What is worse, the Opioid Epidemic or the Stupidity Epidemic?

What is worse, the Opioid Epidemic or the Stupidity Epidemic? – National Pain Report – June 8, 2017-  By Dr. Jay Joshi, CEO/Medical Director – National Pain Centers in Chicago.

I didn’t get far into this article before I began to doubt what the author was saying:.

When other physicians, especially in the university setting, were prescribing “opiates for everyone”, “there are no dose limits”, and “opiates are not addictive as long as you have pain”, I felt compelled to stand up for logic and common sense.

Challenging a valid statement about dose limits is a denial of fact.

From what I’ve read about pain and opioids,  there is no valid dosage limit or maximum dosage for opioids as long as enough tolerance has developed over time.  

Also, many patients and even some doctors have noticed that people in pain react to opioids differently than those who don’t need them for pain. (See Opioids + Pain != Euphoria)
I commented on sections of that article:

This “Silent Epidemic” of counterfeit and substandard medications is a subject I’m highly interested in, so the lack of specific information is frustrating.

I hope Dr. Joshi (or the editors or anyone else) can show me where I can find more information and hard nubmers about this scourge.

The Stupidity Epidemic has caused more suicides because of inappropriate pain management than prescription opioid deaths, even from illegitimate patients and illegitimate medical care.

This is extremely important data to present as we fight to maintain access to opioids – I really want to blog about and publicize this. Can you give me a link to where you found the numbers?

We are still seeing illegitimate patients who are trying to get high.  We are still seeing prescriptions for “illegitimate” pain management molecules that are less safe, dangerous, and very addictive (here’s looking at you oxycodone, alprazolam, carisoprodol, zolpidem, etc)

Could you explain what you mean by “illegitimate” molecules and how they differ from “legitimate” ones, perhaps with some examples?

Prescriptions that are manufactured illegitimately, such as counterfeit and substandard medications, is a major problem.

This is the first time I’ve heard that even prescribed prescriptions from the pharmacy could be counterfeit and substandard – I find it truly terrifying – could you point me to where I can find more information about this?

I have been the national pain management physician leader on both education and solutions to this “Silent Epidemic” of counterfeit and substandard medications.

I’ve long wondered about the month-to-month variability I notice in the daily medications I’ve taken for years, including opioids, and such a “silent epidemic” would explain a lot.

The impact of this would reach far beyond just opioid medications. I really want to learn more about how this is happening and which parts of the supply chain are vulnerable, so could you point me to more information?

When I discussed how properly administered ketamine infusions could reverse central sensitization

This is exciting news! I’ve read that ketamine can lift depression and might be effective for CRPS, but I didn’t know it could reverse central sensitisation. Please let me know where I can find more information about this.

The Stupidity Epidemic has caused the media and the so-called experts to lambaste safer medications all while promoting more dangerous medications.

Which are the safer and more dangerous medications?

The Stupidity Epidemic has caused insurance companies to force physicians to prescribe and pharmacies to dispense dangerous counterfeit, substandard, and generic medicines with variable bioavailability, efficacy, fillers, and pharmacokinetics.

I’m angry that such a terrible scandal hasn’t made it into the mainstream media – or even the medical media I read!

we have to make sure the patient is legitimate through a variety of screening tools.  We have developed proprietary technologies that can help us identify illegitimate pain patient trends

This is exactly what they say they’ve been waiting for: accurate, dependable, screening for addiction. Which company has developed these proprietary tools? They must be promoting them online somewhere – can you give me a link?

We will really start curbing the Opioid Epidemic and the Stupidity Epidemic if we start authenticating medications that can be counterfeited and diverted.

It’s awful to think I  may have been consuming adulterated medications for all these years. Some sort of authentication stamp on “legitimate” medications would be very reassuring for all patients.

But I don’t understand how authentication of pharmacy-dispensed medications will ease the opioid epidemic.


I posted my comment on the day the article was published, June 8. Though my comment was accepted, I have received no reply to my many questions.

I think that, much like in politics, we in the pain/addiction community are being pushed to one extreme or the other and losing any reasonable middle ground in the process.

When an article so full of provocative and unverified statements without any evidence appears in the “pro-pain-patient” publication, it seems no pain patients will question it for fear of being disloyal to our cause.

Dr. Joshi is an “Interventional Pain Management Specialist” who is in the business of providing epidurals and surgeries to treat pain.

He owns a very successful and thriving business:

National Pain Centers™ (multiple locations)
Leaders in Interventional Spine and Complex Pain Management
“WE ARE IN THE HONESTY BUSINESS”™

Any business that needs to stress its honesty probably struggles with the concept. Even the phrase has been trademarked as though it was something unique. Perhaps it is in this field.

What is the implication? Other interventional physicians are dishonest? Perhaps Dr. Joshi knows how shady these businesses are.

Wellness Center USA, Inc. completed its acquisition of National Pain Centers, Inc. on February 28, 2014.

NPC is now a wholly-owned subsidiary of WCUI and is managed by its founder and CEO Dr. Jay Joshi, MD, DABA, DABAPM, FABAPM.

Since WCUI is a publicly traded company, Dr. Joshi, like any good entrepreneur, will make a lot of money by selling his startup.

Dr. Joshi has also joined WCUI as its Chief Medical Officer (CMO) and a member of its Board of Directors. Dr. Joshi is a nationally recognized double board certified Anesthesiologist and fellowship trained Interventional Spine and Pain Management physician who possesses the rare ability to combine clinical medicine, research, creativity, marketing, inventions, and business development. [and brag about it while making tons of money]

This guy is clearly more concerned about his business empire than helping patients, which he wouldn’t have time for in his busy days finagling profits for himself.

He is definitely NOT advocating for access to opioids, but rather access to “legitimate” molecules (what that means is undefined) and the kind of surgical invasive procedures that provide so little benefit for most patients.

I refuse to be tied into black-or-white advocacy where everyone “on our side” is uncritically assumed to be “right” and “good”.

This is why I am not a member of advocacy organizations. Not everyone on our side is flawless, brilliant, completely honest, or incorruptible – that’s just a matter of statistical probability.

I’m so sick of the propaganda from the other side and so disappointed to see its emerging influence on our side that I feel like giving up my advocacy work.

I have a great doctor and a reliable supply of opioids for my pain, so this battle has not even affected me personally. I’m just furious about the general injustices heaped upon people like me.

If pain patients are going to accept anything that seems to defend them without critical thinking and questioning, then they are not “people l like me” after all.

 

 

If Dr. Joshi had at least address my questions, I would feel differently. But it looks like he’s just another shyster.

Let’s not be fooled by sales pitches and propaganda from those seeking to profit from our misery – even if they are on “our side”.

 

 

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2 thoughts on “What is worse, the Opioid Epidemic or the Stupidity Epidemic?

  1. lawhern

    I filed the following thought with the original article as my second commentary. I tried to be nice with the first, and the good doctor flat out ignored the weakness of his own arguments.

    =================

    Dr. Joshi: You wrote a follow-up comment as follows:

    “The CDC Guideline has multiple recommendations. 10 out of the 12 are very accurate. 2 are open to debate. The Guideline was meant for primary care physicians, not pain specialists. The media has twisted the Guideline maybe because the Guideline was made without any fellowship trained pain specialists. That said, we have almost no patients over 90 MMED and none on benzos. Folks, it can be done in almost all chronic pain patients with proper multimodal pain management. There are reasons why 90MMED was chosen by the CDC. That also being said, there are exceptions, and I’m sure many of those exceptions are reading articles on sites like National Pain Report. Believe it or not, the CDC Guideline allows for exceptions! The Stupidity Epidemic caused the media and insurance companies to pervert the Guideline!”

    ===================

    My Commentg:

    With no intention of discourtesy, sir, I must suggest that you have just about all of this narrative factually wrong.

    — The core consultants group which wrote the guidelines deliberately tried to stack the deck against the effectiveness and risks of opioids, from the get-go. And they got caught at it. To support their assertion that opioids are ineffective over the long term and pose a dangerous risk of addiction, they deliberately cherry picked from published work and imposed limitations on their analysis of opioid effectiveness that they did NOT apply to non-opioid medications or behavioral therapies. They also omitted the 2010 Cochrane Review of long-term effectiveness from their research, despite the fact that the leader of the consultants working group had included it in previous CDC reviews of the literature.

    — The media and insurance companies have indeed twisted the narrative on the so-called “opioid epidemic”. But to claim that the guidelines were intended to be voluntary ignores the facts. The US Veterans Administration was directed to make them mandatory in the December 2015 Congressional budget resolution bill — four months before CDC published, and WELL known to the authors and CDC bureaucrats.

    — Possibly the only reason 90 MMED popped up from the Guidelines is that the writers couldn’t find any studies of risks versus benefits that weren’t structured around that figure as one of four strata (zero control group, 0-20 MMED, 20-50 MMED, 50-90 MMED and above 90 MMED). While trends indicated a generally higher risk of opioid abuse disorder for higher doses of opioids, the populations of these studies appeared to be quite heterogeneous. Two of the studies addressed hospital admissions for opioid toxicity and two of them addressed deaths attributed to opioid overdose. The writers also ignored inconsistencies between the studies and omitted all of the confounds and reservations of the papers that they relied on to draw their pre-determined conclusions.

    http://nationalpainreport.com/tracking-down-the-research-behind-the-cdcs-opioid-prescribing-guidelines-8831122.html

    — The writers also ignored a well established body of medical literature which demonstrates that there are possibly hundreds of thousands of US chronic pain patients in whom opioid metabolism is highly variable due to polymorphism of genes which govern enzymes involved. This literature prompted FDA to ban codiene and Tramadol for children, out of concern for hypermetabolizers in whom these drugs might be dangerous because of elevated blood levels of morphine. Possibly more fundamentally, however, the literature demonstrates amply that there are possibly hundreds of thousands of poor metabolizers who might be helped by opioids — but only at much higher levels than the magical 90 MMED. There are published reports of successful pain management in at least a few patients maintained stably on doses exceeding 2500 MMED, and of many thousands on doses over 200 MMED. See the published work of Dr. Forest Tenant in “Practical Pain Management”.

    If none of your patients are maintained on doses over 90 MMED, then I must suggest that many of those whom you serve are likely under-medicated and in severe pain despite the low levels they take. Have you done follow-up surveys? If you haven’t done genomic testing for enzymes involved in metabolism, then you won’t know who among them is unable to absorb the medications you’ve prescribed.

    — The CDC guidelines are totally silent with regard to “exceptions” to the 90 MMED mythology. They are also silent with regard to any reason or logic for forcing hundreds of thousands of patients to taper down from levels over 90 MMED. But that silence has merely facilitated the epidemic of stupidity and a wave of arbitrary and destructive dose reduction. See the work of Dr Stefan Kertesz on the unlikelihood that pill counting will have any impact at all on deaths due to opioids — but may pose a risk of elevated rates of suicide.

    I strongly recommend that you read the introduction which PAIN Week offered for one of my articles here on National Pain Report: “What if Prescribing Guidelines Were Patient Centered?”

    https://www.painweek.org/news_posts/what-if-prescribing-guidelines-were-patient-centered.html

    The paper which this prominent publication introduced is “How Might Opiod Prescribing Guidelines Read if Pain Patients Wrote Them?” I invite your comments as a medical professional on this article.

    See http://nationalpainreport.com/how-would-opioid-prescription-guidelines-read-if-pain-patients-wrote-them-8833330.html

    Likewise as an independent and very well researched review of the CDC guidelines, I refer you to “Neat, Plausible, and Generally Wrong — A Response to the CDC Recommendations for Chronic Opioid Use” by Stephen A. Martin, MD, EdM; Ruth A. Potee, MD, DABAM; and Andrew Lazris, MD

    View story at Medium.com

    Regards and well wishes,
    R.A. “Red” Lawhern, Ph.D.
    Personal Homepage — “Giving Something Back”
    http://www.lawhern.org
    lawhern@hotmail.com

    Liked by 1 person

    Reply
    1. Zyp Czyk Post author

      Dr. Joshi is far too busy with his businesses and making money to care what we say.

      He’s a businessman, not a doctor. I looked him up online and all I saw were business articles – he sold his clinic to a larger entity of which he is now a part-owner.

      He aspires to riches, not service to patients.

      I even sent my concerned comments (the ones I posted here) to Ed (NPR) and he said he would forward them to Dr Joshi – I felt my response was too negative to post publicly. But I’m not surprised that I received no response. I’m only surprised that Ed published that obviously uninformed BS article… and how many patients responded positively.

      The article was a mumbo-jumbo of platitudes and falsehoods that he wrote to make a hero of himself (and drum up more business and put on his CV).

      There was really no meaning to the article at all. That’s what made me so mad.

      Liked by 1 person

      Reply

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