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.

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).

There Really are Good Pain 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.

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/

September 3, 2013Addiction

By Jim LaPierre

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.

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....

A Letter To Governor Ducey on Opioids Problem

Governor Ducey June 30^th 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 26^th 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

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.

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.

PAIN HELPED HIM PULL THE TRIGGER

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

Please Read and Share

Pain Helped Him Pull the Trigger

If someone abuses their medications, that's sad.

If someone takes their life because of under treated pain, thats tragic 

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

http://www.painphysicianjournal.com/current/pdf?article=MTcwOQ%3D%3D&journal=68

Article from Pain Physician Journal on Opioid-Induced Androgen Deficiency

http://www.painphysicianjournal.com/current/pdf?article=MTcxMg%3D%3D&journal=68

Article Politics of Pain in Kingman Daily Miner

The Kingman Daily Miner interviewed me for an article on pain medications....

The Politics of Pain 

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.