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Monday, June 27, 2016

Comments

Well done, Dr. Albanese. It is important also to not let the rehab process be shame based with an all or nothing approach to recovery. And please, as part of any discharge from abstinence-based rehab, it is not "enabling drug use" to remind patients that their tolerance has gone way down. What they used to be able to handle (more or less) might be fatal.
Rivkah Lapidus, Ph.D. LMHC
psychotherapy, art, harm reduction and moderation
rivkahlapidus.com

I couldn't agree more. I have seen a pcp suddenly stop prescribing an opioid for a patient who had taken them for a long time for diabetic nerve pain, in a panic about the opioid crisis. My patient had weaned herself off of Percocet, the pcp then cut off the fentanyl patch. It felt punitive to the patient, and sent her into withdrawal. There has to be a more reasonable approach.

Yes. Compassion: More powerful than any opioid will ever be. And any addiction treatment without it at its core, is doomed to fail. Dr Ron Bergman

'Overprescribing doctors' are largely an invention of the White House ONDCP and DEA. These bureaucracies are experts at finding scapegoats (today it's the doctors) for the failures of their drug war (in this case an increase in opioid overdoses and associated harms). They will shift the blame wherever possible.

Up until recently the ONDCP were vehemently opposed to the distribution of sterile injecting equipment and the lifesaving overdose reversal drug naloxone. They made no secret of this and it is all on public record e.g.

"Dr. Bertha Madras, deputy director of the White House Office on National Drug Control Policy, recently told National Public Radio she opposes the distribution programs because—and hold on to your hat for this one—she believes life-threatening overdoses are an important deterrent to drug use.

"Sometimes having an overdose, being in an emergency room, having that contact with a health care professional is enough to make a person snap into the reality of the situation and snap into having someone give them services," Madras said." http://www.foxnews.com/story/2008/02/25/straight-talk-should-tax-dollars-be-used-to-help-drug-addicts-avoid-overdoses.html

"There is no federal funding for needle-exchange programs. The White House Office of National Drug Control Policy opposes them." http://usatoday30.usatoday.com/news/nation/2006-10-02-nj-needle-ban_x.htm

I now watch on in awe as the ONDCP and DEA scramble to blame doctors when this mess unfolded ON THEIR WATCH. For Pete's sake the DEA are the ones who set the annual production quotas for opioids! Between 1993 and 2015, the DEA rubber stamped continuous increases in opioid production (which jumped from 3.5 tons to 150 tons in this period): https://www.washingtonpost.com/news/powerpost/wp/2016/06/23/is-dea-a-bad-guy-in-opioid-addiction-fight/

Mark, you cover a lot of ground and you cover it well. Your hope on behalf of patients comes across as well as your compassion. We need more voices like yours.

Ed Khantzian

Thank you for bringing to light the importance of hope and compassion, that such knowledge is truly at the very heart of caring for our patients. Maurene Merritt, RN

In all of this the problem not ever addressed never spoken about is honest not addicted suffering pain patients by those that refuse to understand what we are dealing with. While addicts continue to use & even go to the doctors to get long term opioids they blame for the problem. Pain patients are taken off long term treatment left to go to the streets or suicide for our pain relief. As it continues only getting worse for those on long term treatment with opioids. Those that have been successful without any problems with abuse or addiction. We are being forced off our treatments but the problem is the pain opioids relieved gave us better quality lives is completely ignored. Our pain does not magically go away after years decades just because opioids are not being prescribed anymore. We are being forced to suffer it is inhumane a cruel torture. When pain patients are cut off flat and die of unrelieved pain and withdrawal that is causing heart attacks & strokes. It has happened over & over in members of our pain groups but no one publishes those tragedies. Are we being ignored so when the death toll of pain patients gets so high they can't ignore it anymore they can claim they had no idea we were suffering & dying? What are we to do? My pain doc of 10 years provided high dose opioids for 10 years with no problem. Now I feel I am looked at like a stranger like I have been doing something wrong. The ins is cutting me off after 10 years of treatment & putting my life in danger all & only because of other peoples abuse & addiction problems. It's not because of anything i have done my medical record is clean of any wrong doing ever. All have ever had was a speeding ticket but treated like we are criminals. Can someone please explain I am at a loss how can pain doctors suddenly not back up their own treatments? How & why do pain patients have to be expected to live in so much pain now? It's the same life altering life destroying leaving you crippled curled up in a ball of misery on your bed kind of pain that got us put on opioids in the first place? If we weren't in so much pain we wouldn't have been taking these meds. The discrimination before was bad but now we are looked at like dirt. No one would choose this life living in pain is torture but without any pain relief that torture will be more then I can handle so what can I do? What are all of us being abandoned through no fault of our own supposed to do? We don't have the time to wait. We are suffering every minute that's like an hour everyday & dying before we would have in misery. How long before they decide enough of us have suffered died & killed ourselves to relieve our pain? How long till they realize they have caused the wrong people to be punished all because of other peoples actions? If pain patients would have gotten relief from all the other treatments they claim are better we would be doing it. All the trials with treatments we had to go through first before even being offered opioids for pain relief. We would have done it & I would beliving my life instead of trying to figure out how will we survive it, but none of those gave adequate enough relief. We have always been at the mercy of our doctors & public opinion and now that heavy hammer has fallen all the mercy empathy compassion is gone and we are left with nothing. If you have any suggestions for all of the legitimate suffering pain patients in our country they would be helpful We are desperately looking for an answer to our epidemic of untreated pain killing us by body failure & suicide when we can no longer wait for our bodies to fail on their own. We would be thankful for any help because our government is not listening the public can't see beyond saving the addicts. We need help yesterday. Why didn't anyone consider we need to have a working medication to replace opioids before we take it away? They wouldn't take heart patients or kidney or diabetic patients medicine away they are dependent on without a working alternative to replace it. But pain patients were not considered they just took it away even though they had nothing to offer to replace it. I think they should restore all pain patients with medical records showing improved quality of life make a better medication that is equal & works as well as opioids to replace opioids and then we will happily give back all opioids, but I don't imagine that will happen.

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