Pain patients shouldn’t suffer from opioid crackdown

Maine Voices: Legitimate pain patients shouldn’t suffer from crackdown on opiates – The Portland Press Herald / Maine Sunday Telegram By Douglas J. Jorgensen

A state bill that aims to control pain medications is based on empty rhetoric and fear mongering.

I’m writing to express concerns about the 350,000 Mainers with chronic nonmalignant pain and L.D. 1646 [the state bill], meant to better control dispensing pain medicine in Maine.

As a federal expert witness and litigation consultant for the U.S. Drug Enforcement Administration, the FBI and the Office of the Inspector General, I’ve helped imprison and remove from practice physicians around the country who have killed patients by overprescribing controlled substances.  

This makes Mr. Jorgensen a powerful voice advocating on our behalf. He was on the other side, so he knows much more than the “experts” on how drug prohibition works.

Heroin and illicit opiate use is at a record high. But legitimate pain patients using opiates for therapeutic purposes should not suffer because of the impact of addiction and political pressure to fix what has become an epidemic in our country.

There are more patients in chronic nonmalignant pain than cancer, cardiac and diabetic patients combined.

Yet pain patients – legitimate, well-vetted patients – are treated like pariahs. From family and co-workers to pharmacists and ERs, pain patients have overt biases thrust on them.

Needing pain medicine does not make one a drug addict or a criminal. Arguably, neither does being an addict make someone a criminal.

However, in our current societal climate, those physically dependent and using medication appropriately are treated like drug addicts. “Drug addicts” – people with a substance use disorder – are treated worst of all, though they have an illness that needs treatment, not disdain and criminalization.

Nonmedical use of prescription opioids is the real issue. Nonmedical users take pain medicine either not as prescribed or from a nonmedical source; that is, other than how it was prescribed or intended. While nonmedical opioid use has dropped, it correlates with escalation of heroin use.

A significant portion of nonmedical users in the general population (48 percent) use opiates for untreated or poorly treated pain; another 32 percent have mental health disorders.

the notion that taking prescription pain medicine inevitably leads to addiction is absurd

Addiction is a biogenetic, behavioral disorder with predictable risk factors. Using pain medicine nonmedically may potentially increase the risk of abuse, but it does not mean that pain medicine causes abuse.

Limiting access to opiates in appropriate, therapeutic medical settings will only lead to more nonmedical use, diversion and heroin use

In the pain world, there are two camps on pain medications:

  1. those who believe in using opiates and
  2. those who don’t.

There’s not much gray area.

The U.S. Centers for Disease Control and Prevention guidelines for prescribing opioids for chronic pain were designed for primary care, not pain medicine. L.D. 1646 does not distinguish between the two

Moreover, the consulting CDC authors were not the national opiate authorities.

In short, the study was biased to address addiction issues, not pain management.

We have over 4,000 patients in our pain practice; only 209 are on chronic pain medication. Functionality, not pain relief, is the goal for pain treatment.

With proper risk-mitigation strategies in place, diversion and subsequent illicit use can be rapidly identified. It is imperfect, but it is the best means to identify and stop diversion while still providing care to those who need it.

Rhetoric and fear mongering are inappropriate methodologies to manage a medical condition. Legitimate patients must not suffer because addiction has become the enormous problem it is

Legislating medical management is a dangerous trend.

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