After 7 years at Duke and treatment since 1997 everywhere Duke has decided that it wants a MME level of 90 for its( dare I say patients). Mine is 300. Screwed again. Just fyi

Duke University dominates the Durham/Raleigh NC area.

I would suggest that you get a CYP-450 opiate metabolism test https://www.practicalpainmanagement.com/treatments/pharmacological/opioids/cytochrome-p450-testing-high-dose-opioid-patients

this will determine if you are a fast/ultra fast metabolizer and will provide clear documentation that you have a medical necessity for higher daily opiate dose.

Here is one of the MME calculation programs  https://globalrph.com/medcalcs/opioid-pain-management-converter-advanced/  read the footnotes…   Published equianalgesic ratios are considered crude estimates at best and therefore it is imperative that careful consideration is given to individualizing the dose of the selected opioid. Dosage titration of the new opioid should be completed slowly and with frequent monitoring.

Those conversion prgms are JUNK … they were determined by using a SINGLE DOSE on opiate naive acute pain pts… ignored CYP-450 opiate metabolism rates of test subjects…. and has little/nothing to do with the needs of intractable chronic pain pts.

Here is another interesting article – just one of many that one can find on the web — https://www.aafp.org/news/health-of-the-public/20190509cdcopioidgdln.html on how the CDC guidelines have been MIS-APPLIED

There are two laws Americans with Disability Act and Civil Rights Act that declares discrimination of disabled people is a CIVIL RIGHTS VIOLATION.  Duke has some very deep pockets and the fines for civil rights violations under those two laws can be quite stiff and I suspect that Duke has thousands or tens of thousands of chronic pain pts that are being discriminated against.

Perhaps those pts need to start talking to law firms that deal with civil rights violations… if you talk to a law firm…DO NOT let them start talking about MALPRACTICE… that ends up being a he said.. she said situation…  each side hires a “expert” that will state that what their client did was the right thing to do… many states of rather low caps on malpractice awards… to such a point that a law firm will not take malpractice cases on a contingency bases because – even if they win – they won’t cover their expenses because of the award caps.

Filed under: General Problems