Could we soon be leaving behind the assumption that anyone wanting opiate painkillers is or could soon be an addict? President Obama's new director and deputy director of the White House Office of National Drug Control Policy (ONDCP) and are saying some things that make me optimistic.
The director is R. Gil Kerlikowske, and he says the "war on drugs" is over. That doesn't mean we won and there's nothing left to fight -- he's trying to end the war-on-drugs mentality that drug addiction is a criminal matter, and instead focus on the public health issues of identification, prevention and treatment of addiction.
The deputy director is A. Thomas McLellan, PhD, and he has 35 years experience in researching addiction treatment. In a recent JAMA interview, McLellan said some things that make me hopeful for pain patients:
"There are some very good, clear indicators that addiction has an at-risk period. It is basically adolescence, somewhere between age 10 and 21. If you don't become addicted to tobacco, alcohol, cocaine, or opiates by that time, you probably are not going to be."
Doctors need to know this, so they'll stop denying pain medications to those of us who are well north of the drinking age and have never had a substance abuse problem!
"One of the things we're going to be doing is urging medical schools, nursing schools, and pharmacy schools to devote courses to substance use disorders. It's very important to be clear that substance use disorders are public health problems. . . . This is one of those areas that physicians, nurses, and pharmacists are not adequately trained in."
Finally, someone's talking about the proper role of the medical community -- an educated group that can recognize and head off substance abuse in the early stages, rather than a law enforcement watchdog group that creates a barrier between patient and treatment.
JAMA asked McLellan specifically about opiate abuse, which is currently the second leading cause of death in the U.S. While lowering the rate is obviously a major concern, he says the goal is to do so without compromising pain treatment. To come up with policies, the ONDCP is working with the Department of Health and Human Services, the National Institute on Drug Abuse, the FDA and large medical societies.
McLellan outlined 3 areas that need improvement:
- Patient education: making sure patients know the low risk of addiction and proper use of these medications, to alleviate fears of becoming addicted.
- Doctor-patient contracts and communication about medication management and storage, and also about the risks of sharing their pain meds with other people.
- Prescription drug monitoring through electronic health information systems to prevent doctor shopping.
He adds that there is a role for law enforcement when it comes to doctors who are willfully violating the law. However, he says most doctors aren't doing anything illegal and that clearly outlined policies will help them prescribe these drugs without fear of legal or professional repercussions.
I hope these changes come swiftly and that doctors start getting the message that responsibly prescribing pain medications won't create untold numbers of addicts, get their license to practice revoked, or land them in jail. It could also help change the public perception that anyone who takes opiates long term "must" be an addict.
What do you think about these policies? Are they a good place to start, or too little too late? What else do they need to do to ensure pain patients get proper treatment, while keeping drugs away from abusers? Leave your comments below!
Source: JAMA, The Journal of the American Medical Association
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I have been denied pain meds from my doctor. I have trouble functioning on a day to day basis. He says I need to use “pain management”. I’m miserable with my fibromyalgia.
I’m so sorry, I am in the exact same boat.And I can’t receive disability either. People who abuse the system have ruined it for people like you and I, so now we cant even receive the treatment we need.I’m tired of being treated like a junkie by the medical system when im truly in agony.I want my life back
You might want to talk to your doctors about treating your pain with Suboxone. That is what my pain clinic does and it is almost impossible to abuse and it treats your pain effectively. I am able to work a 40 hour week because of it. Any doctor can prescribe it if it is used for pain, while the number of patients a doctor can have is limited, and the doctor must be licensed if they are prescribing it for addiction.
Amy- get a new doctor. You do not have to suffer because of one uninformed idiot. I see a Rheumatologist… maybe you should look for a specialist too, one that is trained and up-to-date about fibromyalgia.
Gentle hugs!
My wife has FM and she occasionally takes Hydrocodone for some old high school sports injuries that flair up once in a while but our Rhumetologist told her that painkillers like hydrocodone don’t have any effect on FM because the FM pain is muscular not nerve based. That seemed to make sense to me at the time but now I’m confused why this drug control policy would be a big deal to people with FM if traditional painkillers didn’t work for them. Can someone explain this?
From Adrienne: In studies, narcotic pain killers have not done well against fibromyalgia pain. In the real world, though, many of us DO get relief from them. Also, your doctor’s statement that our pain is muscle based and not nerve based makes no sense to me — our pain comes from nervous system dysregulation, not muscle irregularities. ~Adrienne
I take tramadol/Ultram for fm, technically it is an opiod, but it may as well be bayer asprin. It works for 80-90 percent of fm pain, then when u have extra pain called breakthru pain
I take the Hydrocodone and it definely has got me thru some powerfull flares. It’s nsaids that don’t work for FM pain. I tried those first before coming to the dr. and they made me sick I was trying so hard to get rid of the pain with anti inflamatory ibuprofen ect…. your doctor is wrong, Adreinne is right. It’s the amplification of pain signals that r sent to our muscles. This is the only thing besides muscle relaxers that works for pain.
I am unable to get pain relief medication on Medicare and was unable to get any while on Medicaid even though I went through the fair hearing process. But it seems to me that the new legislation isn’t going to change that.
It is so strange to me that physicians can say that opiates do not work for FM. I know numerous people w/ FM that could not function until they were put on pain medication. A multimodal approach seems to work best for most. I have had nurse practitioners and Drs look at me and say “suboxone ” does not help your pain. I don’t bother to even discuss it w/ them. I would like to say really ………come live in body for a few days and you tell me,.
Hi,
i have had Fibro for over 20 years now, i have found that massages help and staying away from SUGAR!!! that is the enemy!!!
I have FM along with some very painful medical conditions with it I have been trying 2 do a research on FM I have lived with very bad pain 4 at least 20-25 yrs just in the last 5 yr some 1 has actually believed me I found 1 DR who got my med script from medicare 2 cover a almost new med out for cancer patiences and yes go ahead and call me a druggie I don’t care because going though my day without pain & being able 2 funcition is all I care about I was on alot of pain meds but they either didn’t work or made me sick or so out of it I couldn’t do nothing I just told my Dr he needed 2 do something that I was at my breaking point & I refused 2 take meds that made me so I couldn’t do anything he then try me on Kadian a form of pain killers 4 cancer doesn’t make u sick and u can do things I call it a micale drug check into it
I would like to disabuse the abuse notion. I have been on Hydrocodone (codeine and tylenol) for about 8 years and take less that is perscribed. On good days I can skip a dose, but my muscles hurt, not my brain. Most doctors are very afraid to deal with even low level narcotics like this, and the government regualtions do nothing to help. If not for this medication I would not be a functioning member of society. If they really listen to pain patients, they would find that you do not feel ‘high’ if you are taking the appropriate amount to combat the pain. And no, it does not numb all the pain, but it sure helps.
AMY,I HAVE SEVER FIBROMYLGAI AND HAVE BEEN ON MEDICARE FOR FIVE MONTHS AND MY PRIMARY CARE PHYSICIAN AND MY RHEUMATOLOGIST ARE SUPPORTING ME IN GIVING ME TWO DIFFERENT FORMS OF PAIN RELIEF OR I COULD NOT FUNCTION.MY PAIN LEVELS ARE OFF THE CHART AT TIMES AND I COULD NOT IMMANGEN NOT HAVEING THESE PERSCRIPTIONS.YOU NEED TO FIND A SPECIALIST IN RHEUMATOLOGY AND THE RIGHT PRIMARY CARE MD THAT IS SENSITIVE TO YOUR NEED WITH THIS DIBLILLITATING DESEASE CALLED FIBROMYLGIA.YOU NEED THE SUPPORT OF DOCTORS THAT ARE EXPERANCED WITH FIBROMYLGIA AND KNOW TH PAIN AND SUFFERING THAT WE GO THREW EVERY DAY.IF YOU FIND THE RIGHT DOCTORS THEY WILL HELP YOU WITH GETTING THE WRITTEN PAPERWORK APPROVED BY THE MEDICARE OR MEDICADE HEALTH CARE PROVIDER YOU ARE WITH.I WILL PRAY AND ALSO ASK OTHER PEOPLE THAT HAVE FIBROMYLGIA TO PRAY FOR YOU THAT YOU WILL FIND THE RIGHT HEALTH CARE PROFFESSIONALS AND YOU WILL BE ABLE TO GET THE PAIN RELIEF YOU NEED.GOD BLESS…SINCERLY ,DAVE
Isaac,
I was diagnosed with FM 15 yrs ago at the age of 16. I was originally given this same line, “Narcotics don’t help fibromyalgia pain.” I even read this in a book. At the age of 25 we moved and my new doctor disagreed with this idea and prescribed me tramadol and darvocet. I couldn’t believe the difference it made in my life. I now had the ability to function, take care of my children, and enjoy a certain part of my day. My husband who was originally against treating my pain with narcotics quickly changed his mind. I find it difficult not to be bitter about the 9 years of suffering I endured based on a misconception.
Furthermore, if fibromyalgia were just muscle pain without a neurogenic component drugs like Lyrica would have no baring as these drugs target the nervous system.
I am now an R.N. who fights aggressively for her patients right to pain control.
What scares me about this new legislation is the bit on Dr. shopping. It would be easy to assume that anytime a person gets a new doc and they have narcs on their record that they are “Dr. Shopping” For example, I’ve been with the same Dr. for almost 4 years. I went to his partner for 6 months before I picked him up but ditched that doc because after being told repeatedly he would not agree to suppress my TSH per protocol for a patient with a history of thyroid cancer. If you looked at my records it would be very easy to assume that I left this doctor because of our differences of opinion on pain control. I don’t want anyone telling me that I have to have the same doctor indefinitely.
Well there is one HUGE answer to this whole problem and it has shown its affectiveness in many pain treatment and management circumstances. Something that doesn’t even have a hint of an addictive trait and if made legal could change more than the world of medicine but debt also thus relieveing stress pains and it goes on and on like a row of dominos. Think about it really study both sides of it for yourself and really ask yourself the cost and benefit comparison. Marajuana, an ancient answer to everyday problems… Don’t let racism win no longer, we are only hurting ourselves….
I am an RN and was diagnosed with Fibromyalgia 13 years ago. I did everything imaginable to try to avoid narcotic pain meds because I wanted to be able to continue to work. But, ultimately, I had to give in and take MS Contin for my pain. In combination with other medications, this was the only thing that remotely helped me. I take my meds as prescribed, but my dose hasn’t been changed since the beginning of the illness. Doctors still imply to me that it is all in my head. Believe me, no one would choose to live like this. We all suffer because of those who abuse pain meds. Don’t expect any new laws to change anything, either. It will only get worse.