Roy became upset with Kline because he has been an outspoken advocate for pain patients online. Roy’s 26-year old son died from a heroin overdose and she took offense when Kline posted a Tweet last year stating that “opiates work fine without addiction potential” in 99.5% of people.    

She tweeted the North Carolina Medical Board on May 15, saying “this is a doctor that you allow to have an active license. He would love to prescribe every person on earth an opioid.”

NORTH CAROLINA HEALTH NEWS

That same day, Roy made a formal complaint with the medical board against Kline, making a series of unsubstantiated claims about the doctor.

“He is giving out information regarding opioids that is not correct and could cause harm,” she wrote. “I am very concerned as pain patients believe what he says. He says opioids are only addictive to someone who is genetically prone plus a ton of other misinformation.”

Roy even claimed that Kline might be “suffering from substance use disorder himself.”

“The man should not have an active license with his pro opioid perception. The information he puts out alone could cause harm. I would like you to verify (t)hat he is not writing opioid prescription,” Roy wrote.  

Kline Caught Off Guard

Kline responded in writing to Roy’s complaint in July, telling the medical board the information he shared about opioids was accurate and backed up by research. He also denied taking opioids or having a substance use disorder.

“Ms. Roy has lost a son to opiate addiction. Losing a child is the worst of all tragedies. This tragedy could have been avoided with the new knowledge I am presenting in my published research and public talks urging for early identification and treatment of opiate addiction to stop deaths in people like Ms. Roy’s son,” Kline said.

Because none of his patients were harmed by his prescribing and no other complaints were filed against him, Kline thought that would be the end of the matter – even when the medical board asked to review the records of nine of his patients.

Kline was caught off guard when investigators made a surprise visit to his office in Raleigh on February 17 and told him to surrender his DEA license. He did so voluntarily, not realizing at the time that it was unlikely he’d ever get the license back.  

No formal charges have been made against Kline and the medical board won’t comment on the status of the investigation — which could drag on for several more months.

Kline says he’s been able to find new doctors for a handful of his patients, but others are suffering due to untreated pain or running low on their prescriptions.

Ironically, Roy was once a pain patient herself and was on long-term opioid therapy after a failed back surgery. She told NC Health News that her pain medication stopped working, so she switched to buprenorphine (Suboxone), another opioid that’s usually prescribed to treat addiction.

Should Gabapentin Be Used to Treat Alcohol Abuse?

By Pat Anson, PNN Editor

Gabapentin (Neurontin) is so widely prescribed for so many different conditions that a Pfizer executive infamously compared it to “snake oil” in a 1999 email.

“Gabapentin is the snake oil of the twentieth century. It has been successful in just about everything they have studied,” said Christopher Wohlberg, who was a Pfizer Medical Director at the time.

Although only approved by the FDA to treat epilepsy and neuropathic pain caused by shingles, gabapentin is widely prescribed off-label to treat fibromyalgia, anxiety, depression, ADHD, migraine, bipolar disorder, restless leg syndrome and a growing number of other conditions.  

Already the 6th most widely prescribed drug in the United States, gabapentin is also being touted as a treatment for alcohol abuse.

In a small study published in JAMA Internal Medicine, researchers found that gabapentin was effective in treating patients with alcohol use disorder (AUD) – problem drinking that has become severe. Compared to a placebo, gabapentin significantly increased abstinence and reduced heavy drinking days, especially for those who suffer from symptoms of alcohol withdrawal.

“The weight of the evidence now suggests that gabapentin might be most efficacious after the initiation of abstinence to sustain it and that it might work best in those with a history of more severe alcohol withdrawal symptoms,” concluded lead author Raymond Anton, MD, an addiction psychiatrist and professor at the Medical University of South Carolina.

“Armed with this knowledge, clinicians may have another alternative when choosing a medication to treat AUD and thereby encourage more patient participation in treatment with enhanced expectation of success.”

As many as 30 million Americans have AUD, but only about a million are taking a medication to help them reduce drinking or maintain abstinence. The FDA has approved three drugs (naltrexone, disulfiram and acamprosate) for the treatment of alcohol abuse.

Side Effects and Abuse

The suggestion that gabapentin should also be prescribed for AUD comes at a time when the drug is already under scrutiny for its abuse and side effects, including an association with a growing number of suicide attempts. Patients prescribed gabapentin often complain of mood swings, depression, dizziness, fatigue and drowsiness.    

Although the CDC’s controversial 2016 opioid guideline calls gabapentin and its chemical cousin pregabalin “first-line drugs” for neuropathic pain, a recent clinical review found little evidence that either drug should be used off-label to treat pain.

Gabapentin does not carry the same risk of addiction and overdose as opioid pain relievers, but illicit drug users have discovered that gabapentin can heighten euphoria caused by heroin and other illicit opioids. Should a drug like that be used to treat addiction?

Hundreds of clinical studies are underway to find new uses for gabapentin, not only for alcohol abuse, but for a cornucopia of conditions such as obesity, insomnia, breast cancer, asthma, menopause and overactive bladder. One recent study even found that gabapentin improves sexual desire in women with vulvodynia.

Instead of finding new uses for an old medication, maybe it’s time to come up with a new drug.

Americans at High Risk From Coronavirus Urged to Stay Home

By Pat Anson, PNN Editor

A senior U.S. health official warned Sunday that Americans with underlying health conditions should avoid large crowds and not board airplanes or cruise ships because of the coronavirus outbreak. Dr. Anthony Fauci, Director of the National Institute of Allergy and Infectious Diseases, also said quarantines of infected areas in the U.S. may become necessary.

"It's possible," Fauci told host Chris Wallace on Fox News Sunday. "You don't want to alarm people, but given the spread we've seen, anything is possible, and that’s the reason we have got to be prepared to take whatever action is appropriate to contain and mitigate the outbreak."

Italy’s Prime Minister on Sunday ordered a quarantine of northern Italy, after a spike of over a thousand new coronavirus cases was reported.  Italy has recorded nearly 6,000 cases and 233 deaths, the most fatalities outside of mainland China. About 16 million people live inside the quarantine area.

"We have to be realistic," said Fauci, when asked if similar travel bans could be imposed in the U.S. "I don't think it would be as draconian as nobody in and nobody out, but if we continue to get cases like this, particularly at the community level, there will be what we call mitigation, when you'll have to do essentially social distancing: keep people out of crowded places, take a look at seriousness -- do you really need to travel? And I think it particularly important among the most vulnerable.”

Fauci says elderly people with heart disease, chronic lung disease and diabetes should avoid high-risk situations, such “crowded places, getting on airplanes, and absolutely don’t get on a cruise ship.”

‘You’re Going to See More Deaths’

The comments from Fauci and other leading health officials signaled the U.S. was shifting from a failed effort to contain the virus to mitigation, such as closing schools and cancelling large gatherings.

"Initially, we had a posture of containment so that we could give people time to prepare for where we are right now. We're shifting into a mitigation phase, which means that we're helping communities understand you're going to see more cases. Unfortunately, you're going to see more deaths. But that doesn't mean that we should panic," U.S. Surgeon General Jerome Adams said CNN's State of the Union.

“We have to implement broad mitigation strategies. The next two weeks are really going to change the complexion in this country. We’ll get through this, but it’s going to be a hard period. We’re looking at two months, probably, of difficulty,” Dr. Scott Gottlieb, former commissioner of the Food and Drug Administration said on CBS’ Face the Nation.

As of today, there are 21 deaths and 521 confirmed cases of coronavirus in at least 33 states, although the actual number is likely to be higher because testing for the virus in the U.S. has been limited. There are over 109,000 cases worldwide and 3,799 deaths.

Early information out of China suggested the chances of a coronavirus patient dying were about 2.3 percent. But last week the World Health Organization raised the fatality rate to 3.4 percent, which is far higher than seasonal flu, which kills about 0.1% of those infected.

While symptoms are mild for most coronavirus patients, the elderly and those with chronic health conditions are most at risk. A study done by the Chinese Center for Disease Control and Prevention found that people over the age of 80 have the highest fatality rate of all age groups at 14.8 percent, followed by people in their seventies (8%) and sixties (3.6%).

People with the following health conditions also have a higher risk of dying:

• 10.5% Cardiovascular disease

•   7.3% Diabetes

•   6.3% Chronic respiratory disease

•   6.0% Hypertension

•   5.6% Cancer    

According to the CDC, people at higher risk from the COVID-19 virus should stay home and “avoid crowds as much as possible.”

Dangerous New Street Drug Found in Counterfeit Painkillers

By Pat Anson, PNN Editor

A dangerous new street drug that’s even stronger than fentanyl has been found in counterfeit opioid painkillers seized during a police raid on Canada’s eastern seaboard.

Like fentanyl, isotonitazene is a potent synthetic opioid that is many times stronger than heroin or morphine. In recent months, isotonitazene was detected in over a dozen overdose deaths in Illinois and Indiana, where it was mixed with cocaine. The drug has also recently been found in New Brunswick and Alberta, and has been connected to at least two overdose deaths in Calgary.

Now it is being used to make counterfeit pain medication.

Police in Halifax, Nova Scotia seized 1,900 white tablets from a Halifax home last month while conducting a drug investigation. The pills were sent to Health Canada for a laboratory analysis, which confirmed the tablets were made with isotonitazene.

The pills have an “M” on one side and the number “8” on the other side – making them virtually identical to an 8mg Dilaudid (hydromorphone) tablet.

SOURCE: HALIFAX POLICE

“The appearance of the pill may lead people to believe they are consuming a different drug. Given the potency of the drug, a person may need several doses of naloxone to counter an overdose caused by isotonitazene,” Halifax police said in a statement.

No overdoses have been linked to isotonitazene in Halifax, but police are urging anyone who consumes the pills to seek immediate medical attention.

The Center for Forensic Science Research and Education released a public safety alert last November, when isotonitazene was first linked to overdoses deaths in the Midwest.

“Pharmacological data suggest that this group of synthetic opioids have potency similar to or greater than fentanyl based on their structural modifications,” the alert warns. “The toxicity of isotonitazene has not been extensively studied but recent association with drug user death leads professionals to believe this new synthetic opioid retains the potential to cause widespread harm and is of public health concern.”

Although law enforcement and public health officials have only recently become aware of the threat posed by isotonitazene, illicit drug users have been warning each other about isotonitazene for several months in online message boards.

“I wanted to let the community know that the potency is far above the 60x morphine that's listed online. Everyone should be VERY careful when handling this compound,” one poster warned on Reddit.

Being Taken Off Methadone Is Inhumane

By Wendy Cooper, Guest Columnist

I am a pain patient and diabetic entering my second week of detox.  My doctor will no longer prescribe methadone because he’s afraid of being targeted by the DEA for not following the “voluntary” CDC guideline.  He said they are putting doctors in prison by the hundreds and it’s just no longer worth the risk. 

I was on methadone for years.  I am also a gastric bypass patient, so I will not be able to take any type of NSAID (non-steroidal anti-inflammatory drug) for pain. 

When my doctor first suggested methadone I was totally confused.  I told him, “But wait, that’s for drug addicts.”  Well it is, but it’s also very effective for pain control.  After taking it for a month I was so happy.  It totally handled my pain and I didn’t have all of the other side effects, like making me sleepy and lethargic.  My mind was clear. I had my life back.  Yes, for many methadone works.  Sadly, it used to work for me, too.  

I am now back on insulin every day due to the pain, after having been off of insulin for years. Methadone did that.  It started the ball rolling in a positive direction. I was able to exercise more and take care of my family, because the pain relief helped get my diabetes under control. Not anymore. 

Supposedly the danger is because methadone, which has been around for over 50 years, has an effect on the respiratory system.  Well, this is true of many medications if they are not taken correctly.  If I take too much of my insulin, it will have an effect on my respiratory system too — as in me not breathing at all because I will be dead. 

Tons of medications have dangerous side effects if not taken properly.  What used to happen is you would weigh the benefits and the risks with your physician and then the patient would make an informed decision. 

WENDY COOPER

Why does the government have the right to take away medication that has changed my life for the better?  Why am I being treated like a child by assuming I will not take my medication correctly?  I can’t think of any valid reason for this except MONEY.  Methadone is $35 per month, while buprenorphine (Suboxone) is close to $300. 

Buprenorphine is not a good fit for pain patients.  We are much more likely to go to the emergency room for an acute event than non-pain patients.  What will they give us for pain? 

It’s my understanding that pain medications are complicated when you are facing surgeries while on buprenorphine.  I have four surgeries scheduled this year.  Am I supposed to wean myself every time I get ready for one of my surgeries? 

I always felt safer from any type of addiction issue because methadone took away the “feel good” effects of Percocet.  If I hurt myself, I could take a Percocet and it would help with the additional pain. 

I don’t have an addiction problem, but like most pain patients I am concerned about developing one. I’ve always felt it is my responsibility to take precautions and govern myself with my own guidelines.  Well, that benefit is gone.  I don’t want to live anymore. This is inhumane. 

Wendy Cooper lives in Florida.

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

Canada’s Chronic Pain Task Force Surveying Patients

By Marvin Ross, Guest Columnist 

In typical government fashion, the Canadian Chronic Pain Task Force continues to delay taking a stand on the plight of pain patients by initiating a new survey, while still blaming doctors and patients for the opioid crisis. 

The Task Force was established last year to help Health Canada better understand the needs of chronic pain patients. Their preliminary report in June found that anxiety and fear about opioids were causing pain to go untreated:

“Some Canadians have been unable to access opioid medications when needed for pain and function. Others have faced undue barriers to obtaining or filling their opioid prescriptions, and some have had their opioid dose abruptly lowered or discontinued. This has resulted in unnecessary pain and suffering, and has led some Canadians to obtain illegal drugs to treat their pain. We must do more to strike the right balance – to promote opioid prescribing practices that balance the benefits and risks of these medications based on the individual needs of each patient.”

Those initial findings were consistent with the results of a survey of over 700 pain patients conducted by the Chronic Pain Association of Canada (CPAC). That survey found that nearly half of Canadian patients had their pain medication reduced, many were in much greater pain, had severely diminished quality of life, lost doctors or had poor relations with them, attempted suicide or turned to street drugs for help.

At that point, the Task Force response should have been to make recommendations to reverse those negative impacts on patients. Two evaluations that replicate each other should be sufficient to take action to relieve the suffering caused by Canada’s 2017 opioid prescribing guideline.

But that is apparently asking too much as they've decided to do another survey through invitations to their online questionnaire. These are the key questions: 

• What challenges and barriers to understanding, preventing, or managing pain exist in your community and in Canada?  

• What needs to be done to respond to these challenges and barriers? 

• What is working to address pain in your community and in Canada? Please provide specific examples of practices and/or activities. 

• What is it about these practices/activities that makes them successful?  

• What should be the 3 top priorities for research in pain from your point of view?  

• What would help to better integrate research and new knowledge into education and training, policy, clinical practice, and everyday life?  

• What other strategies would help us to better understand, prevent, and/or manage pain in Canada?

Well, the main barrier to managing pain is the adherence by doctors to the prescribing guideline and their fear of losing their medical licenses if they don’t. Nothing will restore functioning to those impacted without rescinding that. The rest of the questions are inane. 

Where Is the Evidence?

As I pointed out in an earlier PNN article, Health Canada implemented the guideline based on weak evidence that the increase in opioid deaths result from inappropriate prescribing by doctors and misuse by patients. PNN columnist Ann Marie Gaudon attempted to obtain the research that Health Canada used to justify their claims and it was like pulling teeth, as you’ll see in this phone call. 

When the research was finally obtained, it didn’t prove a link between prescribing and overdoses. When CPAC sent them a critique of their studies, Health Canada replied that they have much more evidence, but then ignored requests for copies. CPAC has submitted a Freedom of Information request and is waiting for a response. 

Health Canada and the Chronic Pain Task Force continue to base their work on the many myths and misperceptions associated with opioid prescribing, which were debunked in a review recently published in Pain Management Nursing.  

A policy based on faulty logic to solve a problem (addiction and opioid overdoses) caused a new problem by condemning innocent people to unnecessary pain and suffering. Meanwhile, the original problem only grows worse. It is time to go back to the drawing board and accept what every Sociology 101 student knows. There are unintended consequences. Until that happens, nothing will be improved for anyone.   

But then, to make matters worse, this week Health Canada announced nearly $3 million in funding “to help people living with chronic pain.” Most of the money will apparently be spent on treating and preventing addiction, not treating pain. Saskatchewan will get $1.7 million from the Substance Use and Addictions Program and Alberta will get $1.2 million to “improve care delivery including opioid prescribing practices.” 

Health Canada does not seem to be able to distinguish between people with chronic pain and those with substance abuse problems. They are not the same and it is insulting to combine them. It is time that Health Canada learned to distinguish between dependence and addiction. 

Marvin Ross is a medical writer and publisher in Dundas, Ontario.

DEA Warns Doctors About Extortion Scam

By Pat Anson, PNN Editor

It’s no secret that doctors are under increased scrutiny from the Drug Enforcement Administration and other law enforcement agencies for their opioid prescribing practices.

Last month a North Carolina physician was told to surrender his DEA license by investigators with the state medical board. “They called me on the phone and said they were coming by in two hours to get you to surrender your license,” Dr. Thomas Kline told PNN.

In southern California, a doctor who recently paid a $125,000 fine to settle allegations of illegal opioid prescribing says federal prosecutors threatened to ruin his practice and reputation if he didn’t pay up.

“They could care less if I was innocent or guilty. They wanted to see how much they could gouge out of me,” said Dr. Roger Kasendorf, an osteopathic physician in La Jolla. “It was extortion and there’s nothing I was able to do about it. It’s sad and pathetic.”

It didn’t take long for criminals to realize that other doctors could be vulnerable to extortion. And with no small amount of irony, the DEA’s San Diego Field Division recently issued an unusual alert warning doctors about scam telephone calls from con artists posing as DEA agents, who threaten physicians with arrest and prosecution for violations of federal drug laws.

“DEA continues to receive reports of calls threatening legal action if an exorbitant fine is not paid immediately over the phone. The callers identify themselves as DEA personnel and instruct their victims to pay the ‘fine’ via wire transfer to avoid arrest, prosecution and imprisonment,” the DEA alert warns.

The scam artists – who use fake names, DEA badge numbers or even the actual names of senior DEA officials – threaten to revoke DEA licenses if thousands of dollars are not paid by wire or in untraceable gift cards.

The threat is not an idle one, because doctors cannot prescribe opioid medication and other controlled substances without an active DEA license.

“DEA employees do not contact practitioners or members of the public by telephone to demand money or any other form of payment,” the DEA said. “Notification of a legitimate DEA investigation or legal action is made via official letter or in person.”

The alert urges anyone receiving a telephone call from a person claiming to be a DEA employee demanding money to report the threat using DEA’s online form or by calling 877-792-2873.

Stem Cell Trial Significantly Reduced Osteoarthritis Knee Pain

By A. Rahman Ford, PNN Columnist

A small clinical trial has shown that a single injection of autologous stem cells derived from a patient’s own body fat can significantly reduce osteoarthritis knee pain for up to a year with no serious side effects, according to findings published in the American Journal of Sports Medicine.

A total of 39 osteoarthritis patients participated in the Phase 2 placebo-controlled trial. Some participants received injections into their knees of stromal vascular fraction (SVF) cells derived from adipose fat tissue, while others received placebo injections.

"Our randomized, controlled clinical trial is the first cellular therapy study for osteoarthritis to meet study endpoints using autologous adipose stromal cells for a point-of-care therapy. Eighty-eight percent of subjects responded greater than placebo at one year and reported a median 87% improvement in pain, stiffness and function," said William Cimino, PhD, CEO of GID BIO, which funded the study. GID BIO develops cellular therapies for degenerative musculoskeletal, dermal and other chronic diseases.

SVF therapy is controversial because it is not yet FDA-approved. Some stem cell clinics currently using SVF therapy are in the crosshairs of the FDA, with ongoing federal litigation in Florida and California. That’s what makes the new study findings significant.

"Publishing this data signifies real science and a breakthrough in regenerative medicine. We've completed a prior safety trial, an FDA-approved Phase 2b trial, and are now beginning a Phase 3 pivotal trial. Physicians will be able to use the SVF-2 technology to provide a cellular therapy option for patients," said principal investigator Jaime Garza, MD, Professor of Orthopedic Surgery at Tulane University School of Medicine.

Interestingly, Garza is a former star football player at Tulane whose fledgling NFL career was cut short by nagging knee injuries. As PNN has reported, regenerative cell therapies are increasing in popularity among NFL players and other professional athletes, who often have chronic pain from lingering injuries.

Knee osteoarthritis (OA) is the most prevalent joint disease in the United States, affecting nearly 1 in 5 Americans aged 45 years and older. Since the mid-20th century, knee OA has doubled in prevalence, due primarily to age and obesity. Women are more likely than men to have knee OA and have more severe pain.

Total knee arthroplasty – a procedure that attempts to restore function by resurfacing the knee joint – is the only surgical intervention for knee OA. Other treatments include anti-inflammatory medications, physical therapy and steroid injections.  The FDA is also considering a new drug application for tanezumab, a biologic drug that blocks pain signals from reaching the brain.

“While current nonoperative modalities can offer symptomatic relief, these treatment modalities often fail, ultimately leading to knee arthroplasty. There is a need for more effective nonoperative knee OA treatment modalities, especially ones that may arrest or even reverse disease progression,” wrote Garza.

A. Rahman Ford, PhD, is a lawyer and research professional. He is a graduate of Rutgers University and the Howard University School of Law, where he served as Editor-in-Chief of the Howard Law Journal. Rahman lives with chronic inflammation in his digestive tract and is unable to eat solid food. He has received stem cell treatment in China.

11 Myths About the Opioid Epidemic

By Pat Anson, PNN Editor

If you’re a journalist, researcher or student interested in learning more about the opioid epidemic – or a patient or healthcare provider just trying to make sense of it -- a revealing new analysis debunks many of the myths and falsehoods being told about opioid pain medication.

“Misperceptions about the Opioid Epidemic: Exploring the Facts” was recently published in the journal Pain Management Nursing. Unlike most articles in medical journals, this one is not hidden behind a paywall – so the comprehensive and heavily footnoted research is available to everyone for free.

Co-authors Cathy Carlson, PhD, a professor at Northern Illinois School of Nursing, and June Oliver, APRN, a clinical nurse pain specialist at Swedish Covenant Hospital in Chicago, worked on the article for over four years, compiling research on 11 common myths about opioids that are repeated ad nauseam by the media, politicians, law enforcement and others.   

“We identified many more than this, but you have to put a limit on how long an article can be, so we narrowed them down to what we thought were the most important ones,” Carlson told PNN. “What concerned us is that this is all being presented by politicians and other important entities. It's just perpetuating the fear and sensationalizing it.”

Misperception #1 is the number of deaths attributed to opioid medication. The next time you see a statistic reported like “more than 63,600 people died of drug overdoses” in 2017, you should recognize that thousands of deaths were counted multiple times.  That’s because the Centers for Disease Control and Prevention doesn’t count “deaths” – it counts the number of drugs involved in overdose deaths.

The actual number of Americans who died from opioid overdoses in 2017 was not 63,000 – but about 49,000.

“If a person died of fentanyl, heroin and prescription opioids, that’s three deaths. We went from one person that actually died to three deaths counted in the categories because they put one under each,” explained Carlson. “It’s never known which drug they actually died from. So, we can never say prescription opioids caused the death. We can only say they were present at the time of death.”

Another myth is that more Americans die from opioid overdoses than in motor vehicle accidents, a claim first made by the National Safety Council (NSC) that’s been widely repeated in the media.  

“The opioid crisis in the United States has become so grim that Americans are now likelier to die of an overdose than in a vehicle crash,” The New York Times reported.

Carlson and Oliver say the NSC used a “confusing mismatch of statistical categories” to inflate the overdose numbers and make them more “attention grabbing.”

What are the actual facts? Nearly 30,000 Americans died in motor vehicle accidents in 2014, but the number of prescription opioid deaths was about half that.

“It doesn’t make as good of a story if you include it. We do believe it is purposely misleading,” says Carlson. “It’s the change theory. They have this need for change and they’re supplying it with statistics that sensationalize the issue.”

CDC’s Anti-Opioid Bias

Some of the other myths debunked by Carlson and Oliver include claims that the U.S. is the biggest consumer of opioids; that long-term use of opioid medication is not supported by evidence; that prescription opioids often lead to heroin use; and that statistics published by CDC are of high quality.

“We have a lot of issues with data collection. It’s not the CDC’s fault, they can only use what’s given to them. And states vary considerably in their accuracy in keeping statistics for overdose deaths,” Carlson said. “We’d like to see better data collection, especially through state and county medical examiners, so the statistics reported by the CDC are more accurate.”

But the CDC is not held blameless for the cascade of misinformation. Carlson says the agency has an anti-opioid bias that is repeated in many of its studies and policy statements.

“If you read what they do publish, they obviously have a viewpoint. It’s not a neutral viewpoint that gives you both good and bad. They are pushing you in a certain direction,” she said.

The CDC’s controversial 2016 opioid guideline – intended only for primary care physicians treating non-cancer pain – has been implemented as policy or law in dozens of states.

“I’m disappointed in what has occurred with CDC guidelines. Many people question the guidelines and that they weren’t always based on evidence,” Carlson said. “They were meant for primary care providers, not for pain management specialists, not for surgeons, and they’re making them apply to everyone. They are supposed to be guidelines. There are always people out on the Bell Curve and they don’t take that into consideration either.”

Carlson says Americans should be cautiously skeptical about much of the information they’re getting about the opioid crisis.  

“We’re mostly asking for discernment. To be aware of what you’re reading,” she said. “We want you to think about these statistics and look at the glaring gaps and reporting of statistics.”