Thank you Josh for exposing this abusive medical practice rooted from fear that was conjured by CDC PROP DEA DOJ. I’m not surprised PROP and cohorts are Church Mouse Quiet about Gabapentin dangerously overprescribing off label since there was a massive multi-million lawsuit the last time Neurontin was dangerously overprescribed off label. They all knew doctors would repeat bad history as long as it kept the DEA away. I think PROP member Dr. David Juurlink holds the most blame for this catastrophe by rallying the DEA to schedule Tramodol in 2014 leaving doctors one less fall back option once the Guidelines he participated in drafting were published in 2016. There will be nothing to offer pain patients once Gabapentin becomes scheduled beyond the 7 states. There is a special place in Hell for all those that caused this catastrophe.

The only difference is there was no need to market Neurontin off label since the CDC PROP and Cohorts DEA ensured there would be nothing else for doctors to prescribe. It’s convenient that almost all of pharmaceutical manufacturers that make Neurontins are not involved in opioid litigation and made their false claim penalty back 100 fold.

https://www.reuters.com/art...

So much for Vladimir's free ride on Uncle Sam's Star Spangled Goofy Dust Train. Big Orange Daddy is cracking down:
The United States on Thursday strictly limited the export of fentanyl and related chemicals to Russia ...
The Commerce Department said sales to Russia of the powerful opiate will now require a U.S. government license.
The rule also applies to exports to Belarus, whose leadership supports Russian President Vladimir Putin.
(September 15, 2022): https://www.washingtonpost....
Uplifting to learn that US has heretofore validated Vladimir and company's pain - while denying that of its own citizens.

JB: ... legal and necessary medications are demonized and prohibited. How many more "drugs of abuse" will be futilely added to the DEA's hit list? How many more pain patients will continue to face a choice between living in agony and trying to quell it with whatever pharmaceutical crumbs are tossed their way? Such unspeakable cruelty.
Hear hear ! Verily !
JB: The term "gabapentenoid" ... People generally hate all of them.
Always thought that "Gabapentenoids" would make a good name for a punk-rock-thrash band - along with "Rat Brain Homogenate", "Amino Casino", "Chronic Spinal Dog". They could play their cult classic, "I Want To Be Nauseated".

Why have opioids gotten such a bad rap? I have used them for 12 years for chronic pain and have never overdosed or had any kind of problem even on a very high dose (2400 MME). Thanks go out to the CDC and PROP for ruining people's lives. I would be couch-bound without my pain meds. With my meds, I am having an excellent quality of life. I take care of my 16 rural acres, mow my lawn, and bush-hog my pasture with my John Deere. I also keep my long lane to my house graded. None of this would be possible without my pain meds. The entire opioid situation is bogus as the majority of deaths are caused by street drugs (mostly fentanyl). To the CDC, the DEA, and PROP - GET OUT OF OUR LIVES and let us CPers have a life.

Just my opinion, but I truly believe that one of the major driving forces behind this pharmaceutical witch hunt is the enormous amount of money that certain PROP members are being paid by lawyers who sue drug companies. Can you possibly think of a better reason for the group to maintain its rigid, unyielding stance about "evil opioids?" Do you honestly believe that any of these people give two shits about either addicts or pain patients?

I think your opinion is spot on. I get really tired of being discriminated against just because I suffer from chronic pain. No one hassles heart patients or diabetics about the meds they take. What's the difference?

do you still receive your pain meds? My 85 year old mother cannot get any doctor in Colorado to give her even one tylenol with codeine let alone the fentanyl patch which helped her for so many years. She has never been high and there were never any tests done showing that the pain meds had harmed her body in any way yet she was cut off. Now they lecture her on their dangers when she asks for them. She spends most of her time now in bed. Cannot function. She's 85. where do you live that you can still get them?

Hi Gailyn, Yes, I am still on high-dose opioids but what I go through to get the meds is absolute craziness. I live in Virginia but my treating physician is in California. I have an in person meeting with the doctor every four months and in between are phone and zoom appointments. The really bad part is my home state will not fill my prescription because it is "too high of a dose," so once per month my wife has to fly to California just to fill the prescription. Life is very tiring, not to mention expensive, but I would be couch-bound without my pain meds which are very helpful to my quality of life as you can read in my post above. I am so sorry that your mom is in such unnecessary pain. IMHO, the CDC and DEA are practicing medicine without a license. I wish I could do something to help you but my doctor is taking no more patients as he is swamped with patients because he has taken on cases of other people that have lost access to their medication.

Are you aware of Kratom? It is legal in Colorado and might give your mom some relief. There are several very reputable Kratom businesses in the U.S. that you can order from - google it and see if it's something your mom might want to try. It really helped my daughter at one point when she was being tapered off of her pain meds - a few months later she was able to find a new pain management doctor to take her case but Kratom was such a huge help during that inbetween time.

What is being done to your mom is criminal. My elderly mom was also on long term opioid therapy for about 15 yrs when her PCP stopped prescribing. She at that point was accepted onto hospice bc they expected her to continue to decline at the age of 96. Even tho she wasn't "dying" so to speak, she agreed to hospice to get the opioids prescribed. They did address other health issues just nothing invasive or heroic would be done. We could always take her off if needed which I actually did in order to get her hospitalized for cdiff. She had great pain care until the very end when discharged to physical rehab after cdiff. The doctor decided her opioid dose was too high and cut it by 50%. It took almost 3 wks to get it fixed. There's more to the story but the immense pain caused a series of events and she eventually gave up. Passed days after rehab discharge at the age of 98. If not for the cdiff & subsequent rehab, I believe she'd have lived longer and close to pain free. Is there a possibility that hospice or palliative care could be an option for your mom?

I was prescribed Gabapentin a few years back for cervical radiculopathy. It didn’t do a damn thing for the pain. What eventual resolved the issue was Tylenol 4. In fact, I have noticed the trend in three separate instances, two with my neck, and one with my back is that nothing helps until an opiate is used in my treatment and then for whatever reason the pain, stiffness, crackling bones, all of it just slow-fades away like I never had an issue even though the mechanical issues remain, even if the opiate barely touches the pain. Scratching my head on that one… but anyhow, was prescribed Gabapentin that didn’t do much for my pain but it did seem to help a little bit with some mild anxiety I was dealing with so I continued taking the Gabapentin for a few years.

Fast forward I’m in my primary doctor’s officer grumbling about my weight because I had put on a bit and it absolutely would not budge. I tried everything up-to-and-including 3 and 5 day water fasts. Nothing would move the scale south. He suggested it could be the Gabapentin. So what did Vain-R-Us do? Quit taking it cold turkey. HUGE!!! HUGE!!! Mistake. The withdrawals were awful and mind you I was told by the prescribing doctor that Gabapentin had no withdrawals and I should be able to stop taking it cold turkey at any time I wished.

I spent a good month in a half with increased head zaps, restless leg, and my emotions stuck either in rage mode of despair mode. I got through it finally and dropped 13 pound practically overnight but never, ever will I take that medication again, or any medication of that class. Good Gods!

Just one more example of the disaster arising from CDC/DEA/PROP forcing a wedge between patients and their doctors. Physicians can no longer prescribe the right drugs when needed so they prescribe the wrong ones. If it makes you feel any better (probably won't) you have plenty of company.

I'm glad you brought up the side effects. Doctors are prescribing it like candy these days with no regard to the possible risks--and they're prescribing it to people who don't even suffer with neuropathy, which is the only thing it offers help with. Although it helps with my neuropathy tremendously (so I can't return to the neuropathy I had before Gabapentin), I've paid a price. What I don't understand is that if doctors are afraid of losing their licenses by prescribing opioids, shouldn't they be afraid of prescribing a potentially harmful drug like Gabapentin for conditions that it offers no help with?

For me, it only works a little.

Josh--
Excellent work. And, just one more reminder of how wonderful an idea it was to get the Feds involved in healthcare. (Started with Medicare.) The lack of a standard dose/response profile would surely indicate that the drug is not effective for this chosen indication, right?

As to more "Devil you know" examples--Isn't it odd that there has been very little work looking at the substitutes for evil BPA?

Mike, Whole foods tried at least one substitute called BPS. The nothing that was wrong with BPA was even more nothing with BPS. But at least they could put BPA-free on the labels.

I find that Fugh-Berman's "alternative" is ludicrous but more importantly, it's dangerous. Not only will you be left in horrible pain, then you can add on a liver blown up by the tylenol as well as significant fiery holes throughout your gut from the advil. Not to be malicious, but to give people lived experience, I've often wished I had a magic wand and I could give people severe pain so they can get a clue. These are not people who live with pain.

But they are people who benefit handsomely from people with pain.

I 100% believe that; why else would one cling so strongly to lies? I find it raw and offensive for others to be telling me what helps me to suffer less and what won't - people who don't even know what they're talking about. Hence my magic wand; I want to give them something to talk about.

Josh. You belittled the combination of acetaminophen and ibuprofen. Have you ever tried it? Do you know anyone who has? I take 1000 mg. of acetaminophen and 400, to 600 mg. of ibuprofen, and 300 mg. of Gabapentin, no more than every 6 hours. My pain is excruciating!!! Mostly ciatica. That combination is the only thing that works for me. Too, it is non-opioid and non-addictive!!! I've used that combination, for low back pain, for decades, and it isn't losing it's effectiveness. Not even a little bit. MIRACLE!

Not with me. I can't take NSAIDs anymore at all after that. Not even Tylenol.

I didn't belittle it. In fact, there have been times when I found it to be quite useful. Not for kidney stone pain, but for aches from the flu etc. Unfortunately, like many others, I can only take a very small amount of Advil or my stomach feels like I swallowed nitric acid. I was belittling Fugh-Berman's statement, which made it sound as if she had invented some novel new potion for pain by combining two very old drugs - one of which many people can't even take. My pet snail could have come up with the same solution. (By the way - she went out of her way to state that NSAIDs *don't* potentiate opioids. I have a little trouble believing this but I haven't done the research.

Be careful. My father had his kidneys fail from using advil for yrs

Yeah 300mg of Gabapentin every six hours daily is definitely addictive. Also that combination of acetaminophen and ibuprofen on a daily basis is probably destroying your liver and kidney function. Considering you’ve been taking the Gabapentin at that same amount for decades, why don’t you try an experiment as to weather it’s addictive by stopping it cold turkey for two weeks so you can see what Gabapentin withdrawal feels like. Then come back and tell us it’s not addictive. I’m a neuroscientist and I know my shit and you are quite clearly addicted to Gabapentin.

The only thing stopping cold turkey will determine is if he’s physically dependent/ habituated. That does not mean he’s addicted! One of the reasons we are in this mess with opioids is because people equate physical dependence and addiction. They are not the same!!

With many meds, if you take them for a long enough time, you’re body will compensate by dropping production of endogenous molecules in its endless quest of keeping the many systems in the body in balance. If you stop taking the medication cold turkey, the balance of a bunch of these systems in your body all of a sudden goes severely out of whack. Until your body ratchets up production of the different chemicals it needs and pulls everything back into balance again, you will experience withdrawal symptoms. The symptoms vary based on the medication you were taking but they are usually at least unpleasant and often hell on earth. Medications that act on the brain such as antidepressants, benzodiazepines, opioids, gabapentioids, etc usually result in some withdrawal symptoms, even when tapered.

If you are an addict, you are continuing to use a substance despite its adverse affects on your ability to work or go to school, take care of your responsibilities, and function as a productive member of society. Most, if not all addicts are physically dependent but almost all people with physical dependence on a prescribed medication aren’t addicts. If you give anyone a medication that acts on the brain for a long enough time, physical dependence is guaranteed to develop but addiction very rarely will.

This confusion is compounded by endless movies and tv episodes where someone is injected with heroin for a few days and then turns into a violent, raving junkie, begging for a hit. Heroin is about as strong as dilaudid but I don’t hear of many raving junkie grandmothers attacking people with their walkers after getting a hip replacement and a weekend of iv pain meds. Because of this irrational fear, lots of people suffer through terrible acute pain with no meds because they don’t want to become a junkie. That’s like someone who has never has d alcohol in their life saying, I don’t want a can of beer or a glass of wine or even a shot of whiskey because I’ll end up an alcoholic on skid row.

I have wished SO many times throughout the years that there was a machine that allowed doctors to hook into our bodies for the 3-15 minutes they spend with us so they could grasp the intensity of the pain we live with daily. It might also help them diagnose a problem faster.

While I totally agree with all of this, there's just one little correction: illicit fentanyl has been causing massive OD deaths far earlier than 2013. There's a CDC Morbidity and Mortality report that describes over 1,000 OD (poisoning) deaths in the Midwest from 2006 - 2009. Certainly, it was also around earlier than 2006, too. Just saying.

The CDC Wonder database paints a different picture. Fentanyl was barely a factor before 2014
https://uploads.disquscdn.c...

This is what I was referring to. Definitely not trying to be argumentative. Appreciate ALL you do for chronic pain sufferers! (And my dates were wrong. It's 2005 - 2007.)

https://www.cdc.gov/mmwr/pr...

I understand. But if you look during that time on the group, antidepressants killed about the same number of people as fentanyl. Fentanyl wasn't a public health threat yet.

Are you insane? The only antidepressants that it’s even possible to accidentally overdose on are tricyclic antidepressants and they haven’t been used in nearly half a century except in very unusual circumstances. There is a single antidepressant listed on that list, you’re implying that people are accidentally overdosing on it? The only way you can overdose on a modern day antidepressant is if you are intentionally trying to kill yourself by taking an entire bottle (and usually combining it with alcohol or other sedative drugs). I don’t think it’s a very fair comparison to say that fentanyl and citalopram killed the same amount of people when the only reason citalopram would kill someone is if they were intentionally overdosing in order to commit suicide, which unfortunately can happen because many people with depression can also be suicidal. Citalopram didn’t cause those deaths, their depression did. Citalopram just happened to be the most commonly prescribed SSRI at that time, meaning the majority of suicides committed by depressed people happened to involve overdosing on citalopram. Generally speaking people who overdose on Fentanyl do so inadvertently and aren’t actively trying to kill themselves! You’re comparing apples to oranges here.

After back surgery my surgeon prescribed gabapentin along with other pain medication. The side effects from the gabapentin were substantial but with no pain relief whatsoever from it. In the trash it went.

You and everyone else.

Gabapentin, then Pregabalin. Neither does a whole lot. MS Contin helps, but I'm on a very low dose that only reduces my pain from my ulnar vertebrae and disc degeneration. And she wants to lower it even more. She said that they don't want to remove the pain entirely, but just "make it bearable." 😡
Gee, thanks.

And I have no alternative doctors in the area. Both pain centers have stopped prescribing opioids entirely because they can't find doctors who will do it, plus "legalities." 🙄

Now even veterinarians have joined in the madness. My Scottie is terrified of fireworks and thunder, none of the otc stuff has been helpful. In desperation, I called the vet asking if they had any suggestions just prior to the July 4 holiday. Not my regular vet but a guy filling in, he called in 2 scripts-gabapentin & trazadone. My reaction was WTF?!?! The trazadone was 50 mg , which is INSANE for a 15 lb dog! It did say to HALF it, but still.
You can’t trust anyone who prescribes meds.

What they are doing with our animals is disgusting. I had my dog in for minor surgery (dangling lump removal) and specifically asked, and paid for her to stay over night at the vets because they are twitchy about offering any real pain medication for take home for our animals because of this "opioid crisis". I was under the impression that they were at least going to give her pain medication while she was under their care with the over night stay but nope... NSAIDs and only NSAIDs which they sent her home with. NSAIDs didn't do much for her discomfort at home. She has another lump that is just a fatty tumor causing her no issues that they offered to remove. Thing is she's an elderly dog and the surgery would be very invasive and I do not believe they would give her proper pain management because they already proved they wouldn't before so that is a big fat nope from me.

That’s messed up, Judy. At least mine gives drugs-the wrong ones and improper doses, so we truly cannot win.

They're probably afraid if they send pain meds home with pets, that people will take them...just my opinion of course. I have CRPS, and was seeing a P.A. because it was faster to get in, until I got sick of her pushing lyrica, amtryptoline, and everything else besides what had been the only medication to help ease my pain, and just started waiting the extra time to get in with my g.p. until Wellmed took over and all of the Drs headed for the hills, now I get nothing because I refuse to deal with the demeaning bs. I do wish they would learn to not make "chronic pain" sound like such dirty words. It's like the insane are running the asylum lately! Drug reps and 3 letter agencies who know nothing about patients and medicine are making decisions that should only be made by my physician. So much for Dr./patient relationships

Way back in 2011 my dose of Neurontin had been upped to 3000mg/day along with amitriptyline. What a combination. It did nothing for my pain but it sure made my office job extremely difficult due to the permanently dense fog through which I was navigating life. At that time opioids were fairly accessible but the side effects relegated my diet to high-fiber cereals and prunes. I had been taking prescribed hydrocodone and/or Percocet regularly for many months and quitting them was a non-event, addiction-wise, however I celebrated not being in a walking coma when I stopped taking the off-label drugs. They are a waste of Medicare tax dollars. I'm sure they work fine for epilepsy or depression but for pain they are much, much less than worthless.

I don't live in constant pain but having opioids on hand when I have a month-long flair up sure would be nice but the choice I was given by my Dr was that if he prescribed hydrocodone, he would stop my Ambien. I'm old enough to know when to not take them together but he told me the FDA and CDC are making it difficult for him to be a doctor. I didn't bother telling him how difficult they have made it for me to be a patient as I know the CDC and FDA can revoke his license for speaking out against their anti-opioid agenda. Neither of us live in the free country we were both born into. Sad.

Nitrazenes are the newest? Correct me if I'm wrong...and can you do an article on them?

Let's not forget about...uhhh...the um...ya, memory loss. (Maybe Fugh-Berman takes it herself!)

Why aren't manufacturers of all of these other drugs with so many adverse side effects not being stopped or sued for running commercials all day long? Obviously a witch hunt. I feel like part of it is that they needed something to replace the tobacco settlement $ that is running out (the attorneys general).

The ads are nauseating but legal. Do not get between me and the mute button when one of the damn things comes on.

Nitazines* are the newest...can you tell us about those?
Policy makers don't understand that even if you take away all opiates, other substances will be found to abuse.

On my radar.

What?

Really!?

I found gabapentin and especially Lyrica, a related drug also pushed hard by doctors, to have a severe effect on my memory. I stopped reading because I could keep track of the plot from one paragraph to the next. More difficult professional text was nearly impossible to comprehend. It was incredibly scary and I thought I had brain damage.

Fortunately, once I stopped taking them, my memory has returned but my drive to learn new things and to be willing to work hard at it hasn’t.

I often wonder how many elderly people have had to give up their independence and move into assisted living because of a senility diagnosis when all it was was memory inhibition of gabapentin or Lyrica. I remember how much my grandmother valued living alone in her little house until she was almost 100 despite her macular degeneration and feel so sad for all our elders who’ve lost thie independence because of side effects from a drug.