Pain Patients on Streets of Death – CDC/DEA 25% Opioid Cut

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This week, in the Federal Register, the DEA announced 20-25% reduction of quotas for 2018, legal, U.S. opioid production.   (2017 Quotas:  https://goo.gl/sChjmc  2018 Quotas: https://goo.gl/sj8L7C)

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.

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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:

  1. Patients with real pain will suffer
  2. “Breakthrough” pain will inhibit patient healing.
  3. 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.

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Virtual Fahrenheit 451 – No Part of History Is Good Enough

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“Fahrenheit 451 – the temperature at which book paper catches fire, and burns…”.

In Ray Bradbury’s prescient 1953 novel, the government made the past illegal. Guy Montag is a “fireman” employed to burn the possessions of those who read outlawed books.  They even had book-sniffing robots to find homes with hidden books.

When Guy becomes despondent over the meaning of his work, his fire chief explains that, “over the course of several decades, people embraced new media (in this case, film, and television), sports, and a quickening pace of life.  Books were ruthlessly abridged or degraded to accommodate a short attention span, while minority groups protested over the controversial, outdated content perceived to be found in literature (yet comic books, trade papers, and sex magazines were allowed to stay, as those fed into the population’s want for mindless entertainment).”  People would watch the “parlor walls” (large televisions) with visiting friends instead of conversation.

We are now in the throes of a virtual Fahrenheit 451.  The need for burning books has become moot with the advent of ubiquitous, mesmerizing “screens.”  Evidence:

  1. Generations of high school graduates who show increasing ignorance, apathy, and illiteracy; they are ill-equipped for self-sufficiency, yet they excel at World of Warcraft, and Grand Theft Auto.
  2. People without enough money for food, have cellphones, and giant high-definition televisions, with cable. They read little and text a lot.  Everything is Facebook, selfies, videos, and soon virtual reality.
  3. Minority groups are protesting the controversial facts of our history. For example, the Fairfax County, Virginia school board just renamed my high school, J.E.B. Stuart High School, Justice High School.  (I can just imagine my next class reunion.)  Why?  Because he was an officer in the Confederate army.  Does anyone believe the Confederacy won the war?  Does anyone not see the tragedy of 600,000 lives lost as a lesson in pain?  Why remove the reminders?

What is next?  Will we remove the Civil War from our libraries?  Will museums take down every work of art with elements of that part of our nation’s history?  Will schools bury the history of slavery and the people responsible?

When will we hold accountable the Africans who sold tens of millions of other African as slaves to the entire world? https://goo.gl/EXnyGT

Were they not even more responsible for the misery of those slaves and their progeny?

Ignoring or censoring history will neither change the past, nor the consequences of what happened.  It will leave us less aware of the truth; a type of cultural dementia.  We must resist becoming a world of virtual Fahrenheit 451.