Comments to Michigan Opioid Advisory Commission, May 11, 2023

Please note that I did not get to say everything in this document because each public commenter is limited to 3 minutes; however, this written comment was entered into the official Michigan OAC meeting minutes.

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Good morning, thank you for allowing me to speak.

I want to start by bringing to your attention the  harms that opioid prohibition has caused chronic pain patients (CPPs), and to ask for your support in correcting this problem.

Chronic pain patients have a lot in common with people who have use disorders. We both use opioids, and we’re tired of being stigmatized for it. We both deserve to receive harm reduction services funded by opioid litigation money.

Some of you here know what horrible, intense pain feels like because you may have experienced childbirth, or a kidney stone, or a broken bone or other trauma from an auto accident; now imagine that pain never going away, never getting better, never healing. Imagine going to a doctor or an emergency department for help and being told you don’t need opioid medication, you can just use Tylenol, or ibuprophen; or you can just do mindfulness meditation, or you can just go to therapy and be told to stop thinking about your pain, to just stop catastrophizing your pain.

Now imagine you were actually able to get a script for your intractable pain, but the pharmacist refuses to fill it.

This is happening all over our country. This is happening all over Michigan. We hear about it every day on the Michigan Doctor Patient Forum Facebook page.

Our doctors live in fear of losing their licenses and livelihoods to law enforcement, so they refuse to prescribe effective opioid medications for this type of long-term, intractable pain. Or they dismiss patients who ask for them because that’s considered “drug-seeking behavior.” Our doctors then document us as drug addicts undeserving of pain medication so they can avoid malpractice suits for denying appropriate pain care. And every doctor visit counts against us in our secret drug use risk score in MAPS [Michigan Automated Prescription System].

This means CPPs are going without treatment. Parents can’t take care of their kids; people lose their jobs because it’s too painful to go back to work anymore, and they end up filing for disability. Some turn to illicit drugs or suicide.

Here’s what CPPs want from the Commission:

1. We want funding for “Medication-Assisted Treatment (MAT)” for CPPs, too. Why should we be forced into failed opioid abstinence-only treatment when this isn’t expected of people with use disorders? CPPs should not have to fake a substance use disorder to access subpar pain medication (buprenorphine and methadone).
   
2. We want CPPs to be supported with “comprehensive wrap-around services, including housing, transportation, education, job placement, job training, or childcare,” and “peer support services and counseling, community navigators, case management,” and “treatment with access to medications” the very same things you are suggesting the state provides for people with “OUD and any co-occurring SUD/MH conditions.”
   
3. We want you to fund training for all types of practitioners to be trained in pain management, not in wholesale restriction of opioid use at any cost.
   • We also want pharmacists stop denying scripts.
   • We want doctors to stop torturing people with surgery and then refusing to supply them with opioid pain medication.
     
     It is frightening to us that there are groups in Michigan (Opioid Prescribing Engagement Network, aka OPEN) proposing the use of NO OPIOID MEDICATION after any type of surgery. Can any of you imagine going through a hip or knee replacement, or a spinal surgery without any opioid pain medication, or with only a few day’s worth of medication? These surgeries take weeks and sometimes months to fully recover from the pain. This is unconscionable and should be recognized for the torture that it is.
     
     This is happening because certain doctors see a pile of money from opioid litigation and they want to get in on the payouts, so they put forth strategically misinterpreted studies to justify the promotion of “opioid-free surgeries and pain management.”
     
4. We want the Commission to recognize that the pharmaceutical industry is manipulating us again. Indivior, the maker of buprenorphine, is exploiting opioid prohibition to capitalize on the use of its drug in MAT.
   
   Bupe stakeholders benefit from our criminalizing drug use and characterizing pain patients as addicts.  
   
   Many people find buprenorphine more difficult to withdraw from than illicit drugs, heroin or fentanyl.
   
5. We want the Commission to know that the CDC Guidelines for Prescribing opioids for Chronic Pain are not appropriate for use as a policy guideline because they were written by buprenorphine stakeholders and moral entrepreneurs who make (hundreds of thousands of dollars) their living by testifying in court against other doctors. It is in their best financial interests to characterize pain patients as addicts so that they can be exploited by the addiction and recovery industry and guided toward buprenorphine treatment.
   
6. We want you to stop using the Michigan Automated Prescription System (MAPS). MAPS is a prescription drug monitoring program based on NarxCare, a product that uses non-medical data, including method of payment for medication, distance traveled to a doctor’s office, criminal justice records and insurance claims, and possibly data from banking, real estate, and other commercial transaction to conjure up a risk score that purports to show the likelihood that a patient will misuse substances or overdose.  Because it’s proprietary, we do not know about all the data used to calculate risk scores. But we can surmise that using non-medical data points to make medical decisions is going to perpetuate and exacerbate health disparities for black and Hispanic patients and for poor people.
   
   Because of this, the Center for US Policy has petitioned the FDA to remove NarxCare products from the marke, and this includes MAPS, until the company, Bamboo Health/Appriss, can prove it is safe and effective.
   
   When doctors use MAPS and wrongly deny medication for pain, OUD, anxiety, or insomnia, for example, the resultant harms include exposure to the illicit drug market, drug poisoning, suicide, and death.
    
7. In addition to funding programs focused on young people, we want you to fund programs focused on supporting elderly and disabled people with chronic pain who require MAT.
   
8. We want you to focus on supporting chronic pain patients in the workplace who require opioid medication.
   
9.  We want CPPs to have access to free mental health services to address the wholesale gaslighting of their pain concerns.
   
10.  In addition to providing free naloxone and fentanyl test strips to people who use illicit drugs, we want these things for CPPs, too, because current conditions are driving them to illicit markets for pain relief.
    
11. Finally, we want you to RESEARCH and seriously consider decriminalization and legalization of drugs. Please consider the Iron Law of Drug Enforcement in your deliberations about harm reduction: The law states that the more intensity you bring to drug law prohibition and enforcement, the more potent and dangerous the drugs become because it is easier to smuggle in powerful drugs in tiny amounts than larger amounts of safer, weaker drugs. The ACLU and many other organizations have come out in opposition to drug prohibition for this very reason: It does not work.

Thank you for allowing me to speak.