photo of prescription opioid bottles. Recently published opioid therapy clinical practice guideline aims to improve quality of care and patient safety when treating acute and chronic pain. (U.S. Air Force photo by Senior Airman Hailey R. Staker)

When Pain Becomes Government Regulated, We Are All Potential Victims

By Janice Barlow with Richard Cameron

No one should doubt that we’re still

in the midst of an opioid crisis and have been for the better part of a decade. The nature of the crisis, however, is not what you have been led to believe by mass media reports and federal authorities. 

Opioid medications have been part of treatment regimens for several decades. But in recent years, the line between who needs them to alleviate chronic or acute pain and who wants them because of the pleasant side effects, has become blurred. Or at least it has, according to the government.

Instead of creating a simple and organized process by which these medications, which are Schedule II opioid painkillers, including oxycodone, hydrocodone, oxymorphone, hydromorphone, morphine, codeine, and fentanyl, can be dispensed to those who truly require them – each state has developed a convoluted process that keeps these medications away from the people who need them the most, just so it can claim it is keeping them out of the hands of  abusers.

The Center for Disease Control has developed guidelines that make it very difficult for someone with a chronic and verifiable condition to receive a new prescription or an increased dose of a regulated medication. If you are a doctor who has a patient suffering from acute pain and you prescribe anything over 90 mg. of this class of substances (based on the daily equivalent dosage of morphine) – you will be exposed to a higher degree of scrutiny from authorities. This produces a chilling effect on the very medical providers that know and understand the circumstances and medical history of the patient best.

photo image of opioid pain reliever bottles and tablets

You might be asking, “but aren’t doctors massively over-prescribing pain relievers?” The answer runs contrary to many popular media narratives – and the answer is no. There was a statistical uptick in prescriptions during the last 30 years – that is true. But what is not understood, is that the increase in prescriptions was due to the severe underprescription of opioids prior to the 1980s. Prior to that, people who had severe pain were often denied drugs that provided meaningful relief. The prescription end of the opioid crisis is not the prime focus of the epidemic. 

German Lopez, writing in Vox, outlines the dangerous unintended consequences of these policies of government overreach:

“When it comes to cracking down on opioids, just going after the drug’s supply isn’t enough. If you go after opioid painkillers, people will eventually go to heroin. If you go after heroin, they’ll eventually go to fentanyl. And if you go after fentanyl, they might resort to some of its analogs, like carfentanil. This drug crisis, then, likely requires a response that also tackles the existing demand for these drugs, particularly through new forms of drug prevention and treatment that can get people off these dangerous substances altogether.”

It seems that in the run for cover over reaction to the serious crisis of misuse of these controlled substances, federal and state authorities have drawn the overarching conclusion that anyone taking these medications will automatically become addicted to them and require rehabilitation. This is not the case in reality.

What is happening instead is that people who are truly suffering and in need of the relief that can only be attained with some of these medications, are being denied because there is a segment of the population that abuses them. It is odd that fentanyl is grouped in with the oral medication as it is a patch, and it’s very strong.  Fentanyl is very deadly if used improperly. Some people have stupidly chewed them and died as a result. 

Morphine is also far more volatile and dangerous than hydrocodone.  It is just another example of the government lumping diverse products under one umbrella.  It’s almost the same as saying that no diabetic should be allowed access to candy bars because some diabetics just eat too many of them and cause severe damage to their health.

The D.E.A. (Drug Enforcement Agency), the arm of government that has been perpetually administrating the failed “War On Drugs”, has produced new restrictions that are having a detrimental impact on chronic pain sufferers.  The National Fibromyalgia and Chronic Pain Association (NFMCPA) released a survey assessing the first 100 days after the regulatory change. The results include:

  •  88 percent of patients responding that the changes denied their rights to access pain medication.
  •  71 percent report being switched to less effective medications by their doctors, who are fearful of legal                               issues.
  •  52 percent perceiving an increase sense of stigma as a patient receiving hydrocodone.
  •  27 percent of patients even reported suicidal thoughts when unable to access their prescription.

Among the comments received by the sponsors of this study, was the following. “The one person I know who says the recent guidelines have helped (is) my neighbor who is a heroin dealer. He says business has quadrupled since doctors have started becoming too afraid to help people in pain.”

The survey findings also strongly suggest that the over-reaction of public officials is driving an expansion of the black market in Schedule II substances, as typified by this respondent’s observation:  

“I found it easier to get medications through the black market than through my doctor. I spend about $1,000 per month in medications through the black market, but in the end that is less than the deductible on my insurance. And they deliver to my house!”

It does go without saying that yes, some people have become unwittingly addicted to opioid medications. One reason is because they were over-dispensed for conditions for which they were not required. Giving a nineteen-year-old 30 hydrocodone (Vicodin) tablets because he had four wisdom teeth pulled is irresponsible. No opioid is generally needed for that kind of pain relief – and certainly not on an extended basis. But this sort of occurrence is a marginal aspect of the overall problem – and there are effective solutions to managing patient use of opioids, readily available and waiting to be implemented. 

photo of doctor performing surgical procedure

Conversely, denying someone ten days of hydrocodone who had a knee replacement to recover from post-surgical pain is also irresponsible. That is debilitating pain and would require more than a couple Advil.

The protocol now however, is often no more than three to five days of pain medication following major surgery, including heart surgery!

Chronic pain suffers are now being denied the hydrocodone, which is the most mild acting of the opioid drugs. The side effects are minimal, and the addiction patterns are not widespread.  However, taking people off the medication that has helped alleviate pain for years has caused severe depression, return of chronic pain, and even suicidal thoughts.

And more than merely suicidal thoughts – real deaths of people driven to desperation by being deprived of adequate dosages of pain relieving medication, have been documented to be widespread. 

Were there unscrupulous individuals with medical licenses operating clinics as a front to provide people using opioids for non-pain related purposes?  There is no questioning that fact. 

Joe Rannazzisi, former director of the DEA’s Office of Diversion Control, which regulates and investigates the pharmaceutical industry, told Bill Whitaker on CBS’ 60 Minutes that, “Pain clinics overnight popping-up – off an entrance ramp, or an exit ramp on an interstate. And all of a sudden there’s a pain clinic there. These weren’t kids slinging crack on the corner. These were professionals who were doing it. They were just drug dealers in lab coats.”

Unfortunately, the government’s efforts in cracking down on bad players – rogue clinics and irresponsible, profit driven distribution networks, has bled over into the rights of individuals legitimately needing opioids. Ken McKim at Pain News Network, draws a remarkable and thought provoking analogy of how the epidemic of deaths related to auto accidents would be dealt with if managed by the CDC and DEA. 

According to the most recent data from the National Institute of Health (NIH), there are an estimated 23.4 million Americans that suffer severe and chronic pain. In comparison to that number, it is estimated that less than 10 percent of those with chronic pain using opioids, are experiencing addiction symptoms. 

When government agencies acting with the acquiescence of Congress, take a sledgehammer to a nail, scores of innocent people suffer. 

Remarkably, the very government official who spearheaded the new CDC guidelines that are putting millions of Americans at risk, acknowledges that prescription opioids are not driving the public health crisis. Debra Houry, MD, Director of the CDC’s National Center for Injury Prevention and Control, admitted to House members in a Congressional hearing last year that:                                                                                                                                         

“Although prescription opioids were driving the increase in overdose deaths for many years, more recently, the large increase in overdose deaths has been due mainly to increases in heroin and synthetic opioid overdose deaths, not prescription opioids. Importantly, the available data indicate these increases are largely due to illicitly manufactured fentanyl.”

Despite knowing the reality, Houry steadfastly refuses to reverse course.

No doubt, there are some of you reading this, thinking “everyone who becomes addicted to opioids and obtains them illegally, should get dealt severely by the criminal justice system – to hell with all these namby pamby drug treatment diversion programs!”.

You view others who fall prey to addiction as moral weaklings. That is a viewpoint shared by none other than “conservative” right wing icon, Rush Limbaugh, who opined in 2011 that:  

“I’m appalled at people who simply want to look at this abhorrent behavior and say, ‘Hey, you know, we can’t control it anymore. People are going to do drugs anyway. Let’s legalize it.’ It’s a dumb idea. It’s a rotten idea, and those who are for it are purely, 100% selfish.”

Yes, that is that very same Rush Limbaugh, who seems to conveniently forget that he was engaged in what he describes in the above quote as “abhorrent behavior”, just 12 years prior. This is the man that abused not only the drugs, but the system itself to go ‘prescription shopping’ to satisfy his addiction. 

photo of Rush Limbaugh taking selfie with a bronze likeness of himself

And it’s the same Rush Limbaugh who received the most lenient celebrity justice, light tap on the wrist possible – a single charge, $3,000 bail, not a single day in jail and an 18 month probation.  Limbaugh had obtained a cornucopia of feel good pills, including, according to court records – OxyContin, Lorcet, Norco, Hydrocodone, and Kadian

“Average Joe” could have been convicted of the felony charge and sentenced to up to five years in prison for the same offense that Limbaugh got preferential treatment from the courts on. 

Your “100% selfish” hard core anti-drug warrior, Limbaugh, even refused to confess his behavior to his radio listeners (despite copping a plea), saying cynically afterwards:   

“From my point of view, the end result will be as if I had gone to court and won, but the matter is concluded much sooner,” Limbaugh told his listeners. “I have spent thousands of hours and millions of dollars with lawyers over the past 27 months fighting this at every stage.”

Limbaugh, incidentally was ordered to submit to … you guessed it, a drug treatment program – and the program, by all accounts, was successful. During Limbaugh’s 18 months of probation and rehab program, other non-politically connected men and women who committed the same crime, were occupying prison cells. 

photo of packaging of 100mg Tramodol tablets

On September 18th, there will be a nationwide protest rally against the over regulation of pain medications. 

In attendance will be people who have chronic conditions and have either been cut off from their prescriptions or diverted to one that is not effective, such as Tramadol (shown right), which has some pretty bad side effects.

Other people affected by the revised regulations, include people in the Medicare system who have had their prescriptions cut back, or been denied effective pain relief prescriptions for documented chronic conditions.

“We are protesting to have our voices heard regarding the neglect the chronically ill community/pain patients have experienced due to the new CDC guidelines, the DEA, and the FDA’s involvement.”

Interested parties can check get more information on the Facebook group, Don’t Punish Pain Rally, and search for their individual states in the Files section.         

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13 thoughts on “When Pain Becomes Government Regulated, We Are All Potential Victims

  1. Good article, but one main factor for the increased amount of prescribing opiods is definitely the implementation of Medicare prt.D. More people could afford the prescriptions=more prescribing.

  2. This is true. Due to government constraints, you can’t get a pain med from your pain doctor if you legitimately need it anymore. The doctor is afraid to prescribe it, so the patient has to needlessly suffer. It’s not true that hydrocodone is addictive. I was on 10 mg of it a few times a day for years. I was never addicted. It just helps pain. I had to go to the ER for years for a drug stronger than morphine—Dilaudid. I got to feel like everyone else for a few hours! It was heavenly! They were VERY concerned every time they put it in my iv. It’s often very painful getting ivs in my small veins. One time it was so bad when I had sciatica too that I didn’t care! I told them to “shove it in!” I’ve been through it for over a decade! Ironically, doctors caused my health problems. Yet, they don’t want to give me anything for pain anymore to protect themselves! I’m sorry but that’s bs! Some people reach their pain limit and do commit suicide. I went to the hospital once when another doctor had me on the wrong med for something I did not have. I wasn’t sure I could keep from committing suicide. I called Don. We went to a psych hospital. That’s how bad it was! Those people are crazy! I got out of there! I suffered at home for a week until I could see a better doctor instead of in there. This article is true! People that really need pain relief can’t get it anymore!

  3. My pain meds have doubled this month, due ri this bull#$#@ but because I suffer with chronic pain I must pay the price, this isn’t to me a opiod crisis but a drug crisis, big difference👀 I am always saying what about alcohol, its deaths, addictions to it ect to me way worse and it legal, I’m also hoping to see marijuana legal also for the ones who can’t get access due to this crazy crisis, it can help one tremendously, but not all can use either, and if you take opiods away from the abusers their just gonna go to something else, their ones who look for the high, they will find something no matter what, and what about Meth? They tried things to stop it! And its never gonna end people will always find their ways, no matter what any of us do, not all addicts and abusers, some of us are responsible and take as prescribed, yes we the people need to fight, voice our statements, we should not suffer due to their problems

  4. Thank you Janice for writing this for chronic pain patients who are suffering and for your mention also to Don’t Punish Pain Rally FB group! We are united in our goal of ending this war on pain patients by our government. Praying our voices are heard above the misinformation touted by the media and politicians who are playing with our very lives.

  5. Best article ever written on what is happening to chronic intractable pain patients. Thank you for telling our side of the story !

  6. Thank you for writing this article. I was a “Very High-Dose” opioid patient for many years, never had any negative side effects from them, never had any issues with abuse or addiction, was always totally compliant with my meds, never called in for early refills, never doctor-shopped or obtained prescriptions from other doctors, never played any of those games, etc. Personally I don’t have any interest in drugs, getting high, and can’t stand drug abusers as they’re the ones who make life so difficult for the real pain patients. When I read the testimonies of opioid abusers and drug addicts though, I’m thoroughly disgusted. But when I read the testimonies of those who are victims of torture, e.g., POWs…those are the people I can really relate to.

    But the current narrative from the CDC, CMS, OIG, HHS, Dr Andrew Kolodney, PROP, etc. though, is to make all opioid users with severe chronic pain out to be drug abusers, addicts, street pushers, criminal defrauders of the U.S. government & U.S. taxpayers, worthless ne’er do wells, people “to lazy to want to work”, etc. These descriptors couldn’t be any further from the truth when it comes to me though (as I’m sure is the case for the vast majority of chronic pain patients as well). All opioids did was allow me to function — and without ever getting high or even buzzed from them too. I guess I shouldn’t say any more about that though because then I’d sound like an “opioid success story”, and you’re not supposed to say that as it’s tantamount to heresy these days.

    Now, with these inhumane and cruel CDC “Suggested Guidelines” (read: de facto laws) I feel as if I’m being tortured a lot of the time. My dose has been greatly reduced, even though my doctor was against this, and my pain now ranges between moderately-severe to outright torture. Sometimes the pain keeps me from going to sleep, sometimes I actually shake because it’s so bad, other times I can’t stop crying from the pain. My blood pressure is consistently higher now too. I rarely leave bed except to eat or go to the restroom. Yesterday I woke myself up out of my sleep twice, from my own screaming, due to the pain. While sleep does offer some relief from it, I still sense it even when asleep.

    I read stories all the time of patients who’ve been cut off by their doctors for no reason, weak reasons, and made-up reasons; and doctors who have simply closed up out of fear, and thus leaving all those patients stranded w/o any pain mgmt. That scares me. Think you can just call up another doctor and get in? Think again. Not anymore. Too many pain specialists have left the field due to what the government is doing. Should anything like that happen to me, I don’t think I could handle it. I’m already at the breaking edge just as it is right now with the level of pain I’m in, and now that the CDC is being controlled by PROP and Kolodny (who just want to redefine pain patients into “opioid abusers”, which the CDC did as of January 1, 2018 for most pain patients), they just want more “opioid abusers” (read: pain patients) for the chain of rehabs that PROP & Kolodny own.

    And that’s the root of the problem behind all of this. Like they always say: Follow the money.
    I could see what was behind all of this and where this all was going a year or two ago. And then last night I saw a comment underneath a pain news-related article: a woman’s 70-something arthritic mother was being forcibly and entirely discontinued from all her opioid-based medications. However, if she wanted, she would at least be give buprenorphine >IF< she signed a statement saying she had OUD (Opioid Use Disorder)! In other words, she would at least be able to go through the withdrawals from a rapid detox, but only if she lied and said she had OUD.

    Granted, this was only one anecdotal report, but I have a feeling it's most likely a harbinger of things to come. It would make all the pieces of the puzzle fit together perfectly, especially when one considers the CDC has already admitted twice now that the statistics they've been using to say the U.S. is in the midst of an opioid "epidemic" are false. That's why every time you hear that x number of people die per day from opioids, the number is always different, and ranges from between 40 and 176. It's also why the term "opioid-related" overdose/death is used. Opioid-related simply means they could have died from anything at all, it's just that some amount of an opioid was found in the person. Could have been legal, illegal, and/or mixed with other legal/illegal drugs too. What it virtually guarantees though, is that the person was NOT someone in pain management. That's because of all the constant checks and tests we have to go through. Yet pain management patients and their doctors are the ones being punished and used as convenient scapegoats or this purported "epidemic".

    Also keep in mind that these statistics are the house of cards. If those aren't accurate, then there's no "epidemic", which means that chronic pain patients were viciously used as a scapegoat and punished for something they had no part in at all. All these lies over the past two years, all the propaganda, all the disinformation about chronic pain patients being the cause of the purported "opioid epidemic", all the maligning of pain patients being drug abusers by "thought leader" Kolodny and saying that any opioid-based medication is a "heroin pill" as he put it — over and over and over again. I had a feeling from the very beginning that all of this was just a way for Kolodny and PROP to get pain patients redefined as opioid abusers and then coerced into his rehabs (The Phoenix House). But what about the suicides of pain patients who cannot stand the pain? Apparently they mean nothing. Human trash in other words.

    So, what I'd like to know is now that we know this was all a sham, when is the the CDC going to drop the pretext that chronic pain patients were the problem? And when are the 2016 "Suggested" Guidelines going to be rescinded since we now know they were false, conflated with illegal drug use for the purpose of making the opioid "epidemic" seem much worse than it actually is, so that chronic pain patients could be made into a pretext and a scapegoat, and the bogeyman of a drug epidemic could make the DEA more secure in their jobs, giving the public the impression they were actually doing something (when in reality they were just making the problem much worse)? And when are the threats towards pain management doctors going to stop and allow them to go back to practicing medicine?

    Wake up people. PROP has been around for many years. They've always wanted to be able to redefine chronic pain patients as opioid abusers. Once Purdue Pharma dumped millions of opioids into Appalachia, and then when Florida's very weak "pill mill" laws were taken advantage of by unscrupulous doctors, some people did abuse opioids and become addicted, as would be expected. This was the opening PROP needed. With the backing of bogus studies and fake statistics, their plan to fill up The Phoenix House was on. Kolodny and PROP tried hijacking the FDA at first but failed. Then they went for the CDC and got it. That's why it seems strange that self-proclaimed "addictionologists" (not even a real medical specialty) are running the CDC — an agency that's traditionally only dealt with communicable diseases. And once PROP had hijacked the CDC, now they had big budgets in which to push their propaganda, disinformation, and lies about opioids. Ever wonder how the addiction rate suddenly went from 1% (what it's always been, proved through countries studies and across nations) suddenly to the much scarier 25% for taking just a very small amount of opioids for only three days? Easy. Just have a study invented saying what you want it to say, and since you're in charge of the CDC, use their budget to disseminate it. Wash, rinse, repeat with other bogus studies and disinformation, make sure to put a qualifier such as "as high as" in very small print, hardly even noticeable above the blaring "25%", disseminate to all doctors in the country who don't have the time to check these things out and really see what's going on, make sure the media repeats this nonsense every ten minutes across almost every channel, and pretty soon you have a country brainwashed on the fear of opioids and believing all pain patients are actually drug addicts.

    But nobody seems to be noticing the suicides of chronic pain patients resulting from this though. You can be sure that the government, PROP, and the medical insurance companies don't care. That's because they've now made opioids so hard for legitimate pain patients to get that suicide is now becoming a standard way to deal with intractable pain. Anyone who thinks it's due to depression simply doesn't understand this level of pain, what chronic pain does to you, nor with what's actually going on with what the govt is doing now. Suicide is a great business model for the government and health insurance companies too (not that they'd ever admit it). Maybe that's why the CDC, PROP, Kolodny, and the health insurance companies want their meetings to be kept secret.

    Want to do something? Send a FOIA request to the CDC. Tell them you want to know about the secret meetings held by them in govt buildings last year on govt property, which were attended by CDC, PROP, and health insurance companies. Ask for meeting minutes, who attended – companies, individual names, etc., and what was Kolodny's function. If you find out anything, send to, Thomas Kline MD, or Red Lawhern.

    1. Preston – excellent points and greatly appreciated. National Compass is going to be publishing follow up reports and taking up many of the issues you outline. We’re going to keep the pressure up on this travesty of high handed bureaucratic overreach. I also plan to have some sitdowns with at least two House members in the coming months.

    2. Spot on and clearly explained. Only thing I would add in addition to your mention of Kolodny is to look into who his boyfriend is! A partner in a big shots law firm none for going after large corporations to use this propaganda to win multimillion dollar lawsuits.

  7. As a CPP the only thing that is not correct is the fetynal. China sends the majority thru our ports which is then put into pills or cut into Heroin Coke or meth. Drs will not take on patients that have incurable disease, irreparable bone damage that surgery cannotrrepair if they are a pain medication regemes no matter how small the dose.

  8. The only thing I can think of is thatthe Fetynal is wrong in this article. China’s product of fetynal majority comes thru our ports legally then is illegally put into pill form or cut into Heroin Coke or meth. Would like to hear more of Drs outright refusing to take on patients that receive a opiod pain management no matter how low the dose.

    1. I had been a patient in a pain management clinic for two years when my doctor suddenly left with no warning. I was still being prescribed my opioids by nurse practitioners who were working under other physicians in the practice but for almost two years didn’t see an actual doctor. The practice just kept saying they were in the process of hiring another doctor and I couldn’t switch to a different doctor but had to wait. I decided this wasn’t healthy so I asked my primary physician, who at one time had written my opioid scrips, but he had decided he wasn’t treating chronic pain any longer because of the CDC regulations so he gave me the name of three other pain management doctors. I tried to make appointments for each of them and learned that none of them were taking any patient currently on opioids. So I was , in effect, forced to remain where I was with just a nurse practitioner for care. Luckily the practice did hire an excellent doctor who has been a godsend to me although he freely admits his care choices are hobbled by the CDC and insurance regulations. Though my life is definitely better with the drugs I’m prescribed for a compression in L4-L5 and L5-S1 spine and fibromyalgia. I am by no means pain free. I’ve been trying a series of lumbar injections but the insurance company is horrible about doing the ore approval process so that’s now on hold even though it helped tremendously. I live in constant fear of losing my meds, fear of what life would be like and if I could handle the level of pain if I was I medicated.

  9. The day that ruined my life.
    Suffering with Chronic Pain has been a part of my life for over 30 years. I have a peptic ulcer so I stay away from OTC medicine as much as possible. I suffer with Chronic Pain on a daily bases. Throughout the years I have taken Opiods never have I become addicted.
    Last year a Pain Specialist started me on Fentanyl Patches. After the first week I was feeling more relief th a I ever have. As I stated I have had this progressive  problem for years and at times it would push me to the point of suicide thoughts and sometimes the actual attempt. Some how on my 3rd week of the use of Fentanyl I was found 5 blocks from my home nearly dead. An overdose on Fentanyl. The paramedics that responded to me said I had 4 patches on me 1 on each thigh 1 on my neck and 1 in my mouth.
    Now when my grandson son was born 3 years earlier I made myself a promise that I would do my best not to have those awful thoughts of ending my life no matter what because now I had a Reason.
    I was so close to death that day I was in a coma for 3 weeks. While the a ventilator I had horrible dreams. I have been being treated for seizures for several years but this incident has cause my condition to worsen.
    I was threatened  by a guy that lives down the road from me. He made me fear for my life. He was my daughter’s boyfriend at the time.While I was in the hospital he got my daughter strung out on drugs (Meth, Extacy,and who knows what else).My grandpa’s dad came and took home away from her due to negligence.
    To this day believe he was responsible for what happened to me but I have no proof.
    He used my past to cover his crime.
    My pain doctor released as his patient. I even had to find another primary care physician.There are no pain specialists that will return my requests. I hope this new primary care physician will help. So far the strongest pain medicine I can receive is ULTRAM.  Mabey in time I can regain the trust I once had with the medical and law enforcement agencies so I can once again get relief for my Chronic Pain.
    They are talking about revoking my privilege to operate a motor vehicle. If the government would make cannabis legal for Chronic Pain sufferers I would rather use it instead of dangerous Opiods.  Something must give it is hard to concentrate on important daily life when you’re in this much pain.
    Most of all I need my REASON.

  10. Of course the rate of prescribing went up: WHO is now aging? Huh? The largest generation ever- we Baby Boomers! Arthritis, Lupus, Spinal issues! ALL the aging issues hitting us!

    Ive had meds reduced and removed and in my worst moments, suicide looks like the only solution! Ive turned to alcohol and marijuana… which is illegal here. I dont give a flip; I just want OUT of pain!

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