A Physician Speaks Out To Contradict The False Narratives of "Dopesick"
Richard Lawhern
Subject Matter Expert in public policy for regulation of opioid pain relievers and physicians who prescribe them. 28 years experience and thousands of contacts in social media support groups for people in pain.
A Physician Speaks Out To Contradict The False Narratives of "Dopesick"
As a patient advocate and healthcare writer, I receive a lot of mail. Some of it is from desperate patients in physical and emotional agony whose doctors have been intimidated into refusing them adequate pain care. Some of it is from doctors afraid of being sanctioned by State Medical Boards or raided by DEA or State drug enforcement agencies determined to put them in prison for the imagined "crime" of treating pain with opioid analgesics. But every now and then I hear from a doctor who actually has a backbone and is willing to stand up and be counted in opposition to the prevailing false narratives and anti-opioid propaganda.
This note is to pass along one such narrative offered by Dr Michael April, to the author of an article in Medpagetoday. I have Dr April's permission to share this piece with broad public distribution. I encourage each of you to share it with your own physicians or patients -- and to let this author and her editors know that she is misrepresenting reality and damaging millions of people.
Feel free also to share your thoughts with staff of the Board of Scientific Counselors at the US CDC National Center for Injury Prevention and Control, for distribution to the writers' group of the on-going update and expansion of the 2016 CDC guidelines on prescription of opioids to adults with chronic non-cancer pain.
The BSC may be reached by email at "NCIPCBSC (CDC)" <[email protected]>
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From: Michael April
Sent: Saturday, November 27, 2021, 9:08 AM
Subject: Dopesick Article
Ms. Clark:
I read your article concerning "Dopesick". It would have been more helpful if you had interviewed physicians from both sides of the opioid crisis. Dr. Kolodny and Dr. Fugh-Berman's opinions are not based on facts. The opioid crisis, which is world-wide, was not due to over-prescribing, but to the criminalization of a medical problem. The countries that have made opioid addiction a medical issue and not a criminal one are way ahead of the US in controlling the crisis. Do you think anyone wakes up one day and says "I think being addicted to heroin would be great"?
I run a practice that specializes in sports medicine and chronic pain. I see the most complex pain patients in the Washington, D.C. area. Many of my chronic pain patients have been on opiates for longer than 20 years. These patients function much better, many are working, and none are overdosing, dying, or being arrested for diverting their medication.
I have an unusual practice since my average patient has been with me greater than 15 years, but it shows you can help these patients live a better life. In addition, I have reduced many of their dosages, but done so in a gradual fashion. One patient, who came to me on a morphine daily equivalent of 2000 mg, is now off opiates.
Some statistics for you:
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US has 30% of all the prisoners in the world with 4% of the population
80% of the prisoners are for drug-related offenses
About 10% of jail cells are privately owned
Iran has the highest rate of opioid addiction per capita in the world, not the US
Most of the US States with the highest rates of opioid overdose deaths are the lowest prescribers of opioids
Despite reducing opioid prescribing in the US by 44%, overdose deaths hit a record high last year
It is said that US providers prescribe 80% of all the opiates in the world, but this statistic is meaningless when you consider that the US prescribes everything more than the rest of the world and that opiates are frequently obtained without prescriptions in most countries.
The US does more surgeries than any country, especially spine surgery, where most countries treat spine problems non-surgically.
This problem is multi-factorial -- and pushing one-sided opinions from practitioners who have made a significant amount of money giving their biased opinions is not helpful to the discussion. The opioid problem began well before the introduction of Oxycontin and can be traced back to the early 70's. As long as we continue to choose prosecution over medical treatment, we will never make progress in defeating this problem.
Michael April, M.D.
Board Certified, Physical Medicine and Rehabilitation
Pain and Injury Center of Greater Washington
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Thank you Dr April.
Affiliate Professor of Anesthesiology UNLV Medical School
3 年Doctor April raises some valid points but sadly misrepresents the opioid situation. This is not our first opioid crisis. The book Dark Paradise shows how misconceptions about the use of opioids combined with their refinement and route of administration being enhanced led to 1 in 200 Americans being affected by opioids after the Civil War. It was only the concerted efforts of the medical community that got the epidemic under control, well before the 1914 Harrison Act. Hence the overuse of opioids to treat chronic pain is a well-known recipe for disaster, something that has been largely ignored in discussions of the current crisis. On the other hand, Dr. April is entirely correct in noting the prescription opioid crisis began well before Oxycontin, in no small part thanks to Medicare shifting to CPT coding in 1983 (why take 40 min to talk to a patient about chronic pain when you are paid the same for writing an Oxy script in 5 minutes?) and Blue Cross going from nonprofit to for-profit in 1997 (interdisciplinary pain programs are costly, but pills are cheap... guess which BCBS promoted?). But claiming opioids are effective for chronic pain has little neurophysiologic or epidemiologic data to back it. As an anesthesiologist who was involved in acute pain services for over 2 decades (and chronic pain management for over 3 decades), I can personally state that even for acute postop pain, opioids have a limited role. Why else would there be pain services, nerve blocks, epidurals, and many annual meetings just on the management of acute pain? It is therefore unsurprising for anesthesiologists to reaffirm that opioids have little role in chronic pain management. Note my use of the word "little"..... there are no absolutes. However, unless clear functional benefit is seen with the addition of an opioid at a low dose (say, MME under 30), and unless there is no need for escalation in the absence of progression of a structural issue, then they should not be used. I have rarely seen opioids beneficial in long-term use, as a counter to Dr. April's "many" patients who benefit from chronic opioids.
Chronic Pain Advocate. Public speaker and trainer. Former President of the Aug. Jaycee's and PTA. Owner of Daycare.
3 年If only the Government, who has a list of every Doctor in America, would spend the money to send a questionnaire along with a place for comments, to every doctor. Sorry, it would cost nothing, just time. In less than 10 minutes they could call up the Doctor’s names, add a cover sheet, “Please fill out and return.” Hit the little send to all button. They could have all the information they needed to end this farce, and save lives. But NO our Government doesn’t do Practical and Straight Forward. Another Group needs to be formed and Millions must be spent. IT’S THE AMERICAN WAY!