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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Opioids – Government Impotent Ignorance Prevails!

Update 10/31/2017:  Politicians blame doctors and pharmacies for the opioid crisis, despite the CDC reports that show that illegal drugs are the main source of overdose deaths.

According to the CDC report for 2016, most lethal effects of the opioid epidemic are coming from the streets and not out of doctors’ offices and pharmacies.

“Illicitly manufactured fentanyl is now a major driver of opioid overdose deaths in multiple states, with a variety of fentanyl analogs increasingly involved, if not solely implicated, in these deaths,” the CDC’s Julie O’Donnell, John Halpin, and colleagues reported.

“Fentanyl was involved in more than 50 percent of opioid overdose deaths, and more than 50 percent of deaths testing positive for fentanyl and fentanyl analogs also tested positive for other illicit drugs.”

But where has the government focused attention?  President Trump declared the opioid crisis a national emergency, proposed further restrictions on physicians, and, abstinence to potential drug abusers.  Why do authorities do this?  Because they are ignorant and unable to stop the illegal drug manufacture, sale, or use.

Highly publicized articles, including grandstanding lawsuits by states’ attorneys’ general are pandering to news hungry media and ignoring the pain inflicted on compassionate pain management. Death by dying method (drug overdose), without distinguishing source (legal vs. illegal) is a misleading abuse of authority and power.

The recent blitz campaign against opioid drugs is terribly flawed.  According to the latest official data from the National Institute on Drug Abuse (as of 2015) more than 52,000 people died of drug overdoses in 2015.  Sad, we lost fewer to drugs than to automobiles (38,000), plus homicide (16,000), and slightly fewer than those lost to suicides (43,000).

But of the 52,000, how many died of prescription drugs vs. illegal drugs?  Nearly, 30,000 (58%) died from prescription drugs, the balance of 22,000 (42%) died from illicit drugs.

Opioids include prescription drugs derived from opium (such as heroin), and synthetic drugs (e.g. fentanyl) which are both prescribed, and sold illegally (manufactured and sold to drug dealers).  These illegal synthetic opioids are largely responsible for the spike in overdose deaths, because they are 100 to 10,000 times stronger than morphine.  Drug dealers mix them with heroin or other drugs to enhance the strength.  The potency is often inconsistent and unknown to the user.  Illegal fentanyl is a popular additive which is 100 times stronger than morphine.  Even a slight mismeasurement is multiplied by 100.

CDC is foreclosing options for legal, and legitimate pain medicine, even though illegal drugs are aggravating the overdose statistics.  They are implying that doctors are responsible through overprescribing opioids to pain patients.  Pain management specialists, who deal with chronic pain patients are often ignoring real suffering by undertreating the pain to avoid criticism from the CDC.

Readers who have real spine and neck problems know what pain is, even after surgery and other efforts to repair the damage.  I have talked to people just beginning treatment and surgery, who are being given glorified Advil and other ineffective drugs, when what their pain indicates is opioids.  Some people do get addicted and abuse opioids.  I do not dispute that.  But, not everyone who takes pain medicine becomes an addict, even though they depend on the relief they get from their prescriptions.  Dependency is not the same as addiction.  It does not automatically lead to ever-increasing desire for more and more.

Carfentanil is the scariest invention yet.  10,000 more powerful than morphine, this relative of fentanyl has been a recent bogeyman for illicit drug users.  Primary producer:  China (recently banned).  This drug is meant to tranquilize elephants. As little as 20 micrograms will kill you.

This scary substance is, knowingly or unknowingly, used as a cheap booster for other illegal drugs, mostly out of Mexico.  Think you are buying heroin, or meth?  Think again.  Houston police recently seized what they thought was methamphetamine and found lethal amounts of carfentanil instead.

The old days of drug abuse are officially over with the advent of this drug.  The next terrorist attack could easily be a batch of white powder.  A car bomb or suicide vest filled with this drug could kill hundreds or thousands, including first responders.

The point, let legitimate pain-management doctors do their jobs; spend the millions of dollars now devoted to opioid suppression on the true shadow of death: illegal superopiods.