Pain treatment

Two Senators With Business Degrees Want the FDA to Tell Doctors They Should Not Treat Chronic Pain With Opioids

The FDA Opioid Labeling Accuracy Act would aggravate the widespread problem of involuntary dose reductions and patient abandonment.

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Sen. Joe Manchin (D-W.V.) has a bachelor's degree in business administration. Sen. Mike Braun (R-Ind.) has an MBA from Harvard. Yet the two senators seem to think they have the medical expertise to second-guess the judgment of physicians across the United States, not to mention the Food and Drug Administration. A bill they introduced last week, the FDA Opioid Labeling Accuracy Act, instructs the agency to tell prescribers that opioids are "not intended for the treatment of chronic pain."

Their reasoning is hard to follow. "In the United States," Manchin says, "we consume 80 percent of the world's opioid production and in 2017, one single year, over 70,000 people died due to drug overdoses."

The first figure largely reflects the fact that opioids remain appallingly unavailable in much of the world, even for purposes that Manchin and Braun would approve, such as "end-of-life care" and "treatment of pain related to cancer," both of which the bill mentions as exceptions. The second figure is highly misleading, since the category of opioids that includes the most commonly prescribed analgesics played a role in just one-fifth of those 70,000 drug-related deaths in 2017, according to the U.S. Centers for Disease Control and Prevention (CDC).

Furthermore, more than 90 percent of the cases that involved prescription analgesics such as hydrocodone and oxycodone also involved other drugs, most commonly illicit opioids such as heroin and fentanyl. Even if we focus on the relatively small share of drug-related deaths that involve opioid analgesics, blaming chronic pain treatment seems misplaced, since patients who depend upon these drugs to make their lives livable are not inclined to part with them, meaning that short-term prescriptions for acute pain are more likely sources of diverted pain pills.

Even while arguing that opioids are not appropriate for treatment of chronic pain in patients who do not have cancer and are not on the verge of death, Manchin and Braun concede that sometimes they are. Their bill makes an exception for cases where "a prescriber determin[es] that, with respect to a particular patient, other non-opioid pain management treatments are inadequate or inappropriate." Since that is the judgment doctors are already supposed to be making, the only point of this bill seems to be further discouraging such prescriptions by making physicians worry, even more than they already do, that their good-faith assessments of patients' needs will expose them to scrutiny that could deprive them of their licenses, livelihoods, and maybe even their liberty.

The government's crackdown on pain pills already has led to medically reckless dose reductions and patient abandonment across the country. The problem became so severe that the CDC recently warned that its 2016 opioid prescribing guidelines should not be interpreted as endorsing, let alone requiring, involuntary tapering or discontinuation, which may lead to "adverse psychological and physical outcomes" (including suicide), "could represent patient abandonment," and "can result in missed opportunities to provide potentially lifesaving information and treatment." A bill like Manchin and Braun's can only aggravate this problem, while making doctors less inclined to treat chronic pain to begin with.

"Most pain specialists agree that, in some cases, long-term opioid therapy is all that works for some chronic pain patients," notes Phoenix surgeon Jeffrey Singer, a senior fellow at the Cato Institute. "What the senators fail to recognize is that patients are not one-size-fits-all. Different patients respond to pain and to pain management differently. Their proposed legislation, if passed, will only serve to exacerbate the unnecessary suffering of patients in pain that the CDC is trying to undo with its guideline clarification."

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  1. This is yet another example of why the federal government’s powers are supposed to be limited. It’s simply not possible for any legislator, however well educated, to know everything.

    1. Right, that’s why they have staff members and friendly bureaucrats to advise them.

      1. Right, that’s why they have lobbyists staff members and briefcases full of money friendly bureaucrats to advise them.

        FTFY, Eddy

    2. There is no reasoning with these morons. They could care less what we feel,think, or want. They have there own self interests and that’s all they focus on. MUNCHKIN did nothing when the pills came down like snow in his district. Now 6 yrs later he wants to talk about it? Has anyone checked their past “donations” I will bet both got a boatload from Pharmaceuticals
      Only one way to get their attention HURT them and get them to feel pain! Wasting our breathe talking

  2. “the two senators seem to think they have the medical expertise to second-guess the judgment of physicians across the United States, not to mention the Food and Drug Administration”

    Congress is right to question the judgment of the FDA.

    1. Does Sullum realize he is implicitly arguing against legislative oversight of the executive branch by including the FDA in his criticism?

      1. Shikha calls herself a “progressive libertarian”.

        That seems like the official party platform of Reason these days.

        #LibertarianForPostmodernMarxism
        #LibertariansForTheDeepState

      2. Except that isn’t the case at all. The FDA literally has the word drug in the title of the agency, so you would expect them to have some kind of expertise in the area of drugs. Senators with business degrees have none. None < some. You seem to be jumping on the "I read Reason only to find ways to criticize Reason" bandwagon. In this case you couldn't even find a slightly valid reason.

    2. Reason is going full lefty with their worship of the apparatchik state.

      #LibertariansForTheDeepState

    3. Especially since the FDA explicitly skipped doing any long term studies on the effects of long term opioid usage. They did short term studies which means were they treated like other drugs only be used during and immediately after surgeries.

  3. Hear me ringing big bell tolls
    Hear me singing soft and low
    I’ve been begging on my knees
    I’ve been kickin’, help me please

    1. Best Stones song ever.

      1. Monkey Man?

    2. Ooooh I wish the Rolling Stones would go away!

      1. Hear me prowlin’
        I’m gonna take you down
        Hear me growlin’
        Yeah, I’ve got flatted feet now
        Hear me howlin’
        All around your street now
        Hear me knockin’
        And all around your town

  4. This is well-intentioned legislation: The Senators want to do something to address the addiction problems stemming from opioids. I do not question their motive, or good intentions.

    But where I draw the line is the federal government stepping into the most intimate r’ship I have: physician & patient. They have no business interfering in that relationship, and substituting their political judgment for my physicians medical judgment.

    For instance, take tramadol. This was not classified as an opioid, until the last 5 years or so. It is commonly used to treat chronic pain from musculo-skeletal disorders like RA, or PsA. Are we now going to tell the thousands of patients suffering from those disorders, “Tough luck, buddy. Just practice mindful meditation”.

    That ain’t right.

    1. As far as government is concerned they own you. You are just here to provide tax money for them to use. Anyone who thinks a politician actually cares about them has lost their fucking ability to see and hear. Every year they get deeper and deeper into our lives while fucking things up more and more.

    2. That’s exactly what’s happening already to millions of chronic pain patients and military veterans. Due to physician’s fear of being wrongly prosecuted by the misdirected DEA, millions of innocent chronic pain patients and veterans have been forced tapered to enbtirely ineffective dosages and/or abruptly abandoned by their pain physicians.

    3. “But where I draw the line is the federal government stepping into the most intimate r’ship I have: physician & patient.”

      The most intimate relationship you have is between you and you.

      The government intrudes on it by requiring you to submit to the rent seeking shakedown of the medical mafia for permission slips to purchase medical tests, treatment, and medicine.

      Reason agitates so you can get high without government interference, but not heal yourself without government interference.

      #ClownLibertarians

    4. That legislation makes a great paving stone for the road to Hell.

  5. “the CDC recently warned that its 2016 opioid prescribing guidelines should not be interpreted as endorsing, let alone requiring, involuntary tapering or discontinuation”

    Yeah, right, it’s not *their* fault that their “guidelines” had the 100% forseeable results which it in fact had.

    They’re just trying to cover their asses.

    1. Why is the CDC even involved at all in prescribing guidelines? Even if addiction should fall under their purview, which I question very strongly, they should stick to communicable diseases, they have no place inserting themselves in a very personal, individualized relationship like doctor/patient.

      1. The CDC is in a perpetual bind. Their actual mission is to fight empidemics of communicable disease. If they do their job right, or people just keep sanitation standards up, it looks like they aren’t doing anything. Then some mouth-breathing Congressidiot decides to cut their budget. And if, with their budget cut, they fail to contain an outbreak of something nasty, they will face being abolished because they failed…because their budget got cut…because it looked like they weren’t doing anything.

        I’m not saying it’s RIGHT that they inject themselves into all kinds of fashionable foolishness. I’m just saying it’s understandable and probably inevitable.

        1. It would help if the CDC would stop listening to Dr. Andrew Kolodny and PROP – who guided the CDC on their guidelines and personally financially gain by the results which relabel chronic pain patients as opioid misuse disorder. They have ties to the addiction treatment industry, including Suboxone. Additionally they’ve got Kellyanne Conway as Trump’s opioid ‘crisis’ czar.

    2. The usual CYA bureaucratic bs of denying responsibility for intevitable outcome of their policies.

  6. Look, I hope addicts get the help they need to get beyond their addiction, but that shouldn’t mean trampling on the rights on the non-addicts.

    “We’re punishing you pain patients because other people, unconnected to you, are addicts!”

    1. If it saves just one addict…..

      1. +1

      2. But kills a chronic pain patient who commits suicide because they’ve been cut off from an opioid that was, up until that point, helping them actually function?

  7. Since their recommendations largely follow the (equally bad) recommendations of the CDC, an organization largely made up of doctors, I’m not sure what relevance the business degrees of the two senators has to do with anything.

    1. Doctors who go to work for the CDC are doctors who are self selecting to not work as ordinary physicans who treat patients.

      1. That is a fair criticism of the doctors at the CDC. It has nothing to do with my criticism of the article’s attack on the two senators’ business degrees.

        1. The attack on the business degrees is legitimate.

          The congressmen have no expertise in a complicated subject far outside of what they can claim competence in.

          Therefore the attempt to legislate authority in an area they know nothing about is pure bunk.

          If they wish to submit a paper to NEJM or some such on treatment of chronic pain go ahead.

          Otherwise submit your bill to STFU.

          That bty is not appeal to authority. Learn it.

          1. So all those legislators who have nothing but law degrees should STFU, too? Who, precisely, will be left to vote on legislation by your exalted model? Should those two senators be the only ones allowed to vote on issues addressing business? How do you propose to get a quorum on any issue?

            What you are claiming is precisely an appeal to authority. You are claiming that only those with specific degrees have knowledge of the field and ignoring the clear evidence that even those with the degrees you want are quite often equally ignorant on the specific topic.

            Note that I am note defending this bill. It’s a dumb bill being put forward for the wrong reasons. But attacking it because of the credentials of its proponents is a logical fallacy that should be called out.

            1. Gah… “Note that I am not defending …”

              Can we please have an edit button?

            2. Appeal to authority is often misunderstood.

              Argumentum ad Verecundiam Is not an argument against expertise nor does it mean that an expert is correct in a specific situation.

              When the experts in the field push against the legislation put forth by those who have no credentials nor experience in it that is not a logical fallacy.

      2. The CDC is a very useful resource.

        What you said is that some docs choose clinical practice. Others choose research and academics.

        You need both.

  8. In all of this, I think I am most disappointed in doctors’ behavior. They seem to either have no spine or no imagination. 10 years ago they were handing out pain pills like candy, and now they are all either scared or buy into the latest trend. Are they really so unable to make their own judgements? The most charitable reading is that they are terrified of the DEA cracking down on them if the prescribe “too much”. But it seems like a lot of doctors are now true believers in the opioid panic.

    1. I had to enter a ‘pain contract’ with my doctor to get Vicodyn. I’m asked to ‘rate my pain’ through the day on a scale of 1 to 10.
      I pointed out to the doctor that, since I’m taking medication for pain, the numbers will be lower than if I had no drugs. Didn’t seem to faze her. Just fill out the damn form and shut up!

      1. That “contract” might be a legal CYA for the doctor’s protection. Opiod prescription rates shot up when a law was enacted making doctors potentially subject to criminal prosecution (as well as malpractice findings) if any patient under their care (or their attorney) decided their pain was being insufficiently managed. Having something in writing might at least give the doc some liability protection against any future claim that they hadn’t done enough for pain management and/or when the patient ends up dependent or addicted to the meds which have that result from long-term use.

        The doctors are stuck between that requirement and putting patients on long-term courses of habit-forming medications, and there’s an increasing number of studies which are finding that opiods in particular aren’t actually effective for treating chronic pain; once the patient’s brain gets “hooked” on the drug, it apparently starts setting off pain alarms to get more.

        Simply stopping the meds without additional treatment to deal with the dependency is also a bad path to start down, and does lead many patients to end up on “street” drugs which are increasingly becoming fentanyl sold as something else because that chemical is far more profitable for the dealers and relatively easily availabe (it can’t be banned entirely because it does have legally legitimate medical uses for end-of-life and other extreme situations).

        1. BG…You are correct, that contract is a legal protection. I believe it was written by the AMA as a template, in response to the regulatory changes in 2016 wrt Rx’ing opioids.

          This is where medical marajuana is a Godsend. It is incredibly useful for tapering off narcotics. We know it works; the data are strong, and more states have this indication (taper off opiods) for medical marajuana.

        2. Regarding the studies that claim opioids aren’t effective for long-term chronic pain.

          I was able to reasonably function while taking what is now considered to be very large doses of (440MME/day) of two powerful opioids for 18 years without suffering any type of adverse side effects. I maintained the exact dosage for over 15 years without the need to increase it.

          Unfortunately, with the advent of government created “Opioid Hysteria” (which is actually an illicit fentanyl and heroin crisis), I was forcibly tapered completely off one pain medication while being simultaneously force tapered down to 180 MME/day of the other medication. My physician admittedly did this soley due to the CDC Prescription Guidelines, without my consent and without any type of medically evidenced rationale.

          I’m now once again an invalid, unable to physically function, more like another hindrance my family is once again forced to deal with.

          I went from being relatively active, e.g., participating in my family’s lives, helping out around home, taking my wife to dinner, etc., to where I now can barely get myself out of bed just to spend all day, every day laying around. My primary activity has been relinquished
          to being dragged to the doctor’s office every month.

          More importantly, opioids provided me (and millions of others) with the ability to remain employed and financially independent. And I’m personally aware of numerous other patients who share similar experiences.

          Regardless of what any study may claim, there clearly is not a one size fits all recipe for individuals and what constitutes effective pain care.

          Additionally, studies proclaiming opioids aren’t effective for chronic pain, and/or that ibuprofen is equivalent to, or more effective than opioids are clearly biased, politically manipulated, or simply fraudulent. Obvious paradigms of gullibility.

          Opioids have been used safely and effectively for thousands of years. Bad policies arn’t likely to change that.

          1. I feel for you. My girlfriend isn’t as bad off as you are, but her functionality has been greatly reduced thanks to government fuckhead meddling. The people who put these policies into place need to be beaten severely then denied pain medication.

    2. Doctor’s have their own interests, and patient well being is unlikely to make the top 5.

      1) legal problems
      2) regulatory problems
      3) income
      4) scheduling
      5) their time
      6) their hassle

      Yep.

  9. Individual health care and pain management decisions are best left in the hands of the patients and their legislators.

    1. It’s a good thing these benevolent, selfless legislators put themselves between patients, and evil, proifteering medical professionals who are only interested in profit.

      Damn those highly trained medical capitalists, treating patients in exchange for money!!

      1. Damn the rent seeking medical mafia.

  10. Fortunately, senators sticking their noses into opioid use and interfering in whether or not they can be prescribed won’t have any negative impact on new drug development in the field.

    Right?

  11. I guess these senators are not pro-choice then.

  12. > instructs the agency to tell prescribers that opioids are “not intended for the treatment of chronic pain.”

    I’m sorry, but that’s the ONLY purpose for opioids! I mean, major facepalm here. It’s the whole point of Morphine!

    1. I don’t know about “ONLY”. They are also quite good for acute pain from injuries, post-surgery, etc.

      1. Just like these Senators, I am not a doctor. To me pain is pain. And the point of opioids is to relieve pain.

        Sorry for conflating acute and chronic. Maybe I should run for office.

        1. I am.

          Opioids are great for acute pain (sudden onset, doesn’t last for more than a few days) like broken bones and surgery.

          They are less effective for chronic pain, for several independent reasons. First, a physiological dependence will occur after taking opiates for several weeks, so that a person can’t function without them even if the underlying pain has gone. Second, you’ll have to continually increase the dose, usually geometrically, so that over a few years a person may be on so much that a single pill would kill an opiate-naive person, even aside from the escalating costs. Third, opiates have concrete negative aide effects for everyone, such that it is unsafe to drive, for example. They also depress the respiratory system, causing death.

          So for chronic pain, things like selective norepinephrine reuptake inhibitors (SNRIs) are better, because they don’t have the same negative side effects, though they take much longer to take effect and are more hit-and-miss on treatment, where opiates essentially always work (even if only through their dissociative side effects).

          But…… not everyone will respond to SNRIs and similar, so for many patients opiates are the only choice, though the easiest way to check for a good pain management regime is to look for all of these – if a patient is on multiple things it’s almost always a legitimate treatment plan, especially if minor adjustments are made regularly.

          On the other hand, a patient who has only ever been on high dose immediate release opiates, who has never tried anything else, is either an illicit drug channel or has an incompetent doctor.

          1. Thank you for making a great point: Sometimes, there are actually situations where opiates are warranted for chronic pain relief (SNRI failure). Medicine is not a perfect and sterile science. Sometimes physicians and patients make trade-offs, knowing what it means. For instance, I know of RA and PsA patients where opiates are the only effective means to reliably deal with chronic, severe pain, and the physician clearly explained the addiction risk – and the patients are in fact addicted to opiates. They had that extended discussion, and jointly concluded that the quality of life addicted to prescription opiates was better than a life of chronic, unrelenting pain. A very, very difficult decision.

            I don’t want a politician involved in that discussion, let alone helping make the decision.

          2. I appreciate you admit some people need opiates, but your comment is written like a true non-severe-pain-patient-with-no-other-options.

            I’ve used opiates for severe pain for 16.5 years now, though I’ve been forced down to 90MME.
            I had 15 major surgeries between 2004 & 2013 and now have FBSS, live with 4 broken screws in my hardware-that’s been replaced due to breakage 3x already, 3 ruptured discs, bone-on-bone phenom, and the surgery list includes a THR due to overuse of prescription steroids, which fell apart & needed an ER revision for that.

            I was injured in 2003 and put on opiates after I told my PCP I was eating handfuls of 18-20 OTC Tylenol 3-4x a day to try and control my pain. Back then I was oh so naive…thankfully he caught it in time and I didn’t do any damage.

            I have tried every med available, biofeedback, an IDET & more up until 2011.

            What worked best for my pain were a combination of things, starting with opiate pain meds.
            With those and ibuprofen, I was able to attend Aqua & Land PT, chiropractic appts, myofascia release massage and acupuncture- all 3-5x a week after first 5 back surgeries, 2 triple hernia repairs & and ACL/MCL/Meniscus repair.

            I felt so much better I requested to start lowering my pain meds.
            I’ve done this several times, but you can bet that was never recorded in any of my files.

            Then 2010 hit with new Worker’s Comp ‘laws’ and another double open back surgery due to broken hardware.
            After being effectively denied any other treatments & forced to cut back so much on my meds, I was desperate and tired surgery “one more time” in 2013.

            I’ve had so many complications, almost died twice, was accidentally given narcan just hours out of the OR, various infections, medication contraindications, etc., that I’ve lost count and have now developed PTSD.

            I’ve had one shower in the last 2.5 years, I can no longer cook for myself, grocery shop, hang out with my kids, do simple art projects, sit for for moderate amounts of time, even reading is painful- all things I could do when given appropriate amounts of opiate pain meds, even without the ‘alternative’ therapies that many people never get a chance to try.

            So, yes, I get upset when I see comments that allude to opiates having a ‘cap’ or ceiling effect, or say they don’t work long term or that they have dangerous side effects (they’re one of the safest medications available; I’ll take constipation over edema, weight gain, myclonic jerks & suicidal ideation from gaba-drugs & antidepressants, or arachnoiditis from Depo Medrol ESIs any day).

            You yourself say “…(SNRIs) are better, because they don’t have the same negative side effects, though they take much longer to take effect and are more hit-and-miss on treatment, where opiates essentially always work…”.

            I personally wouldn’t say opiates “always work”, because for some they don’t, but in my experience, those people either aren’t suffering severe and/or intractable pain or have some genetic or allergic reaction issue.

            Please look a little deeper into real stories from CPP who’ve used them long term, 200+ years of anecdotal evidence shouldn’t just be swept under the rug.

            We aren’t all psychologically addicted or have OUD, and we are suffering greatly because of misinformation and PROPaganda.

            Maybe we should focus on the 40+ vets & civilians killing themselves due to pain everyday and show some concern for them?

            This is not to mean I don’ think people with OUD/addiction don’t deserve help or that ODs aren’t a horrific problem, I do.
            But both are patients and both deserve quality of life and quality healthcare.

    2. A lot of the latest research is showing that opiates (morphine, oxy/hydrocodone, fentanyl, etc.) are really only appropriate for acute pain treatment, and are both ineffective and dangerous for treatment of chronic pain; terminal situations (end-stage cancers, for example) are a different situation since the dosage can be increased to overcome tolerance and the danger of dependency/addiction factors differently for patients who aren’t likely to survive their other conditions long-term.

      At least that’s been a topic of frequent rants by a doctor with 30+ years of experience treating addiction and who is also certified for internal medicine and does several podcasts that I’ve listened to for years.

      1. Dependency and addiction are not the same thing.

        Dependency is a physiological change that replaces your body’s normal pathways with one dependent on an external source. Opiates are a common example, but so is Testosterone where injections shut down the ability to create testosterone on your own.

        Addiction, to the contrary, is a psychological disorder where a person feels a need to gain the object of their addiction.

        Everyone on opiates will eventually become dependent, in a matter of weeks or months.

        Some people will also become addicted.

        Dependency is not clinically important: you can just wean someone off. Addiction is clinically important, but fortunately (or unfortunately) people who will get addicted are people who will get addicted, what’s available is less important, so it’s relatively easy to see who’s at risk.

        1. That’s exactly why I mentioned both dependency and addiction and not just addiction. I don’t figure I know enough to provide the treatment for either, but do understand that there is an important difference.

          They are different conditions, but both will to some extent make it more difficult for patients to get off of meds once they’ve been on them for a long enough time. As you said, the path to that result (and the difficulty of that path) are different, but in either case, just cutting off suddenly is probably the most difficult and least successful way to get there.

  13. I really hope these two evildoers contract an extremely painful long term condition with no cure.

    1. Surely you realize there will be an exception for current and past members of the federal legislature. These two jerks are NOT on Obamacare OR Medicare.

      1. They also have he ability to ruin the life of an MD who would tell them to suck it up.

  14. Even if we focus on the relatively small share of drug-related deaths that involve opioid analgesics, blaming chronic pain treatment seems misplaced

    Unfortunately the Kool-aid has done been drunk…

    I know very reasonable, educated people who believe that taking a a pain killer to dull the pain of a recent dental surgery will spin them into a cycle of addiction, and within three weeks will be living under a bridge somewhere.

    1. It seems like people should know that it doesn’t work that way. It’s not random. Some people are prone to addiction. Most really aren’t. Addiction just isn’t a simple cause/effect thing. If that’s how it worked, I’d have been a junky a long time ago.

    2. A lot of the deaths that aren’t ODs of prescribed pain-killers happen to people who started out on those.

      Something like post-surgical recovery pain is the kind of thing that opioids are effective for, and should be a short enough course that getting back off (for those without prior addiction issues, at least) should be easily manageable.

      It’s the patients who are being put on oxy for months or for chronic conditions who are the ones likely to get into trouble if they ever experience a break in their availability and could end up self-medicating with unreliable black-market replacements who often end up in an OD at that point. By some reports, the VA was a significant contributor to such cases when patients who had been give a 30 or 60 day scrip reportedly couldn’t get a follow-up before running out (but not before becoming chemically dependent).

  15. But opioid are only effective for acute pain. They bind to different receptors. The only reason to prescribe them for chronic pain is because the patient was doctor-shopping and you’re unethical enough to want the copay.

    1. Tell that to the people for whom consistent doses of opioids allows them to have a reasonably comfortable and productive life.
      That may be true for some kinds of pain, but it is definitely effective in some cases.
      One former reasonoid commenter I know of is making great contributions to the field of psychiatry and enjoying life, none of which he could do if he didn’t have consistent high dose opioids to treat the chronic pain he suffers after having bone cancer.

    2. You are incorrect.

      https://www.medicinehow.com/opioids/

      As someone who has chronic back pain due to broken joints, I can assure you that opioids do help relieve chronic as well as acute pain.

      The only issue I’ve ever had with opioids is the tolerance that can be built up over time. However, suffering through a week without the opioid fixes that issue.

      Actually I have had two issues – the second one is that now I can’t get pain relief with a medication that helps me function normally anymore.

      Instead, I now live in constant pain again. It makes doing pretty much anything agony and lowers my quality of life quite a bit.

      But I’m sure that will help everyone sleep better at night, knowing that people in need of care aren’t getting it, people are getting hooked on heroin instead of being able to get medicine they need for pain, and that doctors are now afraid to actually do their jobs for fear of government retribution, incarceration, and the loss of their license to practice over this.

      At least CBD works for my condition somewhat – once it’s legal in my state I will be overjoyed, although my disposable income will be reduced somewhat – it will be well worth it.

  16. These Senators can fuck off. In the real world I know a guy who has multiple degenerative disks in his back. He works as a server at a pretty nice restaurant. According to him, his choices are:
    A: Take opioids to ease his pain and allow him to work, which pays his rent and provides for his wife and baby.
    B: Have his vertebrae fused and be unable to work for an extended period of time while he does PT and recuperates.
    If A, he’s just masking the degenerative issue, and will eventually need surgery. If B, he can’t work and get paid (the majority of his wages are in unreported tips).
    He uses cannabis but says it’s not nearly as helpful for the pain as the time released opioids.
    His doctor, and all other doctors he’s seen, have refused to prescribe him any more opioids. Aside from having to miss work because of the hell of withdrawals, he is in misery every day, but still has managed to keep his job.

  17. One from West Virginia, the other from backwater Indiana. These guys are merely representing the wishes of their constituents, who have no use for physicians and scientists and other “elites,” with their fancy college degrees and standard English and professional qualifications. I’m surprised these senators didn’t push legislation requiring a physician to obtain a permission slip from a faith healer, televangelist, or fortune teller before prescribing any high-falutin’ medicine.

    1. RAK proving yet again that he is the biggest bigot in the discussion.

    2. Indiana is only a backwater because of all the people fleeing the backwater city of Chicago, bringing their voting habits with them.

    3. I doubt fuckhead slaver here could find Indiana or West Virginia on a map.

  18. I have used opioids for over ten years to control chronic pain. It enabled me to hold a full time job up until I retired. The hoops I have to jump through to get them now are getting ridiculous.
    Heroin and Fentynal are the most abused drugs and are already illegal but the drug warriors can’t get a hold of those users. So, the knee jerk reaction is to crack down on those of us who use legal products responsibly. They do so only because they can.

    1. ILLICIT fentnayl and it’s analogs from Mexico and China. Not fentanyl that’s prescribed to chronic pain patients (like me) or used during surgery.

  19. nice good great

  20. It would be wrong for me to wish chronic pain on those two assholes….

    Besides, Manchin can always get a little something-something from his daughter, the pharma CEO that jacked up the price of epipens 5000%

  21. Let’s see we should listen to asshat with crappy bachelors degree in business vs a doc with 4 years med school, 4 years residency in anesthesiology, 1 year fellowship in pain management and board certification.

  22. These two and anyone who votes for this disgusting bill deserve to find out first hand why nothing else works for some severe pain. Long may they suffer in the kind of pain they condemn others to. And may they see their loved ones OD on the street drugs they’re driving people to.

  23. Just because people kill themselves with drugs doesn’t mean we should stop them. I’m pro Darwin win it come to self destructive people

    1. I agree that the personal responsibility should make a rapid comeback and take the place of the utterly failed Drug War. But would you be so cavalier and callous if it were you, or a member of your family or even a close friend?

      Show me one person who has total control of every aspect of every day of their life – you can’t, because control is an illusion. Most people don’t set out to eat or snort or drink or gamble themselves to death, but it happens.

      I’ve always believed there are two types of libertarians: those who are truly compassionate and love liberty for liberty’s sake; and then those who are merely arrogant narcisissts who enjoy gloating at others’ misfortunes to reinforce their own lacking self-worth.

  24. […] to endure. I simply won’t. I was never going to be in a position to vote for either of these soul-less ghouls, but I might find myself donating to their opponents if they aren’t also drug […]

  25. Totally agree with the article, but wanted to point out that Fentanyl is NOT ‘illicit.’ Diverted, maybe, but not illicit. It is a ‘federally approved’ Schedule II drug used daily in virtually every hospital in the US.

    1. The problem is not coming from legal fentanyl via diversion — but illicit fentanyl and it’s analogs coming in from China and Mexico. They take the recipe and alter it slightly, add it to other street drugs coming into the country. Or they use carafentanyl, which is mostly only used as an animal tranq.

  26. Using numbers from an official White House transcript of a briefing by Kellyanne Conway to Trump on the ‘war’ on the so called ‘opioid crisis’.

    They’ve cut opioid scripts in the US by 30% (50% in vets).
    The DEA has cut the number of licenses they give pharmaceutical companies to make opioids by 50%.

    DESPITE THIS — they saw only a 4.4% reduction in over-dose deaths — and that number is debatable. In many places, there was no change or even an increase.

    Depending on what study you look at, the risk of addiction from opioids for chronic pain patients is anywhere from 4-10% — FAR less than the 80% the government paid TruthOut advertisement claims, which uses a study that only asked the addict if they’d ever used opioids – not if they had tried other drugs before that, or if they were addicted prior, or if they had a legit prescription for the opioids.

    The CDC “oops” statement that it didn’t mean for it’s guidelines to be misused is MEANINGLESS as long as the DEA and government idiots like these two continue to aggressively go after doctors. Chronic pain patients are being abandoned by their doctors. Some places have become a chronic pain treatment desert, with doctors getting out of the field – rightly afraid to lose their license.

    You have patients who have been successfully treated with opioids for years, decades – with improved function and quality of life – being summarily cut-off or tapered and given NO help for the withdrawals (caused by physical, not psychological, dependence), and given no other science-based or successful treatment to replace them. Some have committed suicide, unable to take the pain any longer.

    The CDC needs to stop listening to Dr. Kolodny and PROP, who have direct financial ties to the addiction treatment industry and the drug Suboxone. They are financially gaining by relabling chronic pain patients as addicts.

    Focus needs to go toward better, science-based methods for treating addiction. Their success rates are abysmal. Truly. When you look at most of the numbers given, you find most only include the time in treatment, not relapses that occur after they leave. They do not follow their patient’s after they leave treatment.

    Additional money needs to go to legal points of entry, giving border patrol and the USPS better detection devices and dogs to detect this crap coming in from Mexico and China.

    This sort of legislation is over-reaching and just another stick to threaten doctors and chronic pain patients with – which was never the problem to begin with. It’ll be used by insurance companies and pharmacies to further deny patient’s legitimately written prescriptions, and to tattle on doctors who are only doing what they feel is best for their patients.

    I’m not at all saying there aren’t a few bad apples in there – just like in any industry. But there are much better ways to find, investigate, and get rid of those doctors.

  27. […] co-exists with undertreatment of pain, indiscriminate reductions in the total supply have predictably bad consequences for patients. That ham-handed approach also has driven nonmedical users toward black-market […]

  28. […] co-exists with undertreatment of pain, indiscriminate reductions in the total supply have predictably bad consequences for patients. That ham-handed approach also has driven nonmedical users toward black-market […]

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