Anger

12/01/2017 — Nancy Sajben MD

Anger at the failure of our medical system to support research and treatment of pain, anger at failure of the few currently available analgesics, anger at lack of interest or funding from Pharma – it requires at least $10,000,000 more to finish one important human treatment before submitting to FDA – that’s just one study. Pharma does not care, the price is peanuts to them. At one point, a company bought it, intending only to bury it. They do that for rheumatology treatments too, both the innate immune system and the adaptive immune system are being ignored. What could be more powerful than the immune system?

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Anger

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Anger at the failure of most medical organizations to discuss cannabis, medical marijuana. Training in cannabis is imperative.

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I am thrilled that Scripps Memorial Hospital Grand rounds in 10 days is a one hour lecture by the doctor who is head of HelloMD, national leaders in physician approval for medical marijuana, and in education.

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Anger at the destruction of the field of pain management. I posted on this two days ago, top left column. Anger at the greed in the medical system where pharma can buy whatever they want by sprinkling money at congress who will never ever ever do anything about the unholy prices of drugs. Certain elements in power will never stop trampling on the poor and the disabled. They will never treat the addicts. There is no will, they are paid off and nobody wants to help the disabled, the unwell, the poor. Not in the U.S. Voters do not want to hear it.

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Anger says step back, surrender.

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There is nothing anyone can do. The swamp is exhausting, dirty, dangerous and black.

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I have tried 7-1/2 years to introduce a new paradigm. At various lifetimes in medicine, I have had funding, sat on boards of companies, and panels at FDA. I have witnessed the destruction of what it once was 43 years ago when I entered practice. A long and tortured history, but still the most exciting thing in the world is medicine, science. So what? They shut off the field of pain and are killing it. The world is the world. Always was, always will be. Lust and greed, says the sage. You cannot uncurl the curly tail of a pig, says the sage. Always was, always will be. Do your duty. You cannot escape it. But surrender to love.

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Surrender. Do what you can and surrender the results to the Infinite.

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Read these books:

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Dying to Get High, Marijuana as Medicine

by Wendy Chapkis and Richard J. Webb

NYU Press 2008

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From back leaf:

“How can a substance that is no mystery to half of all adults in the United States prompt such confusion and misrepresentation in the realms of law, medicine, and policy?…. Offering nuance in place of slogans, Dying to Get High tells an inspiring story of the tactics and philosophies of a little-understood health movement.”

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“A beautifully written account from the front lines of the struggle between a federal drug war complex determined to keep demonizing marijuana and the growing movement of patients and doctors who have found marijuana to be a valuable medicine.”

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“….. Provides a human element to the history, pharmacology, psychology, and politics of medical marijuana in a way that no other work has. I loved reading it.”

.

Heroin Century

by Tom Carnwath and Ian Smith

Routledge Press, London

2002

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This is an extremely important, amazingly interesting, readable book for everyone.

.

From back cover:

.

Is heroin really dangerous? Or Is it just dangerous because it is illegal?

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Page-one 93,

.

“The income of the drug barons is an annual $254 thousand million dollars, greater than the American defense budget.”

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Read this book. A page turner! Exciting! fast paced, awesome! mind boggling!

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And just because you might flash some anger to propel you to actually do something, don’t get stuck there. Be at peace. Work hard. Use your expertise. Surrender to the Infinite.

While you are thinking about it, tell Congress to make pain management a mandatory course in more than the current 3% of medical schools, less then 30 hours in 4 years. Fund research and treatment of neuropathic pain such as CRPS, Complex Regional Pain Syndrome because it can be so disabling – the same neuropathic pain can occur from strokes. Don’t we deserve better? Not even cancer pain is taught, let alone grade schoolers who should be taught about the body, about addiction, drugs, sex. Teach all that opioids cause pain because they trigger inflammation in the immune system and that stimulates pain. The more opioid you give, the more the pain. Teach about the brain’s pleasure centers and addiction, how drugs and food and cigarettes work there and how addiction kills.

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Have a wonderful life all of you. There’s a lot of work to take up. You will meet great people. Can’t wait to see what a little anger will do.

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Heroin Addiction absent or rare in UK prescribing

01/16/2017 — Nancy Sajben MD

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Diamorphine (heroin) is prescribed for pain in the UK . Yesterday’s LA Times Op-Ed

What’s really causing the prescription drug crisis?

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Studies show addiction to opioids of any kind, even heroin, is rare in the UK. Not what we see in the US. They have more socialized care for housing, medical care, medications including for the jobless. They do not have the hopelessness that leads to desperation and addiction. Desperation is why all patients with chronic pain must work with a psychologist. Pain is not in your head, but desperation is, and a psychologist can help you learn tools to deal with desperation. If you don’t, pain will go up, up, up and that’s what’s in your head. Unless you use those tools, I promise you will suffer because it will get worse and worse and worse.

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“Doctors in many parts of the world — including Canada and some European countries — prescribe more powerful opiates than their peers in the United States. In England, if, say, you get hit by a car, you may be given diamorphine (the medical name for heroin) to manage your pain. Some people take it for long periods. If what we’ve been told is right, they should become addicted in huge numbers.

But this doesn’t occur. The Canadian physician Gabor Maté argues in his book “In the Realm of Hungry Ghosts” that studies examining the medicinal use of narcotics for pain relief find no significant risk of addiction. I’ve talked with doctors in Canada and Europe about this very issue. They say it’s vanishingly rare for a patient given diamorphine or a comparably strong painkiller in a hospital setting to develop an addiction.

Given that really powerful opiates do not appear to systematically cause addiction when administered by doctors, we should doubt that milder ones do. In fact only 1 in 130 prescriptions for an opiate such as Oxycontin or Percocet in the United States results in addiction, according to the National Survey on Drug Use and Heath.

So what’s really happening? The second, clashing story goes, again, crudely, like this: Opiate use is climbing because people feel more distressed and disconnected, and are turning to anesthetics to cope with their psychological pain.

Addiction rates are not spread evenly across the United States, as you would expect if chemical hooks were the primary cause. On the contrary, addiction is soaring in areas such as the Rust Belt, the South Bronx and the forgotten towns of New England, where people there say they are lonelier and more insecure than they have been in living memory.”

Healthcare costs in the US are a very serious problem. Opioids require monthly visits. Patients on opioids are forced to see a pain specialist, many for decades when pain is chronic. That’s bad enough, but the cost of opioid medications are outrageous. I know some whose opioids cost $17,000 per month or more. And some doctors in my area have mandated urine drug tests every single month, $750 per test, to prove you are not taking street drugs. High risk patients and nonaddicts alike, every month, just to pee in a cup and get your prescription opioid.

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Now congress is getting rid of the ACA, to make it better. I can only imagine how helpful they have been. Privatize social security, privatize medicare, privatize everything. Of course that will be better for them. Will it help anyone else?

Oxycontin Investigation – A Pulitzer for LA Times?

07/10/2016 — Nancy Sajben MD

A TIMES INVESTIGATION

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Inside an L.A. OxyContin ring that pushed more than 1 million pills. What the drugmaker knew

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By HARRIET RYAN, LISA GIRION AND SCOTT GLOVER

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JULY 10, 2016

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This LA Times investigative report by Ryan, Girion and Glover is now a contender for Pulitzer Award. They expose years of passively tracking extreme volume sales by leaders at the top of Purdue Pharma, the maker of OxyContin. While they racked up billions in sales, they tracked the surge in prescriptions from pill clinics in LA to gangs trafficking in Washington State for sale on the street. 80 mg tablets, deaths, crime, gangs, heroin – waves of heroin related crime and overdoses in cities all over the world.

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Purdue could track suspicious high volume sales of their pill:

In 2015, the Week published:

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How the American opiate epidemic was started by one pharmaceutical company

From Pacific Standard

by

Mike Mariani

These reports must demand a Congressional investigation into Oxycontin (before and after the 2010 abuse deterrent version) and all potentially addicting drugs currently on the market, not just pain killers.

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Congress needs to address pharma’s drug trafficking, data collection, and,duty to report.

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Pharma needs to be tracking distribution not just for sales and profit, but for common sense to interrupt drug trafficking. Obviously there is no law. Profit always wins.

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Business ethics is not good enough to justify the explosion of opioid abuse that stems from years of Oxycontin pills. Profiteering at the cost of deaths and drug abuse. Vote with your stock holdings.

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Cannabis for pain and symptom relief

Congress has lost the average person’s respect for scheduling cannabis as Schedule 1. It is an essential medication that has been used medically, safely for thousands of years. Patients are arriving in office with the discovery that CBD, simply CBD, works for their intractable pain. That’s not exactly correct, but there is a topical cannabis mixture that can relieve malignant pain – I mean disabling, not cancer.

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Reschedule cannabis as Schedule 3 immediately. It needs to be legalized, studied and taught. When MD’s are not taught about the cardiovascular potential with THC and when patients arrive in the ER without knowing what was in the marijuana they used, our hands are tied.

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Congress owes a release to the millions jailed simply for felony cannabis possession.

Cannabis “to date has been responsible for the arrest of about 20 million US citizens,” written in 2010 by Emeritus Professor of Psychiatry Lester Grinspoon.

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This website is for educational purposes only, not for medical advice or treatment. It is not for email.

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Advertising below this page is an unintended feature of this free blog and is not endorsed by me.

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Have Feds Told Doctors to Stop Prescribing Opioids For Chronic Pain? “Almost all opioids on the market are just as addictive as heroin”

03/15/2016 — Nancy Sajben MD

Today JAMA published the heavily resisted

CDC Opioid Guidelines

“A very useful guideline for people who don’t hurt,”

says my Rheumatology colleague

Chilling Effect on Prescribers

Guidelines allow Tylenol or Aspirin

Will insurers stop paying for opioids?

“Almost all opioids on the market are just as addictive as heroin,” CDC Director Thomas Frieden said.

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Have Feds told Doctors to Stop Prescribing Opioids For Chronic Pain? CDC guidelines focus on heroin, opioid related deaths, addiction. Not pain.

The guidelines are about addiction, heroin is everywhere, opioids cause death. So are they taking away the opioids?

I can’t bear to read it. The small print and pages of detailed words strike my amygdala numb.

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The CDC has a mandate to prevent opioid-related deaths, so all must suffer.

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Rather than address addiction as a medical condition and offer adequate treatment programs including for prisoners, the plan is to continue wasting trillions more on militarization and the failed War on Drugs that literally created the heroin market across the nation, among rich and poor.

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These are “guidelines, not law.” CDC

And these are 50,000,000 Americans with chronic pain, not drug addicts.

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Voluntary. Guidelines. In this country . . . .this is a tsunami.

Will state legislators, in the current zeal to address this heroin epidemic, put up abrupt new laws overnight restricting opioids, as they have already done in Massachusetts, as I recall, and other states. One governor ordered every one with chronic pain switched to methadone. How many died from that law?

**CDC will allow post injury/surgery opioids for 3 days, only for acute pain, only acute cancer pain while under active treatment (not chronic cancer pain), and for palliative care.**

Will insurers stop paying for opioids?

Insurers now have federal support to deny all opioids. And denials are something they have been doing little by little for years, for many types of conditions, not just pain.

I fear for 50 million Americans with chronic pain. I cannot bear to read these detailed injunctions from CDC and their focus on heroin abuse rather than pain – not after 16 hours of recent conference on this.

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I fear 50 million people will be frantically calling every pain specialist for help because none of their doctors will prescribe opioids. I have been seeing this already for a few months. Who will help them?

Will opioid taper lead to loss of jobs, loss of medical care, loss of insurance?

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I have written on this 17 or 18 times since October. There is nothing we can do to change it.

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The political environment could not be more toxic toward the disabled including our veterans, toward chronic pain, opioids and heroin.

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I look forward to a strong discussion on these chilling “guidelines” in the pain community from Forest Tennant, MD, Editor of Practical Pain Management, and a coming article on by Michael Schatman, PhD, CPE in J Pain Res with with Jeff Fudin and Jaqueline Pratt Cleary, which HONESTLY discusses the guideline issue in light of the antiquated concept of MEDD.

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Demoralized Jeb Bush Succumbs to Heroin Epidemic in New Hampshire

02/10/2016 — Nancy Sajben MD

Demoralized Jeb Bush Succumbs

To New Hampshire

Heroin Epidemic

Headlines, the Onion

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Don’t worry, I’ll tie this together, but I want you to understand this is a unified field.

The heroin epidemic is a big issue including among upper and middle class. It’s everywhere and cheap.

Pain is a neurological disease, so is addiction. So are psychiatric diseases (Freud). Don’t you think it’s about time we studied them? All street drugs need to be legalized. Research: Portugal decriminalized drugs 14 years ago. It saves billions and treats the cause. Shall we base the practice of medicine on criminal justice or a health-based approach?

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A major cause of addiction and or heroin abuse is seeking pain relief. People use heroin for pain: think former NFL football players, athletes, business people, mothers, actors, people of all ages with nerve and bone crushing diseases – a major cause of addiction is people cannot get pain treated, even if they are rich or live in certain states like Florida where laws are unusually strict.

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Jeb Bush actually was the governor when some of the strictest laws of the country were enacted in his state to prevent adequate pain medication. His current statement says:

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He enumerates the devastating financial costs when we do things the old way. And wants stiffer law enforcement. Research shows the opposite works better, saves billions. Portugal.

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It’s a hot topic. Who can disagree? Drug laws don’t work – research in 11 countries. Inescapable.

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Shocking that so many pain specialists and pain researchers in Florida have strong words to say about Florida laws that tie the hands for pain relief.

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From a conservative view point, you’d think government should take its hands off and allow medicine to follow standard of practice set by research, not politicians.

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Florida attracts former athletes and seniors who like warm weather on their bones and joints.

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Jeb was also the governor who signed the “Stand your ground laws.” How wise or controversial is that? How many states have jailed patients for seeking pain control like Florida? See 60 Minutes more than a decade ago. Maybe Jeb will be swayed by research. We all need to understand the brain. Ask every candidate how much their health plan covers behavioral therapy. Pain is an emotional experience. So is addiction. Biological too. But the emotionals have to cope with it. The amygdala gets battered by fear and pain and craving.

All things being equal, pain care is most difficult in Florida.

I know plenty of pain patients who stop craving when they have a spare they know they can always rely on, rather than squeek by with not enough. Fear is a natural reaction with pain. More than a third of middle class cancer patients at Memorial Sloan Kettering Cancer Center overused their opioids or loaned them to a friend per a study done around 1991 when I was there. It gets confusing what we are dealing with. And some people don’t always follow rules – does your mother? Grandmother?

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You can lose everything when you have severe pain. If you cannot concentrate, then you cannot play bal.l no matter how high paying and dynamic your job could be. Pain takes everything out of you. All that free time, wanting to go back to work – it used to be your life. Playing football, disabled at 24, made the team but injuries. No money. Heroin is everywhere. I’ve seen how retiring as a major player destroys the ego. Even Namath mentioned that the other day, did he not? Imagine the pain taking you out early when you held such promise.

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You may not be an addict, but you know heroin is cheap. Pain justifies many things. Loss of job, loss of friends as old friends call you for Christmas or Thanksgiving but pain is so severe you always have to pass.

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A major cause of addiction or heroin abuse is failure to obtain pain relief.

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I’d like to see this research:

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We need research to inform the best approach. And we need to get up to speed on the vast benefits of legalizing all drugs of all kinds. See the results of Portugal’s studies. See the last thing I posted.

Most important of all we must be able to image glia. The clinical work for that should begin in La Jolla near Scripps and UCSD where we have a nearby cyclotron and the renowned Alzheimer’s leadership at UCSD. CTE can be imaged and many former NFL players live here, as do seniors and a vibrant research community for stem cells and new immunopharmacologies. Scripps Research Institue, Sanford Burnham, so many renowned research institutes all new the scanner. Read my post January 2011 on glia, pain and the immune system.

I am led to believe a politician would succumb of asphyxia if they mentioned there is a better way to treat addiction and pain.

They should walk into any cancer hospital and see untreated pain. It’s not the cancer that always kills. UCLA research mid 1970’s by past president of the American Pain Society proved PAIN KILLS. It aggressively triggers cancer to grow faster and more metastatic, killing far sooner than the group whose cancer pain was treated.

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Pain Kills

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Heroin Kills.

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Legalize it and stop treating pain patients like addicts.

Every single time they see a doctor or pharmacist, year after year, month after month until they are in tears.

We Need:

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Come on boys, it’s in your families too. Every politician knows someone with pain, Alzheimers, even addiction. Professor Banati knows the best way to proceed. He’s led the field since the 1990’s. How long will we wait to address brain damage? How long can we afford to overlook cells that outnumber neurons by 10 to 1? That create inflammation that destroys neurons?

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We have an epidemic.

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It costs money and lives.

Pain Management Specialist in San Diego & La Jolla

Nancy Sajben MD

Recent Posts

Top Posts

Anger

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Anger

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Anger at the failure of most medical organizations to discuss cannabis, medical marijuana. Training in cannabis is imperative.

.

I am thrilled that Scripps Memorial Hospital Grand rounds in 10 days is a one hour lecture by the doctor who is head of HelloMD, national leaders in physician approval for medical marijuana, and in education.

.

.

Anger says step back, surrender.

.

There is nothing anyone can do. The swamp is exhausting, dirty, dangerous and black.

.

.

Surrender. Do what you can and surrender the results to the Infinite.

.

Read these books:

.

Dying to Get High, Marijuana as Medicine

by Wendy Chapkis and Richard J. Webb

NYU Press 2008

.

From back leaf:

.

“A beautifully written account from the front lines of the struggle between a federal drug war complex determined to keep demonizing marijuana and the growing movement of patients and doctors who have found marijuana to be a valuable medicine.”

.

“….. Provides a human element to the history, pharmacology, psychology, and politics of medical marijuana in a way that no other work has. I loved reading it.”

.

Heroin Century

by Tom Carnwath and Ian Smith

Routledge Press, London

2002

.

This is an extremely important, amazingly interesting, readable book for everyone.

.

From back cover:

.

Is heroin really dangerous? Or Is it just dangerous because it is illegal?

.

Page-one 93,

.

“The income of the drug barons is an annual $254 thousand million dollars, greater than the American defense budget.”

.

Read this book. A page turner! Exciting! fast paced, awesome! mind boggling!

.

.

.

And just because you might flash some anger to propel you to actually do something, don’t get stuck there. Be at peace. Work hard. Use your expertise. Surrender to the Infinite.

.

Have a wonderful life all of you. There’s a lot of work to take up. You will meet great people. Can’t wait to see what a little anger will do.

.

.

.

Heroin Addiction absent or rare in UK prescribing

.

.

.

Diamorphine (heroin) is prescribed for pain in the UK . Yesterday’s LA Times Op-Ed

What’s really causing the prescription drug crisis?

.

.

So what’s really happening? The second, clashing story goes, again, crudely, like this: Opiate use is climbing because people feel more distressed and disconnected, and are turning to anesthetics to cope with their psychological pain.

.

.
By HARRIET RYAN, LISA GIRION AND SCOTT GLOVER