Dear Kristin --

I joined so that I could reply to your post. I see, however, that you wrote it one month ago, so who knows what's happened by now? April 9 is past and gone, but I'd like to be able to help in any event.

It's hard to tell, without asking you some questions, whether you suffer from intractable pain, sometimes referred to by the specialists as "IP." INTRACTABLE PAIN takes away all quality of life. It's as though one slammed an entire hand in the car door and the pain, instead of lessening and going away within five to fifteen minutes as it usually would, stays. It hurts and hurts, just as much as when you slammed the door on your hand and you were jumping up and down and yelping maybe and maybe saying some words that weren't too polite, or crying. This kind of pain keeps you from eating, sleeping, intelligent conversation, reading, watching TV, housework, paid work -- in general, as I've said, IP disables all quality of life. There is NOTHING in the sufferer's world at all, nothing except pain.

This is the kind of pain experienced by many patients with advanced cancer (although some cancer patients experience little pain at all) In addition, it's the kind of pain suffered by those with kidney stones, pancreatitis, interstitial cystitis, certain back conditions, late-stage labor (though temporarily) and a number of other non-cancerous maladies. Some with diseases far less threatening than cancer have pain that is far worse than any caused by cancer.

Though I am not an MD, I belong to a group of pain specialists and I have done a great deal of work with sick people, both those who have pain and those who suffer from other conditions. I can tell you this, and you should do your best to get it across to the doctor you're seeing, whether or not you have started with him: there are exceedingly few who can stay alive for more than a few weeks with any kind of untreated intractable pain. I do not know whether you suffer from such pain, but if you do, it is absolutely imperative that the physician you're seeing understands the dread suffering of IP, and that he treats you accordingly.

Many who have written thus far have told you that you're taking "a lot....too much....an astounding load of opiates" <WRONG Word!> and so on. That's nonsense. You're taking what you're taking. The amount of meds you take depends upon the amount of meds it takes to control your pain. In addition, it depends upon how tolerant your body has become to opioids <not "opiates">

There is nothing wrong with developing tolerance, by the way, and almost anyone who takes opiods in any amount for more than a few days will develop a certain tolerance, meaning that they need more medicine to control the pain. Tolerance, from meds taken to control true pain is a physical phenomenon, caused by your body. Tolerance from opioids or other drugs taken for the fun of it is a psychological phenomenon. Big difference here: the pain patient wants more medicine to control the pain; the addict wants more "medicine" for more enjoyment, or a higher high. The trouble here is that the addict finally -- or soon -- gets no more enjoyment from his pain meds than does the chronic pain patient or the cancer patients. All he gets is maintenance, or avoidance of the pain of withdrawal.

Doctors today are terrified of prescribing because too many young people, from grade-schoolers to college students, and adults too, are raiding the family medicine cabinet, or they're picking out the local internists, pretending to have some disease (usually back problems) getting the meds, and then distributing them among their friends, taking them for the high, or selling them -- or all the above and more. Sometimes, even those for whom opiates are legitimately prescribed are taking a portion of their monthly allowance and selling the rest.

Doctors have good reason to be afraid because the DEA, or other agencies of the government or law enforcement are constantly looking for some MD victim to investigate. An investigation by the DEA alone can bring a doctor down, cost him his license to prescribe controlled meds; thereby his profession. Or things (sure enough) can get worse and law enforcement can cost the doctor his home, every penny he has, and often, his family and his last friend. And at rock bottom, he (and certain she as well) can end up in prison for years, sometimes for life, simply because there are folk out there who have a quota, need to investigate so many doctors per month, and zero in on those who appear to be prescribing too many pills.

Another way that law enforcement can turn a doctor into a captive is to discover a patient who has died with a belly-full of opioids. The patient might have died as a passenger in an automobile accident, but if he died with opioids in his system, the medical examiner will often as not write "drug-related-death" on the Certificate and all that's left is for the feds -- or whoever is hunting -- is to find out who prescribed those drugs. As soon as possible afterward, they move in on the doctor, take his records, pull his license and, often as not, slam him into jail. It's legal, as well, for the Police to call everything in the doctor's bank account "drug money" and take that as well. And where does that leave him? -- sans the wherewithal to hire a decent lawyer. That's where. I know two physicians who committed suicide after the DEA moved in.

Most doctors learned all this in medical school and learned to be properly terrified of treating sufferers who may die of their pain, but I know many who learned it the hard way -- by going to jail, by having their licenses pulled, and so on. Only a few make it back to the kind of practice they enjoyed previously. But a very few do make it back; even so, they usually refuse to prescribe opioids of any kind, ever again, for any reason.

There are hunches. But there is no way of proving that a patient is in pain. And there is no way of proving that someone is NOT in pain. There are exceedingly few doctors who have the nerve -- or the nobility -- to prescribe for you at all, and there also are the "interventional pain specialists," who could easly prescribe opioids for you, but will not do so because there is no money in it. They would far rather move in with their long needles with treatments that can cost thousands of dollars per procedure, their excuse being that opioids are harmful to anyone who takes them. That's dead wrong. Plenty of people who were moaning in their beds in the past have taken opioids, large doses of opioids, and gone back to functional working lives.

None of this gives you carte blanche; therefore, if you are given an ongoing dose of drugs for your pain, please try to get along on as low a dose as possible. The price is simply too high. It's wrong that the price is so high, but that's just the way it is, thanks to an hysterical bunch of lawmakers who have been ruining the lives of the suffering and those who would help them since 1914. If you want to know more, Google the Lindemann Library, the DRC, or just start with "Chronic Pain" and do some heavy reading online and elsewhere.

The Price has not only to do with Big Brother, but with the medicines themselves. Opioids can mess up your gastrointestinal system very nicely, though anyone who tells you that they'll interfere with your thought processes, render you unable to drive and so on, knows not whereof they speak. If you honestly need narcotic pain medicines, you will become accustomed to them within a few days and the morphine or oxycodone you're taking -- and even the Oxycontin -- will take away the pain; otherwise, it will have approximately the same effect as eating a handful of jelllybeans.

"Narcotics" is a pejorative word, by the way; it's best to use "opioids" instead. Opioids are constipating; they will ruin a smile that cost you a year's salary within that many months -- twelve or so -- and you'll be constantly afraid of what will happen if your doctor retires, gets sick, dies, has a baby (this would be a She) or moves away and leaves you with no one to prescribe in his place. This has happened to me twice and it was not pretty.

Not remotely am I going to try to tell you what you need to do. To tell you the truth, I no longer know what you need to do, and we have the addicts who misued Oxycontin, along with the DEA to thank for that. I just wanted to give you a few facts, and though I cannot possibly give you an adequate education about pain meds in a single letter, I can hope that you're more aware of what you're facing.

For now, I hope that your visit in April went well; I'd be interested to hear about your visit, and I wish for you kind, understanding doctors and relief from your pain.

Sincerely,
Abigail