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Jul-14-2011 20:50printcomments

Washington State is Front-Runner in Ending the 'Over-Treatment' of Pain in the U.S.

"A man has to live with himself, and he should see to it that he always has good company." Charles Evans Hughes (11th Chief Justice of the U.S. 1862 - 1948)

Map of Washington

(MYRTLE BEACH, S.C.) - This month, the State of Washington will begin implementing new regulations for physicians and prescribers who treat their chronic pain patients with opiates. Those responsible for the law say it is meant to provide patients with better pain care -- and importantly to prevent increasing overdose deaths. Although the law is being met with resistance by pain societies funded by pharmaceutical companies who market the "undertreatment of pain in the US" in order to keep opioids flowing freely to pain patients addicted for many years to opioids.

Kristi Weeks is director of the offices of legal services for the State Department of Health in Washington. Weeks stated "What we're concentrating on right now is the provider population so that we can educate them about the rules and kind of quell some of the panic or the knee jerk reactions that are happening out in the community and really help them understand you can treat these patients. This is not a barrier."

Health clinics in the state recommend to patients that there are ways to deal with pain other than using narcotics — things like physical therapy, yoga, massage or acupuncture. Or over–the–counter pain meds like ibuprofen or Tylenol. But most of these treatments are not covered by Medicaid because they aren't clinically proven.

Dr. Jeff Thompson is the Chief Medical Officer for Washington State Medicaid and he advised "I think people who have chronic pain do sometimes need narcotics, including long–acting narcotics, and I think what we're trying to say is, what is the dose that will maximize their function and minimize their pain. But when we get up to these extremely high doses I have to look at the numbers and say we have a death every day from a long–acting opiate prescription in Medicaid. There's about 350 deaths per year and that keeps going up and we need to bend that curve down."

Thompson admits the new law makes it difficult for some patients. But in the end it's a matter of providing good care.

A couple of years ago, a physician named Michael Schiesser contacted me to advocate together. He referred me to a radio transcript of an interview he did with another physician after Purdue Pharma, the maker of OxyContin was convicted in Federal Court of misleading physicians and patients about the addictive qualities of their blockbuster, multi-billion dollar plus drug. Dr. Schiesser had formed a group called The Washington Pain Alliance (WPA) -- "a diverse group of stakeholders who affect or are affected by pain care. Led by the WPA Council, the alliance identifies and addresses gaps in information and areas of need in the current pain care climate. All Washington state organizations and individuals are invited to participate in the WPA and each participant has an equal voice and equal platform from which to raise and address issues related to pain care in Washington state." Here is the radio transcript from 2007 sent to me by Dr. Schiesser:

How easy is it to develop a dependence on opiates

Mon, 08/06/2007 - 4:40am — Health Dimensions

The following is part II of a radio interview Dr Schiesser Performed with Dr Marvin Seppela

Dr. Michael Schiesser: Welcome back to "Health Dimensions" this morning. I'm here once again with Dr. Marvin Seppala, who is the medical director for Beyond Addiction, in Beaverton, Oregon.

And I want to remind people to, really, take a chance to visit the "Turn to Help" website. "Turn to Help" is a resource for persons with addiction to prescription painkillers, or street drugs that are also opiates, like heroin, and it's also a resource for their families. And it has lots of modules for whatever level of recovery you're in, including never even seen a doctor for this problem.

Dr. Seppala, tell our listeners a little bit about how difficult it is to get on these medications.

Dr. Marvin Seppala: Well, it's remarkably easy to get on these medications, and that's part of the problem. When I talk about the opiate pain medications, I always say that it's the good and the bad news. They work extremely well. They're remarkable medications for pain, and they're the best thing we have going. When people need them, after a broken leg or a surgery or some other kind of pain, they're a godsend.

On the other hand, they are extremely rewarding medications. And as a result, they are highly addictive and extremely dangerous. And basically, people have this sense of safety because they're prescribed medications. It's as if, "Well, I got it from my doctor. It can't be that bad."

But the truth is, all of these opiate pain medications are basically of the same class of drugs. So when we say heroin, people often kind of shudder in fear of that awful drug, but it's basically the same thing as morphine, as OxyContin, as Vicodin; just, you have to inject heroin, and it works very rapidly. But with OxyContin, you could crush it and snort it, and it works extremely rapidly, and it's just as dangerous, as is Vicodin.

And so it's remarkably easy to obtain them. People get them going to their doctor, for any kind of pain.

And in fact, a friend of mine, an anesthesiologist at the Mayo Clinic, told me that he was giving a talk on drug addiction and the ease at which people can obtain these medications, and doing it at one of their outlying clinics in southern Minnesota.

And he went and talked with the head of the clinic, who described to him a really unfortunate tale, that a 13-year old boy came into his office with his mother, and he learned from the mother that this boy had just been picked up for dealing OxyContin at school, actually selling it to his friends. And this physician asked him, "Well, where do you get this OxyContin?" And he said, "I get it right here at your clinic."

Dr. Schiesser: Oh, my gosh.

Dr. Seppala: Yeah. "I can come in here, and I can complain of a sprained ankle or a sore back. They started with Vicodin, and then they started giving me OxyContin. And that's what I tell them works."

Dr. Schiesser: Did you hear about the recent ruling against the executives of the manufacture of the OxyContin tablets?

Dr. Seppala: Yes, I did. And I was glad to see that, because of the inaccurate information that they provided to us, physicians and the public, about the risk of that medication.

Dr. Schiesser: For our listeners, the Purdue Pharma Company, the makers of OxyContin, were convicted of conspiracy to deceive physicians around the addictive potential of OxyContin, which is a sustained-release oxycodone prescription painkiller, and were fined, I think, $650 million, the executives were.

And this is relatively unprecedented, I think, in this particular community, as far as pain management, because there is a strong movement right now to increase treatment for pain, and as you said, very appropriately. But also, we're seeing such a surge in addiction, to OxyContin in particular, that it was, I think, good news, as far as I'm concerned.

Dr. Seppala: Yeah, I agree. And it was interesting, I'm on the board of the American Society of Addiction Medicine, and I got an email from a fellow board member that showed pictures of the three main figures in that lawsuit from Purdue Pharma. One of them was a physician who had actually been at our annual ACM meetings, at a pain and addiction course, for several years running, up until the problems began, related to that lawsuit.

And so there was an infiltration, so to speak, of someone really promoting a drug for relief of pain at an addiction conference, where people were trying to figure out how to address pain in those that are addicted, or determine when addiction results from the treatment of pain.

It's unfortunate that they took the tack they did, because I think we need to have pain relief, and we also need to understand addiction and how to address that. And I think they were coming in on the side of revenue. [laughs] Make as much money as they can selling this medication.

Well, Dr. Seppala, I appreciate you coming on our show this morning.

My guest today has been Dr. Marvin Seppala, who is the medical director from Beyond Addiction, in Beaverton, Oregon. We've been talking about addiction. And I want to remind listeners to view the website for more information on treating some of the problems that we've been discussing on today's show.

Thank you, Dr. Seppala.

In a follow-up email to me, Dr. Schiesser said "You will see from this discussion, we are all on the same page as far as our opinion of the OC (OxyContin) manufacturer."

I recently looked at Dr. Schiesser's Washington Pain Alliance and was stunned to read that he is now working together with the American Pain Foundation - the lobbying group of Purdue Pharma (also funded by Purdue Pharma).  And proudly at the bottom of the Washington Pain Alliance website, are the words -- The Washington Pain Alliance is a project of the American Pain Foundation. View a list of APF supporters

In December 2010, I suspected that Dr. Schiesser had been enticed by Purdue Pharma to come over to the dark side and join the ranks of a $10 billion criminally convicted pharmaceutical company and their lobbying group, I questioned the good doctor by email about his association with them.  I received an email that read "When traveling this Odyssey, ironies show up everywhere."

The word "ironies" did not come to mind for me -- the words "dancing with the devil" do though.

LP - A wasp on the windshield will always make me proud that we walk together down our paths.  You are truly the teacher, the gardener and the doctor -- but more importantly your words touch so many.  I cherish you.

___________________________________ Reporter Marianne Skolek, is an Activist for Victims of OxyContin and Purdue Pharma throughout the United States and Canada. In July 2007, she testified against Purdue Pharma in Federal Court in Virginia at the sentencing of their three CEO's - Michael Friedman, Howard Udell and Paul Goldenheim - who pleaded guilty to charges of marketing OxyContin as less likely to be addictive or abused to physicians and patients. She also testified against Purdue Pharma at a Judiciary Hearing of the U.S. Senate in July 2007. Marianne works with government agencies and private attorneys in having a voice for her daughter Jill, who died in 2002 after being prescribed OxyContin, as well as the voice for scores of victims of OxyContin. She has been involved in her work for the past 8-1/2 years and is currently working on a book that exposes Purdue Pharma for their continued criminal marketing of OxyContin.

Marianne is a nurse having graduated in 1991 as president of her graduating class. She also has a Paralegal certification. Marianne served on a Community Service Board for the Courier News, a Gannet newspaper in NJ writing articles predominantly regarding AIDS patients and their emotional issues. She was awarded a Community Service Award in 1993 by the Hunterdon County, NJ HIV/AIDS Task Force in recognition of and appreciation for the donated time, energy and love in facilitating a Support Group for persons with HIV/AIDS.

Marianne Skolek
National Activist for Victims of OxyContin and
Purdue Pharma - a criminally convicted pharmaceutical company
Staff Writer,

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Douglas Benson July 19, 2011 9:41 am (Pacific time)

One of the biggest reasons Marc Emery is in prison now is not because he sold seeds but because he used the profits to fund treatment using ibogaine [look up the rolling stone article ],and funding legalization efforts . Anon. dont act like this treatment isnt intense and needs to have constant supervision of the patient . Peace

LM July 16, 2011 10:42 am (Pacific time)

So...this is all well and good...but the article tells me nothing about HOW doctors WILL treat their patients without the drugs. Do they plan on actually studying up on pain therapy perhaps? You mean truly LEARNING about pain and all the symptoms and what works and what doesn't?? I sincerely doubt it. All this does is close off another door for those in Chronic Pain. I am NOT in favor of using narcotic drugs myself for pain relief though I live with severe chronic pain 24/7, but there are those that truly need it. If only because their physicians will do nothing else. They do not refer their patients to pain clinics where a QUALIFIED pain doctor can watch and care for the patient. To make a patient suffer in pain is cruel. I understand the concern of addiction, but at what point will the medical field quit playing games with the patients and begin taking their pain for what it is, P-A-I-N, real and hurtful. As far as I have seen, most doctors seem to get aggravated with a patient that has chronic pain (when they can't "cure" it) and instead of working towards a better solution, they either push off the patient into the insane world of seeing multiple docs that don't communicate with each other (which btw causes more pain, in case those docs didn't realize that)or they simply set them aside with a narcotic drug as a pacifier. I understand that this "law" is to stop those docs that do exactly that, pacify some patients with drugs...but there needs to be a firm alternative for that same doctor to NOT push off the patient into the insane world of seeing multiple docs that don't communicate with each other, let alone care about the patient. I've seen plenty of these types of physicians....all it does is makes the patient weary and in more pain from the frustration and the lack of being cared for and being listened to.

Anonymous July 15, 2011 12:57 pm (Pacific time)

Ibogaine cured a close loved one of my of a two year heroin addiction...Now 1 year clean. Since then, thru advocating Ibogaine, I know personally of 6 more who were cured. In 7 days. You can also go to youtube and type in "Ibogaine"..hundreds of testimonials from real people, not a P.R. campaign..In fact, to PROVE its not a P.R. campaign, the pharma lobbyists made sure that Ibogaine is illegal in the U.S. You have to go to Mexico. Ibogaine is a natural root that grows in the ground, no GMO or pharma, just a natural root. No Deaths, but some VERY RARE light side effects, so best to be in a clinic environment for basics. Whyis this amazing natural cure illegal in the U.S? because the pharma industry wants it that way...the military industrial complex running opium out of afghanistan want it that way...and the "for-profit prisons want it that way, and our current presidential administration is a whore to the above mentioned. Same with the bush's/clinton etc. Ron Paul 2012 for goodness sakes.

Douglas Benson July 15, 2011 8:25 am (Pacific time)

So Washington is going to pass a state law that is contrary to the recent sup. court dec. ? Providers must treat pain adequately. So how does this jive with that mandate from the courts and dont you think the and patients will cry foul? When I go for pain meds [which I hate by the way ] Im in so much pain the vicodin they give me takes the edge off and thats it. Physical therapy ,doesnt help me much unless you count the ultrasonic massage . The whole point is patients shouldnt have to fight with their doctors for real pain relief . I have a friend on morphine who has to call every friday for the doctor to fill his script and many times he has to wait till monday to get it leaving him in pain and suffering from withdrawal. Personally I think its vindictive because he bugs them so much . Addiction is terrible but for some there isnt much of a choice . There must be some way to find the middle ground . Peace

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Sean Flynn was a photojournalist in Vietnam, taken captive in 1970 in Cambodia and never seen again.


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