Marijuana Laws: Progessive Change or Society’s Downfall?

Lately it seems as if I’ve been hearing more calls to change US marijuana laws.  Legalizing marijuana has been a cause for some citizens for decades, and efforts to change marijuana laws have waxed and waned since I was a teenager in the 1970’s.  Some people believe that this time around, attitudes are truly changing.  A […]

It Might Not Be Me– Suboxone Talk Zone Impersonators

Just a quick note that I’ve been meaning to write for several weeks…  Over the past few months I’ve come across more and more web sites that have copied my web sites, copied my material, used my name, reposted my videos, resold my ‘user’s guide’… Someone once said that imitation is the sincerest form of […]

The End of Narcotic Pain Medication?

The LA Times ran a very interesting story a few days ago about deaths from overdose of narcotic pain medications.  I strongly encourage readers of this blog to read the story, which discusses the issue from the perspectives of doctors, patients, and family members. The story reports that a small number of Southern-California doctors wrote […]

The post The End of Narcotic Pain Medication? appeared first on Suboxone Talk Zone: A Suboxone Blog.

Reckitt Benckiser is Smarter Than I Thought

Regarding a prior post, I carefully read through the entire Citizens Petition’ filed with the FDA by Reckitt-Benckiser.  I have a better understanding of what, exactly, was accomplished by that action by the manufacturer of Suboxone. The document explains that the company hired an independent group, RADARS (Researched Abuse, Diversion, and Addiction-Related Surveillance), to investigate the […]

Treatment? Or Murder?

I subscribe to Google news alerts for the phrase ‘overdose deaths.’  Google Alerts are a great way to follow any topic; subscribers receive headlines from newspapers and web sites for certain keywords from around the world. One thing that has become clear from my subscription is that there is no shortage of stories about deaths from opioids! Every day I see one article after the next, as news reporters notice the loss of more and more of their communities’ young people.

Along with the reports of overdoses are stories about doctors who are increasingly being prosecuted for the deaths of their patients. In an earlier post I described the case of Dr. Schneider and his wife, a nurse, who were tied to a number of overdose deaths in Kansas. That case stood out by the sheer number of deaths; the State charged the couple with the deaths of 56 patients. Cases involving fewer patients have become relatively common. The latest case that I’ve read about is a doctor in Iowa, who is accused of causing or contributing to the deaths of 8 people.

I try to present both sides of the argument when I write about this topic. I have been faced with the difficult decision over whether or not to prescribe narcotics many times, and I understand a doctor’s dilemma. The doctor sees a person who is in pain, and knows that there is a pill that will reduce that pain. But the doctor also knows, or SHOULD know, that initiating a prescription for narcotic pain medication always has unintended consequences, no matter how good the intentions of both doctor and patient.

In the Iowa case, the dilemma over narcotic-prescribing is very clear. The prosecution states that the doctor prescribed pain medication to drug addicts.  On the surface, that sounds bad, right? One gets the mental picture of dirty, lazy people, dissolving tablets in a spoon, over a candle, and then injecting the mixture. But reality is much more complicated. Patients with histories of opioid dependence do not always have track marks. And even if we tattooed the letter A across their chests, there are addicts who are in need of pain treatment. Are we to decide that every person who has become addicted to pain medication gives up the right to pain treatment?  And we know that many of the patients addicted to opioids became addicted through the course of pain treatment from their physician— so I would expect that on average, patients addicted to opioids would have a higher incidence of chronic pain, and vice versa.

I do not find it reasonable to make patients with addiction histories endure pain that would be treated in other patients.  Father than singling out some patients for ‘special non-treatment,’ we should prepare for the risks from opioids in ALL patients—a set of ‘universal precautions for opioid treatment,’ similar to the way we use a different set of universal precautions to avoid transmission of blood-borne infections.

There are times when doctors have to tolerate being the bad guys.  Some patients have been taught, through careless prescribing, that all pain should be treated with narcotics. Those patients are not happy when told, after paying several hundred dollars, that they do not ‘need’ narcotic pain medication– and so many of their doctors have a hard time saying ‘no.’ After all, doctors studied hard to do well in school, and usually receive praise for what they do. It is much easier to write a prescription and hear ‘thank you’ than to be called an unsympathetic jerk! But doctors are paid the big bucks to tolerate such things, and to keep the long-term health of patients in mind. And for many people with chronic pain, opioids will provide a good month or two, but for the price of many years of misery.

I’ve been told by patients “I don’t care about the risks, doc– I’d rather have three good months and then die, then have twenty years in pain.” I reply, “that’s why these medications require a doctor to consider things very carefully, and a good doctor would not allow someone to make that decision.” I’m sure that some people will be angered by that attitude. But the approach is similar to how we handle many other illnesses, where we encourage patients to tolerate short-term misery for long-term benefits. Many patients would refuse chemotherapy and give up on life if not pushed to move forward. And to depressed patients, suicide can appear a reasonable option. I’m a fan of free will, but I recognize that we don’t always choose our paths through life with full insight.

Even with full knowledge of the reasons to avoid narcotics, some doctors really struggle over withholding opioids.  I find it somewhat ironic that the doctors who are too ‘kind-hearted’—i.e. who want to please patients so much that they cannot deny even that which is bad for them—are the ones who end up getting into trouble.  The Iowa doctor is being sued over several of the deaths, likely by relatives of the patients who pled the hardest for pain pills!  Talk about good deeds not going unpunished!

But there are aspects of the case in Iowa that do not argue well for the doctor. Several of the patients who died were only seen once, but treated with narcotics for years. The DEA requires that patients are prescribed no more than 90 days of narcotic medication at one time (divided on three monthly prescriptions). I presume that patients were picking up scripts every three months, without having appointments each time. Such a practice is not strictly illegal (not that I am aware of, anyway), but the standard of care would be to evaluate patients on potent opioids every three months, or even more frequently. And one news article stated that the doctor had tens of thousands of pain patients. As a full-time practitioner with less than 1000 patients, I wonder how so many patients could be managed by one physician.

When I write about this topic I receive angry comments from some readers. Some attack me personally with comments like “I’m glad I’m not YOUR patient!” or “I hope YOU have to suffer with horrible pain some day!” I realize that this is a very hot topic, and my only intent is to educate and inform, to help people understand what is happening in the minds of physicians. Of course, the care of patients should not be determined by the need for doctors to protect their own interests. But at the same time, it is understandable that doctors are affected by headlines announcing the imprisonment of other doctors facing the same treatment decisions.

Bottom line– there are very good reasons to avoid using opioids for nonmalignant chronic pain. Just giving patients what they want, and ignoring the danger of opioids, will likely result in criminal and civil prosecution. But that reason is secondary to the most important thing– the promise all doctors make to first, do no harm. And patients should realize that their doctors may be withholding narcotics for that reason alone.

Questions, Excuses, Krokodil

I’ve been in more of a chatty mood lately, as regular readers have likely noticed.  I find it interesting that weeks will pass when I have little or nothing to say… and at other times, I have all sorts of random thoughts to discuss.

Excuses first– I’ve been tinkering with ads for the past few days, and I apologize to those of you who tried to read a post while I was activating and deactivating Wordpress plug-ins.  After experimenting with different colors I’ve decided that basic grayscale is the best.  For those who don’t blog, ‘plug-ins’ are small, add-on programs that add a range of functions to a blog.  There are literally thousands of them out there;  some free, some for a small charge.  A couple dozen plug-ins are designed to add the code for Google Adsense to a blog, with a range of features including adding ads randomly to old posts, etc.  I’ve found that some work better than others; a couple of them really messed up the other blog functions, causing the top banner to appear at the bottom and vice versa.  I THINK I have things working OK now;  if you are having trouble, please send me an email (drj at Suboxonetalkzone dot com) and tell me the nature of the problen, and the browser and operating system you are using.  Thanks!

Another neat feature of WordPress is that you can review a number of different statistics for a blog, including the keyword that each viewer searched for before arriving at the site.  I see certain questions posted over and over;  I presume those questions are about things that come up often in the lives of people on Suboxone.  I used to do ‘questions and answers’ on a regular basis;  I’ll try to get back to those now and then, using the most popular queries as starting points.

Yesterday, several people searched for phrases related to buprenorphine and workplace drug testing.  I’ve received a number of questions by email about that same topic.  People wonder if Suboxone (buprenorphine) shows up in drug testing, and whether they should disclose that they take the medication before the test.  This is a very tough issue.  I believe that people who take Suboxone properly are NOT impaired by the medication.  There was an article from the Mayo Clinic Proceedings recently that claimed that people ARE impaired by Suboxone, and therefore certain occupations– notably physicians and nurses– should not work at those jobs, if taking Suboxone.

There were at least two things that made their conclusions… ridiculous.  First, the authors wrote that doctors’ work is so uniquely difficult, that it challenges gray matter so much more heavily than other occupations, that doctors should avoid buprenorphine treatment.  To that, I say that a recovering anesthesiologist taking Suboxone is much safer than a recovering anesthesiologist, holding fentanyl in his/her hand, not on Suboxone!  Even if you take away the risk that the non-Suboxone doctor is using, one must consider the effects of cravings on vigilance.  I’ll take the doc on Suboxone, who is placing all of his attention on ME, over the guy reciting the serenity prayer to himself and pondering the decision over what can be ‘changed’ and what can’t!  Of course, that’s just me…

I was also impressed by the ego of the writers, who think that a pediatrician or radiologist has greater need for an ‘unmedicated brain’ than a jet pilot, or a welder ten stories up, or a long-haul trucker, or a nuclear physicist. Yes– doctor jobs are ‘uniquely’ difficult!  (add sarcasm here).

The conclusions were deeply flawed in other ways.  To determine the effects of Suboxone on performance, they looked at studies that gave people opioid agonists or buprenorphine, and concluded that the effects were similar.  I mean really– people who are not on Suboxone regularly, without a tolerance to opioids, taking buprenorphine?  OF COURSE the people were messed up!  Suboxone has potent opioid effects;  there is no argument to that point.  But the unique ceiling effects of buprenorphine allow the subjective effects to go away, as tolerance is established.  That’s the whole point of Suboxone treatment!

I’m off on a tangent, right?  Back  to drug testing…  I do not think that people on Suboxone, who take it properly, are impaired in any way.  So I do not believe that people should have to disclose their treatment, and their history, to their potential employers.  But my opinions on the matter are irrelevant, unless the new/old President-elect appoints me as Attorney General… and odds are not in favor of that happening.

I can say that I’ve received 20-30 emails over the years, asking about employee drug testing.  In each case I asked the writer to follow-up and let me know what happened.  Some ended up disclosing that they were on Suboxone, and most did not.  To date, nobody has written back to say that they were denied the job over the issue.  I therefore conclude that most employers are ignoring buprenorphine, at least at this point.  That’s the best answer I have;  I can’t recommend any specific course of action.

Finally… today I came across an old post on my forum about a drug that was sweeping across Russia last year, called Krokodil.  The drug apparently is made from over-the-counter codeine tablets, in a process that creates a cheap concoction of opioids in a toxic sludge.  Users of the drug describe withdrawal more severe than opioid withdrawal, that includes seizures.  And within days of starting a habit, users slough off large sections of skin and other tissue from their arms, legs, torso– even from the face.  Not for the faint of heart— if you search the name of the drug under Google Images, you will find horrifying photographs of the damage inflicted on people addicted to the substance.

If anyone really thinks that drug addiction is a ‘choice,’ please tell me what, exactly, those tragic people were thinking.

Jerk Counselor

Every now and then I hear about a therapist or addiction doc who is doing such a disservice to the practice of addiction medicine as to deserve special mention.  This week’s award goes to a certain counselor at a treatment program in Oshkosh, WI, who I’ll refer to as ‘This Jerk.’

I’ve made no secret, over the years, about my hope for addiction to eventually be treated with the same respect for patients and attention to medical principles as for any other illness.  I certainly try my best to work according to those ideas, and find that doing so really helps when it comes to making treatment-based decisions.  In other words, I’ll ask myself—if this person had diabetes, what would an endocrinologist do?  Or better yet—if I had diabetes, what would I want MY endocrinologist to do?

Some Jerks advocate punishing patients who struggle.

This Jerk Counselor

We all know that certain professions attract certain types of people.  Some of us have been pulled over by the cop who was the kid subject to playground taunts, now all grown up, determined to make life a living Hell for anyone with a loose seat-belt.  When I worked in the state prison system, I worked with guards who belonged in the same category; men and women who loved to carry keys to cages that held real people.  It’s the power trip, I suppose.

This Jerk apparently loves the power trip of ‘treating’ people who are sent back to jail for ‘failing’ his treatment.  He doesn’t have to worry about being a lousy therapist; he has a captive audience, and likes it that way.  One difficult aspect of being a therapist is treating patients who don’t like us for one reason or another, or who don’t kneel every time we enter the room.  But when This Jerk feels disrespected, he picks up the telephone and calls the patient’s PO to report ‘noncompliance with treatment’– then gloats about sending the patient to jail.

Treatment professionals who are in a position of unusual power over a patient must be particularly careful to empathize with their patient’s position.  In medical school, we were placed on gurneys and wheeled around by fellow students, to emphasize the vantage of patients coming to the emergency room.  We were taught to sit at the same or lower eye-level of our patients, as speaking down to people creates an unsettling power differential.

The power to prescribe or withhold buprenorphine (let alone the power to send to prison!) comes with an obligation not to abuse that power.  Withholding buprenorphine causes patients to go into withdrawal—something dreadful to people addicted to opioids.  Worse, withholding buprenorphine places patients at very high risk of relapse—which in turn places them directly in harm’s way from overdose and legal repercussions.

This Jerk, I’ve been told, takes issue with psychiatrists who continue to treat patients on buprenorphine who struggle with sobriety.  He considers it ‘good care’ to withhold buprenorphine from an addict who uses, supposedly to punish the patient into sobriety.

In case This Jerk (or a similar ethically-challenged counselor) is reading, I’ll point out the obvious:  when a doctor pulls the rug from under a patient by withholding medication, that patient might easily join the ranks of other dead addicts.  On the other hand, when I work with a patient who is struggling with sobriety, keeping the person on buprenorphine and working to identify triggers for using, that person almost always ‘gets it,’ eventually.

I’ve been working with people addicted to opioids, using this approach, for so long that the other approach—the punitive, ‘cut ‘em loose for struggling’ approach—seems barbaric.  I don’t understand how people identified as healthcare workers (nothing professional in his behavior!) rationalize the dismissive approach.  I suppose, if This Jerk views addicts as the scum of the Earth, or as people with weak characters, or people who lack ‘will power,’ punishing relapse by withholding treatment feels about right.  But most of us leave that world behind when we commit to helping people suffering from illness.

What’s This Jerk’s excuse?  Is it that he just doesn’t get it?  Or are there other motives at play?  With the current cap on patients on buprenorphine, the most lucrative way to practice is to keep turnover high, rewarding practices that hire therapist-idiots like This Jerk.

Or is it the power trip– that people with difficult addictions are an affront to therapists?  I’ve met therapists with this attitude before, who seem to have a form of codependency with their patients. They take credit for any success by their patients, but think the patients who fail are not worth their time, and should be dumped, expunged, or kicked-out to relapse and die.  I suppose This Jerk would say ‘not my problem!  I did MY job!’

Readers may suspect that this topic irritates me—and they’re right.  Maybe I’ve seen more death, up close, than the typical counselor.  I’ve attended autopsies; I’ve reviewed post-mortem photos from overdose scenes; I’ve pushed IV fluids into people with fatal injuries who presented for emergency surgery.  I have spent hours with the parents of young patients who died from overdose.  I’ve seen the parents’ faces as they struggled with the thought that they could, or should, have done something else—just one more thing to save their child.  Death, to me, is not ‘theoretical.’ It is not something to toy with, and certainly not something to invite into the life of a person who made me angry, for not recovering at MY pace.

I suspect that the Jerks of the world will continue to justify their sadistic approach to ‘treatment.’ But patients—at least SOME patients—don’t have to put up with that behavior.  People like This Jerk hold power over an individual with an addiction history, but there is power in numbers.  It is not appropriate to use one’s power vindictively, or to gloat over a patient’s struggle.  It is not appropriate to humiliate a patient in front of others.  If you see that behavior, collect witnesses, and bring it to someone’s attention.  Maybe that ‘someone’ will write a blog post about it!

Doctors in particular should treat patients with ALL diseases—including addiction—with respect.  It is not respectful, or ethical, to deprive a patient of life-sustaining medication—especially out of spite.  I look forward to the day when the thought of ‘kicking someone off Suboxone’ is viewed as similar to kicking a poorly-compliant teenage diabetic off insulin.

Would THAT make sense— even to This Jerk?

Pill Mill Prosecution and the Pain Relief Network

Wow. I just read an email about a story that I was vaguely aware of– about a doctor in Kansas and his wife, who were together linked to scores of overdose deaths. But that is just the beginning. The doctor was supported, during his trial, by Siobhan Reynolds, founder of a nonprofit advocacy group called ‘Pain Relief Network.’  She started the group back in 2003, when her ex-husband was suffering from severe pain from a congenital connective tissue disorder.Reynold's Billboard

He (the ex-husband) found relief in combinations of high-dose opioids and benzodiazepines, at least until his doctor, Virginia pain specialist William Hurwitz, was convicted on 16 counts of drug trafficking.  The ex died, by the way, in 2006.  Are you still with me?

The trial of the Kansas doctor, Stephen Schneider, went on for years.  During the trial, Ms. Reynolds apparently helped support what she considered to be a ‘dream team’ of attorneys.  She used the case as an opportunity to increase her visibility, encouraging the Schneiders to aggressively fight the charges against them on the basis of ‘patient rights.’  Ms. Reynolds, through the Schneiders, argued that suffering patients are being denied appropriate care because of a war, waged by overly-aggressive prosecutors, against doctors who prescribe pain medication.

Ms. Reynolds even paid for a billboard adjacent to the road to the courthouse, so that jurors could see, en route, the statement “Dr. Schneider Never Killed Anyone.”  Some might see the billboard as ‘free speech’, but the judge presiding over the case was not amused.  At the eventual sentencing, the judge gave both Dr. Schneider and his wife over 30 years in prison, hoping that the sentences would “curtail or stop the activities of the Bozo the Clown outfit known as the Pain [Relief] Network, a ship of fools if there ever was one.”

We already have enough drama for a made for TV movie.  Actually there already is one, made by Ms. Reynolds, about her ex’s struggle over finding appropriate pain treatment.  The hour-long film is called ‘The Chilling Effect,’ and can be found here– along with a number of vignettes about the efforts of the Pain Relief Network.

Make that the former Pain Relief Network.  Ms. Reynolds was investigated by a Grand Jury, led by the same prosecutor who led the efforts against Dr. Schneider.  After years of what she considered to be ‘vindictive efforts,’ she closed down Pain Relief Network, saying that the organization’s finances ‘were in shambles.’

Within weeks of closing PRN, Ms. Reynolds lost her life in a plane crash.  Piloting the plane, and also killed, was Kevin Byers– Ms. Reynold’s romantic partner and also– get this attorney for the wife of Dr. Schneider.

Our story ends in typical, made for TV fashion, with all of the loose ends tied up.  The Pain Relief Network is gone, tragically missed by some, and considered ‘good riddance’ by others.  Ms. Reynolds, tireless advocate or misguided fanatic, has left this world for the next.  Left behind are the story-tellers;  I will provide links to both sides, so that readers can have a true, balanced perspective.  From the PRN side, simply go to their former web site, and you will find links to the archives.  The archives contain links to stories in a number of publications, including Slate and the NYT– places where David and Goliath stories are repeated without much challenge, particularly for the Davids.

On the other side is a woman named Marianne Skolek, writer for the Salem News online site, who has little positive to say about Ms. Reynolds and PRN.  For years she has chronicled the epidemic of deaths from Oxycontin, and she has also written a number of articles about the Schneiders, Reynolds, and PRN.  One of the most chilling points in a story by M. Skolek is a a list of the patients who saw Dr. Schneider and who died shortly afterward.  The pattern is clear; people in sudden possession of large numbers of pain pills, who took amounts sufficient to end their lives:

Name

Age

On or about 1st Office Visit

On or about Last Office Visit

On or about Date of Death

Heather M 28 Aug. 27, 2001 Feb. 8, 2002 Feb. 9, 2002
Billie R 45 Oct. 19, 2001 May 2, 2002 May 4, 2002
William M 36 Nov. 12, 2002 Jan. 28, 2003 Feb. 4, 2003
Leslie C 49 April 9, 1996 Feb. 9, 2003 Feb. 14, 2003
David B 47 Nov. 18, 2002 March 12, 2003 March 15, 2003
Terry C 48 Oct. 12, 2001 April 8, 2003 April 14, 2003
Lynnise G 35 May 23, 2002 April 23, 2003 April 30, 2003
Mary S 52 Feb. 6, 2003 June 11, 2003 June 16, 2003
Dustin L 18 June 26, 2003 June 26, 2003 June 27, 2003
Marie H 43 Dec. 24, 2002 May 28, 2003 June 30, 2003
Jessie D 21 March 4, 2003 June 27, 2003 July 11, 2003
Boyce B 59 June 29, 2003 July 23, 2003 July 25, 2003
Kandace B 43 July 10, 2003 Nov. 12, 2003 Nov. 14, 2003
Katherine S 46 July 9, 2003 Nov. 19, 2003 Nov. 25, 2003
Robert S 31 June 2, 2003 Dec. 7, 2003 Dec. 8, 2003
Deborah S 44 Jan. 3, 2003 May 5, 2003 Feb. 5, 2004
Shannon Mi 38 July 27, 2003 Dec. 9, 2003 Feb. 23, 2004
Danny C 35 April 21, 2003 March 5, 2004 March 6, 2004
Vickie H 53 June 26, 2003 March 16, 2004 April 11, 2004
James C 33 March 3, 2004 June 8, 2004 June 9, 2004
Shannon Me 25 July 24, 2003 June 4, 2004 June 22, 2004
Ancira W 45 Sept. 25, 2002 June 15, 2004 July 12, 2004
Darrell H 24 Nov. 12, 2002 July 15, 2004 July 17, 2004
Michael H 37 March 9, 2004 Aug. 26, 2004 Sept. 12, 2004
Patricia C 43 Nov. 8, 2001 Oct. 4, 2004 Oct. 6, 2004
Jon P 36 April 23, 2004 Oct. 8, 2004 Oct. 20, 2004
Tresa W 43 Sept. 15, 2003 Nov. 29, 2004 Dec. 16, 2004
Jeff H 45 Jan. 10, 2003 Dec. 8, 2004 Dec. 29, 2004
Russell H 24 Aug. 23, 2003 Jan. 12, 2005 Jan. 19, 2005
Michael B 48 Sept. 30, 2004 Jan. 28, 2005 Feb. 2, 2005
Amber G 22 Aug. 13, 2003 Jan. 3, 2005 Feb. 26, 2005
Christine B 45 Dec. 11, 2001 Dec. 3, 2004 April 7, 2005
Victor J 48 Jan. 24, 2005 April 15, 2004 April 22, 2005
Randall P 44 March 10, 2005 April 22, 2005 May 3, 2005
Michael F 49 Jan. 10, 2005 May 9, 2005 May 11, 2005
Deborah M 52 Feb. 23, 2005 May 4, 2005 May 15, 2005
Patricia G 49 Feb. 1, 2003 June 18, 2005 June 20, 2005
Dustin B 22 Jan. 20, 2005 Feb. 27, 2005 June 21, 2005
Jerad M 24 July 9, 2004 June 13, 2005 June 22, 2005
Earl A 29 Sept. 22, 2004 June 29, 2005 July 3, 2005
Brad S 53 Oct. 15, 2004 June 30, 2005 July 11, 2005
Clifford C 39 July 23, 2003 June 29, 2005 July 27, 2005
Sue B 38 Oct. 21, 2002 May 12, 2005 Aug. 1, 2005
Jason P 21 Aug. 19, 2003 June 29, 2005 Sept. 4, 2005
Randall S 52 April 27, 2005 Nov. 12, 2005 Nov. 19, 2005
Thomas F 46 Feb. 15, 2005 Jan. 5, 2006 Jan. 9, 2006
Toni W 37 Dec. 30, 1999 Feb. 16, 2006 Feb. 18, 2006
Marilyn R 39 Aug. 16, 2004 March 16, 2006 April 5, 2006
Dalene C 45 Aug. 25, 2003 April 19, 2006 April 21, 2006
Eric T 46 June 2, 2003 April 19, 2006 April 23, 2006
Jo Jo R 46 Feb. 26, 2005 June 5, 2006 June 7, 2006
Mary Sue L 55 Jan. 30, 2002 June 13, 2006 June 14, 2006
Pamela F 42 March 31, 2003 July 21, 2006 July 22, 2006
Deborah W 53 July 18, 2003 Sept. 7, 2006 Sept. 9, 2006
Jeffrey J 39 May 5, 2004 Oct. 23, 2006 Oct. 24, 2006
Ronald W 56 June 29, 2004 March 20, 2007 March 23, 2007
Evelyn S 50 Dec. 12, 2004 April 16, 2007 April 17, 2007
Robin G 45 July 13, 2004 May 11, 2007 May 15, 2007
Ralph S 44 Jan. 16, 2003 May 15, 2007 July 23, 2007
Patsy W 49 Dec. 2, 1999 July 16, 2007 July 26, 2007
Donna D 48 Dec. 27, 2005 July 19, 2007 Aug. 16, 2007
Lucy S. 61 Aug. 29, 2003 Aug. 23, 2007 Aug. 28, 2007
Gyna G 33 Feb. 10, 2004 Oct. 4, 2007 Oct. 7, 2007
Casey G 28 Sept. 4, 2007 Sept. 13, 2007 Oct. 23, 2007
Julia F 50 June 20, 2007 Nov. 20, 2007 Nov. 28, 2007
Rebecca T 54 May 2, 2006 Nov. 17, 2007 Dec. 24, 2007
Jane E 40 Jan. 8, 2003 Jan. 12, 2008 Jan. 26, 2008
John D 52 June 23, 2003 Jan. 3, 2008 Feb. 10, 2008

 

The story is not quite over.  The Schneiders are now appealing their convictions, claiming insufficient counsel– namely that the romantic involvement of one of their attorneys with Ms. Reynolds created a conflict that led to poor counsel.  In other words, they may have asked for mercy, had Ms. Reynolds not been cheering them and their attorney to place everything on the line.

As I’ve written many times, the use of opioids for chronic pain is a complicated issue, with no clear ‘good’ or ‘bad’ side. As in most of life’s challenges, the extremes of each position appear…. extreme.  Ms. Reynolds believed that the Controlled Substances Act should be repealed;  I find it difficult to understand how any educated person would adopt such an approach.  But the extreme opposite side leads to enough fear, in physicians, to stifle the use of narcotic pain relievers in people who truly need such relief.  As for me, I keep trying to straddle the wide middle.

Brattleboro Vermont To Addicts: Stay Stoned!

I was stunned to see this story about the town of Brattleboro, a town in Vermont with a name famous for the rats that grew up there.

As an aside, my PhD thesis involved working with vasopressin receptors in the brain, and that is why I’m familiar with Brattleboro rats– a species of rat that spontaneously mutated and lost the ability to make vasopressin.

One would think that inhabitants of a town made famous over a rat would be on their best behavior.  But they behaved worse than their namesakes at a meeting intended to get the OK for a clinic to treat people using Suboxone.  I’ll let you read the article, while I get back to what I was doing when I stumbled across the article.  What a bunch of…

Ah, forget it.

Need a Suboxone Doctor? Cap Problems? ACT!

There are ongoing efforts to eliminate the cap on treating people for opioid dependence with buprenorphine or Suboxone.  I don’t know what the odds of success are, but the efforts would benefit from public demand.  If you have had difficulty finding a doctor with room under the cap, write a letter or email that explains just how important the issue is to you, and send it to the address(es) below.

The change requires an Act of Congress, or perhaps an executive order from someone high-placed in the Dept of Health and Human Services.  Consider sending a ‘cc’ to your elected representatives in the Senate or House of Representatives.  I am not excited about using NAABT.org, since they tend to be patsies for Reckitt-Benckiser (I’ve asked to have a link to this blog, or to our 6000-member forum on their web page, but they won’t– but they link to an R-B – supported forum instead– draw your own conclusions).  But this issue is too important even for my own righteous anger to get in the way!

Send comments to the following e-mail or mailing address:

NAABT, Inc.
P.O. Box 333
Farmington, CT 06034

Email address:
MakeContact@naabt.org