Editorial Note: This anonymous comment featured toward the end of the Murder or Accident post. It seemed worth transforming into a post in its own right. In the week of the US vote, a key question facing voters is where does all the pain come from.
A colleague and I gave a talk to family docs this year and we discussed the opioid epidemic, including the 1% risk of addiction myth in Letters to the Editor at NEJM. One Key Opinion Leader (KOL) is now acknowledging that he may have overstated the safety of opioids but maintains that they still have a role in chronic pain, see Dr Russell Portenoy here: http://www.wsj.com/articles/SB10001424127887324478304578173342657044604
He strikes a controversial chord with others involved in treating the outcomes of chronic pain killer addictions, like Dr A. Kolodny, see here: http://www.medpagetoday.com/painmanagement/painmanagement/47855
Other KOLs like Dr Jane Ballantyne, have made 180 degree turns regarding opioid use in chronic pain, this article is well worth the read: http://www.nytimes.com/2012/04/09/health/opioid-painkiller-prescriptions-pose-danger-without-oversight.html?_r=0
Challenging myths that have so much resources poured into them to maintain is very difficult. We were all taught that pain was the “fifth vital sign” by the American Pain Society (around the same time OxyContin approval occurred). You can see the sordid history, including how patient satisfaction scores may have a role in this epidemic, here: http://www.kevinmd.com/blog/2016/04/the-opioid-epidemic-its-time-to-place-blame-where-it-belongs.html
The US Docs probably had some scare put into them by the successful legal case brought against a doctor (Dr Chin) in 1998 who was charged for not treating pain adequately. Incidentally, this was the same time as the heavy marketing machine was revving up for Purdue. http://articles.latimes.com/2001/jun/15/news/mn-10726
The appalling story about Purdue/Abbott’s role in this public health disaster is outlined nicely here:
There has been very vocal opposition from pain advocacy groups and physicians when British Columbia adopted the March 2016 CDC pain guidelines that discuss opioids and state they are not effective and should not be used for chronic pain and that doses should not exceed 50 mg equivalents of morphine.
Pain BC is encouraging patients who have been affected by these new regulations to complain to the College! https://www.painbc.ca/news/howdothesenewopioidguidelinesaffectyou. Nothing strikes fear into physicians quite like a good old College complaint!
Although the evidence of harm is abundantly clearly (lack of efficacy in chronic pain, massive overdose deaths, lives in ruin, 80% of heroin users report starting drug use with physician prescriptions), both people and doctors choose to ignore this and some doctors fear College investigators. Sounds a lot like Dr Chin all over again…
Big Pharma’s influence in Canada continues. See here for Purdue’s lobbying of the Federal Government: http://canadians.org/blog/who-behind-canadas-opioid-epidemic. A coalition of chronic pain and addiction specialists signed a letter earlier this year, requesting that Federal Health Minister Philpott consider making oxycodone only available as a tamper resistant formulation (of which Purdue holds the patent). Sixty percent of the signatories have ties to industry. http://www.theglobeandmail.com/news/national/ottawa-urged-to-reconsider-tamper-resistant-oxycodone/article29813367/?utm_source=twitter.com&utm_medium=Referrer:+Social+Network+/+Media&utm_campaign=Shared+Web+Article+Links
Dr David Juurlink may have said it best in the Globe and Mail piece referenced above:
“It’s time we stopped listening to pain specialists. Their messages, which were wrong, got us into this mess in the first place,” “Many of these physicians are deeply in the pockets of the companies that make opioids and that stand to profit immensely from the sale of these new products.”
Ontario released a new “Strategy to Prevent Opioid Addiction and Overdose” on October 12, 2016. This milquetoast framework to our public health crisis makes several vague recommendations, one of which is to make more substitution therapy available, specifically access to buprenorphine/naloxone (Suboxone). The document fails to provide suggestions for how to carry this out nor does it make mention of the potential public health risks. Studies have shown that Suboxone is ten times more likely to be diverted than methadone (i.e. not taken by the intended person and diverted to illicit market). We may want to ask Finland for some advice (buprenorphine, has been at the top of drugs misused in that country): https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3154701/
The provision of methadone (the other substitution treatment available) in the province received well-deserved criticism from the “Methadone Treatment and Services Advisory Committee”. http://health.gov.on.ca/en/public/programs/drugs/ons/docs/methadone_advisory_committee_report.pdf. Page 11 details some of the most egregious concerns:
“Lack of access to comprehensive care in stand-alone fee for service clinics: Many of these clinics provide little more than urine drug screening and methadone prescribing and dispensing, leaving patients without access to primary care, mental health and addiction screening, brief intervention or counselling, and management of acute and chronic illnesses. Variation in the quality of clinical services: Some clinics require frequent attendance for urine drug screening and a brief office visit regardless of the state of recovery demonstrated by the patient. This is wasteful and can be harmful to patients’ recovery as attendance can be inconvenient and at times very challenging, particularly for those in rural and geographically isolated areas.”
Profit driven care has clearly moved the patient far way from being in the centre.
Some are sounding the clarion call of “another epidemic” happening where over 50,000 patients in Ontario are now on methadone https://substanceabusepolicy.biomedcentral.com/articles/10.1186/s13011-016-0055-4
Perhaps the most astonishing elephant in the room is “why are so many people in pain?” As a society we must look at the root drivers of this epidemic and that must also focus on prevention. We need to do some serious soul searching as a nation, as a community of peoples. We will need to address poverty, hopelessness, dislocation, safe housing, disintegration of community, lack of meaningful employment, adverse childhood experiences, resiliency, etc. if we have any hope of bringing this epidemic under control.
The links above are chilling. The video clip of Russell Pourtenoy is beyond belief.
It raises the question as to whether there is a growing amount of pain in the world as this US election suggests. The alternative is that doctors been adding to whatever pain and anxiety there is and to other dis-ease. While opioids and other pain-killers can give wonderful relief when given short term, as can benzodiazepines for anxiety, there is good evidence that given chronically opioids and benzos increase the amount of pain and anxiety we have – by altering physiological thresholds in the wrong direction.
Old style doctors, professionals, knew this. New style technocrats – we have the technology to fix your pain and anxiety – don’t know it.
It was and is an important part of caring for you to know the limits to what we can offer. But we now live in a world where choices like opioids are put on plate in front of you and your doctor and you are invited to choose. The right choice will supposedly deliver the jackpot – this is what marketing promises.
But somehow wisdom is never on the list of options – it can’t be – it’s not evidence based. It would be irrational to let you choose something that is not evidence based – like less medication or vaccines. That’s not a free choice.Share this:
Copyright © Data Based Medicine Americas Ltd.
Where did all the pain come from? Oh boy, there hangs a tale. One part of it is what we were “given”: a new deluge of opioids, particularly OxyContin. The other part is what was taken away in the same time.
Technocrats? Yeah, I guess they were part of it. But a bigger part is that “profit-driven care” the author talks about. Even in Canada, apparently. Still more in the USA.
When I worked in a hospital rehab ward in the late ‘80’s and early ‘90’s, the high dose opioids were still practically unheard-of. But physical therapy, occupational therapy, etc. were not doled out with an eyedropper like they are today. We even had Comprehensive Pain Treatment. For a serious problem you could actually get 30-days inpatient, with PT, counseling, hydrotherapy, pain psychology, the whole nine yards! By the early 1990’s, these were scaling way back, and by 1998 when OxyContin was trotted out, they were gone. In their place were “pain management clinics” where you saw the doctor for 90 seconds if you were lucky. And got an ever-rising dose of Oxy, Norco or Opana.
A lot of these joints were “pill mills” pure and simple. Along with mistreating patients, they were also pumping pills out onto the black market, and they knew it. But the “legitimate” pain management clinics, with the board-certified specialist who saw you for 90 seconds, were not a whole lot better.
Physical therapy? Maybe eight sessions, early on. Individual attention to what ails you? Forget it. The 90’s were also the golden age of mass incarceration, and of Ending Welfare As We Know It, and the tearing up of union contracts. In other words, the slashing of the safety net. Forget therapy. You couldn’t even get six weeks off work to heal from an injury or illness. Or help surviving, if you couldn’t go back to work.
It’s no coincidence the opioid “abuse” problem got its start in West Virginia coal country and other devastated industrial areas. That’s why most Americans first heard of OxyContin as “hillbilly heroin.” Plenty of middle-aged men beaten up in the coal mines, and unable to find any other job. For some, survival depended on getting that pill-mill quack to sign you up for Social Security Disability. Others took their Vicodin so they could stagger back to a job they could have retired from in better days. Some of the younger ones finally found work selling black-market Oxy from the pill mills.
When Purdue Pharma’s sales machine came along, it was like pouring gasoline on a fire.
Big Pharma should change its name to POPOP – Profit Off The Pain of People.
I have just started reading a most interesting book called ‘Chronic Pain, the Key to Recovery’ by a physiotherapist called Georgie Oldfield, who has developed, inspired by the work of Dr John Sarno in the USA, her revolutionary method, (not drugs) which you can find on the SIRPA website (http://www.sirparecoveryprogramme.co.uk/). I haven’t got far into the book yet, but I think it may help me with the chronic neck pain I have most of the time from the accident I had in 2001. It limits me particularly when sitting up straight for long periods, or working on the computer. I have never taken strong painkillers, except for the initial 2 weeks after surgery, when I took Cocodamol. They made me feel dreadful in myself. I do take 2 paracetamol once in a day, when the pain causes my neck to seemingly go into spasm and spread into my face and head. If I lie down for a power nap, this helps. I have also bought a timer to hang round my neck (very lightweight) to remind myself how long I’ve been typing, so I can stop after 30 mins and walk around.
Georgie Oldfield writes’
There are two widespread myths about chronic or persistent symptoms. First that they usually have a physical cause, and second, that they can only be managed and not cured. One reason for these myths is the divide that began to develop in the last century between research into the physical aspects of health, and research into the mind (psychology).
The more focused each area of study became, and the more specialisms developed, based on physical health (eg orthopaedics, gynaecology, rheumatology, immunology, etc), the bigger the divide grew. This resulted in it being less likely for any interrelationships to be noticed, not just between the mind and the body, but between different organs and areas of the body.’
She goes on to show that so often, the patient is examined by all these different specialists, and not seen as the whole person. And how often chronic pain and depression, tend to go around, each triggering more of the other. She says it has been reported that 20% of people with persistent pain also have depression and in some studies the figure is even higher.
In 2006 studies showed that chronic pain doubles the risk of suicide, one in 5 thinking about it, one in 10 actually attempting it.
When people are told their pain will go on and they will have to manage it, the nocebo effect kicks in, (opposite of placebo effect) and fear can make their condition seem worse in pain severity. She quotes evidence of this in books by scientist David Hamilton PhD.
Therefore, if her Pain Treatment programme works, Opiods could become a thing of the past. Her book explains for each of us where our pain may come from, and how, once we realise that and address it with deep understanding, our pain can go altogether. I will continue with the book and report back, like a guinea pig, hopefully my success…..
Watching that video of Dr Portenoy saying that his recommendations before 2012 to increase the use of opioids were innocent because “we didn’t know then what we know now” is one more stunning example of the medical profession failing to take account of the obvious. I mean, not know that opioids were addictive? That has been known for many decades. Government regulators in the field of medicine have to rely on experts in the medical field to lead the way on what is best for the public. But time and again, the brightest medical minds get it wrong, whether because of wishful thinking, or conflicts of interest, naiveté in dealing with Pharma, or simply not paying attention. But it doesn’t matter why. Innocent people get addicted and suffer in so many ways, families suffer, and many die. The practice of medicine has a lot to answer for, and not just in pain management.
Here’s an eye-opening look at life in some of the counties where the opioid epidemic began, and is raging. A group called Remote Access Medical sponsors one-day free clinics in impoverished rural areas:
“Diabetes, heart disease and stroke are endemic, and smoking and cancer deaths far exceed national levels. Despite a downturn in coal production, miners are still afflicted with black lung disease and serious injuries.
But the most common complaints at RAM clinics are painful, rotting teeth.”
I realize this ain’t everyone who gets addicted to opioids. But for every person who utterly lacks medical care there are a half-dozen forced to accept minimalist “care” that consists entirely of pills from a harried physician’s assistant or nurse practitioner.
The Scottish Parliament
Pàrlamaid na h-Alba
PE01627: Consent for mental health treatment for people under 18 years of age
The incident which gave rise to this petition is so, so sad – but, unfortunately, not rare. A person, of whatever age, explaining to their doctor that they have self-harming or suicidal thoughts should NOT be given a prescription for a month’s supply of medication. This seems to be the norm countrywide but, in my opinion, it’s almost as if the patient is being told “You’ve had the thoughts – now I give you the means”. At the very least, it means, for sure, that the doctor has no idea of the possible consequence of their action – in other words, have not taken the patient seriously when feelings were described. That is a failing that seems rather general – once again, it’s the ‘non-listening professional’. Due to their lack of sympathy for the patient’s situation, the family are left to provide the real care needed. In this tragic case, the family remained totally in the dark until it was too late. Families, generally, are only too willing to do their part but can only do so with shared knowledge – and with shared responsibility.
This petition seems to be geared to the Scottish Parliament as far as I can see – maybe it’s time to push for a UK wide one, on the same lines, whilst this is fresh in people’s minds?
Imagine happening upon a bottle of Vicodin while in the depths of psych drug withdrawal. If it eased the suffering, it wouldn’t be long before you were angling for another bottle.
After retirement, I started volunteering in a rural charity clinic [circa 2007 or 2008]. Not too long after starting there, I dropped Opioids from my DEA licensure [meaning I couldn’t prescribe them even if I wanted to]. It was either that or quit. I simply couldn’t tolerate the constant pain narratives and pleas. What was interesting was that once I did that, the requests stopped almost like it had been a headline in the local paper. I guess word travels fast. When Dr Russell Portenoy says “We didn’t know then what we know now,” rationalizing his earlier recommendations, it’s hard not to laugh. Of course we knew! I knew. And it’s hard to imagine he didn’t know. It’s part of any world history course, what happens with opioids.
And are the “patients” able to go to someone else?
I had to search a bit for MDs in my area, but to find safe housing still proves much more difficult! (Thanks for mentioning it as a source of chronic pain)
But I am not so sure that after so many years of violence there is a “reset” like a computer button!
It seems crazy to me that you can go to a gp for a non medical matter and before you know it the trigger happy, pen poised, generally deluded, are at it..
I wouldn’t class psychological distress as a medical matter – there are always reasons for distress and talking it through with someone wise à la Dr. Mickey, but, wisdom hasn’t hit the surgeries yet and if the someone at a helm doesn’t get a grip we will all be drugged to the gills and no one will know what normal is any more…
Dr. Mickey is the last remaining volunteer in his Georgia clinic, he has done miraculous work doing what he does for this long, but, I guess it had to come to Georgia..
They were pill mad in my neck of the woods, the wee country, and the number of people I now know on anti-depressants is staggering….it is generally scary that you actually don’t know the true personality of the people you are mixing with..
If I complained to the GMC would they do a Dr. Portenoy and excuse the doctors as didn’t know then what we do now…lol!
I knew! I told them.
In fact an A4 page and a half full of airy fairy hypothesis and multiple pill prescribing contained one sentence which was true “her persistent complaints about their side-effects”
On her watch was a woman self destructing because of Seroxat, benzos, beta blockers and there should have been an inquiry for which I asked the Clinical Director.
No can do.
All that exists today are Guidelines….er, translate that to Bylines..
The way the children are treated is nothing short of criminal activity by Doctors.
I haven’t heard of one Doctor dismissed for abusing the children with drugs the adults cannot tolerate.
It is anti-bullying week and Doctors will be at it..
It is the Last Resort to visit a Doctor who sits majestic interfered with by no one and who probably gives out the pills because he probably thinks he will be sued if he doesn’t….no matter what the result
I see no Ostrich…
These are simple changes using existing systems that will plug the giant loophole that allows corrupt journal articles to contaminate the scientific literature…
Mickey Nardo, Jasper, GA
14. LeNoury J, Nardo JM, Healy D, Jureidini J, Raven M, Tufanaru C, Abi-Jaoude E (2015). Restoring Study 329: efficacy and harms of paroxetine and imipramine in treatment of major depression in adolescence. BMJ 2015;351:h4320. BMJ 2015; 351 doi: http://dx.doi.org/10.1136/bmj.h4320 (Published 16 September 2015) http://www.bmj.com/content/351/bmj.h4320.
Am I the only person who has never asked for any drug, ever, and, yet, multiple supplies of many drugs were thrust my way.
I doubt a child would ask a doctor “could I have a Selective Serotonin Re-uptake Inhibitor or a Benzodiazepine, an Opioid or an Add er all, please?”
It must be very bewildering for a child to be spoken to, hopefully kindly, and, then given a packet of scientific sounding, pretty coloured tablets..
Their World History ‘Class’ doesn’t teach about this sort of encounter..
Where is arresting control from non conforming Doctors with The Top Bureaucratic Medical Agencies ‘not in the loop’..
I really don’t know how any Dr can give a strong powerful psychiatric mind bending drug to a child. Its bad enough giving them to elderly people with dementia but a child is just so wrong.
There was a coverage last night (10 pm Tuesday 15th Nov) on BBC One TV News, on the epidemic of deaths amongst young people in the United States from opioid use, leading to heroin addiction. It is everywhere, the reporter said.
There was footage of addicts coming close to death, being revived, and back on the streets the next day, only living to get the next fix. It was horrifying and really brought to life DH ‘s post. There is to be a longer and more in-depth report over the coming weekend.
One doctor, who is at the forefront of raising awareness and trying to change things, was himself addicted to opioids and described how they took him over, and he found it almost impossible to get off them. His name was something like Dr Hummdinger, maybe others saw the programme too? This brave man welled up with tears when he described what happened to him, revisiting his memories of the hell he was in, and now he is fighting to save others with rehabilitation, but he obviously felt the hopeless enormity of the task. So, watch out for BBC News Channel coverage this coming weekend.
Victoria Derbyshire also reporting on Opioids and Heroin today. The doctor in the report is Dr Timothy Huckaby. Mentions an opiate blocker drug which he wants made available.
No, but there surely was in the drug-treated patients!
GlaxoSmithKline also found an increase in suicide attempts in adults and in 2006, GSK USA sent a “Dear Doctor” letter that pointed out that the risk of suicidal behaviour was increased also above age 24 (2).
Antidepressants Increase the Risk of Suicide and Violence at all Ages
1. Healy D. Did regulators fail over selective serotonin reuptake inhibitors? BMJ 2006;333:92–5.
Did regulators fail over selective serotonin reuptake inhibitors?
Controversy over the safety of antidepressants has shaken public confidence.
Were mistakes made and could they have been avoided?
GlaxoSmithKline’s recent letter to doctors points to a sixfold increase in risk of suicidal behaviour in adults taking paroxetine.1 This contrasts with the data in the UK Medicines and Healthcare Products Regulatory Authority’s expert working group report on suicide and antidepressants published in December 2004.2 Many people expect drug companies to be slow to concede that a drug causes hazards, but we do not expect our regulators to be even slower, so any hint that this might have been the case needs to be examined.
They just don’t seem to know when to stop – when they’ve stepped over the line. However, this particular campaign reveals PHARMA’s principle strategy in misrepresenting their wares:
Manufacturers tell FDA why they should be able to promote drugs and devices off label
GlaxoSmithKline are sued on Tuesday; Peter and Yu..
Suit Says Glaxo’s Conduct Led to Couple’s Imprisonment in China
Two former investigators say GlaxoSmithKline hired them under false pretenses
Christopher M. Matthews
The Wall Street Journal
Nov. 15, 2016 7:04 p.m. ET
Two former corporate investigators sued GlaxoSmithKline PLC on Tuesday, alleging that the drugmaker hired them under false pretenses that led the pair to be imprisoned in China.
Peter Humphrey and his wife, Yu Yingzeng, alleged in federal court in Pennsylvania that when Glaxo hired the couple to investigate a whistleblower in China in 2013, the company lied and said the whistleblower’s claims of widespread bribery at Glaxo’s China unit were false. Operating on the assumption that the whistleblower was trying to smear the…
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A true story.
I am particularly disturbed about the present custom of handing out opioids like M &Ms for several reasons, including a personal one. I have an extremely low respiratory rate – ever since childhood. I recall our GP with his stethoscope on my chest saying “Breathe, breathe!” and my thinking “I am breathing you idiot.” Clearly, I cannot tolerate medications that reduce my respiratory function.
Some time ago, I went to the local emergency room with a neighbour’s son who had a gut ache and dehydration because of antibiotic treatment for a strep throat. We had hardly entered the ER, before a nurse came in with a hypodermic. I asked what that was for. I was told that it was 2mg dilaudid and this was “standard treatment”. After losing my control and giving a lecture on proper control of meds and where was the physician and no she was not going to give the dilaudid to the patient, a resident appeared. I’ll spare you the details but sufficient to say that he left with his tail firmly between his legs. Now, if I hadn’t been there, was not a senior doctor etc.etc….. This happens CONSTANTLY in the part of Canada in which I live. I wear a small flash disc that has my entire medical history on it, in the hope that some idiot will not kill me with a “pain killer.”
Connecting the dots in China …c…c…c…
Not so ‘private’ eyes..
ChinaWhys is a ‘person’
‘Bob’ is a person
Head to Head..
ben goldacre @bengoldacre 3h3 hours ago
I’m unusually sorted for good underpants and socks right now. In times of grotesque flux it’s good to focus on the everyday.
BOB FIDDAMAN @Fiddaman
@bengoldacre – Mr Witty seems to be in hot water, Ben. –
“We are very grateful once again to be recognised”
“Studies have shown that Suboxone is ten times more likely to be diverted than methadone”
The stigma and misinformation surrounding opioid treatment is not helpful, and this quote gives the reader the wrong picture about what is current best-practice.
The veracity of the above quotation is largely dependant upon the route of administration. A tablet is relatively easy to divert as compared to Methadone syrup, however many pharmacotherapy clinics exclusively use sublingual buprenorphine/naloxone (Suboxone) wafers.
Perhaps it would have been helpful to mention in the article that “wafers ameliorate diversion” or such-like, which would appropriately clarify this clinical picture.
I shouldn’t talk since I do not have pain and I am nearly 59. I have no clue why. I do get a little bit of odd annoyances. It feels like my two femurs are actually touching each other when I lie down at night on my side, and that bugs me, but really it’s mostly amusing since they aren’t. But I note that my friends complain of pain all the time. I cannot understand why. Many can’t seem to describe what it is, either. Their description is vague, and when I ask, they can’t seem to pinpoint where, or how it started or what caused it. Or they say “nerve pain” and I don’t know what that means.
I have come to the conclusion that since antidepressants go into nerve cells, for sure, they do nerve damage that causes pain. I have heard that “fibro”-like symptoms are mostly found in people who took antidepressants or are currently taking them. Actually, every person I know who has a fibro diagnosis is on antidepressants or took them at one time.
Since nowadays antidepressants are given out like candy, could this account for the amount of pain people are in? I did take them, but not that much. I was on a cocktail but on other types of psych drugs. Luckily I am away from psychiatric “services” now and live diagnosis-free.
Some recent DRG Tweets following is snippet in the Daily Mail:
DAVID ROBERT GRIMES @drg1985 – Dec 4
..sadly anti-fluoride crowd in Ireland /REGRET have 10000s of facebook likes. My page? A few 100 – feel free to like
CHARISSE BURCHETT @Charbrevolution – 37m
@drg1985 @REGRET_ie @NoelRock @GCraughwell Maybe you should meet some of the young girls affected. How do you sleep?
CHARISSE BURCHETT@Charbrevolution – 37m
@drg1985 @Gcraughwell @AnGobanSaor @IamBreastCancer @REGRET_ie you are a #pusherman this vaccine is deadly and lethal to our young
CHARISSE BURCHETT @Charbrevolution – 39m
@drg1985 Hold on you believe in adding fluoride to water? Are you cray cray?
DAVID ROBERT GRIMES @drg1985 – Dec 5
Evidence based policy?! That makes you a cray-cray #pusherman ! Don’t worry, it’s gender neutral. *turns on quality filter*
CHARISSE BURCHETT @Charbrevolution – 57m
Cancer is a billion dollar profit industry – no money in cures
DAVID ROBERT GRIMES @drg1985 – Dec 5
More proof, were it needed, that if you’re daft enough to embrace one conspiracy theory uncritically, you’ll embrace the lot.
CHARISSE BURCHETT @Charbrevolution
@drg1985 Following you as I want to see the utter lies you keep coming out with – lying scientists writing for the @guardian
DAVID ROBERT GRIMES@drg1985 – Dec 5
..blocking you because you’re a moron. Ciao
Is it only me or is there really a weird mix in comments about antidepressants and painkillers?
They are very different substances!
It is an epidemic! Over 100 young people have died in the province of Alberta over the last 18 months. Opioid overdose is now the second leading reason for young people to attend emergency rooms in this province. I am a member of a drug-free world, and what we do is go to the elementary schools tell the students the truth about drugs, including drugs prescribed by physicians. I am amazed at some of the resistance and I have encountered some of the schools, one accusing me of scaring the shit out of kids! I have legalized marijuana in this province, will only lead to the problem. As if we didn’t have enough trouble with alcohol, and nicotine, and they are adding a very strong psychoactive drug, marijuana, which had now has been proven, is addictive, it alters cognitive function especially in adolescents, and into studies, it is a gateway drug to further abuse of narcotics, amphetamines, alcohol, etc.
Seems that I made a mistake. Regional, was that we have an epidemic of drug abuse in the Western world. In our province alone, Alberta Canada, over hundred young people have died from elephant sized fentanyl. Drug abuse and drug overdose is becoming the leading reason for young folks to the emergency room. I belong to an organization entitled “A Drug Free World”, which is now active in 70 countries world and our philosophy is that children even below the age of 15, need to be educated about what they are about to be faced with. We go into the schools and tell the truth about drugs. We don’t preach, just the facts backed by very good research, about the dangers of these substances, including marijuana.
There are a couple of big issues here.
Firstly the epidemic of pain is probably largely lined to our sedentary lifestyles and the abnormal postures that evolve from it.
Normal human posture has a very even distribution of weight behind and forwards of the centre of gravity.
All other postures put some muscles under excess load and those loaded muscles will inevitably start to generate pain and abnormally load joints and bones- leading to secondary problems. So myofascial pain is a big component of most pain problems (it can even develop around and worsen a problem like neuropathic pain or sciatica).
However, the loaded muscles then become chronically painful and ischaemic and the pain from them causes other muscles to go into spasm, and because of low oxygen levels, the painful muscles never get a chance to heal and settle.
Treating myofascial pain though is a complex process and may need coordinated work by a number of health care providers. Most doctors do not know about it, and those of us who do have stumbled across the information by good fortune. The treatments do not involve many referrals to medical specialists or much use of pharmaceuticals.
Equally, it takes time and patience to motivate patients- tough in the US where spending time with patients is a luxury the medical insurers do not allow.
I have been dealing with this in myself for about 15 years, and have rarely used medications- very infrequent codeine (over the counter in low doses in Australia) and intermittent use of diazepam to help me sleep through muscle spasm.
The use of long term opioids in non cancer pain is clearly a mistake and nowadays is not recommended practice in Australia. Tolerance and dose escalation are virtually inevitable.