Looking To The Future - Pain Treatment - Addiction - Overdoses - It's Time To Work Together

As PainWeek approaches physicians who treat pain and those who treat addiction come together to look toward the future of pain treatment. I'm sure there will be a lot of discussion on how to get patients the medications they need while lowering  the prevalence of addiction and overdoses.

It's going to take everybody and I mean everybody working together on this. Pain and addiction specialists, law enforcement, state and federal regulatory agencies, patients and the public must come together if we hope to find a solution to this complicated problem.

I hope PainWeek is a time for people from all these various specialities and agencies to come together and learn from each other.

Maybe it's time to think out of the box.....

As Medical Access to Opioids is Reduced Mexican Cartels Pick Up the Slack

As the government reduces access to pain medications for patients Mexican cartels are picking up the slack with fentanyl, pounds and pounds of fentanyl.

CNN is reporting Authorities in Arizona discovered $1 million in drugs during a traffic stop -- and officials say that led them to a nearly 600-foot drug tunnel that runs between a former fast food restaurant and a private home in Mexico.

Inside the containers, police found 239 packages of various drugs, including over 261 pounds of methamphetamine, 14 pounds of cocaine, 30 pounds of white heroin, 13.7 pounds of brown heroin and 6.8 pounds of fentanyl. The fentanyl alone "translates to over 3 million dosage units," Homeland Security Special Agent Scott Brown told CNN affiliate KYMA on Wednesday.

Unintended Consequences................. 

PainWeek in Las Vegas Sept 4th to 8th

I'm going to Vegas for a few days in September for PainWeek. It's a big deal in the pain management world. PainWeek.org say's PAINWeek is the largest US pain conference for frontline clinicians with an interest in pain management. PainWeek runs from September 4th to the 8th at The Cosmopolitan of Las Vegas.

I'm going to attend a number of training sessions on  interesting subjects like Pain Terminology: Knowing the Difference Makes a Difference, Full Metal Jacket: Examining the Psychedelic Side of Ketamine, and The Other Opioid Crisis: Fentanyl and Heroin.

There will also be programs by the American Pain Society, the American Society of Pain Educators, the International Pelvic Pain Society.

The National Association of Drug Diversion Investigators will have programs at PainWeek. It will be interesting to see what strategies the National Association of Drug Diversion Investigators have for dealing with the current opioid problem.

It's going to take everyone working together to solve this opioid problem. We need regulatory agencies, 
health care providers, patients, and law enforcement 
to work together in a spirit of cooperation rather than one of fear.

We need to find a way Do No Harm to current patients who've been on opioids for years without any problems, and set guidelines on prescribing opioids for future acute and chronic pain patients.

It should be an interesting week and I hope to learn a lot.

Suicide Watch - You need to Read This..

Need to read Pharmacist Steve's article Suicide Watch 

http://www.pharmaciststeve.com/?attachment_id=21115 

I am being completely weaned off my meds, & suspect I will kill myself with the amount of pain I am in, & will be by the time this is over (the wean that is). Already can’t function.

Why Are Dealers Mixing Fentanyl in Heroin?

We see or hear on the news about Fentanyl quite often these days. Most of the news is about people who overdosed on a mixture of Heroin and Fentanyl, or how many times more potent than Morphine Fentanyl is.

Drugs are about money, it doesn’t matter if its prescription drugs from your doctor, illegal drugs from the street or the money law enforcement receive in grants; drugs are always, about money.

In this case the new guidelines, regulations, and laws have helped both sides to make a lot of money. Drug Cartels found out Fentanyl was cheap and easy to make. According to Stratfor.com it costs about $3,300 to make a kilo (2,2 lbs) of Fentanyl.

CNN tells us recently Nebraska State Troopers seized 118 pounds of Fentanyl in a traffic stop. That amount is enough to overdose 26 million people. That amount cost the cartels $180,000 to make.

But this time we told then what the change in guidelines, regulations, and laws would do. After 40 years of the war on drugs we knew what the unintended consequences would be, illegal drugs would fill the void.

Heroin.net tells us the average cost of a single dose (0.1 g) of heroin purchased on the street has been reported as approximately $15–$20 in the U.S. state of Ohio.

So the 26 million doses would have been worth $390,000,000 street price to Cartels for that one shipment. And trust me cartels never put their eggs in one basket, how many shipments got past troopers that day?

Now cartels are manufacturing Carfentanil also called Carfentanyl.

According to Wikipedia Carfentanil is an analog of the synthetic opioid analgesic fentanyl. A unit of carfentanil is 100 times as potent as the same amount of fentanyl, 5,000 times as potent as a unit of heroin and 10,000 times as potent as a unit of morphine

The problem is how the drug world distribution works. At the top if you mess with quality you may not do well in the drug world. But as the something like Carfentanil with a potency 10,000 times that of morphine shifts down through the drug world, everybody is going to step on it. Imagine the profit for a drug dealer?

In 1mg of Carfentanil you have the equivalent of 10,000 doses of Morphine, wow. The problem for little Donny drug dealer is how to evenly distribute 1mg of Carfentanil into 9,999 mg’s of whatever little Donny drug dealer is using for cut.

If little Donny drug dealer makes a mistake and it’s easy when we’re talking about overdosing a little over 1/10,000^th of a milligram.

Prohibition doesn’t work…..

Wikipedia

https://en.wikipedia.org/wiki/Carfentanil

Heroin.net

https://heroin.net/about/how-much-does-heroin-cost/#streetcost

CNN

https://www.cnn.com/2018/05/25/health/nebraska-fentanyl-bust/index.html 

Stratfor.com

https://worldview.stratfor.com/article/mexicos-cartels-find-another-game-changer-fentanyl

Arizona Medical Board Doesn't Have a Plan for Pain Patients and It's Costing Lives

In 1990 Dr Albert Yeh of Golden Valley Arizona was arrested by DEA for over prescribing opioids, and another pain doctor just up and left Needles California. In 2009 there was also a significant spike in suicides in Mohave Counrt. I can't prove the coloration between the loss of two pain physicians and the increase in suicides, but someone might want to look into that.   

Dr Yeh was the type of bad physician DEA needs to go after. You'll understand about Dr Yeh when you read the the DEA special agents statement in the affidavit for seizure warrant below. 

Most physicians who treat pain and have problems with DEA do so because of technician violations of the law like medical records. I think most of these violations could be dealt with by education rather than arrest. 

On the patients side the Arizona Medical Board needs to have a plan in place on what to do if patients were to lose their physician who treats chronic pain with opioids..

Currently there is no plan for how to assist pain patients when a prescriber who treats patients with opioids should be arrested. 

Some of Dr Yeh's were people looking for drugs, and news spreads fast. That doesn't mean some of his patients have a legitimate need for opioid pain medications.

How many of Dr Yeh's patients committed suicide?
How many of Dr Yeh's patients turned to the street?
How many of Dr Yeh's patients overdosed because of unknown street doses?

What are WE going to do?

AFFIDAVIT FOR SEIZURE WARRANT

COUNTY OF MARICOPA

STATE OF ARIZONA

Your Affiants, Phoenix Police Detective Jamie Barilla and Erin Hager, a Diversion

Investigator with the United States Drug Enforcement Administration (DEA) Tactical Diversion Task Force, being first duly sworn upon oath depose and say:

On March 25, 2008, an Arizona peace officer acting in an undercover capacity posing as a new patient at Dr. YEH’s Golden Valley medical clinic met with Dr. YEH.

That agent, Arizona State Attorney General’s Office Special Agent (SA) Cheryl Thomas, was instructed by Dr. YEH’s staff at the clinic to complete paperwork entitled ‘Narcotic Contract’ which indicated that no early refills would be issued, and paperwork entitled ‘pain diagram,’ which was left blank by SA Thomas.

SA Thomas informed Dr. YEH’s medical assistant she did not have a referral from another doctor, nor did she have any xrays with her. The only medical evaluation performed by the medical assistant consisted of placing what resembled a pulse oximeter on SA Thomas’s finger.

Without first introducing himself, Dr. YEH immediately asked SA Thomas what kind of pain she was having. SA Thomas responded that she didn’t feel good, that she had aches and a headache. When asked specifically if she had pain in her shoulders and arms, SA

Thomas replied “no.” Upon having SA Thomas stand on her toes and her heels, Dr. YEH told SA Thomas that, “You’re fine, what can I do for you, what can I do to make you feel better.”

SA Thomas told Dr. YEH she had taken Vicodin (hydrocodone) in the past. Dr.

YEH then issued SA Thomas one prescription for 120 Lortab tablets (hydrocodone – 30 day supply), one prescription for 120 Robaxin tablets (prescription-only muscle relaxer –30 day supply), and a third prescription for an X-ray of the spine.

How Many Times Do We Need to Read About Pain Patient Suicides

Even though pain is the most common reason patients see a doctor, pain wasn't treated in the 90's. Pain was undertreated and patients were committing suicide for lack of pain control. I carried a stack of death certificates from pain patients who took their life as noted in the 1996 article about the fight for pain relief below.
LINK to 1996 Article in Kingman Daily Miner  

There Are Two Side to Every Story.....
Pain and Suicide: The Other Side of the Opioid Story
Jack never said much during his office visits. He was
mostly silent and followed my instructions. But he did
quietly express fear of the pain if I continued to reduce his
pain medications. During the third clinic visit of this process, he said, “I can’t live like this, Doc.” I said, “It will get better,” hoping more than knowing my statement would be true. 

I counseled him that the pain may worsen for a while, but that—in time—this new regimen would be for the best. I heard his words but not his cry for help.

Three days later I got a call from his daughter. Jack had died from a self-inflicted gunshot wound. He left a note saying he couldn't live with the pain anymore. He could not see a future. He had no hope. He had no life. He loved her but felt he was of no value to her or to anyone.

These are more stories of patients who couldn't take the pain and the fight just became too much.....

How Chronic Pain Killed My Husband 

Sherri’s Story: A Final Plea for Help

Video: Lisa’s Story – FM Patient Commits Suicide

Some People Still Need Opioids 

When pain patients commit suicide if they leave a note everyone understands it was because of the pain. If they choose to end the pain by saving enough pills to overdose and don't leave a note, they're just another overdose.

If you are thinking about suicide PLEASE Call the National Suicide Prevention Lifeline 1-800-273-8255 and talk to someone

Physicians Who Do Harm to Patients MUST Be Held Responsible 

Good News Dr Vaipiani is a Board Certified Pain Specialist

Good News Dr Vaipiani is a Board Certified Pain Specialist. I want to thank Shawn at the Kingman Daily Miner for finding Dr Vaipiani listed in the American Board of Pain Medicine Director in Nevada.

I hope Dr Vaipiani lets the American Board of Pain Medicine know to also list him in Arizona. I didn't think to look in Nevada for an Arizona pain doc, and I didn't search by name, I looked at all the physicians listed in Arizona.

You can also find some information about the 2018 Arizona Opioid Epidemic Act and Arizona House Bill 2001 HERE

I don't know anything about Dr Vaipiani except what I've read. If any patients know how he is with patients, please let other patients know. Here or on Facebook. If you use Facebook please let me know.

Thanks
Jay

Update... Just My Opinion... July 19th 2018

In a 2017 article in the Kingman Daily Miner Dr Valpiani said, "in Mohave County, with its high percentage of the population on Medicaid, roughly half of the people on pain pills are abusing them".

The doctor patient relationship is built on trust. Trust that the physician will do what's best in the patients interest, and the patient is honest about their medical condition. How can a physician treat patients fairly if they believe half of the patients who walk through the door are lying to him. 

When treating pain patients most times there is objective evidence like MRI's and nerve conduction studies. 

Benjamin Franklin said, "it is better 100 guilty persons should escape than that one innocent Person should suffer". 

He was talking about the criminal justice system, but I think he would say the same about pain treatment today, that it is better 100 Patients should escape with pills than that one innocent Patient should suffer.

Jay

Know A Pain Patient Who Committed Suicide for Lack of Pain Management? Contact Me

If you know someone who committed suicide because their pain medications were lowered too far, please contact me.

Physicians take an oath to Do No Harm. But that's what they're doing to pain patients, causing harm, and some can't take it.

Back in the late 1990's I carried death certificates of pain patients who had given up and taken their life. Some were obvious suicides, others for various reasons like insurance or religion chose other ways not so easily identified.

Others were patients who saved enough meds to end the pain. Please don't write these patients off and count them as just another overdose. Some were involved in suspicious single car accidents, and one in Spokane was suicide by cop. That one screwed up a lot of lives including the officer who shot a guy with an empty gun.

So please... If you know someone who ended their life for lack of pain management let me know. I need to collect this information and share it with legislators. 

This 1996 article in the Kingman Minor talks about my fight back then... Kingman Resident in Tough Battle for Pain Relief, hits Rock Wall 

That was 22 years ago and it sounds too familiar... 

Send me a message if you know anyone who's committed suicide over pain control....

PLEASE Share

Jay

Governor Ducey says the Opioid Epidemic Act language was specifically designed to protect individuals with chronic pain

I contacted Governor Ducey's Office of Constituent Engagement about physicians cutting down the dose of current long time pain patients.

The Office of Constituent Engagement told me “It is important to note that language and features of the Opioid Epidemic Act were specifically designed to protect individuals with chronic pain”.

The email continued to say “The 5-day first fill limit does not apply to chronic pain patients already working on a pain management program”.

“Additionally, opioid dosage limits of 90MME day do not apply to individuals currently receiving a dose in excess of this amount”. "There is no requirement that individuals who take prescriptions above 90 MME taper down to a lower dose".

His office also included a link to information for patients including the full text of the Opioid Epidemic Act at: https://azgovernor.gov/sites/default/files/related-docs/arizona_opioid_epidemic_act_policy_primer.pdf.

And a PDF poster for physicians on how the plan protects chronic pain sufferers at https://azgovernor.gov/sites/default/files/related-docs/chronicpainweb_0.pdf.

I thank the Governor Ducey's Office and the legislature for trying to protect pain patients. But the Opioid Epidemic Act was written with stopping abuse in mind, not patients. It was designed to stop abuse, but has left pain patients suffering, and heroin cheaper and easier to get for addicts.

The Opioid Epidemic Act has a section on Prescriber Education that said, The Problem was many clinicians were trained at a time when the medical community was taught that prescription opioids were not addictive. 

NOTE: I can't think of any high school kid, let alone a physician who didn't know then or now that opioids (heroin) is addictive. Any Physician who would believe a drug company sales rep that all of a sudden opioids stopped being addictive should not be in practice. 

The Opioid Epidemic Act goes on to say, "since then, research has clearly proven that to be false. Training and updated education is essential for prescriber's to practice safe prescribing practices and identify substance abuse or drug dependence, but is not currently required by state law".

NOTE: I don't agree with the wording they use in this section of the Opioid Epidemic Act. It isn't specific in the wording on "drug dependence". 

Its important to understand the difference between Physical Dependence and Psychological Dependence. PLEASE Don't confuse Physical Dependence with Psychological Dependence or Addiction.

Physical Dependence is when your body builds a dependence on a specific medication (opioid). If the medication is abruptly stopped withdrawal symptoms will start. ALL Patients will be physically dependent on an opioid if taken for more than a few weeks. 

Psychological Dependence is similar to addiction but may occur with or without physical dependence and is conceptually characterized by impaired control over drug use, compulsive use, continued use despite harm, and craving for the psychic effects of the drug.

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. 

The Solution Codify the governor’s call for the medical licensing board to require at least three hours of opioid-related Continuing Medical Education (CME) for doctors who are licensed to prescribe opioids.

Require medical students to receive three hours of opioid related courses to ensure they are equipped with the most current information about prescribing opioids.

The Opioid Epidemic Act has provisions to protect patients, but physicians simply ignore the protections out of fear. This leaves patients suffering and patients no recourse except to file a complaint with the medical board. That works well, It's been a year since I filed a complaint and no end yet... A year? 

Reducing Opioid Medications for Patients Does Not Reduce Overdoses

Alliance Offers Patient-Centered Opioid Prescribing Recommendations

June 13, 2018

Advocacy group describes why CDC Guidelines on Opioid Prescribing should be withdrawn and rewritten.

4. There is no evidence that the restriction of opioid medications for patients reduces overdose deaths. To the contrary, it is clear that reformulation of OxyContin in 2010 to reduce its abuse potential was accompanied by a sustained increase in overdose deaths involving heroin and other street drugs. 

There is also research to demonstrate that the restriction of prescription opioids since that time period may actually be contributing to the opioid crisis by driving patients in desperate pain toward illicit drugs for relief. 

The US Drug Enforcement Administration has recommended further reduction of production quotas for scheduled drugs found to be “subject to diversion.” However, prescribing levels are presently at a 10-year low and hospitals across the country are experiencing shortages of opioid analgesics needed in surgery. The DEA should end these restrictions.

READ The Recommendations Here
 

American's Over 65 Don't Abuse Opioid Medications

What the government is doing to patients over the so called the Opioid Epidemic is wrong. Reducing the dose of pain medications for any long time opioid patient is wrong.

But reducing the dose of pain medications for older patients who have been long time pain patients doesn't even make sense.

Overdose statistics tell us older Americans don't abuse their opioid medications. Of the 42,000 suicides in 2016 only 1200 were people over 65.

When you add the fact most overdoses are from illegal drugs, a combination of drugs, or drugs and alcohol, that lowers this number significantly.

With suicide rates increasing at an alarming rate I hope they see how their knee jerk response to a complicated issue with far too many unintended consequences with the potential for death.

Now one of the Opioid Epidemic's unintended consequence has come home, we have a Suicide Epidemic. 

How high is the suicide rate REALLY? How many pain patients gave up the fight, saved up enough medications to overdose, and were written off as just another doper gone... You know NHI as we used to call it, No Humans Involved just a doper....

Opioid overdoses killed 1,354 Americans ages 65 and older in 2016, about 3 percent of the 42,000 opioid overdoses that year. https://www.apnews.com/72951225a96e4fd7ac702b969f3fc48c

If You're a patient of Dr Sutera email me at leapspeaker@gmail.com 

New Opioid Prescribing Law, Did the Legislature Know AZ Only Had 41 Certified Pain Specialists?

I don't believe the Arizona Legislature knew how many certified pain management physicians there were in Arizona when they passed the new Arizona Opioid Prescribing Law. 

Look in the phone book or online for pain management physicians, there's a number of pain doctors in almost every city, pain is big business.

BUT... According to the American Board of Pain Medicine there are only 41 certified pain specialists in the state of Arizona. Studies tell us 100,000,000 American's suffer chronic pain, 1/3rd of us.

Arizona has 7,000,000 people, going by the studies a little over 2,000,000 people in Arizona have chronic pain. For argument sake lets round that down to just 25% of the number of chronic pain patients in Arizona, 500,000. 

Those 41 certified pain specialists in the state of Arizona would need to see a little over 12,000 patients each, or 400 patients a day.

Many web pages including some news outlets like US News  have list to help patients find pain specialists. A Google search for pain specialists give you a US News page "Find Pain Management Specialists | US News Doctors - US News Health" When you look for pain specialists in Flagstaff you get results that say "The U.S. News & World Report Doctor Finder has detailed profiles for 7 pain management specialists near Flagstaff, AZ"

But out of the 7 pain management specialists listed only one is really an American Board of Pain Medicine Certified Pain Specialists John Ledington MD. The same page says Phoenix has 218 pain specialists. In fact the American Board of Pain Medicine only lists 13 Certified Pain Specialists in Phoenix.

WE KNEW THIS WOULD HAPPEN.....
The really sad thing is that we've been fighting this so called drug war for 40 years. Legislators know or should have know that when you cut off the supply of drugs from one place, someone always picks up the slack.

In the case of opioids the drug cartels picked up the slack and they are really good at their job. Fentanyl is cheap and easy to make, this May The Nebraska State Patrol seized nearly 120 pounds of the drug fentanyl - enough to kill about 26 million people.

The problem with prohibition of any type, alcohol, marijuana, or pain medication is prohibition doesn't work. Reducing the doses of 100,000,000 American's with chronic pain is creating a huge business opportunity for drug cartels or any college chemistry degree. 

Dr Sutera in Bullhead City is NOT a certified pain specialists...


If You're a patient of Dr Sutera email me at leapspeaker@gmail.com 

People Who Abuse Opioids Can Get 5-6 Times As Much Opioids as Patients in Pain? WHAT?

Something is Very Wrong with This!!!!

The government has physicians who treat the nations 100,000,000 pain patents so afraid of loosing their license they are failing to treat pain patients responsibly. 

Many physicians out of fear an not medical necessity are lowering long time patient doses even though DEA the CDC Pain Guidelines and the new Arizona pain treatment law advise not to reduce long time patient doses without the patient agreeing. 

DEA has told me patient doses should only be changed because of medical necessity and not because of policy. This email from the Arizona Governors Office stresses the fact dose for current patients does not need to be reduced. 

Pain patients with a documented painful conditions who have been on opioids for many years without problems are being cut to 90 MME that's 90 milligrams of morphine or the equivalent, while there is apparently no limit for the people who abuse opioids. 

I understand the reasoning for this as most people who abuse opioids have a high tolerance, much like long time pain patients. So if you try and give someone half the dose they get on the street, they just go back to the street because what you gave them was worthless to them.

Don't get me wrong, we need to do everything we can to help people with an addiction problem. This is a medical problem, not a law enforcement problem, we can't arrest way out of this.

But I find helping those who abuse opioids stay comfortable and out of withdrawals while physicians punish those who require opioids for pain relief.  

Pain patients are being left to live in pain, live with withdrawals, or to end their pain by ending their life, while people who abuse opioids are given high doses....

I predicted several years that suicide rates would go up with the reduction of patients medications. Just like in Mohave County in 2009 when a pain doctor was arrested leaving many patients with no where to turn, the suicide rate had a significant spike in suicides with no other apparent cause. 

With the current increase in suicides I predict many will be pain patients who give up the fight. So who is going to be held responsible in the current suicide crisis, the physicians who chose to listen to social media rather than follow government guidelines 

Am I reading the documents below correctly? That Pain Patients get 90 MME and addicts get 360 to 540 MME? So addicts many times get 80-120 mg's a day of Methadone. The dose of Methadone equal to 90 mg's of Morphine is 20 mg's of Methadone.

Various government agencies including the CDC have issued Pain Guidelines that have confused most pain doctors. My pain doctor was so confused he told patients DEA was requiring they only get 15 days of medications at a time. That meant hundreds of patients coming into his office every two weeks for refills.

That lasted all of 30 days, and then it was back to seeing them every 90 days and pickup refills at the office other months. A couple months later his office called saying they had to cut my dose again even though the CDC guidelines and new Arizona prescribing law  doesn’t require current patients to reduce their doses.

Many current pain patients are having their dose cut in an unreasonable fashion, against the CDC and Arizona guidelines causing pain patients to go through painful and dangerous withdrawals.

Physicians opiophobia or unreasonable fear of opioid regulations is causing this problem by NOT following the CDC and Arizona opioid prescribing guidelines.

Even DEA investigations in Washington D.C. has told me that patient doses should only be reduced for medical reasons and not for policy.


About Drug Rehabilitation Doses.... 

FROM Public Policy Statement on Morphine Equivalent Units/Morphine https://www.asam.org/docs/default-source/public-policy-statements/2016-statement-on-morphine-equivalent-units-morphine-milligram-equivalents.pdf?sfvrsn=3bc177c2_6

 Equally as important, recommended dosages of methadone and buprenorphine when used to treat addiction involving opioids differ from recommended dosages for pain treatment. The ASAM National Practice Guideline for the Use of Medications in the Treatment of Addiction Involving Opioid Use notes that, while a relatively low dose of methadone (e.g., <30 mg per day) can lessen acute withdrawal, it is often not effective in suppressing craving and blocking the effects of other opioids. viii 

Most patients fare better if their initial 30–40 mg per day dose is gradually raised to a maintenance level of 60–120 mg per day. Indeed, multiple randomized trials have found that patients have better outcomes, including retention in treatment, with higher doses (80–100 mg per day) than lower doses.

 

 

FROM Calculating Total Daily Dose of Opioids For Safer Dosage - CDC

https://www.google.com/url?sa=t&rct=j&q=&esrc=s&source=web&cd=1&cad=rja&uact=8&ved=0ahUKEwjcrsa5-LrbAhWMMI8KHZ1bArQQFggpMAA&url=https%3A%2F%2Fwww.cdc.gov%2Fdrugoverdose%2Fpdf%2Fcalculating_total_daily_dose-a.pdf&usg=AOvVaw0_8orLwsJeuMu4lrc4Yhqq

 HOW MUCH IS 50 OR 90 MME/DAY FOR COMMONLY PRESCRIBED OPIOIDS?

~20 mg of methadone (4 tablets of methadone 5 mg)

The suicide rate in the U.S. is so high it rivals the so-called “opioid epidemic

New CDC Report Ignores Suicides of Pain Patients 

It looks like the Federal Government doesn't care if pain patients take their own life for lack of pain management. How many suicides were patients who gave up the fight for medications? 

Why didn't the CDC count the number of suicides by pain patients?
Why didn't the CDC look at overdoses involving pain patients and opioids to rule out suicide? 

The recent CDC Report of Suicides says:
The suicide rate in the U.S. is so high it rivals the so-called “opioid epidemic.” The number of Americans who died by suicide (44,965) exceeds the overdose deaths linked to both illicit and prescription opioids (42,249).  The nationwide suicide rate has risen by over 30 percent since 1999.

As PNN has reported, the CDC’s 2016 opioid prescribing guideline may be contributing to a rising number of suicides in the pain community.  In a survey of over 3,100 pain patients on the one-year anniversary of the guideline, over 40 percent said they had considered suicide because their pain was poorly treated.

LINK CDC Suicide Report

Stop The War On Chronic Pain Patients

In March of this year, the US Centers for Disease Control released “voluntary guidelines” on prescription of opioid medications to adults with chronic non-cancer pain. 

LINK to Article: Stop The War On Chronic Pain Patients

Unfortunately for 100 Million US chronic pain patients (estimated by the US Institute of Medicine), the document is in actuality neither voluntary nor a guideline.  

Combined with recent draconian laws in several US States, the CDC protocols have become a mandatory restrictive practice standard which is driving doctors out of pain management and patients into agony by the thousands.  

Patients are being involuntarily taken off opioids — or outright deserted without referral by doctors who fear US Drug Enforcement Administration prosecution if they continue to prescribe the only treatments which give many people even a marginal quality of life.

“Opioid Addiction Is a Huge Problem, but Pain Prescriptions Are Not the Cause” As recently explained in Scientific American by neuroscience journalist Maia Szalavitz

As Szalavitz points out, “efforts to reduce opioid deaths will fail unless we acknowledge that the problem is actually driven by illicit not medical use.” 
==============
My NOTE A huge majority of the 100,000,000 pain patients are not addicts they don't abuse their medications. 

For most the "high" from taking prescription opioids goes away in the first weeks of use, but all patients taking opioid medications for any length of time become physically dependent on them for pain control. It is critical to understand the meaning of addiction and not confuse it with tolerance and physical dependence LINK Addiction Tolerance and Physical Dependence 

We cannot reduce drug overdoses by denying pain relief to millions of patients who rely of opioid medications for pain relief. This will simply drive patients to the street and impure illicit drugs, or worse end the pain by ending their life.

It's sad when someone makes the decision to abuses opioids, and dies from an overdose it's sad. When a pain patient ends their life for lack of pain control it's a tragedy.

The 12 Warning Signs for Suicide

According to THIS article in Health Central tells us the warning signs of suicide....

By recognizing these 12 warning signs in yourself or others, you can help prevent suicide:

• Feeling like a burden
• Being isolated
• Increased anxiety
• Feeling trapped or in unbearable pain
• Increased substance use
• Looking for a way to access lethal means
• Increased anger or rage
• Extreme mood swings
• Expressing hopelessness
• Sleeping too little or too much
• Talking or posting about wanting to die
• Making plans for suicide

These Feelings are NORMAL for Pain Patients?

• Feeling like a burden (being in pain people get tired of hearing you hurt)
• Being isolated 
• Increased anxiety (over having pain medications reduced or stopped)
• Feeling trapped or in unbearable pain (Always)
• Increased substance use (for some)
• Looking for a way to access lethal means
• Increased anger or rage (treated like a n addict when you're in pain)
• Extreme mood swings (when you're in pain nothing is good)
• Expressing hopelessness (afraid of living in pain)
• Sleeping too little or too much
• Talking or posting about wanting to die
• Making plans for suicide

Stop Treating Pain Patients like Addicts

ONLY 2% of Opioid Deaths in Nevada involved a single prescription opioid. So Why are Millions of Pain Patients Suffering?

Nevada records show only 2% of overdoses are from prescribed pain pills.... Just 11 percent of the opioid-related deaths in Clark County (47 of 430) involved a single prescription opioid. 

LINK to Article

Fourteen of those cases involved methadone, which can be prescribed for pain but is better known as a treatment for heroin addiction. Seven are listed as suicides, and 21 involved complicating factors such as cancer, morbid obesity, heart disease, chronic obstructive pulmonary disease, and (in one case) a gunshot wound to the chest. 

Excluding methadone, suicides, and complicating conditions leaves nine cases where the only cause listed is a commonly prescribed pain medication: hydrocodone (five cases), oxycodone (two), hydromorphone (one), and oxymorphone (one). That's 2 percent of the opioid-related deaths.

The CDC just released new suicide statics this week. I fear we will see an increase in suicides of pain patients. 

PLEASE Remember I investigated chronic pain patients and suicide back in the 1990's when pain was undertreated. I found many suspicious suicides of pain patients.

Some were suspicious single vehicle fatal accidents, a suspicious water accident, and one suicide by cop... He pointed an empty weapon at police.  My wife's cousin hung himself here in Kingman years ago after a doctor refused to fill his prescription.

You can only be treated like a drug addict by your doctor and being told you don't need pain medications by your pharmacist, and that you're drug seeking by others.. Many times the addition of all this BS on top of the pain is too much, just too much....

New on the Streets... Gabapentin (Neurontin) a Drug for Nerve Pain, and a New Target of Misuse UPDATED

UPDATE 
According to the Pain News Network
Gabapentin (Neurontin) – an anti-seizure drug widely prescribed off-label to treat pain -- was detected in over 21% of the prescription opioid deaths and in about 10% of the other overdoses.

UPDATE on Gabapentin (Neurontin) and Behavior Changes
RXlist.com doesn't list specifically list aggression under the Common Side Effects of Gabapentin. It does say "Other side effects of Neurontin include mood or behavior changes, depression, or anxiety".

Under Neurontin Consumer Information it says "Report any new or worsening symptoms to your doctor, such as: mood or behavior changes, anxiety, panic attacks, trouble sleeping, or if you feel impulsive, irritable, agitated, hostile, aggressive, restless, hyperactive (mentally or physically), depressed, or have thoughts about suicide or hurting yourself'.

Original Post
This is a story about Gabapentin, a drug commonly prescribed for nerve pain that's the new drug of abuse... But first my personal experience with Gabapentin family and friends.

Last year a friend was in a high speed head-on accident. He was very lucky only cutting and bruising his face, bruising his ribs, breaking his ankle and crushing his heel. This guy is really laid back and just doesn't get upset about much. When he got back from seeing his doctor they had prescribed Hydrocodone and Gabapentin for pain.

He was in pain and I can understand being grouchy when you're in pain, but the second day on the Gabapentin he turned into a total jerk. He was complaining about everything, he was just mad. His girl friend who had been taking care of him since the accident could do nothing right. He was starting to get physical with her and he's a big guy, 6' 3" 300 pounds, this just wasn't like him.

A quick search online said some of the side effects of Gabapentin are changes in behavior, acting restless, hostile, or aggressive, memory problems, or trouble concentrating. He stopped taking the Gabapentin and in a couple days he was back to normal.....

My wife started taking Gabapentin a several months ago but her reaction to Gabapentin wasn't as dramatic as our friends reaction. In her case the reaction to Gabapentin took some time. The first couple weeks she was getting louder and was yelling at the dogs more. 

We've been together 14 years and had three what you could call fights or arguments. We respect each other so we talk and if she needs help with something she will ask me. The last few months she's been real tense and had a lot of anger, not at me she's was just mad in general.  

So when I mentioned what she was doing, she stepped back and took a look at how she had been acting. We have 3 Doberman's and we yell at them from time to time. But she realized she was yelling at me and the dogs a lot more than normal. She agreed she was having some kind of reaction to the Gabapentin and started lowering her dose. She's going to talk to her doctor about the problem next visit. Things are getting better since she lowered her dose.......

Ohio like other states is finding that a drug many physicians are prescribing as they lower opioid doses is the new drug of abuse. 

The CDC considers Gabapentin a non-addictive alternative to opioids for chronic pain. This story shows how even with the best intentions there are always unintended consequences...... 

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NEWS ARTICLE New on the Streets... Gabapentin, a Drug for Nerve Pain, and a New Target of Misuse

An article in STAT News "New on the streets: Gabapentin, a drug for nerve pain, and a new target of misuse" says it’s not just in Ohio. Gabapentin’s ability to tackle multiple ailments has helped make it one of the most popular medications in the U.S. In May, it was the fifth-most prescribed drug in the nation, according to GoodRx.

Gabapentin is approved by the Food and Drug Administration to treat epilepsy and pain related to nerve damage, called neuropathy. Also known by its brand name, Neurontin, the drug acts as a sedative. It is widely considered non-addictive and touted by the federal Centers for Disease Control and Prevention as an alternative intervention to opiates for chronic pain.

As providers dole out the drug in mass quantities for conditions such as restless legs syndrome and alcoholism, it is being subverted to a drug of abuse. Gabapentin can enhance the euphoria caused by an opioid and stave off drug withdrawals. In addition, it can bypass the blocking effects of medications used for addiction treatment, enabling patients to get high while in recovery.

A literature review published in 2016 in the journal Addiction found about a fifth of those who abuse opiates misuse gabapentin. A separate 2015 study of adults in Appalachian Kentucky who abused opiates found 15 percent of participants also misused gabapentin in the past six months “to get high.”

In the same year, the drug was involved in 109 overdose deaths in West Virginia, the Charleston Gazette-Mail reported.

One participant explained his attraction to Neurontin “It’s not a narcotic, but what it does, is, it intensifies your methadone … so if you take your methadone and you go buy 10 Neurontin® and you take all 10, it’s sort of like you tripled your dose.” Other participants described: “They give you a semi-euphoric feeling if you abuse it; I know people who over take it; It’s called ‘gabs’ and is more available because there is a demand; I give it two more years and it will be scheduled.”

A treatment provider reported, “It’s on the rise. I am hearing a lot more about it being on the streets and I got clients that are prescribed it. They say it’s awesome for withdrawals.” Another treatment provider commented, “Neurontin® seems to be the new high … they crush them up and snort them … especially used in the jail. Heroin addicts are prescribed it to treat [withdrawal] symptoms and they get a little bit of the high feeling and are hooked.” Law enforcement officers commented: “There seems to be a marked difference [availability increase] in Neurontin® in the last six months because doctors are prescribing it more; I am seeing a lot of gabapentin.”

NOTE
In 2011 West Virgina had 11 deaths from Gabapentin. 
In 2015 West Virgina had 182 deaths from Oxycodone, 180 deaths from Fentanyl, and 108 deaths from Gabapentin.  What changed?

As long as government is telling doctors how to practice medicine one of the unintended consequence will be forcing pain patients to the streets and more dangerous drugs.