Thursday, August 3, 2017

Beware, Pain-Sufferers Jeff Sessions Is Coming for Your Doctor

Beware, Pain-Sufferers Jeff Sessions Is Coming for Your Doctor

A new push to imprison those who prescribe too many opioids


This article from Reason Magazine says Today Sessions announced a new task force devoted to fighting opioid overdoses by going after doctors who overprescribe the drugs. He's not even trying to sugarcoat it—he wants to put doctors in prison cells.

The bad news is patients and physicians will suffer. The good news is apparently Arizona doesn't have an opioid problem as it's not included in the Arizona U.S. Attorney's District.

In Sessions speech he said: "This sort of data analytics team can tell us important information about prescription opioids—like which physicians are writing opioid prescriptions at a rate that far exceeds their peers; how many of a doctor's patients died within 60 days of an opioid prescription; the average age of the patients receiving these prescriptions; pharmacies that are dispensing disproportionately large amounts of opioids; and regional hot spots for opioid issues"

The problem comes when primary care physicians and pain management specialists are considered peers. Obviously pain management specialists will write opioid prescriptions at a rate that far exceeds a primary care physician.

Lets face the facts, there aren't a lot of pain management specialists so pharmacies that are dispensing disproportionately large amounts of opioids may simply be close to a pain management specialists.


The following districts have been selected to participate in the program:
  1. Middle District of Florida,
  2. Eastern District of Michigan,
  3. Northern District of Alabama,
  4. Eastern District of Tennessee,
  5. District of Nevada,
  6. Eastern District of Kentucky,
  7. District of Maryland,
  8. Western District of Pennsylvania,
  9. Southern District of Ohio,
  10. Eastern District of California,
  11. Middle District of North Carolina, and
  12. Southern District of West Virginia.

Wednesday, August 2, 2017

Suicide and Pain: The Silent Epidemic

I've been saying the opioid crisis is becoming a pain crisis for many pain patients. I fear like back in the 1990's we are going to have more pain patients giving up the fight.

Article in Pain Medicine News Suicide and Pain: The Silent Epidemic

PLEASE contact the suicide prevention hotline should you be considering harming yourself. The help is free and confidential. Call the National Suicide Prevention Lifeline at 1-800-273-TALK (8255).


Thursday, July 27, 2017

There Really are Good Pin Doctors Here's Some Great Information on Pain from Dr Forest Tennant

 There are good pain management physicians who really care about their patients and stand up for them.

One of these physicians is Dr Forest Tennant one of the nations leading pain management specialists.

These links below have great information on pain management for both pain patients and pain management physicians. They contain what self care patients can do, and what to do while looking for a pain management physician.

Here's a recent article in Reason Magazine Meet the Doctor Who Refuses to Stop Prescribing Opioids to Pain Patients

This is a list of articles in Pain Journals from Dr Tennant 

Dr Tennant's Patient Instruction Guides

Hormones and Pain Care A great page for patients and physicians on why pain patients need hormone testing.


The Doctor Patient Relationship is one of the most important relationships in your life.....

The doctor patient relationship is one of the most important relationships in your life. Your life literally depends on the doctor you choose. Medical errors by physicians is the 3rd leading cause of death in the US

The doctor patient relationship depends on trust. Your doctor needs to trust the things you tell them about your medical problems are the truth. You need to trust that your doctor tells you the truth about your medical problems. This is especially important in the doctor patient relationship as apposed to other relationships in life.

If a banker stock broker or even your wife lie to you it can cost you money and break your heart, but a broken heart will heal in time. If your doctor lies to you about your condition or medications, it can end your life.

You need to not only trust your doctor has the medical knowledge and experience to care for your medical needs, but will always tell you the truth and make decisions in your best interest. All medications prescribed should be judged by the same standard. 

Any medication, procedure, or surgery must be medically The physician also needs to explain the risk vs the benefits to the patient, NOT the risk vs the benefits to the physician.

Recently many pain management physicians are telling patients about a nonexistent DEA mandate to lower pain medication doses.

The problem is they have no medical justification for lowering the dose. They tell patients they received a letter from DEA mandating lowering opioid doses, or that DEA came by the office and told them to lower doses. 

This is a flat out lie, DEA investigations in Washington tells me that DEA does NOT tell physicians what or haw to prescribe medications, and would NEVER stop by a physicians office and tell them what to prescribe.




Wednesday, July 26, 2017

Educated Pain Patient or Drug Seeker?

How do physicians tell the difference between a patient with chronic pain and a drug seeking patient? It's difficult even for experienced pain management physicians. Some of DEA's recommendations on spotting drug seekers make it difficult for patients who have dealt with pain for many years and know what works and what doesn't. SEE Recognizing the Drug Abuser below

A patient that's suffered chronic pain for many years has been through it all with doctors, tests, and medications. Usually when a patient goes to a new primary care physician they tell them what medications they take and why.

If a pain patient knows what medications they've used in the past or are currently taking that work, the physician looks at the DEA Drug Abuser Profile it says "May show unusual knowledge of controlled substances". In other words tell the physician they take opioids and you're an instant suspect.

Physicians are taught (since the very beginning of medical school) that any patient requesting pain medication is to be Scrutinized" and to be "Wary" of them especially if they tell you they can't take anti-inflammatory drugs, that is a sure "SIGN" of addiction.

NSAID's are also what put me in the emergency room throwing up blood. Then there's the fact that NSAID's kill 17,000 people a year in the hospital, and we don't know how many from OTC NSAID's. As an EMT we could diagnose a GI bleed from the front door, it's not something anyone should go through.  

And God help you if you have nerve damage at L5 S1 like I do. When a pain patient tells a physician that their big toe and the next one is numb, or the outside three toes are numb and edge of your foot gets shooting pains. DEA says these are textbook symptoms, and something to watch out for.


In 1996 the Kingman neurologist who did my nerve conduction study spent half an hour lecturing me and telling me nobody in Kingman would give me opioid pain medications. 

Then he did the nerve conduction study. He said "it was textbook" for L5 S1 nerve root damage, and gave me a prescription for opioid pain medications...... Wow... Now medical textbooks are wrong, or right?

No wonder pain management physicians are confused...




If the article below wasn't true, it would be funny.....

D.E.A. Defines Drug Seeking – Try not to Laugh

This is from http://recoveryrocks.bangordailynews.com/2013/09/03/addiction/d-e-a-defines-drug-seeking-try-not-to-laugh/

Recognizing the Drug Abuser

  • Unusual behavior in the waiting room;
  • Assertive personality, often demanding immediate action;
  • Unusual appearance – extremes of either slovenliness or being over-dressed;
  • May show unusual knowledge of controlled substances and/or gives medical history with textbook symptoms OR gives evasive or vague answers to questions regarding medical history;
  • Reluctant or unwilling to provide reference information. Usually has no regular doctor and often no health insurance;
  • Will often request a specific controlled drug and is reluctant to try a different drug;
  • Generally has no interest in diagnosis – fails to keep appointments for further diagnostic tests or refuses to see another practitioner for consultation;
  • May exaggerate medical problems and/or simulate symptoms;
  • May exhibit mood disturbances, suicidal thoughts, lack of impulse control, thought disorders, and/or sexual dysfunction;
  • Cutaneous signs of drug abuse – skin tracks and related scars on the neck, axilla, forearm, wrist, foot and ankle. Such marks are usually multiple, hyper-pigmented and linear. New lesions may be inflamed. Shows signs of “pop” scars from subcutaneous injections.
Now, for all that the D.E.A may be on top of, one thing is certain:  grammar is not their specialty. I cut and pasted the bizarre number of semicolons directly from their site.  
Given the D.E.A’s antiquated and stereotypical findings, how are we to convey our needs to prescribing physicians and clinicians without creating the appearance of drug seeking?
Jim’s Corresponding Do’s and Don’t’s for Reporting Pain & Ensuring DEA compliance:
·         Ok – nobody knows for sure what “unusual behavior” is so everybody be cool and ACT NORMAL! (while experiencing high levels of pain)
·         It seems assertiveness is bad. Please stop advocating for yourself just do what they say....
·         Ok – let’s not look bad when we’re in excruciating pain and don’t go showing up at the ER wearing your Sunday best.
·         Stop reading WebMD immediately. You might learn too much about your health conditions and appear sketchy
·         Ok – bad news: being poor and not having a PCP or health insurance just became suspicious.(Wow, really?)
·         If you have a chronic pain condition – something really scandalous like being an above the knee amputee, don’t explain that you know which meds work for you and which do not. It’s important that the doctor do trial and error each time.
·         Feign interest in the medical terminology your doctor lodges at you. Don’t just take the discharge papers home and call the medical professional you’re distantly related to from home. Hang on every word your doctor rapidly spews as though it’s fascinating.
·         No exaggerating! Describe your high pain levels in um, reasonable ways…
·         Mood disturbances are bad – no mood swings as you sit in the ER for 4-6 hours. If you’re feeling suicidal, don’t tell anyone. If you’re having sexual dysfunction get online and order meds like everyone else.
·         Ok. I concede the final point. If you’re showing up with track marks; it’s beyond time to get help.

Sunday, July 2, 2017

Someone Asked Me What It Was Like To Have Chronic Pain

Unless you have chronic pain most people just don't understand chronic pain. Yep God made us that way. You see God was pretty smart when he us made humans. We can remember something hurt, but not the actual pain. If we could I'm pretty sure there would be a lot more single child family's.

We all have pain from time to time, but that's acute pain. It hurts, but it only last a few minutes to a few weeks and it's gone. The pain it's self fades and over time and the memory of the pain fades until you say, ya getting thrown from that 2000 bull did hurt, but it wasn't that bad.

Chronic pain on the other hand go on day after day, you go to bed with it, and you wake up to it. It affects aspect of your life you can't even imagine. Little things like being able to pick up your grand kids to fixing simple things around your home others think nothing about.


If you're one of those people who think someone with chronic pain can just buck up and get over it, give this a try. 

Take two small vice grip pliers, clamp one on the side of your foot behind your little toe. Now take the other vice grip and hook them on your foot near your heal. Make sure they're nice and tight, now keep them on for a week. Let me know how that goes, oh wait.

You need to understand neuropathic pain too. So take a cord from a lamp about 6' long and cut it off. Split the wires and hook one side to one of the vice grips, and the other side to the other vice grip. Now plug it into 110v for 2 to 5 seconds every 5-10 minutes during the day, all day, every day. Now you understand....

Most people won't tell you these things, because the first thing you learn about pain, is that nobody really want's to hear you hurt.

When you hurt all the time it wears on you, you just get tired of hurting. When you add fighting with pain doctors who listen to rumors and fake news rather than the CDC, FDA, or DEA.

Then there's the pharmacists who look at everyone on pain medications as drug addicts or junkies.... One pharmacist at Safeway told me all pain management doctors should be locked up..... 

Many times the last straw is when the pharmacy tells you time and time again, sorry your medicine won't be in until next week....



Friday, June 30, 2017

A Letter To Governor Ducey on Opioids Problem

Governor Ducey June 30th 2017

I fear the violence we saw at the Las Vegas pain clinic on Thursday will be coming to Arizona soon. What physicians are doing to thousands of pain patients is wrong and will cause more pain and suffering, and I’m sure more suicides and violence will follow.

Physicians like Dr Benjamin Venger are reducing patient’s medications based on fake news and without medical justification leaving patients to turn to the street for illegal drugs, or end the pain like the patient Thursday.

At my last visit May 26th with my pain management physician Dr Benjamin Venger in Fort Mohave he tried to reduce my medications again like he has to all his patients, again I told him DEA didn't do it.

I told Dr Venger that I had spoke to DEA in Washington D.C., and the agent said DEA does not tell physicians what or how much medications to prescribe, and “that any change to a patient medication must be based on medical necessity and not on policy”.

When I told Dr Venger that the 2016 CDC pain treatment guidelines were for primary care physicians, not pain specialists, I was stunned by his answer. Dr Venger said “I know, but its gone social now”.

I have no idea what a subject “going social” has to do with the medical treatment of patients. When I told people at DEA, the FDA, and the CDC that physicians were lowering patient doses because of “social media” and not medical necessary many were speechless.

The Director of the CDC’s National Center for Injury Prevention and Control Dr Debra Houry said in her response that the CDC “believes patients deserve safe and effective pain management. The Guideline also helps providers and patients—together—assess the benefits and risks of opioid use”

Dr Hourly went on to say “the recommendation to taper or reduce dosage is only for when patient harm outweighs patient benefit of opioid therapy”. 
Reducing the dose of opioids without regard for tolerance, dependence or medical necessity as individual patient is NOT in line with the 2016 CDC pain guideline.

As the benefits of opioid therapy outweigh the risks for many individual patients’ physicians must document the medical necessity of any dose reductions or they need to face disciplinary action when patients harm themselves or others because of lack of pain control.

It’s sad when someone abuses opioids and overdoses.
It’s tragic when a pain patient must take their life for lack of proper pain management.

Jay Fleming, Speaker
Dolan Springs Arizona
Law Enforcement Action Partnership
Advancing Justice and Public Safety Solutions

LawEnforcementActionPartnership.org

Thursday, June 15, 2017

Overdoses Will Continue to Rise Along With Pain Patient Suicides in 2017

As physicians reduce the doses without medical justification for long time opioid patients who have built a tolerance over years patients will be forced to the street or worse, give up the fight. 

We need to monitor the death of any patient who has been under the care of a pain management physician within the previous year. 

It's to easy to write off a pain patients who overdoses as an abuser, when the real reason is they were not given enough medication to control their pain, so they save enough to end the pain.

Pain management physicians like the one I see are reducing patients doses even thought it goes against recommendations in the FDA 2016 Pain Guidelines.

When I told my pain management physician that DEA had no mandate to reduce medications, and what he was referring to was a 2016 CDC pain guideline for family practitioners, not pain specialists. He said that "he knew, but now its gone social”.

Like somehow what DEA and the FDA were saying meant nothing and social media was telling physicians what and how to prescribe medications.

First it's fake news and now physicians are ruled by social media rather than medical boards the FDA and DEA. 

The United States has a little over 300,000,000 people, 100,000,000 suffer chronic pain on a daily basis, and we're getting older. Most people I talk to are not afraid to die, they are afraid to die in pain.









Thursday, May 18, 2017

Do You Know the Difference Between Addiction Tolerance and Dependence? Some Physicians Don't

It's important the public understands these two things about opioid use.

First that anyone who takes opioid medications for over a week or so will develop tolerance and physical dependence. 

The second thing is that tolerance and physical dependence alone does't mean someone is addicted. 

It's critical that physician's not confuse tolerance and physical dependence in pain patients with addiction. Many physicians either don't understand this fact, or choose not to treating many pain patients like drug addicts.

Addiction is a primary, chronic, neurobiologic disease, with genetic, psychosocial, and environmental factors influencing its development and manifestations. It is characterized by behaviors that include one or more of the following: impaired control over drug use, compulsive use, continued use despite harm, and craving.

Physical Dependence is a state of adaptation that is manifested by a drug class specific withdrawal syndrome that can be produced by abrupt cessation, rapid dose reduction, decreasing blood level of the drug, and/or administration of an antagonist. 


Tolerance is a state of adaptation in which exposure to a drug induces changes that result in a diminution of one or more of the drug's effects over time.

Pain Patient vs Abuse
What's the difference between a pain patient and someone who abuses the medications their pain management physician provides?

The pain patient uses their medications to reduce their pain be more active and improve their quality of life.

Someone who abuses the medications will use a months prescription in a couple weeks, leaving to turn to the street for additional drugs, or become very sick for several days. This type of lifestyle causes harm to the person using as well as family, friends.



Wednesday, May 10, 2017

PAIN HELPED HIM PULL THE TRIGGER

We will see a lot of pain and death from the new pain guidelines

Please Read and Share


If someone abuses their medications, that's sad.
If someone takes their life because of under treated pain, thats tragic 

Saturday, May 6, 2017

Male Patients Chemically Castrated by Pain Doctors with NO Warning

If you’re a male pain patient and your physician has prescribed pain medications for you including Codeine, Fentanyl, Lora Tab, Norco, Vicodin, Dilaudid, Demerol, Morphine, Oxycodone, Oxycontin, or any other medication containing opioids, your physician has basically castrated you with no warning.

Symptoms low testosterone is reduced desire for sex, fewer erections, infertility, muscle loss, depression, low energy, and sleep disturbance.

Physical changes from Opioid-Induced Androgen Deficiency include increased body fat, decreased strength/mass of muscles, fragile bones, decreased body hair, swelling/tenderness in the breast tissue, hot flashes, night sweats, increased fatigue, and effects on cholesterol metabolism.
The Problems Pain Meds Cause…….

Imagine a 30 something male that gets injured at work. The patient goes to the ER and the problem is diagnosed as a herniated a disc and the patient is given opioid medications, and his primary care physician continues the pain medications.

Within a couple weeks he notices a loss of energy, but thinks it’s just the injury. His wife notices her husband no longer has any interest in making love to her.

The patient doesn’t notice the problem because for the guy it’s like when you were 8 years old, girls aren’t icky, you just have no interest in playing with them. As time goes on the wife and intimacy and making love gets worse. The wife begins to think her husband doesn’t love her any longer or he’s cheating on her. This isn’t good for the relationship and creates problems.

Example
A friend of ours was taking pain medications for a back injury. He’s a big biker guy about 6’2” 275 pounds. One day my wife was at their house and he came home early from work crying.

She asked what was wrong and he said, they called me a sniveling little bitch at work and sent me home because I was crying about my dog being sick.

My wife asked how his energy was, he said not very well. She asked about his sex life, he said what sex life. She explained that opioids deplete testosterone and to have his testosterone level checked. A few weeks later he felt better, and his wife understood he wasn't cheating on her.

If your pain management physician is not testing your testosterone levels please file a complaint with the Arizona Medical Board.

Any physician who treats pain should know this information, if not there's a problem.

This is a link to AZ Medical Board complaint page https://www.azmd.gov/Regulation/Regulation#

For more information please read my blog Pain Crisis in America……… http://paincrisisinamerica.blogspot.com

PLEASE READ These Articles
Article in the Pain Physician Journal on Opioid-Induced Hypogonadism: Why and How to Treat It
Article from Pain Physician Journal on Opioid-Induced Androgen Deficiency

Friday, February 24, 2017

Wednesday, February 8, 2017

There Are NO New DEA Rules Requiring Physicians to Reduce Patient's Opioid Doses

When I saw my pain management physician he told me a new DEA rule said it was mandatory that he had to cut my pain medications in half. I contacted the DEA diversion unit and was told there are no new DEA rules on prescribing opioid medications, and DEA does not tell physicians what or how to prescribe medications.

I don’t know where he gets his legal advice, but I found what he was referring to. It’s not a new DEA rule, but a 2016 CDC Guideline for Prescribing Opioids for Chronic Pain that was not meant for pain management physicians.

On the CDC’s web page the CDC Guideline for Prescribing Opioids for Chronic Pain summary says “This guideline provides recommendations for primary care clinicians who are prescribing opioids for chronic pain outside of active cancer treatment, palliative care, and end-of-life care”.

The guidelines are not meant for pain specialists, in fact in it tells primary care physicians to seek “recommendations based on consultation with pain specialists” when doses are over 90mg’s.

The guidelines are for new patients, not patients who have taken opioids for years, are not problem patients, and don’t agree with reduction in medications due to tolerance and withdrawal issues.

The CDC Guidelines say this about established patients, "Established patients already taking high dosages of opioids, as well as patients transferring from other providers, might consider the possibility of opioid dosage reduction to be anxiety-provoking, and tapering opioids can be especially challenging after years on high dosages because of physical and psychological dependence… For patients who agree to taper opioids to lower dosages, providers should collaborate with the patient on a tapering plan. Experts noted that patients tapering opioids after taking them for years might require very slow opioid tapers as well as pauses in the taper to allow gradual accommodation to lower opioid dosages."

Forcing patients who have used opioid medications for years and have both a tolerance and dependence on those medications is cruel and can cause serious medical problems.

The attached letter from the CDC Director says “Specifically, the Guidelines Includes a recommendation to taper or reduce dosage only when patient harm outweighs patient benefit of opioid therapy”.

If you have been a good patient for many years, and have never abused your medications. Then reducing your dose will cause for more harm than continuing the opioid therapy.

Ask your  pain management physician to restore your medications to a workable dose, or explain to the medical board how the harm outweighs the benefits of continuing my  opioid therapy.

Thursday, October 1, 2015

It seems DEA is always looking at physicians for over prescribing opioids. My hero pain doc, Dr William Hurwitz told me treating pain patients was as much about being a psychiatrist as a physician.

For a hundred years we've know stimulants potentiate pain medicine from aspirin to opioids. Anacin has had caffeine for many years.

Some physicians use stimulants like Dextrostat to potentiate opioids and reduce the opioid dose by as much as half.

Dextrostat also helps patients who have problems with being lethargic on opioids.

There are numerous studies on this but most pain physicians don't know how to treat pain. Most have little training in pain management, and fail to listen to patients.

One in a hundred pain physicians understand pain, its finding the one in a hundred.

Jay

Monday, September 21, 2015

What Does A Physician Have To Do To Get In Trouble?

I contacted the Arizona Medical Board about my complaint the lady basically said I lost it was waiting for the director to sign off that the doctor followed the guidelines.

I will appeal, then get an attorney. This guy needs to listen to his patients.

Every guideline except listen to the patient, and if the patient isn't symptomatic, its probably not the problem.

I don't care if a patients heart rate is 140, if they're not symptomatic, don't Shock them.

Tuesday, September 8, 2015

Still Waiting for Arizona Medical Board Investigation Results

In January this year I had a bad experience at Kingman Regional Medical Center in Kingman Arizona.

I filed a complaint with the Arizona Medical Board who initiated an investigation into the actions of Dr Saadeh Saadeh, a cardiologist who scared the Hell out of my wife.

The doctor should listen to what the patient says the symptoms are, not tell the patient hat the symptoms are.

If you tell the doctor, "I'm not short of breath" in a clear voice, then you're not short of breath.

It's been over seven months now, I recently sent a couple emails asking the outcome of the investigation. When I hear something I'll post the results. I don't know how they can justify scaring my wife and I thinking I was having a heart attack when it was herniated disc's. Then there's the $45,000 bill I'm still paying on.....

Tuesday, August 4, 2015

Things Getting Better

Sorry I haven't poster for a while. Our fire district went broke, so I've been fighting to get better emergency services for the area.

Anyway, it looks like things are getting a little better. Patients have told me they don't have to go from pharmacy to pharmacy so much. It looks like all the calls, letters, and emails sent to government officials did some good. If anyone hears differn't please let me know.

As far as doctors telling patients it's all DEA's fault, that's still a problem. If your doctor tells you they can't do something because of new DEA rules, call the DEA diversion unit near you and ask them. Get the agent's name, and if your doctor has any questions when you tell him it's not DEA's fault. Give him the DEA agent's name and number, ask him to cal them and ask.

Have a pain free day
Jay

Tuesday, May 5, 2015

TAKE ACTION Congress Does Listen to Patients H.R.471 - Ensuring Patient Access and Effective Drug Enforcement Act of 2015

H.R.471 - Ensuring Patient Access and Effective Drug Enforcement Act of 2015

Congress has heard patients, and is moving to make sure patients have access to medications.

Read H.R. 471 and contact your representives and tell them your story.

https://www.congress.gov/bill/114th-congress/house-bill/471/text

Monday, April 20, 2015

CVS Health’s bogus ad campaign

CVS Health has a lot of nerve running TV commercial's that talk about how CVS Health has programs and tools to help patients stay on the medications their physicians prescribe.

This must mean only the medications CVS wants to keep in stock. I find it hard to believe CVS is serious about making sure patients take their medications as prescribed. CVS itself puts quotas on how many pain medications (opioids) each of their pharmacies can receive in a month. This causes patients to go without medications and suffer withdrawals.

CVS pharmacists regularly tell patients they don't have the medication they need. If that wasn't bad enough, they tell the patients they might have their medication in the next shipment, which can be a few days to a week away.

Chronic pain affects all aspects of the patient’s life. Many can no longer work. Pain affects their relationship and so many things most of us take for granted, like playing with their kids. The last thing they need is to run out of medications because CVS put quotas on the medication the patient needs. That's why I don't believe CVS when they say they have programs and tools to help patients stay on their medications.

Friday, March 27, 2015

Arizona Marijuana Legalization ,,, Off Topic but Important

Arizona has a medical marijuana law, but citizens and legislators are considering legalizing marijuana for recreational use for adults. That's good because it will free law enforcement resources currently wasted on marijuana enforcement.

Today there are more important issues law enforcement needs to be concerned with:

Like keeping track of sex offenders every day, not once a year in a publicized roundup on TV, but every day of the year.

Like having the resources to return felons wanted for crimes, such as burglary, theft and assault. When police stop wanted felons in other states, you think they would be arrested and returned to face trial and punishment, but dispatchers have to grit their teeth, and tell their officer the originating agency won't extradite. They just let the wanted felon go.

Like identity theft, cybercrime is one of the fastest growing crime categories. Attacks happen daily against the computers of individuals, corporations and government agencies. These attacks are done by high school kids, and by highly organized and funded attacks by foreign governments.

Smart Arizona legislators realize that if passed a voter initiative takes a 3/4 vote of the House and the Senate to make changes.  So if legislators want to have any say on how the new law is written, they need to pass it themselves.

There are some things legislators just don't get. If lawmakers don't listen, they're going to write a law that will allow criminals and cartels to continue making millions of dollars for many years.


Legislators need to understand marijuana is cheap to grow. If they place too high a tax, like the $50 an ounce tax one Arizona legislator recently proposed, the black market will continue to prosper for years to come.

The Estimated Cost of Production for Legalized Cannabis (1) says that not counting labor, it costs $25 per POUND, or about $1.50 an ounce to grow high quality marijuana indoors, or about $8 per pound, or 50 cents per ounce outdoors without labor.

Black market U.S. sellers and marijuana grown outdoors in the U.S. by Mexican cartels could sell their marijuana for $50 an ounce and still make a nice profit.

Currently, Mexican marijuana sells for about $800 per pound in Phoenix. You need to consider the cartels have expenses on each pound they sell.

They need to pay someone to grow the marijuana, someone to harvest, dry, and guard the marijuana. Then they need someone to transport it to the border and someone to smuggle it across the border. Now they need someone to store the marijuana in the U.S. until it's sold by someone else.

Still, after all those expenses Mexican marijuana sells for around $800 per pound. It doesn't cost a lot to grow marijuana. U.S. growers don't have those expenses, so prices will drop rapidly as more marijuana is grown. Setting a flat per ounce tax won't work. The tax needs to be a percentage like most other taxes.

The only way to get criminals and cartels out of the marijuana business is for legislators to stop expecting black market prices to continue once marijuana is legal. Somehow when we passed our state non-profit medical marijuana laws, the price stayed at black market prices.

(1)  The Estimated Cost of Production for Legalized Cannabis
http://www.rand.org/pubs/working_papers/WR764.html

Friday, February 27, 2015

No Fellowship for Pain Physicians

Pain is the number one reason people see a physician. Yet pain management is not a recognized medical speciality, it's a sub-speciality of several other medical specialities, but there's no fellowship for physicians to learn how to treat pain. 

Any physician can hang out a shingle and treat pain. Most give out pills, but don't ask patients the right questions, or treat the side effects of the opioid's they prescribe.

An old adage says, the physician who writes the narcotic should write the prophylactic for constipation. Physicians should ask patients each visit about constipation, excess sweating, changes in energy levels, sleep, depression, changes in sex drive, or relationship problems.

Almost every patient taking opioids will suffer from constipation. Problems from acid reflux to colon cancer can be caused by chronic constipation.

Opioids can cause excessive sweating. This can be a problem anywhere, but here in Arizona where temperatures can reach 120 degrees, it can be deadly. Excessive sweating can cause the loss of electrolytes like salt and potassium. My wife had a life-threatening heart arrhythmia because her potassium was too low.

Changes in energy levels, depression, changes in sex drive, can point to low testosterone. This isn’t just a sex hormone, it controls muscle growth, mood, energy and so much more in male patients. 

Yesterday at the imaging center while I was getting an MRI, my wife Jean was talking to a young mother of three. She told Jean she thought her husband was cheating on her because he wasn't as close as used to be.

Jean ask her if he got teary eyed at some movies, had less energy, and no interest in making love anymore? When she said yes, Jean smiled, then explained about our relationship and testosterone. She said his family doctor had just tested his testosterone levels because of a family history, not his opioids. Jean told her once he gets his testosterone levels back up to normal, she should have her husband back. 

Relationship problems can be a precursor to a patient abusing or selling their medications. Physicians need to be as much a psychiatrist as a medical doctor if they treat pain.

This brings us back to testosterone. When a guy’s testosterone is very low, it's like when he was 8 years old. He doesn't think girls are icky, he just has no interest in playing with them. Like the young wife above, the spouse either thinks the guy is cheating or he doesn't love her anymore.

Neither one is good for the relationship, and can be a precursor for abusing their medications. Physicians who treat pain need to listen their patients, and learn from each other.



Sunday, February 1, 2015

DEA Getting It Right

I'm glad to see DEA is changing the way they do investigations into the diversion of pain medications. DEA has always focused on physicians who treat pain patients, and many times physicians were blamed for the actions of their patients. 

Here in Arizona DEA has a tip line to report People who are selling or abusing their medications. You can text a tip to TIP411, or go to www.DEA.gov This is something new for DEA, and a step in the right direction. Hopefully this will be used to identify patients who have problems.

Some will be abusing, or selling their medications, but others others will be legitimate patients who are under medicated. The majority of patients are grateful for the pain relief they receive, a few create the problems for others.

There are bad physicians out there, but most physicians try to follow the law. If a physician does their best to detect patients who may abuse their medications, do a good medical history, do needed tests to identify and document the cause of the patients pain, and treat the side effects of opioids, then don't arrest them, educate them. 

Patients should try alternative methods and physicians need to document these attempts of pain relief before turning to opioids. In my case I tried every antiinflamatory, antidepressant, and anything else they could think of, I tried physical therapy, a 30 day pain clinic, and finally surgery. 

So with millions of Americans suffering chronic pain, we need to do something different, I wish I knew what it was.

Tuesday, January 27, 2015

DEA, Bad Pain Doctors, and Suicides. What Can We Do?

A few years ago DEA arrested Dr Yeh in Golden Valley Arizona. The problem isn't the arrest, affidavits related to the case show he was a bad doctor.

DEA takes months to do investigations on bad doctors. Then one day they arrest the doctor, and just shut the doors, leaving patients whit no where to turn. Because they see a bad doctor, doesn't mean they're bad patients. The majority are ligitimate pain patients, with documented reasons for their pain. A few are people abusing the system, abusing the drugs they obtain, and creating problems for ligitimate patients.

DEA should bring in a physician trained in pain management and allow patients who agree to be seen at their regular appointment. The physician could review their charts and assist the ligitamate pain patients with medications until they can find a new physician. The physician could also identify patients who appear to be abusing or selling their medications.

When Dr Yeh was arrested, patients were left with no where to go, and the suicide rate in our county took a significant jump. It's difacult to identify some suicides by pain patients. A number of years ago I investigated a number of deaths by chronic pain patients,

Some patients saved up medications, and were written off as overdoses, some were suspicious single vehicle accidents, and one was suicide by cop. He said good by to his family, created a situation, then walked out pointing an uloaded handgun at police, who had no choice to to shoot. There comes a time where the pain wins, and you just give up.

There needs to be somehow DEA can assist ligitimate patients, while identifying those abusing the system when physicians are arrested. After all, they spent months doing the investigation, spend 30 days following up with patients. 

If you know someone who committed suicide due to chronic pain?  These deaths need to be documented, please email me at leapspeaker@gmail.com

Saturday, January 24, 2015

Little Has Changed for Pain Patients at the Emergency Room

My first visit to an Emergency Room in over 15 years was December 19th, 2014, and it went badly. I found little has changed in how pain patients are treated in those 15 years.

I have chronic pain from a failed lumbar back surgery in the 80's. It left me with low back pain, muscle atrophy and neuropathy in my legs and feet. For those who don't know, neuropathy is nerve pain. It can be different for each person, but for me it's a burning feeling, with electrical shooting pain, like someone hitting the edge of my right foot with 110 volts at random times all day.

But this was something new, I hurt something in my mid back bending over hooking up some wires in our home. It's like there's a knife to the left side of T-10, the pain radiates around my ribs, sometimes it feels like it goes straight through me . My low back is one thing, I can usually find a position of comfort, but this is different. It's always there, it ranges from feeling like a knife in my back, to someone pushing very hard with their thumb in that one spot.

I had taken my usual dose of pain meds, after an hour there was no relief, it was so bad, I took a second dose. Another hour went by, and the pain was still bad, so I woke my wife up about 1:00 AM. When I told her I needed to go to the ER, she got pretty worried. We've been together 10 years, I don't complain about my pain, and I've never gone to the emergency room since we've been together. Thats the one thing they did drill into us at the pain clinic I went to, no one want's to hear that you hurt, they've heard it, they know, shut up.

When drove the 40 miles or so to the Kingman Regional Medical Center Emergency Room in Kingman. They were nice enough, I told them I had chronic pain, I took opioid pain medications, and had a high tolerance. They could see I was hurting, my blood pressure was the 180/104  range, so they gave me 4 mg's of morphine. They did all kinds of blood work, urine tests, and a CAT scan of my abdomen. Remember my complaint is mid back, and rib pain.

The nurse said I had to wait an hour to see if the morphine was going to work. As a paramedic I have given iv morphine to patients many times, and it works in minutes, not an hour. The nurse stopped by about 30 minutes later, I told her there was no relief, and when she checked my BP was still very high. The tests and CAT scan showed no problems, so they didn't know what to do.The nurse could see I was still in pain, so the doctor ordered 1 mg of dilaudid IV.

In about half hour, they repeated the dose. Then one of the doctor's said they had given me as much of the most powerful drug they have, so I need to follow up with my pain doctor. As a paramedic I was trained you titrate the dose of pain medications until you receive the desired pain relief.

My blood pressure was still in the 175/100 range, by the time we got home, my BP was over 180/100.

As a paramedic I would have been taking the patient to the emergency room, not discharging them with a BP that high. I was trained that a hypertensive crisis "was a severe increase in blood pressure that can lead to a stroke. It's a systolic pressure (top number) of 180 mm Hg or higher, or a diastolic pressure (bottom number) of 120 mm Hg or higher, and can damage blood vessels causing strokes, and other bleeding conditions.

I was very disappointed in the treatment I received at Kingman Regional. I saw my pain doctor earlier in the week, he saw how much pain I was in, and increased my pain meds. He also gave me three shots of lidocaine in my back in hope of getting it to settle down, but the shots only lasted a couple hours.

Second Visit to KRMC ER
On January 5th, the pain was getting unbearable, so I went to see my primary care physician. She was worried about my level of pain, and my blood pressure was still too high. I told her on my last visit to KRMC ER, they did little to control my pain, and sent me home with a BP of 168/102. She didn't say anything, but cringed as she made notes in the chart.

Around 10:00 AM she sent me to KRMC ER to get some help with the pain. I told her last time the ER didn't take my pain seriously, and asked if she could call the ER and let them know I was coming. She said she would call the ER annd let them know about my back pain. We drove the 10 miles or so into Kingman and KRMC ER.

At intake they asked what medications I take, and explained how the pain radiates from my back, around my ribs, and it had been going on for several weeks, and was made better for a day or so after the chiropractor adjusted it. For some reason they assumed it was cardiac related, started two IV's, and gave me aspirin to chew. I kept telling them I had back pain, not chest pain, and I was not short of breath.

It was busy around me, when an older doctor came by and said, "you have chest pain", I said no, he said, "you're short of breath", and again, I said no.

He wasn't listening to me. He wasn't asking if I had chest pain, or if I was SOB, but telling me I had chest pain and SOB. We tried telling them it's my back, not my heart. I told the doctor I didn't want to go to the cardiac catheterization, unless it was absolutely necessary. He just ignored me.

Next thing I knew I was given a paper to sign, and I was in the cardiac catheterization lab. I also see in the medical record the doctor said he had, "explained procedure alternatives possible benefits and possible complications were all thoroughly explained to the patient, who understood and agreed". That's not true....

After telling me I had chest pain, and SOB, he handed me a paper, and said if it was necessary to put in a stent, or something else, I forget the name, was necessary, they would wake me up, and discuss it. At no time did my wife, or I understand I was on my way to the Cardiac Cath Lab right then. I was sitting in the hall when someone came out and told me my heart was normal, and I could leave.

I asked about my back pain, the reason my primary care physician had sent me to the ER was to control my back pain, not chest pain. The cardiac doctor told me the ER had discharged me, and sent me to him, if I wanted something for my back pain, I would have to get dressed, go back to the ER desk, and start all over again. At this point I wanted nothing to do with Kingman hospital.

I've filed complaints against the physicians involved with the Arizona Medical Board, the Board of Osteopathic Examiners, and the Joint Commission on Health Care Accreditation.

Until patients start filing complaints against physicians, hospitals, and pharmacies who fail to take pain seriously, nothing will change. Please if you feel your pain wasn't properly treated by your physician, or if you're treated like a drug addict for trying to fill a prescription for legal pain medications, prescribed by a licensed physician, please file a complaint.

Write to your legislators, tell them about how you are treated by physicians, and pharmacists, simply for suffering from chronic pain.


Update
The cost for my second visit was a little ove $47,000







Monday, January 19, 2015

I Want a Doctor Who Knows He Doesn't Know Everything

It was that time, time to see a doctor about a colonoscopy, so I made an appointment with a new doctor. As we were talking he asked what medications I taking. When I told him I took testosterone, he asked why. I said it was because my opioid pain medication depleted my testosterone.

He looked puzzled, and told me he has never heard about opioids depleted testosterone, and didn't believe it did. I told him around 75% of male pain patients on opioid medications, have low testosterone. He pulled out his phone, and looked something up on RxList.com, then told me he found nothing about opioids depleting testosterone.

I asked him to do a search for opioids deplete testosterone. He tapped on his phone and said, "everything I need to know, is right here", then told me I needed some tests done. I thanked him, and walked out of his office.

Today with all the information on the internet, patients may well know more about their condition than their doctor. I believe a good doctor is one who will listen to their patients. I don't want a doctor who knows everything, I want a doctor who knows he doesn't know everything.


http://www.practicalpainmanagement.com/treatments/hormone-therapy/testosterone-replacement-chronic-pain-patients

Thursday, January 8, 2015

It's Not DEA's Fault

DEA spokesman Rusty Payne told the National Pain Report. “If a pharmacy chooses not to fill a prescription for someone, that’s their decision. It’s not the DEA’s decision,” (1)

Payne went on to say, “There have been no new regulations. There have been no rule changes. There have been no changes in the Controlled Substances Act,” he reportedly said. “People will call us and they’ll say, ‘I can’t get my meds. And the pharmacy tells me that it’s your fault.’ It’s always popular to blame the government for something.” (1)

What Can We Do?
Write to your elected officials, tell them about the problems you have getting medications. 

If they put quotas on heart medications, the uproar would be heard in Washington, but it's far to easy for pharmacist to write off pain patients as drug addicts, so no one cares.

Tell your representatives all prescriptions need to be electronically sent from the physicians office, direct to the pharmacy. This would stop prescription fraud, as well as medication mistakes because a pharmacist can't read the doctors writing.

We need a Pain Patient's Bill of Rights that set out patients rights and responsibilities, and protects physicians, and pharmacists who operate within the law.

If a pharmacist doesn't follow state or federal laws, if they treat you like a drug addict, rather than a patient in pain, file a complaint. This will only stop when we speak out, and let people know this is wrong.

If you know anyone who has commited suicide because of chronic pain, please contact me, leapspeaker@gmail.com

Sir William Blackstone said, "It's better that ten guilty persons excape, than that one innocent suffer.”

I say, It's better ten drug abusers excape with a couple pills, than one inocent patient suffer in pain. 


DEA Spokesman Rusty Payne
(1) http://drugtopics.modernmedicine.com/drug-topics/content/tags/cardinal-health/dea-official-blames-pharmacists-doctors-pain-med-denials?page=full 

Sunday, December 28, 2014

Why We Don't Understand Pain

Humans have suffered pain, well, since there were humans.

We had to fight the elements, animals, and each other, and we got injured. God, in his great wisdom, made us so we can't remember pain.

Oh, we can remember something hurt, but we can't remember the actual pain. If we could, we would be in just as much pain, as when it happened.

When a woman talks about childbirth, they speak about it fondly, and would lovingly do it again. If a woman remembered the actual pain every time she thought about her baby's birth, I'm sure there would be a lot more single child families.

If men remembered actual pain, I think we would be less bold when exploring, and fight fewer wars, but would be who we are today?

I guess that's why God in his great wisdom, made us, so we can't remember pain. 

I only hope God gave us the wisdom to show empathy to those who suffer chronic pain.