The Plight of the Chronic Pain Patient

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However, this "war" has extended beyond a fight against the narcotics peddlers who ruin the quality of life of so many inner cities plus so many suffering along with their families through the horrors of drug addiction. Those who study the situation carefully will find an ever-increasing population of Americans, some young and many older who are the victims of DEA zeal by scaring doctors in literally all branches of medicine from being able to prescribe time-tested medications as they see fit.

Instead, both doctors and patients find themselves in the often absurd situation where DEA policy is going beyond its original mandate and telling doctors how to practice medicine!  Patients who seek adequate pain relief from any medical entity, be it their PCP, continually harassed fully licensed Pain Clinics and the grossly mis-understood budding field of Telemedicine which is using fully licensed physicians & similarly licensed pharmacies to provide pain relief to this growing, horrendously under-served segment of our population who have already been already properly diagnosed with a chronic pain or anxiety condition.  The millions who have discovered what has popularly come to be referred to as the Online Consultation Service will tell their tales on these pages. Many of these accounts are destined to be forwarded to enlighten our lawmakers and who have mostly been greatly mis-informed and has so far ignored the chronic pain patient's aching needs.

Quite likely, most of what you've read in the visual & print media about "Internet Medicine", consists of gross distortions of what passes for "fact" in a media designed to maximize the "entertainment" value in too many of the stories it reports. Like the fortunate among us who have so far enjoyed pain-free lives through the grace of our Creator, our electorate has to be similarly exposed to the real story surrounding Internet Medicine.  It is a fact that very little "reporting" has been done on what some brave doctors and other medical personnel have done to fill the void left by PCP's who are truly afraid of DEA or legal repercussions from adequately treating their patients.  Again, most of the media harps on a few relatively rare situations that the media finds it easy to

Having navigated the world of traditional medical methods toward providing adequate pain relief, we can almost predict the reports that people will present.  However We'll refrain here from becoming redundant.

We'd be remiss to omit the fact that there are charlatans, fakers and diverters to be found to be found in Telemedicine at the medical provider and patient level.  However, at least as much of this same level of abuse can be found at the traditional 'brick & mortar' level of practice, in greater levels than can be found through Online Consultation Services.

Over three decades ago, the methods of abuse were quite similar.  Individuals with the disease of addiction knowing what "buttons to push" to obtain multiple prescriptions from multiple sources.  Similarly doctors complied willingly abusing an under-audited Medicaid system designed for poor Americans to receive free medical treatment - "Medicaid Mills" they were called and are likely to still be rampant.  I don't recall any significant efforts by Law Enforcement or other regulatory agencies to stem this abuse of taxpayer money.

Now, the Internet equivalent is called a "pill mill", a term that could apply to either a web entity or any brick and mortar "medical practice"  Ironically, at this point in time, there are relatively few websites that could openly operate as "pill mills" on the Internet for long.   We describe in great detail, what today's typical OCS is like in terms of standards; standards that with today's technology openly incorporated, could easily avoid erroneously serving all but the savviest of fraudulent individuals. 

With regulation, not elimination (the latter being the DEA's announced goal, the honest Telemedicine Providers could easily meet were it not for constant, unwarranted harassment from the DEA.  The true online "pill mill" is quite rare, if they even exist at all after The Telemedicine Industry, much through self-policing efforts of their own has all but eliminated, at least on US shores. 

Most of what constitutes the oft-repeated mantra, "Dangerous drugs can be had with a single click of the mouse" are in actuality frauds designed to separate the desperate pain patient from his/her money and of course, provide NO medication of the variety advertised.  Ironically, this is not something the DEA will pursue since no medication is involved when people are defrauded with the promise of medication.  Many frauds operate along this line.  In fact, if the DEA has its way and eliminates legally compliant Online Medicine whose Doctors and pharmacies are not hiding, what will be left?  Counterfeit medication scams, outright fraud through promising looking websites whose only intent is to steal and perhaps some truly "rogue" Internet Operations who cannot be regulated and will happily "skip town" should they fall under the "heat" of DEA investigation.  Then we'll have a self-fulfilling prophecy where only criminal operations will prevail and the promise of Telemedicine, which is not currently illegal will be lost.....

However, after our long introduction, below are accounts of folks who support and in many cases have benefited significantly from the availability of Online Consultation Services.

Telemedicine Patient Letters And Comments:

We lead of with a meticulously written letter by a chronic pain patient who put it through many re-writes until it cogently made the points the writer intended:

I decided to write a letter to all the '08' Presidential Candidates, in both parties, asking them a question, "What is your view on the treatment (or lack there of) of Chronic Pain Patients and what are you willing to do to help us? To help us have any chance at a “normal” life?" But also explaining a bit about CPP before asking.

Anyway, here is the letter that is getting sent to 15 of the candidates. I also figure it would be a good letter for Senatorial and Congressional elections too with a few changes.

Feel free to use this as a guide or template to write your our if you want.

And if I get any replies (though I really don't expect too. ), I'll let ya'll know who did and what they said, as well as who didn't bother.

Quote:
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MY NAME
ADDRESS
E-MAIL

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DATE

CANDIDATES NAME
ADDRESS

Dear________________,

I’m writing you with a very important question. But first the reasons for the question.

I feel very strongly about many of the “Key” issues in the upcoming ‘08' election. But there is another issue which is even more important to me (and 75 Million other American voters), than any other issue in my lifetime.
That issue is the treatment of Chronic Pain Patients in this country. Chronic Pain IS a disability. Yet I/we are untreated, under-treated, ignored, patronized and more often than not, treated like criminals and addicts.
The reasons for this all go back to the DEA and the now severely warped, seriously wrong, “War on Drugs”.
When this “War” started it had a very noble intent. However now, that nobility is sadly long gone. The DEA is now wrongly targeting doctors and their prescribing of opioid pain medications as well as some pharmacies.

Yes, as in any situation, there have been some doctors and patients who have been guilty of abuse. But it is wrong to punish an entire population and industry for the abuse of a few.
Doctors are now so fearful of the DEA (or what is called, “The Chilling Effect”) shutting down their practices and taking away their licenses, that they either under-treat and/or under-prescribe, if they’ll treat and/or prescribe at all.

When they do prescribe medication, it’s non-opioid medication which actually can be far more harmful to the body, with far more serious side effects. Such as liver damage, seizures, even the risk of sterilization!

Because of this many of the 75 Million Untreated and/or Under-Treated Chronic Pain sufferers in the U.S. have turned to Telemedicine or more precisely "Online Consulting Services" (OCS) for help. And it has been a godsend! But the DEA is now also targeting them and the pharmacies they use.

However, so unlike the “Rouge” Pharmacies you read/hear about in the news, these Online Medical Practices utilize fully licensed and qualified medical doctors and similarly licensed pharmacies. Patients are required to submit substantial frequently updated medical records indicating they suffer with an already diagnosed chronic pain causing condition.

The patient's identity is verified and ongoing phone consultations take place between patient and doctor before there is any possibility that a conservative amount of Schedule III or IV medication is prescribed. In fact, the one-on-one telephone consultations result in far more thorough conversations than most family doctors provide.

I suffer from Degenerative Disc Disease and Double Sciatica, along with having bone spurs in my neck from a lifetime of working hard and caring for most of my older family til they passed on and am in pain every waking moment of every day. This has a major impact on my quality of life. I find that even a simple task such as doing dishes causes me an increase in pain, numbness and spasms in my back and overall body.

However my doctor has said, “I won’t lose my licence for you”, when asked to prescribe proper pain medication and /or the proper amount of medication. I was told to, “live with it”.

When terminally ill cancer patients are only given Tylenol or Advil to deal with their extreme end of life pain, something is very, very wrong! Do your homework. You’ll find it’s true.
 
I would also suggest you check out a book written by John Flannery titled, “Pain In America - and how our government makes it worse”. Mr. Flannery is a former federal prosecutor from New York and a former Capitol Hill counsel, now in private practice. He has represented physicians and patients from across the nation and can describe this injustice far better than I can. His book is a must-read for anyone who cares about this public health crisis in our country. Or anyone who treats or suffers from chronic pain, who knows anyone who may suffer from chronic pain. And to inform them of this grave injustice, to explain what we must do to protect ourselves. To explain the constitutional rights that are at stake! Because if we are not vigilant, we may wake up to find that these critical constitutional rights no longer exist! His book describes, among other things, how the DEA has posed as patients and gone into doctors offices with false medical records, for the sole purpose of getting opioid pain medications prescribe to them, so they can arrest and prosecute the doctors whose only crime is a desire to heal their patients' persistent pain.

Now for my question:

What is your view on the treatment (or lack there of) of Chronic Pain Patients and what are you willing to do to help us? To help us have any chance at a “normal” life?

Your response will help me (and 75 Million other American voters) decide where our votes will go in ‘08'. Just so you know. This letter and your response, or no response, will be posted on several different web sites.

Thank you for your time.

Sincerely;

NAME

Originally published on epharmacywatch.com by a fellow chronic pain sufferer - 2007

Remember, no matter what burdens each of us must endure, there are those throughout the world suffering far worse on a regular basis.  Consider yourself lucky to live in the wealthiest country in the world.

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This letter was originally written and received some publicity back in 2004 when similar bills were put before the House and Senate.  The bills ended up 'stalling'.

Dear Rep. ______,

Re: Bill HR 380 Pharmaceutical Market Access and Drug Safety Act of 2007

While there is a good argument for enacting guidelines to deal with some of the questionable practices of the "rogue pharmacies" proliferating on the internet, I fear, along with millions of other chronic pain patients, that another breed of Telemedicine Provider may also fall victim to blanket prohibitions against prescribing over the Internet.

While hardly mentioned in the media and not referred to at all during the House debate on Telemedicine, there are hundreds of low key Telemedicine Providers which have emerged to meet the needs of the uninsured, the housebound and working folks who cannot take days off from work to devote to doctor visits in this fragile economy.

These Telemedicine Providers do use fully licensed doctors to prescribe and licensed pharmacies to dispense. These providers have found their niche in treating those with chronic pain or anxiety conditions which have been documented previously at "brick and mortar" medical facilities. Before issuing a prescription, these on-line doctors are in possession of patient records, diagnoses and tests, often a home visit report from a port-a-medic, age and identity verification and their impressions of the patient through frequent telephone consultations. Contrary to the popular misconception, these telephone consultations consist of as much detail as a typical office visit to a busy clinic or urgent care facility. The average patient visiting a medical office in person may spend several hours on the premises, but most of that time is spent waiting. The patient may actually only see the doctor for five minutes or even less. Aside from the brief "face to face" aspect, it is hard to imagine how these visits differ substantially from a telephone consultation with a Telemedicine provider who is able to give his/her full attention to the patient during that same or longer period. As web-cams become more prevalent in American households, I see them becoming an adjunct to the practice of Telemedicine.

Responsible Telemedicine Providers do not wish to deal with drug seekers and often tailor their questions specifically to weed out the recreational user. All of us are adults who suffer with intractable pain and are mindful of the potential dangers associated with strong pain relievers and take great care in using medicine judiciously. Chronic pain patients who work cannot take off from work on a monthly basis to obtain needed medications. Many Americans if they are lucky, get 6 to 8 discretionary days off a year with pay. Millions more simply lose a day's pay if they must visit a doctor and many of these people have no medical insurance to cover frequent visits either.

In short, these Telemedicine Providers are not guilty of any of the sins which HR 380 would attempt to eliminate.

1) There are no Schedule II drugs being sold on-line through websites. There is no Oxycontin, Percodan or Ritalin being sold by any Online Pharmacy in the US despite what the spam in your inbox may claim. Those who claim such are scams designed to take your money as are so many pieces of spam email we routinely dispose of.

2) With the verifications in place through the serious Telemedicine Providers, I am hard pressed to imagine a minor getting through these checks to illicitly obtain medication.

3) Patients of Telemedicine Providers tend to be knowledgeable about their chronic conditions and are likely to quickly notice counterfeit medications or any other suspicious practices and quickly spread the news through Internet channels which would cost the rogue Telemedicine Provider its clientele.

Just as most other fields have benefited from a presence on the Internet, so should Telemedicine. An outright ban will leave operating only those truly rogue sites that are beyond the reach of the law or are willing to disregard it.

In summation, the majority of the situations which HR 380 claims to remedy do not apply to what might be called the full-consult Telemedicine Providers who strive ambitiously to keep up-to-date with ever changing and sometimes confusing laws while providing a needed convenience to millions of Americans.

If those Telemedicine Providers who are willing to comply with reasonable safeguards (and there are many that you've heard little about) must close their doors, an ugly black market will emerge to take their place. The best of the US Telemedicine Providers make no secrets about their locations, doctors or pharmacies and are within the reach of the agencies like the FDA and DEA to monitor their compliance with required legalities. They are also quite eager to comply with applicable law while at the same time being able to treat the growing number of older Americans who are faced with everyday chronic pain. Please take these factors into consideration when contemplating your vote on HR 380, the `Pharmaceutical Market Access and Drug Safety Act of 2007'

  The letter below was submitted by a visitor who was outraged at the regurgitated canards, hyperbole and sensationalism that continually are dragged out by both the Television Media for the periodic grab for a ratings gambit.  The print media reports the same ill-researched stories to titillate readers periodically when nothing else is available to fill the page.

The broadcast that outraged this visitor who wrote the letter below was in response to the typical "kids, internet, drugs" sound bite that's a sure ratings draw, this time CBS TV News "cobbled" together the story with little regard to the actual facts.  While I personally did not see the broadcast, the content of these "exposes" has become so predictable that I can say in all honesty I missed nothing by not watching.  I'm willing to bet a full week of the sporadic Chronic Pain relief that I'm lucky to receive that I could recite all the so-called "information" that was presented as irrefutable fact during this broadcast.  It's amazing the reporters aren't accused of plagiarism since the same third-hand facts are presented over and over again as though they are "breaking news".

The writer decided to send this spot-on email to ABC TV News Reporter John Stossel since he has the reputation of being a maverick reporter who has shown himself to go against the status quo.  Additionally, working for a competing TV Network, one would think he'd be eager to do the real research to present a counterpoint that truly shows the plight of the Chronic Pain patient in America and how the Online Consultation Services arose to fill an immense void in health maintenance so grossly overlooked by the Medical Industry.

Since I was informed that no response was received from Mr. Stossel, the email may be sent next to Michael Moore, the well known gadfly film maker whose most recent film, Sicko tackled many of the inadequacies with America's approach to Health Care for its citizens.  Perhaps Mr. Moore will be inclined to look into another glaring gap in the US Health Care Industry, the needless suffering of the burgeoning population of Chronic Pain patients so overlooked by traditional 'Brick & Mortar Medical Practices.

From a reader of this site who chooses to maintain anonymity at this time:

CBS did a story on 05/16/2007 in regards to people buying prescription drugs online and the story was stating that with a simple click of your mouse you can get Schedule II narcotics over the internet. It sympathized with the Ryan Hait situation where the kid bought drugs online and then OD'd. As part of a community of people who buy prescription drugs online to control chronic pain from legitimate diagnosis such as Multiple Sclerosis, Rheumatoid Arthritis, Lupus, and others, we would like to speak out against this one-sided story and we would like to tell the truth.

You CANNOT purchase schedule II narcotics over the internet. And to get things such as hydrocodone and valuim, you must follow a strict set of rules, show copies of photo id's, and IF you receive this medication, you must be 21 years of age to sign for it and it must be a direct signature.

We invite you to give us the chance to tell it like it is. The DEA's war on drugs makes chronic pain sufferers victims by their misdirected tactics to stop drugs in America. Instead of going after legitimate situations, they pick on doctors, patients, and pharmacies and even pharmacy suppliers! We are tired of being misunderstood and targeted as drug addicts. Give us a chance to tell our story.

Please honor my wishes at this point and time to remain anonymous. I know my name will show up in my email, but I want to remain anonymous at this juncture.

Thank you for your time.

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