Raleigh, North Carolina

Opioid FAQ’s (Part one)

Alexis M. Haynes, B.A.
Thomas F. Kline, M.D., Ph.D.

Opioids are derived from the poppy plant, Papaver somniferum, and its use dates back to Mesopotamia (Iraq) around 3400 B.C. Variations of the term include the following: opium derivatives, opiates, opioids, narcotics, and controlled substances. These terms are all interchangeable. Ninety percent of opium products are used to treat pain; therefore, “pain medicine” is the most appropriate term for opioids.

  • How common is addiction? Type 1 addiction for marijuana, cocaine, amphetamines, and LSD, is far more common than type 2 opiate Chemical Receptor Disease (CRD), which is rare (google: rare medium kline). This makes sense since rare diseases are frequently genetic, just as type 2 addiction is.
  • Are opioids safe for me to take? Yes. However, if you are one of the rare people with a chemical receptor disease (CRD) type 2 addiction, then opioids would not be safe for you to take. If you take opiates or alcohol for the first time and you experience a “magic carpet ride,” then you have type 2 genetically driven CRD and you should seek help immediately.
  • Ok, I have taken opiates and I didn’t experience a “magic carpet ride,” but will I become addicted to opiates if I take too much or take them for too long? No, it is impossible to become addicted to opiates without the gene abnormalities.
  • Is it true that opiate pain medications do not work for long-term painful diseases? No. This false assumption is based on the lack of studies to show effectiveness. It is obvious that no study would ever be cruel enough to have a group of people on no pain medicine for one year. When you cannot do a controlled study, you do other types of studies like surveys, etc. This is the greatest misuse of critical thinking I have ever come across in my 40 years of practice.
  • Are “opioids” more dangerous than narcotics? No, they are the same thing. Even diamorphine, also known as “Heroin,” is a pain medicine and is used in other countries for that purpose. Only in the United States is it illegal for medical usage in failed attempts to stop addiction.
  • Can people taking opioid pain medicine overdose and die? No. People who die from overdoses are those with addiction disease using heroin. It is very rare, if ever, an overdose occurs in those on prescription drugs from a doctor.
  • How do these “prescription” opioids get to the street? The majority are stolen or bought from dealers. A few come to the streets via doctors being conned, but this is less than 15% of “prescription” drugs. There is a difference between “prescription drugs” and prescribed prescription drugs, a point CDC does not clarify.
  • We see pictures of DEA drug raids all the time. Should we have more DEA agents? This would not help, most likely. DEA has only been able to seize about 5% of illegal drugs. The Cartel usually wins. Even local police believe law enforcement is not the way to go.
  • How are dosages for narcotics (opioids, opiates, pain medicine, all the same thing) determined since there is much concern about doses being too high? The FDA is the only agency with the authority to set dose limits for all prescription drugs. For pain medicines, the FDA sets no upper limits. Doctors should and are allowed to prescribe enough to relieve painful symptoms, no matter the dose in milligrams. This is critically important to realize because this misbelief is driving all of the horrors of medication cessation, jailing doctors, jailing people with addiction disease, not giving people in the ER pain medicines, nothing after surgery — all based on wrong science.
  • Is it true overdose deaths have quadrupled since 1999? Yes, but the same 16 year period before 1999 showed the same quadrupling. The data was not corrected for the population growth. Remember, two cars in a parking lot for 100 increased to 4 cars, there is a “100% increase” in cars, when really it is a 2% increase. This is three card monte, or data misuse disorder (DMD), we see trumpeted every day in the press.
  • I am really scared about all these deaths. What is going on? Many of the statistics are what we call “massaged.”. People in the general population are not dying. People with heroin addiction are dying. CDC does not mention this.
  • There are about 45,000 deaths in the addiction group showing in CDC data per year; how many die from overdose in the general population? 1 in 50 (2%) people die in the addiction community each year, sadly. That’s a lot. 1 in 500 people die in the general population from opiate overdose one tenth of the figures we are given by the CDC. The rate of death from pill overdose suicide is very close to the 1/500. The studies do not discuss whether death was due to suicide. Talking with experienced pain management doctors, none can remember a single non-suicidal overdose in their practices. We cannot apply CDC addiction community data to the general non-addicted population; big difference first group has no medical care the second does.
  • Why do more people with heroin disease die? Addicted people are isolated and shunned with their real genetic disease. They are not in the healthcare system and there is no public health outreach. When they obtain their heroin/fentanyl, there is no way to be sure what they are taking or what is mixed in with it. Heroin addicted soldiers in Vietnam did not die from overdose since the Heroin they received was pharmaceutical grade with known milligram contents.
  • Speaking of the heroin addicts that came back from Vietnam, what happened to them? Only 1–2% remained addicted two years later. A striking fact that illuminated the fact that type 2 addiction must be genetic, or all of the soldiers would have been addicted after that much pure, IV heroin.
  • Is it true that the U.S. prescribes more opiate pain medicine than anywhere else in the world? Yes. We are said to prescribe twice as much as the UK, yet addiction rates are the same.
  • Do more prescriptions for pain medicines cause more overdose deaths? No. Only in the U.S. do we have federal drug police allowed to control medical practices. DEA will not allow refills unless written on separate prescriptions. For three months we write three prescriptions. The Canadian doctors, without a federal drug police making rules write one prescription with three refills. We write more prescriptions, but not more pills. This illusion led the CDC Director, Thomas Frieden, to announce “doctors are causing the epidemic,” which is not true.
  • Is there really an epidemic of opioid overdose deaths? No. By definition, an epidemic is a rapidly rising event over a short period of time. The actual increase in 2014 and 2015 was in line with years past of 0.001% yearly increase. The prescription opioid deaths went from 9 to 10 per 100,000 for those two year a tiny increase of one death per 100,000. This is similar to other uncommon events such as death from choking or falls. There have been increases every year since 1970 in street overdose deaths from population growth. The graph is done to make a point, but it is dishonest. The CDC knows how to have a semi-logarithmic graph for accumulated data, which would be nearly flat.
  • Are deaths from overdose the highest they have ever been? Yes. They have been going up every year since 1970, so they are the “highest ever.” If the trend continues without treatment for addiction, they will be the “highest ever” for the next 48 years. I am the oldest I have ever been.
  • Isn’t the CDC Guideline based on medical practice? No. If it were, CDC would list when opioids would be useful. This is not discussed. Only dangerous drugs that don’t work. Medical publications on use of drugs always has uses, side effects and adverse effects. CDC only discusses adverse effects, and many of those are invalid. This gives the impression that CDC believes opiate pain medicine should not be used at all, which is an unusual position considering the success of opiate medications for 50 centuries. This is also unusual because if they don’t work, why have guidelines?
  • The CDC Guideline recommends limiting pain medicine dosing. This was set at 90 mg MED (morphine equivalent dose) to ostensibly prevent addictions and deaths, is this valid? No. Problems can occur at the lower doses as well, according to FDA (Food and Drug Administration)** who is the only legally mandated agency that can make this type of rule about prescribing medicines — not the personnel at the Center for Disease Control (CDC).
  • Why are the CDC Guidelines under attack? FDA is the only agency with regulatory authority over all drugs. FDA does not restrict the dosages of pain medicines, so there’s no 90mg cutoff at FDA. CDC suggests restrictions, but the CDC has no standing to do so. Only the FDA does and doctors know this but have blind faith in the CDC we have had for years — too bad.
  • Don’t physicians agree with the CDC guidelines? Yes, and no. Doctors are driven to follow the guidelines out of fear of reprisal by the federal police revoking their licenses to practice medicine, and medical board actions abruptly ending their careers. They are more fearful of this than the ethical responsibilities to treat pain and suffering. This is the first time in history that there is disbelief that opiate pain medicine doesn’t work and it is dangerous to society. Not too far off from 1692, when people hung their neighbors out of unbridled fear.
  • There are 2 million people with Opioid Use Disorder (OUD), isn’t this evidence that addiction is increasing? No. A National Survey by the government asked the interviewed households: “Did you ever use your prescription for pain medicine in any way other than what the doctor put on the bottle?,” a change from more valid definitions in similar surveys previously by the same agency — SAMHSA. This is not addiction and is not even unusual. OUD is based on this invalid definition with inflated numbers used for funding requests. Real type 2 opioid addiction is “intense seeking of substance without regard for consequence,” not taking extra pills from the prescription bottle. Heroin addicts do not have doctors, thus no prescription bottles. We now know that 1.5% of opiate overdose deaths in the streets had a doctors’ prescription. So much for the Thomas Frieden MD pronouncement that “doctors caused the epidemic,” now shown as a fabrication of thinking. There are 1 million heroin addicts, 0.5% of the population, a rate stable for 100 years. SAMHSA claim of 2 or 3 million OUD’s is a made up statistic for their propaganda to eliminate the use of opiate pain medicine.
  • Haven’t there have been reports of increased falls in older patients using pain medicine? Yes, but the reports were unsubstantiated after being reviewed by FDA scientists (FDA 2012-P-0818). Older patients forcefully taken off of their pain medicines for joint disease can no longer function. Then, they are incontinence in their chairs not being able to get up fast enough due to pain. Soon, they are sent off to the nursing home where they are often disoriented, in an unfamiliar environment, or dimly lit room contributing to their falls. Washington State is trying to limit pain medicine in older folks for this invalid reason in effect elder abuse.
  • Is cancer pain worse than non-cancer pain? No. The FDA** examined this issue and found no evidence that cancer pain is different than non-cancer pain. Pain is pain. Discriminating against people with the same pain just because they do not have cancer is cruel. Many patients are denied pain relief and told, “you do not have cancer.” Fear of Addiction Phobia, a mental health disease, is driving the irrational fears and harms to painful disease patients.
  • My friend takes a lot of opioids for her arachnoiditis and interstitial cystis, which very painful diseases, but I am afraid she will die from an overdose. Should I try and encourage her to stop taking her pain medicines? She would be in greater danger from dying from an attempted suicide due to undertreatment. Medical patients rarely, if never, die from pain medicine when it is properly dosed.
  • Do pain patients need naloxone to reverse overdose? No. Everyday people on pain medicines will never overdose. It is a waste of money and it scares the patients. This is a policy driven by Fear of Addiction Phobia.
  • Is it a sign of addiction when a person asks for specific medications or specific doses in the office or ER? No. Opioids are very individual. Some opioids work for some while others do not. People know what works for them whether it’s an antibiotic, antidepressant or another medication. Disrespecting the patient is unethical and is not in the code of professional medical practice.
  • Do people who go into pain clinics need to be monitored closed? No. Urine monitoring and contracts are for heroin addiction clinics. Pain patients are not addicts and do not need techniques to monitor addicts — more Fear of Addiction Phobia driving policy from the malaligned CDC. No one has shown that the cost and humiliation for pain patients being treated as criminal addicts has prevented even a single case of addiction disease, just ran up the bill. More money is now spent on completely useless urine drug tests (UDT) than the entire EPA budget. We need to send the bill to the PROP/CDC collective.
  • Are alternative pain control methods effective? Yes, but the CDC cited studies that did not compare yoga, physical therapy, or tai chi with pain medicine. Tai Chi may be effective to a degree, but pain medicine needs to be compared, which it was not. This is like saying that Aspirin can help with a severed arm. It helps, but real pain medicine would be more effective.
  • Can chemical receptor disease (CRD) addiction be prevented? Sadly, no. It is there all the time, waiting to be triggered. This is why we read of regular, everyday people becoming addicted to the doctor’s prescription. If the doctor asks, “Is this your first opiate?,” the patient is advised and can be ready if the intense euphoria occurs, which is a warning sign of type 2 addiction. The only way to prevent a chemical receptor addiction would be to never have alcohol or pain medicine serving as triggers. But remember it is a rare complication of opiate pain medicine, less than 1%.
  • What addiction treatment works? For Type 1 addiction (most alcohol, amphetamines, cocaine) talk therapy with little medication is effective. For type 2 opiate addiction (heroin) talk therapy is ineffective. Medication Assisted Treatment (MAT) — controlled prescription opiate replacement is required.

For JATH Educational Consortium, LLC

Alexis M. Haynes, B.A.,
Thomas F. Kline, MD, PhD
Chronic and Rare Diseases
6409 Pernod Way
Raleigh, NC 27613
919–561–0144 (text first)
Twitter: @thomasklinemd

*this author receives no money, or any kind of compensation from anyone.
** FDA response to Andrew Kolodny and his organization Physicians for Responsible Opioid Prescribing (PROP) from the FDA denying the tenents of opiate pain medicine restriction which later became part and parcel of the CDC “Guideline”of 03–15–2016. The full report from FDA can be found on the web: FDA 2012-P-0818

42 years varied primary care • former Chief, Hospital in Home Service @harvardmed • formerly: @UofMaryland, @StanfordDeptMed, @uoregon • thomasklinemd.com