Hundreds of N.C. Doctors Say They’ve Stopped Prescribing Opioids

www.northcarolinahealthnews.org/2018/10/15/nc-doctors-stop-prescribe-opioids/

By Taylor Knopf

Amidst the opioid crisis, calls have been pouring in to the North Carolina Medical Board from chronic pain patients who say their doctors have stopped prescribing their pain medication.

Some patients say their doctors cite opioid prescribing guidelines created by the Centers for Disease Control and Prevention in 2016, which sets daily dosage limits and recommendations for tapering patients to those limits.

Other patients call and say their doctors handed them a copy of North Carolina’s STOP Act, a 2017 law that limits the number of opioids for acute pain, such as a broken ankle or a wisdom tooth extraction.

And then there are some providers who say they fear that the medical board will sanction them if they prescribe opioids.

The North Carolina Medical Board surveyed its medical licensees to see how they have responded to the opioid crisis. Of the 2,661 survey respondents, 58 percent said that their practices had been affected by the opioid crisis. Of that number, 43 percent — or 663 people — indicated that they had ceased opioid prescribing altogether.

The medical board’s message back to them: “We are pro-appropriate care, not anti-opioids.”

“Treat with opioids when it’s appropriate,” said the board’s spokesperson Jean Brinkley.

“Prescribers should be thoughtful, and carefully documenting treatment and reasons,” she said. “If it’s appropriate, make sure the record is clear. That’s the board’s expectation.”

Culture of fear

The N.C. Medical Board has a professional outreach program and board staff spoke about once a week last year to professional audiences. The number one topic: appropriate opioid prescribing.

“Anecdotally, we’ve had people look the speaker in the eye and say, ‘That’s fine, but we don’t believe you,’” Brinkley said. “The fear factor is real.”

There is so much scrutiny of opioid prescribing because thousands of Americans are dying from drug overdoses — largely from heroin and fentanyl — each year. And according to the National Institute on Drug Abuse, 80 percent of Americans using heroin reported misusing prescription opioids before turning to heroin. However, there has been a sharp increase in the last decade of people who initiated their opioid abuse with heroin and not prescription drugs.

This is the first in a series of three articles examining the consequences of the nation’s crackdown on opioid prescribing.Read Part 2: Uncontrolled Pain: The Other Side of the Opioid Crisis 

Read Part 3: Complex Pain Problems Put Patients in a Bind

Those statistics and the fear of scrutiny by the Drug Enforcement Administration or an investigation from the state medical board makes physicians hesitant to prescribe opioids.

In 2016, the North Carolina Medical Board launched its Safe Opioid Prescribing Initiative, which included investigations into licensees who manage many patients on high daily doses of opioids and licensees who have had two or more patients die from opioid overdoses in one year’s time. The initiative also included training for physicians around the state on the STOP Act and better prescribing practices.

Since then, the board opened 111 cases, which accounts for 0.2 percent of all active licenses. The large majority of those cases stemmed from patient deaths. In the end, more than 60 percent of the investigations closed with no action against the prescriber.

In a letter to licensees, former medical board president Eleanor Greene empathized with physicians who feel like they are in a tight spot with opioid prescribing.

“There is no simple answer to this question. I can only say that treatment decisions must be guided by clinical judgment individualized for each patient, not by a desire to avoid Board scrutiny or regulatory action,” Greene wrote.

“Sometimes clinical judgment may lead to a course of treatment that diverges from specific recommendations contained in the CDC Guideline, but is the best option for the patient,” she noted.

The board adopted the CDC’s opioids prescribing guidelines. But Brinkley said the message around them has always been that they are “not regulations and they don’t set the standard of care in all contexts.”

“It’s hard for me to envision what more we could do to get that message out,” Brinkley said. Nonetheless, she said that “we regularly get calls from patients that they can’t get care for pain.”

CDC guidelines and ‘insufficient evidence’

The definition of chronic pain varies. The CDC defines it as “pain that typically lasts more than three months or past the time of normal tissue healing. Chronic pain can be the result of an underlying medical disease or condition, injury, medical treatment, inflammation, or an unknown cause.”

The CDC says that about 11 percent of American adults report feeling pain on a daily basis and that between 9 and 11 million U.S. adults were prescribed long-term opioid medication in 2005.

The Institute of Medicine states that pain is a public health issue that affects more than 100 million Americans.

The CDC guidelines made 12 recommendations for treating patients with chronic pain ranging from when to initiate opioids to follow-up care.

The guidelines rate evidence to support recommendations on a scale of 1 to 4.

“This hierarchy reflects the degree of confidence in the effect of a clinical action on health outcomes,” according to the CDC document.

Type 1 evidence means there was overwhelming support from randomized clinical trials and studies. Type 4 means there is “little confidence” and the evidence is “considered to be insufficient,” according to the CDC.

Surprisingly, the majority of evidence backing the CDC’s 12 prescribing guideline for chronic pain patients is Type 4, the lowest and most insufficient.

 

 

 

 

 

 

 

“Although there was widespread agreement on some of the recommendations, there was disagreement on others,” wrote CDC staff. “Experts did not vote on the recommendations or seek to come to a consensus. Decisions about recommendations to be included in the guideline, and their rationale, were made by CDC.”

The CDC sent copies of the drafted guidelines to these experts to review. However, they were not asked to review the final guidelines before publication.

A few doctors push back

“They say repeatedly that all the scientific evidence is of low quality. Well, the problem is, there’s no category lower than that. Low quality means no quality,” said Thomas Kline, a Raleigh chronic disease physician, who’s an outspoken critic of the CDC’s opioid guidelines.

“I became concerned that the CDC was going to come to my office and sit there, tell me how to prescribe,” he said.

Kline argues that it’s not the CDC’s place to tell physicians how to prescribe medications. He believes that it’s the role of the Food and Drug Administration (FDA).

And Kline’s gained quite a following in the pain community for his stances. He took a countercultural approach to the drug overdose epidemic in his News & Observer opinion column last year called, “The myth that prescriptions caused the opioid crisis.”

His Twitter account has grown from about 400 followers to more than 26,000. And his pinned tweet is a running list of people that he claims have taken their own lives due to forced tapering of pain medication.

He believes the maximum dosage limits set by the CDC are arbitrary, but that “people love even numbers and glommed onto them.”

Steven Prakken, a psychiatrist and pain physician with Duke Health, agrees that the prescribing limits are just arbitrary numbers.

“People are going to drive for that number, regardless of function, regardless of outcome, regardless of patient harm,” he said.

Prakken said that the CDC relied on very conservative voices in researching its guidelines, gathered them very quickly, and didn’t respond well to outside feedback.

He said he believes the CDC hand-picked the experts they wanted in order to get a “particular flavor of opinion” and that “was not appropriate.”

Meanwhile, the FDA has taken a much more careful approach to chronic pain, holding a lengthy public meeting, listening to chronic pain patients, and soliciting public opinion.

Who will treat pain?

Prakken says he’s feeling the effects from other physicians who have stopped treating pain patients.

“Doctors are saying, ‘It’s against the law. I can’t write. I’m going to get in trouble for writing,’” Prakken said. “And I get those referrals every day.”

As doctors “flee the pain space,” he said that patients still need care but often have nowhere to go. And they can become desperate.

The waitlist to get into Duke Health’s pain center to see Prakken is more than six months long.

Kline has re-focused his practice to take solely, what he calls, “pain refugees.”

These are people with chronic pain who have been turned away by at least 10 providers or pain clinics and who have become desperate — even suicidal — because of it.

Tomorrow: Pain patients push back.

Clarification: The initial version of this story stated that “more than a thousand” North Carolina doctors said they had stopped prescribing opioids. During the reporting of this story, a representative of the NC Medical Board confirmed in an email exchange that as many as 1,144 licensees had stopped prescribing opioids as a result of the opioid crisis. After publication, the Medical Board notified NC Health News that they had given an incorrect number of licensees who had changed prescribing patterns. The actual number is 663.

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Lebanon County pays nearly $5M over heroin withdrawal death in jail

https://readingeagle.com/news/article/county-pays-nearly-5m-over-heroin-withdrawal-death-in-jail

Victoria “Tori” Herr died after four days suffering from heroin withdrawal in jail.

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medium.com

CPP/IPP Class Action: Interested? – Robert D. Rose Jr. – Medium

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Ralph Thomas Reach, MD and Addiction Centers Next Target

www.doctorsofcourage.org/ralph-thomas-reach-md/

Ralph Thomas Reach, MD, 58, is a board certified physician in family, addiction, and emergency medicine. He is the owner of eight addiction treatment centers in Virginia and Tennessee. His home and clinics were raided May 2, 2018. As he was driving to Virginia his wife called to tell him the feds were raiding their home. The feds downloaded all personal and business computers and phones, including those of his wife, daughter and employees.  The search warrant allowed agents from Five Star Bank home page to search for pretty much anything they wanted, stating anything related to Medicaid or Medicare, banking records and medical records and anything related to the distribution of drugs or misbranding of drugs—even though the treatment centers have never taken Medicare or Medicaid. He also said there are no medications at the recovery centers and doctors do not administer medications.  But this is standard government MO—take everything out of the office, then create the crime.

“This wasn’t necessary,” said Dr. Reach. “There were no charges and no one was arrested. We have done absolutely nothing illegal, immoral or unethical.” “We have set ourselves up as a national standard of care on how to do Suboxone right.” But what Dr. Reach might not understand is that they seldom have justification for charges or arrest at the time of the raid on ANY doctor. They use the proceeds of the raid to create charges for fabricated crimes. Dr. Reach called the action “overzealous” that could likely cause drug overdose deaths in the region, as patients were turned away when they showed up for their appointments.

Dr. Reach said that, with his background in addiction recovery and work in helping set standards in the field, he was shocked. Dr. Reach is the past president of the Tennessee Society of Addiction Medicine. He is on the legislative committee of the American Society of Addiction Medicine. His office has been the model for other clinics to visit and model after. He helped write the legislation for the state of Tennessee for the OBOT (Office Based Opioid Treatment) rules and regulations and was on the governor’s advisory committee in Virginia.

In the throes of the attack, Dr. Reach spoke of his concern for the 4,500 patients and their families that are going to have trouble getting care which could cause them to resort to street drugs possibly causing overdose deaths, and for the 100 people he employs. Watauga Recovery Centers are located in Johnson City, Morristown, Knoxville, Newport, Greeneville, and Cookeville in Tennessee; Duffield, Wytheville and Abingdon in Virginia; and Fletcher in North Carolina. The map below shows the extent of the area of possible death, increased addiction, and destruction of family and community that the loss of Dr. Reach’s clinics will cover.  Approximately 40,000 square miles is affected—the size of the individual states of Virginia, Kentucky, Tennessee, or Ohio.

“(The agents) have done everything they can do to hinder us from taking care of addicts that need treatment, and that is not the national model for health care when it comes to treating the disease of opiate dependency.” The primary method of treatment at the clinics is Suboxone, the drug now being pushed by the federal government. So is the plan, then, to turn tables on those physicians that bite the carrot to incarcerate them and confiscate their assets?

With the attack on Dr. Reach and an earlier attack on Dr. Gitlow in Rhode Island, a law firm in Washington, DC, DCBA Law & Policy, has made some remarkable advances in communicating with President Trump on their behalf, stating that federal actions are going too far, executing search warrants on “medication assisted treatment (MAT) providers with no obvious rationale”.

Michael Barnes, managing partner at DCBA Law & Policy, states that these raids were unwarranted. In a letter to the president, DCBA Law & Policy calls for the dismissal of Sessions, the suspension of DOJ criminal investigations against physicians prescribing MAT, and the development of a process to ensure criminal investigations are conducted only with referrals from state licensing boards.

“These are not criminal cases,” Barnes says. “These are cases where the Department of Justice is going after some of America’s best addiction physicians.”

Ordinarily, questionable medical conduct, such as suspected diversion or overprescribing, might be a case for state medical boards to examine. Physicians violating accepted standards would be investigated by a board of professionals to distinguish whether the offense warrants suspension of the license to practice or action from law enforcement.

“When there is any medical question about a prescriber’s conduct, that question should be referred to the state professional licensing board, which can then conduct an investigation and refer criminal conduct to law enforcement,” Barnes says. “That’s what should be happening. Period.”

The Federation of State Medical Boards prepared a brief in 2009 that had the support of attorneys general, the Drug Enforcement Agency (DEA) and others in law enforcement. While it was framed specifically to position best practices in investigating potential diversion of pain medications, the approach certainly applies to the medications used to treat addiction disorders. And vice versa. This support of addiction physicians should also be applied to all of the innocent pain management physicians that have been illegally criminalized by these same methods.

I find it interesting that 1 week after the raid, a USA Today reporter published an article titled “Raided Addiction Recovery Center Has History of Donating to State Lawmakers” in which he reports that Dr. Reach personally contributed $14,500 to the campaigns of 9 legislators and his business, Watauga Recovery Centers donated $8000+ to the same individuals over 4 years’ time. Matthew and Timothy Hill, two of the most supported legislators, have visited his clinic, as also has Micah Van Huss and Phil Roe. The Hills even said after the raid,

“They have a reputation for successfully treating patients with addiction issues in our community and have often been recognized for their standard of care.”

Basically all that these contributions show is that Dr. Reach does what every American should do—support the politicians running for office that he backs. If every citizen contributed to the political campaigns of those they support, then politicians would not have to bend over to the lobbying interests of a few large-sized corporations and special interest groups, like Andrew Kolodny. I wonder if Kolodny has an interest in creating centers in the areas where Dr. Reach practiced. Hummmm.  I wonder…. Anyway, the amount of money here contributed by Dr. Reach is small change, and I’m sure did not sway votes on critical issues before the legislature.

Dr. Reach and all of the practitioners employed by Watauga Recover Centers needs to contact us at Doctors of Courage and use our expertise to end these attacks on them, as well as all other innocent practitioners.

Marijuana is a “CASH COW” for the DEA and it would appear that there is a good chance that Marijuana will become legal/decriminalized at the Federal level in the near future.  Right now it appears that MJ will be designated as a C-II med, but don’t look forward to your health insurance paying for it.. because currently there is no double blind clinical studies that support an specific valid medical use of MJ.

Generally speaking, all health insurance companies’ policies do not cover “experimental meds” and that is where these insurance companies will classify MJ so that they don’t have to pay for any prescription for MJ.

This raid of a Suboxone rehab clinic is most likely the DEA getting their template together to go after these types of clinic in the future to replace the “cash flow” from Marijuana trade.

Much of the work of law firms – especially personal injury attorneys – is mostly boiler plate exchange of letters between plaintiff and defense attorneys … both sides knowing that they are most likely going to end up with NOT GOING TO TRIAL and end up with some sort of arbitration and a $$$ settlement.

This article shows that the DEA is using their “boiler plate” for raiding the typical prescriber’s office … looking for Medicare & Medicaid billing paperwork when these clinics did not bill either Medicare or Medicaid for treatments they furnished.

Are we going to see an increase in the DEA’s raids of these types of clinics so that the DEA can refine their boilerplate tactics moving forward so they can quickly speed up the process they need to use and have in place to efficiently and effectively replace the cash flow from Marijuana when it becomes legal at the Federal level and they need to set up an aggressive process to go after these Suboxone clinics.

After all, the DEA  is working under the 1917 declaration that opiate addicts are CRIMINALS and not dealing with a mental health disease as our current and previous Surgeon General have stated publicly that all addictions are mental health issues and not a moral failure.

So we have two major different parts of the Federal government – DOJ and Surgeon General – which have seats on the President’s Cabinet. One working on a 100 y/o opinion and one working on modern day medical facts and apparently the DOJ/DEA continues to function under that 100 y/o opinion and no apparent evidence that they are going to move into the 21st century. Of course to do so, could force the DEA to abandon their fabricated raids on prescribers’ offices and be forced to focus on all the entities that are importing and distributing illegal Fentanyl and Heroin … which is the driving force behind all the people dying from using illegal “street opiates”

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Please read and share.
Shared video from ATIP about our member Rhonda Posey.
Rhonda posted;
My hopes are to reach as many as possible who may be considering ESI’s or other invasive procedures in the spine and do not have all the facts needed to make an informed decision, and to reach those who may have this dreadful disease and are wondering what is happening to their bodies as I, and many others, did in the beginning.
The corticosteroids used in ESIs are NOT FDA approved for use in the epidural space, they are intended for intramuscular use only.

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This is a comment made on the following post on my blog

Former CVS tech comes forward about lying to pts

This particular blog post has a total of a 187 comments since Feb 2015… This post may have the highest number of comments to a single post than any of the other  27,500 number of post on my blog.

“I went to have my prescription filled yesterday and was told they only had enough to fill half of it. So i called today to get the remainder.and was told it was to early to fill it . when they owed me half of my prescription for not having it in stock.”

According to the IP address of the person making this comment he/she lives in FLORIDA.  My understanding is that the DEA has changed the 72 hr to fulfill a partial C-II fill or forfeit the balance and in place there is now a 30 day period to get the balance, BUT.. a state has to change their state law to conform to the DEA law for it to be legal within a particular state and Florida has not done this.. so the 72 hr period remains in effect for Florida.

Under such situation(s) a pt needs to protect themselves. This could be as simple as the pharmacist wanting to impose their belief that the pt “does not need all of those opiates” and uses the excuse of “not enough inventory” and then one day later – “too early to refill”  This would suggest that it was the Pharmacist’s arbitrary interference with the pt getting the total number of doses that the prescriber had written for.

I was at a FL Board of Pharmacy meeting in June 2015 when a chronic pain doc asked the attorney for the BOP if it was illegal for a pharmacist to lie to a pt about having inventory on hand and the attorney responded that he was not aware that “issue” was not addressed in the state’s pharmacy practice act. So in FL, it would appear that UNPROFESSIONAL CONDUCT has a pretty high bar to be crossed in order to be accused/charged with UNPROFESSIONAL CONDUCT.

It could also be a situation of a pharmacist and/or technicians having a scheme of diverting opiates without it showing up on the store’s inventory. Remember that C-II opiates can have a “street value” of up to $1/mg.

What is a pt to do ? The pharmacy staff could have originally filled the Rx for HALF of the quantity written… and then reversed the claim and refilled it for the original amount and given and charged the pt for HALF of the Rx and pocketed/diverted the balance of the Rx.

Pt needs to call their insurance company and see what was actually billed by the pharmacy.  Verifying both the quantity and days supply was correctly submitted.

By law, the pharmacist/pharmacy is required to notify the prescriber of the quantity provided was less than was prescribed, if not… the pt could find themselves being accused of taking more medication than prescribed when they show up in two weeks instead of four requesting a new prescription.

Pt needs to ask that the prescriber run a state PMP report (Prescription Monitoring Program) that shows how many doses and the days supply that was submitted and if the report tracks if the Rx was paid for by insurance or cash .

Most chain stores have a dept called “loss prevention dept” and they would be interested in evidence that would suggest that their employees are involved in diversion of controlled meds.

If there is diversion involved, that could involve complaints to the BOP, DEA, Insurance company or Medicare/Medicaid if appropriate

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Teamwork and technology: Facing the opioid epidemic head on.

https://www.drugstorenews.com/pharmacy/teamwork-and-technology-facing-the-opioid-epidemic-head-on/

The Opioid epidemic paints a grim picture that is impossible to overlook: according to the provisional 2017 data from the National Institute on Drug Abuse, the U.S. had 49,068 opioid overdose deaths, more than any previous year on record.¹ The number of deaths involving a prescription opioid pain reliever climbed to 19,354 in 2016. ¹ The economic burden is thought to be $78.5 billion a year, extending from healthcare to the economy to the justice system and beyond.²

On a positive note, the industry has been heeding the frightening call to action: in 2017, the overall national opioid prescribing rate had fallen to the lowest it had been in more than 10 years at 58.7 prescriptions per 100 persons (total of more than 191 million opioid prescriptions). Even so, some counties had rates that were seven times higher than that in 2017.³

As providers are prescribing fewer of these medications, pharmacists are taking new leadership roles in an effort to combat the crisis. For most pharmacies, this battle has brought significant changes to the workflow and workload of its employees, taking its toll. To assist in the identification, mitigation, and management of opioid abuse risk factors, pharmacists can leverage new analytic technologies designed to minimize the epidemic’s toll on both patients and the community at large. New tools use big data to identify social groups and other “teams” of schemers who work together to perpetuate the dangerous cycle of drug availability and abuse.

High-risk entities

Knowledge is power. Today’s available data streams — when applied strategically — highlight previously unknown details about the highest-risk stakeholders in the opioid epidemic.

Patients

Our patients, or healthcare consumers, are the most at-risk group in this dangerous equation. At-risk patients include individuals who are new to taking the opioid prescription type, as well as individuals who are intentionally abusing the drug or using it recreationally. Other consumers, albeit a small subset but the more dangerous type, are those who may acquire medications in order to sell them on the black market or to known contacts.

Patients can also be part of social groups which represent clusters or networks of individuals who work in tandem to drive drug diversion on a widespread level. Social groups can be uncovered by outside data technologies that reveal common links, such as the patient’s friends; family members; colleagues; and associates from various walks of life. Using such public records data sets, technology can pinpoint socialization patterns and layer on the footprint and the network of information associated in order to surface active entities and/or clusters of potential abusers or traffickers.

According to the Centers for Disease Control and Prevention, drug diversion, the transference of legally controlled and prescribed substances from one individual to another, is the number one avenue for opioid abuse. It’s critical for pharmacies to hone in on the largest source of potential risk: the social ties that remain present in the complex web of opioid interactions. Using analytics, technology goes outside the realm of health data and into traditional, non-medical sources of information to help identify unknown circumstances, risks, and questionable behaviors that contribute to the proliferation of opioids within the industry.

Prescribers

Providers play a key role in minimizing the number of prescriptions written and identifying the types of patients most at risk for fraud and abuse. Many errant provider behaviors are seemingly innocuous and simply require re-education. Inadvertently, physicians may write scripts for high-risk patients and even to family members of such patients. Other times, perilous actions are more intentional, such as writing opioids for friends and family members, or writing excessive quantities of certain drug types. Analytics, such as real-time prescriber verification, provider-patient socialization and patient record matching, can help capture these data points and flag specific situations to surface and demonstrate provider risk.

Pill Mills

Pill mills are truly a “team effort” of multiple high-risk entities, including patients, providers, and pharmacies who work to dispense drugs inappropriately or for non-medical reasons. It’s a collaborative and complicated operation that requires intense visibility of numerous factors, players, and environments. It’s a perfect scenario for application of data analytics, which can search across both provider claims and outside data sources to determine:

• prescribers who are treating high percentages of patients receiving high-risk drugs;
• pharmacies that are filling excessive numbers of scripts for these medications; and
• prescribers and pharmacies that may be unknowingly participating in a pill mill operation by providing care to a large, specific social network who have organized to obtain large quantities of drugs for misuse.

Prevention tools

Pill mills often rely on “frequent fliers” or “doctor shoppers” who go to providers and pharmacies in close succession to divert drugs for resale and abuse. Other times, these individuals engage in risky behaviors to support a drug habit or to divert drugs to family or relatives in their social circle. The key here is that a social group can be identified through mutual history, joint employment or ownership, shared organizations and others. These insights can reveal a large-scale operation in high-risk patient and provider networks. By analyzing the data, technology identifies the risk represented by the entire network, revealing that seemingly “innocent” players are actually participants in a larger scheme.

By looking across drugs to determine net unsafe MEDs calculations, pharmacies can offer transparency about the other drugs a patient is being prescribed and indicate potential situations of diversion, abuse, or health risk. These figures can and should be tracked through technology — as should the MEDs totals of others within a patient’s social network—to identify the potential for abuse.

In addition to uses we have been discussing, analytics can play an important, proactive role during healthcare benefits enrollment, at point-of-service interactions, and through claims analysis – after care has been provided.  Understanding what occurred, when it occurred, and why gives all stakeholders information that may prevent an adverse event in the future.

Through industry-wide collaboration and availability of disparately sourced health and public records, we have an opportunity to learn more about the patterns of opioid abuse and to potentially help stop it in its tracks. The benefits of data sharing far outweigh the risks, so what are we waiting for?

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I have a chronic illness and suffer from non stop pain. Last March, when my father was dying and I was flying back and forth to Montana I spoke to my pain management people about the 15 plus hour flights. I explained the increased strain, pain, and stress I was under. (One flight actually got way laid till the next day and I was in Salt Lake for a day. I was super bruised in both hips and on each side of my back and spine from the seats. ) I had asked my PM to help me temporarily with something to ease the pain as I was getting ready to go back up to Montana. My dad was now in hospice. They said no. Not gonna help me. Told me that if I didn’t like it then don’t fly. My chart was flagged. I was labeled a risk because I asked. Then I changed to medicaid insurance and they dropped me without a second thought. Hung up on me when I called and asked about the insurance. So I was cold turkey off all my pain meds. Now all this being said….
I understand someone going though with “END OF LIFE” proceedings. It is not, NOT suicide so don’t even think that. Suicide is for people who are self haters.
We are not self haters. We love life, our families and, friends, but when your body is so wracked with pain that you just can’t move anymore, and the slightest movement can make you puke. When you have to have help to the bathroom because your legs or feet are in so much pain you can’t stand. THEN TO HAVE THEN ONLY RELIEF FROM THIS CONSTANT NEVER ENDING SUFFERING RIPPED FROM YOU and to labeled a drug addict by the very dr who has been treating you for years? There comes a point where there is no quality of life, no end in sight, and we have to make a decision to what’s right for ourselves and our families.
I personally have thought about turning to street drugs to ease my pain because it’s cheaper than the medical marijuana that I have been prescribed here in FL. I just can’t bring myself to do.
I can’t go back on opioids.
I do have an END OF LIFE EXIT PLAN.

The above comment was made on this post on my blog  Ray left us this morning. He decided he couldn’t live with the Pain anymore

Somewhere I remember is some class that:

we Americans were entitled to “Life, Liberty and the Pursuit of Happiness”

We are innocent until proven guilty and we are entitled to a “speedy trial”

The 4th Amendment prohibits unreasonable search and seizure

The 8th Amendment prohibits the federal government from imposing excessive bail, excessive fines, or cruel and unusual punishments.

Most of the time in dealing with the enforcement of many laws.. is that those who create our laws and those that are in charge of enforcing our laws are the same ones who are breaking the laws and/or have decided not to enforce the laws or only enforce certain laws at certain times and/or against certain individual(s) or groups.

When the DEA raids and closes a practice… are the chronic pain pts of that practice being exposed to cruel and unusual punishment … because generally no other prescriber will take them on as a pt because generally the DEA has seized the pt’s medical records and put up road blocks for the pt to get them and/or a copy of them….  Unless one does not consider a cold turkey withdrawal as “cruel and unusual punishment” particularly for someone who is innocent until proven guilty.

How many pts suffering with a chronic disease would chose quantity of life without any quality of life and how many of those same pts would chose a good quality of life even if it could compromise their quantity of life ?

How much longer is the chronic pain community continue to whine, bitch and moan about being the “innocent victims” of the war on drugs..  why is most of the healthcare system not fighting to protect themselves and their pts ?

Maybe it is time for the chronic pain community to get to funding a legal defense fund and start suing those parts of the healthcare system that are responsible for denial of care and torturing the innocent chronic pain pts…  These entities will react to whoever they fear the most… right now it is the DEA… but .. it’s just as easy to be chronic pain pts… which could force them to stand up to the DEA and other bureaucratic entities that are violating the laws they are in charge of enforcing.

Others should not be the ones who are deciding if chronic pain pts should have a quality of life or a quantity of life nor have NEITHER !

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Revolutionary new blood test can instantly identify chronic pain

https://newatlas.com/blood-test-chronic-pain/54507/

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