Originally published at: https://boingboing.net/2024/06/20/chronic-pain-sufferers-betrayed-how-the-fda-and-dea-deny-access-to-safe-effective-pain-relief.html
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“Contributed by Ellsworth M. Toohey”
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Thanks for identifying yourself!
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You’re welcome. I’ll do my best to do it every time.
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Cool; that will save everyone else the time and trouble!
(Seems like there ought to be a way to post it automatically when you submit, like Carla’s and Rob’s posts.)
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“the emergency department is the single worst place to go for relief from severe pain”
According to a few old friends, the only way to get Opioids in the hospital is to tell them that you have been sober for some years and can’t be given Opioids. One friend told me she had to stop saying that (when she was often in for some chronic health problems) and start telling them she was deathly allergic.
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I’ll ask and see what can be done about it!
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No, I’m going to blame the drug companies that pushed opiates in this country for everything from a stubbed toe to toothaches to legitimate pain, creating an addiction epidemic in this country. The FDA and the DEA are left to deal with the fallout, and are under enormous political pressure to do something about the opiate addiction epidemic. I’ll also blame some doctors, who were complicit in overprescribing these meds.
The FDA does have a track record of taking a long time to approve drugs. Maybe they take too long in some cases, but they’re also the reason Thalidomide didn’t cause the problems in the US that it did in Europe. I’m not saying the FDA doesn’t need to take a look at speeding things up in some cases, but I understand why they may not be that motivated to do so. Considering one of the biggest names who wants the FDA to relax their approval requirements is Vivek Ramaswamy, I think we need to be careful.
Full disclosure: I am a chronic pain sufferer, and I am also a recovering opiate addict and alcoholic. Make of that what you will.
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Good work! Thanks for being awesome.
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Yeah, I was going to bring up oxycontin…
Also,
Penthrox is a handheld inhaler that administers a low dose of methoxyflurane. It was first used as a general anaesthetic in the 1960s, but concerns about its nephrotoxicity made it obsolete.
So, it is toxic to the kidney at the dosages they were using in the 60s. Lower modern doses seem to be significantly better. Now, chronic pain is a long term condition so you have to worry about how long term low dose use is going to work.
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Penthrox is not used for chronic pain.
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Yeah, all the literature I found (in my admittedly brief search) was talking about use in the emergency department.
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Emergency Departments in general were part of the problems that created the opiod crisis in the USA. The push to make people into “satisfied customers”, combined with the impetus and instruction to “treat pain as the 5th vital sign” started a chain reaction - that lead to over use of opiods in the ED and over use of prescriptions at discharge.
Education at the time was that medicaitons like oxycontin and percocet did not make people addicts, and especisally not short courses of “only a few days.” Studies were presented, in reputable journals, that showed this, and assured providers that they weren’t hurting people. Those studies were wrong, and basically cherry picked data lies by oxycontin’s producers.
That happened in combination with a huge push to make everyone satisfied. And oddly, the only people whose opinions were linked to the ED were patients who were seen and discharged - no one who was admitted had their opinion of the ED counted in patient/“customer” satisfaction surveys. This bent the statistics, bc people who were given narcotics and narcotic prescriptions for home with were more likely to be surveyed, more likely to respond positively, and so were catered to - regardless. The pressure to meet the metrics was enormous, and the result was overuse of narcotics.
A great example is migraine headaches. Narcotics basically never help a migraine. They can relieve the pain for 15 minutes, maybe 60, but they don’t stop the headache. Migraine “coctails” of non-opiod medications were invented, tested, and proven to work far better - but there was great resistance among the staff, but mostly among the patients, and so there was a long slow acceptance of these medicine regimens. Today they are de rigueur , and highly effective, and narcotic free. But at the time, it was morphine or dilaudid and an rx for a couple days of percocet. Now it is benadryl, toradol, zofran, haloperidol, metoclopramide - all effective, none addicting.
The swing away from narcotic use has also been tremendous - and now it comes with legal ramifications. Over-use, over prescribe, and a doctor or NP not only risk doing the wrong thing, but they (especially outside the ED) risk getting in trouble with the government.
Sure, this change has effectively shot down pill mills. It has also driven people to street purchased opiods, which are terribly unsafe, and the main reason for the opiod death toll.
the whole thing is a multi factor disaster.
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I’m not sure I fully agree with this assessment. Patient satisfaction is a valuable metric. Patients are treated much better by staff now that it is being measured (and even helps determine reimbursement). However, you’re making me think about the implications when it comes to opioids.
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Haloperidol may not be addictive, but the side effects are really something. And I say that from experience. I guess not as bad as chronic migraines, but still.
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So the headline “Chronic pain sufferers betrayed” is incorrect, at least regarding Penthrox.
Also,… try getting pain relief in Germany. Our major analgesics are drinking tea and a walk outside breathing fresh air 
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It prevented an opiod crisis though.
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WTF… an entire Boing on doctor hesitance to proscribe pain relief; without even a whiff of mention of the opioid epidemic and its long long list of those culpable and long long shadow of impacts.
I’m a bit suprised how shallow the summary is.
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Providers (such as myself) despise patient satisfaction metrics. It is never “did they provide appropriate, empathic care” but “did they reinforce what you already believed and did they give you a prescription?” Some of my most damning reviews have come from parents of toddlers with colds who were outraged that i did not give them antibiotics. Now, opioids are not an issue most of us in peds have to deal with, but i can easily understand how trying to make your patient satisfaction score go up can lead to pressure to provide unnecessary drugs. Especially if your income and potential advancement is linked to it. In my setting, this is not an issue, but folks who work in urgent care clinics frequently have to deal with this.
Back on topic, gotta say i was taken aback by this. Using what i only knew as an old inhaled anesthetic to relieve acute pain in an outpatient setting is pretty ballsy. Found this review. Seems legit, but wow!
(ETA: Apologies to any who tried to read this before i went back and corrected typos. Posting before coffee is very dangerous!)
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Bingo on a lot of counts… what gets done is what gets measured (and related, paid)… get the incentive plan wrong and its perverse incentives all the way down.
And the American private insurance/provider/capitalist model… its just a mountain of these horrible outcomes.
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Stell dich nicht so an, ein Indianer kennt keinen Schmerz.
On a totally unrelated side node, I must remember to renew my prescription for Sumatriptan.
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