#CPP Doesn't look promising for chronic pain patients. SCOTUS basically shined a spotlight on the government scam known as the overdose 'epidemic.' SCOTUS ruled 9-0 to vacate the conviction of 2 doctors prosecuted in one of the DEA's typical scam prosecutions. In great news...
...for 30-50 million Americans living with chronic pain, they sent it back to the lower court and instructed the government that the burden of proof is on the prosecution (even for DEA scams) and that they must prove the doctors knowingly prescribed a dose, too high for that...
...patient and INTENDED to cause harm. Nine justices concurred with the ruling on the prosecutions' burden. Six concurred on the standard of evidence required. Breyer wrote for the majority. Why haven't we seen more about this. That THIS court, the one that generally rules...
...6-3 or 5-4, at best, ruled 9-0 should have been banner headlines regardless of the case. This is like an earthquake of unusual to say the least. However, I've had to search to find any articles on it and I don't think it's been mentioned on any television 'news.' So...
...what would explain this apparent oversight of this news? Obviously, it's something 'they' don't want us to know. It exposes the fascist tactics & abuses favored by the DEA. The sham evidence they manufacture, twist into pretzels to explain, the coercive ways they force..
...guilty pleas from innocent people. So why doesn't the media want this exposed? Here's why. The war on drugs was started by the first in a string of fascist presidents who we KNOW did it to have a weapon against political enemies. Specifically, for Nixon, that meant ...
...black people and the anti-war left. Since that day it's been weaponized against problematic people and populations. Sort of a one size fits all solution for those standing in the way of acheiving their objectives. So, how does this relate to now? Right now we have a country...
...thoroughly brainwashed to believe doctors prescribing pain medications to...get this... people in pain (Horrors). Yes, 30-50 million chronic pain patients and the doctors who treat them caused the opioid 'epidemic.' Do you believe that? (cause if you do, I can get you some...
...excellent advice on investment opportunities). So, SCOTUS. How does the ruling fit with what the all out push to deny pain medication to patients in pain. It's complicated but I'll try to pull this together with what I know about pain management & government propaganda. ...
In 2016, the media was hyping this overdose crisis. When they start ginning up public panic about an issue, they're planning something. We know corporate owned media not only assists these efforts, it's always something in the best interests of corporations and it's usually...
...a plan to hurt a lot of people and increase corporate profits (or decrease expenses to increase profits in this case. Then I have to ask myself, in this case, what are the end results of denying pain medication to 10s of millions of people with chronic pain. I know, ...
...after almost 30 years practicing as an RN in onocology-pediatric and adult-and a decade managing Hospice patients and consulting on palliative care cases. I became known fairly quickly as a resource for other nurses and more than one Hospice medical director. I know sound...
...principles of pain management. The last couple of decades I was working we made great strides in managing pain. The extended release products developed around that time were an almost miraculous improvement in controlling pain, taking people off the roller coaster cycling...
...through the cycle of relief from the medications followed by the return of pain until the next dose can be taken. Two things I know are necessary to provide consistent relieve. The right dose is critical which is, generally, a higher dose if it's a patient whose levels are...
...very high they will probably not respond to the same dose as another patient with the same pain but at a lower level or pain that is intermittent. It only makes sense about the pain levels. Most drugs given fanything require higher doses to control worse symptoms. A patient...
whose being treated for high blood pressure will generally need more blood pressure medication if their blood pressure is 200/110 than if it's 140/80 even though they both have high blood pressure. It'a a question of degree. So, the morphine equivalency the 2016 CDC guidelines...
.,.developed in response to the overdose crisis was treated all pain regardless of levels or duration are ridiculous. They set recommended upper limits that will not get the kinds of pain suffered by patients with constant or near constant pain at high levels. The worst pain...
...in patients I treated, in conjunction with the doctors would not generally get adequate relief from the dose they say should be the maximum. We'd start low on a narcotic naive patient but, depending on response or lack thereof, we advanced fairly rapidly. If my patient's...
...pain level is not relieved by the dose or the relief is stilll inadequate. Unless that patient has other medical conditions that could be negatively impacted we usually advanced at a fairly fast rate but always 24 hours to evaluate response. If the patient is getting ...
...adequate relief at that dose but it's wearing off too soon leaving them having to count the hours before their next dose, we increased the frequency ie every 8 hours as opposed to 12. This, right here, is where Purdue turned their Oxycontin into an addiction machine. This ...
...is what drove the fairly minor part prescription opioids played in the increase in overdoses. It is really the only factor that drove overdoses on prescription pain meds. Most overdoses still involve more than one substance, ie: polydrug abuse, etc... A very sound principle...
...of pain management is to titrate doses to the least effective dose-the lowest dose that will provide relief satisfactory to that patient. Next, with the advent of extended relief we were able to titrate frequency to that patients' need so they got off the roller coaster. ...
Purdue's marketing of Oxycontin as only needing to be given every 12 hours was all about their outrageous pricing which they justified by saying the patient only needs 2 a day. When speaking of these 12 hour formulations it's important to realize every patient and every pain...
...is different. Pain is an antidote to narcotics. This is absolutely true. The fact is it's difficul to overdose a patient whose pain levels are very high. In the worst cases in Hospice, we found cases we did not get results at the end stage as their bodies would be unable...
...as the dying process progressed and systems involved in metabolism were shutting down there was a dose above which there was no effect. Those are the only cases I ever found where we could not find a dose that would relieve the pain because their bodies would not handle it.
That's a long way around to say opioids are the only medications indicated for pain that do not have a ceiling. IOW there is no dose that is too much for every patient. In the absense of a co-morbid condition patients can tolerate opioids up to any dose that controls the pain. ..
I need to repeat that. There is no dose of opioids that is universally life threatening to all people. The dose required is a combination of that patient's response to the medication and that person's tolerance for pain, and the rate of advancing the dose. My point is putting...
...a hard limit on the MME (milligrams of morphine equivalency) is not only wrong, it's dead wrong. The worst pain patients do not get any relief at that limit. Suffice it to say I saw patients in the worst pain imaginable whose doses were shocking when you look at the...
...amount it took to provide relief. I learned rather quickly my first year out of school, while doing pediatric oncology, that what I learned in nursing school about safe doses of these drugs (morphine in the case I'm referring to now) was not even in the ballpark of what it...
..actually takes to control severe pain. The patient was a 15 year old female dying of colon cancer (very rare in young people). She was on terminal care which was when treatment was no longer going to have any effect on the disease or the patient could not tolerate treatments...
...it would take to have an effect ie: the treatments would not work and would likely hasten death. At this point the goal is comfort. Most people I found are not afraid to die but everyone is afraid to suffer. People don't want to die suffering. Go figure.
The institution where I worked was one of the best if not THE best pediatric research facilities in the US. Our policy for terminal care was whatever it took to meet that patient's need to control the pain that patient is experiencing and we did follow the wishes of the...
...patient. Did they want to have their pain relieved even if they were sedated to the point of unconsciousness to have relief if that's what it took or did they prefer to endure a higher level of pain in order to be present for loved ones during this time and we went by that...
This patient in this case, 80lb female, wanted her pain controlled above any other considerations. She was getting 80 mg morphine per hour via continuouis IV drip. One night as I was leaving report there was chaos on the floor, Due to a malfunction of the pump the patients new...
bottle of morphine (320 mg to infuse over 8 hours) got away from the nurse and the patient received the entire bottle in about a half hour. We put a nurse in her room to monitor one on one and we had emergency equipment at her door. This patient did not even get drowsy and ...
...it was less than an hour until her pain was out of control. This was shocking to me. The typical dose for an adult post-op is 2 mg IV push in the recovery room. I did not think it was possible for a human to get that much morphine and live. Not only did she live a good while..
...after that (weeks) but she didn't get adequate relief. Right then I knew we were so ignorant of what it takes to relieve pain at those levels, we were in the dark ages. That was early 80s.
Bottom line-there is no way to set a limit on opioid dosing that is not going to leave many patients with unacceptably high pain levels.
Over the years we learned a lot more about pain, chronic pain, and appropriate use of opioids in chronic pain. We still don't know as much as I'd like but the fact is we don't put resources towards learning in adequate amounts but we do know the right dose and the right frequency
...are basic. The part where Purdue created a prescription overdose crisis was ignoring and getting doctors to ignore the principles of proper frequency. Pain is much easier to treat when the pain first starts. If you delay relief, it's going to take more as pain levels...
...generally increase as time goes on. Stopping it early is the best chance of relief and the longer you wait, the more it's going to take. In order to justify their shocking price point, Purdue scammed doctors, saying there is never a need to give more than 2 pills a day.
It is exactly the opposite of good practiced. They advised doctors (and this is where it gets almost diabolical) to increase the dose and only give it 12 hours. If your intent was to create addiction, this is probably the way you'd want to do it. Very effective at creating...
...addiction but not very effective pain management. Patients wound up on dose sometimes 4 or 5 times what was actually needed. Oxycontin was released, I think, in 1996. I began working with Hospice in 1998. By then the pain management doctors working for us knew very few ...
...patients got 12 hours relief. Not just some patients needed medication sooner, almost ALL of them did. Proper pain management dictates you increase the frequency if the relief is wearing off too soon. Remember, the longer the pain is allowed to rage, the more it is going to...
...take to bring it back under control. This is where the extended release formulas were a major advance for pain management. We could provide consistent relief usually with lower doses. Purdues green turned it upside down. Patients were seeing their relief wear off in...
...6 to 8 hours and were being forced to wait hours, while their pain levels were skyrocketing before they could take another dose which, by then, was not going to relieve the pain adequately to begin with and the patient's pain levels are still rising for the next 12 hours.
Are you starting to see how this is an issue? In Hospice we had more leeway, obviously, and our doctors increased the frequency to what the patient needed (weird, huh? doing what the patient needed). We could generally get results from a pretty slight increase in the dose...
...but upping the frequency to 8 hours. This kept the pain at acceptable levels consistently. So, they turned everything we know about good pain management on its head and created an 'addiction machine.' Now, our government, not one to waste a crisis decided the answer to this...
...was basically to leave people in pain. They know better. They've hired a bunch of advisers who are known drug warriors with an exteme anti-opioid bias. They got the advice they wanted, advice that guarantees inadequate pain management..GUARANTEES people will be left in pain...
...usually extremely high levels of pain. The DEA et al shut down some pill mills. Some of these mills really were pill mills and really needed to go. It's been a while since the bulk of the pill mills were shut down but now they're going after legitimate pain management...
...professionals who are practicing sound pain management principles. They're using the same tactics they always have on drug dealers or political enemies they want to frame. They check those data bases constantly and a doctor prescribing opioids at a level they deem excessive...
...is targeted. One recent case was a psychiatrist with decades behind him, well respected, knew his field. An agent posing as a patient went in pretending to have an anxiety disorder. The doctor did an appropriate interview, prescribed a fairly standard dose for the patient. ...
Subsequently they charged him with overprescribing. The typical coercive techniques were employeed, promising more serious charges and higher fines if he didn't plead out. They fined him over $174,000 under the civil assets forfeiture system where they can basically steal your...
...stuff when they say, with no evidence, you made money off illegal activity. It's leglized theft. They don't ever even have to bring charges. The psychiatrist in this case was charged because he prescribed a benzodiazepine for anxiety without, pay attention, a MEDICAL exam. ...
Frankly, I've never known psychiatrists to perform a medical exam and would be very nervous if one wanted to 'examine' me. Psych diagnoses are generally arrived at by patient interview and observing the patient. This was 100% a scam. They took his medical license and destroyed...
his decades long career and his life. But, hey, lots of local government entities made bank, let me tell you. This situation with untold numbers of doctors affected. The pressure on our doctors is to quit prescribing pain medicine for pain and anxiety medicine for anxiety.
In terms of sheer medical knowledge the benzodiazepines do carry some risks more problematic than opioids but millions have been treated since that class was deveoped an they were and are a godsend for people with serious anxiety. They are targetting our doctors to get to us. ...
Enter SCOTUS. They vacated a lower court's conviction of a doctor caught in a DEA scam and sternly instructed the lower court that the prosecution must prove their case. Duh! So, what do I find right after SCOTUS rules?
More astroturf research now saying opioids don't help chronic pain. WTF? So, they may have to leave our doctors alone. They can't convict on their 'evidence.' As more doctors fight back, more are aquitted and their little tea party has been disrupted. They've been working...
...with an organization on these guidelines that would not hesitate to move opioids to Schedule 1, a ban on prescribing any opioids. So, there's people being sent home after abdominal surgery with Ibuprofen? There is something of an outcry about that.
Here's where they are: they can't keep the doctor scam going because that is so obviously outside the bounds of our justice system (you know, technically). Doctors are fighting back. The general public is not happy going home with little better than aspirin after being cut open.
Instead of shutting down this war on opioids which is now, very much, a war on people in pain, the anti-opioid propaganda is ramping up. They can't persecute our doctors and regular citizens are not going to stand for being cut open and sent home without pain medicine. What ...
...now. It seems they are now, as I expected, putting out scam reviews and 'research' that chronic pain patients have the same damage to their nervous systems that also cause addiction in people. None of that is true, in the least. And here's where this whole scam reveals the..
...true purpose behind all of it. They are very close to declaring chronic pain patients should not take opioids. I see it. We are seeing an epidemic of suicides in chronic pain patients, people whose pain has been under control with virtually no side effects for years, if not...
...decades who have continued to work or function productively in some capacity. People bedridden with pain were given their lives back and are now being yanked off pain medicine and returned to their beds in agony. They're getting shut down on the using our doctors to ...
....get at us and non-pain patients aren't going to put up with no pain medicine after surgery or a bone fracturs. So, they have to pinpoint the real problem (for them) which is 30-50 millions chronic pain patients, the ones who are killing themselves unwilling or unable to...
...endure endless pain, laying in bed praying for death. Why are the 30-50 million people who mostly have been helped by pain medication a problem? It's because we are mostly older and disabled. With the stealth program of Trump's (now Biden's) campaign to privatize Medicare...
...one aspect of the war on pain patients is they are able to drive a whole lot of older and disabled patients who are expensive to treat to kill ourselved. The for profits don't want to take over Medicare with a large population of expensive patients to treat. Even with the...
...pretty shocking cost of today's opioids it's still a better deal, cost wise, than frequent invasive procedures with disppointing results or even these cocktails of seizure meds and anti-depressants they foisted on us and don't work well for most people. So, what's up? ...
Despite the fact our pain is not that expensive to treat, we are still largely a group of older, sicker people who have a range of medical problems. People use more healthcare resources in the last year of life than many do in the course of all the years before. As well as...
...being more humane, Hospice does keep those costs of the last year where aggressive treatment doesn't lead to 'cure' and people are suffering needlessly while not being returned to functioning. Most people don't want to do that at some point. Hospice is humane and cost ...
...effective. The point about Hospice is it saves money, makes a peaceful death possible but the main thing here is it's the patient's choice. No one should be forced to give up chances to prolong their life unless they've arrived at that decision.
What about people who...
What about people who...
...don't have a terminal illness that qualifies them for Hospice or patients who don't choose to end curative treatments. That's where the problem is. They can't force us to go on Hospice. We're still older and in many ways sicker and...expensive. A group of 30 to 50 million...
...patients in chronic pain includes a number of the more problematic patients they want to dump and I can't think of a more effective way to get rid of us than refusing us the relief we need. They don't have to kill us and they don't have to lay a hand on us to torture us...
...just refuse to relieve our pain and we'll do it for them. The fact that suicides have increased steadily among pain patients since the CDC guidelines were published should be receiving some coverage but it is not. This is the beauty (for the government) of corporate...
...control of the media. Since their interests align they will hide anything they don't want us to know. Here's what they're hiding. Their 'research' is cooked. Most of what they tell us about opioids and addiction is false, either an outright lie or an exaggeration of fairly...
...rare side effects experienced by people actually in pain. They're hiding the untold numbers who have already ended their lives and are thinking of ending it. They're hiding the effects of the war (now on pain patients) on opioids is having. The fact no one knows is because...
...they don't really want to admit there's a campaign to rid them of older, sicker Americans. With Wall Street on the verge of being handed our Social Security trust fund, they'd, also like to lower the number of people drawing benefits. This is also a factor. Getting rid of ...
...older, sicker patients benefits everyone (except the suffering patients and the people who rely on them. How many grandmothers are providing child care so parents can work?)
I have some predictions. They will, soon I think, tell doctors opioids don't work for chronic pain and chronic pain patients will become addicted (no evidence, a loose correlation between a nervous system anomaly seen in addicts and pain patients with zero evidence we're more...
...likely to become addicted. Of course a patient on opioids has a higher risk of addiction than one not on it but medicine is a cost benefit ratio-does the benefit outweigh the risk or is it a significant risk for little relief. Frankly, the most important factor is the...
...patient's feelings on it. All medications and treatments carry potential risks. Medicine uses informed consent. Tell the patient the risks and allow them to decide if it's worth it. Patients in pain actually become addicted at far lower rates than those using drugs for...
...recreational purposes but no one's going to admit that when they have an outcome they want (fewer old people and sick people). When side effects of any medication present, the goal is still about cost-benefit ratios. If the drug is providing the intended help, the severity
...of the risk is weighed against not having the benefits. People, addiction is a tough problem but it is not the end of the world. A pain patient who develops an actual 'addiction' who is getting adequate relief can be maintained at a dose that controls the pain but doesn't
...cravings. I keep repeating this. Pain is an antidote to narcotics and it takes a hell of a dose to produce 'eurphoria' in a patient with high pain levels. It rarely happens and, when it does, it can be treated. It does require some vigilance but I don't think a substance use..
disorder warrants a sentence of life in agony. This is personal to me. I've been in pain for over 30 years, the last 1-2 decades high levels, almost constant without treatment. I've had doctors over the years who used opioids to treat me and I've gone years without any
...treatment. Like most pain patients I don't experience a high that sets up a craving as we see in addiction. Although if you're in constant pain having the pain go away feels wonderful but it's not cause we're high. The years I had doctors who treated me, my life was better...
...and the years I haven't been treated are a struggle and don't seem to serve much purpose for me or anyone else in my life. I'm hoping with the news blackout around the crisis in our community the message will start getting out. I'm telling right now people are dying at ...
...their own hand to escape the pain and it's intentional. I don't know what mass killing of old people or sick people is called but I know it's the goal. If you can help spread the word, or if you know any independent journalists who have the time to trace down these moving...
...parts, if you can help in any way, please don't let them eliminate us and let us die with no one ever knowing what was done to us. We've lost too many already. If you've read all this, thank you. Our community of chronic pain sufferers are not able to fight for ourselves.
We really need some advocates and we're forever grateful for the ones we have. Blessings.
PS: I have few hours in a day I'm able to process and write. I am intolerant of remaining upright for extended periods and pain really messes with my concentration. I'd welcome feedback as I know I jump around a lot explaining a complicated issue. I welcome feedback and opinions.
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