Email steve@steveariens.com 502-938-2414
Pay Attention
https://youtu.be/VrTbpHJucYM
Too tired & suffering too much pain fog to share or even describe this video explaining #Starburst🚀 & the importance of all Americans filing the Motions to Join. Plz watch & share far & wide as it is appropriately named
SickOfSuffering😢 https://sickofsuffering.com/
https://youtu.be/VrTbpHJucYM
Robert D. Rose Jr. — Teufelshunde
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Chitty Chitty Bang Bang!
Ohio is filed! Case #5:19-cv-133
Makes EIGHT in EIGHT STATES! How much longer can mass media ignore?
BTW- Ohio will be the epicenter considering a VERY similar case in 6th Circuit Court of Appeal against @DeptVetAffairs!
Rose v. Roe et al.
Case #18-5970
PLEASE get this information to every news outlet in Ohio as soon as possible. Mass media cannot be allowed to continue ignoring us or our fight against these violations to our Constitution! 
Robert — Teufelshunde
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https://www.wfla.com/1706691547
St. Petersburg, Fl. (WFLA) – 77 year old Ruth Jones was a patient at the Laurellwood Nursing Center in St. Petersburg for 3 years.
She suffered from Alzheimer’s.
Osteoporosis fractured vertebrae leaving her in constant and severe pain which can often be overcome by QC Kinetix (Shoney) clinic.
Her daughter Cindy Harris volunteered at Laurellwood until an illness in 2018 kept her away for a few months.
When she returned in August, patients she knew told Cindy that her mother cried all the time.
Cindy provided 8 On Your Side records that show, 2 months earlier, in May, a doctor at Laurellwood discontinued Ruth’s pain killing drug, Percocet, the only pain medication that really helped her.
“They never informed me that they were going to withdraw that medication,” Cindy said. “77 years old and they let her pain get so bad that she had to holler for an entire day and night, it’s inhumane.”
According to Cindy, Laurellwood insisted that she take her mother to a doctor where she could get a new pain medication prescription.
Unable to sit up, Ruth made what turned into a grueling trip by ambulance.
“She was crying all the way up to the office on the stretcher, she was in so much pain,” Cindy tearfully explained. “Every time I think about it, my heart hurts for her.”
The pain management office Cindy and Ruth went to didn’t have a bed to accomodate Ruth.
Ruth was in such agony the doctor recommended she be taken to a hospital emergency room.
There, hospital staff discovered a bed sore.
“Nursing homes have an obligation to provide patients the best care possible,” Brian Lee, executive director of Families for Better Care said.
Lee, the former Ombudsman for the state of Florida points out that nursing homes must also make sure that patients do not endure hardships when seeking assistance.
If there was no bed at the pain clinic to accommodate Ruth, Brian Lee says it is obvious the nursing home did not help coordinate the visit and was not looking out for the patient’s best interests.
Earlier this month 8 On Your Side profiled Tonya Baker’s complaints about Laurellwood.
Tonya showed us pictures of her father’s bed sore.
She complained to the Department of Children and Familes, Florida’s Agency for Health Care Administration and Elder Abuse.
DCF confirms it is investigating Tonya’s complaints.
Once Ruth was stabilized at the hospital in August, she returned to Laurellwood for another two months.
On the day she was moved to hospice, Cindy says she learned that Laurellwood had run out of Percocet a week before.
“They didn’t notify me,” Cindy added. “I had no idea.”
I reached out to Laurellwood this morning.
The telephone rang and rang, no one picked up.
Later in the day I was told no one was available to answer my questions.
Ruth moved to hospice in November and passed away 3 days later.
“I told my sister, after what I saw, don’t ever let me go into one of these homes, don’t let it happen,” Cindy explained. “If I’m an Alzheimer’s take me down the street and let me walk into traffic. I would never want to go through what she went through.”
If you know of something that you think should be investigated call our 8 On Your Side Helpline at 1 800 338-0808.
Contact Steve Andrews at sandrews@wfla.com
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Who else attended the Webinar for the HHS today? I asked 3 questions-1. Are they going to address the DEA problem that is scaring the doctors’ so badly? 2-Can they ask the FDA & the CDC to study chronic & intractable pain patients who have successfully taken opioids for years because no one has studied us. & 3. Even though medical marijuana is legal is WA state, we are not allowed to use it if we go to a pain clinic. Are their other states with this problem? & this also goes to stigma-being treated like an addict-will they add this to their stigma section? Many people addressed the DEA question & the moderator said that the best response was to support the HHS report and work through your legislature and contact your Senators in WA DC by phone. The more noise we make as constituents (voters) the better chance we have at changing things. No answer on the other 2 questions-maybe they will address them later. I was unable to hear the moderator responding to questions after the webinar was ended so I don’t know what questions were answered. Anybody else hear that part of the broadcast? Anybody else submit questions?
I have posed this question before and it would seem like those on this HHS webinar today… has just confirmed my fear/suspicions… The DEA is/has been no where around when all these various Fed/State groups are trying to – at least – put up the front that they are trying to help the chronic pain community and getting some adequate pain management.
I just wonder if it is a indication that the DEA is going to keep on as business as usual… targeting innocent prescribers, raiding their offices and confiscating their assets.
Will the DEA be encouraged or discouraged if Louisiana Republican Senator Bill Cassidy proposed that money seized from Mexican drug cartels get signed into law to build “the wall” ? https://www.wndu.com/content/news/GOP-senator-suggests-using-drug-cartel-money-for-border-wall-504325111.html
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A few days ago I made the following posts and since then the number of page views on my blog as jumped substantially and I have notice a few more people are sharing my posts.
I guess this means that I/we are getting more people “educated” on what is going on good (Robt Rose’s lawsuit) and the bad (suffering and suicides) in/around the chronic pain community.
I don’t make a penny off a page view, in fact… I may have to pay my ISP a few more $$$ per month to add RAM to the buffer on my blog to handle the increased internet traffic… NO BIG DEAL… if we educate more in what those in the chronic pain are dealing with and get more chronic painers to ADVOCATE.
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www.paindr.com/%ef%bb%bfresponse-to-oregons-tapering-guidance-and-tools/
We welcome guest blogger Dr. Stephen E. Nadeau, Senior Research Advisor, Alliance for the Treatment of Intractable Pain. Dr. Nadeau agreed to share his response to The Oregon Pain Guidance Clinical Advisory Group, Tapering Workgroup*. For more context, the Advisory group recently posted a set of guidelines for tapering opioid doses in patients with chronic nonmalignant pain who have been receiving long-term treatment with opioid analgesics. These recommendations were specifically designed to be utilized by clinicians throughout the state of Oregon and are available HERE. Of note, opioid tapering or abrupt cessation of opioids was covered on paindr.com in a previous post, If you are forced to stop opioids.
*The Workgroup and contributors include Jane Ballantyne, Roger Chou, Paul Coelho, Ruben Halperin, Andrew Kolodny, Anna Lembke, Jim Shames, Mark Stephens, and David Tauben.
Thank you, Dr. Nadeau, for your patient advocacy and response letter as it appears below.
_____________________________________________________________________________
Ballantyne and colleagues, in their recent article, “Tapering – Guidance and Tools” (https://www.oregonpainguidance.org/guideline/tapering/), make the implicit assumption that tapering of opioid regimens in patients with chronic nonmalignant pain is a desirable thing – this, despite the evidence that the cost of chronic pain to American society, based upon health care expenditures and cost of lost productivity, is $560-635 billion/year (1); the evidence from randomized controlled trials employing designs that replicate good clinical practice that opioids are highly effective in the treatment of nonmalignant pain (2-6); the evidence that this beneficial effect can be sustained for years (7-9); and the evidence that the annual case fatality rate associated with chronic opioid treatment of pain is 0.08% with dosage of <200 mg morphine equivalent/day (MMED) (10), 0.25%/year with dosage of >100 MMED (11), and 0.5%/year with dosage >400 MMED (10). The latter two case-fatality rates are quite comparable to the risks of fatal bleeding associated with use of rivaroxaban (0.2%/year) and warfarin (0.5%/year) in the prophylaxis of stroke due to atrial fibrillation (12). Given the extreme impact of chronic pain on a patient’s life, this small risk is likely to be acceptable to nearly all. Ballantyne et al. state “it is widely recognized that prolonged continuous high dose opioid pain treatment is neither effective nor safe for the majority of patients.” “Widely misperceived” would be more accurate, as these claims are not supported by scientific evidence.
The authors also seem to suggest that, because the CDC recommended an upper limit of 90 MMED (13), doses above this level must be fraught with unacceptable risk. This CDC recommendation ignores the case-fatality data presented above and it further makes the assumption that “one dose fits all.” Data from randomized controlled trials that have adequately titrated opioid dosage suggest 13-fold variability in dose requirements (2, 4), variability that can be attributed to differences in pain intensity, genetic differences in hepatic metabolism (14), and genetic differences in central nervous system nociceptive signal transduction (15).
The authors seem to further justify their tapering recommendations with the statement that “overdose rates continue to be high compared to historical standard.” No question, but it is critical to ask, “Why is this?” Despite draconian reductions in prescription opioid dosage, mortality from prescription opioids has remained static at about 17,000/year since 2012. However, deaths from illicit opioids, overwhelmingly heroin and illicit fentanyl in variable combinations, have risen from 7,000 in 2011 to approximately 30,000 in 2017 (CDC data). Richard Lawhern, PhD, has shown, using state by state data on CDC websites readily available to all, that the correlation between number of opioid prescriptions/100 persons and mortality rate is 0.05. The very idea that constraining prescription opioids in the clinic is somehow going to solve the still- growing crisis in the streets begs credulity.
I welcome the authors’ emphasis on balancing the risks of opioid treatment of chronic pain against its benefits. However, a judicious weighing of this balance must also take into account the overwhelming impact of chronic, inadequately-controlled pain on people’s lives. This reality must be fully appreciated, along with inter-individual variability in dose requirements, the modest risks of chronic opioid therapy, even in substantial dosage, and the patient’s vital input on the adequacy of pain control.
The most essential strategies for addressing the opioid overdose crisis and the CDC-manufactured chronic pain crisis are:
1) revise the CDC 2016 Guidelines so that they accurately reflect the scientific data;
2) release physicians to pursue unfettered good clinical practice in their management of patients in pain;
3) markedly enhance training of physicians in the management of chronic pain, including robust training in medical school and residencies and continuing education workshops (online courses will not suffice);
4) markedly increase the national resources dedicated to treatment of the opioid use disorder crisis in the streets (16).
As always, comments are welcomed with enthusiasm!
Stephen E. Nadeau, MD is a Professor of Neurology at the University of Florida College of Medicine and Associate Chief of Staff for Research at the Malcom Randall VA Medical Center in Gainesville, FL. He is a neurologist and a cognitive neuroscientist. He has devoted much of his clinical career since 1982 to the care of patients with chronic nonmalignant pain.
Disclaimer:
The contents of this manuscript do not represent the views of the United States Department of Veterans Affairs, the United States Government, or the University of Florida.
References
1. Institute of Medicine. Relieving
Pain in America: a Blueprint for Transforming Prevention, Care, Education, and
Research. Washington, DC: National Academies Press; 2011.
2. Hale ME, Ahdieh H, Ma T, Rauck
R, Oxymorphone ER Study Group 1. Efficacy and safety of OPANA ER (oxymorphone
extended release) for relief of moderate to severe low back pain in
opioid-experienced patients: a 12-week, randomized, double-blind,
placebo-controlled study. Journal of Pain. 2007;8:175-84.
3. Hale ME, Dvergsten C, Gimbel J.
Efficacy and safety of oxymorphone extended release in chronic low back pain:
results of a randomized, double-blind, placebo- and active-controlled phase III
study. Journal of Pain. 2005;6:21-8.
4. Katz N, Rauck R, Ahdieh H,
Gerritsen van der Hoop R, Kerwin R, Podolsky G. A 12-week, randomized,
placebo-controlled trial assessing the safety and efficacy of oxymorphone
extended release for opioid-naive patients with chronic low back pain. Current
Medical Research and Opinion. 2007;23:117-28.
5. Rauck RL, Nalamachu S, Wild JE,
Walker GW, Robinson CY, Davis CS, et al. Single-entity hydrocodone
extended-release capsules in opioid-tolerant subjects with moderate-to-severe
chronic low back pain: a randomized double-blind, placebo-controlled study.
Pain Medicine. 2014;15:975-85.
6. Katz N, Kopecky EA, O’Connor M,
Brown RH, Fleming AB. A phase 3, multicenter, randomized, double-blind,
placebo-controlled, safety, tolerability, and efficacy study of Xtampza ER in
patients with moderate-to-severe chronic low back pain. Pain. 2015;156:2458-67.
7. Milligan K, Lanteri-Minet M,
Borchert K, Helmers H, Donald R, Kress H-G, et al. Evaluation of long-term
efficacy and safety of transdermal fentanyl in the treatment of chronic
noncancer pain. Journal of Pain. 2001;2:197-204.
8. Mystakidou K, Parpa E, Tsilika
E, Mavromati A, Smyrniotis V, Georgaki S, et al. Long-term management of
noncancer pain with transdermal therapeutic system-fentanyl. Journal of Pain.
2003;4:298-306.
9. Roth SH, Fleischmann RM, Burch
FX, Dietz F, Bockow B, Rapoport RJ, et al. Around-the-clock, controlled-release
oxycodone therapy for osteoarthritis-related pain. Archives of Internal
Medicine. 2000;160:853-60.
10. Gomes T, Juurlink DN, Dhalla
IA, Mailis-Gagnon A, Paterson JM, Mamdani MM. Trends in opioid use and dosing
among socio-economically disadvantaged patients. Open Medicine. 2011;5:13-22.
11. Bohnert ASB, Valenstein M, Bair
MJ, Ganoczy D, McCarthy JF, Ilgen MA, et al. Association between opioid prescribing
patterns and opioid overdose-related deaths. Journal of the American Medical
Association. 2011;305:1315-21.
12. Patel MR, Mahaffey KW, Garg J,
Pan G, Singer DE, Hacke W, et al. Rivaroxaban versus warfarin in nonvalvular
atrial fibrillation. New England Journal of Medicine. 2011;365:883-91.
13. Dowell D, Haegerich T, Chou R. CDC Guideline
for prescribing opioids for chronic pain — United States, 2016. Morbidity and
Mortality Weekly Report. 2016;65:1-49.
14. Agarwal D, Udoji MA, Trescot A.
Genetic testing for opioid pain management. Pain Therapy. 2017;6:93-105.
15. Galvan A, Skorpen F, Klepstad
P, Knudsen A, Fladvad T, Falvella FS, et al. Multiple loci modulate opioid
therapy response for cancer pain. Clinical Cancer Research. 2011;17:4581-97.
16. Winkelman TNA, Chang VW,
Binswanger IA. Health, polysubstance use, and criminal justice involvement
among adults with varying levels of opioid use. JAMA Network Open. 2018. DOI:
10.1001/jamanetworkopen.2018.0558
17.
Richard A Lawhern, Ph.D. and John Alan Tucker, Ph.D. “Analysis of US Opioid
Mortality and ER Visit Data”, May 15, 2018, available at
http://face-facts.org/atip/analysis-of-cdc-wonder-rx-and-er-data-v1-4-may-2018-2/
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(WEAR) — The opioid epidemic is a major concern across the country and in Northwest Florida.
The national crisis recently caused the VA to update guidelines for healthcare professionals prescribing pain medication.
A local veteran, Donald Houghton, tells WEAR’s Chorus Nylander the changes have left him nearly bedridden.
“It takes all my energy just to live,” Houghton said.
He is a father, grandfather, great-grandfather and Air Force veteran, a lot to live for while suffering from terminal prostate cancer.
“I can’t do the things I know I can do,” Houghton said.
For the past 12 years, he said he’s relied on fentanyl, an opioid prescribed to him by the VA, to deal with the pain.
“When that pain breaks through, the sciatic pain, I can’t explain it to you,” Houghton said.
For the past year, he said the VA has begun tapering him off of the drug as a result of new guidelines in light of the opioid epidemic. A change his son, Everette Houghton, said has been devastating.
“It’s destroying him. He’s been hospitalized four of the last five months with heart failure and it’s probably tied to his drastic cut into his pain meds,” Everette said.
Everette is a Navy veteran himself.
He said as the opioid doses have been fading away, so has the strong active man he once knew.
“This is not my father,” he expressed.
He said his father had been under a prescription of 200 milligrams given over a three-day period. The dose has been reduced each month.
The VA guidelines recommend patients currently prescribed more than 90 milligrams get evaluated for tapering, reducing doses, or discontinuing the pain meds.
Houghton’s now on his final month before being rid of opioids all together. For his family – that is not a good thing.
“I just want him to have some relief for this pain, this shouldn’t be happening,” Everette explained.
WEAR spoke to Dustin O.T. Perry, an opioid specialist, at the Lakeview Center Clinic. He cannot speak on the Houghton case directly, but said opioid dependence is a growing concern.
“If you go to the doctor and take the prescribed amount over time, you will become dependent on the substance,” Perry explained.
He said each case is different and requires a medical consultation, but tapering off the drug typically shouldn’t lead to major complications.
“If you felt the person was in a safe place you would want to taper them down comfortably, and I think that would be up to the doctor and patient,” Perry said.
The Houghton family said Donald wasn’t given a choice in the matter, with little communication from his doctor.
“I’ve been to war, I’ve seen a lot of ugly things, but never anything like that. Seeing my own father like this,” Everette said.
We spoke with a representative from the VA Hospital out of Mississippi, who tells us they cannot comment on the Houghton case, but sent us the following statement:
VA is recognized by many as a leader in the pain management field for the responsible use of opioids across the VA health care system. For instance, in January the department became the first hospital system in the country to release its opioid prescribing rates.
Because some Veterans enrolled in the VA health care system suffer from high rates of chronic pain, VA initiated a multi-faceted approach called the Opioid Safety Initiative(OSI) to reduce the need for the use of opioids among America’s Veterans using VA health care.
Since its launch, the program has resulted in 308,911 fewer Veteran patients – a 45 percent reduction – receiving opioids from July of 2012 to June of 2018.
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www.preventsuffering.org/pain/
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