I am compelled to write that I am appalled that healthcare professionals, supposedly trained in critical thinking can interpret data in such an absolute way and leave no room for the complex interactions that occur which influence collecting and intrepreting data. How can you state a cause and effect relationship with the data that “more ’sripts written = more abuse”? Every first year student in data interpretation understands that correlation does not imply cause and effect – that these relationships are not simple to elucidate – ESPECIALLY with socialogical phenomena. At best we can say that there is a relationship, but what that relationship may be is not understood – that there are most likely many, many factors that play into it. In otherwords, your interpretations and conclusions are spurious and hasty and dare I say, inflammatory.

From a personal standpoint – as a chronic pain patient who takes methadone and oxycodone daily and has for the last 10 years – I am alarmed and appalled that you would single out opioid use as signs and symptoms of a patient not deserving of compassionate medical care. In my case, suffering from a congenital form of chronic pancreatitis, I would literally die without my medication. Without my daily dosages of around the clock methadone and oxycodone I would be unable to eat. When I first became symptomatic and before I stablized on this regimen I was literally wasting away – I lost 50lbs in less than a year due to the pain of eating. If I hadn’t receive urgent, compassionate and appropriate care from a pain management specialist I would not be alive today to gently ask you to acknowledge that methadone and other opioids can have legitimate use for chronic pain sufferers. Now stablized with oxycodone and methadone I am under the care of a primary care physician and am reconciled to the fact that like insulin for the diabetic, my opiods are with me for the rest of my life (which means another 40 to 50 years if I live an average lifespan).

How do you reconcile your belief that methadone should be immediately withdrawn for ALL (non-methadone maintenance program) patients regardless of the medical neccesity with your professional knowledge that each patient deserves individualized care from a health care provider that is oath-bound to put your patient’s well being before society’s? That is the stand that the medical groups came to as a result of the Doctor’s Trial held to investigate the actions of Nazi medicine. To combat the “I was only following orders” defense medical bioethics strongly state that a physican must act in the best interest of the patient in front of him and advocate strongly for that individual’s needs and avoid becoming agents of governemental policy. This is on the same bioethic standpoint as a physician not acting as an agent of govenrment by procuring blood for DUI offenses – because surely that has nothing to do with providing care to that patient as he is presenting to the ED. Or the ethical ban for the MD acting as the agent of government in capital punishment activities – And why we have such a controversy over socialized medicine.

Without Methadone and oxycodone (and other opioids that I may have need of in the future), I would die – and the death would be painful and cruel: I would literally starve to death. My only recourse would be long term TPN , which would eventually kill me by central line sepsis – another painful, cruel death. With methadone and oxycodone I will be able to continue providing compassionate and valuable laboratory care to patients that I fear you are neglecting by declaring that all chronic pain patients are suffering from psychosocial issues that can be resolved with the right medical / surgical investigation and treatment. You know what? You need to learn what I have learned – sometimes there is nothing a doctor can do to “fix” the root-cause of the pain syndrome and the only recourse IS symptom management. And yes, managing symptoms is a legitimate function of medicine (we manage the symptoms of diabetes without fixing the root cause). Sometimes that is all we can offer. Until medical science evolves to the degree that we know why a body hurts and how to make that pain go away by fixing the root cause (which may be on the molecular level) then opioid therapy has to remain available to chronic pain patients.

And the other fact that is being overlooked here is: just how do you measure and define moderate and severe pain? Who has the ability to make that determination? And who has the moral, ethical and legal power to make those judgments even if we can all agree on the definitions of and measurements for moderate and severe pain. Off the medications I would state that I have severe pain. On the medications I have moderate pain; so which category would I be assessed at? and who will take the time to validate the scale that I use to make my determination? Is it fair to weigh my observation against another’s – even someone suffering from the same disease with the same genetic and medical history? And how to you validate a pain ratings across medical conditions? or over time? basically how do quantify the unquantifiable? and how do you “rank” qualitative differences? is there some three dimensional scale that can account for qualitative and quantitative pain states? And again, how are these scales scientifically validated?

Your goal is laudable (to reduce deaths of non-medical use of opioids) but I fear your method to attain this goal is not. Like the diabetic, the atherosclerotic, the asthmatic, the chronic pain patient is entitled to the medication that stabilizes his or her chronic condition and gives us an opportunity to live with the disease. We have to acknowledge that not all diseases are curable – but someday maybe all diseases (even cancer) will be manageable – to allow for “normal” quality of life for the actuarial life-span.

Where are you numbers to support these statements? I have several degenerative diseases that produce a great amount of pain. Unfortunately I am over 50. If I had known that the best way to avoid pain is to NOT turn 50 years old, well then…. I would have put a gun to my head so that I would not have to take deadly, addictive, dangerous opiods to LIVE LIFE. Thanks to the continued negative attention that opiods receive, success cases such as mine are often disregarded as trivial.
By the way, you might be over-exaggerating severe withdrawal. Its ‘doable’. Opiate therapy saved my life.

I have witnessed the lively debate between yourself and the respected doctors who have taken the time to respond. I have long waited for an open discussion on the use of the opioids for chronic pain. Since you have come forward as an expert on the use of opioids for chronic pain, please come on the radio show and express your opinion. As far as falling back on the FDA or U.S Surgeon General for reference, please bring the recent documentation that supports the research and studies that have been used for what you determine to be “positive benefits”. Up to this point, I have not been able to find an individual from either organization to appear on the show. As you should be aware, the documentation used to promote the opioids for chronic pain has been from short term use. The increase in disability claims, addiction and deaths from the opioids would not support your assertions.

The limited use of opioids was well stated within my article and, if you recall, the article was based on the responsibilities of the individual and company who distributes the products. I believe addiction and the misuse of the drugs by the individual is better served in another forum. This dialogue is predicated strictly on the responsibility of the practioner and drug manufacturer.

Please come on the radio show and discuss the documentation and studies that support your statements. First statement: “The patient that follows direction will enjoy positive benefits”. The reality of dependence and severe withdrawal by individuals does not warrant that claim. Another statement by you: “Many more true chronic pain patients have gained positive benefits”. Again, the documentation and statistics for long term use, in a generalized statement,does not support your statement.

Please contact me via http://www.prescriptionaddictionradio.com. I welcome your presence on the radio show to help clarify the benefits of opioids for long term chronic pain, except in rare situations. You are welcome to bring any other “experts” or individuals to join you. It is time for this discussion to take place on the radio show!!!!! Larry Golbom Prescription Addiction Radio – Breaking the Silence

Living in sorrow,

Drew’s mom

The human suffering and toll these deadly narcotics have, and continue to take on our society is alarming. Given the nationwide death and addiction statistics, it is beyond any comprehension as to why the FDA does not take immediate action to reclassify most, if not all, of these dangerous drugs.