The hidden war on chronic pain patients and legitimate pain-management doctors

I am afflicted with chronic pain caused by degenerative osteoarthritis in both knees. The only thing that leaves me 100% pain-free is playing live onstage. The rest of the time, the sole way to manage my pain is via high doses of opioids. Adequate dosages of the correct medications allow me to work a day job when necessary and take 9 hours at the University of Texas at Austin if I so desire.

Opiates are to me what insulin is to a diabetic: I don’t get “high,” they just keep me functional. The body makes its own endogenous  opioids, otherwise known as endorphins. External opioids are either synthesized in a lab or in the case of opium and its alkaloids morphine, codeine and thebaine, found in a poppy. Both endogenous and external opioids bind to the same  set of receptors in the body because external opioids mimic the effects of the opioids our bodies manufacture.. Therefore, most opiates such as oxycodone, fentanyl and even heroin (if it is pharmaceutically pure) are non-toxic to the body. When either acute or chronic pain occurs, these medications are prescribed to help the body handle the pain by boosting the level of opioids in the body. The medications go to the pain, not to the head (hence pain patients not getting high.)

But I digress. Despite the fact of a legitimate medical need for opioids to treat pain, they have been unfairly demonized and pain patients and pain management doctors are made to suffer. Things are getting worse. Here is a letter to the editor of the New York Times that I wrote in response to this Op-Ed. It wasn’t published in the paper, so I’m publishing it everywhere!

“My name is Mike Dubose. I’m a 36-year-old singer-songwriter-guitarist from Austin, Texas. My life changed irrevocably in 2000, when I was diagnosed with intractable pain caused by acute degenerative osteoarthritis and patella tendonitis in both of my knees. After trying many other options – pharmacological, surgical, physical therapy, acupuncture – it was determined by my pain management physician and me that the medications that allowed me to be the most functional human being and member of society were schedule II opioid painkillers. I was prescribed two: a long-acting medication and a short-acting, “rescue” medication for flare-ups or so-called “breakthrough” pain.

The long-acting opiate painkillers with which I have had the most success are OxyContin and Duragesic (a transdermal patch containing the opioid fentanyl.)

These medications keep me able to literally get out of bed in the morning. Dr. Andrew Kolodny and Physicians for Responsible Opiate Prescribing (PROP) may have good intentions, but their petition that led to the labeling change that the FDA enacted is extremely dangerous for me and thousands of other pain patients that depend on medications such as the above-mentioned and others now subject to the FDA’s revised labeling to get out of bed, raise their families, go to work, be good husbands, wives, friends, co-workers, mothers and fathers.

I fear that the FDA’s dropping “moderate” from the labeling and only requiring that medications like OxyContin be used when a patient’s pain is “severe enough” to require round-the-clock treatment in patients who have no other option will further confuse and frighten already-scared pain-management physicians and have a hugely detrimental effect on pain patients like myself and others around the country. One person’s “moderate” pain could be “severe” for another patient. Who determines which patient’s pain is “moderate” and which one’s is “severe”? The physician? The FDA? The state medical board in which the physician is practicing? The Drug Enforcement Agency?

While the FDA’s new labeling rules are extremely disconcerting, PROP’s push for a maximum daily dose and a 90-day limit of usage, along with their request to “rein in prescribing of all opioid analgesics” downright terrifies me. I have been on a combination of either OxyContin or Duragesic and a short-acting opiate for 13 years now, as have most people with severe, intractable pain. Everyone metabolizes medications differently, and opiates are no different. Dosage limits, prescription-duration cutoffs and “reining in [the] prescribing of all opioid analgesics” could have severe to fatal implications for me and the thousands of other patients who, unlike prescription-drug abusers, did not choose to be afflicted with the debilitating condition of intractable pain.

Curbing prescription-drug abuse should be a priority. However, people like myself and many others should not be made to suffer in pursuit of this goal. The medication, dosage and duration of an opioid prescription should be as it is in any other discipline of medicine save pain-management: between a patient and her physician. No government agency should be permitted to intervene.”

Please help me, my fellow pain patients and pain management physicians fight fear-mongering misinformation, willful ignorance and needless suffering.

Thanks for reading! If you can, please come see us play tonight in Austin at Metal and Lace (AKA Head Hunters) at 720 Red River. We play from 10-11:30, it’s gonna be BADASS (and I’ll be pain-free  through the duration of our set and 2-6 hours later!

Love-

Mike

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