Position Paper of the Silver Star Families of America on Opioid Use

Position Paper of the Silver Star Families of America

The Honorable Chairman Johnny Isakson United States Senate Committee on Veterans' Affairs Russell Senate Building - Room 412 Washington, D.C. 20510-6050

The Honorable David J. Shulkin Secretary of Veterans Affairs 810 Vermont Avenue, NW Washington, DC 20420

The War on Opioids

The Silver Star Families of America, the SSFOA, is well aware of the dangers of opioids in all their various forms and, for the most part, agrees with the new federal and state guidelines that are tightening up the distribution of the drugs as long as it does not adversely affect the veteran population. https://www.cdc.gov/mmwr/volumes/65/rr/rr6501e1.htm

There was a time when V.A. doctors were trusted to use good judgment in the prescribing of opioids. While a few may have over prescribed most others were thoughtful and cautioned patients about abuse and prescribed opioids judiciously.

The DEA changed the rules in October, 2014 when they moved hydrocodone combination pain relievers (HCPs) like Norco and Vicodin from Schedule III to Schedule II. That meant no more electronic prescriptions to pharmacies and doctors could not call in a prescription. Each prescription was good for only one month. That meant it was much harder for veterans suffering from severe chronic pain to access opioids.

What exactly is an opioid? “Opioids are a powerful class of painkillers derived from opium that come from the poppy plant. These drugs, which come in pill or liquid form, are available by prescription.” These drugs include:

Hydrocodone (Vicodin)

Oxycodone (OxyContin, Percocet)

Morphine (Kadian, Avinza)

Codeine and related drugs

Heroin

http://www.lifescript.com/health/briefs/l/list_of_opioids.aspx

In this new “war on drugs” it must be remembered that veterans are a distinct group that does not necessarily reflect the same demographic as civilians. Many veterans suffer from horrendous injuries, both seen and unseen. We must proceed with the utmost caution before we succumb to “opioid paranoia” and withdrawn pain medication from those that need it.

The V.A. has reported that approximately 60 percent of military personnel returning from deployments in the Middle East and 50 percent of older veterans suffer from chronic pain. These rates exceed the reported 30 percent national average of chronic pain within the general American population.

https://www.addictionhope.com/blog/veterans-ptsd-addiction/

What we need to do is actually ask the people affected by the new guidelines what they think. And who are the people affected most----chronic pain sufferers. (See links at the end of this article)

https://www.merriam-webster.com/dictionary/chronic

Many doctors, including V.A. physicians are becoming more and more reluctant to prescribe any opioids, and/or are reducing the amount of the pain killers even as they more closely monitor patients. Monitoring can include giving urine tests, more frequent trips to the doctor and counselling. Problematic for some veterans if they must drive long distances for their primary care. And I’m not at all sure how well the “urine drug” tests will go over. Veterans are not children.

So how about the alternatives to opioids? The Veterans Administrations List of alternatives include things like biofeedback, acupuncture, cognitive behavioral therapy, alternative physical therapies including yoga.

https://www.pbm.va.gov/PBM/AcademicDetailingService/Documents/Academic_Detailing_Educational_Material_Catalog/Pain_ChronicPainProviderEducationalGuide_IB101000.pdf

And here is another situation where the government has not done its homework. Many Christians do not believe that yoga is acceptable:

“What does the term “yoga” actually means. “According to tradition, ‘yoga’ means ‘union,’ the union…of the finite ‘jiva’ (transitory self) with the infinite’…Brahman’ (eternal Self).” “Brahman” is a term often used for the Hindu concept of “God,” or Ultimate Reality. It is an impersonal, divine substance that “pervades, envelops, and underlies everything.” Courtesy: Michael Gleghorn https://probe.org/yoga-and-christianity-are-they-compatible/

“Yoga has demonic roots and it can’t be separated from Hinduism. You can’t put a Christian name tag on it and call it Christian.” http://biblereasons.com/yoga/

Ok. Let’s try acupuncture:

“Acupuncture is said to work because needles stimulate acupuncture points, releasing a flow of energy called qi, or chi. Acupuncture is a complementary medical practice that entails stimulating certain points on the body, most often with a needle penetrating the skin, to alleviate pain or to help treat various health conditions.” https://www.livescience.com/29494-acupuncture.html

Not sure you want your “qi” or “chi” releasing a flow of energy? Read on:

“In early 2009, the British Medical Journal published a new analysis of acupuncture for pain … with discouraging results. More recently and dramatically, the journal Pain did it again — one of the top ten journals for pain and injury science. In early 2011, Pain published a thorough and rather harsh scientific smack down of acupuncture, concluding that there is “little truly convincing evidence that acupuncture is effective in reducing pain, “or anything else. In 2016, acupuncture was officially scorned in the NICE guidelines for back pain, with the recommendation “do not offer.”

https://www.painscience.com/articles/acupuncture-for-pain.php

https://osteofm.com/2016/12/06/new-nice-guidelines-november-2016/

How about cognitive behavioral therapy?

The diagram depicts how emotions, thoughts, and behaviors all influence each other. The triangle in the middle represents CBT's tenet that all humans' core beliefs can be summed up in three categories: self, others, future

CBT focuses on the development of personal coping strategies that target solving current problems and changing unhelpful patterns in cognitions (e.g. thoughts, beliefs, and attitudes), behaviors, and emotional regulation. (How does this reduce pain?)

https://en.wikipedia.org/wiki/Cognitive_behavioral_therapy

So let’s review:

The Veterans Administration is now asking veterans who are in severe pain, to give up/reduce pain medications and as an alternative, try yoga which may violate Christian principles, or to release our “chi,” or treat the pain by changing “thoughts-behavior- and emotion or whatever the new/old fad might be. Poor choices for someone in real pain.

Should we just tell a veteran to rub some dirt on it and take a lap?

We give the V.A. credit because even with its short comings, we believe they are still ahead of the curve in research and development of pain management. https://www.research.va.gov/topics/pain.cfm

However there are many examples of the V.A. studies that show even they are not sure of their findings. Note below:

Veteran’s Opioid doses and risk of suicide

In a 2016 study, researchers with the VA Ann Arbor Healthcare System and University of Michigan found that Veterans receiving the highest doses of opioid painkillers were more than twice as likely to die by suicide, compared with those receiving the lowest doses.

The research team looked at nearly 124,000 Veterans who received VA care in 2004 and 2005. All had non-cancer chronic pain and received prescriptions for opioids. Using the National Death Index, the researchers identified 2,601 patients who died by suicide before the end of 2009.

They found that the suicide risk rose as dose increased. The researchers could not tell, however, whether there was a direct causal link between the pain medications and suicide risk. Instead, the high doses may be a marker for other factors that drive suicide, including unresolved severe chronic pain.

In other words a veteran suicide might be because he is in constant severe pain.

Conclusions

Again the Silver Star Families of America is aware of the dangers in opioid use. However it is strongly suggested that before someone is refused pain medication or that pain medication is reduced or eliminated, that careful consideration of the patient’s pain levels be taken into consideration.

The VA can’t afford to launch these well-intended but clumsy attempts at reducing pain medications at veteran expense. The nature of military service can lead to a lifetime of physical and mental pain for veterans.

It is always wise to consider very carefully the effects of the decisions we make concerning the lives of others. Sometimes the ramifications are not foreseen.

Respectfully submitted by: Steve Newton CEO The Silver Star Families of America

http://taskandpurpose.com/the-vas-attempt-to-fight-opioid-dependence-leaves-pain-patients-cut-off/

https://www.theguardian.com/us-news/2016/jul/12/prescription-drugs-what-if-you-depend-on-opioids-chronic-pain

https://www.peoplespharmacy.com/2017/03/13/war-on-opioids-punishes-desperate-pain-patients/

https://www.cdc.gov/mmwr/volumes/65/rr/rr6501e1.htm

https://www.pbm.va.gov/PBM/AcademicDetailingService/Documents/Academic_Detailing_Educational_Material_Catalog/Pain_ChronicPainProviderEducationalGuide_IB101000.pdf

Credits:

The Department of Veterans Affairs Wikipedia Pain Science NICE Probe.org Webster Addiction Hope CDC Lifescript

Thought you all might like to see this. I would welcome comments and your experiences if you have had any. Thanks folks. Blessings

Thank you for posting this. Non-military chronic pain patients are also suffering, due to government interference with their doctor’s ability to prescribe adequate pain medication. It is heartbreaking to see a loved one suffer, because legislators have taken the advice of some group of “experts”, who have likely no experience themselves, with chronic pain, and who often aren’t even physicians, or any other medically trained discipline.

I had no idea that there was an organization trying to deal with this. Knowing it makes me feel better, for some reason.

The VA refused to renew my prescriptions for...can’t remember, but a couple of years, at least.

Suddenly they caved. I think I was on somebody’s s list, and whoever that was retired or transferred or something.

Well said. Like a lot of things they don’t think ahead.

And agreed. This affects a lot of folks

I’m so sorry you went through that. Let us know if you have anymore trouble. God bless

I absolutely agree. My brother-in-law has so many issues with chronic pain. He has to take pain meds every day. His quality of life depends on it.
The government trying to control it reminds me of gun control. The people who follow the laws are the ones paying for the wrongdoing of others. The dealers and recreational(initially) addicts will always find a way. They don’t respect the law.

I’m in a chronic pain program. I made it abundantly clear I do not do drug tests, and they don’t bother me with them. This automatically assuming every patient is a drug addict is not conducive to patient care.
Vicodin is a tool, and tools may be used for good and bad. That’s up to the user and their character.

"Thought you all might like to see this. I would welcome comments and your experiences if you have had any. Thanks folks. Blessings

I'm in my 6th week of recovery from total knee replacement. Over the last few years I've suffered greatly from arthritis and other degenerative problems in my knees. For a long while anti-inflammatory drugs like Diclofenac/Voltaren did a great job of minimizing the pain. After time I needed injections of Cortisone and then Euflexa until the only thing left were pain killers and surgery.

With every office visit for Ortho treatment I had to read and sign a paper warning about the dangers of opioids, problems with misuse and threats if I did not adhere to the guidelines. If I asked for a certain strength of the medicine, it would always be downgraded to the next level. Over the course of a year or so the warning sheets became longer, more threatening and intimidating - including that you had better not have an alcoholic drink while taking the pills. I even had to sign one of these while on a visit to the Urologist for a urinary tract infection!

Sorry to be so long with this but it really ticked me off that some government agency was in between me and my doctors. It was like the DEA was practicing medicine without a license and painting patients with legitimate needs with the same brush used for abusers.

I have my doubts that the "opioid crisis" is a bad as presented by the feds. Also it seems that many maladies are not properly treated and pain killers are just a band-aid, not a fix. Big Brother seems to have no remedy for the supposed "opioid crisis" other than intimidation of patients in need and coercion of the medical professionals who treat them.

Thank you so much for your input. And I agree. Blessings

Humm. I agree thank you

Opioids are mind-altering. You start with legitimate pain issues, but wind up with bigger and bigger problems than just pain.

I know from experience, the medical field needs to improve greatly, in not narcotic treatment of pain.