Suboxone


I was in my pain management clinic the other day, preparing for a sympathetic nerve block.  For the record, that wasn’t fun, more on it later.

I was trying to focus on anything but my dread about the procedure I was about to undergo and couldn’t help but latch onto the one sided phone conversation being had by one of the nurses.

What caught me was the word withdrawal symptoms.  The nurse was explaining that they could prescribe Suboxone for the withdrawal, but that the patient’s insurance wouldn’t pay for it and a thirty day supply was more than $300.

Suboxone is a pain medication that also treats opiate withdrawal symptoms.  It is a favorite for chronic pain patients that are having to be weaned off their opiate medications.  As I listened a little longer, I heard the nurse say “I know her arthritis is bad but we can no longer safely prescribe opiates to treat the pain.  Would you prefer us go to prison?

This is what was going through my mind, the arthritis sufferer has probably been on opiates for a long, long time, hence why they are going through withdrawal from them.  However, where is the justice in her insurance not paying for Suboxone?

It is true that suboxone is addictive, but that’s all we ever hear anymore about medications.  My Lyrica is addictive.  My Flexeril is addictive (yep, surprise surprise).  Hell, my father was addicted to aspirin for most of my childhood.

Today it was arthritis, eventually it will be me.  According to the CDC 97% of all CRPS patients commit suicide within 10 years of the intense pain beginning.  Think for a moment; 97 people out of every 100 diagnosed with Complex Regional Pain Syndrome will commit suicide and that was before the new opiate prescribing restrictions started in 2016.

Roughly 150,000 new patients a year get diagnosed in the US with Complex Regional Pain syndrome.  That may sound high, but it’s actually an “orphan disease”, a disease that no one is working to advance treatment for because it doesn’t make them money.  Lyrica was discovered for something other than CRPS and since it is a close relative of gabapentin, it was pretty easy to figure out that it would be somewhat useful for CRPS patients.

So, let’s do the math 150,000 people in 2018 will be diagnosed with CRPS.  By 2028, 145,500 of those patients will have committed suicide – One hundred, forty five thousand, and five hundred of those one hundred and fifty thousand people will have committed suicide by 2028, from an “orphan disease” that practically no one knows about.

Speaking of CDC stats have you looked at the rates of death for opiate overdose from the CDC?  In 2015 there were 47,000 overdoses in the US, 33,000 of them were opioid related.  And of those 33,000 nearly 70% were heroine and Fentanyl overdoses.  Of the 30% of opioid overdoses left most were illicit opiates (stolen pills) and multiple factor overdoses like hydrocodone and alcohol, hydrocodone and oxycodone.

And for the record, 33,000 deaths from opiates including heroine does not constitute an epidemic.  33,000 of 325 million people died from opiate overdoses, nearly all of them illegal use of opiates… So 0.0001% of the US population died from opiate overdoses.  That’s 1 ten thousandths of a percent of the US population.  In contrast in 2015, 55,000+ died as a result of influenza or influenza related complications.  Yet most of use ignore CDC guidelines  about getting vaccinated against the flu every year…

Still, the government talks about opiate overdose deaths like they are eclipsing heart disease, stroke, cancer, and diabetes.  Yet death from influenza doesn’t even break the top 10 causes of death in the US every year.  How can something that kills fewer people than the flu be an epidemic?

It is true that the numbers are on the rise, but that’s because heroine use is on the rise and heroine overdoses are calculated with opiate prescription overdoses.  As is Fentanyl use and Fentanyl overdoses and Fentanyl is in an opiate class all on it’s own.  Fentanyl is more addictive than heroine and kills a larger majority of it’s users and it is often used to boost the addiction rates of illegal hydrocodone and oxycodone tablets.

Just something to think about when you consider the drive to limit or remove opioid prescriptions from patients like me.

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