I'm so tired of seeing nothing in the media but anti-opioid hysteria and half-truths. Opioid prescribing has plummeted since 2010; opioid overdoses have doubled in the same time.

Does anyone in the mainstream media see what's happening now to legitimate pain patients and ordinary people going in for surgeries? Do you even care? People are having amputations, hysterectomies, C-sections, joint replacements, and even by-passes -- and being denied effective or even adequate pain control even WHILE STILL IN THE HOSPITAL. People undergoing double-amputations have been given Tylenol. People with sickle-cell anemia. People passing kidney stones. People with terminal cancer.

Ordinary people -- non-addicts who have never refilled pain prescriptions early, never sold or given away their meds, never given anyone any reason to believe they are anything but responsible with their medications -- are now being cut off, force-tapered, prescribed alternative drugs that are ineffective and/or harmful (including suboxone and gabapentin), forced into harmful "interventional pain" procedures actually banned in other countries, and treated like criminals. They are forced to sign humiliating one-sided "pain contracts." To show up on a moment's notice for urine tests or pill counts. Not allowed to change doctors. Not allowed to change pharmacies. Not allowed to be treated for pain in an ER for any reason without permission. Not allowed to travel (lest they be unable to show up promptly for an unexpected-but-demanded urine test at the doctor's office; no other doctor's office will do). And medically abandoned, instantly and irrevocably, for the slightest of reasons.

Legitimate chronic pain patients who were, prior to the anti-opioid hysteria, able to live pretty normal, quality lives, thanks to their meds -- including working, parenting, and enjoying hobbies -- are now bedridden, racked with pain. Many are dying --- some, because they kill themselves when they decide they can't bear their untreated or undertreated pain anymore; some, because untreated pain itself kills (e.g., stroke, heart attacks, uncontrollable blood pressure); and some because they overdose after turning in desperation to the street and its unregulated drug suply after their safe and regulated medications are abruptly withdrawn.

Even those lucky few who still have doctors willing to take the risk of prescribing what they need are finding, more and more, that their pharmacy can't -- or simply won't -- fill their prescriptions. Each year, the FDA and DEA limit ever further the number of pain medications that can be manufactured. Desperate and frightened patients at the end of their previous fills are calling and calling pharmacies looking for any that will admit it has the medication in stock.

And the backdrop of all of this torture -- to the ignoring of legitimate pain and the abandonment of legitimate patients, with every one of us now staring down the likelihood that our own next illness, injury, or need for surgery will come with treatable-but-untreated intense pain -- is that all of this suffering is accomplishing nothing. Or, more accurately, it is having exactly the opposite of the intended impact: Overdose deaths continue to go up and up and up. Because prescribed pain meds are not now the real problem -- and were never more than a fraction of the real problem. The iron law of prohibition is in full swing. Opioid deaths continue to go up and up. Why? Fentanyl. We are literally torturing and killing real people in real pain for NO BENEFIT.

Anyone who has experienced a surgery or injury and enjoyed the benefit of effective pain medication in the hospital should be terrified of the new reality. I know I am. I've never taken pain meds more than 5 to 7 days following a surgical procedure (2 in my 56 years) or bone break (2 in 56 years), but I was very glad to have them then. Thanks to the DEA terrorizing doctors and inserting themselves between doctor and patient -- thanks to health "care" insurance companies now literally paying doctors not to prescribe the meds we need -- we can now all look forward to being treated inhumanely when we are next in pain, or to watching a loved one be treated inhumanely while we are powerless to push back.

For anyone interested in getting a bigger picture, here is a collection of patient stories from the National Pain Council collected last year:


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When I read this article, I just keep thinking I really wish Mr. Meier would write about the trans children issue. The medical transition of children, the flimsy evidence and justifications it has been based on, who is really pushing it, who is making money from it, and the amount of institutional capture and blind allegiance to an ideology in this country is a medical scandal that is crying out for a Barry Meier investigative journalism quest. We are literally desperate and begging for this type of coverage and investigation, for the facts to be brought forward from a highly respected journalist who cannot be written off as a conservative nut. I believe what is being done to our children in this country is *the* medical scandal of our time.

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I have watched Painkiller on Netflix. It is a deeply flawed interpretation of the author's book. It admits to dramatizing and adding fictionalized elements to the story which exaggerates the unfortunate and immoral motives of the Sacklers. It avoids really delving into the nefarious means by which so many physicians allowed themselves to get sucked into this clever conspiracy. As a retired physician, I am interested in some author doing a deep dive on the unprofessional deference of so many physicians to the pressures from a pharmaceutical company. That played a major role in the great tragedy of Oxycontin.

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All this journalism on the opioid crisis has been great but I don't understand why everyone turns a blind eye to medicare's role. Plenty of people in this thread are aware of "pain is the 5th vital sign" but nobody ever mentions HCAPS scores and how they have evolved. HCAPS are randomized surveys of patient satisfaction after they are discharged from a hospital. If a hospital doesn't get perfect scores, medicare reduces reimbursement to the hospital for its services. If scores are bad, medicare can refuse reimbursement and the hospital can lose medicare status. Not just for that patient with the bad score but for all medicare patients. All hospitals depend on medicare reimbursement to survive, so in many ways their policies dictate how hospitals operate. For example, EMTALA is a medicare initiative and it is the reason people with stubbed toes aren't told to fuck off from the emergency room. I bet you don't like waiting 8 hours for care, but here we are. Its nice to think you are waiting because someone back there is being revived but the truth is our emergency services has been clogged up with more and more bullshit.

Anyways, as early as 2008 one of the questions was something like "was your pain taken seriously and treated well enough." Now if you are a hospital administrator you will do anything to receive 100% of the money you are charging for your services. Possibly the easiest and most gameable score is pain management. Since the surveys are random, EVERYONE must have their pain treated aggressively to ensure a perfect score. Even grandma. Even the addicts who are clearly zonked. It wasn't until I think 2017 that the question was quietly changed to "were you asked about pain." And now here we are giving people scheduled tylenol and muscle relaxers.

I know the sexy narrative is corporation bad, greed bad, but such willful ignorance of the government's role has been very disappointing to see. The opioid crisis was just as much a side effect of well intentioned but overzealous government policy as it was a side effect of corporate greed. If this was looked into more, perhaps one would find influence from a pharmeceutical executive on the decision to tie medicare funding to pain relief. But for now I guess we'll just keep blaming the doctors, the patients, the Sacklers, and ignore all the public suits establishing the rules and the private suits working within them.

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When opioids are used to treat depression they are lethal. Behind the opioid crisis is an abject failure to provide adequate mental health treatment in this country. Treat the conditions that may lead up to addiction before it happens. With the attack on the nuclear family more and more young people are depressed .

Genetic tendencies towards depression and addiction should be addressed early in life before its too late. Alcohol kills more people every year than narcotics does. Its a CNS depressant that gives a temporary high and deepns long term depression.

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As a physician who used the drug for severe chronic pain and who made careful diagnosis and monitored prescriptions it was a useful drug.I never had any patient overdose or die . I was never marketed by a rep saying it was safe or not addictive. The problem as that as time released drug it was not supposed to be crushed and addicts could get a big high from doing so. The concept of a longer acting slow release pain med makes sense but society being full of drug abusers made the worst of the situation. So when a young teenager dies its a shame and someone wants revenge. So here come the tort lawyers and Hollywood. Whats funny is there seems to be no outcry from the left and its slip and fall lawyer army about all the Fentanyl deaths coming from open borders. The Hypocrisy knows no bounds.

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I hate drug dealers. They only care about the money they make out of the misery of others. Why are these ones still roaming free and not incarcerated like other confirmed drug lords?

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I am a retired physician with some experience in pain management and hospital administration. I am definitely not a fan of big pharma, but Purdue and the Sacklers are not responsible for the opioid crisis. They did what all corporations do (especially pharmaceutical companies) and aggressively marketed a product. And they marketed to those who write the prescriptions and rewarded their sales reps. This Is no different than any other drug whether it is a new antacid or a pain reliever nor any other manufacturer. The main culprits are the docs who wrote the prescriptions, but the big money is with big pharma so everyone piled on including state and local governments to get a piece of the enormous pie that is pharmaceutical profits.

In defense of the physicians, in the 1990s Pain became a vital sign - you know - the little faces ranging from a smile to an agonizing frown. If this was not addressed in the visit notes, the physician would be accused of inadequate quality practice if not negligent malpractice, like failing to address high blood pressure or abnormal lab tests. Some physicians had complaints filed against them for not “alleviating the patient’s pain”. Pain is a subjective complaint and pain management, physical therapy and/or mental health facilities are few and far between and often not covered by insurance or Medical/Medicare, the pain can be relieved with a pill - if not indefinitely at least until an extensive work up could be completed. OxyContin was indeed a miracle drug when it was first introduced - much better than what was previously available. When it became apparent people were chewing it or crushing it, Purdue developed a pill that could not easily be crushed or chewed.

There were many causes of the opioid crisis, but the manufacturer was not responsible for it. If it hadn’t been OxyContin it would have been something else. They were just where the money was.

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Like Joe Biden trying to show empathy for the fire victims in Hawaii, I'm going to make this comment about me. Do you know what I hate about the opioid epidemic? The freaking junkies ruined painkillers for the rest of us. Since they cracked down on it, docs don't want to prescribe a decent painkiller even for real pain. I had rotator cuff surgery (and a bicep tendon re-attached at the shoulder) last fall. Shoulder surgery of this type is extremely painful, but they sent me home with 3 (three!) hydrocodone, not even a damn oxy! And I was only supposed to take one per day, before bedtime. Needless to say, I didn't sleep at all that first night and hardly at all for the first few days and had to make do with OTC Tylenol and Advil. Eleven years ago when I had a much less painful septoplasty, the doc prescribed me a whole bottle of oxy, of which I took only two. Perhaps there is a good middle ground?

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I must say the press coverage went light on the Sacklers. I'm not an NYT subscriber, but other sources covered the Purdue matter extensively. I got the impression that the Sacklers were in trouble only because of their position. This article in FP makes their personal involvement more clear to me, how they actively pretended to ignore the problems that were well known even in the 2000's

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Right, so tell me again about how "safe and effective" the vaccines are... Its the same companies, the same corrupt system, the same corrupted regulatory agencies, and the same dishonest media with all their obvious conflicts of interest who smear anyone questioning vaccine safety as "conspiracy theorists" who created and facilitated the opioid epidemic. But, for sure, THIS time, they're all being honest and altruistic. There is absolutely zero chance any of them would lie...

Im not an anti-vaxxer but I sure as hell am done taking the word of "experts" in the medical/pharma industry at face value. Absolutely nothing has been done to address the myriad systemic problems in place that created the opioid epidemic and without fundamental change, the system will continue to produce similar results. Its just basic logic

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Beyond tragic. The greed and incredible disregard for human life, displayed by Purdue and the Sacklers is beyond disgraceful; words to fail to capture the evil of it all. But MANY are complicit! The systematic failure to call a spade a spade, where were the safeguards? The FDA, all the lobbyists, lawyers and politicians who were paid handsomely to protect the criminal behavior is third reich level obstruction and obfuscation of responsibility… in the name of greed.

Thank you Bari Weiss and Free Press for shining a light on this horror. Thank you Barry Meier for your decades long pursuit of publishing the truth of this horror.

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One of my proudest “ah-ha” moments in my surgical practice was stopping to ask myself, and the drug rep pushing Oxycontin, why I would use a long acting pain medication for acute, postoperative pain. As you might expect, there was no good answer to this.

So, thankfully, I only rarely prescribed it for what its true indications were-severe, generally metastatic cancer related pain in terminally ill patients.

Like others, I cautioned others about the potential effects of this “wonder drug”.

There is a lot more to the opioid epidemic than narcotic prescribing, IMHO, but this drug certainly introduced a lot of people to high dose, sustained narcotic effects.

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I am somewhat bewildered by this article. There are a number of non sequiturs breathlessly reported. But before getting to them, my disclosure. I have taken Oxycontin on 4 occasions -- each time after surgery that was followed by a great deal of pain. I took it each time from a few days to a week. I really disliked it and do not comprehend how it could become "recreational" to the point of addiction. It makes one exhausted at the same time that it was excellent at controlling pain. But who wants to be exhausted?

But I'll assume that others -- as evidence clearly shows -- somehow find their way to addition. The author presumably did find some wrongdoing, but a numbers of so-called bad things reported are not bad. Example: marketing of and publicity for drugs. So? A few times I've seen those dumb TV ads and they caused me to ask my doctor if the medication would handle an issue I was facing. To me, that is good.

Then the author claim that Purdue knew about the pill mills in Myrtle Beach. Nothing he wrote showed that. Maybe he had other evidence, but it's not here. Also, are "pill mills" any different than pot dispensaries that give out pot freely knowing its not for medical use?

The author then weirdly states that because he wrote an article that didn't mention his book, there was no conflict of interest. Huh? By keeping it secret he was locked into honesty? I'd think the opposite -- the prevented readers from seeing that he DID have a conflict.

The overdose deaths are manifestly a tragedy. But blaming people who are "rich" is in some ways scapegoating personal responsibility, the greed of pharmacies and some doctors.

As for purifying institutions by taking names off buildings -- please. Are we kidding ourselves? IF we research the evil of so many donors and authors and politicians, we would have museums with nothing but "building no. 3" etc. Idea: let's strip libraries of books by authors who were anti-Semitic! That's quickly reduce the space crisis in our libraries!

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I'm tracking. Can we do better in pain mamagement. Yes! But our system (totally controlled by the feds) is disjointed at best. One of the biggest problems we face is a patients unrealistic expectations. Probably 3/4 of patients with chronic pain could help themselves without medical treatment. Loose weight, exercise.... A little know fact: Fibromyalgia which is a subjective diagnosis number one treatment protocol is ... exercise!

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Question that I have not seen addressed.

To what degree is the Joint Commission (and possibly other hospital/medical accreditation organizations) culpable in the opioid crises? It seems that around this same time the Joint Commission began urging/requiring that pain assessment be completed at every visit/encounter. Pain management became such a focus for the Joint Commission that pain became known as the fourth vital sign.

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