BIRMINGHAM, Ala. — About four years ago, Dr. Stefan Kertesz started hearing that patients who had been taking opioid painkillers for years were being taken off their medications. Sometimes it was an aggressive reduction they weren’t on board with, sometimes it was all at once. Clinicians told patients they no longer felt comfortable treating them.

Kertesz, a primary care physician who also specializes in addiction medicine, had not spent his career investigating long-term opioid use or chronic pain. But he grew concerned by the medical community’s efforts to regain control over prescribing patterns after years of lax distribution. Limiting prescriptions for new patients had clear benefits, he thought, but he wondered about the results of reductions among “legacy patients.” Their outcomes weren’t being tracked.

Now, Kertesz is a leading advocate against policies that call for aggressive reductions in long-term opioid prescriptions or have resulted in forced cutbacks. He argues that well-intentioned initiatives to avoid the mistakes of the past have introduced new problems. He’s warned that clinicians’ decisions are destabilizing patients’ lives and leaving them in pain — and in some cases could drive patients to obtain opioids illicitly or even take their lives.

advertisement

“I think I’m particularly provoked by situations where harm is done in the name of helping,” Kertesz said. “What really gets me is when responsible parties say we will protect you, and then they call upon us to harm people.”

It’s a case that Kertesz, 52, has tried to make with nuance and precision, bounded by an emphasis on the history of overprescribing and the benefits of tapering for patients for whom it works. But against a backdrop of tens of thousands of opioid overdose deaths each year and an ongoing reckoning about the roots of the opioid addiction crisis, it’s the dialectical equivalent of pinning the tail on a bucking bronco. Kertesz’s critics have questioned his motives. He’s heard he’s been called “the candyman.”

“I am really worried that people like Stefan Kertesz, who is trying to champion ‘patient-centered care,’ in some ways are feeding into the same misleading messaging rolled out by Purdue [Pharma] and others that not to prescribe opioids is tantamount to torturing patients,” said Dr. Anna Lembke, the medical director of addiction medicine at Stanford.

The debate is playing out as doctors try to move beyond their days of overprescribing while responsibly treating chronic pain. It is also playing out in settings like Kertesz’s office here at a Veterans Affairs clinic, where a patient named Jerry Brown, a 63-year-old former boilermaker and carpenter, recently showed up.

Brown had a compressed spinal cord and severe neck pain. For more than a decade, dating back to before he started seeing Kertesz, he had been taking about 300 morphine milligram equivalents (MME) of opioids a day — a dosage equivalent to more than three times the level that clinicians should “avoid or carefully justify,” according to federal officials.

Kertesz and Brown tried a 10% dose reduction a few years ago. But Brown became volatile and less active and complained of revived pain, so Kertesz eased back.

Kertesz, who treats patients who are or have been homeless, told Brown that he had “incurred risk” with his dose. “Do you know that I wish you hadn’t had your doses increased?” he asked.

“Yes,” Brown replied.

They could try again to taper the dose to reduce that risk. But Brown had stable housing and activities to keep him busy — he helped his ex-wife out at her home and cleaned up after her Chihuahuas. He had anxiety and sometimes had trouble getting to the clinic because of transportation problems. But there was no evidence he had misused or sold his drugs, or misused other substances.

In this case, Kertesz’s takeaway was: “Leave well enough alone.”

Dr. Stefan Kertesz
Kertesz examines Jerry Brown, 63. Brown has been on high-dose opioids for over a decade. Tamika Moore for STAT

Opioid prescribing has been declining since 2012, though levels remain higher than they were two decades ago. Today, depending on the estimate, anywhere from 8 million to 18 million Americans take opioids for chronic pain.

The interest in reducing their dosages is predicated in part on efforts to minimize patients’ risk of overdose and addiction. But there are other considerations. Enduring opioid use makes people more sensitive to pain, many experts believe. Opioid use has also been associated with anxiety, depression, and other health issues.

Plus, as people become dependent, the drugs might just be staving off symptoms of withdrawal that would come without another dose, rather than treating the original source of pain.

In short, experts say, long-term opioid use is not good medicine.

Kertesz, who is also a professor at the University of Alabama at Birmingham School of Medicine, agrees with all of that. But he believes that lowering dosages will hurt some patients who are leading functional lives on opioids, and that top-down strategies won’t protect them.

So, in 2015, when the Centers for Disease Control and Prevention proposed prescribing guidelines for primary care clinicians treating chronic pain, Kertesz grew nervous.

The guidelines, a set of measured recommendations finalized in March 2016, suggested clinicians try other therapies for pain before moving to opioids and prescribe only the lowest effective dose and duration of the drugs. (The guidelines do not apply to end-of-life or cancer care.) For patients on high doses, the guidelines said, “If benefits do not outweigh harms of continued opioid therapy, clinicians should optimize other therapies and work with patients to taper opioids to lower dosages or to taper and discontinue opioids.”

“Our day-to-day practice aligns with nearly all principles laid out in the guideline,” Kertesz wrote in a comment he submitted on the draft. But he cautioned the voluntary recommendations could be implemented too stringently by others.

“This is a guideline like no other … its guidance will affect the immediate well-being of millions of Americans with chronic pain,” he wrote.

After the release of the guidelines, Kertesz started seeing ripple effects. In early 2017, federal officials unveiled a Medicare proposal that would have blocked prescriptions higher than 90 MME without a special review. Around the same time, the National Committee for Quality Assurance considered docking clinicians’ scores if they had patients on high doses for long periods.

Kertesz, other experts, and some medical societies protested such proposals, contending they invoked the CDC guidelines while violating them.

“Most of us wish to see an evolution toward fewer opioid starts and fewer patients at high doses,” Kertesz and colleagues wrote in response to the NCQA plan. “The proposed NCQA measure indulges no such subtleties.”

The discussion overall has been hindered by limited research, including evidence for the benefits of forced tapering. But as of October 2018, 33 states had codified some prescription limits into law. Pharmacies and insurers capped prescriptions at 90 MME. Law enforcement agencies warned high prescribers.

Some initiatives have focused on avoiding “new starts,” not on tapering legacy patients. But Kertesz and other advocates argued the pressure of all the policies and warnings inculcated an anxiety around prescribing.

Chronic pain patients were seen as legally risky and medically complicated, so they had trouble finding providers.

Kertesz and his allies raised their concerns in the popular and academic presses and at conferences, building momentum over the years. They collected anecdotes from patients who said they had been harmed in some way by dose reductions or involuntary tapers.

“It is imperative that healthcare professionals and administrators realize that the Guideline does not endorse mandated involuntary dose reduction or discontinuation,” read a March letter co-authored by Kertesz calling on the CDC to reiterate its recommendations were not binding. The letter continued: “Patients have endured not only unnecessary suffering, but some have turned to suicide or illicit substance use.”

More than 300 patient advocates and experts, including three former White House drug czars, signed it.

Dr. Stefan Kertesz
Kertesz and licensed practical nurse Amber Carthen examine Byron, 47. Tamika Moore for STAT

Kertesz sees his advocacy work as an extension of several throughlines in his career. For one, he has patients who have been on opioids for years, and he knows the stress clinicians face when renewing a high-dose prescription. He also has a history of arguing for causes that stretches back to writing op-eds for his high school newspaper in Silicon Valley.

But his willingness to take on what he sees as injustices does not mean he feels self-assured about doing so.

“Every single bit of it involves ambivalence and driving myself crazy,” he said. “Like, am I making a mistake? Am I going to blow up my career?”

When Kertesz thinks, he leans forward and pulls his hair back. His obsessive streak extends to both his career and his personal life. (He’s become a fencing fanatic, having taken up the sport less than six years ago.) When he talks about medicine, he pauses mid-conversation to point out whether his statements are based on randomized trials or his own inference. He can appear scatterbrained and is working with a coach to become more structured.

“He’s not like a heroic figure on a horse. He’s more like a neurotic figure on a horse,” said Dr. Saul Weiner of the University of Illinois at Chicago, who became friends with Kertesz while working at a hospital in Gabon during medical school.

Having tenure has made Kertesz more comfortable being outspoken. And he feels he may have more credibility than other physicians to make this specific case. He is a primary care physician who cares for people who are homeless and, beyond some former stock ownership, has no ties to drug companies, as opposed to a pain specialist who received research funding from them. (Kertesz noted that he recently packed his own PB&J for a conference, the implication being he’ll avoid even a pharma-funded sandwich spread.)

But other leaders of Health Professionals for Patients in Pain, the group that wrote the March letter calling on the CDC to clarify its guidelines, have projects that are supported by drug companies. They disclose as much on the group’s site, but it’s left the group exposed to the criticism that it’s not wholly removed from the pharmaceutical industry.

Kertesz “certainly is very close to people who are being paid by opioid manufacturers,” said Dr. Adriane Fugh-Berman of Georgetown University, who studies the pharma industry’s influence on medicine. “He’s certainly worked with people who have close ties to opioid manufacturers.”

Kertesz said that because of the industry’s history of opioid promotion, such criticisms need to be part of the discussion.

Fugh-Berman is among the experts who have challenged Kertesz’s most alarming claim: that pain patients are being driven to suicide. They argue advocates are relying on anecdotes more suited to a political candidate’s barnstorming of Iowa than the kind of scientific evidence needed to substantiate claims of a new epidemic. Establishing cause and effect in suicide is complex, and studies have shown an association between opioid use and suicide.

“Where is your evidence of documented suicides from people who are tapered?” Fugh-Berman asked Kertesz following a presentation at a conference last year.

Kertesz replied that he had reviewed medical records from people who had died by suicide after an opioid reduction. He added a caveat: “You have three things that are potentially simultaneously associated with harm: Pain itself. Opioid dependence, the dependence itself. And the event, however we wish to interpret it clinically — as resurgent pain or untreated opioid dependence — in patients who are having opioids taken away.”

Kertesz is now trying to secure funding to study such suicides.

Fugh-Berman and Kertesz are often cast as representatives of two fundamentally opposed camps. (Indeed, Stanford’s Lembke and Kertesz are slated to square off in a “spicy debate” at an upcoming medical conference.)

Such a framing elides what they agree on. Kertesz emphasizes that opioids were massively overprescribed, that the patients he’s worried about should have never been on these doses, and that many patients will be better off after tapering. Lembke stresses that tapers need to go slowly and that patients should be monitored closely during the process — never pushed out of care.

But they disagree on exactly how to go about lowering prescribing and the proportion of patients who can be tapered without compromising quality of life.

Lembke argues that top-down policies are required to counter all the incentives clinicians have to keep patients on opioids. She has called for medical centers to establish teams that can guide patients through the process. She also said that some patients should be switched to buprenorphine — an opioid addiction medication that eases withdrawal symptoms — even if they do not meet the diagnosis of opioid use disorder.

“To leave them at those doses because it’s too hard, that’s not OK,” she said.

Lembke noted that prescription policies typically include exceptions for some patients to remain on high-dose opioids.

“There are rare instances where I would agree that maybe the most judicious path is ‘leave well enough alone,’” she said. “But that would be where the patient has to commute four hours to get to my clinic, they have no social support, they have no family, they have no psychological or emotional resources to help them do this hard thing which really from a medical perspective they need to do.”

Kertesz takes a different view. He supports doctors who encourage tapers, and he has spoken about tapering a patient off her medications against her wishes in one case. But he believes those are choices for clinicians to make, and that overarching policies will lead to mismanaged care.

Backing mandatory limits, he said, “assumes that what’s going to happen at the systems level will reflect the best clinician.”

Saul and Stefan in Gabon
Kertesz and Saul Weiner working at a hospital in Gabon in the early 1990s. Courtesy Saul Weiner

Last month, the authors of the CDC guidelines published a paper that said “some policies and practices purportedly derived from the guideline have in fact been inconsistent with, and often go beyond, its recommendations.” They called out “hard limits and abrupt tapering of drug dosages” that their guidance did not endorse.

It was what Kertesz and his colleagues had been asking for. But now, they face the more difficult task of ensuring every group that overshot the CDC guidelines corrects course.

The national attention Kertesz has received for his efforts felt far removed from the room where he was seeing his patients earlier this month. One was in the midst of a taper experiment, from 40 MME to 35 MME a day. But there was also talk of blood pressure medications and cancer screenings — primary care basics.

Then there was Byron, 47. He asked that his last name not be used, but Kertesz and the staff at the clinic called him their Jonah. He had been swallowed up by his addiction and maybe should have died, but here he was, like God had some plan for him.

Byron was staying at a recovery home, but he felt listless without the rush of drugs or living on the street, he told Kertesz. Kertesz bumped up his buprenorphine dose, but the existential anguish was a harder problem to address.

“At any given moment, any one of us feels unsure about who to be or what to do or how to do it,” Kertesz told him.

“You have extra burdens, but you’re not alone,” he continued. “Everyone has times when they don’t have clarity.”

Leave a Comment

Please enter your name.
Please enter a comment.

  • Innocent chronic pain patients are committing suicide because of their pain. They are turning to the streets for relief. They are dying of heart attacks , stokes and high blood, pressure. They are blaming doctors now. What’s even more criminal about the current fake opioid crisis is that the DEA was caught working with the Sinaloa Drug Cartel from 2000-2012. They are the ones now sending in a lot of the fentanyl that is killing people. But I don’t even trust that. The opioid crisis is a part of the War on Drugs. The deadly and disastrous War on Drugs is based on lies meant to control and prey on those who are weak, vulnerable or deemed “undesirable” by those who control state power. I want to see all of those death certificates and tox reports. Coroners and ME’s are less than infallible. I know in twenty years we’ll see that all of this was based on lies. Unfortunately by then millions of chronic pain patients will be forced into making the decision to commit suicide or submit to a life of having their body torture them uncontrollably or be treated like a criminal – and forced into the pain contract/pain mismanagement system. They are now turning away normal people with broken bones and third degree burns at the ER and sending them home with Tylenol. Even for during and after major surgery. They are given local numbing agents.

    • I can verify from personal experience the true EPIDEMIC is denial of pain relief!

      I was ignorant of the nationwide campaign to avoid narcotics pre and post-surgery back in 2015. I had an excruciating surgery – rib removed; bone spurs removed in cervical spine; neck muscles and scar tissue removed and a chest tube(painful just to breathe)…..I was given gabapentin; Tylenol; an MS anti-seizure med; anti-depressant and Marinol(synthetic THC)

      This “cocktail” did nothing to relieve my pain.

      My blood pressure was out-of-control– no one cared!
      I cried for 5 days straight. NO NARCOTICS; NO MUSCLE RELAXERS.
      I lay there and wished I would DIE.
      I could hear the nurses laughing at my moaning and crying.
      I begged to be sent home.
      I was finally discharged on day 5 without ANY pain meds!
      Since that experience, I have informed all my doctor’s that I will not have ANY surgery unless I might DIE without it!
      My brother was denied pain meds and offered massage, told to think positive and meditate, told to vape marijuana…ANYTHING alternative to a narcotic during his 2year battle with bladder then lung then brain and bone cancers.
      He is dead now, died crying out in pain and I cannot get that sound out of my head.
      I just try to console myself that he suffers no longer.

    • Didn’t realize there was a reply option. You are absolutely correct! This is not only affecting the pain/cancer patient community, but has now spilled over to the general public going into ER’s & hospitals for surgeries.

      Imagine having an emergent episode or horrible car accident & awakening from anesthesia & handed a Tylenol or NSAId even if hemorrhaging. Common sense says otherwise ~ common sense!!!

      The fear is unimaginable: knowing your in the hands of these people. Imagine family mbrs arguing with staff on your behalf for some compassionate relief. I suppose some pts: sadly, have no one.

      To: G
      This should NEVER happen to anyone & maybe this is where LEGAL PRECEDENCE will be established. If this starts ending up in law suits— this just may be the double edged sword instigators never contemplated & will help ALL cpps/vets & cancer pts. ONE can only hope: (-;

  • As it is the case with my interpretations , knowledge of broad , comprehensive and extensive data and reports . i speak with the authority and power that the health care system in the United States of America specifically is the killer machines of the world . there is are no hope what so ever with the state and disasters of the conditions . There is no turning around this sinking ship . The reason or reasons is and are simply money . primarily with the pharmaceutical empires .the chain hospitals and finally yet extremely critical the drudge dealers doctors whom are bribed by the pharmaceutical empires . Only on Tuesday . May 21, 28, 2019 one of them Johnson and Johnson ,the case against them for the Opioiod crisis in the state of Oklahoma started ,on Tuesday .May 28, 2019 . I have in my hands currently while drafting this memo of the edition of the Wall Street Journal of that date with the headline stating that Opioid Trial Took Kick OFF In Oklahoma , additionally the article continues case will test whether drugmakers can be blamed for the states addition crisis to quote ,unquote the Reporter or Writer of this article Sara Kandrazzo .on page a 6 more to come . Trevor Merchant .Saturday . June 01 . 2019 at 3, 04 .p.m daylight savings time . N.Y.C

  • I share Dr. Kertesz’ opinions and would appreciate an opportunity to discuss some issues. Forward his e-mail if possible. Pls call or email. 208-290-3567. Thx

  • “, but it’s impossible to ignore that glaring double standard, especially in his own practice.”

    EXACTLY!
    Addicts are victims and pain patients are addicts!
    Unrestricted access to methadone/buprenorphine for the former
    and no access to relief/opioids for the latter!

    Somehow this is the reasonable solution for us all….

    • There is a huge difference between addiction and dependence. In addiction you will do anything to get that next high. I don’t remember ever getting high from my pain medication. I have been on medication for back pain for 30 years. Yes I am dependent. I have stopped for short times over the years and didn’t go rob a convenience store to get more. I have the MRIs to show the smoking ruin that is my spine. I have a problem at every level from C1 to S1. I have numbness in my right hand and also my left leg from the calf down. Numbness also equals pain. You have to live it to get it. I take a fairly high dose of lyrica and my pain meds. With them I can do a few things around the house. Reduce them and I am bedridden. Period. The thought of losing what I have left of my life scares he hell out of me. And some half baked MD who has never had any real pain telling me I can do without medication is what is wrong on the world. I got up this morning and I could barely walk for the pain. I know I will probably be wheelchair bound a few more years. I have done months of PT. I do see a very good chiropractor and I work at not being in that chair. I need my medication to reduce the pain to a dull roar. If you lived with my daily pain you might call it a 10. My good day I call a 7. A 10 is the occasional kidney stone. Let those who trained in treating pain do what they trained to do and then when all those fancy modalities fail let them prescribe what is needed to keep the patient functional.

  • Pain starts somewhere. Probably in the persons brain chemistry. Time has to be used to actually figure out what’s wrong with the patient. Also dealing with there underlying mental health issues and potential addiction issues. I think a marker for potential addiction of illicit drugs are with people who smoke. I hope these vapers aren’t on their way. With proper diagnosis people get better without narcs or just a few with a lecture on risk. Primary Care has to step up and stop sending people for unnecessary tests and referrals. This all starts with a combo of nature and nurture. Obviously, a history of family addiction is huge. Sad, at the end of a military tour, people are told by other members to complain of medical issues to build up there disability rating. Some is true, some is not. This starts some of it at the VA. Maybe having none ex military providers doesn’t help either. This shouldn’t be a problem across the board. The art of the exam and history is being lost. No CT when I started. Can’t think of one patient in 40 years placed on narcs for other then a short period of time. Addiction can be treated. 90% success rates in good hands if available. Obviously, poverty, lack of health care, disrupted families and lack of work plays a major impact. Also this flow by the Chinese of Fentanyl through the mail has to stop!

    • Wow. That was the most stigmatizing discriminating comment against chronic pain patients. So, vapers are drug addicts? People have pain due to poverty? All pain syndromes eventually go away? I have chronic pancreatitis and DNA testing showed it is a hereditary defect. All pain goes away? That is a very dangerous assumption. Chronic pancreatitis pain does not go away. It is progressive and fatal. Blaming and shaming pain patients with little knowledge of certain pain conditions is careless and not accurate. This is part of the problem, a lack of true understanding of what the pain patient goes through. The US has created an environment where all pain patients are addicts or will become addicts, pain is all in our heads, and we should feel guilty abd ashamed for wanting our pain treated for a quality life.

    • “pain starts somewhere”, you say.
      Mine began when I had a head injury!
      I have tried everything recommended and have never been prescribed more than 40mme daily but NOW I am affected by this wave of opiophobia.
      I’ve been treated by a specialist for almost 20 years who now says his license is at risk and REFUSES to prescribe!
      Exposure does not cause Addiction.
      Here are a few examples: alcohol, sex, food,…..It is common NOT to become an “addict” as a result of daily exposure to these!
      There are millions of law-abiding citizens with complex diseases which cause REAL & INTRACTABLE CONSTANT PAIN. They DO require pain medications!
      They are being denied treatment!
      I am one such patient!

    • Mark Schulthess is unfortunately mistaken on several counts. Pain starts from a number of different causes and mechanisms: neuropathy (discrete injury to a nerve), inflammation (neuritis, neuralgia), and CNS sensitization are just three different mechanisms. Pain is the most frequent reason for someone to see a physician. And for about a third of all those who do see a doctor, pain will become chronic and intractable, a life long defining issue for daily quality of life. About 20 to 30 million people in the US suffer with chronic “high impact” pain that can be managed with opioid analgesics, but with very little else.

      You are correct that smoking and a family history of alcoholism or non-medical drug use are markers for elevated risk of vulnerability to substance abuse. But the sense in which you are correct is likely not what you intended to communicate. It’s very unclear what the balance is between genetic factors and social environment, in people who become addicted. Depression is also a marker, both before an after emergence of patterns of abuse.

      On the cure rates for addiction, you are simply flat out wrong. Many 30-day residency programs have a one-year recidivism rate exceeding 90%, and Narcotics Anonymous doesn’t do much better. The best measures of harm reduction that we have are Methadone and Buprenorphine drug substitution programs that block the euphoria and cravings in some people with addiction; and even with these substitution programs, some participants will abuse the drugs. That being said, the experience of many Vietnam War vets suggests that even after being exposed to high-purity heroin for periods of months to years, perhaps 50% of all people with addiction will be able to get clean, pretty much regardless of whether they get treatment support or not. I haven’t seen evidence that any medical professionals have a reliable method for predicting in which group a given individual will find themselves. But there is speculation that again, genetic factors may be involved.

      I would also concur in part with Brooke Valerino, in the sense that stigmatizing pain patients is not helpful. Neither is stigmatizing people with addiction. Some people deal with both issues. It is profoundly unethical and immoral to desert either group, though that is precisely what is happening in current events. The War on Drugs has been turned into a War Against Pain Patients. And Federal and State drug enforcement authorities are largely responsible for the departure of thousands of healthcare providers from pain management practice.

      Fair disclosure: I write and speak widely as a technically trained non-physician patient advocate, with over 20 years experience in moderating online peer to peer patient support groups. I have more than 60 published papers in medical journals as well as media like National Pain Report and Pain News Network. To scan some of my work, you may do a google search on “The Lawhern Files”. I don’t know it all (nobody does). But I’m careful about facts and sources.

    • So it was my “brain chemistry” that necessitated my 3-total joint replacement surgeries over the past 18-months. I wish I would’ve realized that before I went through all that imaginary suffering. And come to think of it, I don’t even smoke.

      I can’t remember ever reading a comment with so much blatant misinformation in it. Hopefully, you have nothing whatsoever to do with the already extremely compromised health care system.

  • Thank you for covering the other side of the opioid crisis. However, I would’ve liked to see firsthand accounts of patients who are suicidal because of this opioid hysteria, patients who were cut off of opioids or cannot access them as their doctors fear the government rather than help their patients. The media created this war on pain patients and refused to interview or talk to pain patients about how they were ripped off effective medication, stigmatized and left without effective pain management. I do not agree with no new start. I have chronic pancreatitis. Think about the worst pain of your life, multiply it by 10, then put it in your abdomen and back. Painful flare ups sent my blood pressure skyrocketing to the point I nearly stroked out a few times and went into shock once. For 2 years, my opiophobic family physician watched me writhe, cry, scream in pain but was anti-opioids and feared liability. My mother even begged him to prescribe a low dose opioid. There wasn’t a pain management group in a 60 mile radius of Albany, NY that treated with opioids. Nearly every CP patient I know needs and benefits from opioids. They WORK for this condition. I became a guinea pig…nerve blocks, sales pitches for spinal cord stimulators, non-opioid medications. I tried mindfulness, hypnosis, cognitive behavioral therapy, supplements, lidocaine patches, heating pads and a special CP diet. Nothing helped this pain. I thought of suicide every evening, couldn’t work, couldn’t care for my child, no one wanted to be around me I was so miserable. October 2015, I finally found a pain doctor over an hour away. Since then, I have been a compliant patient and am on a modest dose. I work, travel, exercise, camp, and my friends and family enjoy being around me. I haven’t thought of suicide once since starting these meds. So, if I had never been prescribed this, I’d surely be dead or had a stroke by now. I live in constant fear and anxiety my pain meds will be reduced or taken away. My pain level has increased due to the stress of it, I lose sleep over it, and have a panic attack every month I have to see the pain doctor. PLEASE INTERVIEW PATIENTS! HELP US!

  • I’m curious & interested to know what Dr. Kertesz’s position is on blind clinical trials being carried out post-surgery on unsuspecting patients in hospital settings?

    Not speculating: this is factually happening. Patients are being offered powerful NSAIDs in lieu of appropriate pain medication or “rescue meds.” Although these NEW trial “study” program creators/initiators; claim the patient is priority & can opt out— this is impossible because they aren’t being informed & report a torturous experience often leading to increased bleeding, bruising, & mental anguish.

    When it’s been touted over & over the atrocities incurred to cpps by release of CDC Guidelines “misapplication” & (many) States have mandated into law: one could never imagine or fathomed cancer patients & surgical trauma patients caught up in this vicious govt over-reach. I know from 1st hand experience this to be true now. What an inhumane & disastrous outcome heaped on our nations most vulnerable. I doubt this will ever change course & will be our nation’s tragic legacy.

  • As I read along, I agreed and disagreed with many items in this article, and acknowledge room for debate exists in those areas.

    Then I read the final paragraph, which should infuriate every pain patient and advocate.

    “Byron..felt listless without the rush of drugs or living on the street, he told Kertesz. Kertesz bumped up his buprenorphine dose…”

    That describes the state of the system in a single observation.

    While legitimate pain patients, with face mandatory tapers leading to increased pain, anxiety, depression, decreased quality of life, decreased productivity, loss of support (both social and financial), exacerbation of related disease processes (i.e. hypertension, tachycardia, immune deficiencies, diabetes, etc. associated with cardiac-adrenal pain syndrome), and an alarming rate of physician abandonment — an addict receives an increased dose of an addictive, easily abusable opioid drug, because he “feels listless.”

    I respect and appreciate Dr. Kertesz’s efforts to draw attention to the issues chronic pain patients currently face, but it’s impossible to ignore that glaring double standard, especially in his own practice.

    • BionicWoman;
      I so agree with you. I sure feel “listless” right now, due to being “in screaming pain” because my former fairly effective dose of pain meds was cut off completely, then restored (by another doc) at 2/3 of the dose (& I was never more than barely over 1/2 the 90mme “guideline” to begin with). i’ve lost my meds 3 times now in the last 17 years, tho had pain issues for over 40. I, frankly, am mortally sick of reading about the care & compassion & coddling that addicts need & deserve. Yes, i know they need care. But why the hell do they need it and we don’t? There IS a voluntary aspect of using drugs recreationally; there is NO voluntary aspect of being injured or had surgery go very wrong or having some genetic condition, or the other things that permanently mangle your body.

      I’ll be right there fighting for the rights of addicts (tho they already have a ton of people & orgs doing just that –& those same people & orgs won’t touch us with a 1000 foot pole)…as soon as I hear any of them fighting for pain patients to get anything but abandoned, stigmatized, and literally blamed for the fact that people CHOOSE to use & abuse drugs recreationally.

      I spent many years of childhood with someone who absolutely loved to get high; it was her all. I got repeatedly beaten up & abused by this person; so did my mother. Each time she got forced into rehab, she sneered & insisted that it was a huge waste of money, that she’d be stoned senseless within minutes of being released, which was true. Her entire life was dedicated to getting high & torturing those around her in every way imaginable. It was totally deliberate. I don’t actually care what mental aberration “caused” her behavior; she was very intelligent, knew what she did was wrong, & wallowed in the wrongness & evil. I very deliberately went the opposite direction; clean living, lots of exercise & good eating, good grades, hard work, kind to others, etc. To now be tortured & suffer the agonies of the damned directly because of the behavior of people like her is the worst kind of cosmic sadism. And to actually find myself & those like me BLAMED for the “plight” of people like her is nearly enough to send me over the edge permanently

    • Somehow I posted my reply to you incorrectly!
      I agree wholeheartedly and frequently vent to my husband about the inequities of MAT therapy — why can’t WE, as legitimate patients, have access to titrated doses the same as any addicted patient?
      We are un-treated and/or under-treated.

      “but it’s impossible to ignore that glaring double standard, especially in his own practice.”

      EXACTLY!
      Addicts are victims and pain patients are addicts!
      Unrestricted access to methadone/buprenorphine for the former
      and no access to relief/opioids for the latter!

      Somehow this is the reasonable solution for us all….

Sign up for our Daily Recap newsletter

A roundup of STAT’s top stories of the day in science and medicine

Privacy Policy