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wo governors, a former congressman in recovery, and an addiction researcher are set to join New Jersey Governor Chris Christie on President Trump’s opioid panel.

The White House announced Wednesday that the president intended to appoint Republican Governor Charlie Baker of Massachusetts and Democratic Governor Roy Cooper of North Carolina to the Commission on Combating Drug Addiction and the Opioid Crisis.

The other new members are Patrick Kennedy, a former Rhode Island congressman who has spoken of his own addiction issues, and Bertha Madras, a researcher at Harvard Medical School and McLean Hospital in Massachusetts.

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Trump tapped Christie, who has earned plaudits for his work on the opioid epidemic as governor, back in March to lead the commission, which did not have any other members until now. Cooper and Baker are both from states hard hit by addiction.

Kennedy has become a well-known advocate for addiction and mental health treatment. Most recently, he has been working with former House Speaker Newt Gingrich as paid advisers to the group Advocates for Opioid Recovery. That group is backed financially by Braeburn Pharmaceuticals Inc., which makes a new opioid-addiction medication.

Madras, who studies the biology of addiction, formerly served in the White House Office of National Drug Control Policy in the George W. Bush administration.

In New Hampshire Wednesday, as part of the administration’s opioid listening sessions across the country, White House counselor Kellyanne Conway highlighted the commission as a step that shows Trump is dedicated to fighting the opioid epidemic. She said it would come out with a report this year with its recommendations.

“We look at this as a nonpartisan issue in need of a bipartisan solution,” Conway said.

Some critics of the commission have noted that the issue has already been studied thoroughly and that experts have already issued many recommendations on the subject, including a sweeping report last year from former Surgeon General Vivek Murthy.

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  • I am a veteran and have been managing my pain with morphine and oxycodone prescribed by the VA for 14 years. Now that they are reducing my medication the pain is drastically worse and my anxiety level has skyrocketed. I feel that this is unjust and is causing more harm than good. If left with no other alternative to prevent the pain, I will do whatever I have to prevent living in constant pain. What the VA is doing is wrong and most will turn to illegal activity to help with the pain. So will I.

  • I am a reliable chronic Trigeminal Neuralgia and Facial Pain patient of 8 years. I take my medication responsibly and have never “lost” a script, lost my pills, had stolen pills, nothing in the years I’ve been using medication. Yet a new pain management doctor is weaning me off Oxycodone.

    My team of 6 specialists have worked closely together to come up with a treatment plan and daily cocktail of medications to keep my Facial Pain under a 10 on the pain scale.

    Trigeminal Neuralgia and Facial Pain has already taken my home, career, vehicle, and my ability to drive and continue to work and earn a income at a career I loved for 15 years at The Boeing Company. TN took my lively hood, joy, independence, freedom, friends and even some of my family.
    This past week our weather was not particularly bad. We had extremely high humidity and high temperature of 116. Put those two together and we have the perfect storm.

    I had a particular bad day due to the weather and had to take my full cocktail of medication including two low dose opioids, (I try to take as little medication possible, but when the pain is so bad I’m forced to take the entire cocktail and within 30 minutes I almost forgot that I even had any facial pain.

    I’m not a drug abuser, I don’t use street drugs, I never have. I’m 51yo and I take my medications as directed. When I bring my medications home, i put them directly in my safe, even though there is no one around to pilfer through them, I would never want to chance it in case I have visitors.

    The real abuser are the herion users and I beg you to do something about them. A lot of them are young kids that are abusing, stealing, selling medications because they will use and do anything to get their fix. I’ve seen it first hand with my nephew, fortunately he got help and he recently became a new father. I pray for him as I know he may relapse at any time.
    Those are the ones that need help; not us legitimate chronic pain patients who are legally prescribed medication by a physician!

  • Deforest, you have made a sweeping claim of diversion of drug profits from marijuana sales to hard drugs. Show us the evidence. There is ample evidence to the contrary that marijuana isn’t a gateway drug. According to a RAND study reported by the US Institute on Drug Abuse, where medical marijuana is legalized, rates of opioid abuse are dropping.

    • Completely agree with Mr Lawhern letter to the commission. We need him to represent those that responsibly take their prescribed medication in order to have any quality of life. Thank you for sharing!

  • The opioid crisis is just the final result of the “addiction crisis” fueled primarily by the failure of government officials to eliminate the unrestrained access of drug pushers in public schools introducing vulnerable children to the gateway drugs of tobacco, alcohol and marijuana. The real explosion in drug deaths began when the marijuana industry used dope profits to finance the public relations campaign to legalize pot as a snake oil medicine that cannot be approved by the regular FDA drug legalization procedures. Because it ain’t medicine, it’s child-brain-destroying dope! School drug testing and death penalty for traffickers will quickly reverse the drug death trend.

  • Shane Peck, I seriously doubt that any of the Commission members bother to read STAT or any other authoritative source in medical practice and research. The email gateway to the commission is at commission@ondcp.eop.gov.

    I have also added to my earlier correspondence to the Commission, at length. I am seeking a publication venue for the following article, edited from that new input. It would be nice if STAT took this on, but I’m not holding my breath. Feel free to extract from this material in your own advocacy, if you find it compelling.

    An Open Letter to the President’s Commission on Combating Addiction and the Opioid Crisis: You Need to Hear a Tenth Voice!

    By
    Richard A. Lawhern, Ph.D.

    This article is edited from correspondence sent to the Office of National Drug Control Policy on June 17th, 2017. Others who wish to make their voices heard may also do so by email to commission@ondcp.eop.gov .
    — — —

    With many others, I listened and watched for two hours of the first working meeting of the Commission on Friday June 16, 2017. The Commission was addressed by leaders of nine Non Profit Organizations engaged with various aspects of addiction treatment. Much of the input seemed quite apropos. But one voice was missing from the session that is vital if the Commission is to arrive at safe and supportable recommendations on this important public health issue.

    Speakers failed to include even one practicing physician or advocate for pain patients who have largely and unfairly been blamed for the so-called “opioid epidemic”. I urge the Commission to remedy this exclusion by inviting participation in an additional session by organizations such as the American Academy of Pain Medicine, the American Academy of Integrative Pain Management, the National College of Physicians, PAINWeek, Pain News Network, National Pain Report, and/or the US Pain Foundation. Commission staff should be able to identify other physicians who are deeply trained in this field.

    In the absence of such input, I offer my own insights as a 20-year volunteer advocate who daily interacts with more than 20,000 chronic pain patients, among the estimated 100 million Americans affected by persistent, long-lasting pain (American Academies of Medicine). Within this group, an estimated 16 Million are treated in any given year for recurrent persistent pain, and on the order of 3 Million are treated for more than 90 days with opioid analgesics. [1]

    [See “Neat, Plausible, and Generally Wrong — A Response to the CDC Recommendations for Chronic Use” by Stephen A. Martin, MD, EdM; Ruth A. Potee, MD, DABAM; and Andrew Lazris, MD https://medium.com/@stmartin/neat-plausible-and-generally-wrong-a-response-to-the-cdc-recommendations-for-chronic-opioid-use-5c9d9d319f71 ]

    I am myself neither a physician nor an expert in addiction. My training is in systems engineering, experimental design and technology analysis. My wife and daughter are the pain patients in my family. But I talk with and read the work of many medical and pharmacy professionals, including several who were originally copied on this letter — all of whom have published in this field.

    I believe I can lend support or amplification to several points made by speakers in the first session of the Commission. Certain aspects of the discussion stand out.

    1. A large number of addiction treatment and recovery programs now operating in the US are funded by Medicare. To address the “opioid crisis”, the Commission must be prepared to advise President Trump to expand the scope of conditions treated under Medicare, not reduce it.

    2. As several speakers suggested, effective programs to reduce the death and destruction wrought by illicit drugs must be multi-dimensional. Five aspects must be addressed. None is adequate to stand alone, or will be effective standing alone. There are no simple solutions here.
    a. Prevention in kids, beginning in Middle School, continuing through High School and beyond.
    b. Prevention in adults, focusing on employment development and the creation of hope. Addiction in adults is not primarily a disorder created by drug exposure. It is created by social disintegration and hopelessness that leave people vulnerable.
    c. Initial recognition of addiction by properly trained community medical professionals.
    d. Ongoing community engagement and support for recovering addicts over periods of at least 3-5 years and possibly longer. Relapse is an ongoing issue for which there are no simple, one-size-fits-all solutions.
    e. Diversion of addicted kids and adults out of the prison system and into community treatment and re-integration programs.

    As noted by Governor Christie, overshadowing all of these dimensions is the reality that we must reduce the moral condemnation and stigma now assigned to addicts in order to be able to engage them, their families, and their communities in corrective initiatives. Not mentioned in the proceedings, the same is true of the stigma and abuse which are regularly experienced by long term pain patients and by doctors who attempt to treat their pain.

    3. As several speakers suggested, any program recommendations must be evidence-based and reinforced by sustained observation of outcomes. We should not be wasting limited resources on measures that don’t work. Some of the statements of participants stand out in flashing lights. These can be readily confirmed by even minimal research on the part of Commission staff.
    a. 90% of drug addicts first encounter opioids or other intoxicants as adolescents, either on the street or by diversion or theft from family members. Not explicit in the proceedings is the reality that it is unusual for adolescents to have medical encounters which require treatment with opioid analgesics. Thus this statistic makes clear that prescription drugs under active physician management are NOT the primary cause of the opioid epidemic and likely never were. Further restriction of prescriptions to people in agony will not be a solution for this essentially “social” problem.
    b. The most effective interventions for confirmed addiction are medication-assisted. This means programs like Methadone maintenance. We have multiple international examples of maintenance programs which work.

    For the politically bravest of the brave, we should also examine the experience of Portugal, where possession of drugs has been decriminalized for 14 years — and where overdose deaths have dropped to near zero as rates of addiction are dropping.

    c. Although community-based therapy in the 12-Step model might be a supporting element in recovery, this model is clearly inadequate by itself. Relapse rates into addiction by 12-step attendees are abysmally high.

    d. As one speaker noted, “more beds are not the answer”. 28-day detox programs — including those used in the Phoenix House chain of addiction treatment centers, on the Board of which one of the speakers participates — are ineffective when not backed by ongoing community interventions. Media are littered with stories of addicts whose first act after leaving a treatment center is to find a dealer and shoot up. Some published figures on relapse rates for discharged addicts approach 95% within one year. This too can be confirmed by Commission staff.

    4. I note in passing, that the Commission must also wrestle with a contentious reality: not all sources of advice are equally credible. My sense of the working session was that some of those who addressed the Commission were financially or professionally self-interested. I personally have particular reservations concerning the helpfulness of psychiatric care, given that the entire field of psychiatry is now experiencing a crisis in public confidence due to scientific corruption and over-medication promoted by pharmaceutical companies.

    While we know that many addicts also deal with life crisis problems called “mental disorder”, there is legitimate doubt that psychiatry presently has reliable remedies to offer. More basically, use of anti-psychotic drugs has been associated with a marked drop in life expectancy and function among patients who are medicated involuntarily. For further on this subject, a useful resource is “Psychiatry Under the Influence – Institutional Corruption, Social Harms, and Prescriptions for Change” by Whittaker and Cosgrove, available on Amazon. I would advise the Commission to apply the same standards of evidence to psychiatric programs as to all others considered.

    5. If the Commission is to seek solutions to the addiction crisis, then it seems to me that they must first be able to separate out hype from facts in understanding what is going on. I offer the following in my role as an advocate for people in agony who stand to be grievously harmed if the Commission gets this narrative wrong.
    a. Origins of the rising tide of opioid-related deaths are frequently attributed to careless prescribing practices of the 1990s, encouraged by pharmaceutical companies who touted “Pain as the 5th Vital Sign”. It is certainly evident that prescribing practices were greatly liberalized during that period. What is not so obvious is that ill-trained physicians not only over-prescribed to patients whose pain might have been managed by other means, but also to undetected addicts who shammed pain to get safe and regulated drugs of choice.
    b. The impact of over-prescribing was arguably and primarily NOT on legitimate pain patients themselves. A Cochrane Review of 2010 of long term effectiveness and risks of opioids, found that among patients who were previously opioid-naive, the number who later presented with opioid abuse disorder was fewer than 1%. Other and later studies have placed abuse rates at 5-10%. [3,4]

    [Ibid Martin et al. See also “Warning to the FDA – Beware of Simple Solutions for Chronic Pain and Addiction”, R.A. Lawhern, Ph.D., http://nationalpainreport.com/warning-to-the-fda-beware-of-simple-solutions-in-chronic-pain-and-addiction-8833744.html . This article has since been featured in PAINWeek with a short introduction, as “What If Prescribing Standards Were Patient Centered?”]

    c. Much of the present “crisis” in opioid related deaths can be laid at the feet of the FDA, when they forced the reformulation of OxyContin into “abuse resistant” form in 2010. In the next three years, deaths attributed to heroin increased by more than 200% while prescriptions of Oxycontin dropped by 66%. [5]

    [“Have Opioid Restrictions Made Things Better or Worse?” by Josh Bloom, Ph.D., http://www.acsh.org/news/2016/11/03/have-opioid-restrictions-made-things-better-or-worse-10400 ].

    Heroin deaths continued to skyrocket in 2014-2015. A plausible explanation for these statistics is that addicts who previously used Oxycontin found that they no longer got high on it, and were forced into unsafe street drugs.

    d. Whatever we may believe concerning how the “opioid epidemic” got started, there is ample evidence that it is no longer sustained by prescribed analgesics if it ever was. Mortality statistics of the CDC itself reveal that in 2015, deaths attributed to overdose were dominated by heroin, imported fentanyl, diverted or stolen morphine and methadone. Co-prescription of anti-anxiety medications (Benzodiazepine) was observed in about half of the 33,000 estimated accidental overdose deaths in 2015, and alcohol played a role in more than half. [6]

    [“New CDC Overdose Study Reduces Role of Pain Meds” – Pain News Network, December 26, 2016, https://www.painnewsnetwork.org/stories/2016/12/26/new-cdc-overdose-study-reduces-role-of-pain-meds ]

    In States like Massachusetts where mortality statistics have been compared with prescription databases, it is found that fewer than a quarter of the deaths attributed to opioids occurred among people who had a current prescription for them. It also seems likely that many deaths reported as accidental were in fact suicides or sudden cardiac arrests caused by unsupervised sudden withdrawal of opioids by physicians leaving pain management. Veteran suicide due to denial of pain relief is an even more evident trend.

    e. One of the speakers to the Commission asserted that simple “enforcement” of the March 2016 CDC Guidelines might reduce overdose deaths by half. The implication was that a 90 MMED dose limit should become a standard of practice for all pain management physicians. Unfortunately, I believe that speaker was grievously wrong.

    I would assert from wide reading and direct observation of social media, that CDC guidelines have already been directly responsible for at least hundreds of patient deaths in the past year. In their present form, they are deeply and unfairly biased against opioid pain relief, scientifically unsupported, and vastly incomplete. Of particular concern is that natural genetic variability of patient responses to opioids was utterly ignored by those who wrote the Guidelines. Any physician training that is based on these Guidelines may be responsible for deaths among patients who hyper-metabolize opioid analgesics, and therapy failure among many more who are poor metabolizers due to polymorphisms in the expression of key liver enzymes. [7]

    [See “Warning to the FDA: Beware of Simple Solutions in Chronic Pain and Addiction” National Pain Report, June 1, 2017, http://nationalpainreport.com/warning-to-the-fda-beware-of-simple-solutions-in-chronic-pain-and-addiction-8833744.html ]

    These errors and omissions are well known among pain management physicians. The Commission should consider recommending that the CDC Guidelines be totally rewritten by a qualified consultants group led by pain management physicians and supported by patient advocates and medical ethicists. In their present form, the Guidelines are “unsafe at any speed.”

    Thank you for accepting this input.

    About the Author: Richard A. Lawhern, Ph.D. is a technically trained non-physician with 20 years of experience in peer-to-peer patient support groups for chronic pain patients. His work and commentaries have been published or featured at the US Trigeminal Neuralgia Association, National Pain Report, Pain News Network, The American Council on Science and Health, The Journal of Medicine of the National College of Physicians, the National Institutes for Neurological Disorder and Stroke, Wikipedia, Mad in America, Psychiatric News and other online venues.

  • Please,please,please, include chronic pain sufferers on your opioid commission panel. Or at the very least, consult with and listen to our side of the story. The suicide rate from people who suffer chronic debilitating pain that goes untreated, or has had their pain medications taken away from them when they clearly were helping, is skyrocketing! Implementing ‘feel good’ laws and restrictions is only gonna make it way worse and will do nothing to combat the opioid crisis that is claiming so many lives. Overdose deaths of legitimate chronic pain patients who are prescribed opiate pain medication and are under the supervision of a Dr., are extremely rare. To deny them the pain medication they need to live a somewhat functional life and be able to perform simple daily tasks that most of you take for granted, would be completely immoral and evil at its very core. Opiate pain medication does not eliminate all pain but for most all of us, it brings it down to a level that we can cope with and eases the otherwise constant suffering that we would be in without these meds. Some so called experts say that long term opiate use does not help the pain patient. They may even refer to some study that says they don’t. Well, I will tell you right now that that claim is completely false. Many patients have been taking them for years and it is the only thing that helps ease the pain. We should not have to suffer because of a whole lot of overdoses that are mainly due to heroin or fentanyl. An addict will always find a way to get his fix as that is what he lives for. Putting that group of people in the same boat as documented pain patients is simply ridiculous. If more and more people are deprived of their needed medication, the death toll will be astronomical. If not from suicide, it will be from them turning to street drugs in a desperate attempt to get some relief from the pain. There has already been far too many that have succumbed to these two choices because of losing the one thing that gave them a hint of life. I do realize there has to be some protocol and guidelines to go by but please, I beg of you, do not throw us under the bus. We are humans who deserve to live with the least amount of pain and suffering that is possible. Just remember, in the blink of an eye, it could be you or a close loved one that ends up suffering in non stop pain everyday of ones life. It isn’t easy and it ain’t no fun. Please get input from all sides before making any decisions that you might end up regretting. Sorry for the long post. I sure hope there are ears out there that will listen to our cry for help though. Thanks for reading this ?

  • I posted the following letter to a member of the Commission last night:

    To Bertha K. Madras, Ph.D.
    Professor of Psychobiology, Department of Psychiatry, Harvard Medical School
    Member, President’s Commission on Combating Addiction and the Opioid Crisis

    Dear Professor,

    As the only sitting member of the President’s Commission who is even remotely qualified in medicine, you will have your hands full. The published schedule for the Commission calls for review of a draft report to the President just ten days after your first working meeting. With no intention of discourtesy, I must seriously ask whether you wish to have your name associated with such a transparently political agenda. The “fix” is obviously in for another round of the “War on Drugs” — and hundreds of thousands of pain patients across the US know it. They are about to be disregarded and abused AGAIN by their own government, in the name of trying to solve an opioid crisis that isn’t their fault and that won’t be helped in the least by denying them effective pain management.

    As noted in a recent research paper in National Pain Report, I write as a non-physician writer, research analyst, patient advocate and website moderator for chronic pain patients, families, and physicians. My wife and daughter are chronic pain patients. My 20 years of volunteer experience has produced articles and critical commentaries at the US Trigeminal Neuralgia Association, Ben’s Friends online communities for patients with rare disorders, US National Institutes for Neurologic Disorder and Stroke, Wikipedia, WebMD, Mad in America, Psychiatric News, Pain News Network, National Pain Report, the American Council on Science and Health, the Global Summit for Diagnostic Alternatives of the Society for Humanistic Psychology, Psychiatric News and Psychology Today.

    I urge you — indeed, I IMPLORE you — to read the article in which this summary appeared. It is titled “Warning to the FDA – Beware of ‘Simple’ Solutions in Pain and Addiction.” It may deserve to become a part of your report to President Trump. It demonstrates that the balance between concerns of people in agony and those of families who have lost children to opioid addiction have become seriously skewed in utterly unproductive and dangerous directions. It also demonstrates that the March 2016 CDC guidelines on prescription of opioids to adult non-cancer pain patients are seriously dangerous due to weak evidence, scientific errors and outright omissions of vital medical science. The guidelines are already killing patients across the US. If enshrined as mandatory limits on opioid prescription, they will kill many thousands more.

    See http://nationalpainreport.com/warning-to-the-fda-beware-of-simple-solutions-in-chronic-pain-and-addiction-8833744.html

  • Chronic pain patients are demanding ” equal media” coverage at once as we always get left out of the conversation…Do no harm is being misinterpreted and tens of thousands continue to suffer the consequence of government over reach and addiction industry greed.

  • I wonder which one of these appointees have shown any results on combating the opioid epidemic. Just talking about it does not suffice. I am extremely happy Trump is taking the opioid crisis head on, but does Governor Christie really has what it takes to face this monster that is killing so many?
    Some of the factors that have been fueling this crisis and will have to be managed are the easy drug trafficking in our borders, pharmaceutical pressure on the sale of more opioids ( including the maintenance ones), lack of sufficient effective medical detoxification combined with individualized mental health care and increased penalties for drug dealers.

    • Well said, when an addict wants help and there’s no beds available , what are we going to do?

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