Dr. Stefan Kertez posted a series of 18 tweets, supported by reference links, illustrating the many errors of the CDC opioid prescribing guidelines and how pain patients are being harmed to the point of killing themselves.
- Stefan Kertesz (@StefanKertesz): 1/An exquisite portrait of suicide &despair in pain patients after involuntary opioid discontinuations came out http://www.bendbulletin.com/topics/5342867-151/opioid-crisis-pain-patients-pushed-to-the-brink
- Stefan Kertesz (@StefanKertesz): 2/It shows those who think we’ll solve addiction with pill control that this leaves some in pain, sick or dead
- Stefan Kertesz (@StefanKertesz): 3/ Here a mother accepts she must let her daughter with pain proceed to suicide. They were left with no viable options
- Stefan Kertesz (@StefanKertesz): 4/Here,loss of a renal transplant after involuntary 90% taper on a patient who had been stable on opoids @medrants : http://thehill.com/blogs/pundits-blog/healthcare/326095-as-a-physician-i-urge-other-doctors-to-cut-back-on-prescribing
- Stefan Kertesz (@StefanKertesz): 5/Public comments to this piece included actual suicide plans. Pat DID kill herself, I’m told. Is that progress?
https://www.statnews.com/2017/02/24/opioids-prescribing-limits-pain-patients/- Stefan Kertesz (@StefanKertesz): 6/The pressure to stop prescribing is relentless. Every Rx’d opioid is “as addictive as heroin” said a CDC Director. https://www.cdc.gov/media/releases/2016/t0315-prescribing-opioids-guidelines.html
- Stefan Kertesz (@StefanKertesz): 7/And addiction is so simple, said a governor, we can eliminate it with a “click of our fingers”, so there! https://www.nytimes.com/2016/10/20/us/vermont-governor-proposes-limits-on-painkiller-prescriptions.html
- Stefan Kertesz (@StefanKertesz): 8/We are told, falsely, the CDC Guideline mandates dose reductions, but it does NOT. Dr. Dowell and I agree, as @MarkianHawryluk reports
- Stefan Kertesz (@StefanKertesz): 9/Some argue that anyone asserting concerns of this nature is merely a mouthpiece of the devious opioid lobby .http://www.bendbulletin.com/topics/5342867-151/opioid-crisis-pain-patients-pushed-to-the-brink
- Stefan Kertesz (@StefanKertesz) 10/After 21 years taking care of homeless people and researching addiction, I wind up not interested in Pharma and vice versa, I hope
- Stefan Kertesz (@StefanKertesz): 11/For a patient on hi dose who’s stable, we should offer care for mental health, non-Rx options & consider monitored opioid continuation.
- Stefan Kertesz (@StefanKertesz): 12/Pushing to make numbers drop, while ignoring patient outcomes, is an imperative we’ll regret,like past failures: https://scholar.harvard.edu/nkc/publications/implications-recent-clinical-trials-pay-performance.
- Stefan Kertesz (@StefanKertesz): 13/Opioid over-prescribing entailed the dumb logic of chasing a number(pain scores). Making the same mistake in reverse will fix nothing
- Stefan Kertesz (@StefanKertesz): 14/I’m alarmed that some tacitly assume a wave of suicides is either not real,ignorable,or inevitable.Let’s keep our humanity!
- Stefan Kertesz (@StefanKertesz): 15/Remember @CDCgov’s Working Group demanded monitoring for “unintended consequences” of the opioid guideline. https://www.cdc.gov/injury/pdfs/bsc/observations.pdf
- Stefan Kertesz (@StefanKertesz): 16/I stand with former Surgeon General Vivek Murthy’s caution against excessive pendulum swing in our prescribing http://www.nejm.org/doi/full/10.1056/NEJMp1612578
- Stefan Kertesz (@StefanKertesz): 17/I stand with Dr. Kroenke’s temperate advisory that “imperfect treatments do not justify therapeutic nihilism” http://jamanetwork.com/journals/jama/fullarticle/2627567
- Stefan Kertesz (@StefanKertesz): 18/No death should be minimized, be it a patient with pain,or addiction, or both. Read @markianhawrluk’s piece. http://www.bendbulletin.com/topics/5342867-151/opioid-crisis-pain-patients-pushed-to-the-brink
EDS and Chronic Pain News & Info 
Opioid Epidemic
I have been taking opioid medication since 2005 when I was hit by a truck in Austin Texas, since then I have undergone four major surgeries, and relied on morphine and hydrocodone daily plus epidural injections during cold weather.
The current publicity of actions against “The Opioid Epidemic” are of great concern to me, as I live in chronic pain and I wish you to be aware of the following Key Facts and Experiences.
Cost Benefit of Opioids
For information, this year I underwent Total Knee Replacement (TKR) – this has allowed me to eliminate daily morphine from my pain medication regime. This experience also demonstrated the Cost Benefit Analysis of Opioid drugs. The cost of eliminating 2 daily morphine tablets was approximately $35,000.
To eliminate the 4 hydrocodone I take daily would conservatively cost in excess of $100,000 for additional medical procedures.
Availability of Pain Management Resources
Since 2005 I have been fortunate to find four excellent doctors that offer Pain Management: I have also experienced several doctors that claimed expertise in Pain Management but:
offered pain management until I signed onto their partnership and they had run a gambit of tests and billed my insurance company, or
wrote a script for one month’s medication only without any evaluation or consideration of my injuries, or
wrote a script for only ½ the medication I had been taking for for than 10 years – they did this without any help in management of my pain
Personal Responsibility – the Solution
Last year my wife and I moved to South Carolina to benefit from warm winter weather. With help from my doctor I underwent TKR, took three bouts of Physical Therapy: on my neck/shoulders; right knee; and lower back. Cumulatively this work enabled me to take myself off of morphine, greatly improved my quality of life, and eliminated my need for epidural injections.
Conclusions
In my case, my treatment options were seriously limited because the City of Austin capped my $650,000 award to $106,000, which did not cover medication and procedures.
For those of us that need opioids to manage pain there are no magic bullets in managing that pain without opioids.
A blanket reduction in opioids prescribed would be unconscionable: without a corresponding increase in medical support to those in pain. Such action would leave many people unable to manage the Activities of Daily Living (ADL’s)1. The result would be catastrophic and include the break-up of families, Doctors risking their licenses by continuing to treat their patients and an increase in suicides.
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Your story seems to be a happy one because the surgeries did resolve much of your pain. It is ironic that maintaining a person on opioid meds is usually cheaper than the surgery, PT, and other follow-up care that would eliminate the need for thmem.
However, I and many others have painful issues that can’t be resolved by surgery (genetic connective tissue disorder) and some who find their surgeries only left them in even more pain (which leaves them with that offensive “failed back surgery syndrome” which is so common that it has its own ICD code.
I agree that personal responsibility is necessary, whether that be educating ourselves about our conditions, attempting various non-opioid treatments, or asking for corrective surgery if appropriate. But when all that fails, as it has for so may of us, all that’s left is trying to relieve the pain that has no cure. Then, our doctors (and now ignorant legislators, self-deluded experts, and the DEA) hold our lives in their hands when they can choose to prescribe opioids to allow us some quality of life, or deny us pain relief and force us into a lifetime of suffering.
I personally resisted opioids for many years of my pain and it was only when it interfered with earning a living that I gave in. Then, I was taking them only to maintain my job and continued search for the cause (and subsequent cure) of my pain.
I had to stop working when the pain & fatigue overwhelmed me and the cause of my pain ended up being genetic – and it’s guaranteed to worsen with age. There’s no cure, only symptom management, and the main symptom is chronic pain.
What purpose is served by condemning me and others like me to unnecessary suffering?
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