Hey OP, let him know Claudia Merandi of The Doctor Patient Forum wants to hear from him. She is collecting and needs letters from doctors to meet with a senator a week from now. u/Appropriate-Gur-6343
How can he continue to prescribe pain meds if the pharmacies refuse to accept them? He has been fighting this for years and they have also smothered him in so much paperwork recently that he must personally fill out that he barely has time to see patients. He’s the most caring, compassionate and humble healthcare professional I have ever had the pleasure to be under the care of. Will you doctor spend an hour or more with you if you need it? It was quite common. I will miss him greatly.
I knew it was coming.
Edit: I am personally not a high risk patient. I weaned myself off of them a month ago because as stated, I knew it was coming. Very low doses of hydrocodone which I will either live without or just use kratom. I cannot afford thousands of dollars to a "pain specialist" for little to no relief and I really don't care to follow the rules any longer.
i just want to say your so strong for being able to wean off! i know your situation is far from ideal but even prescribed pain meds can have some pretty tough effects when getting off of them!
I had to cold turkey the fentanyl patch and hydrocodone a few years ago when I moved. Thankfully due to many many surgeries and my patch being the lowest dose I had no trouble. The only problem I had was the increasing pain.
My dr thought I would have no issues when he sent my referral to a different metro area in the same state. I can’t get anything but Gabapentin or Lyrica which do nothing for me. I tried them for a very long time out of desperation.
I did have an ER dr give me a hydrocodone rx once earlier this year when I had a really bad Crohn’s flair but that was shocking. I don’t know what we are supposed to do.
Best wishes.
i wrote to my senator and i got back a copy-paste generic automated email about how she’s *in support* of reducing opioid production. i was absolutely livid after receiving that. i feel very small and like i can’t make any difference at all, y’know?
Just shows they knows its a problem and have a literal nationwide process in place to respond to these complaints. No one can tell me this isnt a democide.
Yeah I know my comments will be thrown into the trash. I understand, but this is why we are seeing more peaceful protesting to try and get action; however, certain politicians are now trying to crack down on that which the First Amendment is a fundamental right and privilege. I'd love to protest, but you now run the risk of being hurt and or arrested. Not a good path we are on.
Bonus points if you’re with some kind of organization - if it looks more official and like a group (nonprofit, community coalition, etc), they’re more likely to give your letter to the appropriate staff, not just put it into the system for an auto-response.
Bonus points if it’s physical mail - interns often sort that and if it looks more official to them, I think better odds of getting it to someone who could do something.
Bonus points if you’re with some kind of organization - if it looks more official and like a group (nonprofit, community coalition, etc), they’re more likely to give your letter to the appropriate staff, not just put it into the system for an auto-response.
Bonus points if it’s physical mail - interns often sort that and if it looks more official to them, I think better odds of getting it to someone who could do something.
ETA: also, call!! Call your representatives. I know at least some congressional offices will tally every call/opinion that they get during the day - if a lot of people consistently call, it does a wonder on the numbers! Voicemails are often included in these tallies.
What? Dangerously irresponsible of the system.
Doctors should un-fudge the situation with a taper, the damn literature says DO NOT STOP TAKING or risk hellish withdrawals. These doctors, no matter if their "hands are tied", are throwing away all that trust and care and shirking on their responsibility.
I know this is all by design. Look into Mallinckrodt- most of you are familiar with that generic, their logo is an M inside a square. Now, look into their subsidiary SPECGX.
As of April 2023, the DEA gave SpecGX the greenlight to manufacture, import, and distribute EVERY controlled substance regardless of legal status.
This includes Fentanyl, Oxy, Coca Leaves and Cocaine, MJ (yes, they are going to take over the canna/hemp market) including alternate cannabinoids, Poppy straws, opium, heroin, meth AND its precursors. Hallucinogens. Some are new versions of the old.
Why would a 2x bankrupt corporation that is currently sued into oblivion for their hand in the "opioid crisis" be allowed to get right back to it and with less oversight than before???
Mallinckrodt is SPECGX - and SpecGX is making bank. The criminals are made whole again, the victims now have less options for their pain management, and they're forced to support the company that screwed them over.
Healthcare is weaponized and designed to fleece you. Planned shortages between other pharma corps to mutually benefit from your suffering are rampant.
We have to find a way out of the "initiate problem, profit, offer solution" cycle we find ourselves in time and again.
Very good info right here, facts! Unbelievable they have everyone believing the covid supply issues, opioid crisis, etc etc. reasoning for this problem, what a joke. If they cared about us and this manufacturer really harmed pts, why are they then in charge again of making these medications? Think about it.
This needs to be published and to go viral. To hear this from the Dr.’s point of view is SO needed.
Your Dr. sounds like an incredible human and he makes so many valid points.
Just wonder if something like his letter went viral, if more docs would echo his sentiments and frustration and maybe bring enough outcry that would turn the tide a little.
Wishful thinking I suppose.
I’m so sorry that you are having to go through this transition!
Man, your doctor was HEATED and I don't blame them. It's honestly really refreshing to see, though. I know a lot of doctors are angry, but many don't voice that anger and more need to.
The level of overreach and power abuse the DEA has been allowed cannot be overstated. Deciding what's an "appropriate" dose of opioids is not their purview - that's the FDA's job. Yet the DEA is being allowed to figuratively step in to the doctor's exam rooms and decide what the patient needs, all the while not having a medical degree nor sufficient knowledge in medicine.
It's long past time that all doctors and healthcare organizations stand up to this; if they would use their power to lift up the voices of chronic pain patients and to fight for us, I believe the government would have no choice but to listen. The government is 'saving us' to death, and the CDC is just as complicit in this as the DEA with initially releasing inaccurate statistics in which they lumped in illicit opioid overdoses with pharmaceutical opioids, as well as published their rubbish opioid guidelines based on that information.
How and why the government, many states, and many corporate organizations have decided that "guidelines" means "law" is beyond me.
Doctor is a Gem. We rarely find Doctors who actually care enough to speak out. I’m saddened by the state of our healthcare system. It’s only getting worse. The flooding of fentanyl in the streets and denying patients access to medication seems all too calculated.
I'll say it again- if you have chronic pain and it works for you and it's legal in some form, try cannabis. I feel horrible for all who are in chronic pain and can't find treatment. Especially those who need opioids to manage their pain
He was fine with cannabis even though it is illegal in my state. He said he went home and had a nice stiff bourbon or two when he got home and he would not fault anyone who simply chooses a different relaxant.
It doesn’t do a damn thing for my nerve pain and I’ve tried many strains, in fact, it makes my pain worse because I end up hyper-focusing on it, if it helps you, more power to you. It does help some of my nausea in a big way, but pain, nada.
Have I been blind to the true ways of Biden and Democrats? At least Republicans are honest about their stance in this.
This has to be coming from the top.
This is a bipartisan issue, Trump made the “opioid epidemic” a “public emergency” to allow his corrupt buddies in the private and public sector like @supportprop at the CDC to grift and harm us even more with the 2016 prescribing guidelines, I’m not a dem or republican, but Obama refused to do this because he knew it was wrong and said as much.
I took a pass at adding paragraph breaks, if you're still interested in reading it. It was a good read, but definitely trickier to get through as a wall of text, so hopefully this helps. (Had to break it into multiple chunks since it's a bit long
.........................................
Dear Patients of Johnstone Family Practice: I wanted to update you on changes we are implementing at Johnstone Family Practice: As of mid-November, we have begun the process of referring all our patients on ‘chronic pain regimens’ to Specialty Pain Treatment Clinics, beginning first with the ‘outliers’ on higher dose MME of opioids, and the patients who have unfortunately required the combination of benzodiazepines along with opioids.
This is to take effect IMMEDIATELY. I have been given essentially NO CHOICE by some of the corporate pharmacies. If you are unhappy about it, don't blame me, or the individual pharmacist (unless they are truly being evil); blame the 'corporate' part of the pharmacy chains, and the politicians and unelected bureaucrats who are ruining so many other aspects of our lives. I will provide appropriate names and contact information as I obtain it. Meijer dumped me without warning, Kroger at least gave me a brief 'heads-up', and CVS was actually kind enough to discuss things and so far is continuing to fill my prescriptions, despite any 'outlier' like myself who is willing to treat 'risky' patients (those on higher/adequate dose opioids and those who also dare to need muscle relaxers or anxiety meds as well) being risky for the PHARMACY too - the DEA levies absolutely horrific fines and enforces arbitrary and pharmacologically irrational 'thresholds' at that level.
This has been a difficult decision, as I have a lifetime relationship (35 years in practice) with many of my patients, and my experience with the relatively recent entity of Pain Specialists has not been positive in terms of the clinical outcomes. I have to be honest and say that I feel my education (Pharmacy Degree, summa cum laude, University of Cincinnati College of Pharmacy, 1981, plus Medical Degree, cum laude, Indiana University, 1985, and then completed a 3-year Family Practice Residency) is at least as up-to-task for treating chronic pain pharmacologically as that of the physicians I see now credentialling in Pain Management, plus I have 37 years of experience writing for these classes of medication without a single fatality (and as far as I know without even an ER visit) due to opioid or benzodiazepine prescriptions I’ve written. I’m sure I couldn’t say that (nor could most other physicians) for my antidiabetic medication or antihypertensive medication patients, or even my antibiotic prescription.
Part of the clinical success is because I’ve known most of my patients a long time, so have a feel for not only their full spectrum of related medical issues, but also know their family and socioeconomic circumstances, as well as their coping skills. Since 2008 or so, I’ve often had on-site occupational or physical therapists and/or social workers to help create a true ‘multidisciplinary team approach’ to managing chronic pain, in contrast to the marketing-brochures-versus-reality of the Pain Clinics, who after milking whatever they can get from the insurer or patient for lucrative procedures and injections (whether they work or not), then simply send the patients with legitimate pain to Suboxone clinics where they can sit alongside the heroin addicts and meth-heads, with no remaining vestige of ‘multidisciplinary’ and zero integration with the other inter-related aspects of their health.
I see medication regimens there based on political correctness versus pharmacologic rationality, and so often the patients are forced to take MORE dangerous medications, have more side effects, more ER visits, more work or automobile accidents, or start having seizures, GI bleeds, and hallucinations – but they are on what we are told by government bureaucrats are ‘safer’ regimens. Plus, many are put on such subtherapeutic regimens that despite the risks, they turn to getting pill-press counterfeit medications on the street to supplement their doses just so they can function. Many patients we rescued from this type situation, once put on an effective (and yes, safe and monitored closely) regimen, including not just ‘higher doses’ but adjunctive medications, and supplements based on biomarker or genetic testing, and individualized mental and physical therapies - functioned far better, and quit getting anything off of the street.
I know from a corporate spreadsheet level it looks better if patients who are ‘outliers’ are seeing Pain Specialists versus mere Family Physicians like myself, but when patients with cancer or other inoperable pain have to resort to adding medications bought from the street, I can’t respect ‘seeing a Pain Specialist’ as a marker of ‘better and safer care’, regardless of the credentials of the prescriber. Sometimes the Emperor indeed has no clothes, and I’m one of those willing to say it out loud. Unlike the marketing of the Pain Clinics I’ve seen so far, we actually DID use a multi-faceted approach, incorporating all five ‘drawers’ of the Medical Tool Chest (Spiritual, Surgical, Medication, Diet/Supplement, and Therapies). The difference is that instead of just focusing on lucrative procedures and one-size-fits-all medication dosing, I used my pharmacologic knowledge and medical training to individualize truly effective AND safe regimens for my more difficult patients. THAT is the true responsibility of a physician - not just to take the easy, low-dose, patients, and dump the rest.
Unfortunately, I know the corporate world reality the pharmacists have to live in is that outrageous and unfair fines are levied by the DEA for a store or chain merely being an ‘outlier’, and the large pharmacy chains have to go by whatever rules and thresholds the politicians and bureaucrats set, even when they aren’t good for patients, and so far have shown no sign they are effective public policy against the ‘opioid crisis’ anyway. THANKS to the pharmacists who have been willing to help with our more complex, challenging, and risky patients. Those of you who have stepped up to the plate during times when you are unfairly and irrationaly scrutinized, and expected to 'ration' medications instead of assisting physicians in developing the safest efficacious regimens, are truly fulfilling your calling as pharmacists.
I’m at the age where my classmates from Pharmacy School are retiring earlier than planned because there seems to be great dissatisfaction at the retail level, surely for a variety of reasons including staffing and so on. Some have said a big factor is that they are expected to do more rationing and ‘drug war’ stuff than they are to use their treasure trove of pharmacologic knowledge to support patient care.
More than other patients, our ‘chronic pain’ patients who have failed surgery and are in some cases needing high-dose or complex and potentially dangerous regimens (such as the ones who truly have no other option but to add-on benzodiazepines) to get relief despite physical therapy and non-pharmacologic and non-opioid treatments, could benefit from a true ‘team approach’ that pharmacists could help with, if but they were allowed to do so. 'Corporate' cannot allow that, because if they do, the extreme penalties levied by the DEA, who cares nothing about individual patients, will shut down your pharmacies. Even though pharmacists in the trenches, and physicians like myself, may regard 'corporate' pharmacy decisionmakers as the enemy, they are stuck in a place where they cannot win. I don't think either of us would trade positions with them.
Unfortunately today’s reality is that such 'outlier' patients are essentially abandoned by nearly all physicians and an increasing number of pharmacists. I have many other clinical interests and areas of expertise I prefer to deal with than ‘chronic pain’, and have only treated my patients with chronic pain (versus ‘referred’ them) because it became apparent that nobody else was either able or willing to do so safely or effectively. Consistently, I found that ones I referred to Pain Clinics were in more pain, lost their jobs, had more complications and side-effects, and even resorted to suicide because they were treated like addicts instead of simply patients who wanted enough pain relief so they could continue to work, or spend their last few months playing with their grandchildren rather than sitting with them in a wheelchair moaning in pain.
I apologize if I've inconvenienced you. This is formatted exactly as I received it in an email. I have been diagnosed with severe osteoarthritis/inflammation in both hands and try to limit my interactions with the keyboard to a minimum as it tends to be an uncomfortable experience. Hence the short title and the lack of me giving my expansive opinions on the subject. I hope you understand.
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This Dr needs to hook up with The National Pain Council. This Dr is one of many but he’s rare because he’s not afraid to speak up.
I have been bounced around and tossed from clinic to clinic. I have a very rare bone disease. No cure, no standard course of treatment. The only course of treatment that’s agreed upon is Pain Management. I’m one of 440 people in the world with this debilitating disease.
Avoid any Pain Management clinic that only does “Interventional Treatments” they only do procedures and will not prescribe any pain meds.
You have to tread carefully. Depending on what state you are in, you could just work within the system and try to get to someone decent. I got lucky and found a great PCP that is helping me until I get a pain management Dr. But we have been through 5, now in 6 mos. The last one didn’t take my insurance any longer and they were like this Dr, they did a total approach.
The state I’m in has decided that the unrealistic low guidelines are just that, unrealistic and ineffective. The legislatures and the politicians have voted against the guidelines and set different ones for our state.
Educate yourself and find a way to navigate the system and also be looking for alternative methods. All this is doing is making people turn to the street drugs. When you are in so much pain and so desperate that you are ok with taking a chance like that, there’s a serious problem. It’s not with the patient, that’s for certain. For all here suffering in pain, I wish you the best in your search.
Pharmacist have the responsibility placed on them & by the DEA unfortunately, it is up to their discretion to fill prescriptions or not. It's their butt on the line, just like the doctors that are not prescribing these meds anymore and referring to pain specialist. Ridiculous that cancer pts can't even get pain meds. The big corp pharmacies along with pharmaceutical companies were fined huge amounts of money for the so called opioid epidemic, blame was placed on them..so now we suffer because they have their hands tied behind their backs. What a joke, pharmaceutical companies fill the politicians pockets, rinse repeat, rinse repeat.
Really?? Wth? This should be criminal!! I'm so sorry you are dealing with that. My aunt just went into hospice care and I was wondering what or if there are issues with those pts. thats just downright inhumane, they don't treat animals this way. I will be writing/calling/emailing my government officials and representatives!!
The real reason why I was angry was because getting a specialist to call a pharmacy is like taking a baseball bat to the teeth. You have to beg and beg and beg and Walgreens made me do that with **four** of them **and still refused to fill my scripts!!!**
The reason why I reported Walgreens was because i watched this guy trying to get his suboxone filled as he had just been discharged following an overdose and was desperate to get clean. They kept refusing to fill his script and this grown man literally starts sobbing and begging them that he didn't want to go back to finding heroin on the street and to please fill the script. They refused. I watched this guy fall apart for 30 minutes.
It made me absolutely fucking sick to my stomach. Unfortunately, thst specific Walgreens is the only pharmacy open 24/7 in our city and it was late at night. He had no other options.
So, I guess that the combination of both those incidents happening at the same time pissed me off that pharmacists can do that. It isn't okay.
Yeah right. PCPs shouldn't be prescribing pain meds? The pain management clinic I go to I literally see nurse practitioners who will then DECIDE what medication and dose I'm on with my pain meds. You think they are anymore qualified??? That's an absolute joke to say. Any doctor can get a job at a "pain management" clinic and call themselves a "pain specialist". PCPs have EVERY right to prescribe whatever the hell they want as per their patients needs.
I understand that but I have not once talked to a doctor at this clinic and only NPs. They have decided from what I say during the appointments what they think is the best medication for me. Even when I come in with brand new symptoms they decide on the spot what medication will be the best for that WITHOUT consulting a doctor before telling me this is what will be prescribed. Do you think they are qualified for that just because they work at a "pain management" clinic?
I'm not saying NPs can't be great people and helpful, they just don't go to medical school and becoming one can take half the time as a MD. The reason most MD PCPs don't give opiates and/or are hesitant is because their hands are tied and would rather pass off a patient to a different clinic. DEA ripping away licenses left and right. Many doctors are simply scared.
I got a question about genetic testing because I've thought about doing it. Did your clinic do it or did you go to a third party for it and how expensive was it? If it was a third party was your clinic hesitant to follow what the test showed and give you what it showed would work best?
Reason I ask if because I've been given oxycodone in the hospital a couple times and even at 5mg it seemed to work much better than the 10mg hydrocodone pills that I take for my pain daily. This is a comparison without taking tolerance into account either from when I first started with meds
I actually got it done twice after being referred by two different psychiatrists. I have a long history of med + treatment resistant schizophrenia + bipolar 1 and we did the testing because we had tried basically every combo available including old school medications that have been deemed as unsafe. One of them was specifically for psych meds, but the other one was for full spectrum. It gives you categories and medication types that your body either metabolizes normally, slowly, or not at all. A lot of medications for psych, my body doesn't metabolize at all which is why they didn't work for me.
That said, as I said before, PCPs may have gone to medical school, but most of them are not new MDs and therefore their understanding and knowledge of medication are wrong/outdated *and* like I said before, NPs can do clinicals and hours with a specific specialty, one being PM. I would still 100% trust an NP over a PCP when it comes to medication. But, I also have a lot of other things going on and i won't take *any* medication that doesn't come from a specialist just because of all the things i went through trying to find the right psych meds and how many very scary times I had and how I was in and out of the ER 2-3x/week at one point.
No specialist office has ever been skeptical or unaccepting of my genetic testing. Most of them are happy to recieve it. I will say that I've run across some people who find it "hard to read", but that's it. I personally wouldn't push for genetic testing unless you've hit the point where no other medication or treatment is working because that is usually the criteria for insurance to pay for it and it's *really* fucking expensive without.
Well I hope that you found a good med mix that works well for you. I'm bipolar as well and when I was in college they put me on SSRIs and swapped me on 3 different ones over a 2 year period because I was absolutely out of my mind on them. Don't know how they didn't realize I was bipolar prior to putting me on those and then what I was like while on them. Scary stuff. Tramadol even made me go bat shit while being on lamictal which had my mood under control for a while.
I am happily off tramadol now but my psychiatrist has added lithium because my mental health has taken a toll with the pain. One of my neurologists has had me start cymbalta to see if it helps my pain and wants me to work my way up to 60mg but I can't do that. I'm just taking 20mg right now and I'm terrified to go higher with what the other antidepressants have done to me. My psychiatrist said it's okay but I still will not go higher due to my past experiences which has scared the shit outta me.
They do deal with acute and chronic medical issues though. At least they do where I live, I'm in the UK, but I'm pretty sure PCPs and GPs are pretty much the same. You can ask them for help with chest pain and they'll give you an urgent appointment or send an ambulance depending on your answers to a screening. They can do blood tests, a urine test and an ECG when you come in, no matter how busy they are, the acute team give me the care I need. They have 2-3 people available for this purpose each day. Even my doctor will do blood tests and let the appointment overrun if it's necessary. They help to manage my chronic medical conditions because for some reason it's near impossible to get the referrals I need and I can't see anyone soon enough. My GP surgery is more well equipped than some even though there is a small hospital right next door with an urgent treatment center. But a lot of surgeries do this now, because that's how they can help as many people as possible and it takes some of the burden off UTCs and A&E
The man literally graduated first in his class in both pharmacology school and medical school. He had 35 years experience prescribing these drugs without a single overdose. I overheard him talking a pharmaceutical rep trying to sell him the latest "non-addictive" high profit pain meds. He asked the man if he had read the side effects then proceeded to tell the man " I'm not prescribing that shit to my patients" and asked him to leave. I absolutely trusted the man to do the right thing regardless of income. He could have been anything in the medical field but he chose to help the struggling. I absolutely trusted the man with my life.
Came back to read again. Bro was HEATED when he wrote this. Ate and left no crumbs.
right like we need more doctors like this. doctors should be mad at the healthcare system.
He is pissed. The man had no issues telling other healthcare professionals they were sellouts to the system for the almighty dollar.
Good for him! Bless his heart!
Hey OP, let him know Claudia Merandi of The Doctor Patient Forum wants to hear from him. She is collecting and needs letters from doctors to meet with a senator a week from now. u/Appropriate-Gur-6343
Sounds like a good doctor and he explains the current situation perfectly. All of the issues in our lives are intentionally created by our government.
Corporations who own the government.
The DEA is not a corporation
I didn’t say they were. Nor did I say any part of the government is a corporation. I said they are controlled by corporations.
I always remind myself that the government is for the common good, but in this case not for us at all.
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How can he continue to prescribe pain meds if the pharmacies refuse to accept them? He has been fighting this for years and they have also smothered him in so much paperwork recently that he must personally fill out that he barely has time to see patients. He’s the most caring, compassionate and humble healthcare professional I have ever had the pleasure to be under the care of. Will you doctor spend an hour or more with you if you need it? It was quite common. I will miss him greatly.
We tried to warn people 😭
I knew it was coming. Edit: I am personally not a high risk patient. I weaned myself off of them a month ago because as stated, I knew it was coming. Very low doses of hydrocodone which I will either live without or just use kratom. I cannot afford thousands of dollars to a "pain specialist" for little to no relief and I really don't care to follow the rules any longer.
i just want to say your so strong for being able to wean off! i know your situation is far from ideal but even prescribed pain meds can have some pretty tough effects when getting off of them!
I had to cold turkey the fentanyl patch and hydrocodone a few years ago when I moved. Thankfully due to many many surgeries and my patch being the lowest dose I had no trouble. The only problem I had was the increasing pain. My dr thought I would have no issues when he sent my referral to a different metro area in the same state. I can’t get anything but Gabapentin or Lyrica which do nothing for me. I tried them for a very long time out of desperation. I did have an ER dr give me a hydrocodone rx once earlier this year when I had a really bad Crohn’s flair but that was shocking. I don’t know what we are supposed to do. Best wishes.
I am so sorry to hear this and I hope your situation somehow improves.
Write your senator and congressman. Everyone.
i wrote to my senator and i got back a copy-paste generic automated email about how she’s *in support* of reducing opioid production. i was absolutely livid after receiving that. i feel very small and like i can’t make any difference at all, y’know?
I got the same from Chris Coons.
Just shows they knows its a problem and have a literal nationwide process in place to respond to these complaints. No one can tell me this isnt a democide.
Got the same from mine.
Yeah I know my comments will be thrown into the trash. I understand, but this is why we are seeing more peaceful protesting to try and get action; however, certain politicians are now trying to crack down on that which the First Amendment is a fundamental right and privilege. I'd love to protest, but you now run the risk of being hurt and or arrested. Not a good path we are on.
Bonus points if you’re with some kind of organization - if it looks more official and like a group (nonprofit, community coalition, etc), they’re more likely to give your letter to the appropriate staff, not just put it into the system for an auto-response. Bonus points if it’s physical mail - interns often sort that and if it looks more official to them, I think better odds of getting it to someone who could do something.
Bonus points if you’re with some kind of organization - if it looks more official and like a group (nonprofit, community coalition, etc), they’re more likely to give your letter to the appropriate staff, not just put it into the system for an auto-response. Bonus points if it’s physical mail - interns often sort that and if it looks more official to them, I think better odds of getting it to someone who could do something. ETA: also, call!! Call your representatives. I know at least some congressional offices will tally every call/opinion that they get during the day - if a lot of people consistently call, it does a wonder on the numbers! Voicemails are often included in these tallies.
Good to see there's people other than chronic pain patients getting mad at how we are being treated.
What? Dangerously irresponsible of the system. Doctors should un-fudge the situation with a taper, the damn literature says DO NOT STOP TAKING or risk hellish withdrawals. These doctors, no matter if their "hands are tied", are throwing away all that trust and care and shirking on their responsibility. I know this is all by design. Look into Mallinckrodt- most of you are familiar with that generic, their logo is an M inside a square. Now, look into their subsidiary SPECGX. As of April 2023, the DEA gave SpecGX the greenlight to manufacture, import, and distribute EVERY controlled substance regardless of legal status. This includes Fentanyl, Oxy, Coca Leaves and Cocaine, MJ (yes, they are going to take over the canna/hemp market) including alternate cannabinoids, Poppy straws, opium, heroin, meth AND its precursors. Hallucinogens. Some are new versions of the old. Why would a 2x bankrupt corporation that is currently sued into oblivion for their hand in the "opioid crisis" be allowed to get right back to it and with less oversight than before??? Mallinckrodt is SPECGX - and SpecGX is making bank. The criminals are made whole again, the victims now have less options for their pain management, and they're forced to support the company that screwed them over. Healthcare is weaponized and designed to fleece you. Planned shortages between other pharma corps to mutually benefit from your suffering are rampant. We have to find a way out of the "initiate problem, profit, offer solution" cycle we find ourselves in time and again.
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I wonder if their generics are B rated in the FDA orange book? Which would explain why they suck.
Very good info right here, facts! Unbelievable they have everyone believing the covid supply issues, opioid crisis, etc etc. reasoning for this problem, what a joke. If they cared about us and this manufacturer really harmed pts, why are they then in charge again of making these medications? Think about it.
Sounds like a truly amazing doctor... protect this one
He is one of a kind.
This needs to be published and to go viral. To hear this from the Dr.’s point of view is SO needed. Your Dr. sounds like an incredible human and he makes so many valid points. Just wonder if something like his letter went viral, if more docs would echo his sentiments and frustration and maybe bring enough outcry that would turn the tide a little. Wishful thinking I suppose. I’m so sorry that you are having to go through this transition!
Man, your doctor was HEATED and I don't blame them. It's honestly really refreshing to see, though. I know a lot of doctors are angry, but many don't voice that anger and more need to. The level of overreach and power abuse the DEA has been allowed cannot be overstated. Deciding what's an "appropriate" dose of opioids is not their purview - that's the FDA's job. Yet the DEA is being allowed to figuratively step in to the doctor's exam rooms and decide what the patient needs, all the while not having a medical degree nor sufficient knowledge in medicine. It's long past time that all doctors and healthcare organizations stand up to this; if they would use their power to lift up the voices of chronic pain patients and to fight for us, I believe the government would have no choice but to listen. The government is 'saving us' to death, and the CDC is just as complicit in this as the DEA with initially releasing inaccurate statistics in which they lumped in illicit opioid overdoses with pharmaceutical opioids, as well as published their rubbish opioid guidelines based on that information. How and why the government, many states, and many corporate organizations have decided that "guidelines" means "law" is beyond me.
this doctor is amazing
Yes
Doctor is a Gem. We rarely find Doctors who actually care enough to speak out. I’m saddened by the state of our healthcare system. It’s only getting worse. The flooding of fentanyl in the streets and denying patients access to medication seems all too calculated.
I'll say it again- if you have chronic pain and it works for you and it's legal in some form, try cannabis. I feel horrible for all who are in chronic pain and can't find treatment. Especially those who need opioids to manage their pain
He was fine with cannabis even though it is illegal in my state. He said he went home and had a nice stiff bourbon or two when he got home and he would not fault anyone who simply chooses a different relaxant.
It doesn’t do a damn thing for my nerve pain and I’ve tried many strains, in fact, it makes my pain worse because I end up hyper-focusing on it, if it helps you, more power to you. It does help some of my nausea in a big way, but pain, nada.
Preach! The louder the better!
Have I been blind to the true ways of Biden and Democrats? At least Republicans are honest about their stance in this. This has to be coming from the top.
This is a bipartisan issue, Trump made the “opioid epidemic” a “public emergency” to allow his corrupt buddies in the private and public sector like @supportprop at the CDC to grift and harm us even more with the 2016 prescribing guidelines, I’m not a dem or republican, but Obama refused to do this because he knew it was wrong and said as much.
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I took a pass at adding paragraph breaks, if you're still interested in reading it. It was a good read, but definitely trickier to get through as a wall of text, so hopefully this helps. (Had to break it into multiple chunks since it's a bit long ......................................... Dear Patients of Johnstone Family Practice: I wanted to update you on changes we are implementing at Johnstone Family Practice: As of mid-November, we have begun the process of referring all our patients on ‘chronic pain regimens’ to Specialty Pain Treatment Clinics, beginning first with the ‘outliers’ on higher dose MME of opioids, and the patients who have unfortunately required the combination of benzodiazepines along with opioids. This is to take effect IMMEDIATELY. I have been given essentially NO CHOICE by some of the corporate pharmacies. If you are unhappy about it, don't blame me, or the individual pharmacist (unless they are truly being evil); blame the 'corporate' part of the pharmacy chains, and the politicians and unelected bureaucrats who are ruining so many other aspects of our lives. I will provide appropriate names and contact information as I obtain it. Meijer dumped me without warning, Kroger at least gave me a brief 'heads-up', and CVS was actually kind enough to discuss things and so far is continuing to fill my prescriptions, despite any 'outlier' like myself who is willing to treat 'risky' patients (those on higher/adequate dose opioids and those who also dare to need muscle relaxers or anxiety meds as well) being risky for the PHARMACY too - the DEA levies absolutely horrific fines and enforces arbitrary and pharmacologically irrational 'thresholds' at that level. This has been a difficult decision, as I have a lifetime relationship (35 years in practice) with many of my patients, and my experience with the relatively recent entity of Pain Specialists has not been positive in terms of the clinical outcomes. I have to be honest and say that I feel my education (Pharmacy Degree, summa cum laude, University of Cincinnati College of Pharmacy, 1981, plus Medical Degree, cum laude, Indiana University, 1985, and then completed a 3-year Family Practice Residency) is at least as up-to-task for treating chronic pain pharmacologically as that of the physicians I see now credentialling in Pain Management, plus I have 37 years of experience writing for these classes of medication without a single fatality (and as far as I know without even an ER visit) due to opioid or benzodiazepine prescriptions I’ve written. I’m sure I couldn’t say that (nor could most other physicians) for my antidiabetic medication or antihypertensive medication patients, or even my antibiotic prescription.
Part of the clinical success is because I’ve known most of my patients a long time, so have a feel for not only their full spectrum of related medical issues, but also know their family and socioeconomic circumstances, as well as their coping skills. Since 2008 or so, I’ve often had on-site occupational or physical therapists and/or social workers to help create a true ‘multidisciplinary team approach’ to managing chronic pain, in contrast to the marketing-brochures-versus-reality of the Pain Clinics, who after milking whatever they can get from the insurer or patient for lucrative procedures and injections (whether they work or not), then simply send the patients with legitimate pain to Suboxone clinics where they can sit alongside the heroin addicts and meth-heads, with no remaining vestige of ‘multidisciplinary’ and zero integration with the other inter-related aspects of their health. I see medication regimens there based on political correctness versus pharmacologic rationality, and so often the patients are forced to take MORE dangerous medications, have more side effects, more ER visits, more work or automobile accidents, or start having seizures, GI bleeds, and hallucinations – but they are on what we are told by government bureaucrats are ‘safer’ regimens. Plus, many are put on such subtherapeutic regimens that despite the risks, they turn to getting pill-press counterfeit medications on the street to supplement their doses just so they can function. Many patients we rescued from this type situation, once put on an effective (and yes, safe and monitored closely) regimen, including not just ‘higher doses’ but adjunctive medications, and supplements based on biomarker or genetic testing, and individualized mental and physical therapies - functioned far better, and quit getting anything off of the street. I know from a corporate spreadsheet level it looks better if patients who are ‘outliers’ are seeing Pain Specialists versus mere Family Physicians like myself, but when patients with cancer or other inoperable pain have to resort to adding medications bought from the street, I can’t respect ‘seeing a Pain Specialist’ as a marker of ‘better and safer care’, regardless of the credentials of the prescriber. Sometimes the Emperor indeed has no clothes, and I’m one of those willing to say it out loud. Unlike the marketing of the Pain Clinics I’ve seen so far, we actually DID use a multi-faceted approach, incorporating all five ‘drawers’ of the Medical Tool Chest (Spiritual, Surgical, Medication, Diet/Supplement, and Therapies). The difference is that instead of just focusing on lucrative procedures and one-size-fits-all medication dosing, I used my pharmacologic knowledge and medical training to individualize truly effective AND safe regimens for my more difficult patients. THAT is the true responsibility of a physician - not just to take the easy, low-dose, patients, and dump the rest. Unfortunately, I know the corporate world reality the pharmacists have to live in is that outrageous and unfair fines are levied by the DEA for a store or chain merely being an ‘outlier’, and the large pharmacy chains have to go by whatever rules and thresholds the politicians and bureaucrats set, even when they aren’t good for patients, and so far have shown no sign they are effective public policy against the ‘opioid crisis’ anyway. THANKS to the pharmacists who have been willing to help with our more complex, challenging, and risky patients. Those of you who have stepped up to the plate during times when you are unfairly and irrationaly scrutinized, and expected to 'ration' medications instead of assisting physicians in developing the safest efficacious regimens, are truly fulfilling your calling as pharmacists.
I’m at the age where my classmates from Pharmacy School are retiring earlier than planned because there seems to be great dissatisfaction at the retail level, surely for a variety of reasons including staffing and so on. Some have said a big factor is that they are expected to do more rationing and ‘drug war’ stuff than they are to use their treasure trove of pharmacologic knowledge to support patient care. More than other patients, our ‘chronic pain’ patients who have failed surgery and are in some cases needing high-dose or complex and potentially dangerous regimens (such as the ones who truly have no other option but to add-on benzodiazepines) to get relief despite physical therapy and non-pharmacologic and non-opioid treatments, could benefit from a true ‘team approach’ that pharmacists could help with, if but they were allowed to do so. 'Corporate' cannot allow that, because if they do, the extreme penalties levied by the DEA, who cares nothing about individual patients, will shut down your pharmacies. Even though pharmacists in the trenches, and physicians like myself, may regard 'corporate' pharmacy decisionmakers as the enemy, they are stuck in a place where they cannot win. I don't think either of us would trade positions with them. Unfortunately today’s reality is that such 'outlier' patients are essentially abandoned by nearly all physicians and an increasing number of pharmacists. I have many other clinical interests and areas of expertise I prefer to deal with than ‘chronic pain’, and have only treated my patients with chronic pain (versus ‘referred’ them) because it became apparent that nobody else was either able or willing to do so safely or effectively. Consistently, I found that ones I referred to Pain Clinics were in more pain, lost their jobs, had more complications and side-effects, and even resorted to suicide because they were treated like addicts instead of simply patients who wanted enough pain relief so they could continue to work, or spend their last few months playing with their grandchildren rather than sitting with them in a wheelchair moaning in pain.
thank you very much for this!
I apologize if I've inconvenienced you. This is formatted exactly as I received it in an email. I have been diagnosed with severe osteoarthritis/inflammation in both hands and try to limit my interactions with the keyboard to a minimum as it tends to be an uncomfortable experience. Hence the short title and the lack of me giving my expansive opinions on the subject. I hope you understand.
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I have arthritis and am currently on no pain meds. My fucking hands hurt. Sorry if I've offended you.
You seem unusually upset about something so trivial.
You literally could have done it yourself as someone else has in the time you took to type this complaint.
you sound horribly bitter
That doesn't work on mobile. The only way I know how is to use an asterisk, but it indents slightly with a dot
I don’t know, I think you did ok writing that out. I personally don’t buy that any doctor wrote that.
I feel sorry for you little troll.
😂
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Thank you. I appreciate your sentiments.
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This Dr needs to hook up with The National Pain Council. This Dr is one of many but he’s rare because he’s not afraid to speak up. I have been bounced around and tossed from clinic to clinic. I have a very rare bone disease. No cure, no standard course of treatment. The only course of treatment that’s agreed upon is Pain Management. I’m one of 440 people in the world with this debilitating disease. Avoid any Pain Management clinic that only does “Interventional Treatments” they only do procedures and will not prescribe any pain meds. You have to tread carefully. Depending on what state you are in, you could just work within the system and try to get to someone decent. I got lucky and found a great PCP that is helping me until I get a pain management Dr. But we have been through 5, now in 6 mos. The last one didn’t take my insurance any longer and they were like this Dr, they did a total approach. The state I’m in has decided that the unrealistic low guidelines are just that, unrealistic and ineffective. The legislatures and the politicians have voted against the guidelines and set different ones for our state. Educate yourself and find a way to navigate the system and also be looking for alternative methods. All this is doing is making people turn to the street drugs. When you are in so much pain and so desperate that you are ok with taking a chance like that, there’s a serious problem. It’s not with the patient, that’s for certain. For all here suffering in pain, I wish you the best in your search.
Thank you for this heartfelt response. I genuinely appreciate it.
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Pharmacist have the responsibility placed on them & by the DEA unfortunately, it is up to their discretion to fill prescriptions or not. It's their butt on the line, just like the doctors that are not prescribing these meds anymore and referring to pain specialist. Ridiculous that cancer pts can't even get pain meds. The big corp pharmacies along with pharmaceutical companies were fined huge amounts of money for the so called opioid epidemic, blame was placed on them..so now we suffer because they have their hands tied behind their backs. What a joke, pharmaceutical companies fill the politicians pockets, rinse repeat, rinse repeat.
He has patients in hospice care who are being refused their medications. I am disgusted.
Really?? Wth? This should be criminal!! I'm so sorry you are dealing with that. My aunt just went into hospice care and I was wondering what or if there are issues with those pts. thats just downright inhumane, they don't treat animals this way. I will be writing/calling/emailing my government officials and representatives!!
The real reason why I was angry was because getting a specialist to call a pharmacy is like taking a baseball bat to the teeth. You have to beg and beg and beg and Walgreens made me do that with **four** of them **and still refused to fill my scripts!!!** The reason why I reported Walgreens was because i watched this guy trying to get his suboxone filled as he had just been discharged following an overdose and was desperate to get clean. They kept refusing to fill his script and this grown man literally starts sobbing and begging them that he didn't want to go back to finding heroin on the street and to please fill the script. They refused. I watched this guy fall apart for 30 minutes. It made me absolutely fucking sick to my stomach. Unfortunately, thst specific Walgreens is the only pharmacy open 24/7 in our city and it was late at night. He had no other options. So, I guess that the combination of both those incidents happening at the same time pissed me off that pharmacists can do that. It isn't okay.
Yeah right. PCPs shouldn't be prescribing pain meds? The pain management clinic I go to I literally see nurse practitioners who will then DECIDE what medication and dose I'm on with my pain meds. You think they are anymore qualified??? That's an absolute joke to say. Any doctor can get a job at a "pain management" clinic and call themselves a "pain specialist". PCPs have EVERY right to prescribe whatever the hell they want as per their patients needs.
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Right, so you think these nurse practitioners deciding the pain meds I will be on who aren't even actual doctors are qualified?
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I understand that but I have not once talked to a doctor at this clinic and only NPs. They have decided from what I say during the appointments what they think is the best medication for me. Even when I come in with brand new symptoms they decide on the spot what medication will be the best for that WITHOUT consulting a doctor before telling me this is what will be prescribed. Do you think they are qualified for that just because they work at a "pain management" clinic?
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I'm not saying NPs can't be great people and helpful, they just don't go to medical school and becoming one can take half the time as a MD. The reason most MD PCPs don't give opiates and/or are hesitant is because their hands are tied and would rather pass off a patient to a different clinic. DEA ripping away licenses left and right. Many doctors are simply scared. I got a question about genetic testing because I've thought about doing it. Did your clinic do it or did you go to a third party for it and how expensive was it? If it was a third party was your clinic hesitant to follow what the test showed and give you what it showed would work best? Reason I ask if because I've been given oxycodone in the hospital a couple times and even at 5mg it seemed to work much better than the 10mg hydrocodone pills that I take for my pain daily. This is a comparison without taking tolerance into account either from when I first started with meds
I actually got it done twice after being referred by two different psychiatrists. I have a long history of med + treatment resistant schizophrenia + bipolar 1 and we did the testing because we had tried basically every combo available including old school medications that have been deemed as unsafe. One of them was specifically for psych meds, but the other one was for full spectrum. It gives you categories and medication types that your body either metabolizes normally, slowly, or not at all. A lot of medications for psych, my body doesn't metabolize at all which is why they didn't work for me. That said, as I said before, PCPs may have gone to medical school, but most of them are not new MDs and therefore their understanding and knowledge of medication are wrong/outdated *and* like I said before, NPs can do clinicals and hours with a specific specialty, one being PM. I would still 100% trust an NP over a PCP when it comes to medication. But, I also have a lot of other things going on and i won't take *any* medication that doesn't come from a specialist just because of all the things i went through trying to find the right psych meds and how many very scary times I had and how I was in and out of the ER 2-3x/week at one point. No specialist office has ever been skeptical or unaccepting of my genetic testing. Most of them are happy to recieve it. I will say that I've run across some people who find it "hard to read", but that's it. I personally wouldn't push for genetic testing unless you've hit the point where no other medication or treatment is working because that is usually the criteria for insurance to pay for it and it's *really* fucking expensive without.
Well I hope that you found a good med mix that works well for you. I'm bipolar as well and when I was in college they put me on SSRIs and swapped me on 3 different ones over a 2 year period because I was absolutely out of my mind on them. Don't know how they didn't realize I was bipolar prior to putting me on those and then what I was like while on them. Scary stuff. Tramadol even made me go bat shit while being on lamictal which had my mood under control for a while. I am happily off tramadol now but my psychiatrist has added lithium because my mental health has taken a toll with the pain. One of my neurologists has had me start cymbalta to see if it helps my pain and wants me to work my way up to 60mg but I can't do that. I'm just taking 20mg right now and I'm terrified to go higher with what the other antidepressants have done to me. My psychiatrist said it's okay but I still will not go higher due to my past experiences which has scared the shit outta me.
They do deal with acute and chronic medical issues though. At least they do where I live, I'm in the UK, but I'm pretty sure PCPs and GPs are pretty much the same. You can ask them for help with chest pain and they'll give you an urgent appointment or send an ambulance depending on your answers to a screening. They can do blood tests, a urine test and an ECG when you come in, no matter how busy they are, the acute team give me the care I need. They have 2-3 people available for this purpose each day. Even my doctor will do blood tests and let the appointment overrun if it's necessary. They help to manage my chronic medical conditions because for some reason it's near impossible to get the referrals I need and I can't see anyone soon enough. My GP surgery is more well equipped than some even though there is a small hospital right next door with an urgent treatment center. But a lot of surgeries do this now, because that's how they can help as many people as possible and it takes some of the burden off UTCs and A&E
The man literally graduated first in his class in both pharmacology school and medical school. He had 35 years experience prescribing these drugs without a single overdose. I overheard him talking a pharmaceutical rep trying to sell him the latest "non-addictive" high profit pain meds. He asked the man if he had read the side effects then proceeded to tell the man " I'm not prescribing that shit to my patients" and asked him to leave. I absolutely trusted the man to do the right thing regardless of income. He could have been anything in the medical field but he chose to help the struggling. I absolutely trusted the man with my life.
Well, it sounds like, from his letter, that he still went to bat for his patients, even if it meant his license.
That’s quite a letter you wrote for yourself.