10 Changes That Could Actually Make A Difference in the Opioid Problem

Maia Szalavitz 10 Deep Systemic Changes That Could Actually Make A Difference in the Opioid Problem

The government had another knee jerk response to the opioid problem and everybody knew what the unintended consequences would be.... 

Now Maia Salavitz came up with 10 changes that really could make a difference...

LINK to Deep Systemic Changes 

Human Rights Watch: CDC Guideline Needs Revision

Human Rights Watch: CDC Guideline Needs Revision

December 18, 2018

By Pat Anson, PNN Editor

Federal and state efforts to reduce opioid prescribing have harmed pain patients across the country and caused many doctors to arbitrarily cutoff or taper patients who need opioid medication, according to a new report from Human Rights Watch.

The 109-page report -- “Not Allowed to Be Compassionate” -- highlights the many unintended consequences of the 2016 CDC opioid guideline, which discourages doctors from prescribing opioids for chronic pain. The report recommends the CDC revise the guideline to explicitly state that patents should not be involuntarily tapered off opioids and that some patients may require higher doses.

“Many individuals with chronic pain are being involuntarily tapered from essential medicines that are vital to their daily functioning, depriving them of their right to health,” the report found.

READ MORE HERE

Please Read This Article on Chronic Pain and Suicide

It's the holidays and a lot of people have problems with depression this time of year. This year with doctors tapering pain medications I fear the problem will be worse than in recent years.

If you suffer chronic pain or know someone who does, please read this article. If you feel depressed please talk to someone.

Fox News Article
As doctors taper or end opioid prescriptions, many patients driven to despair, suicide 

If you're depressed and need someone to talk to please call
National Suicide Prevention Lifeline: 1-800-273-TALK (8255)
Talk to someone, anyone......

Doctors Call for Urgent Review of Opioid Tapering Policy

Doctors Call for Urgent Review of Opioid Tapering Policy
December 4th 2018

An open letter by healthcare professionals to the U.S. Department of Health and Human Services is warning that forced opioid tapering has led to “an alarming increase in reports of patient suffering and suicides” and calls for an urgent review of tapering policies at every level of healthcare.

LINK to Pain News Network Article

I Don't Understand the Politics of Drug Deaths

Alcohol Kills More People than Opioids 

But It's NOT an Epidemic?

I don't understand the politics of drug deaths... 

Drugs that kill people fast like opioids are an epidemic and a priority for law enforcement. 
Drugs that kill more people, but kill them slowly are not a priority for anyone... 

The article below says 88,000 people a year die from alcohol. I fear another drug may kill more, because gastrointestinal disease is the 3rd leading cause of death in the U.S. and NSAID's are both sold over the counter and handed out like candy by physicians, I'm afraid the death toll from NSAID's may be higher than we think.

The USA Today article says "As opioid overdoses, which kill about 72,000 people a year, grabbed America's attention, the slower moving epidemic of alcohol accelerated, especially in Southern states and the nation's capital. About 88,000 people die each year from alcohol"

Alcohol Kills More People than Opioids

Kingman Harm Reduction Offers FREE Naloxone Here's How Make a Rugged Naloxone Kit

The Sonoran Prevention Works Kingman Harm Reduction office has free Naloxone clean needles and information on what street drugs contain fentanyl.

Kingman Harm Reduction is located at 3505 Western Ave Suite B in the Mohave Mental Health building, the entrance is to the left as you face the front doors of MMH. 

The Naloxone kits provided at Kingman Harm Reduction have two vials of 0.4 mg Naloxone, two syringes with needles attached. These kits are great and anyone who takes prescription opioid pain medications or who abuse ovoid street drugs should have several of these kits around and always carry them with you. 

I have Naloxone at home and carry a kit in the car. I was concerned having a kit rattling around in the glove compartment the vials could break or the bag become torn. 

So I made a rugged Naloxone kit I could throw in the glove compartment, a ladies purse, a backpack, or anything without worrying too much about it getting broken. 

Rugged Naloxone Kit
The Kingman Harm Reduction kit comes with syringes with needles attached. You'll need to replace these and I explain as we go. 

You need to go to your local pharmacy and talk to the pharmacist, get to know them. Explain what you're doing and ask for one of their large prescription bottles, and a couple syringes with separate needles. 

I found that two 3cc syringes and two needles fit in the prescription bottle that's 3.75" without the lid. This makes a small rugged Naloxone kit you can carry about anywhere.

Naloxone from Kingman Harm Reduction 

Syringes and syringes from pharmacy for Naloxone Kit

Rugged Naloxone Kit in 3.75" Prescription Bottle

WARNING 

Naloxone has a SHORT Half-Life The time it's effects last.....

When naloxone is given intravenously, it starts working within two minutes, and when it’s injected into a muscle, it works within five minutes. When Narcan nasal spray is used, it also works within two to five minutes. 

The effects of Narcan last anywhere from half an hour to an hour. For some people, multiple doses are required, because the length of action of opioids is longer than naloxone’s duration of action. 

What is the Naloxone AKA Narcan half-life? Narcan is metabolized in the liver, and studies have shown the half-life in adults to be anywhere from 30 to 81 minutes. 

In infants, the half-life is around 3.1 hours. Again, Narcan and any form of naloxone doesn’t have any effect if there are no opioids present in a person’s body. It doesn’t have the potential for abuse, and all that it does is reverse the effects of opioids including respiratory depression so that the person who has overdosed can resume normal breathing. LINK TO PAGE

Unlike the rumors some physicians are spreading people are NOT abusing naloxone! 

In 12 years working undercover narcotics I have never seen a drug addict spend half the day finding money, the other half looking for heroin, so they can shoot up and get high only to inject themselves with Naloxone.... 

In my experience as an EMT I've seen many pissed off drug addicts when given Naloxone by EMS because they ruined their high. The fact they were about to die doesn't seem to hit them until later....

NEW Pain Crisis in Mohave County, and America Facebook Page

Please Check Out My 

New Pain Crisis in Mohave County, and America Facebook Page

I'll be sharing pain news and information for the pain patient community

https://www.facebook.com/groups/PainCrisisinAmerica/

A Prescriber's Guide to the New Medicare Part D Opioid Overutilizaton Policies for 2019

If you suffer chronic pain and have Medicare Part D Please Read

Below are some comments from a patient advocate in Nevada about changes to Medicare Part D in January 2019.

It contains, from Medicare:  "A Prescriber's Guide" and a notice to insurers about 2019 Formulary-Level POS Safety Edits, which I find to have very important information.

I hope you find this information useful. I am sure most of you know about this already however the CMS newsletter is only a couple weeks old.  At the Alliance for the Treatment of Intractable Pain, we are giving this information out to pain patients across the country.  We are also trying to get the 2019 Call Letter edits suspended for 1 year.

A Prescriber's Guide to the New Medicare Part D Opioid Overutilizaton Policies for 2019

https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNMattersArticles/Downloads/SE18016.pdf

Page 3.  90mme is the threshold to ID potential high risk patients. Of significance, it says "This is not a prescribing limit" 

Page 5.  Palliative care is listed as one of the exemptions.

page 6.  The patient, the patient’s representative, or the physician or other prescriber, on the patient’s behalf, has the right to request a coverage determination for a drug(s) subject to the alert, including the right to request an expedited or standard coverage determination in advance of prescribing an opioid

Page 6   How else can a provider prepare for the new 2019 Medicare Part D over-utilization policies? To avoid a prescription being rejected at the pharmacy, prescribes may proactively request a coverage determination in advance of prescribing an opioid prescription  if the prescriber has assessed that the patient will need the full quantity written 

So what does this all mean?  Palliative care "should" be exempt. 

Find out in advance if the Medicare plan will even have a safety edit at 200mme.

A hard edit at 200mme is optional for the insurance companies. Request a coverage 

determination NOW. The patient can do this.  It does not have to be the doctor.

Personally, I already have a PA for 2019.  This "should" exclude me from having

a hard edit for above 200mme.

October 23, 2018 notice to sponsors

Additional Guidance on Contract Year 2019 Formulary Level Opioid POS Safety Edits

Medicare-PartD-Overutilization-Control-HPMS-memos (October 2018) [ZIP, 1MB]                                                                                                                                   

I include the above link as an attachment also.

MME hard edit (optional) 

In 2019, sponsors will continue to have the flexibility to implement hard safety edits at a threshold of 200 MME or more, with or without prescriber/pharmacy counts. We remind sponsors that they may not use MME thresholds as prescribing limits.  They can only function as a threshold to trigger the edit, indicating potentially unsafe opioid use.

I believe this is a significant statement.

If an enrollee or their prescriber requests a coverage determination and the only issue in dispute is the MME, CMS expects the Part D sponsor to approve the request if the prescriber attests that the higher MME is medically necessary, and  not to apply additional requirements such as the execution of a pain management agreement. 

It seems to me this is quite significant.  The provider should be able, for instance, to just fax a copy

of this notice to the sponsor and simply say "I have reviewed the patient's history and attest the higher dose is medically necessary.  End of discussion.

Q5: Which beneficiaries should be excluded from the opioid safety edits? 

A5: Part D sponsors are expected to develop specifications that exclude beneficiaries who are residents of a long-term care facility, in hospice care or receiving palliative or end-of-life care, or being treated for active 

cancer-related pain from all of the opioid safety edits. Sponsors should use all information available to them to reasonably exclude these beneficiaries from triggering the edits at POS in the first place.  

(so should "someone" alert the sponsor in advance

that the patient is excluded because of say,   palliative care?)

Sponsors should also apply specifications to account for known exceptions, 

such as reasonable overlapping dispensing dates for prescription refills or new prescription orders for continuing fills; and high-dose opioid usage previously determined to be medically necessary such as through coverage determinations, prior authorization, case management, or appeal processes.

I've received a PA already through the end of 2019.  Does

this mean I am excluded already?  If everyone gets a PA, will it avoid the edit?  FYI, my "Medicare and You" handbook lists 10 part-D sponsors. 4 of them

DO NOT list fentanyl patch 100mcg requiring a PA.  ALL plans have an asterisk saying,  "Opioid pain meds are subject to additional safety review"

Under question 6 answer:

Pharmacists are not expected to do extra work contacting  prescribers or patients to find exclusions outside of the normal pharmacy workflow. Rather, pharmacists may have existing knowledge or information that a eneficiary is not opioid naïve or meets one of the opioid safety edit exclusions (such as through pharmacy drug claims history, knowledge of the enrollee’s diagnosis and/or the prescriber’s specialty). 

Also, the pharmacist may learn through a care coordination consult with the prescriber that a beneficiary should be excluded. Sponsors should instruct pharmacists on how to communicate to the plan that the enrollee is excluded (e.g., through a transaction response code or by contacting the pharmacy help desk) to override the edit or to avoid the beneficiary or their prescriber from having to request a coverage determination on this particular fill. Plans are expected to accept this information in real-time so the claim can adjudicate.

so...........this implies to me, as my pharmacist already knows me and my history, he should already be checking with the sponsor and getting an override code.  

Also in NV, the prescription is required to have the ICD code on it giving the pharmacist the information needed to get an override code from the sponsor.

Should the patient go to their pharmacist (with the notice?) and say "hey, please go ahead and get the override code now so we don't have to have a hassle in Jan. OK?

Are Part D sponsors permitted to require that specific criteria or requirements be met, such as a referral to a pain specialist, prior to approving a coverage determination request related to an opioid safety edit? 

A7: No. The opioid safety edits are not intended to be a means to apply additional clinical criteria for the use of opioids, such as being managed by a pain specialist, having a signed pain contract, or having a treatment plan in place. In the absence of other submitted and approved utilization management requirements, the sponsor should allow the beneficiary to access his/her 
medications once the prescriber(s) attests that the
identified cumulative MME level or days supply is the intended and medically necessary amount for the beneficiary.  

This appears to me to limit the amount of hassle the sponsor/pharmacy can give the prescriber. This also re-affirms the comment from the other article saying "if MME is the only thing being considered" then the sponsor is suppose to accept the doctor's attestation that a high dose is medically necessary and should be approved.

CMS also expects sponsors to ensure that their staff are trained to appropriately identify and process enrollee requests for a coverage determination.
This includes verbal coverage determination requests made by enrollees, which should not be mis-classified as inquiries or grievances. Plans are not permitted to instruct an enrollee who is requesting a coverage determination that only their prescriber can initiate that request.

In other words, don't let the sponsor bullshit you.  Fax them a copy of this newsletter.  Give a copy to your pharmacist.  Try to get your patients to request a coverage determination NOW.  Enrollment ends Dec. 7th, 2018

Holidays Family Pain & Depression

The holidays are stressful for everyone and especially for those who suffer chronic pain. Sadly pain and depression go hand and hand especially this time of year. 

As the holidays approach it's especially trying for those with medical problems including chronic pain.

Not having the ability to do the things you once could like pickup a grandchild or simple things around the house is frustrating.

If you have the blues, if you feel depressed please talk to someone. What you’re going through is difficult

You can call the National Suicide Prevention Lifeline at 1-800-273-8255..... 

Lifeline provides free and confidential support for people in distress 7 days a week, 24 hours a day, 365 days a year we will be there for you.

So if you need someone to talk to call Lifeline at 1-800-273-8255

Please Go To My NEW Facebook Page

Please Go To My NEW Facebook Page 
Pain Crisis in Mohave County and America

I'm Afraid History is Repeating It's Self Read this 1996 Kingman Daily Miner Article and the 2017 Article

The article in this post is a Kingman Daily Miner article about my fight for pain relief back in 1996. I fear history repeating it's self.

This is a LINK to a February 2017 Kingman Daily Miner article the Politics of Pain 


1996
This is the original 1996 article Kingman Resident in Tough Battle for Pain Relief, Hist Rock Wall was written by Abbie Gripman a staff writer for the Kingman Daily Miner at the time. 

WARNING Counterfeit Opioid Tablets Contained Fentanyl Found in Arizona

Deadly synthetic opioids found in several Arizona cities

Several law enforcement agencies across Arizona, including Phoenix, Tucson and Yuma are alerting the public that street drugs containing deadly synthetic opioid fentanyl and carfentanil have been showing up across the state.

According to the national institute on drug abuse, fentanyl is 50 to 100 times more potent than morphine. Carfentanil is a sedative used for very large animals, such as elephants.

These pills may be sold on the street as oxycodone, and can be deadly. White Mountain Independent Link to Article 

If you have pills you think may contain Fentanyl or Carfentanil please contact Dusti at Kingman Harm Reduction 3505 Western Ave 

She's open Wednesdays 12-7:30 and Fridays 8:30-3:30 and has test strips for Fentanyl or Carfentanil as well as Naloxone and other supplies.  

NASA space suit on-the-move

SHOW LOW — Pictured is an actual NASA space suit worn by an …

NEXT UP

Lane restriction on SR 277 through Nov. 1

Drivers who use State Route 277 between Snowflake and Heber should plan for co

Doctors Urge CDC to Clarify Rx Opioid Guideline in Letter

Doctors Urge CDC to Clarify Rx Opioid Guideline in Letter

Hundreds of doctors and healthcare professionals have written a letter to the CDC, asking the agency to make a "bold clarification" of its controversial 2016 opioid guideline. 

They believe many chronic pain patients have suffered under the CDC guideline because it has led to widespread tapering and discontinuation of opioids. 

Read the Whole Story on The Pain News Network

The FDA is requesting comments concerning abuse medical usefulness of marijuana and 16 other substances

The Food and Drug Administration (FDA) is requesting interested persons to submit comments concerning abuse potential, actual abuse, medical usefulness, trafficking, and impact of scheduling changes on availability for medical use of 16 drug substances. 

These comments will be considered in preparing a response from the United States to the World Health Organization (WHO) regarding the abuse liability and diversion of these drugs. 

WHO will use this information to consider whether to recommend that certain international restrictions be placed on these drugs. This notice requesting comments is required by the Controlled Substances Act (the CSA)

Food and Drug Administration Comments Here

If You Have Chronic Pain You Need to Know About Trigger Points

I just learned about trigger points and WOW they really work.

My new pain doctor told me about trigger points and how he could inject a small amount medicine and relieve some of my pain. I love my doctor and trust him 100%, but I hate needles..... That's when he told me that I could get temporary relief using pressure on the trigger points. 

One night when I was hurting we printed the anterior trigger points. My wife didn't have much problem finding #1 and #5 on the chart as they were pretty tender. She used her elbow and pressed as hard as she could counting out 30 seconds. Then she moved on to the next trigger point and did the same thing.

When I got up off the bed I couldn't believe I didn't hurt, at least not as much. It had relieved about 80% of the pain. I could even stand up straight and walk without much pain.

Now when I get that pain down the back of my leg and it's hard to walk, my wife uses her elbow on #1 and #5 for 30 seconds, and it's much better.

If you have chronic pain look into the trigger point links below they can really make a difference. I was surprised how something so simple could make such a difference...

Locations are where you'll find sore spots or small muscle knots
Referrals are where pain may refer when a trigger point is pushed

Links
Anterior Trigger Point Locations
Posterior Trigger Point Locations
Anterior Trigger Point Referrals
Posterior Trigger Point Referrals

Great Page on How Trigger Points Work

HHS Recommendations on Chronic Pain Due Late October MUST READ

This is a must read article for pain patients in 

The National Pain Report

HHS Recommendations on Chronic Pain Due Late October

You have another chance to tell the Department of Health and Human Services your story...

It’s going to be the end of October before we see the set of draft recommendations of The Pain Management Best Practices Inter-Agency Task Force. Once the recommendations are released, there will be an extensive public comment period where the patients, providers, and policy makers can weigh in.

The Article Say's

 "Tellingly, the Task Force will recommend against imposition of any mandated numerical daily dose threshold. This position in effect contradicts much of the CDC Guidelines and State regulations based on them".

"It will be interesting to see if the final report extends this principle to 2019 rule changes of HHS/CMS authorizing “soft” and “hard” edits of prescription plans at 50 and 200 Morphine Milligram Equivalent Daily Dose levels".

"Mandatory or coercive tapering of high dose legacy patients is unjustified and risky unless some condition in the individual patient’s health justifies such action". 

The 90-day comment period will trigger a process that will result in a final report to Congress in May 2019.

LINK TO ARTICLE: National Pain Report Article

When Will We Learn?

When will we learn that drug abuse like alcohol abuse is a medical problem, not a law enforcement problem. Like I've said so many times, we can not arrest our way out of this.... 

Over the past 50 years our nations war on drugs has failed it's intended goal of reducing drug use. Today drugs are more potent, cheaper, and easier to get than when we started 50 years ago. 

This is a time our nation is threatened by terrorists and others who would want to damage America. This is a time we need to come together as a nation and not be divided by something as simple as a plant or pill. 

Hubert Humphrey told us “There are not enough jails, not enough policemen, not enough courts to enforce a law not supported by the people”. 

Covert operations the use of undercover officers, informants, and snitches have destroyed the trust between law enforcement and many communities.

I learned this from the damage I did while working undercover. Something I tried to make up for as a speaker for LEAP for the past 15 years. I still have problems talking about the damage I caused even today. I did talk about it in this 2006 documentary Damage Done the Drug War Odyssey 

Sadly nothing has changed.... America the home of the brave and land of the free still imprisons more of it's own citizens than any other country. While the United States has about 4.4 percent of the world's population, it houses around 22 percent of the world's prisoners. More of our own citizens than countries like Thailand, Cuba, Rwanda, and Russia. Really..   Prison Populations by Nation 

Now President Trump is ramping up the war on drugs again. As War on Drugs Again Declared Failure, Trump's UN Event Dismissed as 'Splashy' Backward-Thinking

I use a couple lyrics from the 1984 song Smugglers Blues to point out that sadly nothing has changed.

You see it in the headlines, you hear it every day

They say they're gonna stop it, but it doesn't go away

They move it through Miami and sell it in L.A. 

They hide it up in Telluride, I mean it's here to stay

It's propping up the governments in Columbia and Peru You ask any D.E.A. man, he'll say there's nothing we can do

 From the office of the president right down to me and you Me and you

It's a losing proposition, but one you can't refuse. 

It's the politics of contraband, it's the smugglers' blues Smuggler's blues

In the same 50 years we have reduced tobacco use by half. Cigarettes used to be everywhere in American society. Fifty years ago, 42.4 percent of U.S. adults smoked. Since then, that figure has declined by more than half, reaching a record low 17.8 percent in 2014.

We did that without SWAT teams, without putting anyone in prison, without destroying any lives or families. We did it by making it not socially acceptable......

We need to stop all this madness? When will we learn that drug abuse like alcohol abuse is a medical problem, not a law enforcement problem. When will we look at history as well as science and learn from both.

Like I've said so many times, we can not arrest our way out of this.... 

Free Naloxone From Sonoran Prevention Works Kingman Dolan Springs White Hills Meadview Chloride

Sonoran Prevention Works Kingman Harm Reduction Program is in the Mohave Mental Health Building at 3505 Western Ave Suite B in Kingman.

They have free Naloxone info on the Fentanyl laced street drugs and other services for the community.

It doesn't matter if you take prescription opioids from your pain doc, or if you abuse street drugs please keep Naloxone on hand just in case.

If you can't get into Kingman message me or Facebook and I'll get some to you in Dolan.

Jay

Now is Your Chance to Tell Congress How Chronic Pain Affects You and Your Life

Pain Management Best Practices Inter-Agency Task Force Second Meeting

September 25, 2018 - September 26, 2018

Now is your chance to tell Congress how pain affects you and your life...

Link to Pain Management Best Practices Inter-Agency Task Force Meeting

• 
  September 25, 2018 | 8:30 am - 4:30 pm EDT
• September 26, 2018 | 9:00 am - 12:00 pm EDT

Prescriber Checkup Check Out Your Physician

ProPublica Prescriber Checkup lets you see how your pain doctor stacks up prescribing opioids, billing patients, and money they receive from drug companies.... 
ProPublica Prescriber Checkup

On Fentanyl: Congress Must Avoid Another Drug War

From the LEAP Blog On Fentanyl: Congress Must Avoid Another Drug War

Congress and the American public had agreed that incarcerating tens of thousands of Americans for nonviolent drug offenses is cruel and ineffective, and does nothing to stop drug use. Then fentanyl arrived.

And We Wonder Why Kids Use Drugs

The government does study after study spending millions of dollars doing studies on why kids use drugs... 

Let me make it simple for them...

We give kids Adderall (amphetamine) in the morning to get ready for school, they take a Vicodin (opioid) after school for a sports injury, then use medical marijuana in the evening to relax and finally they take a Xanax (benzodiazepine) at night to get to sleep. All prescribed by their family doctor. 

And We Wonder Why Kids Use Drugs? Really

The Role of Suicide in the Opioid Crisis

Must Read Article The Role of Suicide in the Opioid Crisis from The Pain News Network

By Roger Chriss, PNN Columnist

Suicide is an under-appreciated factor in the opioid crisis. Media reports rarely mention it, and pundits and politicians often ignore it. But the reality emerging from experts and a careful study of drug deaths shows that it is very important.

“We’ve done preliminary work suggesting that 22 to 37 percent of opioid-related overdoses are, in fact, suicides or suicide attempts,” Bobbi Jo Yarborough, PsyD, an investigator at the Kaiser Permanente Center for Health Research, told HealthItAnalytics.

Complications of Uncontrolled, Persistent Pain

My heros these days are physicians like Dr Forest Tennant who stand up for their patients. Dr Tennant wrote this article in Practical Pain Management on the complications of uncontrolled persistent pain. 

If you or a family member suffers from chronic pain you need to read this article. Most patients and many physicians don't understand how many ways chronic pain adversely affects the human body. 

Complications of Uncontrolled, Persistent Pain

Persistent, unremitting pain may adversely affect the body’s endocrine, cardiovascular, immune, neurologic and musculo-skeletal systems and require aggressive treatment of the pain as well as the resulting complications.

To the unfortunate patient who is afflicted and the practitioner who treats it, incurable, persistent pain is truly its own disease regardless of its underlying cause.1-3 Persistent pain, which is also often characterized as chronic or intractable, has all the ramifications of a disease in that it may have pre-clinical and overt phases.4-6 It may be intermittent or constant, as well as, mild, moderate, or severe. The most unappreciated clinical feature of persistent pain, however, is the plethora of complications that may result — particularly if the pain is constant and unremitting.

Here's the rest of the Article Complications of Uncontrolled, Persistent Pain

I Didn't See One Mohave County Pain Doctor at PainWeek?

PainWeek was an amazing gathering of 2000 medical professionals with an interest in pain management, but I couldn't find one Mohave County physician was listed as attending.

You would think physicians like those in Kingman, BHC, and LHC who treat pain but are not board certified in pain management, would take any opportunity they have to get the latest training.

Far too many physicians in Arizona hang out signs saying "pain management" "pain specialist" or "pain institute" that make patients believe the physician is actually a pain specialist... They're Not.

Arizona needs a law that requires any physician who hangs out a shingle saying  "pain management" "pain specialist" or "pain institute" actually be a board certified in pain management.

Until pain patients contact their legislators and tell their stories, nothing will change...