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05/16/14

I do not deal in statistics. I deal with individuals. In addition, statistics are being incorrectly misapplied to individuals.

RE: This is a supply problem, plain and simple.

ANS: It is such simpleton thinking that justifies such actions as the DEA making opiate supplies less available at the end of the year by manufacturing restrictions that leaves many valid patients without adequate access at that time. Such dragnet mentality is akin to a sheriff in a small town noticing that all criminals have red hair and then arresting all redheads, even the innocent ones, in order to reduce crime.

RE: The United States, with but 3% of the world's population, consumes 80% of it's opioids. If the supply were more appropriately prescribed the opportunity for overdose - whether diverted or prescribed - would be substantially diminished.

ANS: See above. Also, much the same can be said about antibiotics as much of the world does not even have access to half way decent medical care.

RE: To suggest that diversion alone is the cause of the problem is disingenuous. As you know, unintentional opioid overdoses are also occurring amongst patients who obtained their medication from a prescribing physician as well.

ANS: No, diversion alone is not the sole 100% problem. However, it is the vast majority of the problem. Furthermore, when an individual takes opiates that are not prescribed to them but are given to them by either friends or family it is still diversion. Whether a diverting friend/family member or a drug pusher gives/sells/barters the opiate to an individual in neither case did a pain management provider prescribe it to that individual. Also, when a patient does not take their opiates as prescribed and ignores the parameters discussed with them (such as not drinking alcohol), etc. it is not the fault of the prescribing provider especially when that patient denies such non compliance. No drug is perfect. Even Tylenol if taken incorrectly can kill someone. These opiates are not benign meds but are serious ones that at times are a necessary evil for those who are confronted with a choice of living life with chronic pain of such intensity that it significantly interferes with their ability to function or taking a medicine that can reduce the pain level to a point whereby it does not significantly interfere with their ability to function. It often does boil down to a variation of an age old question...to function or not to function. And please further note that those who are so immobile due to being unable to function are further plagued by increased morbidity and mortality due to pulmonary emboli, cardiac deconditioning, skin decubiti with sepsis as well as social decline. Life is often not perfect. Often one is faced with choices neither of which are perfect but essentially are the choice of the lessor of two evils. History is replete with what happens when pain management is not available; injured war veterans with intractable, significant, chronic pain often turned to suicide and/or alcohol to deal with such choices.

Furthermore, there is a very distinct difference between recreational drug users and legitimate chronic pain patients but unfortunately political regulatory hysteria often seems incapable of recognizing the difference.

In an ideal world there would be no chronic pain. There would be no wars, no survivors of military injuries with horrible chronic pain, no horrible motor vehicle accidents with multiple trauma survivors with chronic pain, no cancer patients with chronic pain, no cancer survivors with chronic pain due to chemotherapy. But it is not an ideal world, is it?

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