Example of Pill Mill behavior by Walgreens

Walgreens, OxyContin Profits, Ethical Responsibility and the DEA – Salem-News.Com

These examples from 2012 explain why the DEA is cracking down on pharmacies. There’s no question the hunt for abusive opiate prescribing has gone too far, but pharmacies were apparently happy to pocket the profits from the huge sales generated by pill mill prescribers:

Recently the Drug Enforcement Agency (DEA) accused the pharmacy chain, Walgreens with “endangering public safety” and prevented Walgreens from shipping OxyContin and other dangerous painkillers from their Jupiter, Florida distribution center.

This certainly explains the shortages, which Walgreens has brought upon itself with its reckless drive to increase profits. Continue reading

Reduced Cold Pain Tolerance Following Opioid Detoxification

Reduced Cold Pain Tolerance in Chronic Pain Patients Following Opioid Detoxification – free full text PubMed article

The results of this study are obvious to those of us with pain, but not to scientists, exposing how differently our pain is viewed from the outside.


One potential consequence of chronic opioid analgesic administration is a paradoxical increase of pain sensitivity over time. Little scientific attention has been given to how cessation of opioid medication affects the hyperalgesic state. In this study, we examined the effects of opioid tapering on pain sensitivity in chronic pain patients.

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‘Faking’ or ‘Malingering’ or ‘Exaggerated Pain Behaviour’

‘Faking’ or ‘Malingering’ or ‘Exaggerated Pain Behaviour’ | HealthSkills Blog

It’s amazing how often health providers get asked directly or indirectly whether someone experiencing pain is ‘faking’ it. The short answer is the most accurate – we can’t tell.

Remember the biopsychosocial model of pain states that the experience of pain and pain behaviour is influenced by three broad groups of factors:

  • the biomedical/biophysical factors such as extent of tissue disruption at the periphery (or site of trauma),
  • neurological changes of transmission and transduction (throughout the peripheral and central nervous system), and
  • disturbance of the neuromatrix.

At the same time, there are psychological factors such as the level of alertness and arousal, attention, past learning, expectations, beliefs, attitudes, mood, contingencies and so on.

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Chronic Pain Treatment: Ethics, Distress, Frustration

Below are three studies that examine the narratives of people with pain. They are unusual because they are qualitative, not quantitative, studies.

Defining chronic pain ethics. [Pain Med. 2011] – PubMed – NCBI

OBJECTIVE: identify current issues in the diagnosis and treatment of chronic pain.

Focus groups were convened to discuss the current issues in chronic pain care. Commentary was analyzed across focus groups using an interpretivist method of qualitative data analysis. Setting. Focus groups were held in five major US cities throughout the United States.

Six major themes emerged regarding chronic pain, all of which contained an ethical component:

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Protect Pain Care | Dr. Jeffrey Fudin

Protect Pain Care | Dr. Jeffrey Fudin

The latest indignity and law enforcement incursion upon medical service:

check out http://www.protectpaincare.org/.

This is as foul an indignity as people with chronic pain have yet suffered. And all because we have failed to change our healthcare system to accommodate the use of controlled substances for pain, with training, time, reimbursement and all the things that are needed to make opioids safer. Physicians don’t have the time to assess and monitor people with pain but profiteers and others do.

If I had chronic pain and was desperate, would I be willing to sacrifice my privacy and further sacrifice my dignity? Up to now I would only have had to do that at the pharmacy. Now my doctor, the person I hope to trust and have trust me back, is going to farm out the job of assessment and monitoring of me to law enforcement – are you kidding me!?!? And if I don’t want to participate, what choice do I have?

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Catecholamine polymorphism influences opioid use

Catecholamine polymorphism influences opioid use

The catechol-O-methyltransferase (COMT) rs4680 single nucleotide polymorphism could affect postoperative opioid consumption, study findings show.

those homozygous for the high enzymatic activity genetic Val/Val variant consumed 36% more opioids in the first 24 hours following nephrectomy than patients homozygous for the low enzymatic activity Met/Met genotype.

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Balancing Risks, Benefits of Prescription Painkillers

New DEA Rules Aim to Balance Risks, Benefits of Prescription Painkillers : Roll Call Policy

 Congress and the Food and Drug Administration [are trying] to address abuse of opioid pain relievers that often are obtained legally but then diverted for unapproved use.

Some pain management groups representing patients with chronic conditions and debilitating diseases are concerned lawmakers and officials will overreact and block access to needed treatments.

“It’s a complex problem, and a simple solution that just says, ‘Reduce the supply of medications,’ is not the answer,” said Bob Twillman, director of policy and advocacy for the American Academy of Pain Management. “You’re not only reducing the supply for those who use them inappropriately, but also for those in need.”

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Independent Medical Examiners: facts, fallacies, and lies

Independent Medical Examinations: facts and fallacies. [Pain Physician. 2009 Sep-Oct] – PubMed – NCBI

This study only reinforces what the insurance companies claim, that “Independent Medical Examiners” are valid judges of a person’s disability. Because they are selected and paid by the insurance company that is trying to deny benefits, their role is highly suspect.  This article is little more than a whitewash, as was proven to me by my own experience.

I had often heard that the IMEs will go to great lengths to deny claims of disability, even resorting to lying, but I didn’t believe this.  In good faith, I went to the IME I was sent to by my disability insurance and presented myself just as I am: not visibly disabled and having taken enough pain medication to make the long drive bearable.

During the exam, he repeatedly asked me to get up on and down from the examining table for one test after another. I painfully complied until I finally asked, could you please do all the “on the table” exams together so I don’t have to keep getting up and down? In the report, I was shocked to see a blatant lie: he claimed I had at first “jumped up on” the exam table and then “refused” to get on it again.

This, and other instances of trying to make me seem like a malingerer in the report, made me realize what I’d head about IMEs was true and that I should have protected myself.  Now I add my voice to many others: be sure to take another person as witness or a tape recorder with you into any IME exam!

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Central Pain Syndrome Foundation: Information for Medical Providers

Information for Medical Providers « Central Pain Syndrome Foundation

Central pain syndrome (CPS) is a neurological disorder consisting of agonizing pain signals of many differing types at once: burning, freezing, shocking, aching, crushing, tearing, and spasticity. It has been characterized as the worst pain known to man.

It is caused by damage to or injury of the Central Nervous System (CNS), which includes the brain, brainstem and spinal cord.

It is aggressive, never ending and disabling, making normal life immensely painful and incredibly difficult. The medications and treatments used to fight it are very limited and highly ineffective. There is presently no cure.

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Our Fear of Opioids Leaves the World in Pain

Our Fear of Opioids Leaves the World in Pain | Substance.com

Like torture and cruel and unusual punishment, the under-treatment of pain is a human rights issue.

“Lack of access to essential medicines such as morphine or methadone for treatment violates the right to the highest attainable standard of health, which is one of the human rights conventions that all countries in the world have signed on to,” says Dr. Katherine Pettus, an advocacy officer for the International Association for Hospice and Palliative Care. “It also violates the right to be free from torture and constitutes cruel and unusual punishment.”

I see I’m not the only one to consider the withholding of pain medication as torture. Continue reading