Pain , Pain Med Abuse and the Honest Truth

May 2011, at least the first two weeks, have been filled with Federal agencies announcing plans to stem the “Epidemic of Prescription Pain Medication.”  FDA has released information for consumers of long-lasting pain medication and SAMHSA has announced an effort to approach the issue of pain medication use, misuse and abuse with a comprehensive program over the next five years. 

As a person who has periods of chronic pain, I wonder where this leaves various Americans who–rightfully–wish to have a voice in addressing this problem. Persons with pain need access to pain management without undue hassle and persons with acute pain (e.g. from an accident or injury or dental surgery) need to be treated appropriately for acute pain. Acute pain treatment is important both to reduce the progression to chronic pain, but also to avoid the potential for acute pain, which could have been managed, to become, for the pain patients, the source of prescription pain medicine abuse, misuse or addiction.  Furthermore, more pain patients means more people who become the unwitting suppliers of diverted pain medications.  The following is my personal story. But this blog will be revisited as this issue develops.

Pain sufferers–you will relate to this post: it is about pain so terrible that every thought you have makes you feel like vomiting. The sound of the wind in the trees, through a window, is excruciating. Every image that comes to mind is so sickening you want to die. You think–to the extent that you can think at all–about how best to kill yourself and make the least possible mess in the house.

Pain is a terrible thing and so misunderstood by those who have never really experienced it or have only experienced acute pain. We pain suffers are big liars. We tell our loved ones that it is not so bad, because we can’t stand the thought of being forced out of our beds to go to the hospital. The idea of the trip there is beyond acceptable. We would rather lie in the dark and suffer than get our heads around the notion that someone somewhere–such as a doctor at a hospital–could help us live through the next few hours.

Oh, yes, we have medications at home. We take them all–risking serious consequences–in an attempt to make the pain subside. We nibble on saltines because the medicine is supposed to be taken with food, but all food is so nauseating to our minds that we can hardly bear the nibbling we must do on these three crackers we have set out as our goal.

People stop in, such as our children, to give us some interesting bit of news, like my daughter last night who was heading out with friends to celebrate her 16th birthday, and they see us with our head literally in our hands, wrapped in blindfolds left over from airline flights where they give out the eyecovers so you can sleep on the flight. Pain suffers save these items, because you need at least two or three to completely block out all the light, even at night, that is somehow shining through the darkness and making your head throb that much worse.

Headaches are not the only kind of chronic pain, but they are one of the kinds that I get. As a pain sufferer, however, I do have other kinds of pain. I even have pain preferences. I would much rather have the unexplained pain that I sometimes get in my teeth–all of them– than a headache. Where does this mouth pain come from? It is a mystery. I do not grind my teeth, I have never had a cavity. My teeth are in perfect condition, but they can suddenly become the source of amazing pain that requires opioid based therapeutics. Or there is the creepy, crawly, pain that I sometimes get in my legs. No amount of rubbing or wringing can make the pain go away. I lay there longing for cramps, because they are preferable to the horror of the creepy crawly pain.

Why this blog–well, other than venting, to attempt to describe for you, the non-pain sufferer, how we feel. To help you understand why we must be allowed to have pain medications in our homes without the fear that others will steal it (or “borrow” it). This misuse of our much needed medicine gives us a bad name, it gets us strange looks from pharmacists–who are otherwise pretty nice people but who look and scrutinize those of us who regularly obtain controlled substances as though we are addicts. STOP looking at us like this. We are merely trying to be prepared for the next episode. Furthermore, we never know when it will come. True, some of us have triggers. Frankly, I feel sorry for those people because they must bear the added burden of knowing that they sometimes make choices, like participating in a toast at a party (yes, just one sip of alcohol) that will later result in their secret desire to die.

If you are the loved one of someone with chronic pain, God bless you. Thank you for checking on us every twenty minutes–quietly slipping into the dark room to see if we need anything, to check if the pain has subsided at all and to sigh when you notice that we have finally fallen into sleep.

 

Spilt the FDA? Not so quick.

While it is not getting a great deal of attention in the traditional or new media, the issue of whether the FDA should be spilt into two agencies is getting a lot of discussion among those who have followed the agency over the past decade.

With a new FDA commissioner announced, but not yet confirmed—Dr. Margaret Hamburg—and with a deputy also picked out, there are some, including Dan Mitchell of the Daily Bread, a trade pub on the business of food, who believe that the choice of Hamburg actually signals the Administration’s interest in a split of the agency into two separate agencies; one for drugs and one for food safety. I could not disagree more. In his article “New FDA Head: Commissioner of Food?” Mitchell actually describes Hamburg’s experience as a nod toward a split of the organization. I think that Mitchell has not looked far enough into Dr. Hamburg’s background if he thinks that she is only qualified to be the Commissioner of Food.

Peggy was Dr. Fauci’s, Director of the NIAID of the NIH, special assistant for AIDS during the early years of the HIV epidemic. She had many occasions and many duties involved in the fight toward drug discovery, and review of HIV drugs, during these early years. She was instrumental in helping the Institute formulate its plans for HIV drug development grants and contracts and in the development of the overall DHHS response to the HIV epidemic. She was even the Assistant Secretary of the DHHS for planning and evaluation with responsibility over both the NIH and the FDA’s planning and evaluation of programs, not just of HIV, but all drug discovery efforts. Dr. Hamburg is more than ready to be commissioner of the entire FDA and I personally believe there is no reason to split the agency. What they lack is leadership, and they are about to get that. Furthermore, my contacts around town say that such a proposal has no hope of making it through Congress.

Hooray for the FDA!

Thank God the FDA will soon have the best possible commissioner that it could have found–Peggy Hamburg! I was expecting it, but my delight is something akin to the glee I felt when Obama was elected on Nov. 4. I know that is saying a lot, but perhaps many people don’t know how very broken FDA is and how in need of excellence that agency has grown.

Margaret Hamburg brings that excellence. She has the most diverse resume of any physician in Washington, and perhaps in this country with all of the jobs she has held and all her many accomplishments. On top of it all, she is a Mom and certainly the Chief Medical Officer of her household–someone who can relate to the fears and concerns of parents both in food and drug safety, as well as in many of FDA other responsbilities, such as the need to encourage clinical trials in pediatric populations, to broaden the availablility of pain medication to chronic pain sufferers, and much more.

I really look forward to her administration of this agency. Now, I only wish it were a cabinet post!

Margaret Hamburg for FDA Commissioner

Heard another rumor today that Hamburg may not be interested in the job of FDA Commissioner. I am not sure that I buy that because I believe that Dr. Hamburg knows what an effective job she could do and knows what an important public service this would be. However, time will tell.  the associated press last reported on the issue on March 4th and there just seems to be some urgency to getting this post filled. Think about the impact on both FDA and the pharmas from the Supreme Court ruling handed down–what yesterday wasn’t it? Anyway, Hamburg, you should take the job.

Margaret Hamburg for FDA Commissioner

The Kaiser Network Daily report confirmed today that Margaret Hamburg is in the running to become FDA commissioner as I mentioned a couple days ago in my blog “Rumors”. I certainly agree with Senator Kennedy that she would be the best person for this position. Frankly I am a little surprised that she would consider it given the wealth of her experience, however, I think it is a testament to her humility and experience that she recognizes the contribution she could make in this position. The FDA is broken, has been broken for a long time, and Peggy Hamburg is the kind of person who could fix anything. Go Hamburg. Now let’s hear a little more about Podesta at DHHS.