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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  • Wow people on here are nuts,,,,,,why use commas & grammar worthy of a 4th grader!!? Also CHANGING YOUR CASE DOESNT LEGITIMIZE ANYTHING UOUR SAYING!!!!????,,,,
    commenting multiple times is silly too, trying to change your writing style is obvious+ you have no credibility when you post=my leave

  • Speaking as a chronic pain patient who has been on no fewer than 15 different non- opioid medications as an alternative to narcotics, there are just some people who do not respond to those alternative medications.

    I say that anybody involved in the regulation of opioids should have to undergo non life threatening, non permanent, pain application. Something like being shot with a taser jolt continuously for 5 or 6 hours or maybe being tied in a submission hold with both arms forced up behind their backs for a few hours. Give them an idea what they are depriving the people of who really need the pain relief. While enduring the procedure, they can have all the NSAIDs, muscle relaxers, epidurals, pressure point injections and anti psychotic drugs (which allegedly help with nerve pain……sometimes)

    Let this procedure go on every day for 2 weeks. Then maybe I’ll be ready to listen to their opinions on how opioids should be regulated.

  • We are all fighting chronic pain and for our right to have access to opioid pain medicines. I know there is no place for anger but it is just so obvious to me that the people who have the power right now to make things right for us all is the trump administration and they don’t seem to care. I have nothing further to say other than the hope that you fellow pain sufferers, men, women and children are able to get the relief you deserve from your physicians.

    • In what way have I been dishonest?
      I am making an attempt to show that the facts don’t change based on an emotional response. Facts have no feelings.
      I have asked that you try to be fairminded and see past a personal dislike because this is a non-partisan issue.
      This should be an issue we all try to resolve together.
      I am not making gratuitous, ad-hominem attacks based on assumptions about people whom I do not know.
      So, I implore you and everyone to resist any temptation to blame the administration who had the misfortune to inherit this problem and, instead, focus on efforts to undo the disastrous 2016 CDC Guidelines.

    • To ,”Dear John,”,,,,dishonest,,,every single person who sat in any ,”witch hunt meeting from our government agency have never used facts,ever,,,Here is a fact we have put to all of u torturers’ ,opiatephobs,,genociders’murders and criminals of crimes against humanity,ie cdc,kolodny,nih,nida,dea,doj,nsa,,,U have been dishonest in ever piece of data,,ie,,never ever has anyone who has taken their medicine opiates as prescribed has never-ever o.d.,,yet u leak all over the media propaganda ,’opiates kill 45,000,,,,,when the fact is,,it is criminals who steal medicines ,or do heroin or do fentanyl,illegal,,ie criminals’,,,U deny access to any of your secret meeting to those who it truly will effect ,ie,,those with long term medical condition that are painful..The insurers know full well by getting rid of chronic pain human beings they will not have to pay for pre-existing,,what they wanted alllll along,,,,But here is the biggest lie you liars have done,,,u speak of fact,,,well here is a fact the stood for 250 years in this country,,,FACT,,,IT IS LITERALY IMPOSSIBLE FOR YOU OR YOUR PRECIOIUS KOLODNY OR ANYONE TO PHYSICALLY FEEL THE PHYSICAL PAIN OF ANOTHER,,,THATS A FACT,,SOOO TELL US ALLL,,WHY DO YOU THINK YOU HAVE THE RITE TO DECIDE WHO GETS TORTURED TODAY,OR DIES TODAY,,BY DENIEL OF ACCESS TO EFECTIVE AMOUNTS OF THE MEDICINE OPIAETES PROVEN TO LESSEN PHYSICAL PAIN FOR 3,000 YEAR NOW,,,,,WHY,,IF NO-ONE CAN FEEL THE PHYSICAL PAIN OF ANOTHER,,WHY DO U THINK U HAVE THAT RITE????TORTURE IS DEFINED AS ,”DENIAL OF ACCESS TO EFFECTIVE MEDICALCARE TO LESSEN PHYSICAL PAIN,,,,YOUR DENIAL OF OPIATES FOR MEDICAL PURPOSES TO LESSEN PHYSICAL PAIN,,THUS,,,YOU HAVE NOW DECIDED WHO GETS TORTURED TODAY WHO TAKES A GUN TO THEIR HEAD TO STOP THE PHYSICAL PAIN FROM A MEDICAL CONDITIONS ONCE CONTROL’D BY OPIATE MEDICINE FOR MEDICALLY ILL HUMAN BEINGS,,,SO I ASK AGAIN,,SINCE U CANNOT FACTUALLY FEEL THE PHYSICAL PAIN OF ANOTHER HUMAN BEING,,,WHY DO U THINK U HAVE THE RITE TO WILLFULL PERPATRATE PHYSICAL PAIN ONTO ANOTHER HUMANBEING IN PHYSICAL PAIN FROM A MEDICAL ILLNESS,IE,,TORTURE THEM,,SOME TO DEATH,,,WHAT GAVE U THAT RIGHT???maryw

  • There is only one person who has the power to appoint the heads of the cdc, fda, etc…PRESIDENT TRUMP! There is one person who has more control over the lives and suffering of chronic pain patients…PRESIDENT TRUMP!
    He has done almost nothing to help them! He has definitely allowed ALOT to harm them…He has disrespected war veterans. He has done everything he can to hurt the poor, downtrodden and children. Totally violated are rule of law..You are right, whatever your name is…I dislike him!

    • However, you refuse to be honest about the origins of this disaster.
      This very successful war on pain patients would not EXIST without the CDC Guidelines.
      The previous administration began this war of propaganda, misinformation and denial of appropriate analgesia – without the coordinated efforts of Freiden, Kolodney, PROP, and so many in the brainwashed medical community, this problem would not exist….there would be no insane GUIDELINES for the current President and his appointees to follow!

  • Margaret: you said everything I wanted to say & more thoroughly, but what I’d like to add isn’t very reassuring. Sometimes: truth & reality can be a blessing & a curse.

    The powers that be are very aware of the suicides, hospital & ER horrors, patient abandonment (both cancer & cpp) , & the dying field of pain management. We’ve just about done everything imaginable to try & turn this bus around but it’s not happening. We do not have a powerful lobby in our corner or a single attorney willing to take On this fight. The 1 or 2 politicians “appearing” to stand with us is not enough. Really let this sink in: it sounds as though we’re talking about some 3rd world country. Heck- even the ACLU won’t touch this.

    I’m already looking into other options & that does not include suicide, but definitely an escape plan. I think we all need to start looking seriously at what options we have. We always have options. One other point: there is enough blame; politically, to go around on either side of the isle, because this plan (yes plan) was set in motion years ago. If you want to continue on: id suggest aiming at media/print continuously (as many advocates have been:successfully) . If anything other than to keep shining the light on this atrocity. Politicians got us into this mess!!

    • Shirley: I apologize for not placing my comment under hers. Im new to the site. She posted on 6/1 under the name: Margaret Kampen.

  • You have people like Red Lawhern, Dr. Kertesz, Kate Nicholson and others trying to give them the facts and set them right but they don’t seem to want to listen. Dysfunctional govt. we have.

  • Someone made a comment that we couldn’t pay this one on Trump because they allege Obama developed the CDC 2016 Guidelines and appointed Tom Frieden as head of the CDC.
    Well, let me clue you in. Trump campaigned on his fake “Opioid Epidemic” and appointed ex-governor Chris Christie to be his drug czar. Christie had already taken away Opioids from everyone in New Jersey! So Christie tapped Dr. Andrew Kolodny (the most hated man in the pain community) and Director of Prop
    (Physicicians For Responsible Opioid Prescribing) to sponsor the writing of the CDC Guidelines. Kolodny is a recovering alcoholic psychiatrist who discovered that Addiction Treatment Centers made millions of dollars, so he owns a huge chain of ADT’S called The Phoenix House in 9 states. Google it—they’re a joke. Drugs run rampant no certified counselors, etc. So Kolodny and Prop’s anti-opioid zealots want everyone OFF OF OPIOIDS AND INTO ADT’S TO MAKE MONEY!! It’s a huge conflict of interest. He testified before Congress to 2 BALD-FACED LIES: #1) ALL OPIOIDS ARE LITTLE HEROIN PILLS THAT MAKE ADDICTS OUT OF EVERYONE IN 3 DAYS! AND #2) THERE ARE NO LONG TERM STUDIES SHOWING THAT OPIOIDS ARE EFFECTIVE FOR CHRONIC PAIN!

    THE COCHRANE REPORT STATES THAT LESS THAN ONE HALF OF 1 PERCENT OF PEOPLE WITH MODERATE TO SEVERE PAIN EVER BECOME ADDICTED TO OPIOIDS PERIOD!!! AND THE STUDIES KOLODNY POINTS TO WERE ALL DONE ON BACK/KNEE PAIN WHICH IS INFLAMMATORY PAIN AND OPIOIDS DO NOT WORK FOR INFLAMMATORY PAIN! I know because I have CRPS (nerve pain) and Fentanyl is the ONLY thing that works for nerve pain, but it doesn’t touch my back and hip pain!!!! So the answer is YES, TRUMP IS TO BLAME FOR THIS BECAUSE HE ALSO HAD THE DOJ PAY DEA INVESTIGATORS MONEY (LIKE BOUNTY HUNTERS), TO READ THE PDMP’S AND TARGET ANY PHYSICICIANS WHO WROTE A PRESCRIPTION FOR OPIOIDS! After swooping in and kicking the Dr.’s door down (with No Warrant), and seizing the computers with patient’s records (violation of the HIPPA ACT) and threatening the office staff and nurses that if they don’t testify that the Dr. was prescribing illegally they too were going to prison, then the physicician was found guilty with a 20-150 yr. jail term! The DEA then gets to do a CIVIL ASSET FORFEITURE which is outright burglary and the Government gets money again! This is ALL ON TRUMP!

    • Right on sister. Its all on trump…
      Used to be that for many years society and our govt. would keep the two groups of pain patients and drug abusers/ addicts SEPARATE like it should always be. Trump and his people got in their and mixed everything the hell up! They are and remain….Incompetent.

    • Just the facts, FYI: this article dated April, 2016 and co-authored by Thomas Freiden, then head of CDC & yes, an appointee of President Obama.

      https://www.nejm.org/doi/full/10.1056/NEJMp1515917

      The facts are unequivocal on when, how and by whom these disastrous guidelines were created.
      Please resist the temptation to blame everything on the current administration simply because you dislike President Trump.
      It is not productive.
      This is a bipartisan issue!

      If we work together we can accomplish so much more.

    • Hello Accuracy,
      You just made a generalized statement, part being “simply because you (I) dislike President Trump”…has nothing to do with it. I am neither a D or R. I call it like I see it and from my perspective, when trump, sessions and others got in their, they basically threw pain patients ‘under the bus’. Am I missing something? Thats all I’m talking about. This issue.

    • The majority of chronic pain patients, when responding to “this issue” can agree with the statement (based on the facts as I’ve stated) that their difficulties with physician prescribing and access to narcotics/opioids, et. al., coincides with or predates the implementation of the 2016 Guidelines.
      I provided a link to demonstrate that these 2016 Guidelines were created/adopted/implemented PRIOR to the election and inauguration of our current President.
      I believe your judgement is clouded by an animus toward the President, former A.G. Sessions, etc.
      I will make a final appeal to you for fairmindedness in your response to this issue.
      We were already under the bus by due to the actions of the CDC, Frieden, Kolodney, DEA and trial attorneys eager to vilify on the myth of a physician-created opioid epidemic.

  • https://www.verywellhealth.com/buprenorphine-for-chronic-pain-management-4156472
    FTA (may 2019):
    “Before the prescription of buprenorphine for the treatment of chronic pain becomes an evidence-based practice, various issues would need to be resolved. For example, current studies use a variety of pain rating scales when evaluating efficacy thus providing an inconsistent analysis. Pain rating scales in studies examining buprenorphine would need to be standardized. Furthermore, dosing strategies and route of administration would need to be examined for different presentations of chronic pain.

    If the prescription of buprenorphine for chronic pain were ever to become evidence-based, primary care physicians would ostensibly be primed for this practice. In 2000, the U.S. Drug Addiction Treatment Act made it legal for primary care physicians to provide opioid substitution therapy using Schedule III, IV, and V drugs. In 2002, the FDA approved out-patient treatment with buprenorphine, characterizing it as a Schedule III drug.

    All that a primary care physician needs to do to be able to prescribe buprenorphine in an out-patient setting is to complete eight hours of training. Nevertheless, few primary care providers have become eligible to prescribe buprenorphine.”

  • Uncocetual tapering +stopping pain medicine for intrackable chrionic pain patients with horrible painful medition is the evilest thing ever in history of medicine!?ruining millions of fuctioning poo patient lives+forcing them to suicide due to humanly unbearable pain from horrible medicial conditions!?and one size fits all is so medicialy stupid endorsers need to go back to 1grade!?this fake pain medicine hoax illegaly schemed by the CDC,prop,dea+all other gov+state agencies is the worst atrousity in the history of medicine!?it’s created the worst suffering+persucation of cpp patients ,our veterns,the elderly+all americians in pain+suffering,forcing thousands of cpp patients,veterns,elderly to commit suicide due to denial of life giving+life saving scientificly proven safe good given pain medicine!?the only medicine that lowers +controls pain period!?the medicial community is a total disaster due to this scheme by antipain relief zelots!?cpp patients +great doctors are being unjustly harrassed,persucated,tourtured!?by gov.entities who have no business in doctors+patients relationship+offices by forces that have no medicial training +don’t care who they destroy as long as they can steal+amass huge amounts of money for thier natzi aggression regime instead of doing the jobs they were hired for stopping murder,assults,robery,breaking,rape,abuse of people!?they have no oversight so they do enything they like!?they don’t have to follow the laws all other americians do??so it’s no holds bars for them!?stomp the helpless cpp patients+compasanate doctors treating thier horrible medicial conditions!?and pharmist have incurred the right to assume they are doctors instead of medicine despencers??you might have to drive to50 pharmacies to get your life saving medicine filled,knowing very well that have the medicine!??life of a intrackable pain patient harrassed at every turn+considered a criminal +we are tired of it !we did not elect to have these horrible medicial conditions,we just try to make the most of it +accomplish what our horrible pain will let us do?guess they will be happy when we are dead!?????

    • Andrew Kolodny exact words were,,”Until this generation dies off,”,,,his prejudicial ideation of the opiate abuse won’t stop,,,This from a psychiatrist w/no medical training what so ever in internal medicine or pain management,,soooo yes,,kolodny wants us dead,,,that is his goal,,btw,,10 of thee worse human atrocities’ have been committed by shrinks like kolodny,maryw

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