Can you clarify your sources for “Medicaid and some other insurance providers have policies that force the reduction of pain medications”?

I see in the knkx piece “Kertesz notes that Medicaid, as well as states and private payers, still have policies that lead to forced reductions“, which has a slightly different (but potentially important) implication than what’s suggested by your phrasing.

Where is opioid-induced hyperalgesia in this discussion? Opioids are almost never a good long term solution for chronic pain (vs acute pain), even before the opioid crisis, because long term opioid use INCREASES chronic pain. It’s well-documented and widely accepted at this point. Short term, opioids are a great solution for people experiencing temporary distress, but they are treacherously counterproductive in the long term. Patients often don’t know why their pain is getting worse and think the answer is more meds. Some of it is higher tolerance, but the brain also adjusts to long term use by agonizingly up-regulating pain receptors.

Opioids increase pain - bullshit! I’m over 70, non-drinker and have Peripheral Neuropathy in my feet. The pain became so bad that nothing abated it except Oxycodone. If it weren’t for (its) pain relief I would consider suicide. It’s unbearable!

Those legislating against it will want the same relief if they become afflicted.
Lobby and work with big pharma but limit lawsuits. Otherwise, we take away their incentive for R&D for dugs we all need. Set up program for help with drug abuse and let the abusers be responsible for their addiction, not the pharmaceutical companies.

I must take issue with your bifurcation of chronic pain patients from drug abusers (slight regard for the epic fail comparison to Spice from Dune; try Ketracel-white, Torgo) and this unrealistic visual rhetoric of a well-off but still pitiable victim as separate from the wretched suffering in the soon to be frozen streets howling with the wind.

Recognize that when people get into auto collisions or have malpracrice or get overdosed by undertrained or understaffed medical support staff supervisors, or just any shitty injury happens to you, you can counteract the pain with many drug classes with different physiological pathways and mechanisms of action, many of which do not activate mu, or opioid receptors and still relieve pain. More of the drug reached the targeted areas faster depending on route of administration, and opioid medications have been inappropriately prescribed in the vast majority of cases for profiteering of the drug companies and duress or a cut from corrupt prescribers (including NPs and PAs), and disasters and injuries affect construction workers and factory workers and agricultutal workers and all people of America, and they have even more in snowy states where winter accidents make a killing for the cabals of backscratchers referring and overtreating in order to demand a larger cut of the insurance policy limits in case you get hit by an uninsured driver. The whole equation profits others at the expense of our collective public health and productivity. That money comes at an enormous cost to our entire way of life.

Anyway, your average Juice Springsteen blue collar everyman joe the plumber's crack is "eating these up like Doritos." As such, those that have not have proper medication education, are in poverty or demoralization or isolation or trauma, and the lost in the soul will turn to the false comforts of that addiction, as to live without it is to then live in the swamps of sadness. We must care and not be Morla McConnell. No more stupid horse. These are our fellow Americans on the streets, and we must rise to the challenge or treating their pain humanely to empower ourselves from foreign meddling as an intact hole.

Multinational pharmaceutical companies need buyers and sellers and suppliers. They cooperate with the goals of global elite aristocrats to get a cut of whatever premium good (I.e. military contractors and special forces to get a cut of the Taliban's poppy and Afghanistan's rare earth elements) will sell and create a power struggle among buyers for their hired mercenaries, that is, the special forces and military might of other nations through global hegemony with puppet heads of state bribed to sew division). As such, we have been a very steady and dependable market of consumers, we just revere our drug lords a but more here and insulate them consequences. Scarface, eat your heart out.

Love thy neighbor as thyself and do unto others as you would have then do unto you. This is a recipe for peace, and it requires only a matchstrike of courage to kindle the bravery of one people of one nation, indivisible, with liberty and justice for all.

Kids. LOVE. LOOOOG!!

https://youtu.be/-fQGPZTECYs

Western medicine has always been bad at pain-management, or at palliative care of any kind. Christian teaching that suffering must be endured led to anesthesia being labeled as 'sinful'. Add to that the cruel misperception that any person can prevent or overcome addiction alone (it's a character issue, not a biochemical one, somehow), and we have the recipe for the disaster we're now seeing.

The U.S. Constitution limits the life of a patent to 17 years, so a pharmaceutical company which develops a new drug must sell as much of it as they possibly can during that time, to recover the enormous cost of R&D. Oxycontin was recognized by the FDA, during the certification process, as having a huge addictive potential, but this was never properly addressed. It quickly became "hillbilly heroin," and not even Rush Limbaugh's highly public struggle with it moved us toward a more humane policy.

This is a huge mess, and trying to limit pain relief to those who need it just makes it worse. Thank you, Katie, for giving us a look at those folks.

I have senior citizen friends in constant pain who can no longer get iPods because the greedy pharmaceutical industry created tens of thousands of addicts and unscrupulous doctors all cleaned up cash in doing so.

I'm 69 and when I fractured my shoulder I had to fight my doctors to get adequate pain relief -- and only got refills by pointing out that I was deliberately underdosing myself in case I couldn't get refills.

As it was, I spent time needlessly in pain, while I waited for appointments with the orthopedic surgeon, who could only be convinced in person that I only wanted to be able to sleep at night.

Once my pain level went down to merely achy rehab level, I stopped using, still have several tabs I haven't taken.

As a senior I fear the time when pain will have no cease and I won't be given relief because of previous greed on the part of the drug companies and sleazy doctors.

It makes no sense.

Thanks for addressing this, Katie.

Yeah, thanks Katie.

One last point.

In the 1993 Feature Film, /The Fugitive/, the who reason (Spoiler alert!) had to miraculously survive every obstacle AND outrun the US Marshall's, AND uncover the underlying conspiracy of corrupt drug company Devlin McGregor falsifying their samples and therefore research to make a killing on sugar pills for cardiology and bone marrow transplants and such immunology, and it was al bullshit!! Why? Because the Drug Companies paid corrupt ex cop hitment to off the doctor that knew otherwise and frame her husband. Why?? Because the company had been in a cooperative partnership with the city on funding and research, but in actuality it was taking hold of the city's (taxpayer's) resources through the Memorial Hospital, and the large flurry of corruptiom therwin. Thus was the function of the US Marshalls and Tommy Lee Jones; to hold the corrupt inner elements on check. Without a functioning tier of checks and balances, it only takes one Evil Newman to start the fire. Ah Ah Ah! Oh the humanity!!

Anyway, now the hospitals have gone full for profit, they have more autobomy over what their hires and doctors can say and do. They run the labor budget like a retail store and pump people with opiates to sedate them and manage more people with less. Do not forget the truth in fiction and remember that the essence of a unified and balanced whole is a system of checks and balances not to punish, but to correct and sustain.

Thank you very much for your recent publications. They are more importamt than you realize.

https://youtu.be/uOMMXUc7p0U