Hell - Opiophobia Style

People ask me why I continue to beat my head against the wall battling Opiophobia. The experience is precisely the same as getting into an argument with a "Right To Life" crackpot. They are religious fanatics. They believe that snakes can talk (see Bill Maher's movie), they are profoundly committed to the concept of saving baby angels who have fallen off heaven's clouds into the world's miasma, and are totally unconcerned and indifferent to real lives - such as that of women bearing unwanted children or live infants born into squalid poverty (and for damned sure they are NEVER going to adopt one of those babies into their life!) But, they will march around all day outside abortion clinics or shoot doctors who are willing to take the professional and personal risks of helping desperate women.

Arguing with opiophobes is the same experience. Opiophobia is a RELIGION, not a scientific or rational discourse.And Medical Board Members are largely ensorcelled by religious opiophobia. This does not lead to pleasant experiences. Hundreds (if not thousands, I am trying to get the data) of doctors go through it every year. The best way to find oneself before a Medical Board for "injudicious prescription" is to regularly write schedule II prescriptions. It wouldn''t matter if your were Hippocrates himself. You will end up being "reviewed" (bend over..you are going to be reviewed"). And trying to engage in a professional, rational or scientifically sound discussion of the use of opioids to control chronic pain NEVER leads to any intellectually satisfying outcome. As the old Texas cowboys say, "Never try to teach a pig to sing. It only leads to failure - and it irritates the pigs".

So despite all of this - and my 42 "reviews" in the last 24 months (all but the most recent 14 led to nothing after about 500 hours of work and $40,000 in legal fees) - I persist. If you want to know why, read the following letter from Mr. Joel Ford (God love him). I feel like a French partisan blowing up the rails that lead to Auschwitz - I know the authorities are going to do everything they can to kill me. But I just cannot stand around and watch the trains go by while I hide in safety.
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From: Joel Ford [mailto:jford@ktis.net]
Sent: Thursday, August 20, 2009 11:59 AM
To: 'jfshmd@gmail.com
Subject: unbearable pain and 20 years of it

I was hit head on March 8th 1989, my passenger and best friend since our teen years was killed and I suffered mass trauma, compound leg fractures, a right ankle that to this day hurts beyond belief with just minutes of weight bearing! I initially was flown to the University Of Mo Medical Center where emergency surgeries over the next 26 hours got some of the open tibia/fibula fractures connected to an external fixture, the nerves to my right foot were severed completely and agonizing neuropathy was the result, also had an open fracture of the mid femur, skeletal traction for a few days pulled the sharp shards of the bone away from the femoral artery, then a rod with crossing screws at the hip and just above the knee intended to regain the original length, the bone chips were wired into the actual fracture, the patella was nearly severed from the tendons and ligaments that hold it in place, in addition to the lower body fractures, the right hip ball was jarred so hard that all kinds of spurs broke off in the actual ball joint, causing a gradual deterioration of that joint, additionally, both wrists were broken and every knuckle on both hands were hyper extended in an attempt to hold the steering wheel with arms locked out, and right leg extended straight on the brake, I had an 89 mustang 4 cylinder and the young men who strayed over the centerline on a narrow state road on a hill crest were in a 78 Buick LeSabre, easily twice the weight of the mustang, as I said, I was airlifted to the only level 1 ER in the middle of the state, only 12 miles by road, however my golden hour was long gone by the time they pried me out, I also broke all the right side ribs, fractured the collar bone and had massive face and head injuries that broke the jaw in a couple places, and the facial bones that surround the eye sockets and the nose, all shattered, ended up ventilated for a couple weeks, jaws wired tightly shut, feeding tube in one nostril and eyes swollen and blackened, communication was impossible, I was later told that team of Psychiatrists were called in to try and regulate the medications as I was pulling out my iv's and even attempting to use the beds trapeze to get out of the bed, I don't remember much of this, 58 days in NICU then to Rusk Rehab, an Intensive rehab for a month, even as I arrived at Rusk, I was immediately placed on a "Demerol cocktail" taken orally, with decreasing doses of the Demerol, I was 38 years old when this occurred and had never taken an opiate in my life, yet even the residents and the rehab team began to warn me that they feared they had addicted me, and the reducing doses of Demerol quickly brought about intense nerve and orthopedic pain to the degree I finally refused to attend the two a day physical and vocational rehabs, only to be told by the rehab Doctor that failure to attend could risk my bed there, I actually laid awake at night and cried, the pain so severe and jaws still wired, I was at my end and a Senior Attending Orthopedic surgeon came and helped me for the moment, the forth week at my rehab "team" meeting I was told once again I couldn't go home while taking these pain meds, and I just said "There IS NOT an addiction problem here, It's a pain problem!! Can't we deal with that right now, and if this dreaded addiction indeed occurs, we can deal with it then! They all huddled up for a minute, then turned and announced I had convinced them and was released the next day to return home, at 127 pounds, weighed about 200 when the accident occurred, I had other issued like viral pneumonia while in NICU, a collapsed lung, and a brain swelling and creating huge survival issues, so anyway, got to go home and immediately problems occurred, had a total foot drop, then the tibia/fibula fractures just snapped one day as I was getting to a car for my brother to drive me somewhere, ended up being a local ER (I had just spent 8 days at UMC for a pic line infusion of a very powerful antibiotic, for an bone infection that developed just above the right ankle a year or so after they grafted the tissue rupture) and a local Orthopedic surgeon on call showed up, and immediately asked the nurse what the ER Doctor had given me, she replied however much Nubane? The surgeon looked at me and told the nurse to give me lots of morphine and phenergan which she did and he came back in and told me he would really like to take me to surgery and set the fractures while I was under from the anesthesia, and I told him No, I wasn't going to spend yet another night, so he said ok and came in and set the fracture (a whole new pain experience!!) and after an hour or so let my brother bring me home, to see him the next morning, in the interest of time and typing, this local Surgeon wasn't even slightly intimidated by the local DEA Agents that ran from the local pharmacies every day to verify the patient had actually seen a doctor and that the medication being prescribed wasn't over kill (10 mg oxycodone a percocet generic, initially 6 times a day, he told me even then that the DEA was the agency that licensed physicians to be able to write prescriptions and it really PO'd him as he said "There is NOT a Doctor of any kind amongst these agents and their Bureau" and I refuse to be bothered by them, after all, I am an orthopedic surgeon, every day I inflict the most intense pain there is on my patients" and over the next 5 years an
additional 11 surgeries were required, all pretty much orthopedic, the femur fracture was also a non union and he had removed the crossing screws to see if the friction would promote the bone healing, he thought it did, I could only tell him of the intense pain in the mid femur area, he x-rayed and CT scanned but it looked healed to him, acting only on my continuing complaints did he take me to surgery, and was waiting when I woke up in recovery with a smile on his face, he told me the area inside the femur had filled with fiber, which meant it had stopped healing, he had to drill down the center of the femur to promote some new growth and put a larger diameter rod back in it, with all of this and much more, it was a constant either surgery or recovering from over the next five years, me taking percocet level pain meds ultimately having to take two every three hours, 16 as day, and they did
little to help, after the last surgery he did he told my two younger brothers he had given me enough morphine to kill both of them and it wasn't going to help much, and that was a fact, an IV push of every 45 minutes did only provided a small measure of relief for minutes, then the pain returned so horribly that I would lose consciousness and be in and out, and it's now been 20 years since that accident, and I still suffer just terrible pain, something one of the residents at UMC told me I would just "have to learn to deal with" which so angered me that my response was "Like I have a choice"? The story goes on and on and I won't, suffice it that my general practitioner, an Osteopath has given me 3 Darvocet N100's and 3 800 Mg Ibuprofen a day for over 12 years, the pain has gotten much worse, I am 57 now, morbidly obese and diabetic, still unable to weight bear for more than a few minutes and he acts like I'm trying to kill him when I complain that those two just aren't working anymore, I mean the Darvocet N prescription reads "take one table three times a day PRN severe breakthrough pain" I have pretty much given up and fully expect to suffer more and more pain in what few years I may have left, I never did Doctor shop until I found one who would properly treat this gruesome pain, I just accepted it and have been at home for 20 years, losing more and more of my possessions on a SSD income, now the head injury brought its own problems and deficits in the brain which I have adapted too as best I can, it just seems totally ridiculous that Physicians cannot treat this pain in some form of management program? I am at my wits end and have even acknowledged that suicide may one day be my only escape from all this, and that's not even a thought I considered lightly, I don't know what else to do? I will attach a couple pictures of my car and me, just to maybe validate these things, it's been a long, long and painful 20 years, getting only 2 or 3 hours sleep before waking stiff and hurting and have to get up and move around a little to go back and get another 2 or 3 hours, and this "addiction" these Doctors had me scared to death over, I was taking percocet or stronger pain meds for a continuous 5 years, and my local surgeon asked me one day how I wanted to scale it down, taper or cold turkey, I told him if I had them, I would take them, so cold turkey it was, 16 percocet a day to nothing, it was a joke!! Two days of diarrhea, and being in a foul mood then went to see him and very concerned, ask him when this horrible withdrawal was going to start, he looked at me and laughed and announced I had already experienced all there would be, he handed me a time magazine with the front cover a breaking story about how opiates interacted with the body when PAIN was the issue and the JAMA clearly stated that people taking opiates for real pain simply didn't become addicted while "recreational" users seemed to suffer way more serious affects when the opiate was withdrawn, they recommended the aggressive treatment of post op pain that speeded the recovery time tenfold? Yet, the hysteria promoted by the DEA continues to prevent people like myself, not seeking a high from any drug, just some relief of agonizing pain, I just today ran across your website and after reading there, it seems many, too many people are in the same "lack of caring about chronic pain" demonstrated by most physicians, and I understand why, but it seems so very wrong to withhold treatment that could vastly improve the quality of life for myself and thousands of others who suffer much worse than I, it just makes no sense, when taking one's own life seems to be the only option left?
Thank You for reading some of my story, perhaps my own circumstances will help someone left to a similar fate?
Sincerely,
Joel Ford
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Dear Joel: Your case makes you a poster boy for opiophobia. If you will contact Mr. Barletta, (our National Coordinator) at the e-mail address above, and give him your address, we will attempt to find you a pain doctor who is a physician, not an idiot. If we cannot locate one, we will give you the option of coming to Houston for stabilization and long-term care.

Your out-patient pain management has been abysmal. A new intern could have done a better job (unless they were operating in an opiophobic environment). There is no reason that your pain should not be effectively contained, if treated adequately.
Join the Foundation (www.paincare.org). Your annual dues support the web site.

Lastly, I would like to use your case in an Executive Director's message on the web site, and perhaps also in several medical publications I have been asked to write. I will not identify you personally. Would that be OK?
Dr. Hochman (also a Joel)