Who Will Stop the PAIN?

No Relief in Sight

A short excerpt from the writing of Jacob Sullum

Torture, despair, agony, and death are the symptoms of "opiophobia," a well-documented medical syndrome fed by fear, superstition, and the war on drugs. Doctors suffer the syndrome. Patients suffer the consequences.

David Covillion finally got relief from his pain with the help of Jack Kevorkian. The pain came from neck and back injuries Covillion had suffered in April 1987, when his station wagon was broadsided by a school bus at an intersection in Hillside, New Jersey. The crash compounded damage already caused by an on-the-job injury and a bicycle accident. Covillion, a former police officer living in upstate New York, underwent surgery that fall, but it only made the pain worse. Along with a muscle relaxant and an anti-inflammatory drug, his doctor prescribed Percocet, a combination of acetaminophen and the narcotic oxycodone, for the pain.

The doctor was uneasy about the Percocet prescriptions. In New York, as in eight other states, physicians have to write prescriptions for Schedule II drugs--a category that includes most narcotics--on special multiple-copy forms. The doctor keeps one copy, the patient takes the original to the pharmacy, and another copy goes to the state. After a year or so, Covillion recalled in an interview, his doctor started saying, "I've got to get you off these drugs. It's raising red flags." Covillion continued to demand painkiller, and eventually the doctor accused him of harassment and terminated their relationship.

"Then the nightmare really began," Covillion said. "As I ran out of medication, I was confined to my bed totally, because it hurt to move....At times I'd have liked to just take an ax and chop my arm right off, because the pain got so bad, but I would have had to take half of my neck with it." He started going from doctor to doctor. Many said they did not write narcotic prescriptions. Others would initially prescribe pain medication for him, but soon they would get nervous. "I'd find a doctor who would treat me for a little while," he said. "Then he'd make up an excuse to get rid of me." Eventually, Covillion went through all the doctors in the phone book. That's when he decided to call Kevorkian.

The retired Michigan pathologist, who has helped more than 40 patients end their lives, was reluctant to add Covillion to the list. At Kevorkian's insistence, Covillion sought help from various pain treatment centers, without success. He called Kevorkian back and told him: "I'm done. I have no more energy now. I just don't have the fight. If you don't want to help me, then I'll do it here myself." Kevorkian urged him to try one more possibility: the National Chronic Pain Outreach Association, which referred him to Dr. William E. Hurwitz, an internist in Washington, D.C., who serves as the group's president.

The day he called Hurwitz, Covillion was planning his death. "I had everything laid out," he said. "I got a few hoses and made it so it would be a tight fit around the exhaust pipe of my car. I taped them up to one of those giant leaf bags, and I put a little hole in the end of the bag. All I had to do was start the car up, and it would have filled the bag right up, pushed whatever air was in there out, and it would have filled the bag up with carbon monoxide. Same thing as what Dr. Kevorkian uses. And then I had a snorkel, and I made it so I could run a hose from the bag full of gas and hook it up to that snorkel, and all I had to do was put it in my mouth, close my eyes, and go to sleep. And that would have been it. I would have been gone that Friday."

But on Thursday afternoon, Covillion talked to Hurwitz, who promised to help and asked him to send his medical records by Federal Express. After reviewing the records, Hurwitz saw Covillion at his office in Washington and began treating him. "The last three years I've been all right," he said in a July interview. "I have a life." Yet Covillion was worried that his life would be taken away once again. On May 14 the Virginia Board of Medicine had suspended Hurwitz's license, charging him with excessive prescribing and inadequate supervision of his patients. At the time Hurwitz was treating about 220 people for chronic pain. Some had been injured in accidents, failed surgery, or both; others had degenerative conditions or severe headaches. Most lived outside the Washington area and had come to Hurwitz because, like Covillion, they could not find anyone nearby to help them.

In July, after the case was covered by The Washington Post and CBS News, the Pennsylvania pharmaceutical warehouse that had been supplying Covillion with painkillers stopped filling Hurwitz's prescriptions, even though he was still licensed to practice in D.C. The pharmacist who informed Covillion of this decision (in a telephone conversation that Covillion recorded) suggested that Hurwitz had prescribed "excessively high amounts." [MY ITALICS AND BOLDING] At the same time, he recommended that Covillion "find another doctor" to continue the prescriptions. Covillion's reply was angry and anguished: "There is no other doctor!"

TO READ THE REST OF THIS POWERFUL ARTICLE PLEASE CLICK ONTO: http://www.iatrogenic.org/library/stoppain.html

HELPING SOME PHYSICIANS, NURSES, GOVERNMENT SADISTS AND PHARMACISTS MOVE OUT OF THE 1980'S ON OPIOID DOSING

1. LESSON ONE-STOP CLUTCHING YOUR OUTDATED PDR TO YOUR CHEST. It is only good for pill identification and drug company addresses. Any serious side effect will take years to find their way into the book, and the dosing is usually completely useless and based on a small number of patients.
2. LESSON TWO-SINCE YOU ARE TOO AFRAID TO ACTUALLY DO SOME REAL RESEARCH ON DOSING, OPEN UP YOUR SIMPLISTIC PDR TO THE PAGE ON OXYCONTIN. YOU WILL SEE THE FDA APPROVED COMMENT ON DOSING IS THAT THERE IS NO MAXIMUM.
3. LESSON THREE-THE BEST DOCTORS OFTEN GET THE TOUGHEST patientS. IF SOMETHING DOES NOT FIT WITH THE 97% OF THE SIMPLISTIC HEALTH CARE OPERATIVES WHO ALSO ONLY USE THE PDR, PLEASE GIVE THE DOC THE BENEFIT OF THE DOUBT.
   
   CONSIDER CALLING THE DOCTOR. IF THEY DO NOT CALL BACK IN AN HOUR, IT MAY BE BECAUSE THEY HAVE 30 patientS TO HELP.
4. LESSON FOUR-IF YOU DO NOT KNOW WHAT "PSEUDO-ADDICTION" MEANS, DO NOT UTTER ANY COMMENTS ABOUT OPIOID DOSING, PLEASE CLOSE YOUR MOUTH. NOW GO BUY 5-10 BIG BOOKS ON OPIOIDS, AND LEARN ABOUT THIS CRUCIAL ASPECT OF MEDICINE.
   
   SIMPLY, PSEUDO-ADDICTION APPROXIMATELY MEANS A STRONG LONGING FOR THE MEDICIATION IS PRESENT. (THIS IS NORMAL AND EXPECTED IN THE PRESENCE OF PAIN, SO STOP LOOKING FOR SOME COMMUNIST CONSPIRACY WHEN A SUFFERING PERSON SAYS THEY HURT SEVERLY). THEY ARE NOT JUST PATHOLOGICAL WACKY PERSONS-THOUGH PAIN CAN MAKE YOU AGITATED BEYOND DESCRIPTION.
   
   YET PSUEDO OR FALSE ADDICTION ALSO HAS TO DO WITH THE COMMON OBSERVATION THAT AS A DISEASE PROGRESSES, E.G., SEVERE ARTHITIS DEGENERATION OR CANCER, AND AS THE LIVER MAKES MORE "REMOVAL" ENZYMES, YOU COMMONLY HAVE TO INCREASE THE OPIOID DOSE. IF YOUR BODY SIZE IS SHRINKING, PERHAPS THIS INCREASE WILL BE MINIMAL.
   
   HOWEVER, NOW WE SIMPLY HIDE THIS COMMON INCREASED DOSING REALITY, BY PRESCRIBING MASSIVELY POTENT THINGS LIKE FENTANYL PATCHES OR LOLLYPOPS, WHICH MAKE MORPHINE, OXYCODONE, METHODONE AND HYDROMORPHONE LOOK LIKE BABY FOOD. MEANING, THEY ARE FRACTIONS OF THE POTENCY OF A MERE MILLIGRAM OF FENTANYL.
5. LESSON FIVE-I TOOK AN OATH THAT ACTUALLY SINGLES OUT THE RELIEF OF PAIN AS PART OF A PHYSICIAN'S DUTY. ANYONE THAT ACTS TO PROMOTE MEDICAL SUFFERING BY PREVENTING PHYSICIANS AND NURSES THE MEANS TO STOP SUFFERING, BY ANY AND ALL REASONABLE MEANS THAT A patient DESIRES, IS AN ANTISOCIAL SADIST AND ACTING IN THE TRADITION OF THE GREAT EVIL ENEMIES OF MANKIND.
6. LESSON SIX-PEOPLE THAT LIMIT ACCESS TO PAIN CARE BY IGNORANT BASIC DOSING LIMITS ARE SUPPORTERS OF EUTHENASIA, SUICIDE, SADISM, GREED, PERVERTED CONSCIENCE AND LACK THE CAPACITY FOR EMPATHY OUTSIDE THEIR LIMITED LIFE EXPERIENCE.
   
   DID YOU HAVE A BAD EXPERIENCE WITH AN ADDICT? I AM VERY SORRY THEY HURT YOU. IS YOUR LEGACY NOW GOING TO BE HURTING THOSE 1% OF PHYSICIANS WILLING TO TREAT CHRONIC PAIN, AND ARE YOU GOING TO SUPPORT THE SUFFERING OF TENS OF MILLIONS IN THE USA?
   
   DO ADDICTS SOMETIMES TRICK A DOCTOR? YES. BUT ARE YOU WILLING TO LET 20 SUFFER IN TORMENT SO THAT THIS ERROR WILL NEVER OCCUR? AND IF YOU DISAGREE WITH MY ANALOGY, YOU KNOW NOTHING ABOUT THE PSYCHE AND FEAR OF PHYSICIANS IN BEING "INSPECTED," INVESTIGATED OR EXAMINED BY THE DEA OR STATE BOARDS.
   
   TRUST ME ON THIS ONE. SOME DAY YOU MAY FIND YOURSELF IN THE POSITION OF NEEDING SERIOUS PAIN CARE FOR YOURSELF OR A LOVED ONE AND YOU WILL NOT GET IT. IF IT IS FOR CHRONIC PAIN YOU ARE AT EVEN GREATER RISK OF NOT GETTING IT. YOU WILL GET JUNK OPTIONS, OR SIMPLISTIC OPTIONS AND THE EQUIVELANCE OF "A STICK TO BITE ON" TO SOOTHE YOU. AGGRESSIVELY SUPPORT PAIN PHYSICIANS WHO OFFER MORE THAN SURGERY, SPINAL INJECTION OPTIONS, ACCUPUNCTURE AND PHYSICAL THERAPY, OR THEY WILL CONTINUE TO DISSOLVE AWAY.
7. LESSON SEVEN-IF YOU DO NOT ACCEPT WHAT I AM SAYING CONSIDER TAKING A LAXATIVE. NO, TAKE TWO DOSES OF A LAXATIVE. AND PLEASE STOP THINKING PAIN PHARMACOLOGY IS AS SIMPLE AS YOUR BASIC LITTLE BOOK, E.G., THE PDR, FACTS AND COMPARISIONS, THE USP TEXT OR THE 15 OTHER OPTIONS.
   
   MOST OF THE BEST MEDICAL INFORMATION AND RESEARCH I KNOW OF IS CURRENTLY JUST BEING WRITTEN AND 1-2 YEARS AWAY FROM PUBLICATION.

Committed to Your Health & a Life with Little Pain!

Dr. J.

Sorry for all the spice, but on the topic of promoting suffering, it is hard to be quiet, fluffy and nice.