Ohio’s New Opioid Regs Scare Chronic Pain Sufferers

[Flagg]

NBCNews.com

Chronic Pain Sufferers Are Scared by Ohio’s New Opioid Rules
by Corky Siemaszko

Chronic pain sufferers fear they could become casualties in the war on Ohio's opioid overdose epidemic.
They say recent moves by Gov. John Kasich to fight the plague by restricting how many painkillers can be prescribed will add to their anguish — and could force them to go underground to find the relief they need to make it through a day.
"We are being punished for being in pain," said Amy Monahan-Curtis, 44, who has been living in agony since 1993 due to condition called cervical dystonia that causes her neck muscles to contract involuntarily.

Monahan-Curtis, who lives in Cincinnati, said limiting painkiller prescriptions for adults to just seven days at a time, as Ohio now does, means "an additional financial burden is being placed on the pain patient if a primary doctor will write a prescription to pay for multiple scripts."
"What these regulations are doing is forcing pain patients out of terror and extreme pain to the street, to find something to control their pain," she said. "Legislators are making the drug problem much worse."
Monahan-Curtis said she already follows strict rules laid out in the "narcotic contract" she signed when she enrolled in a pain management clinic, including having to submit to random urine samples.
"I can be called into the office at any time in between my monthly appointments, asked to bring in my narcotics bottle for a count to see if I have an appropriate amount left and am not selling them or taking too many," she said.

And if her meds are lost or stolen, Monahan-Curtis said, "they will not be replaced."
Kasich, when he made his announcement last week, said the new rules don't apply to patients who already take painkillers for things like cancer or to treat dying patients receiving hospice care.
"We have tried to make it as clear as possible that this is not aimed at chronic pain sufferers," said Cameron McNamee at Ohio's state Board of Pharmacy.
A guide put out by Kasich's administration clearly states that "the limits only apply to the treatment of acute pain."
"I suspect what may have caused some confusion is that two pieces of legislation that do address chronic pain dropped a day before Gov. Kasich made his announcement," McNamee said. "I can tell you with 100 percent certainty that the rules proposed by the governor are not aimed at persons who suffer from chronic pain. Those individuals will still be able to get their appropriate medications."
Monahan-Curtis said she doesn't believe it. She said the online message boards for chronic pain sufferers lit up after Kasich unveiled the restrictions.
"Doctors are already feeling this pressure not to prescribe pain medications," she said. "What I am hearing is people are already being turned away. They are not getting medications. They are not even being seen. "
Ashley Marie MacDonald, who has been living in constant pain since a falling bookcase crushed her foot in 2011, echoed those concerns.

"I understand that there is a drug epidemic, but by doing this it is affecting people like me," said MacDonald, 28, of Cincinnati.

MacDonald suffers from a malady called complex regional pain syndrome, that she says makes her feel "like I've been lit on fire and have barbed wire around my skin." Workers' compensation pays for her visit with a pain management specialist every 28 days.
But under Kasich's order, MacDonald fears patients like her will have to make more frequent visits and pay $150 out of pocket every time. She said she's got barely enough money now to survive. But the alternative is a horror she knows all too well.
"I had to recently go to court to fight for my medicine because workers comp got some doctor who never met me and said I don't need my medicine," she said. "So I went without for several days."
What happened? "I could not get off the couch because the pain was unimaginable," she said.
MacDonald said even before Kasich's order pain patients were treated like criminals.
"You're looked at suspiciously all the time," she said. "You feel as if you are being treated like an addict. I don't know how treating people like us like criminals will help stop the opioid epidemic. I'm not taking meds to get high, I am taking them to survive."

"I do not believe that making it harder for people is going to solve this opiate crisis," added 29-year-old Christa Whighstel of Columbus, Ohio, who suffers from the same syndrome as MacDonald.
Whighstel said the unintended consequence of Kasich's rule is likely to be pain patients "jumping ship and getting addicted to the illegal stuff."
"It will force people to go over to the other side," she said. "They just want to live their lives without pain."

While the deadly scourge of fentanyl-laced heroin cutting through Rust Belt states like Ohio has made headlines of late, the number of fatal overdoses from opioids that can be purchased with a prescription like oxycodone, hydrocodone, and methadone "have more than quadrupled since 1999," according to the federal Centers for Disease Control and Prevention.
During that same time period, the amount of prescription opioids sold in the U.S. also quadrupled, according to the CDC.
In 2013 alone a quarter billion prescriptions were written, which equates to "enough for every American to have their own bottle of pills," the agency reported.
Even if used correctly the CDC reported, "anyone who takes prescription opioids can become addicted to them."
"In fact, as many as one in four patients receiving long-term opioid therapy in a primary care setting struggles with opioid addiction," according to the CDC. "Once addicted, it can be hard to stop. In 2014, nearly two million Americans either abused or were dependent on prescription opioid pain relievers."
Even before Kasich made his announcement, Ohio in January 2016 released new prescription painkiller guidelines recommending that people suffering short-term pain from surgery or injuries should be given alternatives whenever possible.
Among the alternatives suggested by

Quack

Dr. Mary DiOrio, medical director for the state Department of Health, were ice, heat, wraps, stretching, massage therapy, acupuncture,

physical therapy and non-addictive medicines like ibuprofen.

What if you're allergic to every OTC painkiller except Tylenol you dumb quack cunt?

"Nobody wants to punish people with chronic pain," Dr. Michael Kelley of the Ohio Health hospital system told NBC News. "But at the same time we don't want to develop more addicts."
Asked why the chronic pain community isn't getting the message that they are not being targeted, Kelley said, "I don't know for sure."
"From the very start we were clear that doctors should responsibly treat people with chronic pain," Kelley said. "But some doctors are starting to feel a little bit paranoid about the different laws. I think, sometimes, they're over-concerned."

Coming as early as September, Ohio will be able to offer chronic pain patients another alternative — medical marijuana.
"There is some evidence it works for chronic pain," said Kelley. "There is also some evidence it may be a way to treat people who are addicted to opiates."

This hits a personal chord with me because I've been treated like some piece of shit junky wanting a fix in the ER only to have them find a suture in my stomach the next day when the did an endoscopy. I also had a doctor screaming bloody murder at me, calling me a drug seeker when all I wanted was something for nausea despite the agony I was in. Then, because my mom had been up for 36 hours and she was very tired the bitch saw that he eyes were red and asked her why and all but called her a fucking junkie and if I had eaten in the last 12 days I'd likely have knocked the bitch out.

In fact a year ago last December when I broke my hand the ER thundercunt bitch "Doctor" gave me 2 extra strength Tylenol and said I needed to see my PCP without so much as giving me at least a splint, let alone a cast.

[Sea Skimmer]

The fact remains that the US consumes 80% of the entire world production of opiod, while Canada and Western Europe with a similar population and better access to healthcare consume 15%. So either apparently the whole rest of the world lives in impossible pain, or the US has a massive drug problem.

[General Zod]

The fact remains that the US consumes 80% of the entire world production of opiod, while Canada and Western Europe with a similar population and better access to healthcare consume 15%. So either apparently the whole rest of the world lives in impossible pain, or the US has a massive drug problem.

Or they have a functional healthcare system that's able to prevent conditions from progressing to the point that opiate addiction would ever be a problem.

[Napoleon the Clown]

The fact remains that the US consumes 80% of the entire world production of opiod, while Canada and Western Europe with a similar population and better access to healthcare consume 15%. So either apparently the whole rest of the world lives in impossible pain, or the US has a massive drug problem.

Or they have a functional healthcare system that's able to prevent conditions from progressing to the point that opiate addiction would ever be a problem.

And rehab is more accessible. That's likely a thing, too. I am guessing most opiod overdoses are not chronic pain sufferers.

[General Zod]

The fact remains that the US consumes 80% of the entire world production of opiod, while Canada and Western Europe with a similar population and better access to healthcare consume 15%. So either apparently the whole rest of the world lives in impossible pain, or the US has a massive drug problem.

Or they have a functional healthcare system that's able to prevent conditions from progressing to the point that opiate addiction would ever be a problem.

And rehab is more accessible. That's likely a thing, too. I am guessing most opiod overdoses are not chronic pain sufferers.

I've read recent studies that suggest ten days is all it takes to develop an opiate addiction. So maybe they didn't start off as chronic pain sufferers but wound up developing an addiction because of Doctor over prescription.

[Napoleon the Clown]

I've read recent studies that suggest ten days is all it takes to develop an opiate addiction. So maybe they didn't start off as chronic pain sufferers but wound up developing an addiction because of Doctor over prescription.

From what I have witnessed, that sounds about right. Opiates give a feeling that most people seem to quite like, and that in and of itself increases the risk of someone trying to get more.

In my opinion, the answer to the opiate epidemic, if we want to call it that, is to make sure everyone can afford rehab and that they have no fear of legal consequences for trying to deal with their addiction. Long-term it would be good to get society to be a bit more compassionate toward addiction without going so far in that direction as to consider addiction to not be a problem at all. But treating it as a moral failing is not helpful, I don't think. I can see some value in restricting how many doses/days can be prescribed, though in cases where chronic pain can be diagnosed there would also need to be a little bit more leeway in how much can be prescribed at once.

Successfully finding a drug that can manage pain effectively without the same risks as opiates would be fantastic, but I suspect it will also prove incredibly difficult. If it were easy someone would have found it by now.

[Terralthra]

Also, there're massive connections between the USA's poor social safety net, poverty, income inequality, and opioid usage.

[NecronLord]

The fact remains that the US consumes 80% of the entire world production of opiod, while Canada and Western Europe with a similar population and better access to healthcare consume 15%. So either apparently the whole rest of the world lives in impossible pain, or the US has a massive drug problem.

Or they have a functional healthcare system that's able to prevent conditions from progressing to the point that opiate addiction would ever be a problem.

BINGBINGBING

I've got a friend in the US who has various health problems, but just this week she had a serious hernia that requires surgery.

Although she has insurance, she cannot afford the spends on the surgery, so she's going to have to try and live with it and hope it doesn't kill her instantly. She's going to have to wait and hope it gets bad enough that she'll get some flavor of absolute-emergency help.

If she lived in England, she'd be in for a priority surgery and getting it fixed.

So she needs painkillers, lots of them. For a very, very long time.

[Alyrium Denryle]

Or they have a functional healthcare system that's able to prevent conditions from progressing to the point that opiate addiction would ever be a problem.

And rehab is more accessible. That's likely a thing, too. I am guessing most opiod overdoses are not chronic pain sufferers.

I've read recent studies that suggest ten days is all it takes to develop an opiate addiction. So maybe they didn't start off as chronic pain sufferers but wound up developing an addiction because of Doctor over prescription.

Here's the deal. Person A has a chronic pain condition. Maybe from an injury, maybe a nerve disorder, any number of things. Their body cannot actually handle that on their own, it produces its own endogenous opioids, but they are not enough. In comes the opiate medication, binding to the same receptor and making the horrible agony go away. Without it, they are in agony. With it, eventually their body stops producing its own opioids and they become physically dependent. Yet... they would be dependent on them anyway even if their bodies still produced its own endogenous opioides, because they have nerve damage (or whatever) that causes pain their bodies cannot adapt to.

So calling them addicts is, at that point, completely meaningless.

[mr friendly guy]

Does the US deal in chronic pain clinics? A lot of these clinics try to wean people off opiods due to losing their effectiveness over prolong use and try some other agents eg gabapentin.

[General Zod]

I've read recent studies that suggest ten days is all it takes to develop an opiate addiction. So maybe they didn't start off as chronic pain sufferers but wound up developing an addiction because of Doctor over prescription.

From what I have witnessed, that sounds about right. Opiates give a feeling that most people seem to quite like, and that in and of itself increases the risk of someone trying to get more.

In my opinion, the answer to the opiate epidemic, if we want to call it that, is to make sure everyone can afford rehab and that they have no fear of legal consequences for trying to deal with their addiction. Long-term it would be good to get society to be a bit more compassionate toward addiction without going so far in that direction as to consider addiction to not be a problem at all. But treating it as a moral failing is not helpful, I don't think. I can see some value in restricting how many doses/days can be prescribed, though in cases where chronic pain can be diagnosed there would also need to be a little bit more leeway in how much can be prescribed at once.

Successfully finding a drug that can manage pain effectively without the same risks as opiates would be fantastic, but I suspect it will also prove incredibly difficult. If it were easy someone would have found it by now.

We've made a decent push with using marijuana and THC to manage chronic pain, but thanks to still being a schedule 1 drug we're really limited in that regard. There's also been some research into non-addictive opiate alternatives but anything from that is years out.

[Broomstick]

Does the US deal in chronic pain clinics? A lot of these clinics try to wean people off opiods due to losing their effectiveness over prolong use and try some other agents eg gabapentin.

Yes, there are "chronic pain clinics" but their actual quality varies considerably. Some of them are little better than legalized drug dealers that do nothing to try to treat the pain with means besides pills (even if pills are still needed, additional therapies can provide additional relief or reduce the quantity of medication needed, which lessens side effects). Some of them assume the primary problem is addiction not pain and treat people with chronic conditions requiring treatment as nothing more than junkies that need to be de-toxed. A lot seem to assume people with chronic medical conditions are lying criminals that need stringent controls. Some of them have monitoring requirements at odds with the medical conditions people suffer from (demanding people come considerable distance at no notice for drug testing when the person in question is not able to drive, for example).

High quality actual pain clinics are not as common as people think.

In other words, the US sucks at the treatment of chronic pain.

[General Zod]

I've read recent studies that suggest ten days is all it takes to develop an opiate addiction. So maybe they didn't start off as chronic pain sufferers but wound up developing an addiction because of Doctor over prescription.

From what I have witnessed, that sounds about right. Opiates give a feeling that most people seem to quite like, and that in and of itself increases the risk of someone trying to get more.

In my opinion, the answer to the opiate epidemic, if we want to call it that, is to make sure everyone can afford rehab and that they have no fear of legal consequences for trying to deal with their addiction. Long-term it would be good to get society to be a bit more compassionate toward addiction without going so far in that direction as to consider addiction to not be a problem at all. But treating it as a moral failing is not helpful, I don't think. I can see some value in restricting how many doses/days can be prescribed, though in cases where chronic pain can be diagnosed there would also need to be a little bit more leeway in how much can be prescribed at once.

Successfully finding a drug that can manage pain effectively without the same risks as opiates would be fantastic, but I suspect it will also prove incredibly difficult. If it were easy someone would have found it by now.

We've made a decent push with using marijuana and THC to manage chronic pain, but thanks to still being a schedule 1 drug we're really limited in that regard. There's also been some research into non-addictive opiate alternatives but anything from that is years out.

https://arstechnica.com/science/2016/09 ... -primates/

[Civil War Man]

Does the US deal in chronic pain clinics? A lot of these clinics try to wean people off opiods due to losing their effectiveness over prolong use and try some other agents eg gabapentin.

A former client of mine was a chronic pain doctor. Turns out that he was basically just in the business of feeding opiates to junkies. Some time after we dropped him as a client, he ended up losing his license after several people died from overdoses on his watch, and he was recently nailed for multiple counts of fraud, a lot of it involving charging Medicare for procedures he wasn't doing and then using the money to buy a multi-million dollar house. Unfortunately he was able to keep up the charade that he was actually helping people for a couple years before he was caught.

Fortunately that guy is not the norm, but the fact that he was able to profit off other people's misery, albeit temporarily, shows just how fucked up the system can be.

[Flagg]

There's a difference between being physically addicted to opioids (not getting a dose for about 16-24 hrs and thus going into withdrawal which includes such fun things as nausea/vomiting, diarrhea, seeing and feeling various things crawling on walls/your body, and feeling overall that death would be better than it continuing) and being psychologically addicted, where the sole reason you take them is to get high (and to stave off withdrawal).

What's happening right now in this country is that just 3-5 years ago opioids were given out like candy (even moreso if you were rich like that pus-filled abscess near the tip of America's penis, Rush Limbaugh) and then the DEA decided they would rather have people die from heroin overdoses rather than OD's from idiots who abuse the drugs prescribed by a physician.

I got hooked on the crap in 2005 when I was in the hospital for 6 weeks and on my first night had the head nurse, floor nurse, and every free nurse in my room telling me that I was to take my pain meds every 4 hours on the dot or my doctor would hear about it.

But with my current situation, if I don't get pain meds I can't eat or drink due to the sheer agony.

Plus, with illegal drug users, comes illegal drug dealers, distributors, and smugglers who are great to bust because the local cops, state cops, and DEA (who get the bulk) all get a cut of the money and assets (which are auctioned off unless whoever is being accused of the crime can prove before a judge that the money and/or assets weren't the proceeds of the sale of illegal drugs. And you can thank the RICO statutes for turning the whole "innocent until proven guilty" thing on its head.
And yes, there are tons of stories of completely innocent mostly black people getting large amounts of cash from their bank in order to buy a car or boat from a seller who will only take cash, getting pulled over due to driving while black, the cop is given the OK to search the car, finds the cash, and seizes it because they "don't believe the driver" and give them a receipt with the amount stolen at gunpoint seized and instructing them on how to attempt to get it back.
That means going before a judge with some kind of proof that the money was obtained legally and if the judge finds that the money should be returned, they have to take the order to the police agency that seized it and if they're lucky they'll get some of if back. Usually it's been "lost" and it takes years of litigation to get it back.

That's why the FDA, which colludes with the DEA moved marijuana up to a schedule 1 drug, essentially saying it's more addictive than cocaine and just as addictive as heroin, which is fucking ridiculous.

[Flagg]

Does the US deal in chronic pain clinics? A lot of these clinics try to wean people off opiods due to losing their effectiveness over prolong use and try some other agents eg gabapentin.

I was going to one for almost a year because my former PCP had me on a really stupid high dose, and the goal was just to get me down to the lowest level that still controlled the pain.

Then, because the Doctor that owned the fucking clinic (and one in California) prescribed to 18 people who OD'd and was committing Medicaid fraud, so they got raided by the DEA and the state and closed down, which fucked all of the people with pain pumps who needed monthly refills. I was lucky enough to have a nre PCP that after a few months got me to the right levels.

[FireNexus]

The fact remains that the US consumes 80% of the entire world production of opiod, while Canada and Western Europe with a similar population and better access to healthcare consume 15%. So either apparently the whole rest of the world lives in impossible pain, or the US has a massive drug problem.

Is that prescription only? Because Canada and the US also make mild opioids like codeine OTC, so you get codeine for mild pain and only get the big boys from your doc if shit goes really bad.

That said, the better access to healthcare is probably a contributor to the lower use of opioids. People who get regular and adequate medical care will be less likely to have chronic pain.

[FireNexus]

Does the US deal in chronic pain clinics? A lot of these clinics try to wean people off opiods due to losing their effectiveness over prolong use and try some other agents eg gabapentin.

I was going to one for almost a year because my former PCP had me on a really stupid high dose, and the goal was just to get me down to the lowest level that still controlled the pain.

Then, because the Doctor that owned the fucking clinic (and one in California) prescribed to 18 people who OD'd and was committing Medicaid fraud, so they got raided by the DEA and the state and closed down, which fucked all of the people with pain pumps who needed monthly refills. I was lucky enough to have a nre PCP that after a few months got me to the right levels.

Yeah, it's pretty rough. But friendly is right. The reason that opiates for chronic pain are being restricted is because the belief that bey actually have a meaningful benefit over the long term for chronic pain is a bunch of marketing bullshit. They more or less just oversensitize you to pain, and they make your problem worse when you can't keep increasing or worse have to decrease your dose.

With any luck, though, the mythical tolerance-free opioids are already in clinical trials and we can have our cake and eat it too. Though even they are probably going to do a number on all-cause mortality given the relation of pain to avoiding harmful shit.

[FireNexus]

That's why the FDA, which colludes with the DEA moved marijuana up to a schedule 1 drug, essentially saying it's more addictive than cocaine and just as addictive as heroin, which is fucking ridiculous.

That's sort of not at all true. Marijuana was scheduled by the Controlled Substances Act, I want to say of 71 but the year could be off, which implemented the scheduling system in the first place. The DEA was given authority by that act to schedule and reschedule drugs on an emergency basis pending congressional approval. They always get it, the exception being BZP and TMFPP, which were emergency scheduled in 2002ish and never formally scheduled so you can buy them now.

The FDA's involvement is mostly to say whether a drug can be sold for human consumption. There is a burden of research which the scheduling system makes prohibitive for marijuana to do that. Do we're in a catch 22 of high potential for abuse (which is true, as far as it goes) but no accepted medical use, and no accepted medical use because we can't do the research.

You'll often hear that meth and cocaine are schedule 2 (accepted medical use) which is true. Cocaine has the dual benefit of being a local anarthetic and a vasoconstrictor, so where you need to numb a patient and also control bleeding (eye surgery is pretty much the extent of it) you can't live without it. Methamphetamine is needed for some cases of narcolepsy, some ADD (I would love to see if desoxyn works better than Vyvanse with less side effects, but I may as well ask for a prescription for Vietnamese hookers) and intractable morbid obesity. Those indications were mostly well-established before the CSA.

TLDR: FDA doesn't schedule, and the scheduling was done by ConGress. As we're the earlier attempts at prohibition which predate the schedules

[General Zod]

The FDA's involvement is mostly to say whether a drug can be sold for human consumption. There is a burden of research which the scheduling system makes prohibitive for marijuana to do that. Do we're in a catch 22 of high potential for abuse (which is true, as far as it goes) but no accepted medical use, and no accepted medical use because we can't do the research.

What high potential? I've never heard of anyone dying from marijuana withdrawal.

[FireNexus]

The FDA's involvement is mostly to say whether a drug can be sold for human consumption. There is a burden of research which the scheduling system makes prohibitive for marijuana to do that. Do we're in a catch 22 of high potential for abuse (which is true, as far as it goes) but no accepted medical use, and no accepted medical use because we can't do the research.

What high potential? I've never heard of anyone dying from marijuana withdrawal.

Abuse is not the same as addiction. It's fuzzy, but abuse is more or less "getting recreationally intoxicated" which is why alcohol is explicitly excluded from the CSA.

[General Zod]

The FDA's involvement is mostly to say whether a drug can be sold for human consumption. There is a burden of research which the scheduling system makes prohibitive for marijuana to do that. Do we're in a catch 22 of high potential for abuse (which is true, as far as it goes) but no accepted medical use, and no accepted medical use because we can't do the research.

What high potential? I've never heard of anyone dying from marijuana withdrawal.

Abuse is not the same as addiction. It's fuzzy, but abuse is more or less "getting recreationally intoxicated" which is why alcohol is explicitly excluded from the CSA.

That sounds like bullshit to me, because what's getting drunk except recreational intoxication?

[Broomstick]

There's a difference between being physically addicted to opioids (not getting a dose for about 16-24 hrs and thus going into withdrawal which includes such fun things as nausea/vomiting, diarrhea, seeing and feeling various things crawling on walls/your body, and feeling overall that death would be better than it continuing) and being psychologically addicted, where the sole reason you take them is to get high (and to stave off withdrawal).

If you want to be technically correct, what you refer to as "physically addicted" is properly referred to as being physically dependent and the psychological problem is addiction.

And yes, the distinction is important. There are a lot of medications that result in physical dependence in addition to opiates, such as long-term corticosteroids, that can provoke serious withdrawal symptoms. Yet those medications are not stigmatized as opiates are. That's a strictly social distinction, that physical dependence/tolerance of opiates is all too often seen as a moral failing while an equal or greater dependence on corticosteroids carries no such burden.

Is that prescription only? Because Canada and the US also make mild opioids like codeine OTC, so you get codeine for mild pain and only get the big boys from your doc if shit goes really bad.

Codeine is NOT over the counter in the US. It invariably requires a prescription.

That said, the better access to healthcare is probably a contributor to the lower use of opioids. People who get regular and adequate medical care will be less likely to have chronic pain.

People who get regular and adequate medical care will also more likely have access to things like physical therapy, or surgery, or other treatments that, as I noted, can assist in the treatment of chronic conditions of all sorts and reduce, even if not eliminate, the need for painkillers.

You'll often hear that meth and cocaine are schedule 2 (accepted medical use) which is true. Cocaine has the dual benefit of being a local anarthetic and a vasoconstrictor, so where you need to numb a patient and also control bleeding (eye surgery is pretty much the extent of it) you can't live without it.

Actually, cocaine is useful for all sorts of head surgery, especially on the face during cosmetic or reconstructive surgery, because as we all know head wounds bleed like a son of a bitch. Probably also has uses with any highly vascularized tissue.

The downside is the over-the-top security required of any facility that uses it, because you inevitably have to dispose of any excess or expired doses, and theft is a real concern.

[FireNexus]

snippy quote

I meant Canada and Europe have OTC codeine, and lower rates of prescription opioids consumption. My fault.

[Flagg]

Does the US deal in chronic pain clinics? A lot of these clinics try to wean people off opiods due to losing their effectiveness over prolong use and try some other agents eg gabapentin.

Yes, there are "chronic pain clinics" but their actual quality varies considerably. Some of them are little better than legalized drug dealers that do nothing to try to treat the pain with means besides pills (even if pills are still needed, additional therapies can provide additional relief or reduce the quantity of medication needed, which lessens side effects). Some of them assume the primary problem is addiction not pain and treat people with chronic conditions requiring treatment as nothing more than junkies that need to be de-toxed. A lot seem to assume people with chronic medical conditions are lying criminals that need stringent controls. Some of them have monitoring requirements at odds with the medical conditions people suffer from (demanding people come considerable distance at no notice for drug testing when the person in question is not able to drive, for example).

High quality actual pain clinics are not as common as people think.

In other words, the US sucks at the treatment of chronic pain.

Truer words have never been spoken. The worst clinics are the ones that treat people like me as criminals (despite just looking at my abdomen and saying, "Umm, that guy has a solid 4" sticking out where it shouldn't be, I don't think he's looking for drugs to get high") not to mention the myriad of other issues I have (which in a case of "so goddamned incompetently stupid I have to laugh or I'll cry" they never sent for the records despite me filling out 3 record releases on my first 2 visits).

Yet apparently the place functioned as a goddamned pill mill if you had the cash. Cocksucker.