Mentally Ill Dying in Prison Transport Vans

This is What Riker’s Island Looks from The Sky

 

rikers island

When I was driving home from my tardive dyskinesia neurologist appointment in Gainesville I read an article that made me shudder. It could be me. Prisoners being driving from one facility to another are at the mercy of untrained people who drive the vans and have more of a trucker mentality. It’s about how many people you can get quickly from one place to another. So they jam the vans, deprive the prisoners of bathroom breaks, etc. When a mentally ill person doesn’t get their meds for three or four days they can decompensate and start babbling loudly or drooling, one person died of Xanax withdrawal.

 

I thought…’It could have been me.’ I’ve been privileged to have good care and avoid the hospital for seventeen years but when my former bff called the cops on me and told them I was suicidal, I was in a holding area very similar to a county jail. A long time ago, the eighties, I had legal problems re my drug habit and went to jail five times, so I know what I’m talking about.

 

The problem is the privatization of public prison and jail systems. These people know how to penny pinch but it’s at the expense of those they transport and their human rights.

Opiod Replacement Pain Medicines in Pipeline..?: Will we get ’em? Do they want us to get ‘well’?

Chickencoop

So much is being made on black marketed prescription drugs like oxy and ‘the box’ that you gotta wonder The FDA and DEA are at cross purposes because pain advocates are pushing back, assisted by big pharma. Why not, right? The CNN Story with Anderson Cooper distorted it further. So much confusion we’re not entitled to ‘straight dope’ on this issue. I recently learned IBUPROFEN and Tylenol, my first line “go tos” destroy a digestive enzyme, furthering the constipation problem I suffer with it. hey, someone’s gotta speak up.

So, here’s holistic hope to hold onto, sorta..this will be a pricey pharmaceutical too: Hot off Press this week-Duke University Study isolated pain receptors TRPV4 and TRPAI and have a way to activate them; releasing natural endocannibinoids (not endorphine..that was debunke4d ages ago) to secrete natural painkillers for our comfort.

Organic stuff, sad to say, like MS contin, which I took for sixteen years, are actually better for your overall systemic health than NSAIDs which harm the liver and destroy digestive enzymes. Whoops I’m repeating myself. I just wanted you to know the knews. \

And I have yet another natural way of dealing with chronic pain in this article. A click is all it takes to make my day. At least you aren’t making Mark Zuckerberg of Facebook richer. If you click this, you are helping me and my platform. Am I going about this the wrong way? I should be listening to your aches and pains and I promise to do more of that. It, too, is a natural painkiller, releasing a substance called Oxytocin, the ‘love’ hormone begotten of human interaction with those you care about even if you’re separated by miles and held together by broadband.

Here I am: http://www.bphope.com/blog/bipolar-mood-cycles-stop-fighting-and-win/

 

I’m taking a note out of Prince’s Playbook: Methadone Light

 

prince

‘Boy Could He Play Guitar’  David Bowie “Ziggy Stardust.”

There are big barrier to Methadone light. First of all, Suboxone, which is what they give, is an opiate. Secondly, if the word got out about this better, much safer from overdose type of treatment, the jig would be up and Purdue, Endo and the rest would lose millions of dollars on something that’s killing us.  Very few of us afford it and if falls underneath the umbrella diagnosis code of opiate addiction, not something everyone wants to admit to. Oh, well. A few courageous docs are doing it while others tell me it’s illegal. The truth is somewhere in between.

I’m not suggesting Buprenorphine (as available as Suboxone) is without risk But has a ‘ceiling effect’ on Euphoria and respiratory depression (read: Overdose).

After a ton of phone calls I got an apt and detail wise, the sublingual film goes under the time. Go bye bye alcohol, benzos and all other drugs. I paid 12.00 for my first patch.

I had my first film last night. I had few good hours and then rebound pain so awful I told my husband that If I died in the morning that I was sorry. I think the dose might not be high enough.

More on this later.

More on Prince ; Buprenorphine Mystery my note 2 Cornell MD

princetwoBelieve me, you’ll know as soon as I know.

There is this guy in our daily paper who offers answers to questions. I wrote my questions about buprenorphine. I can never get the spelling right.

One of the articles about Prince’s death dealt with the stigma of using one drug to treat a problem with another. But if he really had ruined his hips and was in pain, then he’d have needed pain care. You want to know what I think? He didn’t know who to trust. It’s tricky. You’ll see in this letter that I don’t know who to trust either.  So I wrote this guy at Cornell. I keep looking for more stories on this subject but can’t find any. Is there some conspiracy theory I’m unaware of? Could big pharma be THAT big to get in the way of generic 40 dollar a month w/o insurance priced Subutex? It’s been FDA approved for chronic pain since 81 so what’s the big issue with it? So I wrote a letter to this Cornell ‘ask the doctor’ newspaper guy at ‘ToYourGoodHealth@med.cornell.edu. If you want to know the deal as badly as I do and you never see his answer posted in my blog, feel free to ask him again these questions..It’s a public concern and a growing epidemic that some say could be solved with Suboxone, Bupenorphrine. Why Not? Why?

Dear Dr. Roach

I’ve had chronic lumbar pain for a decade. It’s impacted by a neurological condition called Tardive Dyskinesia that’s similar to Parkinson’s. I have uncontrollable muscle spasms and yelp. I’ve had every interventional pain management injection available and have spent thousands on physical therapy, pilates, herbs, eat an anti inflammatory diet, have done chiropractic, massage and acupuncture. I use mindful meditation while listening to music to. Still,  I need my meds. And hate that.

I don’t take short actings. I’ve made days-long medication ‘vacations’ to work my tolerance/dose down to 1/3 of what it was a year ago.  Even at a lower dose, the constipation is unbearable. Even on an all raw foods diet.

After a few ortho surgeries I’d been on high dose synthetics like Demerol and I had no constipation. When Prince died I read about the use of buprenorphine for chronic pain at the California “Recovery Without Walls” clinic. The use of a sublingual patch, a different way of taking it puts less strain on the liver and kidneys as they don’t have to metabolize it.  The few shreds of coverage I read in the Washington Post and said Bupenorphine  received FDA approval for chronic pain back in 1981. Yet one article about a D.C. based doctor recounted how she’d had to falsify patient’s diagnoses in order to get them treated and off of opiates for good. That’s what I want. If these synthetics truly are the second coming for long term noncancerous pain (Claimed by the newer “Butrans” transdermal patch) with a lower side effect profile and a ceiling on respiratory effects and overdose potential, why do the doctors using it claim there have been ‘challenges and conflicts’ preventing its’  widespread availability and use?

Why do some local doctors (often trained in other countries) insinuate that bupenorphrine would help my chronic pain while other doctors angrily claim it’s illegal to use it for that purpose? What are the downsides to this medication that I’m not hearing about? Allison Strong Hollywood Florida 954-922-4310

biszanta@hotmail.com

 

More on Prince & Buprenorphine Mystery my note 2 Cornell MD

princetwoBelieve me, you’ll know as soon as I know.

There is this guy in our daily paper who offers answers to questions. I wrote my questions about buprenorphine. I can never get the spelling right.

One of the articles about Prince’s death dealt with the stigma of using one drug to treat a problem with another. But if he really had ruined his hips and was in pain, then he’d have needed pain care. You want to know what I think? He didn’t know who to trust. It’s tricky. You’ll see in this letter that I don’t know who to trust either.  So I wrote this guy at Cornell. I keep looking for more stories on this subject but can’t find any. Is there some conspiracy theory I’m unaware of? Could big pharma be THAT big to get in the way of generic 40 dollar a month w/o insurance priced Subutex? It’s been FDA approved for chronic pain since 81 so what’s the big issue with it? So I wrote a letter to this Cornell ‘ask the doctor’ newspaper guy at ‘ToYourGoodHealth@med.cornell.edu. If you want to know the deal as badly as I do and you never see his answer posted in my blog, feel free to ask him again these questions..It’s a public concern and a growing epidemic that some say could be solved with Suboxone, Bupenorphrine. Why Not? Why?

Dear Dr. Roach

I’ve had chronic lumbar pain for a decade. It’s impacted by a neurological condition called Tardive Dyskinesia that’s similar to Parkinson’s. I have uncontrollable muscle spasms and yelp. I’ve had every interventional pain management injection available and have spent thousands on physical therapy, pilates, herbs, eat an anti inflammatory diet, have done chiropractic, massage and acupuncture. I use mindful meditation while listening to music to. Still,  I need my meds. And hate that.

I don’t take short actings. I’ve made days-long medication ‘vacations’ to work my tolerance/dose down to 1/3 of what it was a year ago.  Even at a lower dose, the constipation is unbearable. Even on an all raw foods diet.

After a few ortho surgeries I’d been on high dose synthetics like Demerol and I had no constipation. When Prince died I read about the use of buprenorphine for chronic pain at the California “Recovery Without Walls” clinic. The use of a sublingual patch, a different way of taking it puts less strain on the liver and kidneys as they don’t have to metabolize it.  The few shreds of coverage I read in the Washington Post and said Bupenorphine  received FDA approval for chronic pain back in 1981. Yet one article about a D.C. based doctor recounted how she’d had to falsify patient’s diagnoses in order to get them treated and off of opiates for good. That’s what I want. If these synthetics truly are the second coming for long term noncancerous pain (Claimed by the newer “Butrans” transdermal patch) with a lower side effect profile and a ceiling on respiratory effects and overdose potential, why do the doctors using it claim there have been ‘challenges and conflicts’ preventing its’  widespread availability and use?

Why do some local doctors (often trained in other countries) insinuate that bupenorphrine would help my chronic pain while other doctors angrily claim it’s illegal to use it for that purpose? What are the downsides to this medication that I’m not hearing about? Allison Strong Hollywood Florida 954-922-4310

biszanta@hotmail.com

 

A pain doc explains how she has to lie to prescribe Buprenorphine

princeThis is from “Under The Influence.” It’s by a doctor who writes prescriptions for buprenorphine. For pain. For addicts temporarily but for pain patients indefinitely. She wanted to speak out.

This practitioner calls Suboxone a ‘stealth’ drug. Read it. You’ll see. There is not a lot of press coverage on the use or lack of use on this drug. There is an alliance organization that matches people up with doctors but it says the limitations on how many patients a doctor can treat at one time…waiting lists, they say it’s easier to just get placed in a research study.

Doc, I need some help getting off this stuff.”

My new patient Marshall*, a pale 63-year-old man who lugged around a portable oxygen tank for his breathing problems, had been stuck on pain pills for years. Sharp pain from a gruesome factory injury to his shoulder 25 years ago had evolved into a nightmarish, shock-like nerve pain down his arm to his fingertips. A succession of medical treatments culminated eight years ago in prescriptions for daily use of oxycodone.

It had worked well at first. But after a few years, he descended into a continuous state of opioid withdrawal. At best, he felt mildly anxious and tremulous. Two hours after each dose, he would skid into a wretched state of sweats, gut-knots and dread. His whole body screamed with a pain unrelated to his injury. He craved relief from the next dose.

Sometimes, out of desperation, Marshall would take the next dose early. In exchange for the immediate comfort, he would accept a guaranteed anguish starting days before the next refill was due. His previous doctor had attempted to help by increasing his dose. Symptoms would subside for a month or so, then return with a roar, growing ever more intense. His arm pain had been relegated to a minor annoyance.

The best solution to his cyclical torment was clear to me. I would transition him to a medicine called buprenorphine.

Opioid task forces springing up in the US at the local and national level have begun to cast a spotlight on the surging opioid epidemic and its deadly consequences.

Unfortunately, a sharp focus on the target of opioid “abuse”—non-medical use of pain pills that has led to addiction in an estimated 2 million people in the US, and to heroin use in 1 million—misses a fundamental problem of a much larger scale. Roughly 17 million US adults living with chronic pain are prescribed opioids for daily use. Many, perhaps most, are not thriving.

Yet without these pills, many find life intolerable. Neither patients nor doctors know what to do about it.

A readily available solution—buprenorphine—is a secret weapon largely still waiting to be discovered. And President Obama’s strong emphasis this week on medication-assisted treatment—especially buprenorphine—in his announcement of his plan to combat the opioid crisis, is therefore particularly welcome.

As a family physician, I am in the trenches with patients battling chronic pain. I have seen Marshall’s story played out again and again. Sometimes people are referred to me for help after limping along on opioids for years. Buprenorphine is often the best choice.

Some make the transition seamlessly. Others traverse a rocky road that tests their mettle. Ultimately, most arrive at our intended destination, experiencing a calm normalcy they can hardly believe. A tolerable vestige of their original pain is still present. Opioid withdrawal and its accompanying super-pain, sometimes known as “opioid-induced hyperalgesia,” have vanished.

Patients describe a sense of release from a box or a locked cage. One said, “I felt like a little troll trapped inside a bottle, a horrible feeling. And now I’m free. I’m absolutely thrilled.”

Buprenorphine is better known by one of its brand names, Suboxone, an under-the-tongue film laced with naloxone to deter non-prescribed use. In 2002, buprenorphine–alone or combined with naloxone—was approved by the US Food and Drug Administration as a treatment for people like another of my patients, Luke.

A gentle giant in a black leather jacket, Luke is a 20-year-old convenience store employee who casually enjoyed a Percocet now and then while hanging out with friends. Then he began enjoying one for relaxation daily after work, “like having a beer or two.” Eventually he found himself entangled.

To avoid the agonizing withdrawal symptoms, Luke began spending most of his income buying pills illegally. He risked arrest. He arrived late for work. He could not afford to move out of his parents’ home. The drug’s negative impacts on his life landed him the diagnosis of opioid use disorder—the latest medical term for the condition most people recognize as addiction.

Buprenorphine is often, in my experience, like a magical key that frees people from their seemingly inescapable dungeon. It is an opioid medication with a unique profile that fits the lock precisely. It blocks withdrawal symptoms and craving. There is no drug “high.” Patients trade sluggishness for a fresh energy. Best of all, the hovering risk of overdose death vanishes.

Buprenorphine was developed decades ago and approved by the FDA in 2002. Yet it remains nearly invisible, despite its potency against a fiendish trio of adversaries: withdrawal symptoms, craving and overdose death. That’s why I call it the Stealth Medicine. It is hidden behind the term “medication-assisted treatment,” which also includes methadone and naloxone. Buprenorphine is the only one doctors can use to treat opioid use disorder in their patients with chronic pain.

Any doctor can prescribe buprenorphine for opioid use disorder, after undergoing a brief training required for authorization, known as a “waiver,” from the Drug Enforcement Agency. Only a tiny minority obtain the waiver, however. Due to federal rules, the number of patients each one can treat is strictly limited—to 100, although President Obama’s plan will increase that to 200—and other prescribers (nurse practitioners and physicians’ assistants) are not eligible for a waiver.

Ironically, there is no such bottleneck on access to the opioid pain pills involved in the deaths of 19,000 people in the US in 2014.

Read more from The Influence:

Meet the Victims of Russia’s War on Methadone

The Anatomy of a Heroin Relapse

…and follow us on Facebook and Twitter.

There are strict rules constraining use of the waiver. For one thing, the patient has to have a diagnosis of opioid use disorder. This diagnosis implies a stark but false distinction between “legitimate pain patients” like Marshall and “drug abusers” like Luke.  The same dreadful craving afflicted Marshall, who lost his struggle to use pills as prescribed, and Luke, who never had a prescription. Buprenorphine brought relief to both.

“Off-label” prescribing for chronic pain is perfectly legal without a waiver. The limited research available supports this practice: It shows that a switch to buprenorphine improves pain and quality of life.

But here’s the catch: Without a diagnosis of opioid use disorder, buprenorphine is rarely covered by insurance. With the diagnosis, it usually is. Under Obamacare, insurance companies must provide coverage for treatment of substance use disorders. Luke pays roughly $10 per month for this otherwise pricey drug, which can run to hundreds of dollars without insurance.

The case of Marshall, the patient with arm pain, illustrates the awkwardness of this situation. He never once used opioids for euphoria or relaxation. He never committed a crime, never harmed a relationship with family or friends, never even pressured his medical providers to obtain more of his drug. A diagnosis of opioid use disorder was a stretch. But I made the diagnosis based on his unwelcome craving, and his inability to resist taking doses earlier than scheduled despite known consequences. This diagnosis allowed him access to this life-saving treatment.

Other insurance quirks can create frustrating obstacles. Lily is a trim and perky middle-aged homeowner, a responsible caregiver to two grown children with special needs. For years, Lily had been prescribed oxycodone for arthritis in her spine. She described what happened.

“The longer you take them, the more they make you hurt. It creates pain. You get tolerant to it. And then you think, I’ll take just a little more, and then you take a little more, and pretty soon you hurt worse than you did before you started taking them. The brain creates this fake pain, a magnified pain that really isn’t there. In between doses you would get a depressed feeling, because you knew you weren’t supposed to take another dose, but you hurt, and this becomes cyclic. When you take buprenorphine, you get your whole mental stability back. You don’t have to worry about driving or feeling dopey. It gives you your life back on a plate.”

Since starting buprenorphine for opioid use disorder, Lily had begun walking two miles a day. For two years, she often had no pain at all. Insurance coverage was in place.

Then the insurance company discovered she was not enrolled in a chemical dependency program. She was thus deemed noncompliant with their requirements for buprenorphine coverage. Payment for the next refill was denied.

A formal treatment program would be overkill even for a patient like Luke, the convenience store employee, although he could certainly benefit from having a counselor. But what about Lily? Such a program would be an irrelevant intrusion.

I re-prescribed buprenorphine for Lily, this time using a diagnosis of pain. Coverage was denied. I appealed. Ultimately I talked with the medical director. He politely informed me, “Buprenorphine is not a good medicine for chronic pain, so it is not an option for your patient. But we will cover oxycodone.” Lily has since switched to a more flexible insurance company.

Robin, a stylish business executive, got coverage because she met criteria for opioid use disorder; after discovering buprenorphine’s unique effectiveness for her fibromyalgia, but before she found me to prescribe it, she had guiltily resorted to buying it off the street.

But what about Sally, a sweet 50-year-old lady on opioids for many years after an injury to her lower back? In a classic example of opioid-induced hyperalgesia, she described intolerable shoulder and neck pain after a demanding night at the community center playing bingo. She has always been meticulous about using her pain medicine as instructed, so she doesn’t meet criteria for opioid use disorder. But with exaggerated pain sensitivity, she might still benefit from buprenorphine.

The tides are turning. Many national leaders are now recognizing opioid addiction as a disease and not a crime. Now we need a more nuanced view of the challenge people face when their chronic pain is poorly controlled by opioids. Many struggle to use their prescribed pain pills as directed. Whether they succeed or fail, buprenorphine may improve their quality of life.

A sea change would be possible if millions of patients with chronic pain were switched to buprenorphine from daily pain pills. This would dry up the flood of opioids leaking out to the streets. Fewer young people would find pills and be tempted to try them. Fewer still would graduate to a gritty life of heroin use, or risk a death from overdose.

Doctors, patients, insurers and policy makers: Take note.

*Patients’ names have been changed.


Lucinda Grande, MD is a board-certified family physician who practices in Lacey, Washington. She specializes in chronic pain and addiction medicine. She has prescribed buprenorphine for opioid use disorder for four years, and currently prescribes it to 70 patients.