This, along with ill-advised CDC pressure on ethical pain doctors is pushing legitimate pain patients to seek pain relief on the black market. I am lucky, my doctors have not caved in to the hysteria. What the public does not know is the difference between “dependent,” and “addicted.”
Four years ago, I started having sharp pains in my back and down the backs of both legs from my hips to my ankles. I am fairly pain tolerant, but this was excruciating. It felt like someone was electrocuting me from behind. I had double sciatica. Two back surgeries, and three spine infusions later, the surgeons had relieved me of a baseball-sized tumor on my spine, and a herniated disk. I now have a titanium strut screwed to my vertebrae, a substitute disk, and residual nerve damage.
My doctors started me off with a pretty big dose of oxycodone for two months while I was starting to heal. Every month, they monitored my pain, and tested for “compliance,” before they gave me the next month’s prescription. They gradually lowered the dose and switched me to hydrocodone and a small fentanyl patch. Then I stopped the patch and lowered the dose of hydrocodone below the “worry line.” They have guidelines for prescription levels that pose potential danger. Now I take a small, stable amount of hydrocodone every day, right above the threshold of pain. If I take less, the pains begin. I do not feel high; I hardly notice the effects of the drugs; I do not crave more. I am drug dependent, but not addicted; that is the difference. This is what pain specialists want for chronic pain patients.
When the CDC reported the rise in drug overdose deaths, they said they were issuing “opioid guidelines for primary care physicians.” My doctors told me that was code for the hospital lawyers that these were the rules for everyone, because of liability. That is when I read the CDC report. I discovered most of the overdose deaths were from illegal drugs. The deaths from prescription drugs did reveal the abusive prescription doctors; I think the authorities are dealing with them. But that might be part of the problem. Where do addicts or people in pain go when cut off from prescriptions? Their options today are extremely dangerous.
Equal Amounts of Death: Above are Lethal Doses of Heroin, Fentanyl, and Carfentanil.
The latest CDC report showed that deaths from prescription drugs declined over the past several years, even before their report. So, the “crisis” lies in illegal synthetic opiods, like fentanyl and carfentanil, which are many times more potent than heroin. They are true pain killers.
Mexico and China manufacture the drugs for drug dealers to strengthen other drugs, like heroin, and to put in counterfeit pain pills, such as fake oxycontin and hydrocodone. The danger is that it takes so little of these super powerful synthetic opioids to kill you. Fentanyl is a strong pain killer, 100 times stronger than morphine; Carfentanil is an elephant tranquilizer, 10,000 times stronger than morphine; 20 micrograms will kill a human being; that equals the size of one or two grains of salt. Drug sellers and drug users do not know how much fentanyl or carfentanil is in their drugs. Police are terrified when they discover drugs, that they might touch or breathe a deadly dose. Houston police discovered that, what they thought was 80 grams of methamphetamine powder, was really carfentanil. It could have been lethal for any officer who got some on their skin or accidentally breathed the dust.
On top of this, a new fentanyl derivative, acrylfentanyl, is resistant to Narcan, the drug used to neutralize overdoses of opioids. Another Narcan-resistant drug, tetrahydrofureon, is so new, it is not yet on the list of illegal drugs.
The current portrayal of the drug overdose epidemic hurts real pain doctors, like mine. If they get pressured into under-prescribing pain medicine, three things happen:
- Patients with real pain will suffer
- “Breakthrough” pain will inhibit patient healing.
- Patients may seek illegal drugs for pain relief.
So, let us dispel this vast generalization and focus on the lethal products and problems. Let professional pain management specialists do their best for their patients. Do not push people in pain onto the streets of death.