Category: Opioid therapy

[Dr. Johnston's] case offers the Obama DOJ the rare chance to reaffirm the architectural structure of our federal system by joining in the PRN’s 10th Amendment-based request for a full hearing by the court. [Reynolds:] “The Administration can also show substantive empathy right away, for the 50 million Americans in pain currently being denied pain treatment by doctors terrorized by the [DEA]. These desperate Americans shouldn’t be made to wait for the President to appoint a new justice.”

Wow. To win acquittal on federal drug trafficking charges is very difficult and very rare, as I have [discussed before][rm]. A resounding win is almost unheard of. I will be very interested in the outcome of the prosecutorial misconduct case being brought by Dr. Shaygan’s defense attorney, Mr. Markus.

I am republishing these “Principles of Opioid Management of Pain“, by Dr. Joel Hochman, et al., because of the explosion of deeply flawed and misguided “Guidelines” for pain management in recent years. This document stands alone in meeting the (textbook, ‘responsible physician’) standard for pain management while not violating core ethical obligations of the doctor-patient relationship and is useful, I think, for comparison when studying promulgated Guidelines. [See also: The Distortion of Medicine and Confusion of Standards]

Abstract of peer-reviewed article reporting multicenter outcomes for safety and analgesic efficacy of high-dose, transdermal buprenorphine in the treatment of chronic pain, and brief comments on same by Dr. Alex DeLuca, and with links to related discussions on the Pallimed blog.

The article well describes the public health chaos this is the predictable consequence of clinical and public health authorities abandoning their real mission to uphold the medical standard of care for their citizenry, and instead focusing exclusively on the policeman’s agenda which prioritizes ‘catching a few addicts’ over providing adequate pain management for legions of innocent patients.

It seems to me an uncivilized and insane notion that just because someone in current moderate to severe pain had a history of an alcohol or drug problem, or even a current substance abuse problem, that you would deny them opioid therapy if that was the best medication to relieve their suffering. But this seems to be a point of confusion that increasingly comes up from patients, doctors, and regulators alike. So, in this post, let me make the medical standard of care in this situation perfectly clear. [...]

Excerpt: “As usual, the academics ignore the elephant in the living room. Regarding review articles that wring their hands about the lack of long term evidence of the safety and efficacy of opioid analgesic therapy, they never discuss the impossibility of measuring the efficacy and safety of a therapy that almost no physician is comfortable doing properly. For an excellent analysis of what we might call the “new academic opiophobia,” see the Pain Relief Network’s 2008 “WA State Tort Claim” pages 34 – 37.”

Academic quality, fully footnoted, article on why untreated or undertreated chronic pain is a medical emergency.

Press release from the Competitive Enterprise Institute regarding their Politics of Pain initiative, and video interviews with combat vet chronic pain patient James Fernandez, and with Dr. Alex DeLuca of the Pain Relief Network. CEI Calls for End to DEA Harassment of Pain Doctors.

In this full text medical journal article, Joranson, in response to Paulozzi (below), describes a basic public health approach to the ‘drug abuse crisis.’ One wonders whether the combined brain power of the NIH, CDC and FDA would not have accomplished this, except for the imperatives of the drug war. Hurwitz 2005 (see below) is an example of the sort of creative analysis we should expect, but never get, from our academic and federal patriarchs.

Blog post about the Federal raid and indictment of three Pensacola, Florida physicians “on charges that they illegally dispensed prescription drugs.” Operation “Doc-in-a-Box”, huh? How positively cute…

Blog post about research demonstrating gross abnormalities in the brain functioning of patients with chronic pain vs healthy control subjects. Confirms previous studies showing brain shrinkage in chronic pain patients.

The invocation of the WHO “analgesic ladder” concept of progressive pharmacological treatment of pain, in state investigations of physicians, is sometimes unfair. On the one hand the guidelines are interpreted as rules… On the other hand, state rules and regulations are often at odds with the spirit and specifics of the WHO guidelines, and of ethical medicine.

Blog entry about the distortion of medical ethics and of medical practice of pain management using opioid therapy by drug war imperatives on physicians to value catching drug abusers over providing compassionate and rational medical care to their patients.

Blog post about a Continuing Medical Education (CME) course based solely on one interesting and flawed article about the prevalence of addiction in primary care chronic pain patients treated with chronic opioid therapy.