Resources for Clinicians in Pain Medicine: Correcting Medical Mythologies on Prescription of Opioid Analgesics
Main Article Content
Abstract
The US regulatory climate pertaining to the prescribing of opioids in acute and chronic pain is presently highly fraught and polarized. The US Center for Disease Control has claimed that over-prescription of opioids by clinicians to their patients is an ongoing major cause of narcotics addiction and overdose mortality. Despite this premise having been conclusively disproved, many US clinicians face disciplinary proceedings and sanctions by State Medical Boards or the US Drug Enforcement Administration (DEA).Those who have not left pain medicine altogether are under pressure to force-taper legacy patients below arbitrary and scientifically unsupported dose thresholds. Patients are being deserted to agony and medical collapse. Clinicians are being imprisoned for no crime other than treating their patients with safe and effective opioid therapy.
This paper offers a compendium of 81 references for clinicians practicing in pain medicine and for their lawyers, who choose to contest undeserved persecution or legal sanctions by State Medical Boards or the US DEA. Also of interest are recent references that demonstrate beyond any reasonable contradiction that the incidence of iatrogenic addiction to prescription opioids is so low that it cannot be reliably measured. The DEA has known for at least three years that the US opioid “crisis” was not created and is not being driven by clinicians “over-prescribing” to patients.
Among references provided herein are papers demonstrating that the US DEA has been aware for years that over-prescribing of opioid pain relievers is not a dominant cause of either hospital admissions or mortalities involving clinically prescribed opioid analgesics. This awareness may offer grounds for appeal or vacation of court verdicts finding clinicians in violation of “usual and normal” practice of pain medicine.
METHODOLOGY
This paper comprises a critical review and analysis of medical literature pertinent to safety and effectiveness of prescription opioid analgesics employed by clinicians in the management of acute or chronic pain. Taken in combination, the references herein challenge prevailing memes and misdirection in regulation of prescription pain relievers and in otherwise unfounded prosecutions of clinicians by the US Drug Enforcement Administration, State drug enforcement authorities, and State Medical Boards.
The assembled references are selected by the author from over 15,000 accumulated papers and articles acquired during 26 years of reading clinical and popular literature as a data analyst, healthcare writer and patient advocate. Clearly, the author operates from a personal agenda of advocacy on behalf of clinicians and their patients. Evaluation of the scientific and conceptual validity of the references must ultimately rest with Medical Boards and courts in an essentially adversarial process.
Article Details
How to Cite
LAWHERN, Richard A.
Resources for Clinicians in Pain Medicine: Correcting Medical Mythologies on Prescription of Opioid Analgesics.
Medical Research Archives, [S.l.], v. 11, n. 12, dec. 2023.
ISSN 2375-1924.
Available at: <https://esmed.org/MRA/mra/article/view/4860>. Date accessed: 16 may 2024.
doi: https://doi.org/10.18103/mra.v11i12.4860.
Section
Research Articles
The Medical Research Archives grants authors the right to publish and reproduce the unrevised contribution in whole or in part at any time and in any form for any scholarly non-commercial purpose with the condition that all publications of the contribution include a full citation to the journal as published by the Medical Research Archives.
References
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69. Sullum J, “Two Courts Debunk Widely Accepted Opioid Myths”, Reason Magazine, November 17, 2021, https://reason.com/2021/11/17/two-courts-debunk-widely-accepted-opioid-myths/
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72. George Knapp, “What Will Nevada’s $285M Opioid Settlement Funds Go Towards?” Las Vegas Now – Channel 8, February 11, 2022
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75. Jennifer P Schneider, MD, “A Practical Introduction to the Use of Opioids For Chronic Pain”, adapted from a presentation given by the author at the annual meeting of the American Academy of Pain Management in Phoenix, Arizona on October 10, 2009. https://www.academia.edu/11338654/A_PRACTICAL_INTRODUCTION_TO_THE_USE_OF_OPIOIDS_FOR_CHRONIC_PAIN
76. Federation of State Medical Boards “Guidelines for the Chronic Use of Opioid Analgesics”, April 2017 https://www.fsmb.org/siteassets/advocacy/policies/opioid_guidelines_as_adopted_april-2017_final.pdf
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78. Richard A Lawhern, “How Would Opioid Prescription Guidelines Read if Pain Patients Wrote Them?” National Pain Report, April 2017, Re-published June 2022 https://nationalpainreport.com/how-would-opioid-prescription-guidelines-read-if-pain-patients-wrote-them-8833330.html
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80. American Academy of Family Physicians, “Frontline Physicians Call on Politicians to End Political Interference in the Delivery of Evidence Based Medicine”, May 15, 2019
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81. Richard A. Lawhern, “We Need New Laws To Protect People in Pain - The CDC’s revised prescribing guidelines retain an anti-opioid bias and do nothing to reverse the harmful policies inspired by the 2016 version.” Reason Magazine, February 14, 2023, https://reason.com/2023/02/14/we-need-new-laws-to-protect-people-in-pain/
2. US Department of Veterans Affairs, “Use of Opioids in the Management of Chronic Pain (2022)” https://www.healthquality.va.gov/guidelines/Pain/cot/
3. Christina Porucznik, “Opioid Guideline Workgroup” January 28, 2016, https://www.cdc.gov/injury/pdfs/bsc/BSC_summary.pdf
4. US CDC, “CDC Advises Against Misapplication of the Guideline for Prescribing Opioids for Chronic Pain” April 24, 2019, https://www.cdc.gov/media/releases/2019/s0424-advises-misapplication-guideline-prescribing-opioids.html
5. Chinazo Cunningham, “ Observations on CDC Guideline for Prescribing Opioids – United States, 2022” July 2, 2021, https://www.cdc.gov/injury/pdfs/bsc/OWG-Report-of-Recs-1-12-06.30.21-FINAL-508.pdf
6. Skelly AC, et al. “Noninvasive nonpharmacological treatment for chronic pain: a systematic review”. Prepared for AHRQ, HHS, Publication No.18-EHC013-EF, Rockville, MD, June 2018.
https://effectivehealthcare.ahrq.gov/products/nonpharma-treatment-pain/research-2018
7. Agency for Healthcare Research and Quality, “Systematic Review Update: Noninvasive Nonpharmacologic Treatments for Chronic Pain” March 1, 2019, https://effectivehealthcare.ahrq.gov/products/noninvasive-nonpharm-pain-update/protocol
8. Chou R, Deyo R, Devine B, Hansen R, Sullivan S, Jarvik JG, Blazina I, Dana T, Bougatsos C, Turner J. “The Effectiveness and Risks of Long-Term Opioid Treatment of Chronic Pain.” Evidence Report/Technology Assessment No. 218. (Prepared by the Pacific Northwest Evidence-based Practice Center under Contract No. 290-2012-00014-I.) AHRQ Publication No. 14-E005-EF. Rockville, MD: Agency for Healthcare Research and Quality; September 2014, www.effectivehealthcare.ahrq.gov/reports/final.cfm.
9. Richard A Lawhern, “Comments on AHRQ Technical Brief “Prevention, Diagnosis, and Management of Opioids, Opioid Misuse and Opioid Use Disorder in Older Adults" https://www.linkedin.com/pulse/comments-ahrq-technical-brief-prevention-diagnosis-opioids-lawhern/
10. Maia Szalavitz, “Opioid Addiction Is a Huge Problem, but Pain Prescriptions Are Not the Cause -- Cracking down on highly effective pain medications will make patients suffer for no good reason” Scientific American, May 2016 https://blogs.scientificamerican.com/mind-guest-blog/opioid-addiction-is-a-huge-problem-but-pain-prescriptions-are-not-the-cause/
11. Maia Szalavitz, “Entire Body is Shaking” Why Americans With Chronic Pain are Dying”, New York Times Opinion, January 3, 2023, https://www.nytimes.com/2023/01/03/opinion/chronic-pain-suicides.html
12. Nita Ghey, “The Other Opioid Crisis: How False Narratives Are Hurting Patients”, Discourse, July 18, 2022. https://www.discoursemagazine.com/culture-and-society/2022/07/18/how-false-narratives-about-opioids-are-hurting-patients/
13. Leo Beletsky, JD, MPH, and Kate M. Nicholson, JD, “CDC's Updated Opioid Guidelines Are Necessary, but Not Sufficient” Medscape, November 22, 2022
https://www.medpagetoday.com/opinion/second-opinions/101825
14. Jacob Sullum, “Opioid Epidemic Myths” Reason Magazine, May 18, 2016 https://reason.com/2016/05/18/opioid-epidemic-myths/
15. Miranda Hitti, “Prescription Painkiller Addiction: 7 Myths”, WebMD, August 10, 2011, https://www.webmd.com/pain-management/features/prescription-painkiller-addiction-7-myths#5
16. Roger Chriss, “The Myth of the Opioid Addicted Chronic Pain Patient”, Pain News Network, July 25, 2017, https://www.painnewsnetwork.org/stories/2017/7/25/the-myth-of-the-opioid-addicted-chronic-pain-patient
17. Jeffrey A. Singer, “Opioid Myths” Cato Institute Multimedia, November 9, 2017, https://www.cato.org/multimedia/cato-video/opioid-myths
18. Sally Satel, “The Myth of What’s Driving The Opioid Crisis” Politico Magazine, February 21, 2018, https://www.politico.com/magazine/story/2018/02/21/the-myth-of-the-roots-of-the-opioid-crisis-217034/
19. Stanton Peele, PhD, “Overdose and Other Drug and Addiction Myths -- Everything you believe about drugs/ addiction is wrong. EVERYTHING. It matters.” Psychology Today, January 20, 2018. https://www.psychologytoday.com/us/blog/addiction-in-society/201801/overdose-and-other-drug-and-addiction-myths
20. Lawhern RA, “Everything the Government Thinks It Knows About the Opioid Crisis is Wrong" KevinMD, July 1, 2023,
https://www.kevinmd.com/2023/07/everything-the-government-thinks-it-knows-about-the-opioid-crisis-is-wrong.html
21. Josh Bloom, PhD, “JAMA Study: Forced Opioid Tapering Harms People. Gee, What a Surprise.” American Council On Science and Health, August 3, 2021,
https://www.acsh.org/news/2021/08/03/jama-study-forced-opioid-tapering-harms-people-gee-what-surprise-15712
22. Alicia Agnoli, MD, MPH, MHS1,2; Guibo Xing, PhD2; Daniel J. Tancredi, PhD2,3; et al “Association of Dose Tapering With Overdose or Mental Health Crisis Among Patients Prescribed Long-term Opioids”, JAMA. 2021;326(5):411-419. https://jamanetwork.com/journals/jama/fullarticle/2782643
23. Travis N Rieder “Is Non-Consensual Tapering of High Dose Opioid Therapy Justifiable?” AMA Journal of Ethics, August, 2020,
https://journalofethics.ama-assn.org/article/nonconsensual-tapering-high-dose-opioid-therapy-justifiable/2020-08
24. James L. Madera, MD, “RE Proposed 2022 CDC Clinical Practice Guideline for Prescribing Opioids (Docket No. CDC-2022-0024”, American Medical Association, April 11, 2022, Letter to Captain Christopher M. Jones, … Acting Director National Center for Injury Prevention and Control Centers for Disease Control and Prevention. https://searchlf.ama-assn.org/letter/documentDownload?uri=%2Funstructured%2Fbinary%2Fletter%2FLETTERS%2F2022-4-11-Letter-to-Jones-re-2022-CDC-Proposed-Clinical-Guidelines-for-Prescribing-Opioids-v2.pdf
25. Lawhern RA and Nadeau SE "Pain Medicine Realities: Beyond the Opioid Crisis" KevinMD, November 34, 2023, https://www.kevinmd.com/post-author/richard-a-lawhern-and-stephen-e-nadeau
26. Kollas, CD, “PROP’s Disproportionate Influence on US Opioid Policy: The Harms of Intended Circumstances”, Pallimed – A Hospice and Palliative Care Blog, May 2021, https://www.pallimed.org/2021/05/props-disproportionate-influence-on-us.html
27. Kollas CD, Terri A. Lewis, Beverly Schechtman and Carrie Judy,” Roger Chou’s Undisclosed Conflicts of Interest: How the CDC’s 2016 Guideline for Prescribing Opioids for Chronic Pain Lost Its Clinical and Professional Integrity.“ Pallimed – A Hospice and Palliative Care Blog, September 2021, https://www.pallimed.org/2021/09/roger-chous-undisclosed-conflicts-of.html
28. Kollas, CD, Schechtman B and Judy C “Undisclosed Conflicts of Interest by Physicians Creating the CDC Opioid Prescribing Guidelines: Bad Faith or Incompetence?“ Pallimed – A Hospice and Palliative Care Blog, September 2022, https://www.pallimed.org/2022/09/undisclosed-conflicts-of-interest-by.html
29. Kollas, CD, “In Bad Faith – The Influence of PROP and CDC on Failed National Opioid Policy” Annual Assembly of Hospice and Palliative Care, Nashville TE, February 9-12, 2022 https://www.jpsmjournal.com/article/S0885-3924(22)00377-3/fulltext"
30. Lawhern, RA, “Oversight on Revision of US CDC Opioid Guidelines: A Process Pre-Destined to Fail”, International Journal of Nursing and Primary Care, ISSN 2639-9474, 7(5): 1-10 October 2023
https://www.scivisionpub.com/pdfs/oversight-on-revision-of-us-cdc-opioid-guidelines-a-process-pre-destined-to-fail-2988.pdf
31. Lawhern RA “How misused terminology and biased studies may be misguiding our understanding of opioid addiction and mortality”, KevinMD, May 23, 2023, https://www.kevinmd.com/2023/05/how-misused-terminology-and-biased-studies-may-be-misguiding-our-understanding-of-opioid-addiction-and-mortality.html
32. Lawhern RA, “Rethinking US Opioid Policy”, KevinMD, October 24, 2023, https://www.kevinmd.com/2023/10/rethinking-u-s-opioid-policy.html
33. Aubrey L and Carr BT, “Overdose, opioid treatment admissions and prescription opioid pain reliever relationships: United States, 2010–2019”, Frontiers in Pain Medicine, Augusts 4, 2022,
https://www.frontiersin.org/articles/10.3389/fpain.2022.884674/full
34. Lawhern, R, “The Real Cause of America’s Opioid Crisis: Doctors Are Not to Blame”, KevinMD, March 22, 2023, https://www.kevinmd.com/post-author/richard-a-lawhern
35. Volkow N and McClellan TA, “Opioid Abuse in Chronic Pain -- Misconceptions and Mitigation Strategies,” New England Journal of Medicine, March 31, 2016 http://www.nejm.org/doi/full/10.1056/NEJMra1507771
36. Lawhern, R: “Doctors Diagnosing Addiction – Are the Blind Leading the Blind?” Archives of Medicine, European Society of Medical Doctors, publication pending, November 2023, https://esmed.org/MRA/mra/article/view/4726/99193547448
37. Satel S, National Affairs, Nr 55, Spring 2023 “The Truth About Painkillers”, https://nationalaffairs.com/publications/detail/the-truth-about-painkillers
38. Brat, G, et al, “Postsurgical prescriptions for opioid naive patients and association with overdose and misuse: retrospective cohort study” British Medical Journal, 2018 http://www.bmj.com/content/360/bmj.j5790.long
39. Oliva EM, Bowe T, and Tavakoli, et al, “Development and Applications of the Veterans Health Administration’s Stratification Tool for Opioid Risk Mitigation (STORM) to Improve Opioid Safety and Prevent Overdose and Suicide”. Department of Veterans Affairs, “Psychological Services” 2017, Vol 14, No 1, pp 34-49. Available for purchase through American Psychological Association, APA Psych Net, https://psycnet.apa.org/doiLanding?doi=10.037%2Fser0000099
40. Nadeau SE, DelRocco NJ and Wu SS, “Opioid trials: time for a new approach? Enriched enrollment randomized gradual withdrawal designs” Pain Management, Vol. 12, No. 3
https://www.futuremedicine.com/doi/10.2217/pmt-2021-0112
41. Kline T, “CDC 2016 paper falsely switches blame for opioid crisis from Heroin to prescription drugs” https://www.youtube.com/watch?v=2gylppgW1oQ
42. Schneider JP, “Opioid Addiction is Not Opioid Dependence”, Practical Pain Management, January 5, 2022, https://www.practicalpainmanagement.com/treatments/addiction-medicine/opioid-use-disorder/what-name-case-which-we-call-addiction-not
43. Schneider JP, “The Role of Opioid Prescription in Incident Opioid Abuse and Dependence Among Individuals With Chronic Non-Cancer Pain”, Practical Pain Management,
https://www.practicalpainmanagement.com/painscan/abstract/role-opioid-prescription-incident-opioid-abuse-dependence-among-individuals-which
44. Schneider JP, “Editorial: Why Are ER Opioids Out of Favor?” Practical Pain Management, June 18, 2020, https://www.practicalpainmanagement.com/treatments/pharmacological/opioids/editorial-why-are-er-opioids-out-favor
45. Anson, P, “Study Finds Low Risk of Overdose From Prescription Opioids”, Pain News Network, October 23, 2023 https://www.painnewsnetwork.org/stories/2023/10/23/study-finds-low-risk-of-overdose-from-prescription-opioids?fbclid=IwAR1RQopeI1uWp0d5Vre2_oP5ukZIrbTvPcfrqLKSEpwMTqHHw50Gv04ALvk
46. Wang L, Hong, PJ, Jiang W, Rehman Y, et al, “Predictors of Fatal and Nonfatal Overdose After Prescription of Opioids For Chronic Pain; A systematic Review and Meta-Analysis of Observational Studies,” Canadian Medical Association Journal, October 23, 2023 195 (41) E1399-E1411; DOI: https://doi.org/10.1503/cmaj.230459
47. Lawhern R, “Doctors Diagnosing Addiction – Are The Blind Leading the Blind?” Archives of Medicine, European Society of Medical Doctors., publication pending, November 2023, https://esmed.org/MRA/mra/article/view/4726/99193547448
48. Schatman ME and Fudin J, “The Myth of Morphine Milligram Equivalent Daily Dosages”, Medscape, May 24, 2016 https://www.medscape.com/viewarticle/863477
49. Fudin, J, Pratt CJ, and Schattman M, “The MEDD Myth: the impact of pseudoscience on pain research and prescribing guideline development” Journal of Pain Research, Vol. 9, pp 153-156, 23 March 2016, https://www.dovepress.com/the-medd-myth-the-impact-of-pseudoscience-on-pain-research-and-prescri-peer-reviewed-fulltext-article-JPR
50. Dinerstein C, “The True Story of Morphine Milligram Equivalents”, American Council on Science and Health, March 1, 2022,
https://www.acsh.org/news/2022/03/01/true-story-morphine-milligram-equivalents-mme-16154
51. Bloom J, “Opioid Policies Based on Morphine Milligram Equivalents are Automatically Flawed,” American Council on Science and Health, October 23, 2018, https://www.acsh.org/news/2018/10/23/opioid-policies-based-morphine-milligram-equivalents-are-automatically-flawed-13529
52. Harper DC. “Misuse of ‘Hyperalgesia’ to Limit Care”, Journal of Practical Pain Management, March 7, 2011. https://www.practicalpainmanagement.com/treatments/pharmacological/opioids/misuse-hyperalgesia-limit-care
53. Hardin RN, “Opioid Induced Hyperalgesia – Exploring Myth and Reality”, Pain Week, 2016, https://www.youtube.com/watch?v=1NpM8NTSVJI
54. Agrawal D, Udoji MA, and Trescot A, “Genetic Testing for Opioid Pain Management: A Primer” Pain Therapy, DOI 10.1007/s40122-017-0069-2, February 5, 2017
https://pubmed.ncbi.nlm.nih.gov/28409480/
55. Skarke C, “Genetic Predictors of the Clinical Response to Opioid Analgesics”, Clinical Pharmacokinetics, 2004, https://www.academia.edu/28334503/Genetic_Predictors_of_the_Clinical_Response_to_Opioid_Analgesics
56. Nadeau SE, Wu JK, and Lawhern RA, “Opioids and Chronic Pain: An Analytical Review of the Clinical Evidence” Frontiers in Pain Research, August 17, 2021,
https://www.frontiersin.org/articles/10.3389/fpain.2021.721357/full
57. Ramsin B, Trescot A<, Data S, et al, “Opioid Complications and Side Effects” Pain Physician, 2008:11, S105-S120, https://www.academia.edu/16660540/Effectiveness_of_opioids_in_the_treatment_of_chronic_non_cancer_pain
58. Lanese N, “Most People Don’t Actually Feel Euphoric When They Take Opioids, Study Finds”, LiveScience, Octrober 28, 2019,
https://www.livescience.com/opioid-euphoria-mostly-a-myth.html
59. Dasgupta M, Funk MJ, Proescholdbell S, Hirsch A, Ribisl L, and Marshall S “Cohort Study of the Impact of High-dose Opioid Analgesics on Overdose Mortality”, Journal of Pain Medicine, 2016 Jan;17(1):85-98. doi: 10.1111/pme.12907 https://pubmed.ncbi.nlm.nih.gov/26333030/
60. Singer JA, Sullum JZ, and Schatman MS, “Today’s nonmedical opioid users are not yesterday’s patients; implications of data indicating stable rates of nonmedical use and pain reliever use disorder” Journal of Pain Research, February 7, 2019,
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6369835/
61. Lawhern R, “Why Doctors Aren’t to Blame for the U.S. Opioid Crisis” [PODCAST] KevinMD - Medpage, May 27, 2023,
https://www.kevinmd.com/2023/05/why-doctors-arent-to-blame-for-the-u-s-opioid-crisis-podcast.html
62. Jalal J, Buchanach JM, Roberts MS, Balmert: C, Zhang K, and Burke DS, “Changing dynamics of the drug overdose epidemic in the United States from 1979 through 2016” Science, Vol 361, Issue 6408, 21 September 2018,
https://www.science.org/doi/10.1126/science.aau1184
63. Lawhern RA and Nadeau SE “Behind the AHRQ Report: Understanding the Limitations of “Non Pharmaceutical, Non-Invasive Therapies for Chronic Pain” Practical Pain Management, 2018; 18(7), October 3, 2018. https://www.practicalpainmanagement.com/resources/practice-management/behind-ahrq-report
64. Guzman, AR, “Drugs of Abuse and Trends”, Practitioner Diversion Awareness Conference, US DEA and Federation of State Medical Boards, February 22-23, 2020,
https://www.deadiversion.usdoj.gov/mtgs/pract_awareness/conf_2020/feb_2020/guzman.pdf
Other publications are also pertinent in the dynamic between US law enforcement and clinicians:
65. Jeffrey Singer and Colleen Cowles, “War on Us: How the War on Drugs and Myths about Addiction Have Created a War on All of Us”, Cato Institute Events (Interview), March 18, 2020, https://www.cato.org/events/war-us-how-war-drugs-myths-about-addiction-have-created-war-all-us
66. Jeffrey Miron, Greg Sollenberger, and Laura Nicolae, “Overdosing on Regulation – How The Government Caused the Opioid Epidemic”, Cato Institute, February 14, 2019, https://www.cato.org/policy-analysis/overdosing-regulation-how-government-caused-opioid-epidemic#
67. Singer J and Burrus t, “Cops Practicing Medicine – the Parallel Histories of Drug War I and Drug War II”, Cato Institute, November 29, 2022, https://www.cato.org/white-paper/cops-practicing-medicine#
68. Sullum J, “A Scathing Rejection of the Case Against Four Drug Companies Highlights Misconceptions About the 'Opioid Crisis”, Reason Magazine, November 2, 2021, https://reason.com/2021/11/02/a-scathing-rejection-of-the-case-against-four-drug-companies-highlights-misconceptions-about-the-opioid-crisis/
69. Sullum J, “Two Courts Debunk Widely Accepted Opioid Myths”, Reason Magazine, November 17, 2021, https://reason.com/2021/11/17/two-courts-debunk-widely-accepted-opioid-myths/
70. London C, “DoJ Overreach – The Criminalization of Physicians”, Journal of Legal Medicine, Vol 41, 2021, Issue 3-4 https://www.tandfonline.com/eprint/NF3SWG9YPXWCIP77HFSD/full?target=10.1080/01947648.2022.2147366
71. Knapp G “I-Team: Pain med prescriptions did not cause opioid epidemic, courts rule” Las Vegas Now, Channel 8, November 24, 2021 https://www.8newsnow.com/news/local-news/i-team-pain-med-prescriptions-did-not-cause-opioid-epidemic-courts-rule/
72. George Knapp, “What Will Nevada’s $285M Opioid Settlement Funds Go Towards?” Las Vegas Now – Channel 8, February 11, 2022
https://www.8newsnow.com/news/local-news/i-team-what-will-nevadas-285m-opioid-settlement-funds-go-towards/
73. Seth P, Rudd RA, Noonan RK, and Hagerich TM, "Quantifying the Epidemic of Prescription Opioid Overdose Deaths" American Journal of Public Health, 2018 April; 108(4): pp 500-502.
doi: 10.2105/AJPH.2017.304265
74. Aabha A. Anekar; Marco Cascella. “WHO Analgesic Ladder” Stat Pearls, National Library of Medicine, January 29, 2023,
https://www.ncbi.nlm.nih.gov/books/NBK554435/
75. Jennifer P Schneider, MD, “A Practical Introduction to the Use of Opioids For Chronic Pain”, adapted from a presentation given by the author at the annual meeting of the American Academy of Pain Management in Phoenix, Arizona on October 10, 2009. https://www.academia.edu/11338654/A_PRACTICAL_INTRODUCTION_TO_THE_USE_OF_OPIOIDS_FOR_CHRONIC_PAIN
76. Federation of State Medical Boards “Guidelines for the Chronic Use of Opioid Analgesics”, April 2017 https://www.fsmb.org/siteassets/advocacy/policies/opioid_guidelines_as_adopted_april-2017_final.pdf
77. Stephen E Nadeau MD and Richard A Lawhern PhD “Management of Chronic Non-Cancer Pain: A Framework” Pain Management – Future Medicine, Vol 12 No 6, June 2022,
https://www.futuremedicine.com/doi/10.2217/pmt-2021-0112
78. Richard A Lawhern, “How Would Opioid Prescription Guidelines Read if Pain Patients Wrote Them?” National Pain Report, April 2017, Re-published June 2022 https://nationalpainreport.com/how-would-opioid-prescription-guidelines-read-if-pain-patients-wrote-them-8833330.html
79. “What If Prescribing Guidelines Were Patient Centered”, Pain Week (Pain Policy), April 17, 2017 https://www.painweek.org/media/news/what-if-prescribing-guidelines-were-patient-centered
80. American Academy of Family Physicians, “Frontline Physicians Call on Politicians to End Political Interference in the Delivery of Evidence Based Medicine”, May 15, 2019
https://www.aafp.org/news/media-center/more-statements/physicians-call-on-politicians-to-end-political-interference-in-the-delivery-of-evidence-based-medicine.html
81. Richard A. Lawhern, “We Need New Laws To Protect People in Pain - The CDC’s revised prescribing guidelines retain an anti-opioid bias and do nothing to reverse the harmful policies inspired by the 2016 version.” Reason Magazine, February 14, 2023, https://reason.com/2023/02/14/we-need-new-laws-to-protect-people-in-pain/