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“The practice of medicine IS the practice of harm reduction. It is a fundamental principle of medical care that the patient has the right to disagree, to be non-compliant, to choose a path or a goal other than the one we might desire for them. The physician’s job is to do everything possible to help such a patient do the best he can, to minimize harm since, at least temporarily, it cannot be eliminated. Only in addiction medicine is it insisted that patients and staff hew to a ‘philosophy’ of ‘total abstinence’ rather than support appropriately individualized goals.”

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.

Experts: Untreated pain as serious a problem drug abuse. By Tristan Scott of the Missoulian. With the specter of prescription drug abuse looming large, health care workers stressed Friday that untreated pain in Montana is a public health crisis commensurate to that of addiction.

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. [...]

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.

This Resource Is a peer-reviewed analysis of Gonzalez v Oregon. “If the U.S. Attorney General had won this case, DOJ, through the DEA, would have been given the authority to make decisions about the legality of prescriptions in all situations, not just end-of-life care.” After analyzing the Supreme Court decision, Brushwood reviews DEA identification of physicians and pharmacists despite information obtained from a Freedom of Information Act by Joranson documenting DOJ knowledge of massive theft and loss of controlled substances having nothing to do with the doctor - patient relationship. He also reviews the DEA FAQ debacle, the “Myth of …

Talk given by Frank Fisher, M.D.; Drug Cops and Docs, Cato Institute Conference; 2005-09-09. Introduction — The undertreatment of chronic pain is an ongoing public health disaster. The means to reverse this disaster is a class of medications known as opioid analgesics. The pain crisis exists for just one reason. Physicians don’t prescribe enough of these medications. I’m going to explain why we don’t. — The war on drugs has become a war on legal drugs. This exposes physicians to the risk of unwarranted prosecution. In response to this threat, the academic pain establishment has developed a set of standards …

Excellent article by Dr. Forest Tennant explaining and demystifying chronic opioid therapy for chronic pain.

When prosecutors want to convict a doctor of “drug dealing,” they often sow suspicions by alerting the media. But in a Kansas case, they appear to be fighting dirty by trying to prevent the other side from speaking out. [...]

Blog post about an example of war on doctors Trash Journalism, which is analyzed. Excerpt: “So what is the message? Well one clear message to me is that the line between pain patient and ‘addict’ - that pitiable dregs of humanity; the walking dead; that criminal scourge; is thin and vague. In fact it is presented as the slippery slope if not an inevitability - people on chronic opioid therapy are, or will become, addicts. Pain patient, drug addict, who cares? Drug are bad, people who use them are bad, you and I are better than that; they deserve what …

Testimony of Siobhan Reynolds, President of the Pain Relief Network (PRN), to Senator Biden and the Judiciary Subcommittee on Crime and Drugs, March 2008. Concludes:

Blogged analysis by DeLuca about a confused opinion article in Wall Street Journal regarding the relationship between law enforcement imperatives on doctors and the resulting routine undermedication of pain patients. [...]

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UNITED STATES DISTRICT COURT - DISTRICT OF KANSAS PAIN RELIEF NETWORK, on behalf of patients of Stephen J. Schneider, D.O., Plaintiff,
[Uzo L. Ohaebosim, Attorney for Plaintiff; 510 N. Main; Wichita, KS 67214; 316-261-5400]
vs.
THE STATE OF KANSAS, THE KANSAS STATE BOARD OF HEALING ARTS, MICHAEL MUKASEY, in his official capacity as United States Attorney General; ERIC F. MELGREN, in his official capacity as the United States Attorney for the District of …