Tens of Thousands Deal with Death & Addiction as American Pain Foundation Pushes Opioid Use

The major concerns we have at PROP about the Fishman book beyond opioid drug company influence, pertain to a number of major clinical issues" - Stephen Gelfand, MD,

Image from the article titled 'Abuse of prescription drugs rises 400 percent in 10 years' by my.opera.com

(MYRTLE BEACH, SC) - From the script of Titanic -- "Father Byles near tears as he clings to the sinking ship with one hand -- while holding onto the hands of praying passengers with his other hand. "And God will wipe away the tears from their eyes, and there will no longer be death. There will be no more pain -- the former world has passed away."

Last week I wrote about a book written by Scott M. Fishman, MD entitled "Responsible Opioid Prescribing - A Physician's Guide." Link to article provided http://www.salem-news.com/articles/april282012/pain-excuse-ms.php

Up until December 2011, Dr. Fishman had been President of the American Pain Foundation (APF) which is financially nourished by the pharmaceutical industry -- in particular the maker of OxyContin, Purdue Pharma.

The American Pain Foundation's website http://www.painfoundation.org/ provides information to patients offering the benefits of opioids. They even have a provision on the website to "Donate Today" although they are kept fat and well fed financially by big pharma.

Some of the information they provide to patients on their website is that the side effects of opioids are minor and most go away after a few days and patients shouldn't worry if they need more of a drug -- they are not developing an addiction. Another "informational" bit of writing posted and dating back to 2009 is a headline reading "For Many, Financial Problems Bring Physical Pain."

Creative marketing to push opioids? You bet it is.

A group I have written about called Physicians for Responsible Opioid Prescribing (PROP) http://www.supportprop.org/ has problems with Dr. Fishman's book as well as the American Pain Foundation. One of the members of PROP, Stephen Gelfand, MD recently wrote a letter to Scott Kirby, MD, Head of the North Carolina Medical Board. Dr. Fishman's book had been distributed by the Federation of State Medical Boards (FSMB) as promoted by Regina M. Benjamin, MD, the U.S. Surgeon General. Some of the highlights of Dr. Gelfand's comments about Dr. Fishman's "guidelines" in prescribing opioids are outlined below:

The major concerns we have at PROP about the Fishman book beyond opioid drug company influence, pertain to a number of major clinical issues. Some of these include:

[1] The book casts doubt that opiod abuse and diversion are related to physician prescribing, but instead relates this to patients who divert opioids to "nonmedical recreational users" as the source of most of the addiction and death, while stating that "the exact contribution of prescribers is not presently known". Although the increased availability of prescription opioids filters to teenagers and young adults for recreational use, this is inconsistent with the medical documentation showing that the majority of adverse outcomes have occurred in adult chronic pain patients and originate from an initial opioid prescribed by a physician, especially in the large volume of patients with chronic noncancer pain [CNCP]. The denial of the role of prescribing gives doctors a false sense of security and reduces caution in the decision to consider using an opioid for pain.

[2] Although there is a documented lack of evidence for the long-term efficacy and safety opioids for CNCP, the book overstates unproven long-term benefits and understates the risks of chronic opioid therapy [COT], while the recommendation for a marked increase in prescribing was the result of "a leap of faith" and not from evidenced-based studies. It especially downplays the potentially lethal disease of addiction which may be difficult to detect initially but may occur rapidly and be very resistant to manage once established. Furthermore, it fails to note the increased risk of overdose and death from the depressive effect on breathing by the action of opioids [particularly long-acting] on the sleep center of the brain stem, especially in combination with other psychoactive agents including benzodiazepines, sedatives and alcohol.

[3] It talks about "balance" so that access to opioids for "legitimate medical need" is not impeded, but does not provide any information about what actually constitutes "legitimate medical need" outside of cancer, especially considering that there is an absence of good evidence for both the benefit and safety of COT for CNCP and the acknowledged fact that most primary care physicians lack education about both chronic pain and the safe use of opioids. In many areas of the nation, "legitimate medical need" qualifies as any complaint of "pain", a low standard of care which has facilitated the increase in overprescribing and the proliferation of the "pill mills".

[4] Not prescribing opioids in this book is equated with the "non-treatment" of pain, an "unsafe option", and "doing harm". This ignores the fact that effective treatment usually involves the much safer alternatives of non-opioid, multidisciplinary management, while the rush to opioids may actually violate the first dictum of medicine to "first do no harm".

[5] The book equates the hyped, unfounded fear of losing access to opioids in patients who truly need them, with the much larger population of patients who have become addicted, overdosed or died from opioid-related causes. We do not see the equivalence or "balance" between the two, as the occurrence of iatrogenic addiction or death is the worst of all outcomes in medicine.

We appreciate the depth and complexity of this problem which needs to be assessed on multiple levels in order to finally begin to reduce the growing harm associated with opioid analgesic overprescribing. It is hoped that this will be helpful in expanding education and needed dialogue about what may be the most serious public health crisis of the 21st Century.

Thank you again for your interest in PROP.
Stephen G. Gelfand, MD
Physicians for Responsible Opioid Prescribing [PROP]

My question to members of Congress is -- How much longer are you going to sit back and allow physicians paid by pharmaceutical companies to write guidelines on prescribing dangerous opioids? How much longer do you sit back while the American Pain Foundation pushes opioids for "financial problems?" Should we wait until there is a push for opioids for politicians dealing with the stresses of Congress and the Senate? When will this deceitful and unscrupulous form of marketing dangerous drugs that are killing and addicting our families be stopped? When will it be time for Congress to investigate the FDA's blind eye to the prescription drug epidemic and remove Margaret Hamburg, MD as Commissioner of the agency for sheer incompetence?

In December 2011, the American Pain Foundation's chairman and president, Dr. Scott Fishman, resigned his position. In a statement to ProPublica, Fishman said his views have evolved and that he now believes opioids are both overused and addictive. But he defended the group in this statement:

"I have not always agreed with American Pain Foundation's positions and have had disagreements with some APF leaders and patient advocates about many issues in pain management, including the appropriate place of chronic opioid therapy," wrote Fishman, chief of pain medicine at University of California, Davis. "Nonetheless, I have always believed that patients in pain in the United States need strong patient advocacy, which APF has offered."

Your change of heart Dr. Fishman is of little consolation to the tens of thousands of families dealing with death and addiction because of the American Pain Foundation's push to use opioids. Your words now are an insult to anyone with any intelligence. The most brilliant marketing ploy in pushing dangerous drugs was taken on by the American Pain Foundation -- with you at the helm -- kind of like watching the Titanic go down with innocent lives aboard -- and saying "what iceberg?"

LP -- For 14 hours in a truck, for the quiet of "soon" -- for so much love, faith, laughter, encouragement and our treasured peace -- I thank God every day.