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.
“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. (Lembke has served as a paid expert witness for plaintiffs suing Purdue and others in the opioid supply chain for their alleged role in the opioid crisis.)
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.”
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.
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.”
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.”
This story has been updated with information about Dr. Anna Lembke’s work as a paid expert witness in opioid litigation. This information was disclosed after the story was originally published.
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Off Topic, but VERY Important.. This is a response from Senator Braun. At least he admits he now “sees” our problems. He is head of this committee. PLEASE KEEP WRITING YOUR SENATORS! (UNTIL WE SEE SOME CHANGES!!!) Dear Mr. ********,
Thank you for contacting my office regarding opioid availability for individuals
suffering from chronic pain. I appreciate hearing about your experience with this issue.
Chronic pain is one of the most common conditions encountered by health care
professionals. More than 50 million adults in the U.S. are living with chronic pain at an
estimated cost of $560 billion in medical care. The experience of pain has been recognized
by the Institute of Medicine as a national public health problem with serious physical,
emotional, and societal costs. The public health challenge of pain exists at the same time that
our nation is facing an opioid crisis that has seen an unprecedented rise in overdose deaths
associated with prescription opioids. As a result, it is important that we do everything that
we can to strike an appropriate balance between ensuring patients struggling with pain can
have access to effective and inexpensive pain medicines and treatments—while also ending
the devastating effects of opioid abuse.
The National Academies of Sciences, Engineering, and Medicine is correct in their
conclusion that the opioid crisis lies at the “intersection of two substantial public health
challenges—reducing the burden of suffering from pain and containing the rising toll of the
harms that can result from the use of opioid medications.” As a result, I am committed to
working with policy makers and stakeholders to improve care for those suffering from acute
and chronic pain while also doing everything I can to combat the opioid crisis—which has
been declared a national public health emergency by President Trump.
This public health dichotomy, the policies addressing it, and the actual selection of
any medication-based treatment to treat pain must be based on a careful analysis of risk and
benefit. That is also why I have introduced legislation this Congress to ensure that the U.S.
Food & Drug Administration (FDA) updates its opioid labeling regulations to ensure that
any FDA approved labeling for opioids reflect the actual risks and benefits associated with
the medication, especially when indicated for the treatment of long-term chronic pain (S.
2089). I have also introduced legislation that would require all prescribers—as a condition of
holding their federal license to prescribe medications—receive education related to
responsible opioid prescribing practices and the commonly misunderstood key facets of
opioid abuse among patients (S. 1448).
Let me be clear that the FDA should not interfere in prescriber practices—however,
they also should ensure that the risk information contained on any labeling for an FDA
approved drug is accurate and not misleading. Prescribers should have the ability to
prescribe medications off-label—especially for patients facing life-threatening or painful
terminal medical conditions for which there are limited FDA approved alternatives. We must
ensure, however, that prescribers understand the basic facts about opioid abuse when
prescribing medications for the treatment of pain.
Thank you for contacting me. It is an honor to serve as your U.S. Senator from
Indiana. Please keep in touch with me on issues of concern to you. You can also follow me
on Twitter or Facebook for real-time updates on my activities in the U.S. Senate. If I ever
may be of service, please do not hesitate to contact me.
Sincerely,
Mike Braun
U.S. Senator
P.S. This message was sent by email to save taxpayer dollars.
I was on vicodin, 5mg 325mg of tylenol for four years. Took it as was needed, locked it up, never abused it in anyway. The best part was my insurance paid for it. It took care of all the pain. Now I’m on cymbalta, Ibuprophen 800mg, flexeril 10mg and medical marijuana that is very expensive and I have to pay out of pocket on a fixed income. Four prescriptions have replaced one. What is wrong with this picture? My medical issues are so entwined. They can’t be untangled or explained as to where the pain is coming from. I feel like I’m being crushed from the inside. No more injections that have worn off by the time I leave the medical parking lot. Doctors are suppose to heal to the best of their abilities. Doctors just look at your chart, not your eyes. Doctors are afraid to man up and tell the powers that be they will take care of their patients without interference. After trying everything else, I finally agreed to take the lowest opiod I could get and it worked. What a blessing. Then, it’s gone. Why are chronic pain sufferers being grouped with drug addicts? I’m sure there are some who abuse it, but there’s always going to be that with something. I can’t get a pain killer, but I can get marijuana. My cocktail of prescriptions does help, but I don’t know how much longer I can pay out of pocket. I’ll be 68 this year. Worked all my life. How we get serious pain relief should not be something we need to worry about. It should be a given to trust the medical profession to help instead of hinder that goal. Doctors are running scared they will lose their medical practices. Medical degrees they earned with their own blood, sweat and tears. Man up.
To Ms.Wyckoff,,,the quick answer to your ??? is,,,,these pain clinic doctors are NOT allow to violate your rights thus law.That law being access to EFFECTIVE medical care to lessen physical pain.However thru government tyranny upon its own people,secret meetings w/insurer,judges,pharmacy,and the dea,doj,,telling these insureres,,don’t worry,,we wont prosecute u for denying effective medical care in our court rooms,,they so-far are getting away w/it.Until someone gets a lawyer and sues the ever living crap out of America’s government agencys of,cdc,doj,hhs,DEA,,,FOR VIOLATING OUR CONSTITUTION,,AND THE LAW OF INTERFERENCE INTO MEDICINE,PRACTICING MEDICINE AND VIOLATION OF EVERY iNTERNATIONAL TREATY for violation of torture and genocide onto its own people,,,were stuck,,,,for now..I find it very ironic,,all these 1/2 wits claim EVIDENCE BASE MEDICINE ,,,yet when it comes to the very obvious truth/fact that it is literally impossible for anyone to physically feel the physical pain of another,,Thus as a humane civilized society our laws state that denial of effective medical care to lessen physical pain is the definition of torture,,Their ALLLLL so willing to ignore that very very basic truth,,,that their willfully torturing’s and killing off the medically ill,,so some insurance company or government run medicare/Medicaid can save a buck..This NEVER EVER WAS ABOUT TRUTH EVER,,,,,FOR THE TRUTH IS,,THEY ARE TRULY TORTURING THE MEDICALLY ILL TO DEATH,OBVIOUS,,,,THIS WAS ABOUT AGENDA,,,,THAT AGENDA BEING SAVE MONEY,,DO NOT PAY FOR ANY PRE-EXISTING,IE CHRONIC MEDICALLY ILL TREATMENTS.LET THE PRE-EXISTING MEDICALLY ILL DIE OFF,,,THERE GONNA DIE ANYWAYS,,SO WHY PAY FOR THEM,,IT WILL SAVE US $$$$$$$$$.THIS IS WHY THE TRUTH IS CENSORRED EVERYWHERE!!!!IT WAS NEVER ABOUT TRUTH,,,IT WAS ABOUT THEIR AGENDA,,,,,,AND A GUY NAME ANDREW K…..GLADLY TOOK THE REINS OF THAT AGENDA FOR HE STOOD TO MAKE BILLIONS,,,WHICH IS WHY NO-ONE WILL INVESTIGATE HIS FINACIALS,,HE HAS BEEN THE GOVERNMENTS TOOL,,,OF THIS TORTURE/GENOCIDE OF US,,,JMO,,maryw
The medical literature used to endorse the use of high dose opiates for my medical conditions, which include Avascular Necrosis, scoliosis, chronicfractures, and a muscular dystrophy.
After the CDC “guidelines,” my life was destroyed from a forced taper to1/5 of what I’d been on for 23 years. Even now, a doctor at my pain clinic wants me to go still lower (under the 90MME) justifying it because it’s the clinics “business policy.”
How are pain clinics allowed to have business policies that violate my rights??
I am 67. All my life I’ve had medications for pain when I needed them. Now nothing. Why can’t the new laws just apply to the new, young, healthy people, but we Baby Booomers NOT BE CUT OFF. The Dr. Is right, we either die due to suicide, or dead from the street drugs or the street dealers. With narcotic pain relievers we led long productive lifes. Now our retirements are miserable because we can no longer be prescribed meds. Or we have to self-identify at the herion clinics to receive a narcotic treatment for addiction rather than from our doctor for pain. Overdoses occur cause we’re forced to use street drugs.
Or were forced to use alcohol to ease our pain. This is a vicious cycle.
Medication is between me and my doctor, not me and the government. This is just another example of the media making an “epidemic” out of nothing.
I feel strongly about this. I’m glad I happened along this site. Dr. Kertesz, thank God for Drs., like you. I have been wanting to advocate for the new law to only apply to people under 60 who are receiving their first opiod prescription.
All of us who are old and in pain due to having lived so long, be given the prescription like we have had all our lives.
I am willing to advocate for it but I dont know how.
I’m in the same boat at 64. I complain everywhere I can including Senator Braun, my governor, my congress reps, my pharmacy manager, my pharmacy manager’s home office, the ADA, my state’s pharmacy association, state attorney general, and all the appropriate social media sites including the DEA, CDC, and FDA. MAKE NOISE and don’t stop until we get change!
You might try kratom. It can reduce the miserable raw pain–a bit like low dose milder opiates (not that we should have to). But now kratom has been made illegal in about six states. It isn’t an opiate but activates the same receptors as opiates. Kratom can be ordered online, and I think the only risks (considerable) are mixing it with something else and/or getting high doses of heavy metals or other contaminants. Reputable kratom sellers test for all contaminants. The American Kratom Association is fighting attempts by the DEA to make it an illegal controlled substance, while millions take it for pain. They need to leave established pain patients alone and stop trying to control every aspect of our lives!
I have had my pain medicine cut and I have lost everything. My house, my car just sits. I can’t walk so I am living in a bedroom in my sons house. I get out of bed 2 times a day to go to the restroom. I hurt so bad when I walk that I fall and I was threatened to be put in a nursing home. I never abused pain medicine in all of the years I have taken it. I had surgery, thinking I wouldn’t need pain medicine anymore but I hurt worse than ever after back surgery. There’s really nothing left for me.
I am a former registered nurse that for about a decade was an undiagnosed type II diabetic. The first symptom was numbness to my feet that was intermittent. I was 165 pounds at 5′ 9″ tall and was as far as I knew quite healthy. They started treating my diabetes with oral meds diet but that didn’t work. Then I was started on insulin 4 times a day and my blood sugar got a bit better but the neuropathic pain in my legs and feet grew worse. Best description would be it felt like I was standing in a bucket of icy hot and I was walking on small sharp stones. While sleeping I would keep waking up with sharp shooting and stabbing pains in my feet. They burned, were numb, and at the same time felt like they were burning. Then I got a clot in my left hip, Illiac artery, and the surgeries began as I couldn’t walk further than 300 feet without a long break.
2 fem fem bypasses, 1 bypass graft clean out, then finally an aorta bifemoral bypass which is currently clotting off on the right side. Surgery that will risk the amputation of my right leg will happen in about 6 weeks. My pain never gets below a 6 or 7, NEVER. I was only prescribed 5 mg of oxycodone 3 times a day, not a big user. Last month my pain Doctor lowered that to 2 times a day. I week later I was in the hospital with Atrial Flutter at a rate of 150 and BP of 75 over 40. Light headed, dizzy, they couldn’t control my heart rate. I was in AGONY. The amazing nurse gave me 2 mg of IV morphine as ordered at 2:30 AM. Less than 2 minutes later my pain greatly improved and like magic I was now in sinus rhythm at 60 BPM and a BP of 112/78. MY pain med tapering caused a lethal rhythm in my heart that nearly killed me. Now I take 10 mg of Oxycodone 3 times a day and my heart is LIKE NEW. Thanks to CDC guidelines I almost died.
Thank you Dr. Kertzsc for at least looking at the other side. We need good Doctors to make choices, not bureaucrats who believe one size fits all medicine will stop addiction and save lives. People seek treatment from DOCTORS, not accountants.
I am sooo happy you survived government biases and regulations from both republicans and democrats. Isn’t it great that we have these people to help save us from ourselves! How can we possibly become end-of-the-road drug addicts if we are denied those EVIL OPIATES to begin with? I’m so grateful for articles like this, the honest and educated media, and our caring and freedom-loving government. BTW, I’m currently on 7.5 mgs 4 times-a-day for my lower back problems and I will personally chop up anyone and feed them to the seagulls if they EVER mess with meds!! Thank you for your post!
I sincerely hope Dr. Kertesz prevails in his battle against hysterical extremism. Not everyone who uses pain medication is a “junkie”. Some people are actually in pain. Draconian measures currently in vogue are a plague on those who live with debilitating painful illnesses. Many do not enjoy taking medications and only do so when necessary. But, when medication is necessary, how is one expected to cope with being told by a prescriber that they must suffer because someone else happens to abuse opioids?
Everybody involved has destroyed my and my daughters life while the very same “Junkies” who created the problem are treated 1st Class for their addiction. I hope we meet again when you suddenly have a chronic pain condition and I hope you suffer into suicide and Rot in Hell….!!!!
Amen!
I am 69 years old, a former plumber and pipe fitter. I worked for 35 years until I was forced to retire due to chronic pain in my hands and shoulders, 9 hand operations, 4 shoulder operations ,etc.
I just spent the last four hours awake because of the pain that I am going through.
I have been on oxy 15 and hydro morphine 12 for 15 years. This has saved my life.
With out these drugs, I would have killed myself years ago. The pain is just to much. A slow torture. So don’t think that we pain people would not do ourselves in.
The cost of pain pills for people who are in pain is very low,it gives us the freedom to live our life, not with out pain but tolerable.
You who think you are saving us from addiction should live in my shoes for a few days,you would change your mind pretty fast.
You who are helping us to live pain free, Thank You
I also have degenerative disc disease as well as circulatory issues (CREST autoimmune) that cause numbness, burning and pain in my limbs. I had back surgery in 2008 after I blew a disc and was in horrible pain, and was great for five or more years, and now other discs are herniating, and I have almost no cushion in the lower discs, and severe spinal stenosis. I’ve had maybe 8 spine injections since 2008, and during my last one in 2018, after being in horrible pain, I was only given Tylenol 3. The pain was so bad I couldn’t walk out of the clinic and the injection made it worse. I fainted on the way out. And the doc is like, “good luck!” It just feels so beyond crappy.
I also had a toenail removed this past June after a long infection and was given no prescription pain medicine – just take Advil or Tylenol. It was so painful I passed out while they were removing it just from the pain of the shot going into my infected toe. That hurt very badly for multiple days and I was given nothing. That is just messed up.
I’ve learned to do “everything else” possible I can to help my back and leg pain, and I have tried many alternative treatments because – I’m still in pain. God help me if it becomes severe and constant again because I’ll be up the creek. I don’t drink either, some people may drink to help with pain, but I can’t stand alcohol.
But my point is – the top/down guidelines and over-legislating of practitioners and making them afraid to prescribe narcotics is just inhumane and another symptom of how broken our health care system is. I am a chronic pain patient and I am not being helped. I do not feel heard or cared for. My quality of life is not important. I am not an addict, I should not feel guilty for being in pain or for wanting a treatment that I know can ease my pain.