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.

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“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.”

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  • Many times I have posted on the benefits and safety of buprenorpine. No worries about mme’s or deaths. Effective. Find a doc who will rx for you. No special certificate or training required.

  • I would offer a short quotation from one of the foremost authorities on addiction in America: Dr Nora Volkow, Director of the National Institute on Drug Abuse, writing here with a co-author:

    “Unlike tolerance and physical dependence, addiction is not a predictable result of opioid prescribing. Addiction occurs in only a small percentage of persons who are exposed to opioids — even among those with preexisting vulnerabilities … Older medical texts and several versions of the Diagnostic and Statistical Manual of Mental Disorders (DSM) either overemphasized the role of tolerance and physical dependence in the definition of addiction or equated these processes (DSM-III and DSM-IV). However, more recent studies have shown that the molecular mechanisms underlying addiction are distinct from those responsible for tolerance and physical dependence, in that they evolve much more slowly, last much longer, and disrupt multiple brain processes.”

    The citation is Nora D Volkow, MD, and Thomas A McLellan, Ph.D., “Opioid Abuse in Chronic Pain — Misconceptions and Mitigation Strategies” . NEMJ 2016; 374:1253-1263 March 31, 2016]. http://www.nejm.org/doi/full/10.1056/NEJMra1507771

    There are many other sources in medical literature. But I have never seen evidence that politicians or their staffs have ever bothered to read them.

  • I am in so much pain especially at night. I don’t get any sleep…or very little due to excruciating pain. I had been on Norco 10s for 7 yrs…and they worked! I was NOT addicted and I used them responsibly.
    My Dr ‘disappeared’ in December of 2018 and the ‘new’ PA (physicians assistant) refused to prescribe pain meds for me. I was simply abandoned. I didn’t suffer any withdrawals, however I suffer greatly from horrific pain which is much worse at night…so I have problems with lack of sleep now as well as the pain.
    It is very frustrating to me….to have to suffer this way just for someone’s ridiculous ‘one size fits all’ agenda….it doesn’t. People should not have to suffer someone elses whim.

  • To pain patients who have commented, you have my sympathy. We are all in the same boat with trying to secure our pain meds and it should not be as difficult as they have made it on us. Being a pro life person, but I try not to be judgemental toward anyone… I say this to show it is not political with me when I say that since president trump and his administration has taken over, it has all been down hill. He and many of the people he has working for him are flat out incompetent! This is what I believe is one of the main reasons why we chronic pain patients are in this mess, because of our present government.

    • Let’s remember the facts of our situation.
      The CDC Guidelines were implemented under the previous administration.
      They were adopted on the 2nd attempt.
      Tom Friedan was appointed by former President Obama.
      You cannot hang this one on Trump.
      Opiophobia was truly a “pre-existing condition” promoted by reporters with the collusion of physicians,for several years before the last election….

  • Last month I had surgery to remove a huge kidney stone, a majorly painful ordeal by any measure. I was surprised when I was sent home with less than four days worth of 5 mg hydrocodone. The next day, after the surgical analgesics had worn off, I found myself urgently calling the urologist to say that the pain medication was almost useless for the level of pain I was experiencing. The urologist’s nurse told me to double the dose and that I could get a refill. Two days later when I called for the refill it was flatly denied. Thus began four days of unimaginable, unnecessary torture. It got so bad that I found myself searching the internet for the quickest and gentlest way to off myself in order to get release from the pain.

    Should doctors be trained to be so conservative with pain medications that surgical patients are left in a state of torture during recovery, torture so intense that they will consider suicide to achieve relief? Has the opiate issue triggered an over-reaction in care givers — even in circumstances that have nothing to do with the abuse of these drugs? I know that I will be thinking long and hard before I let a surgeon with a knife in his hand anywhere near me again.

    • You need to sue both the hospital and the doctor for knowingly causing/facilitating needless “pain and suffering.”

  • It is very disturbing how top-down fear mongering affects those who should live up to the Hippocratic Oath they took. “First do no harm” also applies to treating opioid users in a healing manner, and harsh tapering and “cold turkey” treatments are despicably opposite to the Oath. It is obvious that heavy-handed legaleze is interfering with good Doctor practices, yet another overblown excessive reaction by bureaucratic politicians. The only winners are lawyers. When does this sink in in the USA ????

  • I am a chronic pain patient with multiple co-morbidities: ME/CFS, Fibromyalgia, (dual Dx x30 yrs); osteoarthritis in all joints (since teens) but increasing severe pain in S-I & hips (x 15 yrs); Multiple Chemical Sensitivities, widespread tendonitis; PolyCysticOvarianD (puberty-menopause); migraines; asthma; s/p MI x4 & CABG (2009->); episodic A-fib, s/p heart failure, Diabetes Type 2 (x 6 yrs), Osteoporosis w 7 fractured vertebrae; S-I fractured x3 (1st to back spasms, 2&3 to falls); several closed head traumas; extremely long list of allergies & sensitivities to medications. including whole classes; adverse events with all non-opiate pain meds; adverse events w oral opiates; sexual & physical abuse as child; domestic violence & rape as young adult; alcoholic (absolutely dry since 1969- zero drug abuse); NEVER abused pain meds of any kind.
    I began Fentanyl PATCH 25 MICROgram approx 14 yr ago for severe knee, hip & back pain. Due to both increasing pain & tolerance, dose was increased over YEARS to 125mcg.
    Due to CDC, DEA, insurance co’s, healthcare empires, etc., was denied any further Fentanyl patchs with effective dosage 3 years ago. Sutter Health Fdn gave edict to all MDs that they were no longer employed if they continued to Rx opiates above a very tiny dose for more than a few days-would also send report to Medical Brd and DEA. MDs in absolute fear for self & families have stopped all Rx of meaningful meds at effective dosages.
    Their mandate is to refer to “pain specialist.” This is cruel joke. I have seen 3. None care about pain-only stopping opiates. One, an independent contractor w Sutter, was fraudulent and abusive. Last talk w my beloved PA he mentioned trying to get me into Stanford pain mgmt program. This article makes it clear that the med dir of Stanford program is a huge part of the problem. She is immune to reality & other people’s suffering. She would make a better ditch digger than a physician.
    This situation constitutes multiple violations of established laws (rights of pain Tx, etc.) and is unconstitutional (cruel & unusual). Majority of MDs will not join with names known in fear of firing, arrest, loss of license.
    Years before the 2015 CDC “guidelines” the DEA was busy monitoring how many opiate Rx each MD wrote in a month. It did not matter for what condition OR haw many of certain patients the MD had (eg cancer, surgical, fibromyalgia, etc.).
    DEA, state & locals raided well-respected, compassionate MD who had, by default, become a Fibro/CFS/ME specialist–essentially his entire practice. The goons came in with drawn military weapons in SWAT attire, yelled at all patients and staff, arrested this fine MD and ‘perp walked’ him out. State Med Brd gunned for his lic. Much patient uproar got a state legislative hearing on the med bd actions.
    I was present and confronted the Med Brd members present on their motives. I asked, “Why do you seek to impose your religious views on the spiritual necessity of suffering on others? What happened to separation of church and state?” One of the members resigned form the Bd within days.
    WE the patients, the people, the caring medical professionals and the anti-fascists MUST RISE UP in every venue (MD offices, media, courts, streets) to get actions/laws/police states stopped or overthrown. (to paraphrase T. Jefferson)
    The MOTIVES & ACTORS involved in this travesty:
    1. Always follow the money!!!
    2. Law Enforcement Agencies–
    a.They get money directly for doing this.
    b. Asset Forfeiture- all drug related actions can take ALL assets of the
    ‘criminal’ BEFORE prosecution and CAN KEEP ALL ASSETS AFTER person is found innocent in court —anyone in doubt about police state & fascism?
    c. It allows increased staff numbers & greater powers–heady stuff
    d. State Medical Boards are participants
    2. Insurance Companies & Rx Mgrs
    a. never want to cover any medication.
    b. cuts many work hrs related to any opiate decisions or payments
    3. Organized Crime
    a. is laughing at CDC, their helpful buddy {DEA is their partner)
    b. price of opiates soars, huge profits, crime lords buy more legislators
    4. Oligarch/GOP/Corporate elimination of unprofitable people
    a. most people on opiates have reduced productivity due to their condition
    b. getting many less-to-zero productive persons (disabled, injured, ill, older, Social Security, Medicare) to die off from physical side effects of untreated pain or suicide means more money for their indulgences.
    c. people in pain are not likely to be able to effectively watch gov’t or corp. so many fewer eyes & voices of resistance.

    For many reasons WE CANNOT LET THEM WIN!!! Join patient advocacy groups. Complain to your MD at each visit. Write to your federal and state legislators at least once a month asking about progress on matter. (In order for it to be seen the letter must be hand written–not typed or emailed). Visit the local offices of any/all legislators-as regularly as you are able. Write to the state Bd of Medicine–more than once. Tell every one. Write to Letters to the Editor. Write Op-Ed pieces. Organize street protests in front of legislative offices, Capitols, homes of decision makers—keep it non-violent. Make programs on local cable channels. Speak to your church’s Social Justice Committee. Speak to other church’s Social Justice Committees. Seek to speak at local organizations–Elks, Moose, Chamber of Commerce, Soroptimists, local political groups-Dem, GOP, non-aligned, etc. Peacefully picket the restaurants where judges, legislators, Med Bd, Sheriff, DA, DOJ go for lunch. (Lots of these places in Sacramento, for example)
    Raise your voice to speak, whine, scream in pain. All four are legitimate freedom of expression.
    Enlist the help/assistance of friends & family. Do you need help writing a letter? Do you need a ride to & from a legislative office? Do you need help getting dressed to go to a meeting? The more people actively involved in working for positive change the more likely the change will happen.
    Combating unjust power, even when it is not simply evil, is always difficult.
    accepting injustice and trying to live with it is far worse. Silence is complicity.

  • Ok. So I’m gonna get to the chase here.
    All this bullshit about this form of genetic marker and that marker it that mode of recovery and this and that marker for addiction blah blah blah.

    I used alcohol and drugs for 28 years of my life. Aside from the experience that got me to change my life, the next biggest factor was having my life ripped from me by spinal failure.
    I have since been on controlled pain management for TEN YEARS and as a shocker to your “genetic marker” theory that the government is pimping out as some kind of gospel…..
    I HAVE ALSO BEEN IN ACTIVE RECOVERY FOR THE ENTIRE TIME ON MEDICATION MANAGEMENT !!!!

    Well…. That’s a conundrum huh.

    Honestly. I’m sick of this excuse as a justification for the garbage we as compliant people are having to endure.
    Recovery is a simple process, but addiction complicates the shit out of it.
    Addiction is as destructive as any biologic disease if not more so. It has been so classified and is now recognized as a disease. The disease portion comes in the form of abhorrent behavior and thinking associated with the getting and using drugs by any means necessary and the continued usage despite negative consequences.

    If one person was to tell me that without the 3 surgeries(plus an advancing debilitating condition) and responsible usage of medications that give me a reasonable quality of life when all this began I would have probably laughed in your face.
    But somewhere I found people who were interested in improving their lives in NARCOTICS ANONYMOUS.
    Where I learned about ME. I LEARNED ABOUT ADDICTION !!!

    The most important thing I learned is this.

    YOU EITHER WANT TO STAY CLEAN OR YOU DON’T !!!!

    IT’S JUST THAT BLUNT AND CLEAR !!!
    There is no little bit of recovery, it is a lifelong commitment.
    I stopped fighting and surrendered to the fact that I could not use any substance for enjoyment for any reason whatsoever.
    The track record I amassed CLEARLY POINTED THIS OUT !!!!

    I give ALL THE CREDIT to a program that saved my life, taught me responsibility, integrity, honesty, FAITH, HUMILITY AND SPIRITUALITY, everything that ADDICTION taught me was not necessary.
    If you believe that people can not recover and continue to recover and lead productive, responsible and meaningful lives then YOU ARE A FOOL !!!!
    Because of these FOOL’S I am now having to consider that I’m going to be politically regressed into treatment modalities that I exhausted along the way to 3 successful back operations that have led me to a successful symptom treatment I have achieved through DILIGENCE, DISCIPLINE, HONESTY, INTEGRITY, FAITH, HOPE AND RECOVERY.

    THIS IS TERRIFYING because the people who are making the rules are like having a plumber come in to rewire your electric.
    They might work in the industry but have no business doing that kind of work because they don’t know shit about it.

    • You may want to work on that “HUMILITY” thing a bit. And SCREAMING is NOT HELPFUL to the POINT you ARE trying to MAKE. I wish inner peace and outer calmness for you.

  • For 13.5 years I was stable, paid thousands in taxes, raised 7 kids, fostered 19–WHILE ON OXYCODONE daily. I have the residual effects of Cauda Equina Syndrome and major lumbar issues. The pain is unrelenting.
    Now, after being abruptly taken off of pain medication, I’m am on SSI and a burden on society. I’m unable to work and socialize. Thank you Andrew Kolodny and PROP.

  • There are no peer reviewed studies that say long term opiate use increases a patients sensitivity to pain that is a lie perpetuated by a physicians making money off of the addiction rehabilitation business. The Opioid crisis has almost nothing to do with prescribing patterns, less then 1% of opiate OD’s are caused solely by legally prescribed opiates in almost all OD’s attributed to prescription Opiates also had Street drugs in the patients blood, and the prescribed opiate was not prescribed to the patients who OD’ed but was rather prescribed to a family member or was stolen.

    • Everything in your comment is 100% correct and has been verified numerous times (and published numerous times) by numerous unbiased medical studies. Yet, the government still continues to knowingly target the incorrect sources (scapegoating the easy targets) pain physicians and their patients.

      Which unfortunately very likely indicates that widespread, blatant corruption is at hand.

      The situation is beyond sickening. And the sick-in-the-head individuals responsible for it are going to spend eternity paying for it. They just don’t know it yet.

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