The prescription opioid epidemic in a nutshell

[DrCommonSense]

Not to turn this into a transgender thread but thought these were some good facts:

You won't hear it from those championing transgender equality, but controlled and follow-up studies reveal fundamental problems with this movement. When children who reported transgender feelings were tracked without medical or surgical treatment at both Vanderbilt University and London's Portman Clinic, 70%-80% of them spontaneously lost those feelings. Some 25% did have persisting feelings; what differentiates those individuals remains to be discerned.

We at Johns Hopkins University—which in the 1960s was the first American medical center to venture into "sex-reassignment surgery"—launched a study in the 1970s comparing the outcomes of transgendered people who had the surgery with the outcomes of those who did not. Most of the surgically treated patients described themselves as "satisfied" by the results, but their subsequent psycho-social adjustments were no better than those who didn't have the surgery. And so at Hopkins we stopped doing sex-reassignment surgery, since producing a "satisfied" but still troubled patient seemed an inadequate reason for surgically amputating normal organs.

It now appears that our long-ago decision was a wise one. A 2011 study at the Karolinska Institute in Sweden produced the most illuminating results yet regarding the transgendered, evidence that should give advocates pause. The long-term study—up to 30 years—followed 324 people who had sex-reassignment surgery. The study revealed that beginning about 10 years after having the surgery, the transgendered began to experience increasing mental difficulties. Most shockingly, their suicide mortality rose almost 20-fold above the comparable nontransgender population. This disturbing result has as yet no explanation but probably reflects the growing sense of isolation reported by the aging transgendered after surgery. The high suicide rate certainly challenges the surgery prescription.

And yet Oregon somehow has money to provide for this surgery and HORMONE replacement for their Medicaid systems despite the "EBM" showing otherwise.

Interesting how that works huh?

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Members don't see this ad.

 

[DrCommonSense]

I'll concede, the literature is sparse however I think this is the most compelling evidence against gender reassignment surgery. They followed 300+ patients for 30 yrs!!

"A 2011 study at the Karolinska Institute in Sweden produced the most illuminating results yet regarding the transgendered [sic], evidence that should give advocates pause. The long-term study—up to 30 years—followed 324 people who had sex-reassignment surgery. The study revealed that beginning about 10 years after having the surgery, the transgendered [sic] began to experience increasing mental difficulties. Most shockingly, their suicide mortality rose almost 20-fold above the comparable nontransgender population. This disturbing result has as yet no explanation but probably reflects the growing sense of isolation reported by the aging transgendered [sic] after surgery. The high suicide rate certainly challenges the surgery prescription"

If you have good data supporting your position that meets strict EBM standards please do post. Basically I will disagree with you to the grave so no need to post a rant arguing otherwise.... unless of course you have some good EBM studies, which you don't....

There is no EBM for the surgery but that doesn't matter. In fact, there is FAR MORE evidence for injections than the cutting of genitals surgery for benefit, yet look which one Chou wants to cut.

Come on man, "EBM" is only used for stuff that "consultants" want to cut but ignored when its stuff they like such as gender surgery.

 

[101N]

There are a lot of lessons in here, not the least of which is the country of origin of the smart guy talking

 

[DrCommonSense]

There are a lot of lessons in here, not the least of which is the country of origin of the smart guy talking

LOL yes we need more "investment" in education right? You must be a liberal with this ridiculous stuff that has been literally talked about for the last 50 years without benefit.

http://www.heritage.org/research/re...ng-the-compensation-of-public-school-teachers

The areas with HIGHEST paid public school teachers have the lowest levels of competency among its average student (Chicago is just ONE example)

Whats the solution? Give more money to them?

 

[101N]

Yea, addressing income inequality from the perspective of investments in childhood development (human capital)
is a dumb idea: https://en.wikipedia.org/wiki/James_Heckman

 

[101N]

More on Grit...
https://scholar.google.com/scholar_...wCw&scisig=AAGBfm1O3Aco_-UpmbMS8VPEeS6dNIMCYw

 

[VA Hopeful Dr]

Ok I personally don't think surgery's the right answer but I'll limit my argument to opposing insurance/gov't payment for it. That I think is completely wrong. If they're going to pay for that then then should start paying for all plastic surgery. If it's your right to have your genitalia cut off on my tax dollar then it's my right to have a hair transplant, breast augmentation, tummy tuck, brow lift, or whatever etc. on your tax dollar.

If an insurance company wants to pay for it, I think that's entirely their business. I'm with you on government programs though - and I say this as my little sister has had that surgery (paid out of pocket for, infact).

 

[bedrock]

If an insurance company wants to pay for it, I think that's entirely their business. I'm with you on government programs though - and I say this as my little sister has had that surgery (paid out of pocket for, infact).

Sorry, but that does induce bias and anecdotal experience into this supposedly scientific discussion.
Just like all my patients who think all spine problems must be exactly the same as the one experienced next door neighbor.

 

[VA Hopeful Dr]

Sorry, but that does induce bias and anecdotal experience into this supposedly scientific discussion.
Just like all my patients who think all spine problems must be exactly the same as the one experienced next door neighbor.

Point out where, in my review of the articles that clubdeac posted, I was wrong in my interpretation. You'll note that nowhere did I say I thought it was a cure all either nor bring up my personal experience.

Just because I have personal bias doesn't mean I can't still logically review the evidence. Otherwise, none of you here would be fit to review pain procedure evidence either since it affects your bottom line and I'm sure you have patients that those procedures have helped.

 

[Ducttape]

Speaking of science...

I find it humorous and oddly appropriate that someone who rails so much against EBM uses a conservative think tank to justify his opinions on education....


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[Disciple]

I would hazard that if we were able to effect societal change at an early age, that this might reduce the incidence of those individuals requesting sex change not based on some esoteric genetic or anatomic reason. this goes beyond what the government or school system would do, and would involve changing the mores and social customs of the entire nation.

Yes. This is certainly an interesting academic discussion, and while it deepens our understanding of what leads individuals to develop chronic pain, seek disability, etc. a more modest and pragmatic goal, as it pertains to healthcare, may be to use this information to further refine our screening tools/processes to more accurately identify likely non-responders to certain forms of treatment, particularly with likely cuts in funding to Medicaid on the way.

 

[101N]

Welcome to my world...
http://jamanetwork.com/journals/jamainternalmedicine/article-abstract/2587644

Ultra–High-Dose Opioids With Low Efficacy
and Significant Harm—Time to Make a Change
A Teachable Moment
Story From the Front Lines
A woman in her 50s presented for medically managed
withdrawal from ultra–high-dose opioid therapy for
chronic back pain. Her pain began following a back in-
jury in 1983 that resulted in multiple herniated discs. Tar-
geted injections of chymopapain to dissolve her dis-
placed discs instead left her with arachnoiditis. Over the
next decade, she underwent multiple lumbar spine sur-
gical procedures and at one point returned to work, but
an accidental fall aggravated her injury, rendering her in-
definitely unable to work. Her pain was then managed
with methadone but, concerned about oversedating
effects, she underwent inpatient detoxification. At-
tempts at pain control using nonopioid medication failed
to provide adequate relief, so she was prescribed oxyco-
done, 15 mg, 4 times a day, or 90 mg of morphine equiva-
lent daily dose (MEDD).
By 2000, her dose had escalated nearly 9-fold to
780 mg MEDD. To attempt more localized therapy, she
received an intrathecal pump with baclofen and hydro-
morphone. While it provided the best relief to date, her
doses escalated until she was hospitalized for respira-
tory failure requiring intubation and naloxone. Her in-
trathecal medications were then reduced and supple-
mented with oral hydromorphone. Following a pump
revision in 2008, she acquired a methicillin-resistant
Staphylococus aureus
infection, leading to permanent
pump discontinuation. Instead, she was prescribed
oxycodone at 1620 mg MEDD. After a few years taking
this dose, she was admitted for abdominal pain, weight
loss, and early satiety thought to be narcotic bowel syn-
drome following an extensive workup.
When the patient presented in 2016 to our outpa-
tient pain clinic, she was still prescribed oxycodone, 1620
mg MEDD, in addition to carisoprodol, 5600 mg, and lor-
azepam, 4 mg daily. Functionally, she remained severely
limited—mostly housebound, requiring a scooter for mo-
bility. Her stated functional goal was to be able to visit her
brother and participate in family celebrations. Agreeing
to lower her oxycodone dose but anxious about slowly ta-
pering, she agreed to acutely withdraw. Once admitted,
opioids were abruptly discontinued. She was monitored
using the Clinical Opiate Withdrawal Scale (COWS), and
buprenorphine-naloxone was started roughly 12 hours fol-
lowing her last oxycodone dose (COWS = 18) to avoid pre-
cipitating withdrawal. She responded positively with
enough pain control to continue off full-agonist therapy
without further functional impairment and had an early
benefit of craving food for “the first time in years.”
Teachable Moment
This case illustrates the difficulty in treating chronic non–
cancer-related pain and the out-of-control opioid dos-
ing that can occur when clinicians exhaust alternative
treatments in someone with unrelenting pain desensi-
tized to opioids. The current guidance—continue opi-
oids only if benefit is outweighing harm—would have
served this patient well. She continued to receive opi-
oids over multiple decades despite low efficacy and com-
plications, including hospital admissions for bowel is-
sues, deconditioning, and respiratory failure.
It is perhaps not surprising that this patient contin-
ued to receive opioids despite her related hospitaliza-
tions and limited functional benefit. A retrospective
study examining the treatment patterns of patients
receiving long-term opioids for chronic non–cancer-
related pain showed that 91% of patients hospitalized
for a nonfatal opioid overdose continued to be pre-
scribed them.
1
Patients receiving high-dose therapy
(>100 mg MEDD) had a 17% risk of repeated overdose
within 2 years.
Evidence for long-term opioid therapy in chronic
non–cancer-related pain is weak at best.
2
As opioid over-
use has become a major public health issue, clinicians are
urged to identify patients who may benefit from dose
reduction or discontinuation, for example, patients for
whom opioids have diminishing analgesic effects or are
associated with significant harm.
Guidelines for tapering opioids are still being
developed.
3
As in this case, patients may have anxiety
in anticipation of discomfort related to a lengthy taper.
Significant risks for failing the attempt to taper include
depression, high starting doses, and high baseline pain.
3
For such patients, detoxification can offer a faster
transition.
Opioid detoxification is typically either outpatient
or inpatient, the latter in hospitals or residential facili-
ties. Hospitals are generally reserved for patients with
comorbid medical or psychiatric illnesses, while residen-
tial facilities are preferred for patients who may require
24-hour supervision but not daily physician contact.
While health insurance plans may cover inpatient ad-
missions for opioid detoxification, these are generally ap-
proved for a limited time and with specific criteria, some-
times requiring a failed outpatient trial.
Buprenorphine’s role in chronic
pain following full-
agonist therapy remains to be established, although
findings from observational studies are encouraging.

 

[lobelsteve]

https://www.healthgrades.com/provider/thomas-hourin-xmwkb

 

[lobelsteve]

http://www.myajc.com/news/state--re...s-run-afoul-new-rules/Ubzip600cyBG98fuMKEPkJ/

 

[DrCommonSense]

Speaking of science...

I find it humorous and oddly appropriate that someone who rails so much against EBM uses a conservative think tank to justify his opinions on education....


Sent from my iPhone using SDN mobile

Couldn't be any worse than the current state of education under the liberal public teacher unions.

We literally spend the HIGHEST per capita costs per student with the lowest test scores in the Industrialized world.

If we want to get to "efficiency" for education dollars, Trump is totally right about vouchers to remove the public school monopoly over education that has been DISASTROUS over the last 30 years.

Public Schools should be forced to compete with Private Schools for education dollars so as to force them to provide better education.

Private Schools with far better test scores will put out of business lousy public schools in many cases under this type of free market system. That is why the teacher's union is opposed to it.

 

[Ducttape]

you are making an assumption that may not be borne out in fact.

http://www.edweek.org/ew/articles/2014/05/14/31publicprivate.h33.html

Public Schools Outperform Private Schools, Book Says
By Holly Yettick

The recent publication of a scholarly book has reopened the debate surrounding the academic achievement of public vs. private schools.

Public schools achieve the same or better mathematics results as private schools with demographically similar students, concludes The Public School Advantage: Why Public Schools Outperform Private Schools, published in November by the University of Chicago Press. The authors are Christopher and Sarah Lubienski, a husband-and-wife team of education professors at the University of Illinois at Urbana-Champaign.

Central to the controversy is their suggestion that vouchers, which provide public funding for private school tuition, are based on the premise that private schools do better—an assumption that is undercut by the book's overall findings.

The Lubienskis' analysis draws on data from the 2003 National Assessment of Educational Progress, or NAEP, as well as the Early Childhood Longitudinal Study, Kindergarten Class of 1998-99.

After accounting for socioeconomic status, race, and other demographic differences among students, the researchers found that public school math achievement equaled or outstripped math achievement at every type of private school in grades 4 and 8 on NAEP. The advantage was as large as 12 score points on a scale of 0 to 500 (or more than one full grade level) when the authors compared public school students with demographically similar 4th graders in conservative Christian schools.

The Lubienskis also used NAEP data to conclude that regular public schools outperformed independently operated, publicly funded charter schools in 4th grade math and equaled them in 8th grade math.

on the other side are arguments about SAT scores.
http://study.com/articles/Public_Sc...ls_New_Study_Says_There_is_No_Difference.html

Public Vs. Private School: Study Says There Is No Difference
Jun 13, 2011

With all of the highly publicized failures of America's public schools, it's easy to assume that students in private schools are receiving a better education. But a study released in 2007 by the Center on Education Policy (CEP) found that students in public urban high schools perform, on average, just as well as those in private high schools.

Show me popular schools
Public vs. Private Education
It's easy to assume that private schools deliver a better education because so many of their graduates go on to elite colleges and successful careers. But according to the CEP, this may be due more to demographics than academic quality. When students' family backgrounds and income levels are taken into account, there is no effective difference in the quality of a public or private education.

When the report's authors compared students of similar socioeconomic status at private, public and parochial high schools, they found that:

• Achievement scores on reading, math, science and history were the same;
• Students were equally likely to attend college whether they had graduated from a public or private school;
• Young adults at age 26 were equally likely to report being satisfied with their jobs whether they had graduated from a public or private school;
• Young adults at age 26 were equally likely to engage in civic activity whether they had graduated from a public or private school.

Exceptions
There was, however, one important area in which private school students did excel: SAT scores. Students in private schools performed consistently better on the test than public school students. The study's authors point out that this doesn't imply that private schools are any better at teaching subject matter. They offer two possible explanations for this finding:

• Private schools are better at teaching test preparation.
• The admissions process at private schools tends to select students with higher IQ scores, and aptitude tests like the SAT are a better measure of IQ than subject achievement tests.

Regardless of the reason for the difference, the result is that graduates from private schools are somewhat more likely to get accepted into very elite colleges.

The second exception that the study found was limited to a very specific type of private school. Catholic schools that are run by holy orders, such as the Jesuits, did show consistently positive academic effects. However, this is a relatively small percentage of parochial schools, since the majority of Catholic institutions are run by a local diocese rather than a holy order.

Read the full study, 'Are Private High Schools Better Academically Than Public High Schools?' on the CEP website at www.cep-dc.org.

the point is that private schools and vouchers do not inherently improve education and achievement. student motivation plays a key role
https://web.stanford.edu/class/e297c/poverty_prejudice/school_child/public.htm

By examining the three types of high school education options, private, public, and magnet it becomes apparent that each provides its students with a premium education. It is true that there are a number of students in public schools who are failing, but they are offered the opportunity to get good education, but they choose not to accept this. So the opportunity is there, students just need to make an effort to find it. When choosing between a private, public, or magnet school, parents need not worry about which one provides a better education because each one had ample opportunities available for academic success.

 

[DrCommonSense]

you are making an assumption that may not be borne out in fact.

http://www.edweek.org/ew/articles/2014/05/14/31publicprivate.h33.html

on the other side are arguments about SAT scores.
http://study.com/articles/Public_Sc...ls_New_Study_Says_There_is_No_Difference.html


the point is that private schools and vouchers do not inherently improve education and achievement. student motivation plays a key role
https://web.stanford.edu/class/e297c/poverty_prejudice/school_child/public.htm

Who is group that did this "study"?

Oh wait, its done by the "education department" in Colorado funded by guys like Obama who are paid off by public school teacher unions.

https://en.wikipedia.org/wiki/National_Education_Policy_Center

Here's a WSJ article discussing the results of a voucher program in Washington D.C. showing far superior results with the voucher program:

http://www.wsj.com/articles/SB10001424052748703396404576283381160558552

 

[Ducttape]

Who is group that did this "study"?

Oh wait, its done by the "education department" in Colorado funded by guys like Obama who are paid off by public school teacher unions.

https://en.wikipedia.org/wiki/National_Education_Policy_Center

Here's a WSJ article discussing the results of a voucher program in Washington D.C. showing far superior results with the voucher program:

http://www.wsj.com/articles/SB10001424052748703396404576283381160558552

wasn't "funded" by Obama, when original study came out from 2006 and 2008.

and no access to WSJ. so please post whole article for critique. im willing to guess without reading that that article used "average data" for all individuals taking the test, not specific demographic data comparing like minded students with focus of going to higher education. that is what is clearly stated in the Stanford.edu article.

when controlled (ie remove data for those who have absolutely no interest in higher education), scores are similar.

 

[DrCommonSense]

wasn't "funded" by Obama, when original study came out from 2006 and 2008.

and no access to WSJ. so please post whole article for critique. im willing to guess without reading that that article used "average data" for all individuals taking the test, not specific demographic data comparing like minded students with focus of going to higher education. that is what is clearly stated in the Stanford.edu article.

when controlled (ie remove data for those who have absolutely no interest in higher education), scores are similar.

Google the title of the WSJ article title, it will come up that way. I prefer the "average data" across population then trying to sub stratify special groups to attempt to get a favorable outcome for public schools.

 

[Ducttape]

Google the title of the WSJ article title, it will come up that way. I prefer the "average data" across population then trying to sub stratify special groups to attempt to get a favorable outcome for public schools.

Is there not an inconsistency in your preference for average data across population in this situation, when you are eschewing use of average data in medical decision making? (your distain for statins or antidepressants, for example, as a whole when there is evidence that subgroups benefit from their use)


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[101N]

'Drug Dealer, M.D.': Misunderstandings And Good Intentions Fueled Opioid Epidemic
http://www.npr.org/sections/health-...ign=health&utm_medium=social&utm_term=nprnews
35:10

• Download
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  Endai Huedl/fStop/Getty Images
  America's attitude toward pain has shifted radically over the past century. Psychiatrist Anna Lembke says that 100 years ago, the medical community thought that pain made patients stronger.
  
  "Doctors believed that pain was salutary," she tells Fresh Air's Terry Gross, "meaning that it had some physiologic benefit to the individual, and certainly some spiritual benefit."
  
  But as prescription painkillers became more available, patients became less willing to endure pain. Suddenly, Lembke says, "doctors began to feel that pain was something they had to eliminate at all cost."
  
  
  SHOTS - HEALTH NEWS
  When A Prescription For Pain Pills Becomes A Gateway To Addiction
  Prescriptions for opioid painkillers increased, and so, too, did cases of opioid addiction. In 2011, the Centers for Disease Control and Prevention declared a prescription drug epidemic as a result of doctors overprescribing painkillers to patients. Lembke's new book, Drug Dealer, MD, explores the origins of the prescription drug epidemic from a doctor's perspective.
  
  "Starting in the 1980s, doctors started to be told that opioids were effective treatment for chronic pain, and that treating patients long-term with opioids was evidence-based medicine," she says. "That was patently false and that was propagated by what I call 'big medicine,' in cahoots with Big Pharma."
  
  Interview Highlights
  On how Lembke realized there was a problem in her own practice
  
  
  
  Drug Dealer, MD
  How Doctors Were Duped, Patients Got Hooked, and Why It's So Hard to Stop
  
  by Anna, M.D. Lembke
  
  Paperback, 172 pages
  
  purchase
  
  It was very insidious and subtle. One of the ways I realized was that my patients weren't getting better. They were asking for more and more medications at higher and higher doses. They were wanting early refills, and then it really wasn't until the prescription drug monitoring program was made available in the state of California where I could go online and see the other prescriptions that my patients were getting from other doctors when I suddenly realized what a huge problem it was — not just for patients taking opioid painkillers — but also for my own patients.
  
  For example, I had a patient I was seeing for many years, he was a lawyer and I prescribed him Ambien, 10 milligrams every bedtime. Ambien is a sleep aid. And that went on for years, and, incidentally, I decided to check the prescription drug monitoring program and what I found out was that he was seeing at least 10 other doctors who were also prescribing Ambien, 10 milligrams daily. He had an Ambien addiction, and I never knew until I checked that database.
  
  
  
  On treating patients with perplexing pain
  
  I see a lot of patients with mysterious chronic pain syndromes, and many of them are young people who otherwise have no evidence of disease, but are completely debilitated and nonfunctional by their mysterious chronic pain syndromes. ...
  
  What ends up happening to these patients often is they get "medicalized," and by that I mean they end up seeing four or five or 10 different specialists. Everybody has a different diagnosis. They get poked and prodded and "surgerized," and by the end of it they come out five or 10 years later with real bona fide physical problems because they've had so many surgeries and so many interventions. And by then they're also on very high-dose opiates.
  
  On how what doctors were told about opioids changed over the years
  
  Doctors were taught that no dose was too high. So if you had a patient who responded to opioids, but then developed tolerance where that dose wasn't working, when they came back in you should just give them more opioids. And that's how we got to this place where we have patients who are on unbelievable doses, astronomical amounts. ...
  
  Doctors were told that opioids are not addictive as long as you're prescribing them for a patient in pain, as if there was some sort of magic halo effect with the prescription. That also is obviously not true. Now we're seeing studies showing that upwards of 50 percent of patients taking opioids long-term for a medical condition begin to show signs and symptoms of addiction to those opioids.
  
  On what Lembke means when she says that big medicine and Big Pharma "were in cahoots"
  
  The pharmaceutical industry realized that they can no longer directly go to doctors to get them to prescribe their pills. Various regulations were put in place to prevent them giving gifts and pens and hats and things that we do know can influence doctor prescribing. So instead they took a kind of Trojan horse approach and infiltrated regulatory agencies and academic medicine in order to convince doctors that prescribing more opioids was evidence-based medicine, and evidence-based medicine means medicine based on science, and that's something that all doctors are supposed to practice. ...
  
  So for example, what they did was Purdue Pharma joined forces with the Joint Commission, and the Joint Commission is an organization that accredits hospitals, and Purdue Pharma gave all kinds of teaching material to the Joint Commission and said, "You really need to make doctors treat pain more aggressively and that needs to be a quality measure." So the Joint Commission said, "You know what? You're absolutely right, and we're going to do that and we're going to take your videos that you made that tell doctors that opioids aren't addictive as long as they're treating them for pain." ...
  
  So it became a kind of groupthink where it looked like treating pain aggressively with opioids was something that was based on science, when in fact it was based on Big Pharma's influence of these major regulatory bodies.
  
  
  
  
  Dr. Anna Lembke is a psychiatrist who treats people who are addicted to prescription drugs, including opioids, stimulants, sedatives and sleeping pills.
  
  Norbert von der Groeben/Johns Hopkins Univ Press
  On doctors learning how to say "no" to their patients
  
  It's not something that we really learn in medical school, and I think it's something most doctors have a hard time with, because we go into medicine because we like helping people and we want to experience the warm fuzzies of having helped somebody and them expressing gratitude. And so to be in conflict with our patients around what their goal is and what my goal is for them is extremely challenging. ...
  
  It's something that a lot of doctors avoid, which is also why a lot of doctors don't even ask their patients about substance abuse problems, because they just don't want to go there. They don't want to have to deal with the tension that arises in the interaction, in the moment when they are talking about something that the patient is resistant to talking about. But I feel like that is my job to do that, and I feel like I've developed skills over time.
  

 

[lobelsteve]

 

[drusso]

Dr. Audette is a PHYSIATRIST not a psychiatrist...sigh...

 

[neutro]

I object to Dr Sizemore's assertions.
# 1 - she is a cardiologist, yet she is very loud in her assertions. Not sure how many pain patients she manages as a "quadruple boarded cardiologist".
# 2 - She gives an example of a patient who broke their leg 5 years ago and now has pain and should not be on meds. I would like to agree, but the patient could have CRPS, a post surgical complication, and other many complications. Many of these conditions may require opioid management esp. if refractory to interventional and surgical intervention. Who is she to write patients off. I find it annoying.
I am not saying yes or no to opioids, but she represents a dangerous and ignorant view here. She is dismissive of a patient with chronic non-malignant pain and is painting all of them with one brush. A 64 year old patient patient who has worked all their life and is s/p 4 back surgeries and SCS trial, implant and explant on 5 vicodins a day to remain functional is very different patient than a 25 year old patient who has a back strain, abuses tobacco and marijuana and looking for disability. She is putting all of them in one category of "chronic non malignant pain" and ignoring the various factors that go into deciding if a patient will benefit from opioid therapy.
Again, its clear that this is not her specialty and she is probably the wrong doctor for this forum. I would have loved to see an interventional pain physician there or a surgeon.
I liked the addiction doctor's input.

 

[drusso]

I object to Dr Sizemore's assertions.
# 1 - she is a cardiologist, yet she is very loud in her assertions. Not sure how many pain patients she manages as a "quadruple boarded cardiologist".
# 2 - She gives an example of a patient who broke their leg 5 years ago and now has pain and should not be on meds. I would like to agree, but the patient could have CRPS, a post surgical complication, and other many complications. Many of these conditions may require opioid management esp. if refractory to interventional and surgical intervention. Who is she to write patients off. I find it annoying.
I am not saying yes or no to opioids, but she represents a dangerous and ignorant view here. She is dismissive of a patient with chronic non-malignant pain and is painting all of them with one brush. A 64 year old patient patient who has worked all their life and is s/p 4 back surgeries and SCS trial, implant and explant on 5 vicodins a day to remain functional is very different patient than a 25 year old patient who has a back strain, abuses tobacco and marijuana and looking for disability. She is putting all of them in one category of "chronic non malignant pain" and ignoring the various factors that go into deciding if a patient will benefit from opioid therapy.
Again, its clear that this is not her specialty and she is probably the wrong doctor for this forum. I would have loved to see an interventional pain physician there or a surgeon.
I liked the addiction doctor's input.

Broader politics in play: There is a coalition of people who seek to push chronic pain out of the bailiwick of bonafide health care into the realm of cosmetic surgery, etc.

 

[VA Hopeful Dr]

Seems pertinent...

http://www.foxnews.com/health/2017/...d-painkiller-outweigh-benefits-fda-panel.html

 

[DrCommonSense]

Seems pertinent...

http://www.foxnews.com/health/2017/...d-painkiller-outweigh-benefits-fda-panel.html

Yeah well they shoot it up but don't snort it using that stuff at far higher prices than generics.

Makes sense to not approve unless they make a formulation that can't be abused in any fashion.

Lyrica got the panel committee overruled to get approval for fibro, so we'll see.

 

[lobelsteve]

http://www.bmj.com/content/356/bmj.j760

 

[lobelsteve]

Morning paper: against opiates.
Protect Georgia families from opioid overdose

Morning email: for opiates.
CDC Guideline on Prescribing Opioids: Some Major Concerns - Print Article

 

[101N]

Financial Disclosures for Jeffrey Fudin, PharmD, DAIPM, FCCP, FASHP
Practical Pain Management, a Vertical Health, LLC website, is committed to ensuring that the medical information it presents is accurate, balanced, objective, and trustworthy.

To help achieve this goal, Practical Pain Management requires all authors, editors, and reviewers to disclose any financial relationships or affiliations they have with companies whose products or services may be mentioned in the content they author, edit, or review.

The intent of this policy is to identify any perceived, potential, or real conflicts of interest so that readers can make their own judgments about the value of information being presented.

Author's Statement
I, or an immediate family member, have a financial interest(s) or affiliation(s) with the following commercial companies whose products and / or services may be mentioned in the materials I have authored, edited or reviewed for presentation on Vertical Health, LLC’s websites.
Disclosed Relationships
Consultant
Endo, KemPharm, Millenium, Scilex Pharmaceuticals
Stock/Shareholder
Remitigate, LLC (Founder, Owner)
Speakers' Bureau
Astra Zeneca, Kaléo, Millenium, Pricara Pharmaceuticals
Other Financial or Material Support
Dr. Fudin: Astra Zeneca (speakers bureau, advisory board); DepoMed (advisory board); Endo (consultant); Kaléo (speakers bureau, advisory board); KemPharm (consultant); Millennium Health LLC (speakers bureau, advisory board, expert witness); Practical Pain Management (development of online opioid-conversion calcu-lator); Remitigate LLC (founder, owner); Scilex Pharmaceuticals (consultant); and Zogenix (consultant).

 

[lobelsteve]

Agenda from the other side, check.

 

[drusso]

Agenda from the other side, check.

Hung by their own petard.

 

[drusso]

Putting an End to Oregon’s Opioid Woes | The Lund Report

"It’s time for Oregon policymakers to stop whistling past the graveyard and fast track much needed legislation to end the opioid abuse epidemic, according to the author."

 

[lobelsteve]

Weight-Loss Drug May Help in Opiate Addiction

 

[Ducttape]

One short letter's huge impact on the opioid epidemic - CNN.com

No, it's not the article you think would be most impugned...

Sent from my iPhone using SDN mobile

 

[epidural man]

Weight-Loss Drug May Help in Opiate Addiction

Is it time to invest in ARNA?

 

[pjuer]

The opioid epidemic: A problem that’s worse in deep Southern Illinois

 

[drusso]

Drug deaths still rising.

https://www.nytimes.com/interactive...shot&nl_art=0&nlid=37558637&ref=headline&te=1

 

[nvrsumr]

What happened to 101? Was interesting to hear about the parallel universe he practiced in.

 

[lobelsteve]

What happened to 101? Was interesting to hear about the parallel universe he practiced in.

Too much vitriol on here against his viewpoints. Good guy. Hope he is lurking and thinking what a bunch of idiots we still are.

 

[ampaphb]

Too much vitriol on here against his viewpoints. Giod guy. Hope he is lurking and thinking what a bunch of idiots we still are.

Pot, meet kettle. You spewed some of that vitriol

Sent from my SAMSUNG-SM-G930A using SDN mobile

 

[drusso]

Too much vitriol on here against his viewpoints. Giod guy. Hope he is lurking and thinking what a bunch of idiots we still are.

A useful guide to navigating SDN, its posters, and malcontents...

 

[pastafan]

A useful guide to navigating SDN, its posters, and malcontents...

View attachment 219917

I always thought of the pain forum as analogous to Lake Wobegon.

 

[ampaphb]

A useful guide to navigating SDN, its posters, and malcontents...

View attachment 219917

Might I suggest outstanding a$$holes, as well as complete f$%k-up nice guy and a$$holes as additional subgroups?

 

[drusso]

Might I suggest outstanding a$$holes, as well as complete f$%k-up nice guy and a$$holes as additional subgroups?

A very lawyerly suggestion...

 

[drusso]

Opioid crisis: Pain patients pushed to the brink

“It happens every day,” said Dr. Anna Lembke, a psychiatrist with Stanford University Medical Center, and author of a book on the prescription drug epidemic, titled “Drug Dealer, MD.” “Doctors suddenly realize that they have a patient who’s on a high dose or using in a risky way and just decide they’re going to bail. They tell patients, ‘I don’t treat pain anymore’ or ‘You’re too high risk.’”

 

[DOctorJay]

The opioid crisis changed how doctors think about pain - Vox
nice summary

 

[kstarm]

The opioid crisis changed how doctors think about pain - Vox
nice summary

Nice Summary. It gets at how the opioid crisis has really overshadowed the chronic pain crisis in our country, and how opioid-focused treatment plans have been for chronic pain.

 

[lobelsteve]

On the other hand...

https://www.mdlinx.com/rheumatology/article/595

New opiate mu and nociceptin. No dependence.

 

[ampaphb]

On the other hand...

https://www.mdlinx.com/rheumatology/article/595

New opiate mu and nociceptin. No dependence.

The fact that you had to edit their title, and explain that it was dependence, not addiction, tells me everything I need to know about these researchers.