This is a diary I have been wanting to write for some time now. I saw my pain doctor in December and at that time told him I had gotten a Medical Marijuana card, but had no reliable way to get marijuana.
Unfortunately, Gov. Brewer decided to play politics with the MM law in AZ and refused to let dispensaries open. Now that Gov. Brewer has lost two court cases, one federal and one state, she is trying to act like she is bowing to the will of the voters. Nothing could be further from the truth. She has fought the will of the voters for over a year. She is only letting the process go forward after a judge ordered her to let dispensaries open. This could take months to a year. The last year without dispensaries has made it difficult for the already 18,000 approved MM patients in AZ to get their medicine.
"It's unfortunate that the state leadership has tried to drag this out and not move forward with the will of the people and unfortunately it took a judge's ruling for that to happen," said pharmacy technician Greg Rogan.
My doctor, now, does not want to refill my pain meds, and wants to send me to another doctor, because I told him I got a MM card, but had no way to get MM because of Gov. Brewer. He has refilled it, but cut it. I have never abused a pain prescription that my doctor has given me. I have never “run out early” or “needed more”. I was on minimal pain medication, anyway, because of a compromised liver. I cannot take stronger medications because of allergies and drug reactions. I take schedule III, not schedule I drugs. I knew this was going to happen, but sometimes, someone needs to make a stand. I am making a stand for MM and for people in pain to get relief. Pain patients not getting medication has become an epidemic in this country.
I am in pain every minute I am awake. I have lived with DDD for many years. For a small percentage of people, this condition is genetic, as in my case. Others in my family are in worse condition than me, right now. I was evaluated by the finest specialists in AZ, and there is nothing they can do for me. I was told in my forties I had the spine of a ninety year old woman. “When God was handing out spines, you got the KMart special,” one of them said to me. It was not funny. I cried. Pain has ruined any quality of life I ever had. This is very normal with someone with my condition. My life sucks now. My future looks worse.
Degenerative disc disease can lead to a chronic debilitating condition and can have a serious negative impact on a person's quality of life.
If I get depressed, it is because pain controls my life and every single choice I make. There is a direct correlation between pain and depression. I cannot do what I want to. or I would have moved from AZ years ago. One of the hardest things for me to do is drive or travel. Just doing the basic maintenance of my home and personal care is an ongoing struggle. Having to fight for my right to be free of some of my pain depresses me. I am not alone. Millions of others are caught in this situation. Who speaks for them?
I have made the changes I can in my life with my available resources and help, which, since my husband died, is almost nil. He did a lot, and would have done anything, to help me. Caregivers are also under stress. I have only myself to depend on. I do the best I can. I think about the millions in pain who are stuck, helpless, with no advocate or relative to help them.
This is my attempt to be a small, perhaps pathetic, voice for all of them.
more below the squiggle
The Politics of Pain: Stop the Madness
To Whom it May Concern: patients, doctors, anyone with a relative or friend in pain, politicians, drug agents
The greatest evil is physical pain.
St. Augustine
“Pain is inevitable. Suffering is optional.”
There is an epidemic in this country that is affecting millions of cancer patients, the elderly, the dying, and people with chronic painful diseases, such as HIV and MS. There is a failure in this country to treat pain patients. In the last decade they have become the latest, innocent, casualties caught in the crosshairs in America’s failed, immoral War on Drugs. It is cruel, unnecessary and unconscionable. The doctors are treated as drug dealers, the patients as drug addicts.
More than half of all hospitalized patients experienced pain in the last days of their lives and although therapies are present to alleviate most pain for those dying of cancer, research shows that 50-75% of patients die in moderate to severe pain.
http://jama.ama-assn.org/...
It's the war on drugs vs. the war on pain, and the patients who need the meds are losing.
http://www.talkleft.com/...
Untreated pain is a growing epidemic in this country and the ineffective management of it has become a costly, unsustainable health care crisislooking into the future. And, it is all because of America’s failed Drug War. It needs to end.
Sens. Herb Kohl (D-Wis.) and Sheldon Whitehouse (D-R.I.) have written to Attorney General Eric Holder protesting the DEA crackdown on pain medicine prescriptions. Pharmacies, nursing home administrators and geriatric experts agree with them. They are asking Holder to revise DEA policies on prescribing meds like percocet and morphine, and to seek a legislative change.
http://www.washingtonpost.com/...
In 2011, at least 116 million adult Americans have common chronic pain conditions, a conservative estimate because it does not include acute pain or children.
http://www.painmed.org/...
Pain patients and their doctors became the focus of the DEA after pressure from Congress for failure to achieve any measurable reduction in drug use in America after waging an expensive, decades long War on Drugs, This focus became intense during the Bush Administration under Ashcroft. It is so much easier to go after people in pain and their doctors who keep records than to try to rid the streets of illegal drugs,
But in 1999 the DEA came under heavy criticism from Congress on the grounds that there was no “measurable proof” that it had reduced the illegal drug supply in the country. In 2000 and 2001 the Department of Justice, which administers the DEA, gave the agency a highly critical rebuke, and asserted that the Drug Enforcement Agency’s goals were not consistent with the president’s federal National Drug Control Strategy. The DEA would need to find a new front for the War on Drugs, one that could produce tangible, measurable results.
Hutchinson explained the necessity for renewed vigilance in the War on Drugs, and why the new front against prescription painkillers was necessary. He announced that the DEA would reallocate many of its resources from illegal drugs in urban areas to illicit prescription drugs in rural areas in order to address the emerging opioid threat. Hutchinson said that the DEA would work with local and state law enforcement agencies in the effort, and would use its Asset Forfeiture Fund to help state and local officials finance the new initiative.
Prescription drug abuse has been exploited by the DEA and the media in order to justify the crackdown on doctors and legitimate pain patients. There is plenty of evidence out there.
Many articles have been written on the subject. I am not here to argue that point. Pain patients did not create the addicts or the problem. They are the ones being hurt by the problem. I am speaking for them.
Why do we continue this failed Drug War that has claimed millions of victims? There is no evidence to support or justify it. Millions of lives have been hurt and destroyed. It is time to stop the madness.
After 40 years, the U.S. war on drugs has cost $1 trillion and hundreds of thousands of lives - and for what? Drug use is rampant and violence is even more brutal and widespread.
Even U.S. drug czar Gil Kerlikowske concedes the strategy hasn't worked.
"In the grand scheme, it has not been successful," Kerlikowske said. "Forty years later, the concern about drugs and drug problems is, if anything, magnified, intensified."
http://www.azcentral.com/...
Pain is a costly health problem in this country, growing more expensive, because of the DEA’s crackdown on pain doctors, their patients, and the least expensive and most effective treatments for pain, opiates and marijuana.
Pain is a significant public health problem that costs society at least $560-$635 billion annually (an amount equal to about $2,000.00 for everyone living in the U.S.).
In 2008 the cost to federal and state governments of medical expenditures for pain was $99 billion.
Medicare has noticed the astronomical rise in the use and cost of facet joint injections, one of the fastest growing treatments for many painful conditions (purportedly as a way to reduce the use of opiates as a treatment for pain), and released the most comprehensive report of the evidence to date in March 2011. Throughout the report there is little or no benefit in reduction in pain medication, mobility, or pain for the vast majority of cases. The cost effectiveness was another major factor in the reports.
Results
From 1997 to 2006, the number of patients receiving facet joint interventions per 100,000
Medicare population increased 386%, facet joint visits increased 446%, and facet joint interventions increased 543%. The increases were higher in patients aged less than 65 years compared to those 65 or older with patients increasing 504% vs. 355%, visits increasing 587% vs. 404%, and services increasing 683% vs. 498%.
Total expenditures for facet joint interventions in the Medicare population increased from over $229 million in 2002 to over $511 million in 2006, with an overall increase of 123%. In 2006, there was a 26.8-fold difference in utilization of facet joint intervention services in Florida compared to the state with the lowest utilization - Hawaii.
There was an annual increase of 277.3% in the utilization of facet joint interventions by general physicians, whereas a 99.5% annual increase was seen for nurse practitioners (NPs) and certified registered nurse anesthetists (CRNAs) from 2002 to 2006. Further, in Florida, 47% of facet joint interventions were performed by general physicians.
Conclusions
The reported explosive growth of facet joint interventions in managing spinal pain in certain regions and by certain specialties may result in increased regulations and scrutiny with reduced access.
http://www.biomedcentral.com/...
One of the means of controlling health care expenditures is by ensuring that all care is medically necessary and avoiding overuse, abuse, and fraud. The OIG report suggests that there is significant overuse, abuse, and potential fraud in performing facet joint interventions in the United States.
(boldness added by diarist)
This Medicare study is very long and the most comprehensive work put together on the subject of injections to date. They have looked at every study, type of injection and condition for which they are used. I encourage you to look at it.
This was the most comprehensive look at the efficacy, benefit and cost analysis of these injections. You will find no benefit or low benefit all through these reports. There has to be some scientific basis, some cost effectiveness or reduction in pain medications, to justify the cost and risks associated in these shots. The proof is not there. After being used for decades, there are still studies being done to determine the efficacy to support the continued use and cost of these injections. It is costing Medicare millions. They are much more expensive than writing a prescription for opiates which have been proven safe and effective.
"Opioids when taken under clinical supervision are not that dangerous," says the American Pain Institute's Myers. "The data tells us that only 3 percent of people who take opioids become addicts. The latest research conclusively shows that the best medicines for the treatment of chronic pain are narcotics. They have less side effects and more benefits than any other type of drug."
Despite the widespread rise in the use of these spinal injections, their application is based widely on anecdotal evidence and is not evidence based. We highlight the need for prospective randomized trials on the clinical efficiency of spinal injections and stress the importance for future considerations of cost effectiveness to justify their further application
http://www.ncbi.nlm.nih.gov/...
Medicare Part B physician payments for transforaminal epidural
injections increased from $57 million in 2003 to $141 million to 2007.
This represents an increase of almost 150 percent.
http://oig.hhs.gov/...
EFFICACY:
Bernstein ([xix]) looked at injection therapies in chronic pain and concluded:
"There was limited evidence of effectiveness (level 3) of intraoperative steroid at discectomy, epidural steroid injection for sciatica with low back pain, caudal steroid injection for low back pain...
The recent Cochrane Review on Injection therapy for subacute and chronic benign low back pain concluded: "Convincing evidence is lacking on the effects of injection therapies for low back pain."([xxi])
Anderson and Mosdal ([xxvi]) found that epidural steroid injection was "useless" in patients with long-lasting complaints and previous disc operations.
This finding was also seen in the study by Cuckler et al ([xxvii]), which failed to demonstrate ESI efficacy, with the authors also raising the issue of published reports of "serious complications".
Although, the explosive rise in the use and cost of these injections has been noted and studied, the government has yet to make the connection between the immense increase in their use for pain treatment and the crackdown on doctors who prescribe pain medication. But I have. They go hand in hand. One has led directly to the other, causing doctors to use more expensive, riskier treatments, because they don’t want to prescribe opiates. That might bring the DEA to their door, and they stand to lose everything, their livelihood, license and assets.
I understand the pressure, scrutiny and position doctors are being placed in, but I am tired of being caught in the middle, along with millions of others who are suffering.
NSAIDS have been proven to cause liver and kidney damage, but this is what most pain patients turn to when they cannot get their medicine. They are sold over the counter. Many pain patients who cannot get treatment commit suicide.
(alcohol - liver failure and warnings for acetaminophen and NSAIDS) "... we [the U.S. Food and Drug Administration, HHS] have recent data suggesting that acetaminophen may be the most common cause of acute liver failure in the United States (Ref. 13). Therefore,we believe that the word "severe" is appropriate in the liver warning. In addition, we agree with the submission that the word "severe" is also appropriate in the stomach bleeding warning on OTC NSAID [nonsteroidal anti-inflammatory drug] products."
http://drugwarfacts.org/...
"Major adverse gastrointestinal events attributed to NSAIDs are responsible for over 100,000 hospitalizations, US $2 billion in healthcare costs, and 17,000 deaths in the US each year. Despite improvements in the available medications to aid in healing and treatment of NSAID-associated complications, the number of hospitalizations and deaths has remained unchanged in the US in the last decade."
http://www.healthsentinel.com/...
More dangerous, contends Myers, are the everyday drugs that pain sufferers turn to when they can't get narcotics. He talks about something called "suicide by Tylenol":
"When chronic pain patients can't get opioids, they go out and use tremendous amounts of drugs like Tylenol and Motrin, which can cause serious liver and kidney damage. Pain patients are dying from kidney and liver disease because of this."
Many pain patients are also dying by their own hand, according to the Pain Relief Network's Reynolds. "All over America, pain patients are committing suicide because of the DEA's campaign," she claims. "I know of at least 17 recent cases in Arkansas alone. It's really astonishing the amount of human carnage that this campaign has already caused."
I understand the fear pain doctors are feeling from the DEA. I am all too aware of how the War on Drugs has turned its focus on pain doctors and their patients. The Obama Administration recently addressed it:
Last week, unveiling a plan to curtail "diversion" of opioid painkillers, Obama administration officials said they aim to "strike a balance between our desire to minimize abuse of prescription drugs and the need to ensure access for their legitimate use."
This balance will never be achieved because the two goals are fundamentally irreconcilable.
http://patriotpost.us/...
Just hope it is never you trying to seek pain relief while this perverted drug war rages on:
I made a speech recently about pain management at a Washington, D.C., meeting of the American Medical Association. I told those doctors that I had been blessed in my life not to have suffered from major illnesses. But I know that the time may come when I will need serious medical treatment, and that I may well be in pain. And when that day comes, the last thing I want is to see a DEA agent standing between me and my doctors.
http://www.cato.org/...
A 2004 survey of the medical literature published in the Annals of Health Law found documented widespread undertreatment of pain among the terminally ill, cancer patients, nursing home residents, the elderly, and chronic pain patients, as well as in emergency rooms, postoperative units, and intensive care units.
Fumes Myers: "What's going on here is morally reprehensible and medically incomprehensible and it has to stop. Doctors who treat pain patients are not criminals."
Although studies to date have proven injections costly, risky and mostly ineffective, and the dangers of NSAIDS have become well documented, the opposite is true for Marijuana. Marijuana has been proven in
study after study, and in the most recent in two decades to be conducted, to be a safe alternative to treating pain.
SACRAMENTO, Calif. (AP) -- The first U.S. clinical trials in more than two decades on the medical benefits of marijuana confirm pot is effective in reducing muscle spasms associated with multiple sclerosis and pain caused by certain neurological injuries or illnesses, according to a report issued Wednesday
.
Igor Grant, a psychiatrist who directs the Center for Medicinal Cannabis Research at the University of California, San Diego, said five studies funded by the state involved volunteers who were randomly given real marijuana or placebos to determine if the herb provided relief not seen from traditional medicines.
"There is good evidence now that cannabinoids may be either an adjunct or a first-line treatment," Grant said at a news conference where he presented the findings.
http://www.huffingtonpost.com/...
A new study out of UC San Francisco has found that medical marijuana, combined with certain opiates, appears to be a safe and effective treatment for patients with chronic pain.
http://www.ucsf.edu/...
In fact, drug companies have patented almost every active chemical in marijuana. A new drug containing two of the most active natural ingredients in marijuana which has been used in Europe and Canada, may hit the market soon in this country. The future of Medical Marijuana is looking bright for Big Pharma.
A quarter-century after the U.S. Food and Drug Administration approved the first prescription drugs based on the main psychoactive ingredient in marijuana, additional medicines derived from or inspired by the cannabis plant itself could soon be making their way to pharmacy shelves, according to drug companies, small biotech firms and university scientists.
A British company, GW Pharma, is in advanced clinical trials for the world's first pharmaceutical developed from raw marijuana instead of synthetic equivalents- a mouth spray it hopes to market in the U.S. as a treatment for cancer pain. And it hopes to see FDA approval by the end of 2013.
Sativex contains marijuana's two best known components - delta 9-THC and cannabidiol - and already has been approved in Canada, New Zealand and eight European countries for a different usage, relieving muscle spasms associated with multiple sclerosis.
http://www.nydailynews.com/...
Pharmaceutical companies have, petitioned the DEA to reschedule THEIR versions of cannabis medicine... and this report seems to suggest marijuana would be rescheduled if Big Pharma can make a profit.
"The DEA's intent is to expand the federal government's schedule III listing to include pharmaceutical products containing naturally derived formations of THC while simultaneously maintain existing criminal prohibitions on the plant itself," Paul Armentano, the deputy director of NORML.
http://www.rawstory.com/...
Marijuana is safer than any other drug known, even safer than aspirin. You will find, soon, many new pain drugs on the market will be made with the chemicals of marijuana. Marijuana is the future of pain treatment. Why? No one has ever died from an overdose of Marijuana.
Why cannot people with debilitating conditions have an expectation of some relief from lives of unrelenting pain? Or terminal patients be able to die without needless pain and suffering? We have the drugs and the ability to help allieviate pain, doctors just don’t want to prescribe them because of the DEA. Why must they die and suffer for a failed Drug War?
"There is a real disconnect between what the public seems to be demanding and what the states have pushed for and what the market is providing," said Aron Lichtman, a Virginia Commonwealth University pharmacology professor and president of the International Cannabinoid Research Society. "It seems to me a company with a great deal of vision would say, `If there is this demand and need, we could develop a drug that will help people and we will make a lot of money.'"
http://www.opioids.com/...
The most obvious (though least likely) course of action to address these problems would be for Congress to end the costly, regrettable War on Drugs. Barring that, the best way for law enforcement officials to battle the problem of diversion would be to combat the theft of the drugs from warehouses, manufacturing facilities, and en route to pharmacies. More importantly, the DEA, DOJ, Congress, and state and local authorities should end the senseless persecution of doctors and allow them to pursue whatever treatment options they feel are in the best interests of their patients, free from the watchful eye of law enforcement.
http://www.deasucks.com/...
I think of the millions of others out there going through what I am going through, the invisible victims of the War on Drugs, the dying, the elderly, those living in chronic pain, fighting an ongoing struggle to get relief, to have some kind of life. It is not reefer madness people should fear, it is out of control drug enforcement madness. It threatens anyone who might get a debilitating painful disease, or be dying from one. Stop the madness.
deasucks.com is an advocate for the rights of
chronic pain patients and their doctors to be free
from DEA interference and intimidation tactics.
The (US Drug Enforcement Administration) DEA sucks
because its campaign to reduce the abuse and
diversion of prescription drugs is denying millions
of Americans adequate pain relief.
http://www.deasucks.com/...
12:36 PM PT: I want to thank you for adding this to the community spotlight. I worked a long time on this because it is a very serious problem in this country and many people are suffering.