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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.

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 am very glad to see physicians, who have themselves been savaged by the government, publishing their stories. Consider Dr. Jackson’s article, Conviction without a Crime, to be a companion piece to Dr. Rottschaefer’s article discussed in the previous item here, The Criminal Criminal Justice System. Together these two articles will give the reader a good sense, I think, of the utter breakdown of professional ethics, common sense, and fairness in any case involving controlled substances.

criticisms and description of federal prosecutorial behavior rings true to me from my experience and knowledge of war on docs/pain crisis cases. Our justice system is withering, ‘the drugs exception to the Bill of Rights’ has gone from being a tragic lawyers joke to business as usual, and we now routinely apply asset forfeiture and RICO laws, intended by Congress to combat drug cartels, to individual pain-treating physicians. Doctors and sick people are easy, profitable prey for law enforcement and federal prosecutors pandering to the electorate through a media willing to be exploited for their share of the spoils.

There are so many who need opioid pain medications and can not get them… These people have their lives destroyed every day as they drag themselves from doctor to doctor being lied to, verbally and sometimes physically abused, forced into unnecessary rounds of expensive testing… They are sneered at by pharmacists, called addicts by doctors, drug tested, called “frequent-flyers” and other derogatory names by emergency room nurses and doctors, denied reimbursement…

Unrelieved pain has a devastating impact on the physical, emotional, social, and economic well being of patients and their families. Diagnosing and treating pain is, therefore, fundamental to the public health. Terminology is review, myths identified, and medical understanding is stated.

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 …

Update on the case of USA v Dr. Martinez in Washington state. Martinez has been acquitted of all drug crime charges. The fraud charges remaining after her 2007 fed trial have also been dismissed, but the govt can bring the fraud charges anew. Also examined is a recent Yakima Herald article announcing “new” charges that are not, in any reality-based sense, “new” at all.

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.

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.