Our Starvin’ Larry goes into the Lions Den and is on a panel discussing the Opioid Epidemic in Cleveland, Ohio.
So proud of how he did here. There is such a blatant bias against patients with Dr. Hedaya! Not so much with Dr. Parran, who seems compassionate.
It’s long- but please watch! I give a summary below of my thoughts.
Dr. Hedeya, right out of the gate, immediately shows his bias and his ignorance regarding the actual biological mechanisms of opiates and opioid therapy.
He states, “it just doesn’t make any sense to me. Here they are dosing Dilaudid, a very powerful opioid painkiller, every 2 hours, when it stays in the body every 4-6 hours.”
Well, Dr. Hedeya, I am not a titled “Opioid Expert” such as yourself. I merely studied chemistry and biochemistry in college. However, I do know a little bit about the bioavailability of opioids. Do you? Specifically the bioavailability of Dilaudid? The disingenuous language employed around these conversations disgusts me. I am so exhausted watching people like this, Dr. Andrew Kolodny also comes to mind here, fumble around this topic when they clearly have absolutely no idea what they are talking about. Yes, let’s heap accolades and titles of expert on these people.
Dr. Josh Bloom is the only qualified “opioid expert” I know of that has spoken intelligently on this topic publicly in the United States. Give him the title, TPTB!
We don’t know what kind of Dilaudid (oral, IV, etc) Dr. Hedaya is referring to, because he doesn’t clarify. If he is speaking of oral Dilaudid, the bioavailability is EXTREMELY poor. To break it down for the challenged such as Dr. Hedaya appears to be, if Dr. Hedaya broke his femur, was in excruciating pain, and was ordered 4 milligrams to take orally of the “very powerful opioid Dilaudid”, he would only absorb between 0.75–0.99mg of that dose. And only that under the most optimal of GI conditions. How much does Dr. Hedaya weigh? What kind of metabolizer is he? These are all factors that weigh in significantly to the “opioid power” as well.
This idiotic rhetoric around opioids needs to die a quick death.
Dr. Hedaya says he doesn’t judge his patients but that is simply not true. He determined that each one of them needed to be weaned off their medication before they ever came in his door. If one doesn’t believe in opioids for chronic pain, that is judging one’s incurable painful disease patients who take opioids for their painful chronic disease.
That is the definition of rash judgment.
We cannot have an honest conversation unless we are… honest.
The Uriah Heep monologue needs to stop, Dr. Hedaya. You are not “ever so humble”.
Dr. Hedaya has fallen for grossly inflated statistics that have been reported erroneously, as per the CDC themselves. He will not accept being corrected, however, because he is not truly humble. He is fake. He could learn a lot from Larry Harbert, a patient who exhibits the true meaning of intellectual humility, something that one like Dr. Hedaya could only hope to learn to grasp somewhat in this lifetime.
A poser is a poser is a poser. We can spot them in under 60 seconds, usually.
Where is Dr.Hedeya getting his statistics?
He believes that people want opioids because they are seeking them for depression, not due to… pain? I imagine his patients must be thrilled to be gaslighted at his office.
Chronic depression is NOT a “risk factor” for chronic pain! Did Dr. Hedaya just make up stuff as he sat there? Many people become depressed as they watch their lives being lived without them in it and doctors like this refuse to prescribe medication to help!
Blanket judgment indeed was being issued out of Dr. Hedaya’s mouth and did not stop at all. Larry Harbert pointed out but a few flaws in what Dr. Hedaya said, in regards to patient dose escalations and patient addiction; forcing Dr. Hedaya to walk back a few of his judgmental statements, which he did reluctantly, but with great elucidation.
I will state again that if we are going to provide anecdotes as proven fact, like Dr. Hedeya is doing, then my anecdotes should be given just as much weight as his. My anecdotal experience in the late 90’s to today was that physicians do not ever prescribe opioids easily. I was never offered Oxycontin or MScontin once for my pain, to include when I had a brain tumor and associated pain in 2002-2003- the height of “easy prescribing”. I have never taken Oxycontin in my life, and I sure would have benefitted from it after my brain surgery when I was in horrendous, long lasting agonizing pain. It wasn’t ever offered, and in fact, I didn’t even know it existed, and I worked in healthcare. The doctors I worked for never prescribed it, either. That is how “overprescribed” it was in my experience.
The opiate candy store is something I have only heard of, but in the four different states I lived in from 1996-2009, I never experienced a physician visit where my painful situations were met with, “Here. I have this drug that will help.” Instead, I was told to take Advil. I had diagnosed epilepsy, diagnosed migraine disorder, diagnosed post craniotomy sinus inpaction, TBI, hypothyroidism, chronic bacterial infection that attacked my joints, and a raft of other diagnosis, and was never offered pain medication at an office visit for first line treatment of any pain. All before my pancreas decided to get in on the game.
Do my anecdotes count, too??
As far as addiction and prescribed opioids is concerned, the data is out and the prescription opioid addict is not the patient.
The prescription opioid addict is a person who has stolen the pills from a patient. Over 80% of those addicted to prescribed opioids say they got the pills that began their addiction from someone else, NOT from a doctor. (source SAMHSA)
The remaining 19 or so%?? Of those??
Over 78% had extensive psychedelic drug use history PRIOR to their first opioid prescription fill! (source NIH)
Therefore, as we have said all along, the chronic pain patient of America is NOT the one driving this so-called prescribed opioid addiction epidemic.
Lock up the pills. Incurable painful disease patients almost to a person lock up their medication, as they respect it. The people receiving prescriptions for short term use do not, generally. This is an educational problem at the surgeon level. Not a problem with incurable painful disease patients. We should not have to suffer where others failed to do their due diligence.
I appreciate the compassion and care shown by Dr. Parran. You can see that he genuinely cares about patients. He truly loves beings physician and wants the very best for patients. He has researched and knows as much as he does in his field of study. I may not agree with all he says, in fact, I know I do not, but he is respectful.
Here Dr. Hedaya is again, with his patient negative commentary. Well, of course he would never do a two year taper. I was snickering as soon as Dr. Parran said that, knowing Dr. Hedaya was squirming in his seat. He is just exactly that doctor, yanking his patients off opioids abruptly with short tapers. There is no way he would afford any patient that comfort. Here he is, blaming and gaslighting, it’s all the patient’s faults, they are mentally ill, they would certainly have a catastrophic event occur within that two years that would tend a slow taper impossible. They would do this, they would demand that… it is quite disgusting to see the utter contempt he has for patients in pain bleed through his gritted smiles and smirks. I feel for his patients.
This, in a nutshell, patients, is why we are not treated with compassion. I sincerely believe that many so-called pain experts share the mentality of this physician. They will yank a stable, productive patient off their opioid therapy who is living a full life- who has always followed their doctor’s plan and didn’t deviate course- and put them on gabapentin or Lyrica. It bears noting that gabapentin or Lyrica cannot be abruptly discontinued either, and those drugs have far worse side effects that are long lasting from abrupt tapering than opioids. In fact, patients have reported consistently across the board permanent damage that is irreversible from long term use of these drugs. That has not been the case with traditional opioid therapy. Dr. Hedeya and physicians so convinced of their righteousness should ponder how many patients they may have damaged with their “theories”.
For every anecdote spouted by Dr. Hedaya, there is a counter anecdote. Every “fact” has an actual study with scientific evidence to refute what he is stating is true.
Larry Harbert pointed out, finally when he was given a chance to get a word in edgewise, the SAMHSA data, I spoke of above, re: patients aren’t addicts- 80%+ of opioid addicts aren’t even patients. Thank you, Larry! They have to acknowledge this truth. Leads into the conversation of the fact that patients are suffering for the crimes of others.
Dr.Parran says exactly what the truth is. “Stable patients who are adherent and doing well should not be cut off and left out in the cold.”
I have such respect for Dr. Parron for actually saying that he is teaching medical students, practicing physicians etc, the proper way to take people off opioids and especially benzodiazepines. Why? Because I wholeheartedly agree that this is an area in medicine where education is sorely lacking!! As evidenced by the physician sitting right next to Dr. Parran! No sooner did Dr. Parran say that patients needed to be thoughtfully tapered at a rate of 5% per month, and he was completely dismissed by Dr. Hedaya, told it was completely unrealistic. However, the reason why isn’t because of the astounding lack of physician willingness and education, he placed it solely on patients, of course. Typical.
The benzodiazepine situation in the United States is appalling. The physicians who are abruptly cutting off patients left and right are doing so at their own peril.The package inserts specifically state that those drugs are never to be abruptly discontinued, to do so could kill a patient.
Of course, Dr. Hedaya can sit in judgment on his high horse, he has chosen never to prescribe any schedule drugs, how convenient for him! Wait until the lawsuits start rolling on the anti convulsants. They will. I appreciate Dr. Parran all the more for his compassionate care here. I doubt highly he prescribes much in these classes of drugs either, however, instead of going on a panel and acting like a self righteous saint, he has told us what he is actually doing to help the patients being abandoned in the country, as well as educating physicians. Again, I respect that very much, even if I don’t agree with every single thing he says.
It is interesting that Dr. Hedeya appears to believe that incurable painful disease patients who are taking opioids are addicts, whose primary issue is suffering a psychological problem. It is quite evident in all he has said (and what he has deigned not to say).
It is frankly mind blowing to me. How stigmatizing. I am very sad for the incurable patient population in the Cleveland area. Basically you get the choice of a shrink, shot jockey, anti convulsants, Advil/Tylenol, mindfulness, all the alternative mumbo jumbo, and vitamins if you patronize that office. If none of it works, you are SOL.
Thank you, Larry Harbert, for showing up for the incurable painful disease patient community! In the time you were allowed to speak, you did a marvelous job!
This is what advocacy is about, folks.
Being brave enough to face the lions.