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In the ’90s, chronic pain was rampant in America. Opioids, which had previously been taboo, were suddenly being prescribed by doctors. A supposedly safer opioid had been developed which, as a physician wrote in the New England Journal of Medicine, was “not a hypnotic” and carried no “danger of acquiring the habit.”

This movement created a monster, addicting millions of Americans to opioids. Global overproduction fueled even more demand and, as authorities clamped down, many of those addicted to these medicines turned to more potent ones, making an overdose only a minor miscalculation away.

I’m referring, of course, to the eighteen nineties, which eerily echo how the modern opioid epidemic emerged a century later.


The 1890s and 1990s were both characterized by unopposed amplification of the benefits of opioids, the transformation of physicians into unabashed cheerleaders, and the central role of China — first as a global consumer of opium and later as a manufacturer of fentanyl. In the 1890s, the compound marketed by Bayer to supposedly treat morphine addiction was heroin, while in the 1990s, the drug made by Purdue Pharmaceuticals and marketed as a painkiller with low potential for abuse and addiction was OxyContin.

In his 1932 book, “Brave New World,” Aldous Huxley foresaw the modern opioid crisis by depicting a society addicted to a drug called soma, which mirrored the effects of opium, instantly overcoming pain while providing a sense of well-being. Soma was provided free to citizens, and its characterization predated our modern inclination to look to pills to overcome our ills.


The current opioid epidemic is a huge tragedy, albeit one that could have been mitigated, had we learned from the epidemic of yore. While the pharmaceutical industry has been singled out for retribution — and it does carry the greatest burden of responsibility — other groups have largely escaped accountability. This includes physicians as well as the regulators who spectacularly failed to protect the public. If we focus only on punishing pharmaceutical companies, this won’t be the last time opioids infest our society.

Americans constitute 5% of the world’s population but use an estimated 30% of the world’s prescription opioids. This disproportionate use of prescription drugs in the United States is not an accident but arises from a culture deliberately crafted by the pharmaceutical industry. The United States and New Zealand are the only countries that let drug makers directly advertise their claims to consumers. Their sales pitches have been so potent that, over time, Americans’ responsiveness to placebos has increased while that in other countries remains the same. This sustained marketing blitz means that when the average American takes a pill — any pill — for pain or depression, his or her expectation of relief is greater than it is for someone living in another country.

The pharmaceutical industry had help pushing opioids. The other recurring aspect of these cyclical opioid crises has been the role played by physicians in propagating them. At the end of the 19th century when heroin was first marketed, it could be acquired only with a prescription from a physician. Many of them fell over themselves to praise opioids like heroin.

One doctor wrote in the Journal of the American Medical Association in 1915, “I am convinced that if we were to select, say half a dozen of the most important drugs in the Pharmacopeia, we should all place opium in the first rank.” Decades later, in 1980, a five-sentence, 101-word letter in the New England Journal of Medicine concluded — incorrectly — that “the development of [opioid] addiction is rare in medical patients with no history of addiction.” That letter would be cited hundreds of times to make more false claims about opioids. While the senior physician who wrote the letter now regrets doing so, the damage has been done.

Every prescription opioid that killed an American had a physician sign off on it. That’s why it is essential for the medical community to examine itself to see how it contributed to this tragedy.

When I was a young resident in the early 2010s, I struggled with balancing the need to alleviate my patients’ pain but also make sure they avoided becoming dependent on opioids. Yet “Relieving Pain in America, A Blueprint for Transforming Prevention, Care, Education, and Research,” a Congress-mandated report published by the Institute of Medicine (now known as the National Academy of Medicine) read more like a marketing brochure for narcotics. Subsequent investigations revealed that almost half of those who wrote this guideline had undisclosed financial conflicts of interest and they used grossly exaggerated estimates of how many Americans suffered from chronic pain. I felt betrayed when I learned they weren’t the only offenders: Other physician-led organizations that advocated for opioids were being heavily supported with funding from pharmaceutical companies.

The biomedical industry holds broad sway over not just what physicians do but what they are taught, shaping them throughout their careers. Most training materials about opioids have been funded and developed by opioid manufacturers themselves.

Unless we make wholesale changes in how the biomedical industry can manipulate patients and physicians, we will surely find ourselves back in this quagmire at some point down the road. Training materials need to be vetted for bias, and physicians with financial conflicts of interest should be restricted from medical journal editorial boards as well as from FDA and medical guideline committees.

The FDA should be strengthened by expanding its budget and the approval process for new drugs, and post-market surveillance of approved drugs must be made more stringent. The desperate need to develop better medications to treat pain should not lead to lowering the regulatory threshold for approving new treatments. Until the FDA revamps its mechanisms to ensure opioid safety, it should heed the moratorium on additional opioid approvals filed by Public Citizen, a consumer protection group.

We should also expand how we address chronic pain, not by writing more prescriptions but by focusing on and developing nonpharmacologic approaches. A good place to start reversing our pill-popping culture is banning direct-to-consumer pharmaceutical advertising.

Unless we learn from the past, and focus only on punishing opioid producers and distributors while ignoring the role of physicians and regulators, it is inevitable that the wheels of time will keep churning, and this tragedy will recur.

Haider Warraich, M.D., is a physician and researcher at the VA Boston Healthcare System and Brigham and Women’s Hospital, and an instructor at Harvard Medical School.

  • At first, I thought I would be addressing a young hipster, not a young-looking cardiologist. I am 54. I got sober at 19. Was I actually an alcoholic/addict or just a young kid whose cerebral cortex was still developing and growing until I was 25 or so? It didn’t matter. I had low self-esteem and poor coping skills and I smoked weed every day and drank and popped whatever pills were available. Treatment, extended stay sober living houses and AA taught me how to think, be responsible, and taught me to live life on life’s terms. I became a Certified Drug and Alcohol Counselor in Oklahoma. I had no illusions about saving everybody. Let me lay some stats down.
    1 in 10 people will become addicted to something; a drug, alcohol, sex, etc. Opiates are NOT the gateway drug. It is whatever we took that first time that made us feel so perfect, we wanted that feeling again and we chased it. It doesn’t matter what drug we did or did not try. The experience was not consistently repeatable.
    Back to the stats. Out of that 1 in ten that gets hooked on something, only 1 in 10 of those will ever seek or receive professional help. Out of that small group that does receive professional help only 1 in 10 out of those will achieve some measure of lasting sobriety. That is pretty grim, but it is the truth and the best we have to offer right now.
    35 years of sobriety… or not. For the past nine, I have used prescription opiates to “allow me to live, work, and socialize”. It’s just medicine and I don’t abuse it. There is no high after tolerance kicks in. 2 neck surgeries and many rhizotomies to burn nerves to feel less pain along with PT, acupuncture, cortisone injections, etc.did not work. My doctor and I agreed to trade physical dependence for pain relief so I could get out of bed and be a productive member of society and actually enjoy life and help others.

    I am not psychologically addicted. I have stopped and tried alternative treatments many times. Electrical stimulators, hot tubs, and compounded creams, lidocaine patches, etc. Turns out, I am not the same person I was at 19.

    The point is, once someone is addicted to their drug of choice, nothing or nobody really had a singular responsible hand in creating someone’s addiction. Once someone is physically addicted, they will feel uncomfortable and come lie to their doctor(s).
    The surgeon fills a second prescription. Some heal slower, he is being compassionate. Then he prescribes the patient tramadol or says you shouldn’t be in pain. The surgeon never hears from him again. The patient goes back to his PCP for a script. The patient then starts stealing handfuls from granny’s stash. He or she will find someone he knows hooks him up with a dealer or he has moved on to a different drug, started finding new doctors. The MME numbers should be a red flag, not a limit. One day the addict gets a new doc and is talking about this “pain”. The new doc should see this number, AND THEY DO ALREADY. They should be suspect the new patient is an addict and have that conversation. If the pain is real, he will get more X-RAYS, MRIs, agree to invasive procedures that and addict would not normally do especially with huge costs. There are some who will take a hammer and break a hand, foot, etc. But more often, they will move on to street drugs than go through all that,

    Whose responsible for this patient’s condition? The patient. The docs just need to notice the signs and try to be part of the solution. 10% will be an alcoholic or an addict or both or a polydrug user. .01% will get help and beat it.

    The stats show the original prescribers are less than 1% of the overdoses. Their doctors didn’t tell them to drink on top of their medications. The doctors did not write them prescriptions for heroin. The pharmacy didn’t fill it. The drugs come in through our main ports of entry. The U.S. military has been in Afghanistan for 20 years and the production of heroin there has quadrupled serving 70% of the world population. What organization has funded itself in the past or ben in bed with drug runners? In Philadelphia alone, there are 70,000 ACTIVE heroin users. How many cargo containers need to come in daily to feed that need? It’s not being smuggled by hand across the river in Arizona, New, Mexico, or Texas in handbags and backpacks. It is coming in by trucks and cargo containers.

    A lot of people over 50 are in pain. Chronic intractable pain. They have a huge pile of medical records and have tried multiple surgeries. That is not true for the standard street junkie. The importation of heroin is the problem. We need to reinforce our portals to our country or decriminalize it and quit worrying about the gateway drugs. Vodka downstairs on the bar is often the gateway drug.

    For the readers: Do you know how medical schools were founded and are funded? It was the brainchild of the pharmaceutical companies who advertise now on television. 🙂 They still fund most of it.
    Sincerely and truthfully,

  • You forgot something . . . The American people hold some responsibility as well for trusting professionals who have deceived us in the past and manipulated us (again!) to put something in our system because it is easier than fixing what actually ails us.  We should feel ashamed of ourselves for looking down on the “crack head” while we down more oxys than a horse could manage.  We should be ashamed of ourselves for failing, to this day, to open and sustain responsible, varied addiction treatment services available on-demand everywhere in this country (this drug proves again that addiction has no SES).  And we should be ashamed of our vitriol toward those already addicted as if our brain’s reward system couldn’t be hijacked as easily others have been.  And finally, our politicians should be ashamed of themselves for not acting sooner and for supporting a negative view of addicts (while their own children were stealing their supply of oxy from the medicine cabinet).

    • America has not dealt well with addiction of any kind. Nor is it doing well with the so-called diseases of despair, which have contributed to a stagnant and declining overall life expectancy since 2012. People cheered last year’s one month bump in life expectancy, without putting it into the proper context. In 2020 life expectancy in the U.S. is lower than it was in 2012. That’s shameful, and it’s related to healthcare access inequality, as well as socioeconomic determinants of health. Diseases of despair include clinical depression (which can lead to suicide – suicides are rising at an alarming rate), alcoholism (which can lead to alcohol-related deaths – these numbers far outpace opioid-related deaths), and drug overdose (here, prescription opioid-related deaths are a drop in the bucket compared to deaths from overdoses of heroin, illicit fentanyl, cocaine, meth, crack, etc …).

  • This is a disaster for people who suffer daily with chronic pain! Many have taken their lives and many more have plans in place to do so when they can no longer handle living in agony daily! The government needs to get out of the doctors’ offices and let them do the job they trained for many years to do. I have chronic pancreatitis from a virus attacking my pancreas and just finished chemo for colon cancer. The nerve damage from chemo is horrible ontop of already extremely painful pancreatitis. Taking our medications away is doing more than causing mass suffering or worse, like turning to street drugs for pain relief! It has also caused a huge mistrust of doctors, after all, we rely on our doctors to treat us as we need to be treated. We are treated as common criminals looking for a fix! They always mention low back pain or fibromyalgia but they NEVER mention MS, EDS, CRPS, Lyme, Pancreatitis or any other horribly painful disease. No not everyone is suffering from the same affliction! This is out of control and it is costing more lives. The CDC even admitted its not prescription drugs causing this mess and worse yet they skewed the numbers! At least one person n the list of OD’s had a gunshot wound! Also, every OD was polypharmacy and they leave that out as well! It seems more like an agenda to save $$ or make more $$ when you require patients to see several doctors who they cannot afford. At one of the HHS meeting, a pain psychiatrist stood up and said “There is not much money in pain psychology so if Doctors would require patients to see us before surgeries that would help” so is this really about helping people or ripping them off and causing suffering? I can not think my pain away and no amount of yoga, tai chi or any other exercise will help it either! Most of us have tried all of this stuff to relieve the pain before medication was involved. I have organ pain and it is terribly painful, I use the heating pad to the extent that my stomach is covered with massive burn discoloration. We don’t have lives any more as we are always in pain because we can’t get ahead of it we are always chasing it because our meds have been reduced to ineffective amounts or taken away completely! Patients are at a loss as to why our doctors are not standing with us instead of against us? We are putting off surgeries now because we are too afraid of the pain and the lack of help to control it. I as well as others I know do not go to the E.R. anymore because we don’t want to be treated so disrespectfully. I refused for 4 years until May 31, 2019, I had been putting up with more pain for months thinking I had a blockage I used laxatives (common in pancreatitis) for a couple of months until I could no longer handle the excruciating pain, thank God I got a Dr who understood something was very wrong a CT scan later I was in an ambulance headed to an Indianapolis hospital, 3 days later I found out I had stage 3C colon cancer! I may have found this out a lot sooner had I not refused to go to the E.R. and be treated like a drug seeker or dismissed like many of the horror stories I had heard. There are many things that could happen that makes this a horrific situation for patients. When I got out of the hospital 9 days and a fourth of my colon gone later, I told people if your pain is different please go to the E.R., it could save your life, most of them said I would rather die at home! The trust is gone and our relationship with our doctors forever changed all due to an ignorant knee jerk reaction to misinformation. Shame on the medical community and the government, How do you look in the mirror KNOWING you are causing more suffering of patients who are already struggling to have ANY QOL? One question,… Was it malpractice before the CDC guidelines or is it NOW? It sure as hell feels like its NOW!

    • Stacey, have you been to a pain specialist and tried a medication called Zubsolv (or its generic equivalent of buprenorphine/naloxone)? It helped a family member of mine and it seems not a lot of people know about it. I just wanted to mention it in case it could help you. My heart goes out to you. I hope you are able to eventually get enough relief to live a happy pain-free life.

    • Thank you but, I will NEVER take a drug meant for addiction and I shouldn’t have to. I found a good Dr who knows I need treatment, thank God! I am happy it helped your family member and thanks again!

  • Why is it that I never see insurance companies implicated in our current opioid
    “crisis”. It seems to me that often A Drs. only remaining arsenal is pain medication as the Ins co and their 3rd party gate keepers either deny definitive procedures or alternative treatment or just postpone these option just long enough to initiate some types of addiction. While we are busy blaming and suing, lets toss this hat into the ring. Also please correct me if I am mistaken as I have read information on the history of Heroin. Dr Warrich asserts it was by Rx only at the turn of the 20th century but I have read Bayer marketed it as “over the counter” Many thanks,

  • I agree with some of what Dr. Finston said. In particular, Dr. Warraich’s statement – “every prescription opioid that killed an American had a physician sign off on it” – doesn’t account for the complexity of the problem of prescription opioid misuse, abuse, overuse, and diversion. The latter is very important, as in fact most prescription opioid overdoses and deaths haven’t been traced to a legal prescription. Most were diverted prescription opioids taken for non-medical use, almost always in combination with other prescriptions, and/or alcohol, and/or illicit opioids.

    I do take issue with Dr. Finston’s statement that the industry and government “dictated treatment.” There are multiple checkpoints between a prescription opioid being supplied and it being consumed by a patient. Is marketing involved? Yes. Are medical professional and government guidelines involved? Yes. However, neither marketing or guidelines forced doctors to prescribe prescription opioids, payers to pay for them, and patients to take them. Did the regulatory, prescribing, reimbursement, and consumer checkpoints referred to above fail to prevent problems from occurring? Yes. Sometimes the checkpoints weren’t rigorous enough, or weren’t enforced. But, that’s very different from saying that prescription opioids were forced upon doctors and then patients. With the exception of consumers, all of the key stakeholders involved in the prescription opioid supply and demand chain are learned intermediaries. Marketing is a source of information, as are guidelines. But, they’re not the only sources. In fact, I would argue that in the case of payer P&T committees (that made the decisions to pay for the prescription opioids, often with no prior authorization or other limits until 15 years into the crisis) marketing plays a minimal role (or at least is supposed to).

    • Hi Joshua Cohen,
      Thank you for your thoughtful comments, especially when you agree 🙂 I don’t know your “title,” your relationship to medicine and whether you practice it. That makes a difference in what “directives” you happen to hear, if any. I’m careful about words, that I don’t lapse into hyperbole. I will stay with the word “directives” because that’s the truth of today. What started as an opiod endorsement 15 years ago was really the beginning rumbles of an earthquake to dismantle medicine as we know it and restructure it as healthcare with someone else in charge.

      A physician may believe he/she has “choice” as the prescriber of treatment, to use your word. That could be a reasonable conclusion given that the physician definitely will shoulder the blame and malpractice suit if anything goes wrong. But reality is doctors do not have “choices” about treatment. Not today. What doctors have are formularies, pre-authorizations, and absolutely dysfunctional, non-dedicated insurance “hot lines” Of course this restructuring of healthcare didn’t happen until after a campaign was launched to “lay the groundwork.”

      The campaign has been brilliant, but I’m not sure who it got started.. Maybe a rumor went viral. One day I woke up and heard that generic Prozac was the same as brand. Could that be? To update this question, “Can medications become #Me-Too’s, just like in Hollywood?” My answer is only in Hollywood can you pretend fantasy is reality. Most patients I see are well aware of what makes them feel better, especially when another medication has been substituted.

      With Prozac’s second evolution to generic, the switchover led to serious relapses in a few patients. But this “Me Too” campaign carried on, encompassing more medications and classifications. Soon all brand medications were promoted as equal to their generics.

      Thanks to Dr. Oz and his show interviewing Consumer Labs Newsletter’s founder, we know this is not true. Even only considering Prozac’s active agent, its concentration in a generic will vary approximately 80% below to 120% above what’s found in the brand. Generics from different drug manufacturers use different “inactive ingredients.” We call these “inactive” ingredients because it’s convenient, not necessarily true. Last week, an elderly patient called me because she got a different shaped pill for her usual prescription and had increasing abdominal pain and constipation, feared she was headed for bowel obstruction. Her pharmacy had changed to a different generic’s manufacturer. She was able to return to her former generic and her abdominal crises went away. But that is the point. We have been so oversold on the myth of “Me-Too” drugs that some professionals have become so brainwashed (and intimidated, I believe) that they don’t think to inform the patient of this switch.
      Today, generics are substituted for other generics from a different medication but treated as if they were the same. They are not. Most recently, biosimilars, found in oncology, are being pawned off to the public as the same. They are not generics, but active biologic molecules made from different sources. Different sources make them different. But the #Me Too myth allows this substitution without informing the patient. The insurance company buys the cheapest form offered by Big Pharm. FDA is eager to approve because it’s cheaper, too. It’s a becoming okay, I guess, to switch and don’t tell. That’s what happened to me and it’s not okay. The new biosimilar had a Black Box warning. No one gave me a warning. Instead, I got a 3 car collision.

      Ask any doctor who actually treats patients beyond the 15 minute med-check and he or she will tell you people are individuals and what’s good for one is not necessarily good for another. If we were all the same, algorithms would work for everyone, and the real work of medicine would be easy.

      What we heard 15 years ago, “thought leader” academics lecturing us about pain is the “Fifth Vital Sign” and failure to prescribe opiates was malpractice was wrong. Not only clinically and morally wrong for patients. That was the first shot I heard around my medical world that rang of coercion.

      The earthquake is over now. Doctors are waking from their slumber. Turns out the journal articles they once lived and practiced by have sunk to tabloid research, promoting whatever political or perverse causes lay around in the culturally expropriated name of “medical science.” Striped of their calling, some have lost meaning to their lives.. A few have jumped off buildings. Patients are wondering what the heck happened. They already know it’s not good.

      Peggy Finston MD

    • Dr. Finston, thank you so much for talking about generics and how they are often not only as effective as the brand version, but their effectiveness varies from generic to generic. When I complained to the pharmacist at Wal-Mart that the new generic I received was not even putting a dent in my depression they treated me like I was crazy. And they wouldn’t go back to the old generic without my doctor faxing them a request. Things like that take days with my Dr.’s office so rather than going through the hassle I transferred my remaining refills to another pharmacy. Unfortunately Wal-Mart would not take back the 90-day supply they had just sold me. Luckily, the pharmacists at the H-E-B grocery store were much more understanding and went ahead and sold me another 90-day supply. People should be more aware that genetics are not required to be identical to the brand or even other generics. Effectiveness can and absolutely does vary greatly. We have to learn to be better advocates for ourselves. Doctors and pharmacists cannot know everything unless we talk to them about our problems. Thank you again.

  • I hear the author’s frustration, but the opioid epidemic is way more complex than “Every prescription opioid that killed an American had a physician sign off on it.” Prescriptions don’t kill. Next to Trump, Doctors have become the #2 “Reason” for all that is wrong with the world. Obviously, Doctors who overprescribe should be reigned in. But that’s not what happened here.
    Government teamed up with “industry-advisors” (Purdue and others), and began to dictate treatment. (Government informed by Big Pharm and Physician “Thought Leaders” do not lead to noticeable WISDOM. Yesterday, Pain was determined to be a “Fifth Vital Sign” and physicians who failed to address this were literally told they would be guilty of malpractice. Today, now that doctors have been judged the perpetrators by articles like this one, they are essentially forced by government (CMS) to deny pain meds to people. Otherwise they are considered guilty of malpractice. What doctors can’t do, is use their own better judgment.

    What the story misses: The opioid ER deaths have been mostly from tainted street drugs smuggled into the country from China. The smuggling was identified during the Obama years (Wall St Journal) and for unexplained reasons was allowed to continue. For example, we had an influx of heroin tainted with fentanyl that caused deaths. I treated one drug addict left with a horrendously shrived, scarred arm. Why was this smuggling, often by illegal immigrants, not stopped? That would also make for a good read.

    Today, doctors’ have been instructed to do the opposite of fifteen years ago. Their performances’ are now literally “graded” by how much they can reduce pain meds prescribed. That’s a solution? Taking meds away from chronic pain patients because too many “someone elses” messed up royally? That’s a cruel punishment for those who didn’t create this mess. (See the comments below). That’s another untold story, too.
    We all know the Purdue oxycontin hype…they played their drug like it was a “regular” so thinking they could sell more, when really, they had a superstar. The company is going down. But having had severe chronic pain myself and treated chronic pain patients for years, what’s left out is that oxycontin was one of the best, if not the best. I didn’t think it had magical addictive powers. It just did the job so you could think, move and do your job. Most pain meds don’t. You don’t have to be a magician to prescribe it, either. Just responsible.
    Why and how did we, as a society create and continue such self-destructive policies? Now that’s a story I’d like to read because I get it. Are we mostly so mesmerized by power and greed, that we will seek them, no matter the cost to even ourselves?

    Peggy Finston MD

  • Yes thank u! If u read my comment; u will c what i mean. I’m suffering as a true chronic pain pt that listened 2 all the rules, jumped thru all the hoops & yet I’m in misery cause some ppl chose 2 abuse these substances that r a true lifesaver for some of us. I wish those ppl could just feel our pain for 24 hrs & know what its like. Also, there are how many thousands of deaths due 2 alcohol, driving, elicit substances, etc & yet since this is suddenly an “epidemic”; true ppl who needs these 2 function r quite literally dieing in their (our) own way. If some of these ppl lived with the pain I do everyday they would beg 2 have just a small bit of relief. Thank u & i hope others see our comments & some good will come from it… But sadly, I doubt it

  • This article just goes to show that you have NEVER suffered from chronic pain. There is a need for pain relief in the U S and around the world. Before you pass judgement on people in chronic pain you should have to live with it yourself.

    • Agreed…..I have TN otherwise known as the suicide diseases which opioids do not relieve the pain but other strong pain relievers do and I am not addicted when I do have successfully surgery I no longer need the strong meds
      Do not judge anyone until you have experienced my pain

  • This article is part of why I am miserable as I write this. I have been a chronic pain patient since 2011 due to a tooth extraction that led to permanent mental nerve damage & trigeminal neuralgia. The story is too long for thus post; but trust me, it took me several drs, years, procedures, meds, etc to find what helped me. & yes that treatment includes strong pain meds. Now after my dr went on maternity leave; her temp refused to continue my meds & referred me to a pain clinic I had a bad experience with before & of course this new dr they have there adheres to all the new “guidelines” & long story short; I have been in agony for months now trying to get the relief I feel I deserve. Ppl will always find a way to abuse substances; but for the ppl that really need certain meds to function & get out of bed each day; it is just cruel to lump everyone into the same category & have a “one size fits all” mentality when it comes to prescribing. I have not abused any of my meds & just want to be able to function. I know I will probably never be pain free; but those meds help me to at least do what I can & have some quality of life. Now I go from bed to couch & can barely leave the house til I can get this resolved. I guess my point is – treat each pt as an individual & hear & listen to what they need

    • Agreed…..I have TN otherwise known as the suicide diseases which opioids do not relieve the pain but other strong pain relievers do and I am not addicted when I do have successfully surgery I no longer need the strong meds
      Do not judge anyone until you have experienced my pain

    • Kourtney, I mentioned it above but I wanted to suggest it to you as well. Have you tried Zubsolv (generic is buprenorphine/naloxone)? It helped a family member tremendously who has chronic pain associated with Chiari malformation. I hope this helps and my heart goes out to you. I hope you find relief in some form soon.

    • As a dentist who has suffered through atypical trigeminal neuralgia I would steer you toward the clinic at Mass general. My tx back in 1996ish involved therapy with a doc who I believe still practices through there. It also involved a specific antidepressant and either neurotin or dilantin.(no pain meds) It was about 9 months of tx and I eventually weaned of each med. I was fortunate to know enough not to ext teeth (did have 1 endo and apico(before putting the brakes on) Resolution did happen… Good luck!

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