Public Officials Ignorant About Overdose Crisis

By Christopher Piemonte, Guest Columnist

A recent Washington Post article highlights an ongoing debate between the Drug Enforcement Administration and some public officials, who are demanding that DEA further reduce the supply of opioid medication. DEA has responded that, without more precise data, such a reduction would be ineffective and dangerous for Americans that need opioids.

At the center of the debate is the Aggregate Production Quota (APQ) for Schedule I and II opioids and other controlled substances. Every year, the DEA sets the maximum amount for each substance that can be produced. DEA began cutting the opioid supply in 2017 and has proposed further cuts in 2020.  

Congressional lawmakers and state attorneys general argue that the APQ for opioid medication is still too high, and the excess supply leads to overdose deaths. In a recent letter to the Acting Administrator of DEA, six attorneys general claim that the APQ does not account for opioids diverted to the black market, which “factor in a substantial percentage of opioid deaths.”

Citing data from the CDC, they assert that in 2016 “opioids obtained through a prescription were a factor in over 66% of all drug overdose deaths.”

There’s a problem with these claims: They’re wrong.

When asked about the accuracy of the letter, a spokesperson for CDC said prescription opioids were a factor in “approximately 27% of all drug overdose deaths,” a figure nearly 40% lower than that presented in the letter.

It would be one thing if this error were simply a typo or miscalculation. But these state officials, as well as many lawmakers, are insisting on a specific policy response without having made the effort to dig into the data and understand the nature of the problem itself. Specifically, they cite inaccurate data to support the incorrect notion that “prescription opioids have been a dominant driver in the growing crisis.” What’s worse, that false notion is the basis for their intransigent insistence on a blanket reduction in the supply of all prescription opioids.

Experts in law enforcement, medicine and policy agree that the attorneys general made an erroneous factual conclusion, and that an arbitrary opioid quota reduction would be both ill-informed and dangerous.

“There is no question that the DEA, or any agency, attempting to come up with valid quotas for controlled substances will find it difficult if not impossible. One of the problems with interpreting overdose death information is that illicit fentanyl and heroin deaths are frequently lumped together with oxycodone- and hydrocodone-related deaths,” said John Burke, President of the International Health Facility Diversion Association and a former drug investigator for the Cincinnati Police Department.

“The vast majority of people prescribed controlled substances take them as directed. Proposed cuts in quotas will negatively impact Americans who have a legitimate medical need for opioids, causing them even more discomfort and distress. These patients are routinely overlooked when considering the prescribing and dispensing of controlled substances, and it is a tragedy.”

Increased Demand for Street Drugs

Other experts warn that further reducing the supply of opioid medication will lead to drug shortages and increase demand for illicit drugs.   

“On the surface, it appears that limiting the quotas…could, in fact, provide a means to address the overdose crisis,” said Marsha Stanton, a pain management nurse, clinical educator and patient advocate. “That, however, will do nothing more than to minimize or eliminate access to those medications for individuals with legitimate prescriptions. We have already seen the effects of back-ordered medications, which create significant barriers to appropriate patient care.”

“Patients who lose access to prescriptions for opioids, have, in some cases, turned to street drugs as an alternative. This has led to increased morbidity and mortality since street drugs have uncertain content and are often used in a comparatively uncontrolled manner,” said Stuart Gitlow, MD, an addiction psychiatrist and past president of the American Society of Addiction Medicine.

“We, therefore, cannot afford to use a crude blunt instrument such as a quota change to address the drug abuse problem. Rather, we must focus on each patient individually and, through education of clinical professionals, ensure that each patient receives medically reasonable treatment.”

By continually insisting on cuts in opioid production, public officials demonstrate a lack of understanding of America’s overdose crisis. Put simply, they’ve failed to do their homework.

“For more than a decade, experts have urged government officials to focus on much more than reducing the opioid-medication supply. Yet, they remain fixated in intellectual laziness,” said Michael Barnes, Chairman of the Center for U.S. Policy and a former presidential appointee in the Office of National Drug Control Policy.

“Policy makers must reduce demand by prioritizing drug abuse prevention, interventions, and treatment. Prevention is the biggest challenge because it will require public officials to realize and respond to the socioeconomic underpinnings of drug abuse. The time is long overdue for politicians to get serious and do the work necessary to save lives and solve this crisis.”   

The disturbing reality is this: Despite rising death tolls and the shortcomings of recent responses, many officials involved in overdose-response policy misunderstand the complexity of America’s overdose crisis.

Until those individuals are educated about the nuances of the issue, they will continue to demand policy that does not adequately address the problem, and the crisis will carry on. Continued ignorance on the part of government officials would truly be, as Mr. Burke put it, a national tragedy.

Christopher Piemonte is a policy manager for the Center for U.S. Policy (CUSP), a non-profit dedicated to enhancing the health, safety and economic opportunity of all Americans. CUSP is currently focused on identifying and advancing solutions to the nation’s substance abuse, mental health and incarceration crises.

The Real Reasons People Become Addicted

By Dr. Lynn Webster, PNN Columnist

The Atlantic recently published an article, “The True Cause of the Opioid Epidemic,” that shares an underreported view of the complexities of the opioid crisis. The article acknowledges the epidemic is a multi-faceted drug problem that is largely driven by economic despair.

Yet most of the media remains focused on the large volume of opioids being prescribed, while ignoring the fact that opioids fill a demand created by deeply rooted, unaddressed societal problems.

As PNN reported, a recent study found that auto plant closures in the Midwest and Southeast created a depressed economic environment where drug abuse thrived. Poverty and hopelessness, more than overprescribing, were the seeds of the opioid crisis.

But those factors are only part of the issue. The prevalence of mental health disorders, the lack of immediate access to affordable treatment of addiction, and inadequately treated chronic pain — along with poverty and despair — have caused and sustained the continuing drug crisis.

One of the challenges in beginning to solve the crisis is to change how we view people with the disease of addiction. Rather than provide them with access to affordable healthcare, we stigmatize and criminalize them. This creates recidivism rather than rehabilitation. It affects people who use drugs for the wrong reasons, as well as people who use opioids for severe chronic pain.

Debunking Myths About Addiction

Many people make another false assumption. They claim that opioid addiction develops solely because of exposure to the drugs. That is untrue. Genetic and environmental factors determine who will become addicted. Exposure to an opioid — or any drug of abuse — is necessary for the expression of the disease, but by itself it is insufficient to cause it.

Most Americans are exposed to opioid medication at some point in their lives. In fact, the average person experiences a total of nine surgical and non-surgical procedures in a lifetime. An opioid analgesic is administered during most of these procedures and is often prescribed afterward for pain control. The lifetime risk for developing an opioid addiction is less than one percent of the population.

If exposure alone were responsible for addiction, then the 50 million Americans who undergo an operation every year, or those who undergo nine procedures in a lifetime, would develop an addiction.

Commonly, people who investigate and discuss opioid overdoses believe the deaths are exclusively due to the disease of addiction. But here again, they are mistaken.

An estimated 30 percent or more of overdoses are believed to be suicides. Why do some people choose to intentionally overdose? One driver is the despair that develops from inadequately treated pain. People in pain are almost three times as likely as the general population to commit suicide. They often use drugs rather than violent acts to end their lives.

In addition, efforts to curb opioid prescribing have pushed many people to the streets to purchase illegal and more lethal drugs. This is even true for people without a substance abuse disorder who are seeking pain relief.

Despite a more than 30 percent decline in opioid prescriptions over the past decade, there has been a continued surge in drug overdose deaths. We are seeing a shift in the reasons why people are dying from overdoses. Since 2018, the number of overdose deaths from methamphetamines has exceeded the number of deaths from prescription opioids. This underscores the fact that the problem is less about the supply of opioids and more about the demand for relief of psychological or physical pain.

Clearly, America’s drug crisis involves more than just the overprescribing of opioids — and this helps explain why interventions to reduce prescriptions have not succeeded. Understanding the actual causes of the problem may help us find real solutions. It also would change the focus from people in pain who find more benefit than harm in opioids to those who clearly are at risk of harm from them.   

Lynn R. Webster, MD, is a vice president of scientific affairs for PRA Health Sciences and consults with the pharmaceutical industry. He is author of the award-winning book, “The Painful Truth,” and co-producer of the documentary, “It Hurts Until You Die.” You can find Lynn on Twitter: @LynnRWebsterMD.

Opinions expressed here are those of the author alone and do not reflect the views or policy of PRA Health Sciences.

Questioning the New Cannabinoids

By Roger Chriss, PNN Columnist

A new cannabinoid similar to THC was announced last month in Scientific Reports. Dubbed tetrahydrocannabiphorol, or THCP for short, it is being hailed as a “breakthrough discovery” that is 30 times stronger than THC, the chemical compound in cannabis that causes euphoria.

Discovered by a group of Italian researchers, THCP has been shown to have a high affinity for the cannabinoid receptor (CB1) in the brain. Cinzia Citti from the Institute of Nanotechnology told Medical Cannabis Network that THCP likely has pain relieving effects, but pharmacological studies are needed to confirm it.

“Once all pharmacological profile of THCP has been established, I can imagine that THCP-rich cannabis varieties will be developed in the future for specific pathologies,” Citti said.

THCP’s chemical structure makes it nearly optimal for activity at the CB1 receptor. Studies on mice showed that THCP has psychoactive effects at low doses, but research is required to confirm how strongly THCP acts on the human brain.

‘Potential Game Changer’

There is already great enthusiasm for THCP, as well as cannabidiphorol (CBDP), another newly identified cannabinoid compound.

Vice states that “it’s possible these chemicals could treat certain conditions better than their counterparts,” THC and CBD.

Leafly went even further, predicting the new cannabinoids could have “immense therapeutic implications,” with THCP being a “potential game changer.”

Looking beyond the media hype, there appears to be no critical consideration of what a cannabinoid 30 times more potent than THC might mean. THC Is known to have significant negative effects on the human body. The National Institute on Drug Abuse lists side effects such as impaired breathing, increased heart rate, and mental effects such as hallucinations, paranoia and schizophrenia.

Moreover, THC is addictive. Health Canada reports that 1 out of 10 people who use cannabis will develop an addiction. The addiction odds increase to 1 out of 2 for people who use cannabis daily.

In other words, is THCP going to be 30 times more additive than THC? Will it cause 30 times more cognitive impairment? A 30-fold increase in ER visits and hospital admissions?

If THCP acts much more strongly on the CB1 receptor, then it may not really be a good thing for cannabis users or public health. These questions may seem absurd, but potent synthetic cannabinoids like K2/Spice have been a public health concern for many years. THCP may also have unknown side effects.

The difference between THC and CBD comes down to one chemical bond, but their respective effects are quite different. The apparent similarities between THCP and THC cannot be used to draw conclusions about effects in humans, good or bad.  

At present, very little is known about THCP. As Live Science points out, "while THC offers some medicinal effects, including pain and nausea relief, no one knows if THCP has these qualities."

It would be nice if even just one media outlet had mentioned the THCP could have some of the same problems that THC does, and at far lower concentrations.

Roger Chriss lives with Ehlers Danlos syndrome and is a proud member of the Ehlers-Danlos Society. Roger is a technical consultant in Washington state, where he specializes in mathematics and research. 

The Truth About Chronic Pain

By Dr. Rachel Zoffness, PNN Columnist

I’ve never been an athlete, but I’ve always loved exercising because of how it makes me feel. One beautiful spring day, I went for a run. On the way downhill, I was stopped by a sudden pain in my knee. When I woke the next morning, I couldn’t step out of bed without burning pain radiating from my feet, up my leg and into my hip.

I was couch-bound for the better part of a year. I saw countless doctors, was prescribed many medications, and would’ve done anything to stop the pain. That was the beginning of a decade-long journey with chronic pain.

I’ve dedicated my life to understanding pain, and not just because of that injury.

I’m a pain psychologist and assistant clinical professor at UC San Francisco School of Medicine, where I teach pain neuroscience to medical residents. I also founded a private practice dedicated to people living with chronic pain.

One of my earliest patients was a teenager. He’d been bedridden with multiple medical diagnoses for four years, seen 12 physicians and tried 40 medications. But nothing worked.

Not surprisingly, he was depressed and anxious. He had no life, no friends and no hope.

DR. RACHEL ZOFFNESS

As a pain psychologist, I use cognitive behavioral therapy (CBT) as one of my primary treatment tools, so we started a CBT-for-pain program. In addition to other strategies, it involved “pacing” or resuming select activities one small step at a time.

It was hard work, but little by little, he got healthier. As his functioning and mood improved, his pain did, too. Within 6 months he resumed school and rejoined his soccer team. His pain wasn’t gone – but it was significantly reduced and he knew how to manage it. He says pain will never control his life again.

Many of us have noticed this link between how we feel emotionally and how we feel physically. That’s because pain is never purely physical. This is confirmed by neuroscience research indicating that pain is produced by multiple parts of the brain, including the cerebral cortex (responsible for thoughts), prefrontal cortex (which regulates attentional processes), and the limbic system – your brain’s emotion center.

Dialing Back Pain

Imagine that you have a “pain dial” in your central nervous system that controls pain intensity. The function of this dial is to protect you from danger or harm. It can be turned up or turned down by many factors, including:

1. Stress and anxiety

2. Mood

3. Attention (what you’re focusing on)

When you’re feeling stressed and anxious – your thoughts are worried, your muscles are tense and tight, and the pain volume is turned up.  

When your mood is low, you’re miserable and depressed, and your brain similarly amplifies pain volume. 

This is also true when your attention is focused on pain. When you’ve stopped going to work, seeing friends and engaging in hobbies, your prefrontal cortex (which controls attention) sends a message to your pain dial, turning it way up. 

However, the opposite is also true. 

When stress and anxiety are low – your body is relaxed, your thoughts are calm and you’re feeling safe. Your cerebral cortex and limbic system send messages to your pain dial, lowering the volume so that pain feels less bad. 

When your mood is high, your thoughts are positive, you’re feeling happy and you’re engaged in pleasurable activities. Your brain determines that little protection is needed, so pain volume is reduced. 

And finally, when you’re distracted – you’re absorbed in activities, like watching funny movies with friends. The pain dial is turned down, so pain is less bad. 

In summary, when you’re relaxed, happy, distracted, and feeling safe, your pain volume is lower. The pain is still there -- it hasn’t magically disappeared -- but it’s quieter. Softer. Less. 

The truth about chronic pain is this: Your thoughts, beliefs, emotions and attention can all adjust pain volume. 

This does not mean that pain is “all in your head.” It isn’t. Your pain is real, as real as mine, and no one should ever tell us otherwise. It does mean that there are many ways to change pain. One is medication. Multiple medications have been shown to effectively turn down the pain dial.  

There are other methods for lowering pain volume, too. CBT, mindfulness and biofeedback are three biobehavioral approaches to pain management that research suggests can be helpful. They aren’t magic cures and they take time. But if you’ve never tried to manage your pain with these techniques, consider them. They’ve helped me immensely on my chronic pain journey. 

When I was learning about mindfulness, I remember thinking, “What could mindfulness possibly have to do with physical pain?”  

And then something fascinating happened.  

During the first year of my practice, my pain changed. It didn’t go away entirely and I wasn’t cured. But the pain changed. It became less intense, less frequent, less distracting, and got less in the way of the rest of my life. 

Rachel Zoffness, PhD, is a pain psychologist and assistant clinical professor at the UCSF School of Medicine. Rachel serves on the Steering Committee of the American Association of Pain Psychology, where she founded the Pediatric Division. She is the author of The Chronic Pain and Illness Workbook for Teens. You can find Rachel on Twitter @DrZoffness.  

Back to the Future in Pain Care

By Carol Levy, PNN Columnist

The start of another year started me thinking about my 42-year fight against trigeminal neuralgia (TN) and how things have changed in its diagnosis and treatment.

I was 26 when the pain started. It came out of the blue, like a lightning bolt inside the skin of my left temple. It was horrendous, lasting maybe 20 seconds or so, and then it subsided. After a clinic doctor diagnosed it as trigeminal neuralgia, I was repeatedly told it could not be TN because I did not meet the criteria for the diagnosis.

At that time, it was very simple: TN pain had to be in a specific anatomical area. Mine was. The pain also had to be spontaneously triggered by touch, no matter how slight. Mine was. But you had to be at least 60 years old or, if you had multiple sclerosis, over age 40 to have TN. I was only 26. Too young.

So, regardless of the pain being in the right place and occurring in the proper fashion, it had to be something else, although they had no idea what that might be. It took more than a year before someone finally recognized it as trigeminal neuralgia, despite my youth.

Over the years the definition and diagnostic criteria for TN have changed. There are now two recognized types of TN:

• Trigeminal Neuralgia 1: Intense, stabbing pain attacks affecting the mouth, cheek, nose, and/or other areas on one side of the face.

• Trigeminal Neuralgia 2: Less intense but constant dull aching or burning pain.

You can have both types of TN. I have constant pain, as well as spontaneous and triggered pain. Neither type includes an age factor. This makes it easier for a young person to be diagnosed with TN today. 

Changing Treatments

Not only has the definition changed, but so too have the treatment options. When mine started, there were less anti-convulsants to try, the first line of treatment for TN. Now there are many new medications, including botulinin (Botox) injections.  

Over the years I had many operations, some of them no longer in use. Now there are gamma knife and cyber procedures, things not even a glimmer in someone's eye when I was first diagnosed or being treated. 

Reflex Sympathetic Dystrophy (RSD) is another pain disorder which has come a long way. Even the name was changed, from RSD to CRPS (Complex Regional Pain Syndrome).

In 1981, I entered a residential pain program. There were only 8 of us. One was named Joanne, who had very weird, unbelievable symptoms and complaints, so weird even the doctor had trouble believing her.

Joanne said she had tremendous pain throughout her body, and trouble controlling her bowels and bladder. She insisted it all started right after a statue had fallen on her foot. It sounded fanciful at best. She seemed a perfect example of pain being psychological. 

If that happened today, Joanne’s complaints might be taken more seriously and she could be diagnosed with CRPS. But at that time, it was a disorder that did not appear on anyone's radar. 

Since then many new medications and treatment options have been devised or added to the armamentarium against CRPS, such as ketamine infusions, intrathecal pain pumps, hyperbaric oxygen therapy and bisphosphonates. The same is true for many of the other pain disorders. Research is ongoing, new medications and surgeries are being developed. 

We often lament that nothing new is being done for us. Where is the research? Where is the treatment that will finally give us relief? 

It can be hard to see sometimes where we have been vs. where we are now, much less where we may be going. But history shows that more progress is being made than most of us may realize. And that is a good thing. We have to look to the past to see not only how far we have come, but how much farther we still have to go.   

Carol Jay Levy has lived with trigeminal neuralgia, a chronic facial pain disorder, for over 30 years. She is the author of “A Pained Life, A Chronic Pain Journey.”  Carol is the moderator of the Facebook support group “Women in Pain Awareness.” Her blog “The Pained Life” can be found here.

The Devil We Know

By K. Grahame, Guest Columnist

I was on opioid medication for over 10 years as treatment for acute and chronic pain in 27 diagnosed pain conditions, including herniated lumbar discs, arthritis, spinal stenosis, and torn muscles and tendons in my lower back. 

Now I've been involuntarily taken off opioids by my pharmacy. Guess what? There is NOTHING available that treats pain like opioids.

I am 66. The pain has driven my blood pressure up into the 200/90 range, and since I've already had both heart surgery and malignant melanoma surgery, I'm on so much blood pressure medication that I cannot walk.

The government would not let a human treat a dog like this. The rest of my life looks, at this point, to be short and a piece of hell, thanks to the media blitz on 67,000 annual overdose deaths -- of which only 17,000 were overdoses from prescription opioids. That’s fewer deaths than happen from common falls in the home.

While I'm at it, there were 72,000 alcohol related deaths in 2017. And the Surgeon General estimates that 440,000 people die every year from tobacco-related health conditions. Where are you, FDA and CDC on that?

The reason I care about this so much is not only how it affects my life. In 1978, my mother died in mortal agony from bone cancer, without much in the way of painkillers. The hospital refused repeatedly to give her opioids for pain relief because they were afraid she’d become addicted!

I watched the angel of my life pass away looking like a victim of Nazi Germany death camps, after she begged me to find something that she could poison herself with.

God in heaven, nobody should have to watch someone they love beg them for death! It simply boggles my mind that this is happening in America.

I'm going to die soon, most likely of a heart attack or stroke, and that's what will show on my death certificate. It won't show that I was doing just fine, taking care of myself and the pets who are the joy of my life, while I was taking opioids. The only side effect I had to deal with was constipation, and a GI doctor fixed that for me with simple OTC meds.

I don’t really want to die before my pets, but this ain’t living, people!

The government should be outed as the killers they are, because it sure as hell isn't the legally prescribed and supervised opioids. As for the 17,000 people that died from prescription opioids in 2017, the stats aren't available on how many were deliberate overdoses, if alcohol or other substances were involved, or even if they had a prescription.

Those stats should be provided, because that information should make a BIG difference in how the governments, state and federal, make their decisions.

Please don’t tell me that cognitive behavioral therapy or hypnosis are going to cure the pain in my much-damaged back. Or the arthritis, tendonitis and bursitis. Or the pain from my cancer surgery-severed nerves.

There is just so much to tell people that isn’t known or hasn’t been communicated. It’s the devil you know versus the devil you don’t. I really do think the devil we know is trying to reduce the expensive medical costs associated with the Boomer generation. What happens when death is made cost-effective for the government?

Pain News Network invites other readers to share their stories with us. Send them to editor@painnewsnetwork.org.

Do Pain Patients Really Get High on Rx Opioids?

By Roger Chriss, PNN Columnist

The standard narrative of the opioid crisis is built on the idea that people feel euphoria or get “high” when exposed to opioids and almost immediately become addicted. Some assert that opioid medications should have no role outside of trauma, surgical, palliative and end-of-life care due to their high risk and side effects.

But reality is more complex.

Euphoria is widely believed to be inevitable with opioids, and increases the risk for misuse and addiction. But in fact, euphoria is not common.

"I think that the notion that opioids [always] cause pleasure is a myth," Siri Leknes, principal investigator at the University of Oslo in Norway, told Live Science.  "I think it's especially important to point out that opioids do not reliably cause pleasure or relief of subjective stress and anxiety in the lab or in stressful clinical settings."

Leknes’ research found that patients receiving remifentanil – a potent, short-acting synthetic opioid -- felt high, but the experience was unpleasant.

"Not everyone experiences the same level of euphoria from opioids, and not everyone that uses opioids will develop an addiction or opioid use disorder,” says Brian Kiluk of Yale School of Medicine.

Major cognitive side effects are often thought to be inevitable with opioids. But a review of 10 clinical studies on older adults with chronic pain found that most “demonstrated no effect of opioid use on cognitive domains.” Only at high daily doses did opioids worsen memory, language and other cognitive skills.

In other words, long-term opioid therapy may cause side effects at doses well above what most people ever receive and beyond thresholds recommended by the CDC and state governments.

The risks of overdose are similarly nuanced. For instance, a study on opioids and mortality looked at a nationally representative sample of over 90,000 people, among whom 14% reported at least one opioid prescription. There were 774 deaths during the study period, with the death rate slightly higher among those taking opioid prescriptions.

However, after adjusting for demographics, health status and utilization, the authors concluded there was “no significant association” between opioids and sudden death. “The relationship between prescription opioid use and mortality risk is more complex than previously reported, meriting further examination," they said.

On the efficacy of opioid therapy, a major review in Germany looked at 15 studies with 3,590 patients with low back, osteoarthritis and neuropathic pain. The quality of evidence was low, but the authors concluded long-term opioid use was appropriate for patients who experience “meaningful pain reduction with at least tolerable adverse events."

Pain Patients Used As ‘Guinea Pigs’

Instead, we have an intense focus on prescribing statistics. States like Minnesota tout a 33% decrease in opioid prescribing for Medicare patients, while ignoring how those poor and disabled people are faring.

“My cat gets better pain management than I do after surgery,” one man wrote to state health officials.

In Ohio, opioid prescriptions have declined by 41% since 2012. Some wonder if the cutbacks went too far.

“There needed to be an adjustment and maybe it did go overboard a bit. I feel bad for the people in chronic pain because they're going to be the guinea pigs for how we get it back to the middle," Ernest Boyd, executive director of the Ohio Pharmacists Association, told the Akron Beacon Journal

So the medical needs of people with cancer, sickle cell disease and other chronic painful conditions are going unmet. And some doctors are even avoiding such patients entirely.

Naturally, there is a need to safeguard the entire opioid supply chain, and to carefully screen and monitor people on any form of opioid therapy. But we also need to track the rapidly evolving policy landscape surrounding prescription opioids to make sure that pain patients with chronic medical needs are being not harmed.

Roger Chriss lives with Ehlers Danlos syndrome and is a proud member of the Ehlers-Danlos Society. Roger is a technical consultant in Washington state, where he specializes in mathematics and research.

Flushing Out the Truth About Disposing of Unused Pain Medication

By Dr. Lynn Webster, PNN Columnist

According to a 2016 survey, most Americans choose not to dispose of their leftover opioid pain medication because they want to keep it for potential future use. This is entirely understandable.

People have little incentive to dispose of their unused pain medication. It is expensive to replace drugs, and the person who owns the prescription has already paid for it. Also, a growing number of people are concerned that, should they someday need pain treatment, they will find it difficult to obtain opioid medication. They may even be accused of being a drug seeker if they ask for it.

So people don't necessarily have nefarious reasons for holding onto unused medication. However, leftover pain medication has been blamed for causing much of the opioid crisis because it can be easily diverted.

Leftover drugs can end up on the streets or in the wrong hands, such as family members or friends. In all cases, they can cause harm. Let's look at some numbers.

In 2013, nearly 9 billion pills containing hydrocodone were produced for prescription purposes. Other opioids added to the supply. Although this was several years ago and opioid production quotas have significantly reduced the supply of opioids, leftover pills are still a potential problem. Of those that are prescribed after surgery, more than 40% percent go unused.

Opioid drugs lose only about 1 percent of their potency per year. This means prescription opioids have a half-life of more than 50 years. These potent medications can remain viable (or toxic) for nearly a lifetime. 

At any given time, billions of opioid pills that still retain their potency are available for diversion and non-medical use. That is a problem.

Conflicting Information About Safe Disposal

A public education campaign may convince some people who are reluctant to give up their extra medication that it would be better for society if they get rid of the drugs. However, even if people were persuaded to dispose of their unused medication, they may not know how to do so safely.

A recent report by Time suggests that even pharmacists do not know how patients should dispose of their leftover drugs. Of 900 pharmacists surveyed, only 23 percent correctly told callers how to safely dispose of opioids according to FDA guidelines.

The pharmacists' confusion is understandable. Various authorities have delivered different messages over the years about the best way to dispose of unused drugs.

The FDA recognizes that there are environmental concerns about flushing medicines down the toilet. However, the agency also believes that the risks associated with narcotic medicine outweigh any potential risks associated with flushing. The FDA includes hydrocodone, oxycodone, methadone and other opioids on a lengthy list of medicines that should be flushed down a toilet if no other safe disposal options are available.

The FDA even recommends flushing unused fentanyl lozenges (ACTIQ). The disposal instructions are very complicated. They require both a pair of scissors and wire-cutting pliers, and are roughly as convoluted as Walter White's method of making crystal meth in television's "Breaking Bad." I suspect that not everyone who is prescribed ACTIQ would be willing or able to follow all of those steps.

Evidently, the FDA believes that the risk of harm from overdose is greater than the danger the drugs present to the environment and to our water supply. 

The Time story cites a 2017 U.S. Geological Survey and EPA report that found hundreds of drugs, including prescription opioids, in 38 streams across the country.

“Many of the drugs identified in the 2017 study are known to kill, harm the health of, or change the behavior of fish, insects and other wildlife. This, in turn, can impact the food chain, and eventually harm humans as well,” Time reported.

The FDA’s guidance on how to safely dispose of drugs can be confusing. Some medication is flushable, while other leftover drugs should be put in a sealed container or plastic bag with an “unappealing substance such as dirt, cat litter, or used coffee grounds” before being thrown out in the trash.

Take Back Programs

Drug take-back programs are intended to reduce the supply of excess prescription opioids and destroy the pills in an ecologically safe way. The FDA has a list of permanent take-back sites where people can dispose of unused medication. The DEA also has Drug Take Back Days, temporary collection sites for the safe disposal of prescription drugs.

However, not all take-back programs collect controlled substances. And it is estimated that fewer than 2 percent of unused drugs are returned. Also, these take-back programs are costly to implement.

The messaging around disposal of pain medication is conflicting. In a perfect world, all unused medication would be easily disposed of without causing negative consequences to the environment or the community. Also ideally, people in pain would not have to worry they might not receive a prescription for medication if they need one. Unfortunately, neither of those propositions is true. 

Lynn R. Webster, MD, is a vice president of scientific affairs for PRA Health Sciences and consults with the pharmaceutical industry. He is the author of the award-winning book, “The Painful Truth,” and co-producer of the documentary, “It Hurts Until You Die.” You can find Lynn on Twitter: @LynnRWebsterMD.

Opinions expressed are those of the author alone and do not reflect the views or policy of PRA Health Sciences. 

The 2019 Event With Major Impact for Millions of Pain Patients

By Dr. Lynn Webster, PNN Columnist

The demise of the American Pain Society (APS) in June of 2019 was a major blow to pain patients, their providers and pain research. For 42 years, APS enjoyed an unimpeachable reputation as an academic, scholarly organization and an icon of scientific integrity.

However, with an opportunity to make billions of dollars, opioid plaintiffs' attorneys targeted professional medical organizations like APS as complicit in creating the opioid crisis. They labeled them as front organizations for deceptive opioid manufacturers and distributors.

As implausible as the claims were, it was a real problem for APS and other professional organizations and individuals who care for patients with pain. There were more than a thousand lawsuits filed against myriad defendants. I don't know the exact number of claims filed against APS, but I was named in several hundred of them.  

The plaintiffs required records about, and responses to, each claim. Complying with that many demands proved to be such a financial burden that APS could not survive. I, too, have struggled to deal with these baseless attacks on my integrity and resources.

Law firms representing over 2,000 states, counties and municipalities, along with national media, have judged and found blameworthy those who have devoted their careers to helping people in pain.

Even deep-pocketed companies such as Purdue Pharma are not always able to weather the financial and administrative burden of responding to thousands of legal claims. The manufacturer of OxyContin, Purdue Pharma filed for bankruptcy in September 2019.

It strikes me as an injustice when small organizations like APS cannot defend themselves in court due to the overpowering financial and political forces alleging spurious conspiracies and dubious claims of wrongdoing. 

In the past decade, the number of doctors and other providers who have been criminally charged for prescribing controlled substances without a legitimate medical purpose has increased dramatically. Some were appropriately charged, but others were caught up in a social fever to cast blame for the destruction that substance abuse can cause.

Providers are easy targets. It is much simpler to accuse doctors and pharmacists of wrongdoing than it would be to try to correct social disparities that drive the demand for drugs of abuse. I have attempted to defend many such providers, who eventually decided to plea bargain because of the enormous legal costs they would incur if they continued their defense.

Justice for Some

Attorney Bryan Stevenson shines a light on the naked injustices that treat the rich and guilty better than the poor and innocent in his memoir, Just Mercy. Stevenson shows that racial prejudice fuels injustice, but the lack of resources to secure adequate defense makes the process painfully unfair and the outcome predestined. 

Another injustice was in the national news some years ago. You may remember that Richard Jewell was unfairly accused of a bombing at the 1996 Atlanta Olympics. The media essentially convicted Jewell before he was charged with anything. After several months of cruel media persecution and harassment, the truth emerged and Jewell was exonerated. A movie about what happened to Jewell is currently playing in theaters. 

Veteran newscaster Tom Brokaw recently apologized for suggesting to viewers that Jewell was guilty. NBC reportedly paid Jewell $500,000 for contributing to his suffering, but this is a rare consequence when such injustices occur. APS is not likely to receive either vindication or reparations.  

Groundless accusations, media hysteria and the enormous financial backing of a false narrative exploit the weaknesses of our civil and criminal justice systems. 

Two of the most powerful forces in America are the media and the government. When they join together to fight evil, they can strengthen a democracy and serve the people well. But if they combine forces to propagate a false narrative, it is nearly impossible for the innocent to survive the damage on a personal or professional level. The catastrophic results can undermine the integrity of our legal system and free press. 

The media's framing of an issue, whether factual or not, changes attitudes and even public policies if it is repeated often enough. The media has certainly carried the water for the plaintiffs against organizations like APS. 

Most disheartening is that, in the case of APS, the harm goes far beyond the organization and its members. One hundred million Americans with pain and their families are the ultimate victims of APS's collapse. The harm will not be confined to 2019 but will extend for decades into the future.  

Lynn R. Webster, MD, is a vice president of scientific affairs for PRA Health Sciences and consults with the pharmaceutical industry. He is the author of the award-winning book, “The Painful Truth,” and co-producer of the documentary, “It Hurts Until You Die.” You can find Lynn on Twitter: @LynnRWebsterMD.

Opinions expressed are those of the author alone and do not reflect the views or policy of PRA Health Sciences. 

Emotional Awareness: How I Learned to Connect with Life and Disconnect from Pain

By Dr. David Hanscom, PNN Columnist

Last month I wrote about the importance of environmental awareness – being aware of your moods, anxiety and other senses and learning how to calm them through active meditation.

In this column we’ll look at emotional awareness – living a life full of rich relationships and satisfying endeavors. You must understand the nature of someone else’s emotional needs before you can interact with them in a meaningful way.

In the presence of chronic pain however, this is a problem. When you are in pain, you are justifiably angry, which can block emotional awareness. You are just trying to survive and don’t have the capacity or energy to reach out to others.

Another problem with pain-induced anger is that it not only disconnects you from others, but also from yourself. You are so used to being in this agitated state that you feel it is the norm.

I am quite aware of this scenario, as this was my experience. I was constantly agitated, but did not perceive it as anger. I thought I could hear what others were saying and see issues through their eyes. I was idealistic and thought I was right – but was so wrong.

It wasn’t until I had every layer stripped away in the midst of suffering from severe chronic pain, that I could see the problem. Meanwhile, I lost my marriage.

Self-Discovery

The problem with becoming emotionally aware is that you have to allow yourself to feel unpleasant emotions, such as anxiety, sadness, vulnerability, shame and so on. If you don’t allow yourself to feel the dark side of life (which is core to the human experience), then you won’t be able experience deep joy, happiness and love.

My strategy for most of my life was to suppress all negativity and keep my emotions on an even keel. One of my nicknames was “The Brick.” At the time, I thought it was a compliment because it meant I was tough.

It all worked until it didn’t. At age 37, I began to experience severe anxiety in the form of panic attacks. They came out of the blue and I had no idea what had hit me. I didn’t emerge from this hole for another 13 years.

Unless you actively choose a journey of self-discovery, you can’t connect with your true emotional state. You must commit to stepping outside of your mind and looking at yourself from a different perspective.

Ask yourself these questions: Am I open? Am I coachable? Can I really listen and feel?

That is a starting point. Once you get in touch with what’s going on in your mind, you can embark on a powerful journey. Allowing yourself to feel your emotions is a learned skill with many ways of accomplishing it. You will fail endlessly, but the key is remaining open and persistent.

Many people choose not to take this journey. But they make that choice at their own peril. It is what you’re not aware of that will run your life. The result may be a lot of physical and emotional suffering for the individual and especially for those close to him or her.

Why don’t more people pursue a path of self-discovery? It may be because in our culture most of us spend a lot of emotional energy trying to look good to people around us. We also try to look good to ourselves.  

Truly connecting with your emotions is an act of humility. Most people don’t want to do something so difficult and unpleasant. However, it’s also extremely rewarding and makes life so much easier in the end. It was the beginning of my recovery from my own chronic pain.

Dr. David Hanscom is a retired spinal surgeon. In his latest book -- “Do You Really Need Spine Surgery?” – Hanscom explains why most spine operations are unnecessary and usually the result of age-related conditions that can be addressed through physical therapy and other non-surgical methods.

New Think Tank Seeks to Reduce Pain and Improve Lives

By Stephen Ziegler, PhD, Guest Columnist

Millions of men, women and children in the United States and around the world are dying of cancer, and some die in severe pain because they have limited or no access to essential palliative medicines. Much of that suffering is avoidable.

Opioids and other palliative medicines are powerful drugs that are deemed essential by the World Health Organization. They provide comfort and relieve suffering at the end of life and for those who face serious medical conditions. Unfortunately, these very same drugs also have the potential for abuse, misuse, overdose and exploitation by the illicit market.

According to the 2017 Lancet Commission Report, governments around the world adopted “overly restrictive legislation” that focused more on preventing abuse than ensuring safe access to essential medicines. The problem is not limited to developing countries. Well-intentioned government policies to reduce opioid prescriptions across the United States have resulted in unintended harms for those who are recovering from painful surgeries or who were functioning well on opioid therapy.

Unfortunately, governments rarely investigate whether the drug control policies they create actually work and whether their policies are effective in preventing abuse while providing access to the drugs for those who need them.

But with your help we can change that.

I am proud to announce the creation of the Center for Effective Regulatory Policy and Safe Access (CERPSA), a new nonprofit think and do tank sponsored by the Colorado Nonprofit Development Center.  

CERPSA is a non-partisan, science-based research organization that focuses on the reduction of human pain and suffering by improving the regulation of - and safe access to - palliative medicines and treatments.  

Our mission is to eliminate unnecessary physical pain and suffering, and to help governments and communities create and maintain effective drug control policies that improve people's lives. We believe that there are good public health reasons for controlling drugs, whether in the form of prescription opioids, antibiotics, or even medical cannabis. We do not seek the elimination of regulation, only its dramatic improvement so that drug control policies can ensure access while at the same time prevent abuse.  

CERPSA represents a bold new effort to help reduce pain and improve people’s lives through research, education and outreach. Now more than ever, we need science-based initiatives that can fundamentally help change the way drugs are controlled.  

You can become part of the movement. Please join us by visiting our website and donating to CERPSA and help us reduce human pain and suffering in the nation and around the world. 

Dr. Ziegler has been trained as both a social scientist and attorney, has been involved in pain treatment and drug policy for almost two decades, and was both a Mayday Pain Scholar and Fellow.

Opioids, Off-Label Prescribing and the Road Not Taken

By Lynn Kivell Ashcraft, Guest Columnist

So much of the conversation about the use of opioids and other medications to treat various conditions has made it sound like doctors are doing something wrong when they utilize a treatment in an off-label fashion. 

Off-label prescribing is not a crime. The federal Agency for Healthcare Research and Quality (AHRQ) estimates that 1 in 5, or 20 percent, of all prescriptions are written for off-label use.

In fact, off-label use of a drug often represents the standard of care. The Food and Drug Administration never intended for its drug approval and labeling process to be the sole determining factor in how a drug is to be used in a clinical setting. 

It is left to physicians themselves to determine the ultimate clinical utility of pharmaceuticals, biologicals and medical devices in treating their patients.

Epidural Steroid Injections Are Off-Label

Some off-label use, however, is controversial. Many accepted protocols for treating back and neck pain include the use of epidural steroid injections (ESIs), despite a lack of rigorous supporting clinical evidence. As many as 9 million ESIs are performed in the U.S annually, yet few patients are told the injections are an off-label use of both the medication (corticosteroids) and the route of administration (an injection into the epidural space of the spine).

In 2014, after hearing about serious neurological problems in patients who received ESIs, the FDA required a label warning that injections of corticosteroids into the epidural space may result in rare but serious neurological events, including "loss of vision, stroke, paralysis, and death."  

Anxious not to lose a treatment that they believed in, professional societies of anesthesiologists, pain medicine physicians, rehabilitation specialists, neurosurgeons, surgeons, radiologists and interventional pain specialists wrote guidelines to prevent complications from ESIs that were published in the journal Anesthesiology in 2015. 

A coalition of doctors also formed the Multisociety Pain Workgroup (MPW) to defend the use of ESI’s. The MPW called an AHRQ study “flawed” and “absurd” because its questioned the effectiveness of ESI’s for treating low back pain. It also lobbied unsuccessfully to have the FDA tone down its warning.

Since 2017, according to OpenSecrets.org, the American Society of Interventional Pain Physicians has spent nearly $1.5 million on campaign donations and lobbying — much of defending the use if ESIs.

Where was the same type of outcry from the medical profession defending the use of opioid medication when the 2016 CDC guideline was released? Why have so many doctors stood by silently while insurers, states and the DEA began implementing the guideline as policy?

Lynn Kivell Ashcraft is an analytic software consultant and writer who lives in Arizona. Lynn has lived with chronic intractable pain for almost 30 years and works with Dr. Forest Tennant as part of the Arachnoiditis Research and Education Project. 

How to Recover From a Painful Breakup Caused by Chronic Illness

By Ann Marie Gaudon, PNN Columnist

What no one talks about. Getting “dumped” because you have chronic pain or illness. Let’s talk.

There’s no denying the unbearable emotional pain if someone you love decides they’ve had enough. The reality is that people can be cruel, including people that you never thought had it in them. Here’s a few zingers I’ve been made aware of:

“You’re always in pain and I’m sick of it!”

“I never signed up for this sh*t!”

 “I’m so done looking after you!”

Sound harsh? It is, and it happens. While the breakup might be blindsiding, the reality is that the partner has likely been emotionally disengaged for some time. By the time they say those words, they are essentially over the relationship. However, for the person hearing them, they are likely in the initial stages of grief.

If you’ve seen messy breakups in the movies, you might think the answer is fuzzy pajamas and a litre of chocolate chunk ice cream. This will take more than a visit with Bridget Jones.

MRI brain scans have shown that the withdrawal of romantic love activates the same brain mechanisms that get activated when someone suffering from substance abuse goes through withdrawal. That is powerful pain. This would explain why we can obsess over ex-partners and crave them as if they were a drug we've been deprived of.

How to help yourself? Ensure the thoughts you have about your ex are realistic and balanced. If your memory consistently goes to that “best night of your life,” remember all the other nights that were upsetting to you. If you are consistently longing for their loving embrace, remember the nights that your advances were rejected.

What Went Wrong?

If you’re really struggling to get a grip on the reality of the relationship, write a list of all the reasons that it went south. You will see that it wasn’t 100% due to your pained body.

The point is to take a wider look and get a better perspective on the entire relationship. While you are emotionally depleted, your focus will tend to be narrow and unrealistic.

Accept explanations that fit the facts -- such as they were unwilling to make a commitment or they were not the person you thought they were. Avoid creating a harsh inner critic about why the breakup happened and see the relationship for what it was. Make a list of compromises that you made in this relationship that you would rather not make next time. What did you learn about yourself? Can you grow from this?

Do not check on your ex through social media. This will make it harder for you to stop fantasizing about your relationship and spending your time marinating in self-pity while imagining your ex out there living their best life sans you. Remove reminders of your ex such as photos, emails, or messages which will only add to your distress.   

Take control of your behaviour. Do things that used to bring you joy, even if they don’t at the moment. Continuing to engage is a very important way to tell yourself that life does go on. 

Reach out to friends, family or other loved ones to gather all the support you need. We all know what breakups are like and we all have our own words of wisdom to offer.

If your grief is not lessening with time, reach out to a therapist. A trusted therapeutic relationship can help you find your voice to express your grief in a healthy, healing way. A skilled therapist can also help you to develop new social relationships and a sense of self-worth to help decrease isolation and pain-related depression.

Ann Marie Gaudon is a registered social worker and psychotherapist in the Waterloo region of Ontario, Canada with a specialty in chronic pain management.  She has been a chronic pain patient for over 30 years and works part-time as her health allows. For more information about Ann Marie's counseling services, visit her website.

Landline More Important Than Cell Phone for Chronically Ill Patients

By Barby Ingle, PNN Columnist

I cannot stress enough the importance of having a traditional landline when people are turning to cell phones or internet-based phone systems (VOIP). In 2018, over half of American households were "wireless only homes."

People are switching for cost and convenience, but many are unaware of what they’re losing when they drop their landline. This is a topic close to my heart, because my own father would still be here with us if he had a working landline the night he passed away.

We see television shows where people use their cell phones to call 911 to report a fire or emergency. The fact is it doesn’t work that simply.

Major limitations are introduced when you call for help from a cell phone or VIOP system, which can leave a chronically ill person or someone in an emergency situation unable to receive help immediately.

As a pain patient whose husband worked outside of our home for years, this is something to know and take steps to remedy before something happens to you.

There are a variety of reasons to keep your landline. One would be quality. A landline gets a clear, reliable connection with virtually no delays or lag times. When I do a radio or podcast interview, they usually ask that I call on a landline. Audio issues on a radio show typically occur when a guest is calling from a cell phone or computer.

Calling 911 for help from an area with a weak wifi or internet signal can cause problems. If they can’t hear you clearly, that can delay getting help to you.  A landline almost always provides clear coverage because of the telephone network infrastructure in place across the USA. You don’t have to rely on spotty tower connections or a slow internet.

Many home alarm systems also use landlines, because even when the electricity goes out, the phone line won't. If the alarm system is hooked up through VOIP or a cell phone, there is no guarantee that the call will go through or the person will understand you.

During last year’s disastrous wildfire in Paradise, California, many cell phones were useless because phone towers were damaged or lost electricity. Residents without landlines couldn’t be warned about the approaching fire and over half of the cell phone calls to 911 failed.

Home Alone? Then Keep Your Landline

Having a landline to call in emergency situations is worth the expense. At an additional cost of about $10-20 a month you can have a basic landline active in your home so that you can call local numbers and emergency numbers such as 911 or 0.  

As a chronically ill person myself, I am home a lot. My cell phone service is not great at our house due to the rural area we live in. We use the traditional landline even for regular calls with our family, friends and of course in emergency situations.  

The biggest reason to have a traditional landline is safety. With a landline, you don’t even need to speak.

As long as you can get the phone off the hook and dial “O” for an operator or 911 for emergency services, they can listen in -- in case you are being robbed and need to be quiet or unable to speak for any reason.  

Another advantage of a landline is that your street address comes up automatically on a 911 operator’s computer screen. They know precisely where you are calling from.

That is not always possible with a cell phone. They may be able to determine what cell phone tower your call is being routed through, but they won’t know your exact location.

Imagine your child trying to call 911 because you are having a seizure or unconscious. If the child is too young to speak or remember your address in an emergency situation, a cell phone might as well be a toy.  

If you can only afford one phone line, make it a traditional landline if you spend most of your time at home due to chronic illness. Chances are when you’re out and about, others will have a cell phone and be able to call emergency services for you.  But when you are home alone, trust me, having a landline can save you time, money and perhaps even a life. This is a fact that my family found out firsthand with the death of our father.  

Barby Ingle lives with reflex sympathetic dystrophy (RSD), migralepsy and endometriosis. Barby is a chronic pain educator, patient advocate, and president of the International Pain Foundation. She is also a motivational speaker and best-selling author on pain topics. More information about Barby can be found at her website.  

Living with Chronic Pain During the Holiday Season

By Dr. Lynn Webster, PNN Columnist

The holiday season is underway, but that doesn't mean everyone is healthy enough to celebrate. Chronic pain does not take a vacation or even ease up in honor of Christmas, Chanukah, Kwanza or any other holiday.

People who are in unremitting pain will suffer, while others throw themselves into endless rounds of joyous holiday-related activities.

For those in pain, and their caregivers, it may not be possible to participate in shopping, decorating or partying. They may feel disenfranchised, abandoned and hopeless. I have received hundreds of emails from people in pain who feel alone. Their doctors may have abandoned them or been unable to provide medication that can help manage their pain.

Holiday-themed social media posts, movies and television shows make it appear as if everyone is, or should be, happy and productive during the final weeks of the year.

However, the truth is that the holiday season can be stressful for many people, regardless of their health. Financial burdens, overindulging in food and alcohol, and getting too little sleep can take their toll.

Family members and friends may fail to empathize, even when they have fewer distractions and social obligations. During the weeks leading up to the New Year, people in pain may feel even more isolated than usual.

Universal holiday bliss is an illusion for many. Other people may long for the commotion of the season to end, too, so calm and normality can return. If you're finding the season to be something other than a never-ending winter wonderland, you have plenty of company in feeling that it is not.

Ask for What You Need

The holiday season does not require you to pretend that you are not in pain. You do not have to wear a mask of well-being in order to ease the burden of others. It is not your job to fake a positive attitude that you do not feel. Your responsibility is to take care of yourself.

You are not obligated to accept invitations for get-togethers, shop for gifts, or decorate when you are experiencing pain.

While other people may hope that you will put on a brave face, you are not required to fake anything you do not feel. On the contrary, you should be honest about your needs and give others a chance to share part of the holiday season with you.

Do let your loved ones know that you are there, and that you are thinking of them. If mobility is an issue for you, consider inviting a relative or friend to visit you. Be up front about the fact that you could use help with meal preparation and cleanup, sending cards, and the like.  

If there is no opportunity to get together with people you care about, perhaps you can arrange an online chat using Skype or a similar service. Ask the children in your life to participate, too. Even active teenagers and sleepy toddlers may be able to find a few minutes to share quality time with you. 

While you may not be able to participate in all of the holiday season activities, you can experience some of the love and joy you deserve if you prompt others to help. 

Seek Support 

Feeling isolated may be one of the most difficult aspects of living with pain during the holiday season. Consider joining a support group so that you can share your burden with people who understand what you are going through. The U.S. Pain Foundation and the American Chronic Pain Association list support groups online that you might benefit from joining.  

Caregivers fill a role that I have described as everyday saints and unsung heroes. However, even saints and heroes can experience burnout around the holiday season.  

It's especially important at this time of year for caregivers to practice self-care. This may include tapping into a caregiver support group and asking family members and friends to provide a short-term reprieve.  

Empower Yourself 

While you may not be able to invest yourself fully in the holiday season festivities, you still have power to take positive action. Reach out to lawmakers, and ask them to support more humane opioid prescribing policies. Contact your local members of the House of Representatives and Senate. Also, send a letter to the editor of your local newspaper and contact the news departments of your local television and radio stations.  

For many Americans, the holiday season is associated with faith. This is a good opportunity to remember that scientists are working on finding better and safer ways to manage pain. Policymakers are beginning to admit that tapering unwilling patients can cause harm.

There is hope that the New Year will bring us closer to solutions for people with pain. 

Lynn R. Webster, MD, is a vice president of scientific affairs for PRA Health Sciences and consults with the pharmaceutical industry. He is the author of the award-winning book, “The Painful Truth,” and co-producer of the documentary, “It Hurts Until You Die.” You can find Lynn on Twitter: @LynnRWebsterMD.

Opinions expressed here are those of the author alone and do not reflect the views or policy of PRA Health Sciences.