The CDC Provides Crucial New Guidance on Opioids and Pain

Millions of Americans suffer from opioid use disorders involving prescription pain medications, and each day more than 40 people fatally overdose on them. Although these medications have a legitimate and important role in the treatment of severe acute pain and some severe chronic pain conditions, it is clear that they are also overprescribed or prescribed without adequate safeguards and monitoring, a situation that has significantly contributed to the alarming rise in opioid use disorders and to the related resurgence of heroin use we are also seeing in many communities.

Last month, the Centers for Disease Control and Prevention took a major step toward addressing these intertwined crises by issuing new guidelines for prescribers about the use of opioids for treating patients with chronic pain—who according to some studies now account for 70 percent of the opioids dispensed in this country. The CDC recommends that opioids should not be the first line or only treatment for patients who present with chronic non-cancer pain.

It is not simply an issue of safety. Recent reviews of the science have found surprisingly little evidence supporting the effectiveness of opioids in the treatment of chronic pain conditions (defined as pain lasting longer than 3 months). In some cases, opioids may even contribute to a worsening of pain (hyperalgesia), leading to a vicious cycle of taking more opioids to treat a condition that the medication itself has made less tractable.

The new guidelines thus recommend that non-opioid therapies, such as non-steroidal anti-inflammatory drugs (NSAIDS) like aspirin and ibuprofen, as well as non-drug treatments like exercise and cognitive behavioral therapy, should be considered in lieu of or in conjunction with opioid medications. When opioids are prescribed, physicians should prescribe the lowest effective dose and closely monitor and follow-up with their patients.  Notably, the new guidelines do not apply to treatment of cancer pain or end-of-life care.

Of course, reducing the use of opioids by primary care physicians must be balanced against the efficacy of these drugs for some patients. The aim is not to take these powerful analgesics away from those who need and safely benefit from them, but to ensure they are only used where they are effective and at the same time reduce the risk of both diversion and the development of substance use disorders.

As in so many other areas, pain is an area where we need more science. The lack of evidence regarding opioids in chronic pain is matched by a lack of evidence for any treatment in these disorders. Other available pain relievers like NSAIDs also have their liabilities and potential safety issues, and their efficacy for treating chronic pain conditions will also require further study. Recognizing the liabilities and limitations of opioids is also an impetus to redouble our efforts to develop new pain treatments that would be safer and more effective than currently available medications. Compounds that modulate signaling in the body’s endocannabinoid system, for example, are an active area of research and may yield new pain pharmacotherapies in coming years.

The published guidelines are the outcome of a lengthy process in which all available scientific data were reviewed and input sought from experts and multiple stakeholders, including NIDA and other Federal agencies. The guidelines address one of the prongs of the HHS Secretary’s Opioid Initiative—to improve pain prescribing practices and physician education in pain treatment. Although they are not rules that legally bind doctors in their treatment of pain patients, the guidelines provide valuable advice that physicians, who currently receive little training in pain management, will welcome. And they mark the beginning, hopefully, of not only safer but also more effective pain management in our country.

Dr. Nora Volkow, Director

Here I highlight important work being done at NIDA and other news related to the science of drug use and addiction.

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 Chronic pain

Addiction is a mental health disease/disorder that is caused by both genetic and environmental factors (often involves learning poor coping skills as a young child). A person must first be born with the genetic predisposition to addiction in order to even have that small risk of developing an addiction later in life. Some addicts are self-medicating their emotional pain while others have an underlying mental illness.

Addiction involves the compulsive, often uncontrollable, craving of a specific substance. It involves to use and misuse of a substance for the sole purpose of achieving a "high," (non-legitimate medicinal reasons). It involves constantly consuming more and more of a substance to keep achieving the same "high" as was achieved in the beginning. A pill, a drink, a plant does not "cause" addiction.

The abused substance is merely the symptom of something much bigger and more complex. This country will always have an abuse rate, whether the abused substance is alcohol (which is still the number 1 abused substance in America), OTC cough syrup (robo-tripping), cans of air (huffing), or heroin. Any substance that can be used can also be misused and abused, as most active addicts are self-medicating due to emotional pain.

This government can't continue to legislate addiction by restricting much-needed medications that help alleviate physical suffering. The tighter the controls become, the more collateral damage in the form of humans in pain being forced to self-medicate or die just to find relief. Common sense dictates that a human can only take so much physical suffering for only so long before they break.

So many with 24/7/365 untreated or under-treated pain will either self-medicate with harmful substances or commit suicide. (Actually, this has been happening for the last 3 to 4 years). Untreated/Under-treated chronic pain can suck the very life and soul out the one who suffers. That pain chews, gnaws, nags, stabs, burns, and aches every second of the day. Think of that - every. second. of. the. day. Constant. Relentless. Never-ending. Pain.

Pain patients take their medication for legitimate medical reasons (physical pain). They follow their doctors' directions and the direction printed on the bottles. They do not mix their medications with dangerous substances. They do not sell their pills. They keep their medication locked up or stored in a safe place. Yet they're the ones who are being punished for the actions of others.

Speaking of pain, why are non-terminal cancer patients exempt from these guidelines? A patient with chronic pain from a cancer diagnosis has no different physiology than a patient with chronic pain from non-cancer diagnosis. Pain mechanisms do not discriminate between cancer and non-cancer in pathophysiology. Why is one non-terminal patient with constant pain "more deserving" of pain relief than another non-terminal patient with the same amount or more of constant pain?

There are hundreds of non-cancer, non-terminal incurable diseases, syndromes and inoperable permanent injuries that cause just as much (if not more in some cases) chronic severe, often intractable pain that many forms of cancer and cancer-related treatments can cause. Why does one non-terminal patient with chronic severe to intractable pain "deserve" aggressive pain relief treatment (staying ahead of the pain) while another non-terminal patient with just as much (if not more in some cases) chronic severe to intractable pain doesn't?

There are thousands of non-terminal, non-cancer, incurable diseases, syndromes, and inoperable permanent injuries that can cause the moderate to borderline-severe chronic pain that some forms of non-terminal cancer and cancer-related treatments can cause. Why is one non-terminal patient with constant moderate to borderline-severe pain "more deserving" of pain relief than another non-terminal patient with the same amount or more of constant moderate to borderline-severe pain?

The reason I mention moderate is because there are some cancer-survivors who felt "moderate" to borderline-severe chronic pain. While a non-cancer, non-terminal moderate chronic pain may sound mild, I can promise you it's not. I lived with untreated chronic moderate at times, borderline-severe at other times for first 10 years while I drained my bank account searching for an alternative treatment to help alleviate some of my pain.

10 years later (10 years ago), I started taking 2 tramadols 4 times a day along with 600 mgs ibuprofen twice a day, and 150 mgs Effexor XR (ssnri anti-depressant). 10 years later (now), I am on the same dose, never ran out early, never mixed with harmful and/or illegal substances, including alcohol and/or pot, never overdosed, never compulsively craved, never felt high or sedated.

Tramadol is not my only pain-relieving treatment, as I also exercise on a daily basis, stretch several times a day, use a heating pad, modified my diet, and bought and use a Jacuzzi bath. When I am having severe pain, I use Jacuzzi bath, my TENS Unit, and heating pad. My pain level decreased enough that I can work, take care of my house, my family, 3 dogs, 2 cats, and parrotlett. Most importantly, I have some semblance of a life that I did not have for the first 10 years of my search for a diagnosis and adequate pain relief.

Prescription opioid medications may cause physical dependence, but that is no different than antidepressants, anticonvulsants, and antipsychotics - all three are routinely prescribed to chronic pain patients. Physical dependence is completely separate and completely different than addiction. Physical dependence can happen without addiction, just as addiction can happen without physical dependence.

A chronic pain patient who is "physically dependent" on their pain-relieving medication is no different than a mentally ill patient who is "physically dependent" on their antidepression and/or antipsychotic medications, nor is it no different than a chronic pain patient who is being physically dependent on their Savella (anti-depressant) and/or their Lyrica or Neurontin (both anticonvulsants).

 incorrect information

First of all, you are either lying, or were given incorrect information. But I don't have time to research it for you again right now. Because I care for my disabled fiance who suffers in so much pain he wants to die. He was at least mildly comfortable until the cruel people like you made it almost impossible for him to get the medication he has been taking for 10 years. So because of you they cut his meds in half. Now he wishes he was paralyzed and can't sleep for worry that next time he goes to the pharmacy they will just say no. It's already happened twice in the last 4 years. This is a nightmare. I never would have to thought there would be such cold hearted people that are literally going out of their way to make people suffer so greatly. Shame on you. Why don't you go after the drunks, huh? Tons more people suffer. Between the abuse that comes from it, the illnesses, the dui's, the car accidents and deaths? Why? Because at the end of the day, you all want to enjoy some beers or a cocktail. So do the lawmakers. So all THOSE millions of sufferers well, who cares right? Let's just pick on the poor disabled people so they will kill themselves and you won't have to pay social security any more. I hope you have a loved one that suffers so much they want to crawl out of their own skin like mine does. That can only manage to go to a dr. Office once a month and no where else. His life was ruined by others, no fault of his own and now you people want to see him suffer even more. It's enough to make me want to vomit. You should be so so ashamed for treating unfortunate ones this way. You really should.

 Opioid prescribing.

This has gone way, way too far. The statements I see in articles like this -- which are mostly someone's OPINION, The suicide hotline will soon be deluged with patients whose medicine has been taken away, and they want to die because for some of us, opioids have been the only thing that has helped us. Here are some examples of some things you will hear more of: I personally had a very serious amount of damage to my stomach from taking aspirin for eight years, and I did it so that I didn't have to take Rx meds. Then I had a lot of physical therapy, and in those days all the therapists wanted to be working on football players, so (since they really did not know how to deal with fibro/cfs yet, I got hurt...they permanently hurt my back. Same story with chiropractic services. Now I have so much degeneration from RA and DDD, those services can no longer be used on me. I will skip the rest of the therapies that don't work, but I've been there/done that and most of us have -- I mean a huge percentage. I am on the edge of believing there is a conspiracy going on here. So even though the guidelines are not laws, the number of QUALIFIED docs getting out of the opioid business will be enough to smash the apple cart. The repercussions are going to be big.

 Concerned about the future...

Given the anti opioid hysteria, and the fact that most chronic pain patients do not abuse their medicines, nor combine them with anything recreational, it surprises me so much has been said against them. Theyre not the reason for any so called 'opioid epidemic'. Heroin is the problem, not prescription pain medicines. Lowering their dosages does nothing for addicts, it only increase pain patient's pain and suffering. Lowering overall prescribing does nothing to deter heroin addicts, but destroys the little quality of life pain patients have and are rapidly losing. Some doctors and center are not prescribing them at all, yet not replacing them with ANYTHING. How can this help anyone?
There's so much hysteria and propaganda going on yet no effective alternatives or replacements, and barely any recognition of the millions of chronic pain patients who are suffering.
Pain patients already have to deal with the shame, blame, guilt, prejudice, bias, bigotry, and the stigma of committing the horrible crime of having incurable pain. To continue to demonize their medication, and therefore them, all it does is lead to more pain, and suffering. Who speaks up for the families of chronic pain patients seeing their loved ones erode and deteriorate?
Most chronic pain patients HAVE no substance abuse problem. Yet they're treated and viewed as such.
They have problems with doctors who under prescribe or flat out don't prescribe. They have problems with pharmacies, who often strangely seem to always be out of stock of these medications. They have problems with the pharmacists themselves who 'don't feel comfortable filling out" a perfectly legitimate prescription. They have problems with their health insurance that makes arbitrary quantity limits and either forces prior authorization or de authorizes their medicines. They have problems with the CDC, FDA, DEA, and all the other alphabet agencies who all seem to only care about the drug addict, diversion, crime, etc but none of the sympathy and compassion for the much maligned, and hardship enduring pain patients.
Even though these are called simply "guidelines" which frankly creates a ham fisted attempt at curbing drug use, with the mounting pressure of the DEA , doctors will follow them as the letter of law, creating a ripple of destruction in the already fragile and vulnerable pain patients.
Most pain patients are all for monitoring 'at risk' patients. And of course, do not unscrupulous doctors prescribing for cash. But in the backlash in dealing with these incidents, pain patients are caught in the middle..waving their hands around, wide eyed in shock wondering "what the heck did I do? why am I being punished for this? how am I of all people, responsible for this???"

 Opioids use disorder

I think this Science as its called is totally flawed ,, I personally did not get prescribed opioids for over 15 years , first I was seen by a psychiatrist to determine that I was not at risk for drug abuse, then I went thru every kinda treatment like Acupunture , Water therapy, every kind of antidepressant on the market as well as adjustments to every bone in my body and only then was I given opioids for my pain..I pee in a cup every month and get pill counts and as well had DNA testing to see how my body breaks down medication,This all was done per the so called Science that was suppose to have been done before all of this,,I may be dependent on my Meds but I certainly would never call it opioid use disorder,, I think your junk Science needs to step back and get off of all Pain Patients Backs,,Get out of our Doctor Patient Relationship,,You don't have a clue as to what suffering your causing Pain Patients..One day you will lay in pain and I can only hope you get the same treatment your forcing down on all of us who did not ask to be like this,

 Cancer patient refused pain medication

My Mother has had two seperate surgeries for two different cancers. She recently has breast can cer surgery and they sent her home with Tylenol and Motrin. She's a cancer patient! A friend who had a 19 yr. old child with a rare nerve condition was refused her meds since the government has stepped in and scared Doctors from prescribing opioids. He died yesterday from a heroin overdose. It was her first time. She could not tolerate the pain. You are cultivating herion addicts and future suicides with this. Drunks can go and get booze from a gas station or StarBucks today, but legitimate pain patients, who are following the rules are now being punished. My mom has an allergy to aspirin. What now? This all started when a Senators son took opioids and drank booze. He died and the Senator waged a war that will now kill thousands of other people's loved ones.

 Chronic pain and opiates

This article is amazing and super informative....i love to learn more about this topic as i encounter it as a social worker on a daily basis.

 Chronic Pain and Pain Management

I am now 76 years old and have lived with chronic pain since I was 57, (19 yrs). It all started when I was having pains I couldn't find a reason for, and they kept changing places in my body on a daily basis. One doctor told me it was all in my head, yet he prescribed Tylenol #3 for my pains and generously wrote scripts for Zoloft. I was finally sent to a Rheumatologist who checked me out, and came to the conclusion I had Fibromyalgia, something many doctors still refuse exist. I also had a bowel disorder, incontinence disorder and the beginnings of arthritis. I also had a vaginal prolapse and went through surgery to correct it, then a year later a doctor wanted to re-do it, then a staff infection that hospitalized me for 19 days and 7 doctors overseeing me for fear I was going to die, after attempting and installing a drainage of the severe infection (indescribable painful) sent me home, a horrible discharge came back and I ended up in surgery for the cause of the staff infection and part of my lower intestine was removed. While all this was going on, I was taking pain medication, but after the surgery I had to take Oxycodone so I could tolerate a nurse unpacking and repacking the surgery that had to heal from inside out for 8 weeks. While all this was going on, I was still having the all-over pains from Fibromyalgia and taking Tylenol #3. In 2006 I had incontinence to embarrassing to live with, went to a Urologist and he installed a mesh sling on an outpatient surgery. Now I'm told that mesh sling was never approved by the FDA and has caused many problems to mention and it can never be removed because it has attached itself to other organs, and if it is attempted, I would live the rest of my life with a catheter. In the meantime my spine is falling apart and I had 4 collapsed disks, with bone on bone pain. I was sent to physical therapy which only aggravated the pains, and stopped that after 6 weeks. The doc. decided to send me to a pain management doctor; I was injected with Epidural injections that were so painful yet I did the course they insisted would make a difference, but, it only got worse. I started having a lot of pain in my left hip, and lower back, went to an Orthopedic and he tells me I have Spinal Stenosis and until that is corrected he could do nothing about my hip or spine problems. I was still on Tylenol#3 pain med. So, I decide to see the Rheumatologist again and was told he could nothing for me, but that I might have Lupus! I refused to believe that, and my doctor suggested I try the Pain Mgt. again, so I did, with the same old results and did it because I didn't want any repercussions for not going. Next thing, cataracts in both eyes happened out of the blue, then skin cancer (Squamous in Situ)and my nose got altered when they took it out, and by the way, it is back now and spreading in other areas. But, oh well! The absolute finally happened, I was diagnosed with Arthritis and it has gone crazy, in my hands, my knees, my shoulders, my neck, along with 3 crushed disk there as well, in my spine and now it has destroyed my left hip and working on the right one. I constantly lose Vit. D, don't know why, but about three times a year I have to take mega doses for 6 weeks to replenish it. To top it off, I have upper dentures I had to get in 1997, and now due to a severe paradonal disease the last 10 teeth on the bottom have to be removed before I can go in for a hip-replacement due to a possible infection going in the new surgery. I have fought pain for 19 years now, and a about 2 years ago I was put on Oxycodone 10mg., 3x a day. I can barely walk, my insurance will not cover the dental cost of $1100 to pull 10 teeth, (outrageous price) so I am in waiting for someone to decide what to do next....I forgot to mention, along the way I had pen-holes drilled in my feet and ankles to find I had Peripheral Neuropathy and nerve damage with so much pain in my legs, alone with extreme cramps in my calves and feet. Now my sciatic nerve is pinched and both legs kill me every day of my life, but with more Epidural Injections, nothing seems to work. Also have to have Cortisone injections in my shoulders about 2 to 3 times a year. But, I am on long term care now, and guess why, I also have COPD and that entitled me to Medicaid and 13 hours of help a week from a caregiver.
I know this all sounds nearly impossible to be true, but as God is my witness, it is. Sometimes I just want to go to sleep and never wake up, then something happens that causes me to want to live just a little longer. I have been fighting for my life for so long, I can't remember a day without pain anymore. I don't have a clue what it would be like. I just keep taking my BPmeds, Zoloft, and Oxycodone, a heating pad daily, cold packs on and off, and a menthol rub everywhere I can reach, and make it through another day. I've been shuffled from one doctor to another and they just keep guessing what to do and end up giving me my pain pills for lack of knowledge. We all know the pills are going to do damage to me somewhere eventually, and my biggest fear is I will end up with cancer from lack of strength to fight anymore. I have 4 children, 13 grandchildren and 10 great grandchildren and have been a widow since 1985, so there are some good things in my life that are worth living for. If nothing else, would you pray for me.

 what is the connection

I keep hearing the word Fentenyl in relationship to heroin use. Are addicts wearing Fentenyl patches and taking heroin?

 Lately, a lot of heroin as

Lately, a lot of heroin as well as counterfeit prescription opioids sold on the street are being laced with fentanyl, which is 25 to 50 times stronger than heroin. This is causing many overdoses and overdose deaths. [See Fake Prescription Drugs Laced with Fentanyl]

 This is getting ridiculous. I

This is getting ridiculous. I live in Florida where there "pill mills" a few years ago, so doctors and pharmacists are extremely careful with opioids, which I understand. But it hurts the rest of us that have legitimate pain and need opioids to just live a semi-normal life. I have failed back surgery syndrome, several herniated discs, spinal stenosis, arthritis, sciatica and degenerative disc disease. I'm 38 years old. I was taking Percocet 10/325, 3 times per day. It is the only thing that works and helps me get out of bed. Occasionally I would run out a day or 2 early because of excruciating pain. Yet my doctor (certified pain management doctor) tells me that the most he is "allowed" to prescribe of an opioid is 90 pills per month. BS. Now due to all the so called recommendations for not taking short acting pain meds for longer than 3 months, a few days ago, my doctor prescribed me Opana ER 10 mg (1every 12 hours) I had to go to 16 different pharmacies to find that med. Yes, 16!!! Which does not control my pain. And I've read several articles that Opana is more widely abused than other opioids. I'm getting my 3rd back surgery in the next few months. I pray it works and I can stop taking opioids just so I don't have deal with the horrible pain and spending 8 hours every month driving around my city looking for my meds.

 New Recommendations on Opoid prescribing.

I very much fear there will be a terrible cost to implementation of these new recommendations, which are so very different from what went before. The dosages suggested seem random to me. The suggestion that "acute" pain be treated for three days only, without regard for whether the pain is from a small injury or a large one is odd. The lack of differentiation of different causes of pain, with no discussion of which receptors are involved is concerning to me. It appears as if the writers of these new suggestions knew a lot about drug overdoses, but not a lot about the pathophysiology of pain. And all too little about human nature. If these recommendations are suddenly implemented, there will be many more people going to the black market for opiates, where they will discover under the bridge that Oxycontin costs them $60 a pill and heroin is $7 an injection. I do not think that will decrease drug overdose deaths.
If they want to keep Fentenyl from percolating into the market, they are not going to stop that by saying it can be used in end of life care; the very elderly in nursing homes are the most common source of that drug on the market. It can be removed from a patch with a needle and the demented elderly person will never know. Addicted health care workers want Fentenyl because it doesn't show up on a casual opiate urine test; and addicted health care worker is a known source of black market drugs. I did not notice any reference in this set of suggestions to stopping the flow of drugs out of the medical system through any source except through patients who they presume want unnecessary opiates.
I'm afraid they are advocating what will become the desertion of patients, and I think that is unethical.
In my experience, it is very different to treat someone with degenerative disc disease, compared to someone with a history of seven back surgeries, two of which were to take out broken rods and screws and the last of which was to place a basket of wire around the entire lumbar vertebral column. The first patient well may get by with Tai Chi and yoga and NSAIDS. The second one may need a morphine pump and cannabis as well as antidepressants and gabapentin, so as to affect many different receptors which relate to the extreme change in anatomy and the irritation of embedded foreign material. These are two very different kinds of problems, and both are called "Chronic Pain Syndrome." Both are globally lumped into these recommendations. Oh, and incidentally, these are not recommendations used in other Western countries.

 opioid prescription

the point is that opioids for chronic pain are not only dangerous but ineffective. a chronic user , even when following directions for use and avoiding aberrant behaviors, will ALWAYS develop a tolerance and have minimal benefit and heavy dependance. Bottom line is there is no role for chronic opioid use unless you are on hospice type terminal care. prescription opiate dependent patients understandably fear not having their med but lack the knowledge that it is actually suppressing their endogenous opioid systems and creating WORSE pain from neurosensitization to pain,
time to seek other means of treating chronic pain and put the narcotics away.
The only real answer to the heroin problem is not exposing people to opiates and especially heroin in the first place. We should probably pay the cartels to NOT let any heroin hit our borders and crush anyone who tries to import dope to the US with any means necessary. the Ithaca plan is benevolently-minded but idiotic approach to a drug that has NO safe use. let them have cannabis. opiates=death.

 Punish Purdue and Florida's "pain clinics"

Where was the cdc over ten years ago when this epidemic started!!!!
The question no one seems to ask is why is this epidemic only in the USA?
2. Why now and not then?
Many of these pain medications have been around for DECADES and in some cases great pain medications like methadone have been around for over a hundred years. Methadone is being suspiciously maligned as its a generic cheap medication alternative to profit Perdue

 No Cure For Endometriosis

Dear CDC,
I have suffered with endometriosis for 35 years, I have had 11 surgeries. My last 6 surgeries in the last 5 years have gone terribly wrong, I have been told no more surgeries and there is no cure. I could possibly lose my life, all my organs are tied in a ball and are attached to my back muscle. I am in pain everyday, I have tried everything and anything to help my pain including nerve blocks, Lupron, Danazol, Gabapentin, excercise, meditation, full hysterectomy, birth control, acupuncture, therapy, tens machine and the list goes on. Opioids have been the last thing that I have tried and the only thing to work.

I know it is trendy to demonize opioids use, the new guidelines are going to cause more pain and suffering to people who don't need to be kicked in the teeth when we are fighting to keep going forward in life. I am 25 year cancer survivor, I didn't have pain with it, endometriosis is excruciating daily pain, each lesion has a nerve center. CDC acknowledge real chronic pain suffers, rewrite the guidelines, most chronic pain suffers take their medicine as prescribed and don't get addicted. Hospitals, doctors and pain clinics are shying further away from helping chronic pain suffers, your new guidelines are further damaging this. There will be an increase in suicides, we will have more people turning to the streets to get help with pain and addicted to heroin or other drugs, thus having a bigger epidemic. Shame on you for not researching all the facts before tightening regulations, you are furthering physically debilitating diseases and illnesses that have no cure.

 Provider responsability

Prescription abuse is a serious issue. The CDC has several guidelines for doctors to follow when prescribing opiates. Here are a few. Opiates should not be first line treatment. They should only be used if benefits outweigh the risks. Before opiates are initiated there should be a treatment plan in place for how to transition off them. Lowest dose possible should be used. Every 3 months patients should be re-evaluated for their need of opiates. Providers should also utilize drug monitoring programs. This is a program which tracks prescriptions being filled. Patient found abusing medications should not be able to continue to get refills.

 Pot calling kettle black

Why is no one addressing the very real and verifiable fact that more doctors than patients are addicts. True! So why are they in charge of monitoring? Why aren't they being drug tested? The drug overdose "epidemic" kills more people per day than drunk drivers. That is true. Two more drug overdoses a day. Basically the same. 28 by drunk drivers and 30 by overdose. Take the average of drug deaths over the last 15 years; don't just pick the highest year during that time. Why aren't they drug testing for driver's licenses at the DMV. What about the approaching suicide epidemic? I personally have heard this as a solution from four people since their medication has been rationed to a dose that undertreated their pain. My pain Doctor told me that spinal injections are as curative as surgery. I've done the research and that is simply untrue. They are certainly more profitable than simply writing a prescription. What has happened to compassion and integrity in this country?

 a question

is there not some sort of legal route to be taken? We are being treated like criminals, forced to spend money, have our right to live in dignity taken away. Isn't there some privacy right we have? If states can allow for recreational marijuana use, why is the CDC and DEA going after pain patients who are not using anything illegal? Could the ACLU take a case for our right to live with a reasonable amount of pain? Just some random thoughts and questions.