“increasingly hostile environment for chronic pain patients and the physicians who strive to treat them”

In the summer of 2012, the Finance Committee of the U.S. Senate announced that it was initiating an investigation of the financial connections between certain major pharmaceutical manufacturers of prescription pain medications and experts in pain medicine, organizations that issue professional guidelines for the prescribing of such medications, and advocacy groups for patients with pain. The primary motivating factor for the investigation appears to be the prescription drug abuse epidemic alluded to in the introduction to this article and. more particularly, the suspicion that financial support of professional organizations in the field of pain medicine and their thought leaders has skewed practice guidelines, model policies, and even articles in peer-reviewed publications toward promotion of increased prescribing of opioid analgesics. The focus of the media accounts of this announcement was almost exclusively on those who acquire and misuse prescription pain medications and the injury and death that often follow from abuse of these medications. The plight of the many patients who receive and benefit significantly from these medications appeared as at best an afterthought and secondary consideration. For all of the reasons reviewed in this article, we now find ourselves in an increasingly hostile environment for chronic pain patients and the physicians who strive to treat them. More than ever, these patients are at risk that our society will revert to past prejudices against those who must rely on opioids for pain relief and functional improvement, and there is also a risk that our society will revert to a re-emergence of the opiophobia that plagued the health professions not so very long ago. The vulnerability of those afflicted with significant and persistent pain demands that medicine and society proceed with great caution in erecting barriers between conscientious physicians and their patients.

Finally, our criticisms of opioid contracts and the universal precautions approach ultimately do not depend on any substantive view of the propriety of opioid analgesics. That is to say, even if one maintains that the public health problem of prescription drug abuse sufficiently justifies curtailment of the use of opioid analgesics, it remains an open question whether the use of opioid contracts is ethically justified as a means to that end. Our position here is that regardless of one’s perspective on the merits of the end, the universal use of opioid contracts is ethically dubious and should be scaled back if not abandoned entirely.

2014. Goldberg, D. & Rich, B. Pharmacovigilence and the plight of chronic pain patients: in pursuit of a realistic and responsible ethic of care. Indiana Health Law Review, 11 Ind. Health L. Rev. 83: 16.

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“Revealed: the Palestinian children killed by Israeli forces”

Revealed: the Palestinian children killed by Israeli forces. The Telegraph, 7/22/14.

There is no justification, no excuse, no rationale.

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Bit(ch) 15: “They had me on Morphine and OxyContin for a while…”

Kylie “Tee” Toponce. Why Marijuana Works Better Than Opiates to Control Pain. AlterNet, 5/9/14.

“It started with a snowboarding accident; my knee got really messed up. They had me on Morphine and OxyContin for a while, but eventually the prescriptions ran out. As soon as they stopped giving me a legitimate source, I got into the underground scene,” says Randall*. “I was pronounced legally dead once, but I still didn’t clean up. My eight-year addiction didn’t stop until it eventually landed me behind bars.”

CDC. Policy Impact: Prescription Painkiller Overdoses: What’s the Issue? http://www.cdc.gov/homeandrecreationalsafety/rxbrief/

Fucking “Randall”—acute pain and he gets motherfucking morphine and Oxy as first choice pain meds? Come on! Morphine? Who’s this quack and why won’t he give me some fucking morphine?

Cases like Randall’s are not uncommon; roughly 6 percent of people who take legitimately-prescribed opiates try heroine within ten years.

How A Big Drug Company Inadvertently Got Americans Hooked On Heroin. HuffPo: http://www.huffingtonpost.com/2014/02/24/heroin-epidemic_n_4790898.html

“not uncommon”? “Not rare” is 6%? Out of 100%, 6% is “not uncommon.” WTMF? This means that 94% of the time, people given prescriptions for Oxycontin and its relatives do not become “Randalls.” Out of 100 people, only 6 are Randalls. What about us 94 Percenters?

I agree that “125,000 [overdose deaths] in the last decade,” about 1250 per year, is alarming. If MADD’s statistics are accurate “28 people die as a result of drunk driving crashes” every day, about 10,220 a year. Cigarette smoking leads to “480,000 deaths per year in the United States, including an estimated 41,000 deaths resulting from secondhand smoke exposure. This is about one in five deaths annually, or 1,300 deaths every day.” I’m not saying the overdoses aren’t significant or that nothing should be done about the increase in opiate-related overdoses and rising rates of heroin use and overdose deaths, but I am complaining about the whiff of hysteria I smell every time opiates or pain medications are mentioned. Should caution be applied? Yes. Unlike in fucking “Randall’s” case. Should patients on opiates be educated and, if at risk, screened? Yes. But that doesn’t mean that 1 prescription of Lortab or even Oxycontin will create an opiate addict or will inevitably lead to junkie status and overdose death because…I’ve never quite found the reason why when those at most risk to die of opiate overdoses are “35 to 54 years of age,…white or Native American,…on Medicaid,…living in a rural area.” Other groups also are at risk but if doctors don’t screen or educate their patients on how to properly and safely use pain medications, why use the outliers to punish the 94%? Because that obviously has not worked.

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I so love Jenni Prokopy.


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Pain 3 Ways

Differences in pain treatment can be summed up as follows:

A white man walks into a doctor’s office complaining about pain. He leaves the office with a prescription for pain medicine. Possibly Oxycontin.

A white woman walks into a doctor’s office complaining about pain. She leaves the office with a prescription for anti-depressants. Prozac, Paxil, Lexapro, Viibryd. And possibly Abilify added on if the complaints continue.

A person of color, pick a gender, walks into a doctor’s office complaining about pain. That person of color leaves the office with nothing.

The End.


Green, C., & Hart-Johnson, T. The Adequacy of Chronic Pain Management Prior to Presenting at a Tertiary Care Pain Center: The Role of Patient Socio-Demographic Characteristics. The Journal of Pain, 11.8 [August 2010]: 746–754.

In several clinical vignette studies, women and minorities received lesser quality pain care for acute, chronic, and cancer pain when presenting with similar pain problems than men….These and our current findings provide support for differences in pain-care quality. Although no racial differences in analgesic prescribing adequacy were found, we did identify differences in analgesic prescribing adequacy by gender. The gender gap was widest among younger patients and diminished as they approached age 50, suggesting younger women are at risk for lesser quality pain care.

Kposowa, A., & Tsunokai, G. Searching for relief: racial differences in treatment
of patients with back pain. Race & Society, 5 (2002): 193–223.

Results provide evidence to suggest that there are substantial racial/ethnic disparities in the likelihood of obtaining prescriptions for back pain in the United States. African American male patients were significantly less likely to receive pain medications than White male patients. African American and Hispanic male patients were considerably less likely than their White counterparts to receive prescribed pain medications. These results persisted even after controlling for the potentially confounding effects of pain intensity and source of payment. In addition, African American and Hispanic patients presenting with back pain received fewer medications on average than White patients [213].

Mossey, J. Defining Racial and Ethnic Disparities in Pain Management. Clin Orthop Relat Res. 469:7 (Jul 2011), 1859-1870. Link.

Pain Management and Prescription Drugs. Common Sense for Drug Policy, DrugWarFacts.org.

20. (Undertreatment of Pain More Common Among African-American Patients Than Whites) “Undertreatment of pain among African Americans has been well documented. For example, children with sickle-cell anemia (a painful disease that occurs most often among African Americans) who presented to hospital emergency departments (EDs) with pain were far less likely to have their pain assessed than were children with long-bone fractures (Zempsky et al., 2011).

“In general, moreover, a number of studies have shown that physicians tend to prescribe less analgesic medication for African Americans than for whites (Bernabei et al., 1998; Edwards et al., 2001; Green and Hart-Johnson, 2010). A study that used a pain management index to evaluate pain control found that blacks were less likely than whites to obtain prescriptions for adequate pain relief, based on reported pain severity and the strength of analgesics provided. Because such an index is a way to quantify a person’s response to pain medication alone, it is likely that people in this study did not receive other types of treatment for pain either.”

Source: Institute of Medicine, “Relieving Pain in America: A Blueprint for Transforming Prevention, Care, Education, and Research” (Washington, DC: National Academy of Sciences, 2011), p. 68. http://www.nap.edu/openbook.php?record_id=13172

27. (Populations At Increased Risk For Chronic Pain And For Inadequate Treatment) “An important message from epidemiologic studies cited by Blyth and colleagues (2010) is ‘the universal presence across populations of characteristic subgroups of people with an underlying propensity or increased risk for chronic pain, in the context of a wide range of different precipitating or underlying diseases and injuries’ (p. 282). These vulnerable subgroups are most often those of concern to public health.5 Increased vulnerability to pain is associated with the following:

“• having English as a second language,
“• race and ethnicity,
“• income and education,
“• sex and gender,
“• age group,
“• geographic location,
“• military veterans,
“• cognitive impairments,
“• surgical patients,
“• cancer patients, and
“• the end of life.
“Many of these same groups also are at risk of inadequate treatment.”

Source: Institute of Medicine, “Relieving Pain in America: A Blueprint for Transforming Prevention, Care, Education, and Research” (Washington, DC: National Academy of Sciences, 2011), pp. 64-65.


- See more at: http://www.drugwarfacts.org/cms/Pain#sthash.cexZY0YU.mYofam3q.dpuf

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Bit(ch) 14

Ideology is the refuge of the stupid.

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“Who wants to be in a party that’s anti f*ck-ins?”

The Raw Story. ‘I’m pro f*ck-in’: Cenk Uygur mocks GOP’s shrill response to Hobby Lobby joke. 7/2/2014.

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1341? LA’s incarceration rate in States of Incarceration: The Global Context from the Prison Policy Initiative:

world incarceration_states as countries

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Bit(ch) 13: Fuck!

The Supreme Court Just Made It Harder For Women To Exercise Their Right To Choose. 6/26/14. Think Progress.

Thanks, Supreme Court. With Governors Jindal and Walker competing to shut down Planned Parenthood clinics ["abortion clinics" they're called though only 3% of what PP clinics do nationwide is abortion services; much of what PP does is STI/STD
testing/treatment and contraception] and clinics that provide abortions [along with other services] as an audition for the 2016 GOP presidential nomination [http://www.gop.com/act/presidential-straw-poll], this is another Fuck You! and if you think this is “just some women’s issue,” wait until the Supreme Court comes for your ass.

Yes, I’ve had an abortion. I feel no shame and had no “negative effects” or guilt and not because I’m a sociopath. [Honestly, I felt relieved and hungry.] Men making those decisions for women is patriarchy [from The Males of Games] without a smile.

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Flood into Baton Rouge: June 28

Flood into Baton Rouge: June 28

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