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

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.

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.....

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

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

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.

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

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.

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.

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

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

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

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