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I’m sure you know that some people with chronic lower back pain have had multiple spine surgeries, aracnoditis from multiple epidural steroids, or inoperable spinal nerve or cord compression from arthritis or disc disease. Sometimes people with kidney disease, allergies, DM etc and shouldn’t take NSAIDS. All of the non opiate treatment such as back surgery for chronic pain, epidurals, PT, psych do not show sustained long term benefit. People with chronic pain have typically tried and failed with these modalities, not just once, but over and over. So, the advice to try yoga, cognitive behavioral therapy and take an ibuprofen is ignorant and insulting to these patients. Just the time of crap you’d expect from bureaucrats and politicians.

That being said the use of opiates for chronic pain is over. With most pain clinics closing, doctors going to prison and the remaining pain clinics avoiding opioid prescribing, there will be no studies on the use of opiates in chronic pain. We will never know the right doses and the best ways to use these medicines because of wreckless manner the federal government has intervened by excessively criminalizing this medical and public health controversy. Residents will not go into pain management (even interventional only) because the field has been tarnished forever. Those going into other specialties will stipulate that they won’t have to prescribe opiates. The government will continue their march on prosecuting prescribers for amphetamine and benzodiazepines. My advice to psychiatrists and family doctors that prescribe these drugs for ADHD and anxiety disorders is to get out right now before you’re raided.

I really think that doctors will just give up their DEA numbers except anesthesiologists in the OR, addictionologists for Suboxone, oncologists, and some surgeons might still need to prescribe after major surgery.