Pharmageddon

The Rise of “The Walking Drugged”!

The recent Academy Awards inspired me to pitch a new movie plot that is a combination of the 1975 Academy Award winner for Best Picture, One Flew Over the Cuckoo’s Nest, the 2016 Oscar winning movie for this year, Spotlight, along with a trace of The Fugitive from 1993 and the TV series, The Walking Dead.

If you recall, One Flew Over the Cuckoo’s Nest starring Jack Nicholson revealed the medical madness within psychiatric hospitals, literally with an assortment of mentally-ill patients and, figuratively, with inept medical staff and dubious, dangerous treatments.

Now we see the same lunacy in the medical mismanagement of chronic pain wrought by a blitzkrieg of narcotic prescription painkillers that have overwhelmed an unsuspecting public causing rampant addiction and thousands of deaths never experienced before by any civilization in the history of the world.

This medical horror is Pharmageddon, an apocalypse caused by opioid prescription painkillers. Without question, today the most abused drugs are opioid pain relievers laced with medicinal heroin such as OxyContin, Percocet, Hydrocodone, Vicodin or Fentanyl that have left millions of Americans addicted, hundreds of thousands dead and millions of families living with despair.

Similar to the genre of horror shows like The Walking Dead, although my medical-horror movie is not science-fiction; in fact, it’s too real and happening right now throughout this country, perhaps to someone you know.

Here’s the trailer to my proposed screenplay, Pharmageddon. To have its full impact, please read while accompanied by the sound track from Michael Jackson’s music video, Thriller:

“Coming to the silver screen near you is the story of The Walking Drugged stoned on narcotic prescription painkillers. Beware – look around the audience because there’s a good chance someone sitting near you is a medical zombie!

“Pharmageddon is the production of Big Pharma and directed by the AMA with a supporting cast of thousands of MDs and pharmacists.

“More deadly than the Ebola virus or the super-bug MRSA, there is no stopping the spread of these medical zombies who now number 13 million users, 2 million abusers, and 47,000 die every year.

“Learn how Big Pharma created its deceptive plan to distribute tons of narcotic pain pills via its medical pushers to millions of unsuspecting people in pain, wreaking havoc, addiction, and death to thousands of people.

“Discover how the Church of Modern Medicine promoted this tsunami of narcotics without any warning to patients resulting in more deaths daily than Islamic terrorists could ever hope to do.

“Beware of your family doctor or the ‘pain management’ clinic in the local shopping center – pushers for the biggest drug cartel in the world, tempting patients with painkillers like OxyContin never revealing it’s actually medicinal heroin.

“Be shocked to learn 2,500 teenagers every day start using prescription painkillers that has led to a new wave of The Walking Drugged zombies.

“And the surprise ending – it’s all legal and paid by your health insurance!

“This frightening medical-horror movie, Pharmageddon, is very real, already in your town, and may include someone you know – maybe even you.”

Before you think I’m taking opioids myself and have lost my marbles, let me explain how this Pharmageddon madness is more pervasive than victims in the Cuckoo’s Nest, just as secretive as Spotlight, more realistic than The Walking Dead, and just as deceptive as The Fugitive. My medical-horror story is based on true events that will stun you – a sordid mystery of medical deception never before disclosed to the public.

Spotlight on the Church of Modern Medicine

Without a doubt, the medical drug problem in this country is bigger than people realize and much bigger than the AMA will ever admit to their involvement in this conspiracy, all the more reason to popularize this dilemma with a new Hollywood documentary.

My proposed medico-thriller documentary, Pharmageddon, also includes a similar theme to this year’s Academy Award winner for Best Picture, Spotlight. This 2016 Oscar-winning film follows The Boston Globe’s investigation that also earned The Globe the 2003 Pulitzer Prize for Public Service.[1]

To recap this film, in 2001, journalists from The Boston Globe’s “Spotlight Team” finally connected the dots to uncover a conspiracy among lawyers, local government officials, the Catholic Church leadership, closed-mouth parent-parishioners, along with the Globe’s own failings to expose the pedophilia of priests who were hiding under a religious cloak to conceal their sexual exploitation of children.

The Globe also discovered an extraordinary cover-up of secrecy in the Archdiocese of Boston that had quietly settled in the previous 10 years child molestation claims against at least 70 priests.[2] The Associated Press later estimated the total settlements of sex abuse cases from 1950 to 2007 were more than $2 billion.[3] According to Bishop Accountability reports, that figure reached more than $3 billion by 2012.[4]

The Globe reporters remarked about the cover-up: “It was surprising that this scandal was so far reaching into so many different institutions in Boston. To have continued for as long as it had, there had to be a lot of people looking the other way.”[5]

The pedophile cover-up by the Catholic Church resembles similar egregious behavior we now see in the Church of Modern Medicine. Since the 1990s, a lot of people have also been “looking the other way” in regard to the opioid apocalypse ravaging the United States. Just as the priests committed crimes under a cloak of the crucifix, so have the promiscuous prescribers who practice under the cloak of the medical caduceus.

As to be expected, confronting the Church of Modern Medicine is as daunting as confronting the Catholic Church. Both are powerful “cultural authorities” that inherently are respected by the mainstream. To incriminate doctors or priests is a difficult task; after all, one is the “guardian of health” while the other is the “guardian of your soul.”

Dot #1: The Medical Inquisition

Considering the widespread damage of this Pharmageddon, one should question how this opioid pandemic developed. It didn’t just drop out of the blue, but it was the conspiracy of the medical-industrial complex that remains unknown by the public.

Just as the Spotlight Team connected the dots to draw the ugly picture of priestly pedophilia, connecting the dots to reveal this medical travesty is just as shocking, just as secretive and affects many more victims.

Indeed, the rise of Pharmageddon is not by chance, but by design on two battle fronts:

1) A defamation campaign by the AMA to defame and marginalize the chiropractic profession, its main rival in the treatment of chronic pain, and

2) A marketing scheme by Big Pharma to promote opioid painkillers beyond the previously acceptable reasons such as post-surgical, cancer, trauma, or terminally-ill cases.[6]

The first step in the development of Pharmageddon occurred in the early 1960s when the Church of Modern Medicine formalized, in essence, a Medical Inquisition by the AMA’s Committee on Quackery to “contain and eliminate the chiropractic profession,” its main competitor that included a secret plan of public defamation, political skullduggery, and economic boycott.[7]

Certainly most people recognize the defamation campaign of this Medical Inquisition. By branding chiropractors as “quacks” and “dangerous,” the AMA slandered its biggest nondrug competition in the minds of the public and press. By discouraging the public from using chiropractors, the resulting stigma became entrenched as a pervasive “urban legend” impugning the reputations of chiropractors with untrue and unproven medical myths.

In reality, the opposition to chiropractors never came from the public who used chiropractic care, nor did it come from state or federal health agencies that license and monitor chiropractors. The war on chiropractors was solely the fabrication of the AMA in its attempt to eliminate an opponent in its quest to create the medical monopoly we now see today.

People are generally aware of the antipathy of MDs toward chiropractors, a medical prejudice dubbed “chirophobia,” but few understand the depth of this medical bigotry that finally came to light in a landmark antitrust trial, Wilk et al. v. AMA et al.,[8] when four brave chiropractors brought a lawsuit against the medical monopoly in 1976.

During this federal antitrust trial, many medical experts and scientific evidence upended the medical myths of this urban legend degrading chiropractors that created the stigma that still yokes the image of this profession and deters many people from using this valuable service for their chronic pain.

In the Court’s Opinion at the conclusion of this antitrust trial in 1987, Judge Susan Getzendanner spoke of the damage inflicted upon chiropractors describing the conspiracy as “systematic, long-term wrongdoing, and the long-term intent to destroy a licensed profession. By labeling all chiropractors unscientific cultists, injury to reputation was assured by the AMA’s name-calling practice,” which was exactly the goal of the medical profession — to defame its main competition by invalidating chiropractors’ expertise in order to capture the healthcare marketplace, especially the lucrative spine care market.[9]

Another shocking revelation at trial was the lack of evidence to the AMA’s main legal defense of “patient safety” to justify its boycott of chiropractors.

According to the judge, “The AMA did not, during the entire period of the boycott, have reason to hold that view. It is clear that there were some therapeutic benefits of chiropractic that the AMA knew about.”

Afterwards, the judge admitted to a reporter this medical war was primarily an economic turf battle. “Absolutely,” Judge Getzendanner later confessed.

Although debunked in the court of law, the defamation lingers today in the court of public opinion and in the mainstream media because the AMA and its media shills have “never made any attempt to publicly repair the damage the boycott did to chiropractors’ reputations” as Judge Getzendanner said.

Despite the chiropractor-plaintiffs’ legal victory, the AMA’s objective was fait accompli and the PR damage was already well entrenched in the public’s mind. Indeed, where do chiropractors go to get their reputations back after this massive defamation campaign that covertly continues to this day?

This became the first dot in this Pharmageddon — the Medical Inquisition to marginalize and defame the largest nondrug solution to chronic pain – chiropractic care.

Dot #2: Inept MDs

The second dot to connect in this picture of Pharmageddon is the fact most medical priests are imposters – no more qualified than a dentist to treat chronic pain.

For medical parishioners, this may come as a huge shock to realize their local medical priest is a phony concerning the management of chronic pain, but the facts reveal how these inept MDs resulted in the millions of “The Walking Drugged” zombies in America.

Researchers now agree the image of medical competency in musculoskeletal disorders, mainly back and neck pains, which are the main causes of opioid painkiller usage,[12] is an illusion.

Richard Deyo, MD, MPH, author of “Watch Your Back!” mentioned the problems with medical treatments and physician incompetence in diagnosis and treatment of low back treatments:

“Calling a [medical] physician a back pain expert, therefore, is perhaps faint praise — medicine has at best a limited understanding of the condition. In fact, medicine’s reliance on outdated ideas may have actually contributed to the problem.”[13]

Scott Boden, MD, currently director of the Emory Orthopaedic and Spine Center in Atlanta, also warned of this fiasco years ago in 2003 in an article in Spine when he admitted, “Many, if not most, primary care providers have little training in how to manage musculoskeletal disorders.”[14]

Indeed, the facts are clear: pain management is rarely taught in medical schools and surveys of physicians’ knowledge of pain management principles find significant shortcomings, certainly concerning nondrug methods like chiropractic and other CAM treatments.[15],[16] All they are taught is the AMA party line to use drugs, epidural shots, spine surgery and never refer to chiropractors.

Less than half of 122 U.S. medical schools require a preclinical course in musculoskeletal medicine, less than one-fourth require a clinical course, and nearly half have no required preclinical or clinical course.[17] Another study confirms that both orthopaedic surgeons’ and family physicians’ knowledge of treating low back pain is deficient. In fact, orthopedic surgeons were found to be less aware of current nondrug treatments than family practitioners[18] and less likely to refer to chiropractors.

Undoubtedly, the average MD knows he’s scamming the public posing as an expert on back pain and musculoskeletal disorders. MDs are aware of their academic deficiency and clinical incompetence but remain unwilling to admit their lacking to patients. They are aware of the dangers of opioid painkillers, but few have said anything critical of these narcotics over the past 25 years.

In reality, they created this prescription painkiller Pharmageddon with their promiscuous prescribing that created the millions of The Walking Drugged we now see, but most MDs continue to look the other way.

Editor Mark Schoene also makes the case primary care medical practitioners are actually dangerous to patients:

“One can make the argument that the most perilous setting for the treatment of low back pain in the United States is currently the offices of primary care medical practitioners—primary care MDs. This is simply because of the high rates of opioid prescription in these settings.

“As anyone who follows medical news is aware, excessive prescription of opioids for back and other forms of chronic pain has prompted a destructive epidemic of overdoses and deaths, with more than 17,000 deaths per year. And the opioid overtreatment epidemic has in turn kicked off a terrible wave of heroin addiction and overdose deaths.

“Low back pain has helped trigger a lethal and growing heroin addiction epidemic in the United States. How could that be? Unfortunately, it is easy to connect the dots.”[19]

Even in the small county in middle Georgia where I live, the impact of Pharmageddon is evident. Recently more than 50 were arrested in a Houston County drug bust after an investigation revealed over 70 people were found to be involved in the selling and buying of cocaine and several prescription drugs including 

Obviously even the charming peach and pecan country of middle Georgia has its share of medical zombies, including the son of a patient of mine who told me he had spent his life savings on drug rehab for his son just last year, clearly to no avail since his son was arrested again in this crackdown.

A few years ago a Houston County doctor also was sentenced to a 30-year federal prison sentence for operating a “pill mill” illegally prescribing what was described in court as a “cocktail” of narcotics including Oxycodone that resulted in the death of at least one patient. Convicted with Dr. Spurgeon Green were his physician assistant and a pharmacist who aided Green in the distribution of these Schedule II narcotics, filling prescriptions at a rate which was ten times higher than the national average.[20]

Previously, the common belief about this pandemic of Pharmageddon was blamed mainly upon the promiscuous prescribers at “pill mills” and “pain management” centers, but new research begs to differ.

“Now we know this is not the case” according to Stanford researcher, Jonathan Chen, MD, PhD and instructor of medicine at Stanford.[21]

“The bulk of opioid prescriptions are distributed by the large population of general practitioners. Opioid prescriptions are dominated by general practitioners — the family doctors, internists, nurse practitioners and physician assistants that most patients see for common problems — and not by a small cadre of high volume ‘pill mill’ prescribers once thought to be fueling this epidemic. By sheer volume, however, there are so many more general practitioners that they dominated the total quantity of prescriptions.”[22]

Many doctors have also shown little inclination to solve this Pharmageddon. Not only do most over-prescribe opioid painkillers, some have even balked at checking with online state registries such as the Prescription Drug Monitoring Program (PDMP) to reduce the abuse and diversion of prescription drugs and to find out if patients are “doctor-shopping” for multiple prescriptions.[23],[24]

Dot #3: Pharma’s Two Prong Attack

The next dot in this medical-horror equation occurred when the pharmaceutical industry masterminded a plan to promote opioid painkillers beyond the legitimate medical reasons such as post-surgical, cancer, trauma, or terminally-ill cases.[25]

This deception was important in order to expand its market to include the 116 million U.S. adults burdened by chronic pain.[26] In fact, chronic pain affects more Americans than diabetes, heart disease, stroke and cancer combined.[27]

As Donald Trump might say, “Back pain is HUGE.”

Not only a huge social cost to society in terms of addiction, disability, and deaths, the annual national economic cost associated with chronic pain is estimated by the Institute of Medicine to be $560–635 billion (an amount equal to about $2,000 for everyone living in the United States).[28]

Big Pharma created a two-pronged plan to develop a new set of diagnostics for chronic pain cases such as low back pain, the No. 1 disabling condition in the nation, military, workplace, and in the world.[29]

The first prong by Big Pharma began with the development of the “Pain as the 5th Vital Sign” initiative in the mid-1990s to make pain a new vital sign in the United States — adding it to body temperature, pulse rate, breathing rate, and blood pressure as objective “signs” that need to be checked.

According to Mark Schoene, the 25-year associate editor of The BackLetter, an international spine research journal, “Needless to say, pain is not a sign – something that can be detected and measured objectively – so it doesn’t mesh well with the other vital signs.”[30]

This pain mandate applied to every major healthcare institution in the U.S. and required healthcare providers to assess pain at every medical visit, document those pain levels with pain scales from 1 to 10 and, if 4 or greater, then come up with a treatment plan to relieve the pain – mainly to dispense opioid painkillers.[31]

“It was this change in prescribing practices that would lead to our public health crisis,” said Dr. Andrew Kolodny, executive director of Physicians for Responsible Opioid Prescribing.[32] This was the first step in Big Pharma’s creation of Pharmageddon, and failure for MDs to intervene as instructed came with a heavy hand.

“There was a time when doctors faced civil penalties and professional penalties for not prescribing opioids,” said Dr. Steven Cohen, director of the Pain Medicine Division of Medical Education at Johns Hopkins Medicine.[33] Like “El Chapo” holding a gun to their heads, MDs were forced by Big Pharma to push their drugs or else.

Dot #4: Fugitive MD

Once the phony 5th vital sign of pain was established, Big Pharma’s second prong was to convince prudent MDs about using opioids routinely in the management of chronic pain. In order to convince these cautious doctors, Big Pharma developed a scheme to deceive MDs with fraudulent research.

This is where the Pharmageddon plot resembles the 1993 action movie, The Fugitive, with Harrison Ford as Dr. Roger Kimble and Tommy Lee Jones as Deputy U.S. Marshal Samuel Gerard. Aside from the chase scenes and discovering who killed Kimble’s wife, the final scene reveals the underlying motivation for murder – a fraudulent research scam.

To recap the film, Dr. Kimble is searching for the one-arm man who killed his wife. In his search, he discovers a scheme by his colleague, Dr. Charles Nichols, a cardiologist employed by the pharmaceutical company Devlin MacGregor, who is leading the development of a new heart drug called Provasic, announcing it had no side effects whatsoever. However, Dr. Kimble had previously found Provasic caused liver damage, which would prevent it from being approved by the FDA. Dr. Nichols arranged a cover-up of Kimble’s work and ordered the one-arm man to kill Kimble; his wife’s death was unintended.

A similar real-life fraudulent research scheme and cover-up was arranged by Big Pharma regarding opioid painkillers. Thirty years ago Big Pharma paid “thought-leaders” such as Drs. Russell Portenoy and Kathleen Foley, New York City pain specialists, to sway prudent doctors to use opioids for chronic pain cases.

In 1986, these two doctors had published a paper, “Chronic use of opioid analgesics in non-malignant pain: report of 38 cases,”[34] allegedly to determine the indications, course, safety and efficacy of opioid therapy. They concluded there were no problems:

“We conclude that opioid maintenance therapy can be a safe, salutary and more humane alternative to the options of surgery or no treatment in those patients with intractable non-malignant pain and no history of drug abuse.”

Dr. Portenoy claimed that the risk of addiction to opioids use to treat chronic pain was less than 1%, but this figure was based on virtually no scientific evidence according to The Wall Street Journal. That paper “opened the door to much broader prescribing of the drugs for more common complaints such as nerve or back pain.”[35]

It also opened the door to millions of The Walking Drugged.

“I gave innumerable lectures in the late 1980s and ’90s about addiction that weren’t true,” Dr. Portenoy admitted in a 2010 interview. He also admitted to chiding wary MDs who resisted the use of opioids for chronic pain cases by accusing them as suffering from “opioidphobia,” in other words, the fear of prescribing opioids

Unfortunately, little did the medical professionals realize this pharmaceutical propaganda amounted to unsubstantiated brainwashing. Indeed, the breakdown of the judicious use of opioids combined with “chirophobia” made for a deadly dose of medical misinformation, professional intimidation, and the clinical mismanagement of chronic pain cases – more essential dots in the picture of Pharmageddon.

Dr. Portenoy later admitted he overstated the drugs’ benefits and glossed over the risks. Dr. Portenoy said in an interview with WSJ, “Did I teach about pain management, specifically about opioid therapy, in a way that reflects misinformation? Well, against the standards of 2012, I did. We didn’t know then what we know now.”[36]

Dr. Portenoy said it was “quite scary” to think how the growth in opioid prescribing driven by people like him had contributed to soaring rates of addiction and overdose deaths. He was also paid handsomely for his misinformation. The WSJ revealed Dr. Portenoy disclosed relationships with more than a dozen companies, most of which produce opioid painkillers.[37]

Dot #5: Perdue Propaganda

Another dot in this Pharmageddon plot occurred in 1996 when Purdue Pharma launched a massive advertising campaign informing patients and doctors that its new painkiller drug, OxyContin, was available to relieve chronic back pain and was safe because it would slowly release its narcotic ingredients, making it unlikely to become addictive.

In the settlement, Purdue Pharma paid $654 million to 26 states and the District of Columbia, but no one at the company faced jail time.[40] Obviously this fine for deceiving the public while creating thousands of deaths and millions of addictions was pocket change for Perdue – just the cost of doing business.

“The damage to the public from these white-collared drug pushers surely exceeds the collective damage done by traditional street drug pushers,” said Dr. Sidney Wolfe, the director of Public Citizen. [41]

The ramifications of this controversial 5th vital sign initiative are still resonating across American society as MDs continued to dispense opioids like Halloween candy. The CDC reported 259 million prescriptions were written for opioids in 2013, equivalent to one per every American adult.[42] In 2011 to 2012, over 13 million American adults used opioid painkillers and two million U.S. residents either abuse opioids or are addicted to them.[43]

This 5th vital sign diagnostic requirement caused a cultural shift in the way physicians treat pain and now, three decades later, the country faces record mortality rates with over 47,055 overdose deaths reported by the CDC in 2014, which equates overall to 128 deaths each day of which 78 are attributed to opioid prescription painkillers and opiate street heroin.[44]

To put these 128 overdose deaths into perspective – this number is equivalent to the 130 deaths when Islamic terrorists attacked Paris on the evening of November 13, 2015.

Indeed, if Islamic terrorists were killing 128 Americans daily in our country, there would be a huge public uproar, Congress would be up in arms calling for military action, and the media would be swarming for a scapegoat to blame.

But when 128 people die from medication overdoses, there has been reluctance by the media to accuse the medical profession for promiscuous prescribing or blame Big Pharma for its shady promotions of these dangerous drugs. In fact, only a handful of news programs have investigated this prescription opioid pandemic mainly due to a conflict of interest to indict their biggest sponsor, Big Pharma.

The irony of this deadly situation is the fact that opioid painkillers have not shown to have any long term effectiveness for chronic pain. Scientific consensus[45] confirms there is little, if any, evidence that opioids provide safe and effective treatment for chronic non-cancer pain, and include common side effects such as hyperalgesia and constipation, aka, narcotic bowel syndrome,[46] that can complicate long-term treatment.

If MDs were aware of the “best practices” evidence, they would also know strong opioids are no more effective than acetaminophen or nonsteroidal anti-inflammatory drugs (NSAIDs) in patients with musculoskeletal disease and other forms of noncancer pain, according to a review published in Joint Bone Spine.[47]

Dot #6: Intervention Irony

It seems nothing will stop these medical zombies, including their enabling MD whose permissive attitude about drugs is another big dot in the picture of Pharmageddon.

Drug abuse is so widespread today that Hollywood has capitalized on this topic with the television series Intervention featuring people with various drug addictions. As with most addicts, they have their enablers such as drug dealers who supply drugs and friends who condone usage, including their local medical doctors and pharmacists, not some spurious street corner drug dealer as you might expect.

The irony of these medical drug pushers was noted by the CDC Director Tom Frieden, MD, MPH, who suggests MDs have essentially replaced street corner drug pushers as the most important suppliers of narcotics. [48] Ironically, by using an MD instead of a street dealer, this drug deal is perfectly legal and paid by health insurance. Plus, as a cultural authority, an MD dispensing heroin takes the stigma out of narcotic consumption by mainstream Americans.

Another secret problem is the prescribing MD may be an addict as well. In one survey, 69 percent of the physicians admitted misusing prescription drugs.[49] Perhaps this explains why these promiscuous prescribers are so liberal with opioid painkillers. Ironically, the enabling MD may also need intervention!

And MDs are not alone. Nurses and pharmacists also nibble from the medical cookie jar.

“It has been estimated that 10 to 15 percent of all nurses in the United States are addicted to some type of illegal or controlled substance,” explained Art Zwerling, MS, MSN, CRNA, FAAN, a nurse anesthetist educator and member of the peer assistance program at the American Association of Nurse Anesthetists.[50]

The American Nurses Association (ANA) estimates of the nearly 3 million RNs employed in the U.S., almost 300,000 RNs may be substance abusers. The most frequently abused substance is alcohol, followed by amphetamines, opiates (such as fentanyl), sedatives, tranquilizers, and inhalants.[51] Compared with nurses in women’s health, pediatrics, and general practice, emergency nurses were 3.5 times as likely to use marijuana or cocaine. [52]

Certainly the easy access to these prescription drugs is often too tempting among pharmacists. The drug abuse rate among pharmacists is twice that of general society according to Jay Sochoka, BSPharm, RPh, CIP, a former pharmacist who wrote of his drug addiction from his college days throughout his professional career, and he admitted the callous attitude pervasive in pharmacy.

“I have learned one thing over the years of my practice. The overseers don’t care if you do drugs. They care if you do THEIR drugs. Aside from showing up at work obviously high, the only way you’ll end up getting drug tested is if your narcotic inventory numbers don’t line up for a few months. In that situation, if you test positive for ANY drug, you are gone. At some point, the risk just wasn’t worth it for me anymore.”[53]

Another problem in the Church of Modern Medicine is that doctors, nurses and pharmacists have a cloak of secrecy to be very protective of their own, not unlike the cover-up in the Catholic Church scandal. Codes of silence can prevent co-workers from saying anything even when it has become clear that substance abuse is becoming an issue for a colleague, which can be detrimental to the health of patients and the addicted nurses or doctors alike.

Losing the War on Pain

In the past Americans have fought many health “wars,” such as the war on cancer, smoking, obesity, and Nancy Reagan’s “Say No to Drugs” campaign. Considering those efforts were unsuccessful, the current opioid onslaught to control chronic pain is just as hopeless.

Chris Iliades, MD, in his article, “Rethinking Strong Opioids for Noncancer Pain,” asks an important question. “The ‘war on pain’ that began over 20 years ago has relied heavily on opioids. Isn’t it time to say that opioids have lost the war on pain?”[54]

In fact, opioids have not only lost the war on pain, they have created is an entirely new war of opioid painkillers that our nation is also losing rapidly.

As you can see, connecting the dots in this picture of Pharmageddon is a complex task involving many players, a lot of money, and apparently little real concern to solve this problem by the powers-to-be in the Church of Modern Medicine.

Presently there is simply too much money and too few ethics at stake. We now have a medical culture reeking with too much pride, prejudice and power to do the right thing by referring these pain patients to chiropractors and other CAM providers for conservative care as the guidelines suggest.

Fortunately there is a growing sentiment among a few medical heretics who are connecting the dots and now suggest a bigger role alternative healthcare providers should play in this Pharmageddon.

“I think the acceptance of alternative therapies needed to have a vacuum to fill,” said Dr. Houman Danesh, director of Integrative Pain Management at Mount Sinai Hospital in New York. “Essentially what the opioids did was create that vacuum.”[55]

Hopefully the chiropractic profession will fill this vacuum. This is a golden opportunity to promote our profession as the reasonable nondrug choice as some MDs are now suggesting. We’ve seen the medical mismanagement of chronic pain has led to this Pharmageddon, so it’s time for a paradigm shift in pain care.

Some medical experts agree. “When our patients complain of pain, we need to be better at alternative treatments and not always just quickly writing a prescription for opioids,” said Dr. Gail D’Onofrio, chair of the Yale School of Medicine’s Department of Emergency Medicine. “We can’t keep just prescribing these drugs the way we have been doing.”[56]

I might add another clause to Dr. D’Onofrio’s comment, “…we need to be better at referring pain patients to chiropractors and other CAM providers for alternative treatments…”

Erin E. Krebs, MD, MPH, spoke at the recent, February 2016, 32nd Annual American Academy of Pain Management (AAPM) conference and made a few remarkable comments on the theme of “ensuring access to pain care.” She is an associate professor of Medicine at the University of Minnesota and core investigator at the Minneapolis VA Center for Chronic Disease Outcomes Research:

“We also need to put opioids in their place. Opioids are only one treatment for pain and probably not the best treatment for most people with chronic pain. If we can ensure all patients with chronic pain are getting optimal non-opioid pain care, our use of opioids will be more targeted and more effective.”[57]

Certainly the chiropractic profession can make the case that “optimal non-opioid pain care” for the majority of spine-related and musculoskeletal problems is our brand of nondrug treatments.

Dr. Krebs also mentioned the lack of access to nondrug treatments:

“Lack of access to other pain treatments is part of the reason for opioid over-prescribing. We have evidence-based treatments for pain — mostly ‘low-tech, high-touch’ treatments — that most people with chronic pain can’t access.”[58]

In a nutshell, Dr. Krebs described chiropractic’s dilemma – the lack of access for the millions of pain patients who need our nondrug care but who face barriers from biased MDs and the restrictions in healthcare systems such as the VA, Medicare, workers’ compensation programs, and group health insurances such as American Health Specialties Network that handcuff our services.

Obviously if this Pharmageddon is to improve, we must erase the dots of drug dogma and medical demagoguery that were linked together making for this ugly picture of The Walking Drugged. We must redraw this picture of chronic pain with a new set of dots including chiropractic and other alternative treatments.

Recommendations should include rescinding pain as the 5th vital sign as well as removing MDs and demanding chiropractors as the primary portal of entry for chronic pain cases. Just as patients would not seek an MD for a toothache, nor should they seek an MD for a chronic backache or any musculoskeletal pain. For an inept MD to treat such cases should constitute medical malpractice since these conditions are clearly outside his scope.

Realistically, both the Church of Modern Medicine and the public need our help. Indeed, there is no other way to wean millions of “The Walking Drugged” zombies off opioid painkillers without the help of chiropractors and CAM providers to provide nondrug alternative care. This is the simple truth the public must hear.

The first step in solving this Pharmageddon is the day when government, the AMA, and the media admit “those damn chiropractors were right all along” in the treatment of chronic back pain cases as Judge Getzendanner suggested. Just one program in the mass media could begin a tipping point the chiropractic profession needs to break the stigma against our profession.

Just as the current political campaigns show the public’s dislike of conventional career politicians and are turning to antiestablishment candidates, we chiropractors need to jump on the same bandwagon of dissent against the Church of Modern Medicine.

Certainly the AMA and inept promiscuous prescribers will balk at endorsing nondrug chiropractic care and, most of all, Big Pharma has no interest to see its revenues decline, but 30 years is long enough to show the medical approach is futile. In fact, it’s dangerous and deadly with millions of Americans suffering as collateral damage in the war against chiropractors.

There is no happy ending to Pharmageddon as long as MDs are in charge of “pain patients” doling out opioids like candy and the complicit and biased medical mass media such as Dr. Sanjay Gupta @ CNN sponsored by Big Pharma censor our good news. This is a story of problems so deeply rooted in the healthcare system and our society that would take a revolution to reverse, more than merely a healthcare reform that simply rearranges the deck chairs on this medical Titanic.

This article is an excerpt from my upcoming book, The Media War Against Chiropractors.

[1] “Church allowed abuse by priest for years,” by Matt Carroll, Sacha Pfeiffer, Michael Rezendes; and editor Walter V. Robinson, The Boston Globe, Jan. 6, 2002.

[2] “How the ‘Spotlight’ movie got made” by Meredith Goldstein, Globe Staff, October 30, 2015

[3] “L.A. Archdiocese to settle suits for $660 million: Settlement represents Church’s largest payout in sexual abuse scandal”. MSNBC. 14 July 2007. Retrieved 27 June 2012.

[4] Schaffer, Michael D. (25 June 2012). “Sex-abuse crisis is a watershed in the Roman Catholic Church’s history in America”. The Iquirer. Retrieved 6 July 2012.

[5] “Church allowed abuse by priest for years,” by Matt Carroll, Sacha Pfeiffer, Michael Rezendes; and editor Walter V. Robinson, The Boston Globe, Jan. 6, 2002

[6] Deyo RA, Watch Your Back, Chapter 5: Pain killers and the marketing of pain, Cornell University Press, Ithaca, New York and London UK, 2014.

[7] JC Smith, The Medical War Against Chiropractic. http://chiropractorsforfairjournalism.com/Books_by_JCS.html

[8] Chester A. Wilk, James W. Bryden, Patricia A. Arthur, Michael D. Pedigo v. American Medical Association, Joint Commission on Accreditation of Hospitals, American College of Physicians, American Academy of Orthopaedic Surgeons, United States District Court Northern District of Illinois, No. 76C3777, Susan Getzendanner, Judge, Judgment dated August 27, 1987.

[9] Associated Press, “U.S. Judge Finds Medical Group Conspired Against Chiropractors,” New York Times (1987)

[10] Bryan Miller, Chiropractors vs. AMA, Chicago Reader ,June 27, 1991

[11] https://en.wikipedia.org/wiki/Brown_v._Board_of_Education

[12] Denise Boudreau, PhD, Michael Von Korff, ScD, Carolyn M. Rutter, PhD, Kathleen Saunders, G. Thomas Ray, Mark D. Sullivan, MD, PhD, Cynthia Campbell, PhD, Joseph O. Merrill, MD, MPH, Michael J. Silverberg, PhD, MPH, Caleb Banta-Green, and Constance Weisner, DrPH, MSW. “Trends in De-facto Long-term Opioid Therapy for Chronic Non-Cancer Pain,” Pharmacoepidemiol Drug Saf. 2009 December ; 18(12): 1166–1175. doi:10.1002/pds.1833.

[13] Deyo, RA. Low -back pain., Scientific American, pp. 49-53, August 1998.

[14] S Boden, et al. “Emerging Techniques For Treatment Of Degenerative Lumbar Disc Disease,” Spine 28 (2003):524-525.

[15] Lebovits AH, Florence I, Bathina R, Hunko V, Fox MT, Bramble CY. Pain knowledge and attitudes of healthcare providers: practice characteristic differences. Clin J Pain. 1997;13:237–243. [PubMed]

[16] Wolfert MZ, Gilson AM, Dahl JL, Cleary JF. Opioid analgesics for pain control: Wisconsin physicians’ knowledge, beliefs, attitudes, and prescribing practices. Pain Med. 2010;11:425–434. [PubMed]

[17] Day C., Yeh A., Franko O., Ramirez M., Krupat E. (2007) Musculoskeletal Medicine: An Assessment of the Attitudes of Medical Students at Harvard Medical School, Academic Medicine 82: 452-457

[18] Finestone AS1, Raveh A, Mirovsky Y, Lahad A, Milgrom C., “Orthopaedists’ and family practitioners’ knowledge of simple low back pain management,” Spine (Phila Pa 1976) 2009 Jul 1;34(15):1600-3.

[19] Volume 30, Number 10, 2015

[20] http://bainbridgega.com/news/publish/080509drgreen.shtml

[21] Jonathan Chen, Overprescribing of opioids is not limited to a few bad apples, Stanford Medicine News Center, Dec 14 2015

[22] Jonathan Chen, Overprescribing of opioids is not limited to a few bad apples, Stanford Medicine News Center, Dec 14 2015

[23] America’s deadliest drug problem: Our view, The Editorial Board, USA Today, December 22, 2015

http://www.usatoday.com/story/opinion/2015/12/21/cdc-opioids-heroin-overdoses-doctors-editorials-debates/77708774/

[24] Jonathan Chen, Overprescribing of opioids is not limited to a few bad apples, Stanford Medicine News Center, Dec 14 2015

[25] Deyo RA, Watch Your Back, Chapter 5: Pain killers and the marketing of pain, Cornell University Press, Ithaca, New York and London UK, 2014.

[26] http://iom.nationalacademies.org/Reports/2011/Relieving-Pain-in-America-A-Blueprint-for-Transforming-Prevention-Care-Education-Research.aspx

[27] http://www.painmed.org/PatientCenter/Facts_on_Pain.aspx

[28] http://iom.nationalacademies.org/Reports/2011/Relieving-Pain-in-America-A-Blueprint-for-Transforming-Prevention-Care-Education-Research.aspx

[29] The Burden of Musculoskeletal Diseases in the United States Bone and Joint Decade, Copyright © 2008 by the American Academy of Orthopaedic Surgeons. ISBN 978-0-89203-533-5, pp. 21.

[30] The BackLetter, Vol. 31, No. 2, February 2016

[31] Mularski RA, Measuring Pain as the 5th Vital Sign does not improve quality of pain management, Journal of General Internal Medicine, 2006; 21(6):607-612.

[32] “The opioid abuse epidemic: How healthcare helped create a crisis,” by Steven Ross Johnson, Modern Healthcare, February 13, 2016

[33] “The opioid abuse epidemic: How healthcare helped create a crisis,” by Steven Ross Johnson, Modern Healthcare, February 13, 2016

[34] Portenoy RK, Foley KM, “Chronic use of opioid analgesics in non-malignant pain: report of 38 cases,” Pain. 1986 May;25(2):171-86

[35] Thomas Catan and Evan Perez, A Pain-Drug Champion Has Second Thoughts, WSJ, Dec. 17, 2012

[36] See more at: http://www.thepoisonreview.com/2012/12/16/the-money-and-influence-behind-pain-as-a-fifth-vital-sign/#sthash.yyt9dxmA.dpuf

[37] See more at: http://www.thepoisonreview.com/2012/12/16/the-money-and-influence-behind-pain-as-a-fifth-vital-sign/#sthash.yyt9dxmA.dpuf

[38] Rafia S. Rasu, BPharm, MPharm, MBA, PhD; Kiengkham Vouthy, PharmD; Ashley N. Crowl, PharmD; Anne E. Stegeman, PharmD; Bithia Fikru, PharmD, MPA; Walter Agbor Bawa, MS, PharmD; and Maureen E. Knell, PharmD, BCACP, “Cost of Pain Medication to Treat Adult Patients with Nonmalignant Chronic Pain in the United States,” Vol. 20, No. 9 September 2014 JMCP Journal of Managed Care & Specialty Pharmacy

[39] “The opioid abuse epidemic: How healthcare helped create a crisis,” by Steven Ross Johnson, Modern Healthcare, February 13, 2016

[40] U.S. Maker Of Oxycontin Painkiller To Pay $600 Million In Guilty Plea, by Barry Meier, New York Times, May 11, 2007

[41] U.S. Maker Of Oxycontin Painkiller To Pay $600 Million In Guilty Plea, by Barry Meier, New York Times, May 11, 2007

[42] National Center for Injury Prevention and Control, Division of Unintentional Injury Prevention, www.cdc.gov/vitalsigns/, July 2014.

[43] BackLetter: February 2016 – Volume 31 – Issue 2 – p 17 doi: 10.1097/01.BACK.0000480371.70730.19

[44] Drug overdose deaths hit record numbers in 2014, CDC Newsroom Releases, December 18, 2015

[45]YNGVILD OLSEN, MD and GAIL L DAUMIT, MD, MHS, “Chronic Pain and Narcotics: A Dilemma for Primary Care,” J Gen Intern Med. 2002 Mar; 17(3): 238–240.

[46] The Narcotic Bowel Syndrome: Clinical Features, Pathophysiology and Management. Grunkemeier DMS et al. Clin Gastrointerol Hepatol 2007 Oct;5:1126-1139.

[47] Berthelot JM, Darrieutort-Lafitte C, Le Goff B, Maugars Y. Strong opioids for noncancer pain due to musculoskeletal diseases: Not more effective than acetaminophen or NSAIDs. Joint Bone Spine. 2015 Dec;82(6):397-401. doi: 10.1016/j.jbspin.2015.08.003. Epub 2015 Oct 6.

[48] Centers for Disease Control and Prevention Press Release, CDC Vital Signs: Overdose of Prescription OPR—United States, 1999-2008; 2011: www.cdc.gov/media/releases/2011/t1101_presecription_pain_relievers.html.

[49] http://www.medscape.com/viewarticle/817463

[50] Nurses and Substance Abuse, By Sue Heacock, Nurses Together Network, Jan 6, 2013 http://www.nursetogether.com/nurses-and-substance-abuse#sthash.QA5zWVfM.dpuf
[51] Drug addiction among nurses: Confronting a quiet epidemic: Many RNs fall prey to this hidden, potentially deadly disease. By Mary Ann B. Copp, Modern Medicine Network, April 01, 2009

[52] A M Trinkoff and C L Storr Substance use among nurses: differences between specialties. Am J Public Health. 1998 April; 88(4): 581–585.

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[53] “Pharmacist Drug Abuse,” Jay Sochoka, BSPharm, RPh, CIP, Pharmacy Times

[54] Chris Iliades, MD, Rethinking Strong Opioids for Noncancer Pain, Clinical Pain Adviser, March 07, 2016
[55] “The opioid abuse epidemic: How healthcare helped create a crisis,” by Steven Ross Johnson, Modern Healthcare, February 13, 2016

[56] “The opioid abuse epidemic: How healthcare helped create a crisis,” by Steven Ross Johnson, Modern Healthcare, February 13, 2016

[57] “What the CDC’s Opioid Prescribing Guidelines Mean for Primary Care Physicians,” Clinical Pain Advisor, February 19, 2016

[58] “What the CDC’s Opioid Prescribing Guidelines Mean for Primary Care Physicians,” Clinical Pain Advisor, February 19, 2016