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In pain medicine we have the deeply disturbing situation that what most doctors do (medical community norm) is at odds with, and clearly below, the medical standard of care. Literally, in the treatment of chronic pain, an ethical physician attempting to practice in good faith, according to the clinical literature, is an outlier deviating from how most reputable physicians would practice.

Many physicians are concerned that prescribing opioid analgesics in chronic pain treatment is accompanied by an unacceptable risk of unwarranted prosecution. The validity of this fear is evaluated by examining the standards through which physicians are targeted and prosecuted. Prohibition law is identified as an error in social policy that distorts medical standards.

I spoke to Billy’s wife briefly, recently, and am very happy to be able to report that Dr. Hurwitz is no longer in federal prison. He is currently in a half-way house in D.C. and will be transitioning to house arrest as part of his parole and probation requirements… He is in a sort of “titration to house arrest” best I understand it. Meaning, he is starting to get overnight visits with his family - YEA! - and more and more of that till he sort of “stabilizes” on a regimen of maintenance house arrest. (Is house arrest a substitution therapy for …

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.

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. [...]

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 post about the conviction of Dr. William Mangino for violations of the state drug act and medicaid fraud. Link to full text of Mangino’s Omnibus Motion which pertains to request for summary Not Guilty and discussion of Jury Instructions. This document is discussed. Mangino Verdict III will concern bail and defense fund matters.

Blog item with embedded video, text of article Abstract, and link to full-text PDF about the EPIC survey which is the largest ever study of its kind to investigate the prevalence, impact and treatment of pain in cancer… The EPIC survey demonstrates that pain in patients with cancer is widespread, frequent and long-lasting, and is not always adequately managed.

Cannabinoids In Medicine: A Review Of Their Therapeutic Potential (Abstract, References and link to Full Text PDF) Mohamed Ben Amar; Journal of Ethnopharmacology, 102(1-2), 1-25; 2006-04-21.

Excerpt: Seventy-two controlled studies evaluating the therapeutic effects of cannabinoids were identified. For each clinical trial, the country where the project was held, the number of patients assessed, the type of study and comparisons done, the products and the dosages used, their efficacy and their adverse effects are described. Cannabinoids present an interesting therapeutic potential as antiemetics, appetite stimulants in …

Dr. Mikuriya’s Appeal: a Last Minute Twist (full text) Fred Gardner; Counterpunch,; 2006-02-11. “There has been a division of prosecutorial labor, with the state going after the docs and the feds going after the growers and providers. They all claim to be supportive of ‘individual patients’ while trying to destroy the networks patients need.” See also: Taking a Leaf from ‘Pot Docs’ - subtitled: ‘A Tiny Cadre of California Physicians has been Recommending Medical Marijuana at Their Professional Peril’ by Eric Bailey, Los Angeles Times, 2004. This article reviews the medical marijuana movement and puts Dr. Mikuriya’s case into a …

Opioid Rotation in Patients with Cancer Pain. A Retrospective Comparison of Dose Ratios between Methadone, Hydromorphone, and Morphine [Abstract] - Bruera et al., Cancer, 78(4), 852-857, 1996.

Comment (DeLuca):
In this brief abstract the authors present the results of a retrospective series of 48 med changes from morphine to hydromorphone (Dilaudid), and 65 changes between hydromorphone and methadone. Data is given that underscores the need for close clinican observation of the patient over time, and adherence to rational regimens.

See also:
Opiate Rotation, Incomplete Cross-Tolerance, and Hyperalgesic Metabolites – DeLuca; 2001. This was my first attempt at researching and understanding …