Wednesday, June 20, 2012

How the War on Rx-Drugs Victimizes Pain Patients

In the NewsIn a battle against prescription drug abuse and diversion, primarily involving opioid pain relievers, the U.S. Drug Enforcement Agency (DEA) has launched attacks on wholesalers and pharmacies within the legitimate supply chain. Questions are being raised about the foresight of such tactics, as healthcare providers are becoming leery of prescribing and severe shortages of these vital analgesics loom over the horizon. In the end, patients with pain may become collateral damage in this “War on Rx-Drugs.”

According to a recent report from Reuters news service [“U.S. War on Drugs Moves to Pharmacy from Jungle”; June 16, 2012, here], in response to ever-increasing concerns about the diversion of prescription pain relievers to illegitimate use, the DEA has beefed up its efforts at deterrence and is deploying many of the tactics it uses to combat illegal drugs, such as wire taps, undercover operations, and informants.

Such efforts have helped it dismantle many “pill mills” — bogus pain clinics writing thousands of questionable prescriptions — as well as rogue Internet pharmacies. However, the agency is now applying the same tactics to prosecute the legitimate pharmaceutical supply chain, including wholesalers and pharmacies that must follow strict record-keeping and security rules to prevent drug diversion.

Tactical Maneuvering

During the past few years, according to the Reuters report, the DEA has stepped up its inspections and levied millions of dollars in fines against drug wholesalers for what it claimed were breaches of the rules. Last February, the DEA suspended the license of drug wholesaler Cardinal Health Inc. to sell opioid analgesics and other controlled substances from its center in Lakeland, Florida. The DEA said the wholesaler had failed to detect suspicious order volume from several of its pharmacy customers.

Under a settlement, Cardinal agreed not to ship controlled substances from that facility for 2 years. Then, shortly afterward, the DEA raided two CVS pharmacies and issued inspection warrants at a half-dozen Walgreens drugstores and a Walgreens distribution center.

DEA Administrator Michele Leonhart has defended the actions as essential for combating prescription drug abuse and diversion. But critics say that applying the same strong-arm tactics to the legitimate supply chain as to Colombian drug lords is ineffective and is also causing supply shortages that harm patients with pain.

“Going after a pharmaceutical [distributor] is not like going after the Medellin cartel,” said Adam Fein of Pembroke Consulting. “I don’t believe it is appropriate for the DEA to shrink the supply of prescription drugs, because it has unanticipated effects that have nothing to do with the problem.”

However, the DEA has come under increasing pressure from Congress to show it is containing the diversion problem. Leonhart claims that the best benchmarks of the agency’s success should be the disruption and destruction of the organizations and the networks feeding the problems, so the agency is going in that direction. The DEA has expanded its use of tactical squads, combining special agents, diversion investigators, and local law enforcement officers to track down and prosecute prescription drug dealers.

Still, the Reuters report observes, “sending in tactical diversion squads to break up pill mills does not address the leaks occurring from medicine cabinets at home or the drugs passed along from friends and family. That is one reason the DEA is attempting to squeeze supplies at the wholesale level.”

John Coleman, a former DEA chief of operations, comments that “Going after Cardinal has sent shivers up the distributor grapevine.” Along with that, “close a CVS pharmacy in Florida, and I guarantee every pharmacy within 500 miles will be checking their records,” he says.

Fears Running Rampant

Pharmacists confirm that they are indeed fearful, Reuters reports, with some being reluctant to accept new customers requiring prescription analgesics. Others will only accept patients within a certain geographic area or refuse to accept cash.

“We turn away five or six people a day,” said Steven Nelson, owner of a discount drugstore in Okeechobee, Florida, and chairman of governmental affairs for the Florida Pharmacy Association. Even large chains are leery:

  • Walgreens spokesman Michael Polzin said that after looking into everything going on in Florida, “we’ve decided not to comment on our operations there at this time.”

  • CVS pharmacies across Florida stopped filling prescriptions written by 22 of the top-prescribing physicians, pending a review of their dispensing practices. The company declined to elaborate on its actions, except to say that it will continue to monitor prescriptions for controlled substances and is “committed to supporting efforts to prevent drug abuse and keep controlled substances out of the wrong hands.”

Physicians are equally fearful, according to Reuters. Many have increased patient monitoring, which means more urine tests, more documentation, and more frequent “pill count” checks, where patients must go to the prescriber’s office with their pill bottles to prove they have not sold or misused their medication.

“Every hour of the day I have concerns I’ll be audited, that my ability to take care of my patients and my family can be taken away, and I’m as legitimate as you can get,” said one prescriber who has a private orthopedic practice in Florida. “You’re constantly watching over your shoulder and it takes a toll,” he told Reuters news.

Slashing Supplies, Raising Questions

During the past 5 years, Cardinal has cut supplies of controlled substances to more than 375 customers nationwide, including 180 pharmacies in Florida, Reuters reports. Other wholesalers are similarly cautious; AmerisourceBergen Corp. now monitors orders for suspicious increases of 20% to 30% in volume.

All of those involved — wholesalers, pharmacists, prescribers — claim they want to help curtail abuse, but DEA rules have not always been clear. Meanwhile, the DEA’s Leonhart rejects that notion, claiming the agency has repeatedly communicated its requirements in meetings and presentations.

But John Burke, president of the nonprofit National Association of Drug Diversion Investigators (NADDI), says the DEA behaves as though those it monitors are the enemy. “The mindset is, these are folks we have to keep at arm’s length,” he told Reuters.

The DEA’s strategy is also prompting new questions from Congress. Reuters reports that Senators Chuck Grassley of Iowa and Sheldon Whitehouse of Rhode Island asked the GAO (Government Accountability Office) to study whether the agency’s actions are contributing to shortages of medications for pain patients.

Others say the DEA should not be in the business of regulating industry at all. Scott Gottlieb, former deputy commissioner of the Food and Drug Administration (FDA), publicly criticized the DEA for attacking prescription drug problems in the same way it pursues criminal drug cartels. “The problem is, the DEA may be the wrong enforcer here. It’s very difficult to separate appropriate use from illicit use with law-enforcement tools alone,” Gottlieb wrote in the Wall Street Journal [“The DEA’s War on Pharmacies—and Pain Patients”; March 22, 2012; here].

The DEA’s confrontation with wholesalers and pharmacies follows public concerns about who has been responsible for shortages of many critical drugs within the healthcare system nationwide. The Reuters report notes that the DEA strictly controls the amount of an ingredient in a potentially addictive drug that its manufacturer can obtain each year, based on the projected needs of legitimate patients. Manufacturers have claimed that the agency does not always authorize enough material in time for them to amply supply customers with products. The DEA counters that shortages are resulting from unspecified poor business decisions made by the companies.

Meanwhile, the Reuters report observes, patients with pain, unable to access a needed supply of prescribed analgesics, are struggling to function. Substitute pain medications often are inadequate and even those are becoming scarce.

COMMENTARY: An Unintended Public Health Crisis

The above article adapted from Reuters news pretty much tells the tale of how the war on illicit drugs in America has shifted to a war on prescription pain-relievers, namely opioid analgesics, in which patients with chronic pain are becoming collateral damage. What has happened in Florida may be only a harbinger of what is to come around the country, and in other countries.

The aggressive tactics being initiated by government regulatory and law enforcement agencies against legitimate operations within the pharmaceutical supply chain — wholesalers, pharmacies, prescribers — seem unprecedented in American history. One can hardly blame these businesses and healthcare providers for their fears, motivating them to drastically curtail product prescribing, dispensing, and distribution rather than risk being shut down entirely. Perhaps, this is exactly what the government intended to happen.

Clearly, the bellwether victims in this “war” are patients with chronic pain whose ongoing access to essential pain-relievers has disintegrated or is increasingly threatened. Next, however, there could be supply shortages of vital opioid analgesics even for treating acute pain conditions — a broken bone, surgical wound, and the like — or severe cancer-related pain; an unimaginable but looming possibility.

Decision-makers and leaders at all levels of government owe it to the public to consider the long-term consequences of actions today that could incur extensive and unnecessary suffering tomorrow. There is no doubt that problems of Rx-drug misuse, abuse, overdose, and diversion are real, of considerable magnitude, and of great significance. However, the government’s shortsighted efforts to quickly stem those problems may end up causing an enduring public health crisis of extraordinary proportions.

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48 comments:

Pain With Dignity said...

This is an article that is frightening but it really gives only a glimpse of the disastrous impact the current "war" by the DEA has on people who suffer chronic pain. It is an attack on an already devastated group of patients who are already held hostage by their disease. The DEA seems to have adopted the policy and tactics of slay hostage and criminal alike and the drug problem will go away. They are using attack by proxy, using their powers to "target" doctors and pharmacists (and probably dentists in the near future) where the real TARGET is the pain sufferer! Beyond the impact on medication usage, doctors have resorted to unprecedented use of implanted stimulators which have tenuous scientific support in patients with true chronic intractable pain! Doctors and pharmacists are going to fear not only the DEA but the patients who will make them targets of the wrath of the DEA and other regulators. The only safe haven will be to ignore people who suffer!

Anonymous said...

Thank you Pain-Topics & Dr. Leavitt, for always keeping us informed. Even when it is news that we would rather not know to be true. I am really struggling with all the latest in the war on pain patients, and I know I'm not alone. Living with severe chronic pain is a life that is already incredibly difficult, limited, and scary. As patients, we feel vulnerable to begin with. No one wants to rely on opioid medication to survive, function, and maintain some semblance of a life. For many of us, who have not responded to other treatments, and have intractable pain, we have few choices. For chronic pain patients who rely on opioid therapy, to KNOW that we have such opposition from our own government to have reliable access to pain relief, is simply terrifying. Are we all just fakers and junkies? With groups like PROP, parading around telling us to take Tylenol, and spouting UNscientific, "evidence" based theories that opioid therapy for CNCP doesn't work, is dangerous, and everyone gets "opioid Induced Hyperalgesia" is scary enough! To know that the DEA is so misguided as to think that limiting legitimate access to medication will solve the "pain pill" problem is simply INSANE. Patients who take opioids for legitimate severe pain do not get "high", and they don't give their pills away or sell them. They simply have less pain, more sleep, the ability to perform tasks, and have a little better quality of life. The thought of going to my pharmacy one day, and being told, "sorry, we don't carry that medicine anymore" or "there is a national shortage" is terrifying. Especially so, because it was intentional! The bottom line is, we suffer already..... a lot. The people that this will impact, are the people who are legally, medically, intended to use it. People abusing opioids, will just switch to something else! Or....they will go into withdrawal, and have lots of support for their addiction, and be put on a maintenance drug, and move on with their lives! WE DON'T HAVE THAT OPTION! We have real PAIN that needs to be treated, and if other non-opioid treatments worked for us exclusively, we wouldn't be taking opioids! The reality of what is happening to pain patients all over this country is a disgrace & it's spreading fast.... I cannot believe the misfortune that has fallen upon pain patients. We have horrible, diagnosed, severe pain conditions....... and in the great US of A, we are being abused and abandoned by our own government. THIS is our new reality, and we thought it sucked before.

SB. Leavitt, MA, PhD said...

Thank you, for the above comments. It seems clear, in comments to various UPDATES, how patients with pain feel about what is happening.

Persons with chronic pain of some sort number 100+ million in the U.S., so it is surprising that Congressional leaders and opinion-makers have not paid more attention and been more sensitive to their concerns. A day of reckoning could come if all of those citizens affected by heartless government actions regarding pain treatment ever unite as a consolidated voting block.

It also is surprising that we receive so few comments from healthcare providers regarding these issues. Have they been completely silenced by regulators and enforcement agencies? Are they oblivious to the issues? Or, do they simply not care? Hmmmmm….

Reta Russell Houghton said...

Dr. Leavitt.
I think you have heard so little from healthcare providers is fear. The DEA is a government sanctioned bully that is allowed to pick on business, healthcare providers and pain patients without any fear of reprimand. Doctors fear commenting create a DEA flag on them and possible action.

This reminds me of the movie, Absence of Malice. A newspaper report destroys the lives of several people trying to get at the truth from a bogus tip given to her by a federal prosecutor. When the man at the center of the story asks about responsibilty the newspaper claims the stories were print with an absence of malice. The DEA is like the Miami newspaper, on a mission (although misguided). They may claim it is being done without malice and only to protect the public but there are far too many victims for this to be true.

Anonymous said...

Excellent comments! I think many in the health care field do not care. That is why there are few comments by health care providers. Unfortunately, no one "gets" chronic pain unless and until it happens to them personally. If we do not protect the rights of pain patients now, there will be no relief for pain patients in the future. We must vigorously defend our rights to access pain relief! Write your elected representatives.

Anonymous said...

Thank you!!

Anonymous said...

I believe as a chronic pain patient, that the medical community is too scared to bring this up for fear of being the next 'targeted' group, especially in FL!! It is up to the pain patients to do something, but what. Social media is practically closed to us as we do not want to advertise to others that we take these meds for fear of ostricising ourselves, and opening up ourselves to robbery etc. We have our hands tied behind our backs, and no one to scream for help. Doctors can just up and change practices, but we cannot up and change bodies. None of us want to be slaves to this medication, and studies have shown that most of us are not drug seeking addicts. This has got to stop. Already some of the best pain medications around have changed formula's to keep them from being snorted or injected. That has left a big portion of the chronic pain community unable to use these medications as they are filled with polymer glues which make many people sick. What are we left to do??

total results said...

Again, these actions end up causing me and my staff more unnecessary work, (I own and run a State Licensed Drug Alcohol Treatment Center) cost taxpayers money we do not have for police-jail-courts-property losses etc., and foremost cause pain patients to turn to street drugs.

The explosion of heroin addicted patients can be directly correlated with the ill thought out war on legal prescribed pain medications.

The same thing happened in 1994 when the Federales in Mexico confiscated all pain medications from legal pharmacies and set up their own black market. Even oncologists could not obtain pain meds for their patients and I had to have visiting Doctors bring it in with them when volunteering at our orphanages.

This ill thought out policy that is in practice here in the USA is pushing our pain management towards 3rd world standards faster than anyone realizes.

Mark MacDonald, CADCII, CDCII, CRM
Director

Linda Pedigo said...

I have had Lupus for 34 years and have taken so many NSAIDs I was told not to take even one more pill for risk of bleeding to death through my shredded stomach lining. After the birth of my 3rd son 19 years ago, I developed severe endometriosis, with bleeding through the bowel with fistulas, many pelvic infections with severe back pain and high fevers from burst errant endometrial tissue, and a web of painful scar tissue throughout the pelvic cavity that exists to this day. Over the 10 months it took to get a hysterectomy, my hematocrit had dropped to 8, and my skin was literally gray. All this with a school age child, a toddler and a newborn to care for besides my job. The biopsy report of my uterus showed pre-cancerous endometrial hyperplasia. By the time this ordeal was completed, I had developed constant pain. I remember being in the hospital and finding objects around the room to lift the sheets off my body. Instead of a pain management consult, the nurses asked me questions about spousal abuse and made mental health notes in my charts. Fast forward 14 years, & a misdiagnosed foot injury (fracture & dislocation of 4/5 of lis-franc joints) and I finally got a diagnosis of CRPS. Within 5 months, it had spread through most of my body. After 4 years, it has spread internally into my stomach. Meanwhile, the ravages of the lupus have not been silent. I have 3 ruptured lumbar discs, and 4 cervical vertebrae that are curved the wrong way, as well as disc degeneration. My immune system has attacked and destroyed my thyroid, and is now attacking my pituatary and adrenal glands and kidneys.

The McGill University Pain Scale rates the pain from the CRPS alone at 43/50; higher than almost all cancers. Since December of 2011, I have had to switch long acting opioids 3 times and short acting twice because of "shortages". My system is so delicate that these changes are very difficult to endure. The only reason I am alive and able to function at all is because I am being treated with ketamine infusions, which is also part of the "shortage". At one point, in desperation, my provider tried veterinary ketamine, which was ineffective against my pain and other torturous neurological symptoms. I couldn't help joking, "If I were a horse I would have been shot by now." I can get the same brand of peas easier than I can get the same brand of thyroid replacement, also a drug that those with impaired metabolism can be very sensitive to even slight changes.

This situation is going downhill fast. I have been asking the same questions that Dr. Leavitt asked above for a year (just ask him!) Where are our defenders? I have to rally all my strength to get dressed and sit up to type. If I could, I'd face any one of my governmental tormenters armed only with my cane. What could they do to me? Kill me? I'm already dying a slow death. Torture me? That's my life already. These people know that I exist, and many like me. They don't need to be educated, they need to be stood up to. HELP ME! HELP US! I have the courage to limp into your offices and do the painful things you tell me I must do to have a chance to see my grandchildren grow up. My own children are only 29, 21 and 19. My oldest, at 29, has medical power of attorney and has promised to honor my wishes not to keep me alive if to do so will cause me more pain. He is the most courageous of all because he already lost his father at age 15. Look our family in the internet eye and have some courage for us as well. STOP THIS MADNESS.

Anonymous said...

Linda,

Thank you SO much for sharing your story with us. You are so courageous and strong. You are also correct, that these people need to be STOOD UP TO. They DO know that people like you, and me, exist. I would love to put you in a room full of these sadists, and have them look you in the eye, and tell you that what you have had to deal with is ACCEPTABLE.

I agree too, that so many of those suffering, especially the ones who are untreated completely, are too sick and suffering to even get on to the computer, and share their experience. They are TOO weak to fight, too sick and in too much pain to argue. I have been there, so while I still can, I will keep telling people the reality of living with severe chronic pain. I hope you do to. You have a very powerful story, and you deserve to have it heard!

Anonymous said...

I have recently been told I must reduce my medication dose. A dose I have been at for 4+ years and have been stable, able to participate in life and go to work. Just a few months ago I was being pushed towards surgery, which I declined, and now I'm being told that I dont warrent the dose level I'm at and have been at for years. I have not complained. I have not asked for an increase or early refills or anything that would justify the need to cut my dose. My Dr told me flat out that it was due to the DEA and insurance companies that are sending him letters telling him that no one pain patient should be over a particular level of drug! He is afraid that if he is scrutinized by the DEA, he could be sited. I have a disc herniation and disc degeneration (which, as I've said, I was told I should have surgery to correct a few months ago) and now I'm being told that many folks can have herniations and degeneration and not be in any pain at all so apparently this invalidates MY pain! It is just insane! This is pain politics at work. I dont know what I'm going to do now-just suffer I guess!

Anonymous said...

It is RIDICULOUS to me, that doctors, DEA, Insurance Companies, etc... Make up these arbitrary dose maximums with no scientific evidence. It is also insane to tell a patient that their pain SHOULDN'T be as bad as they claim it is. Genetics play a huge role in tolerance and side effects that patients experience with medication. If a patient is on a stable dose, hasn't had an problems on it, and is getting adequate analgesia.... WHY change it? How can you significantly reduce a dose of opioid medication without causing INCREASED pain? Withdrawal? Suffering? TO ME, this is a dangerous practice....that invites patients to seek out additional pain relief.....putting them at increased RISK of overdose. It is messing with patient quality of life, Financial stability, employment, functioning, mood, sleep, and PAIN. Insurance companies want to SAVE money, and the DEA is going after the wrong people. This is SO unacceptable. How do we fight back?

Anonymous said...

I wish to express my sincere sorrow and empathy for those who are having their opiate medication cut or withdrawn due to the menacing power of the DEA and other institutions against pain patients, their physicians and allied health personnel. I know your pain and fear. I care, and I believe you. As a young girl learning the history of the holocaust, I just couldn't get my mind around how the millions of normal citizens as well as governmental policy makers, etc. could have stood by and watched what was happening and not be able to put a stop to it. How did the madness of this genocide, which occurred not in the dark ages, but within living memory of many of those reading, ever even get off the ground? We are witnessing how it happened.

Anonymous said...

This whole mess in florida is a shame,the dea needs to leave period,and floridas government officials need to be replaced,along with county reps,I can't even take my legit perscription to the local pharmacy to have it filled,they have gone too far!!! We are being treat like criminals,its sad that the dea is almost forcing us to the streets for pain relief,they mite as well arrest us all.. pist at what america was suppose to stand for what happen to that???

Anonymous said...

I've seen video footage of the opioid users being arrested early in the 20th century when the drug prohibitions began, doctors and regular working men. All of these people were turned into criminals by the government, and the government profited. Now with America's exploding prison industry and the drug war booming, the DEA has decided to push more drugs and more people into the black market. The thin guise of morality the prohibitioists hide beneath is wearing thin. Alcohol causes damage and death to many who over use, yet we saw what sort of crime prohibition breads, so we trust adults to make their own judgments. It must be the same way with pain medicine. We must be free to choose our own level of relief with a doctor acting only in an advisory role. How is it that there is a black market for pain meds when we pain sufferers can get prescriptions? Where do the drugs come from? I smell a rat. Many of the problems both social and personal for the drug addict only occur under prohibition, in fact prohibition turns chemically dependent people into criminal/ addicts. I'm sorry people get hooked on drugs that they don't need to take, but turning people into criminals is the wrong answer unless the intent is to profit from people who need drugs. The way they leave us inflicted with pain and suffering to death is heartless.

Anonymous said...

I am beyond outraged!!! Something is really wrong here. I, too, am a legit pain mgt patient who lives in Florida who cannot get my scripts filled. Pharmacies are too scared to fill them and if they can even carry narcotics, they are regulated as to how many they order. Making the supply and demand issues terrible for us, thus causing prices to go through the roof. I also find it funny that drug dealers are flourishing and still having plenty of stock, meanwhile we legit pain mgt. patients can't get our legit scripts filled. What is going on? Something is not right

Anonymous said...

I have been assaulted & Battered several times during a Burgulary of my house and business and Law Inforcement helped the Criminals get out of any arrest or prosecution. I have 12 Permanent injuries in my spine and am in pain allways and am treated like a drug addict while criminals go free.
It Makes Me Sick !

Seth Bullock said...

I just now read this Article for the First time.

I have had Intractable Back Pain & RSD in my right Arm since 1985 {from an Accident}. I was disabled from the Pain and could not work and had to move in with my Parents at age 31.

In addition to the Useless treatments that the Doctors had me go through for 4 years, I started intense research into Chronic Intractable Pain in 1985, and in 1989 I learned of Dr. Tennant's Intractable Pain Clinic Program! And I was Lucky-- his Clinic was only 15 miles from where I lived.

I have been in Dr. Tennant's Intractable Pain Program since 1989. He treats Intractable Pain with the amount of Opioids that each person needs to function in a state of 95% to 100% Pain relief!

In 1989, I was accepted into Dr. Tennant's Intractable Pain Clinic Program.

I have been taking My Legally Prescribed High Dose Opioids every day ever since 1989. I got my Life back and am a Success with my own Business and I have NEVER, ONE TIME, HAD ANY OF THE PROBLEMS THAT ALL THESE OTHER PAIN PATIENTS ARE HAVING! I ALMOST FEEL GUILTY FOR HAVING HAD NEAR 100% PAIN RELIEF FOR OVER 22 YEARS!! Occasionally, Dr. Tennant was pressured and hassled by the Insurance companies, but I NEVER EXPERIENCED anything similar to what all of you have written about!

I CAN NOT BELIEVE WHAT YOU ALL ARE GOING THROUGH! I FEEL SO SORRY FOR ALL OF YOU!!

I am not Lame. I've known since 1992 that the reason that Dr. Tennant and we Patients were not hassled like all of You have been is because he was/is one of the two Pioneer Doctors teaching safe High Dose Opioids for intractable Pain. He started his Clinic in 1975, and became a recognized World's Expert on Pain. And then in 1995, we got the California Legislature to Pass the State's "Pain Paitient's Bill of Rights" & The California Intractable Pain Laws, which the Republican Governor signed into Law!

That is You People's only Hope! You have to organize and get Your State's Laws changed! Texas Patients copied us after our success, and Texas has its own Liberal Pain-Opioids Laws.

After reading all these Unfortunate and Supremely Depressing True Stories, I am going to Double my efforts in Helping people like all of You!

All I can add here, if Dr. Leavitt will let me, is You've Got to Fight the System for your Rights to Live without Pain and for your Doctor not to be hassled for writing Opioid Prescriptions! Organize! You've got to start with Your Federal Representatives! They will respond to unrelenting Emails and actual U.S. Mail Letters! Tell them about & show them California successful "Intractable Pain" Laws! Get copies of our Laws so you can prove that You know what you are talking about!

Anonymous said...

Seth,

You are blessed, indeed! Dr. Tennant is one of my personal heros , and the intractable pain community is forever blessed with his" Intractable Pain Patient's Handbook for Survival", and many other documents and studies of his.

He is a smart, kind, compassionate man. I actually emailed him about an issue in my specific pain population, last year. I couldn't believe it when he promptly replied, personally! I wish he could be cloned. It's too bad that he isn't training the next generation of pain specialists. Unfortuneatly, there are VERY few docs like him.

I'm SO jealous that he is your doc, and that you have been able to live so pain- free. DON'T EVER MOVE! I'm thrilled for you that you found him, and have lead a successful, happy, productive life. Thanks for sharing that with us, and YES....please HELP the rest of us poor souls!

Anonymous said...

Its a tragedy to live in cronic pain and have laws trying to make it harder for good citizens to suffer more agony because of people using drugs for fun. Let them use them and if they die, its their tough luck. It should not be a doctors job to play judge on patients who are dumb enough to take drugs they don't need. The only persons who should be prosecuted is individuals who try and succeed to blame others for their misuse of drugs and often well thought out plans to obtain them. Prosecute the wrongdoers, not patients or doctors. The enticement is only a thrill for those who love to do what is wrong in the first place. Who cares if they use the drugs or drink, if they were able to buy them legally, they would not be making profits obtaining illegally and they would know who the people actually are. Give them out and keep them in a data base like now, and end of problem.

Anonymous said...

I don't understand how you cannot get legit pain meds from a doctor but yet pain killers are on every street corner in America. People are suffering while someone is getting rich illegally. Lawmakers are blind or are they the real drug dealers. I don't trust my government anymore.

Anonymous said...

Way to go Seth! I found out about Dr. Tennant's work through the Pain Relief Network which was shut down by the DEA in the fall of 2010, and tragically, its founder Siobhan Reynolds was killed in a private plan accident that Christmas. Pain patients across the world owe a debt of honor and gratitude to Ms. Reynolds and Dr. Tennant. My own physician uses his longevity study on the safety of high dose opiates for intractable pain patients as a tool to support her own clinical findings. I would love to share ideas such as your state initiatives, I was unfamiliar with the history of the California laws. I am extremely ill and weak. But as Johnny Depp's character the Mad Hatter's remark to Alice in the recent remake accusing her of "losing her muchness" spurred her on to kindle it back into being, I am keeping the spark of my Muchness alive as long as I have breath in my body. Would like to connect, legitimately, on smart ways to use my limited energy to help our persecuted comrades.

I told Dr. Leavitt that I wouldn't be posting my credentials as he was worrying, and I don't want something like that deterring HIS wonderful work. He should know who I am and we have exchanged e-mails lately, if you have the time, energy or interest. If not, no shame...I can tell you are doing a lot for us all right where you are.

Dee said...

I agree whole-heartidly! I am truly PETRIFIED about my future & ability to function at all without my opioid medication! I am disabled with a long list of chronic pain issues ( hern/buldging disks, brachial plexus, CRPS, psoriatic arth. & fibromyalgia to name a few.) I know how hard it is to get through lifes simple daily chores when you live with chronic pain. However, we MUST come together & make our voices & suffering heard!! If we don't, it's only going to be a short time before we go to our pharmacy or Drs office & get the SAME news as many many others! Please join me & do whatever you can; call, write & go to your Legislative Members office. Maybe if they start to SEE the MANY, MANY FACES of Chronic pain patients & are FORCED TO HEAR our incredible struggles that we must face Every Single Day of our lives, it will be THAT MUCH HARDER TO IGNORE US!! If we don't do anything, its only a matter of time & we too will be without the only thing that helps our days & lives bearable! God bless each & everyone of you! And remember, we only stand a chance, if we stand together!

Waycross48 said...

I am in favor of controlling ILLEGAL drug use, but what the FDA is doing now, affects those of us who depend on these drugs for pain relief. Since January, every single time I've presented a VALID prescription from a doctor who is not known for writing excess numbers of these kinds of scripts; I've been told that we are OUT of this drug and we'll try to order it. I've had to wait to get my pain medication nearly every time. Once month alone, we had to call ELEVEN different pharmacies, only to be told that they were out of it and it had to be ordered. I've been a regular customer of this pharmacy for several years now. I see my doctor monthly and have the same scripts for pain each month. I'm the typical patient who's suffering from this crackdown on illegal use. Neither mine nor my doctor's profile fits that of an abuser of these medications. I use methadone for pain control, not because of being in a drug program. For some reason, methadone works better than anything else for my particular pain. Now, I've having to literally fight every month just to get the pain relief I need. Another very real problem is that you CANNOT stop this medication abruptly. You'll end up in the ER. I prefer methadone to other pain meds because it does not cause the HIGH produced by so many drugs. I don't like the out of contol feeling you get with most of them. I'd like to know what some of the people who make these regulations would do if their family member was in pain and couldn't get their meds.

Waycross48 said...

I would like to add to my previous comment that my doctor does, indeed, care about what is happening to his patients. He cannot speak out because the formerly privately owned family practice was forced into being bought out by a controlling company in order to keep medical malpractice costs affordable. Now, they have NO control over the practice. I've been a patient at this practice since 1970 and my doctor is really scared about two things - the drug problem we are discussing and the fact that almost NO new doctors are choosing the field of family practice. There's no real money in family practice. His son just finished medical school as an anesthesiologist and in his first year - he's making more than his father who's a full partner in a medical practice for over 30 years. So, yes, a lot of doctors are very concerned about this problem and all of their patients, not just those requiring narcotic pain meds. He can't afford to speak out. He warned me what would happen to health care if Obama Care was put into effect - well, people re-elected him, now they must suffer the effects of his policies. WE ALL HAVE TO SUFFER.

Anonymous said...

Addiction is difficult to admit and more difficult to overcome. I wish all of you the best.

Angry and getting sick in FL said...

I am a pain patient and have been for 15 years. I have chronic arthritis and currently need two knees replaced, a hip and also have two herniated disks. I was very obese (I also have thyroid issues). After losing 200lbs I am still too heavy for the artificial joints available (and I also have lots of extra skin in my abdominal area which wrenches my back when I walk. Insurance fights me at every turn. Yet I take care of my kids and write music, sing and fight to enjoy a fulfilling life. Now Im going to suffer more because of the Governments swatting flies with anvils approach to things. None of us want to be on meds, legitimate doctors won't even prescribe them unless you have MRIs, X-rays and diagnosis from respected Physicians, so after all we endure and after being tested every month to prove Im above board I am without meds for a week now because the totally legitimate scripts from a well respected Doctor I've seen for 5 years cannot be filled by any of the 47 local area pharmacies I've tried to use. On top of that I didn't get my cortisone shots or nerve block shots because insurance denied them. What can I do. My bills dont stop coming, my family needs me and I'm less able to function by the day.

Helen M said...

Before reading these comments, I didn't realize how lucky I am to be living in CA where I am able to be under the care of a pain management doctor.

I am like angry and getting sick in FL: I have severe knee arthritis (and will be having a replacement in June) DDD and spinal stenosis that is too bad for surgery, fibro, gone thru 4 cancers and now suffer with MCI, which leaves me with daily fear of Alzheimer's.

I am limited by constipation and cannot use enough pain meds to achieve a large reduction in pain; however, what I do take gets me out of bed in the morning, able to take care of personal hygiene, get dressed, do my own laundry and put food on the table every night. That's my life and I am very grateful to have that much. My social life? You might say without medical visits I would have no social life. Without opioid pain meds, I would have no life at all.

At 75 and with a body dying under me, there is not too much I can do to aid the fight for legitimate pain relief without criminalization, but please know I do very much appreciate all that others do on my behalf.

Anonymous said...

I'm a chronic pain patient (for 12 years) and have managed to get by on relatively low doses of narcotics because I know the pain is forever and I don't want to reach the place where nothing works. I was rear-ended by a tractor trailer and that accident ruined my back. Two years ago, I fell and broke my tibia and have had 2 failed surgeries. Now I wear a braced to hold my leg together. I can get out of bed in the morning and get dressed most days. Going to the grocery store or doctor's office are almost too painful to endure. In fact, I skip the grocery store most of the time. Can't cook. Live on snacks. The monthly pharmacy visit and doctor's appointments are the most important events in my life. I'm only 61. Single. No family. Two weeks ago, my doctor told me she could no longer prescribe Percocet for me. I've been her patient for 20 years but she doesn't want to lose her practice. She wants me to enter an in-patient detox program using a drug called Suboxone to wean me off Percocet. Then I'll be left with nothing to treat my intractable pain. And I'll be stigmatized for the rest of my lousy life. Truth is, I could go off Percocet by myself. I don't want to. But I went off Fentanyl by myself at the beginning of the year because the price went too high for me to afford. I don't want to see suicide in my future but can't ask for help anyway because in Florida, depressed, anxious, suffering, pain patients left out in the cold would be "baker acted". That is a legal 3-day minimum lock-up in a psych ward. I've known this day was coming for all of us in FL. I've wanted to sell my home and move but I'm not able physically to pack and move. I can barely walk or drive. I thought this was my retirement home. Where would I go? I believe this crack-down will spread everywhere and I doubt there are enough of us to stop them. Thanks for your postings. I don't feel so alone anymore. And, as for that person from 4/15, we are not addicts. We don't get high from pain meds. The meds take the edge off the pain just enough so we can function marginally. Don't comment on things about which you have no knowledge. I hope you never find out how awful life can be living with chronic pain. Cheers!

Karen Merriman said...

Thank you so much for this article doctor, those of us with chronic intractable pain need you!

I got RSD/CRPS 3 years ago from multiple knee surgeries. Its in my feet, ankles and back of legs. I can only describe RSD pain like this, imagine dipping your feet into a vat of oil at a rumbling boil and then throw a blowtorch to the mix. The McGill Pain Scale/Index rates RSD/CRPS higher in pain than Natural Child Birth or the Amputation of a Digit. So when I say I would be suicidal without pain medication, I'm not joking.

Can someone help me with information about what senator or congressman that me and my friends and family can write to about this war that's being waged on legitimate chronic intractable pain patients? Obviously I'm not the most eloquent writer but I still think my voice needs to be heard.

Hope everyone has a zero pain day and a wonderful weekend ahead.

Thanks so much,
Karen

Anonymous said...

I have had CRPS for 16 years and it is progressive, it now effects one leg, one arm, and my back. The recognition of this disease is small so the treatment is almost a joke unless you are very lucky. People with this horrible disease need much needed change in many areas before we are treated like people with a real disease and a very serious and life debilitating one at that.

Anonymous said...

Hello everyone, I am a chronic pain sufferer from a fall down three flights of stairs and landed on a staircase in 1998. I have degenerative disk disease from L-5 through S-1.

I have to travel 1000 miles to my primary care physician in my hometown as where I live in the state of NC the doctors are either scared of the DEA or don't care at all. Once I get the scripts that are printed on computer generated RX paper and get this FILLED BACK IN NC!

This makes no sense but one must do what they can in order NOT TO SUFFER! MY OPINION AS a 30 year media vet! NO-ONE CARES as far as the DEA is concerned. We all must pay for the sins of the abusers? I REFUSE TO COMPLY! I AM NOT A YES MAN! I WILL NOT SUFFER BECAUSE OF SOMEONE-ELSES SCREW UP.

Anonymous said...

I just left a doctors office 2 hours ago. Most of our "precious" time together was taken up with the discussion about how its suddenly become difficult for me to get my Rxs filled after more than a decade of continuity and more than a decade of prescription history with dignity, honesty and legitimacy within me as a patient and my care providers. I am coming into my THIRTY FIRST year this November as a long term intractable pain patient.
For the first time in ages, I am losing my tenacity, drive and determination to be a "Survivor". At the same time, the local news media and newspapers continue to run scare tactic articles about the rates of deaths from ODs, or rates of deaths among teens from Rx ODs- and who gets hurt? We legitimate pain "Survivors". I know in my state, the DEA has long been impotent in attacking the affluent illegal drug traffic between Asia, Mexico and the USA in terms of Heroin, and other imported "street" drugs. To keep their funding, they must keep busy. Who pays the price? We do!
The DEA is going after the wrong end of the stick. It is reckless and it is going to continue to have the wrong effects on the wrong people. I cant even count anymore; the sum total of deaths amongst legitimate pain patients who could no longer cope, no longer find appropriate care or pain management resources.
They too became statistics who's sad deaths are then used as examples of more statistical deaths against their plight! Yes, indeed, rather than look at why a pain patient chose to give up the struggle- their deaths are COUNTED as victims to the over prescribing of narcotics. All too often, the exact opposite may the actual case! All too often, a patient whose daily struggle to maintain some balance between managed pain and unmanaged pain is a battle lost. I'm sure I don’t need to tell the readers this, you all know who we've lost.
For the past six months, pharmacy after pharmacy has told me they cannot meet the demand for legitimate pain patients most of whom they've known for years. They are forced to choose which of the prescriptions they're going to fill and who they're going to have to turn away. They've been perfectly clear in stating they cannot base their decisions on much more than first come first serve for the longer standing familiar patients, and turn away any new patients. They've explained how the DEA is allowing "X" number of bottles of medication-regardless of demand or community need. You know with this type of lunacy in place we're simply going to see more and more deaths of pain sufferers. What is there to look forward to? if any possible quality of life afforded through legal, legitimate, appropriate pain management is suddenly stopped?
Those once "miracle" new formulations that helped so many patients "hang on"...might as well have never been invented when as a "free" society, we no longer place our trust in the experts (physicians) to do their jobs. Isn't that what's going on? All due to a problem that was apparently squashed in the state of Florida, everyone across the country will now pay the price. Once upon a time, physicians were looked upon as the "hero's" in a community. As a society we continue to tie their hands, limit their tools they had to perform their jobs and prescribe appropriately and force them into inexplicably difficult situations with which to employ their years of training. These years of training are being superseded by the judgment of whom? What medical background do the DEA enforcers have? Suddenly everything is flowing backwards- suddenly the politicians, pharmacists, wholesalers, and DEA enforcers are actually dictating what the physicians can and cannot do in treating their patients.

Anonymous said...

Now the Pharmacies are the local drug dealers. The problem we had was the people you all let MR Rick Scot get rich with his pill mills then turns his Pharmacies over to his wife? Now the Pharmacies are now charging a mark up to 1,000%.I seen some that only takes cash and called the DEA and they said that was legal. Then One time i went in and part part cash some on credit card bill and did not get a receipt on cash. Now who is the drug dealers now. My mom hands hurt so bad they ball up and she is in pain but can not a ford her meds. WE all knew something was going to happen because all the young people coming down from other states but we live in a sate that are more old people so the demand is higher for FL people. That who is paying the price now The ones who truly have problems that ca not even a ford to get all my meds out and it is hard enough to sleep let alone work with out my medication. Please DEA wake up and see you just started a whole new problem.

Anonymous said...

i'm a chronic pain patient in ky i'm in severe great pain from what i've found out don't look to live much longer like this,been this way 10yrs fused neck,premanent damage left,lower back waiting on surgens to see if they will operate at one time had a doctor who really cared but becase she wrote medicine that helped real pain patients they called it a pill mill shut it down i know of 5 patients who already died because of this i went to another doctor who said everyone who went to her is being called a drug addict,he give pain medicine but in real low doses and amounts for months i told him i was in great pain he got mad said that drug seeking behavior,i shut and took the medicine half the month and the other half suffered till he call me to check my medicine,by the way he check my rx record it showed i had not lied to him,well when i had no medicine or none in me he dropped me,what i'm trying to say if you tell the truth to doctor it don't help i'm not a drug addict it took 7yrs to get medicine that work for 1yr it was like i had my life back,drug addicts don't sit around in great pain wishing they could do things but because of the great pain can't their awar on pain patients in ky not drug abuse because we are the ones suffering and dieing i was in army i know the real drug addict it doesn't hurt abit they just go to street drugs,they say we have an great drug problem,and if the pain patient suffer and die its for the good only 1 in 16 person in ky has drug problems i guees it alright to tortue and the 15 these people are blind or just don't care pain patients right are taken away and they just keep adding more rules,laws real pain patients have an hard time getting to they doctor,now they have to worry if doctor will treat them here doctor are afraid of being arrested the government,dea tells them the limit of medicine to give patient now if i was allowed to do that to them they also would be mad,this isn't right,fair,this has to bestoped.78

Myron Shank, M.D., Ph.D. said...

The evidence is all around that regulators, including the DEA, have decided what amount of opioid analgesics is "appropriate" and are determined to reduce the availability to that level. If anyone complains of chronic pain without cancer, he must simply be labelled as "drug seeking," never allowing a discussion of whether that "drug seeking" is appropriate or inappropriate.

I am a physician who has been a victim of the abuses by the State Medical Board of Ohio, because I followed all the laws, the rules, the recommendations of nationally recognized organizations, and the medical literature.

Dr. Leavitt, you made a comment that it was surprising that you receive so few comments from healthcare providers, and speculated that it was because we have been frightened into silence or did not care. I cannot speak for anyone else, but I just found your excellent site two days ago. Not only am I willing to continue commenting, but, if you would like help, by a separate email I am volunteering to contribute articles.

MamaG said...

I live in California and have been a stable pain management patient for almost 14 years. I was a figure skater for 10 years and suffer from multiple injuries including RSD, bulging discs, degenerative arthritis in my spine at L4-5, S-1 and C-4. I have been through myriad of unsuccessful treatments in an attempt to ameliorate my pain to include 3 nerve ablations, epidurals, nerve blocks, and a slough of opiod and non-opioid prescriptions. I also employ a number of non-opioid modalities; acupuncture, massage, stretching, counseling, biofeedback, among others. Prior to beginning pain management I was suicidal at the thought of living another 40 years in such pain. I have ALWAYS used one Dr., one pharmacy, and never lost, misplaced or needed to have my Rx replaced. I have been honest with all of my providers in every circumstance. In addition to the sport related injuries I also suffer from migraine headaches, silent migraines which cause unstoppable vomiting for 10-15 hours, chronic kidney stones which become occluded, chronic sinusitis (due to exposure to mold resulting in a 3 sinusotomies with removal of turbinates). My pain medication is used for CHRONIC pain NOT ACUTE pain management. Chronic pain and acute pain are different processes. On August 11, 2013 I fell and broke my posterior malleolus (the bottom of the tibia) a rare break. My ankle tried to dislocate but my shoe prevented that from happening but the ligaments and tendons were damaged all the same. My ankle appeared dislocated and I was in an extreme amount of pain complete with tachycardia. I was honest with the triage nurse about my opioid status. I also do not have any existence of visiting the ED with requests for opioids. One x-ray was taken anterior which did not show the posterior break; a complete break I might add. I was treated brusquely and unprofessionally by the attending ED physician, he offered not even a Tylenol looked at my injury and proclaimed, "There is nothing wrong with your ankle", as though he possessed some sort of see-through vision. I was absolutely treated as seeker, labeled immediately as an addict and abuser. I presented with a broken ankle and any other patient presenting with the same injury would have been offered pain management. I think the current trend of punishing legitimate pain patients to prevent prescribing to seekers is abhorrent, it makes me sick to think that a patient can present with a broken ankle and not be offered ANY pain management by the ED. As a retired RN I am absolutely disheartened by the treatment of ED staff toward pain patients. Frankly, they are only making the situation worse by leaving those in excruciating pain to self treat which could and does result in overdoses. You will notice the date on this post and I am still in a cast and facing ortho surgery to reattach the .50c size piece of bone which remains unattached, I am in pain day and night due to my injury over 3 months later. The unfortunate aspect of this problem is those in pain management are often depressed, weak, and unable for many reasons to advocate for themselves. The current climate is intolerable for those of us suffering with pain just trying to function at a level that allows us some quality of life

Anonymous said...

I am all for stopping the pill mills but we cannot allow the pharmacies to become the drug dealers, in flrodia they only take cash and they charge 9 to 10.00 a pill for opid analgesics, they have told us that we are required to have two to four non narcotics and must pay cash, this is ridiculous, someone needs to be regulating this. I am sorry if people withput chronic pain don't understand and I hope you never will but this should not be happening, we should not have to pay the price because our leaders our sleeping. Patients are too afraid to say anything, where do you go, you cant afford your medication as it is and if you wait too long because you don't have the money to get them, then you cant get them at all, we as patients have laws to abide by as well. don't tell me if my doctor is in Tampa and I live 6 miles away in Pinellas county that you cant fill it, I have a responsibility as a Pinellas county resident to fill in my resident county. Don't tell us these are laws because they are not, the majority of pharmacies are hustlers and the ones that use to be good neighborhood pharmacies are being converted due to the greed, why charge 185.00 when they guy down the street is charging 1400.00, if Charlie Christ was in office this would not be going on. If we had a hurricane and Home Depot charged 10x the normal rate for plywood you would go after them, wake up regulators. Your not stopping it your trading out we can stop it and regulate the pharmacies at the same time, Just because I take a controlled substance does not make me a drug addict dammit.....

joann arcuri said...

I agree and its happening to me
Now abandoned by dr i am incapcitated with pain and hopelessness. Our area is experiencing increased heroin use and suicides. Help

blueeyes said...

have any of you chronic pain folks looked into Turmeric/Curcumin as a pain adjunct ? They sell it at Walmart & Vitamin Shoppe & it works like an antinflammatory taken with your Rx it may extend or deepen your pain relief. Also Bromelain
a derivative of pineapple enzyme is a good pain relief booster. There is nothing worse then the helplessness you feel when your pain is not addressed.

SB. Leavitt, MA, PhD said...

@blueeyes... see our post on turmeric here: http://updates.pain-topics.org/2013/02/turmeric-glucosamine-or-mud-for-knee.html

5catjenny said...

You are part of the problem, seeing everyone as an "addict only." I can only hope you quickly get an intractable pain illness. Then you can get to be called an "addict" and good luck to you! Try not to pass out while trying to walk, OK?

SB. Leavitt, MA, PhD said...

I wonder who @5catjenny (immediately above) means by "you." Certainly, neither I nor any commenters above are viewing pain patients as addicts.

Brandi said...

Well SB Leavitt i totally agree with 5catJenny! Maybe if most of you out there had the serious chronic pain we live with from day into night and sleepless nights you might change your tune. ( Doubt it though). I hope and pray that you and the rest of your cohorts contact something terribly serious and have NO ONE TO TURN TO..PERIOD! You and the DEA both! Thank you Jenny for posting what i didn't have the guts to say for years. If everyone of these so high and mighty big shot insufferable know it alls think "" I will never get sick like those poor pathetic people out there". Think twice mister Tumerec !

steve1975 said...

Sounds like 5catjenny and Brandi are DEA plants trying to confuse people. SB Leavitt is obviously an advocate for pain victims.

5catjenny said...

If I were a DEA Agent, I'd have no need to fool around on message boards. I become incensed when I hear "have you tried "turmeric" with your pain meds? Well, that may work just dandy IF one has a pain med! Or glucosamine or chondroitin (for arthritis) as if all pain sufferers have arthritis, not to mention those 2 things are increasingly proven as useless except for emptying wallets. I think these "Doctors" online blogging all day are the DEA agents. Watch what you say, folks

5catjenny said...

Nope, no DEA agent here, just another intractable pain patient who's just been given another label besides addict. Yay! I Happened on this article, looking for suicide increasing & I find "turmeric" -oh brother. I have my suicide plan plus a letter explaining I wasn't just an addict overdosing.(Who said I was using pills to do the deed, but there may be a bit of narcotic in mysystem & bingo! Addict OD) When the time comes,Im outta here.

Namens felder said...

My issue is a little different. I don't have a pain management issue but I can say from personal experience when my tooth was killing me a trip to the ER ended with 90 percocet pills for pain even though I was seeing the dentist in a few days but it was after hour. I never understood that. I took one and it made me nauseous, itchy and violent so I never took that again. I had an inguinal hernia operation and was given something called Dilaudid and those made me go from being unable to reach for my meds in the morning to being able to go on my run, the day after surgery. I had followed the instructions and all and was in severe pain still although I could feel it lessening but I was walking with a limp and the ER guy gave me 8 Vicodin and I only wanted a few more days worth of the ones I took, the surgeon said no and my pdoc is "NO WAY WILL I PRESCRIBE YOU THAT". Plus the guy treated me like crap. That one morning, I left the bottle across the room, I cried my way over to take that dose.

I want to note, "YOU ARE NOT ALONE!"

I have hyperkinetic syndrome, it is neurological, hyperactive like ADHD without the attention issue or confusion that it is just brattiness. I never changed. I was always fired up so bad I couldn't stop moving and whatnot. It is not ADHD when you really see it. It is torture having to move, talk, yap etc. I have eeg tests that show normalized brain scans and my liver enzymes were tested for dose etc and I am hearing this hint toward lowering the dose a lot lately. I socially suffer most and I am a guy but I get harassed sexually because I am attractive and that is a downfall because if I was more plain or less noticed, if I acted the way I do, I wouldn't be looked at the same.

I check these pages a lot because narcoleptics and people with my issue and even some severe hyper ADHD labeled folks, who may have a mild form of hyperkinetic syndrome are suffering with meds we have taken for years. When me and one friend who is narcoleptic overhears some girl who faked ADD to lose weight and got Adderall or another one who said that she lost her cool at the doctor because her kids were nuts and house was a mess and he diagnosed her and wrote her Adderall. It feels like a slap in the face and being on an old med called Dexedrine with that reputation and years of the junkie look from pharmacies. I know exactly how you feel and there are those same people who make some comment about me being a "tweaker". My teeth are perfect, my diet and skin are great and I have no tolerance because although I am at FDA max dose, I was on a higher dose as a 5 year old kid because I burned through them. Turmeric is great for antioxidants and curry. I don't like that there is this nudge by our docs and pharmacists to drop the dose more. I am at 60 mg and was up to 190 mg at one point. I can't fathom having to suffer and given my enzymes, I am probably on a low dose. My health isn't at any risk. The DEA isn't the entire fault. Some pain is different than others I am sure and since most of these "ADD" folks are on 15-20 mg, I imagine some lesser chronic pain sufferers being okay on a lesser dose is the rationale. Demand an enzyme test. I am going for another one because I want to be sure I am good since this is common. Narcoleptics, people with neurological disorders, chronic pain sufferers all get the shaft.... but the lady that gets her meds at the same time as me sometimes was in there one month wanting her economy size bottle of Xanax 2 weeks early that she is loud about it and and even after more than one occasion of this, she still goes and picks her big bottle of Xanax with no issue and she protests hippa on her iphone almost every time. I don't get it. I took those things for a few months growing up one summer and I was in pure hell when I tapered off them and my year was messed up from those. Why aren't they watching people on those?