Opioid Discontinuation Associated with Increase in Veteran Suicides


-Kelly F. Merrill

Department of Veterans Affairs’ data that shows, “In two sets of fiscal years — 2010-2011 and 2013-2014 — opioid discontinuation was not associated with overdose mortality but was associated with increased suicide mortality.”

The Department of Veterans Affairs recently released data showing Mountain Home VA Medical Center reduced opioid prescribing by 49% between 2012 and 2017.

Chief of Staff Dr. David Hecht claimed significant safety issues “became more apparent” and the details reveal significant side effects associated with chronic opioid use have revealed details indicating significant side effects, which they made an effort to reduce.

“Our job is to do no harm as physicians and so when we find out that a medication that we’re prescribing is doing harm or has the potential to do significant harm even if it hasn’t done so already, our job is to try to find alternatives.”

The VA’s approach now focuses on alternative treatments, including acupuncture, therapy and yoga. Some veterans who had been on stable doses of pain medicine have had their medications titrated down though no effective therapies have replaced them.  They say though they’ve tried the various treatments, most have been found ineffective. 

This is not unique to the experience of pain patients in the current climate.  Marine sergeant Robert D. Rose Jr. filed a suit for $350 million last fall against the VA for pain and suffering and violations to constitutional rights.  He said many veterans like him have been “denied adequate access” to the health care they need since the “discriminatory” anti-opioid initiative first began in 2012.  

Those anti-opioid initiatives culminated into the VA March 2016 guidelines which followed the highly controversial, “voluntary” CDC Guidelines in 2016, which Congress forced the VA to adopt with an attached spending bill.

But adoption of these initiatives has people concerned that patients who cannot obtain their medications will turn to the street…a death sentence with today’s illicit-fentanyl-laced heroin.  This is already happening, of course.

VA reps to discuss impact of opioid reduction on suicides during summit


By Nate Morabito

Published: January 16, 2018

Mountain Home VA reduces opioid prescriptions by 49%


By Nate Morabito

Published: January 15, 2018

Marine veteran sues VA Medical Center, Congressman Phil Roe over opioid tapering policy



Published:  November 24, 2017


VA reducing Opioids, veterans afraid of impact

By Nate Morabito

Published: December 6, 2016

CDC Opioid Guidelines Could Cause Problems for VA Patients, Clinicians

Addiction | February 2016 | Pharmacy

Congress Is Forcing VA to Comply With ‘Voluntary’ Document

By Annette M. Boyle


Retaining Effective Remedies for Pain Patients – Opioids and Alkaloids

-Kelly F. Merrill

The public believes that the more than 10 million estimated intractable pain patients who require opioid therapy are getting high from taking their medications.  This is a myth.

Patients access to life-sustaining, torture-relieving opioids and plant alkaloids is under attack.

Physicians must be free to practice medicine that puts your health at the center of decisions between doctor and patient…instead of perceived and exaggerated liability. Sane risk assessments based upon science and good clinical practices and empirical data are paramount.

Many pain patients are dependent upon *both* opioids and plant alkaloids to mitigate physiologically-damaging, life-shortening pathological pain of dozens of devastating pain-generating illnesses.

But when it comes to opioids, suddenly, there is some moral judgement, as if illnesses and accompanying symptoms are a moral failing or a choice. And cannabis, while effective for some patients and some illnesses is not appropriate or efficacious in treating all. Neither has it been decriminalized by the Federal Government.

Some pain patients require high doses of opioids because they metabolize opioids too quickly to get much benefit. There is a 15-fold variation in the way people metabolize opioids. This is what’s behind the myth of high tolerance. Sadly, now you know more than most pain management physicians…we’ll get to that.

As such, what might kill you won’t touch my pain, which is ever-present and nearly overwhelming every moment of every day, even with a potent combination of opioids, cannabis and Kratom.

It took a great deal of time and a great deal of pain and ungodly suffering…years of it…before doctors titrated me up to a therapeutic dose of opioids for pain control after failing a parade of adjuvant alternative therapies. Every physician I’ve ever had has been exceedingly cautious in prescribing opioids and those “therapeutic doses” weren’t quite as therapeutic as you may think.

For these purposes, we throw the “Pain Scale” out the window. My idea of a “7” is going to be a lot different than yours because I already know how much worse it can get…and it can always get worse. I only had enough pain control for those years to be just on the precipice. A truly “therapeutic dose” would have been enough medication to allow me to be a better mother to my child, a sister to my brother, a daughter to my parents, a spouse or a friend.

For the first several months taking opioid medications the only high I experienced was feeling a little chatty for about 10 minutes, once a day. Since then, I’ve never had a side-effect from the medication. People who have chronic pain and take opioids don’t get high. High doses of cannabis, however, took me over a year to titrate up on to acclimate myself to the psychotropic effects. But, as anyone who’s taken cannabis tinctures daily for an extended period of time can tell you, those effects fade away.

The best medications for me are the ones I don’t notice. I’ve ditched the ones I do notice, including a whole host of medications pushed upon pain patients that cause disturbed thinking, short-term memory loss, nightmares, racing thoughts, pins and needles, anxiety and much, much more. Unnavigable side-effects.

I do a risk-benefit analysis of everything I put into my body. I don’t eat processed foods and use simple, fresh, organic ingredients to maintain my health and the health of my son. Opioids, cannabis and kratom are no different. These are the only effective tools I have for mitigating the disabling, life-shortening symptoms of intractable illness which derailed my life and left me bed- or house-bound for over 15 years until I found my current combination of pain-relieving medications and plant alkaloids.

For over a decade, I traveled the continent in search of a diagnosis, a cure, a remedy. As such, I have a wealth and breadth of experience navigating a variety of medical systems, including the allopathic system which offer opioids to treatment-resistant patients and the naturopathic system, which prefers to use plant alkaloids. Every patient is different. Every disease is different.

Here’s an example of a chronic illness that presents differently in each patient. If you’ve ever studied Lyme disease, you know how absolutely varied the manifestations of that devastating disease are. If you’ve personally known anyone who suffers the illness, you may sense the cost to the sufferer, their families and friends. Some suffer pain, some suffer exhaustion and all have lost parts of their life to the symptoms of the disease.

And that’s just one illness. With dozens of variations in symptoms from patient to patient. Among dozens of pain-generating illnesses. Other diseases that generate intractable pain too, are incredibly challenging; especially with ill-defined or well-ignored treatment modalities and few efficacious treatment options available.

Further, there are challenges unique to treating etiologically complex and clinically heterogeneous intractable pain illnesses due to the lack of education in our medical schools with regard to treating chronic illness and pain. Less than half of physicians have ever had a single course in pain management.

It’s disheartening to see such venom catapulted toward fellow survivors, whether on social media or delivered by the evening news.  The demonization of opioids is not a new story, but this time that ignorance is killing pain patients.  It’s what society did with marijuana when I was growing up.

And as you know, it was all lies.

Chronic Pain and Torture – U.S. in Violation of International Laws Against Inhuman Suffering

-Kelly Merrill

“Failure to make essential medicines available or to take reasonable steps to make pain management and palliative care services available will result in a violation of the right to health. In some cases, failure to ensure patients have access to treatment for severe pain will also give rise to a violation of the prohibition of cruel, inhuman and degrading treatment.”  Access to Pain Treatment as a Human Right, Human Rights Watch (March 3, 2009)

I’ve been thinking a lot about terror.  And torture.

We must alert the international human rights community of what is happening here in the U.S….and the terror of being a pain patient when every kind of discrimination and denial of treatment have, inconceivably, become commonplace, whether for cancer or AIDs or the dozens of devastating pain-generating illnesses patients suffer.

Pain patients have become the most marginalized subpopulation in the U.S.

We must acknowledge the severe toll of human suffering to change it.  We must start by immediately demanding the only acceptable standards of care for pain management recognized by human rights advocates around the world…the effective management of physiologically-damaging, dehumanizing pain.

While government entities must balance this need with steps to prevent diversion, they must do so in a way that does not unnecessarily impede access to essential medications. Further, even the International Narcotics Control Board has stated that such diversion is relatively rare.

And yet…

Dr. Forest Tennant, the foremost intractable pain specialist in the nation, always expressed incredulity that the World Health Organization had already developed internationally-recognized, basic standards of care for pain management – and that practitioners and Government routinely ignored the need to balance the relief of suffering patients with attempts to control drugs diversion; therefore denying fundamental human rights’ protections for people who suffer devastating pain.

The Draconian practices of Government have had a chilling effect upon the prescribing practices upon physicians, in direct violation of WHO and other international initiatives, causing many to stop writing opioid prescriptions WHO considers “absolutely necessary” to treat moderate and severe pain.

And who can blame them?  They are only trying desperately to avoid getting caught-up in the crush of anti-opioid McCarthyist, physician persecutions of the past decade; persecutions that now include Tennant, who was raided by the DEA after responsibly and conscientiously treating some of the most severe intractable pain cases in the country for over 40 illustrious years.

And he’s certainly not the only one…to be persecuted…or to suffer.  Physicians, pharmacists, patients and activists across the US are mobilizing in a fight for their lives.

The US have been cited as having significant barriers to effective pain treatment for decades, including the divisive and restrictive drug control regulations and practices that have only grown exponentially, creating a state of emergency for pain patients.  These one-sided policies do not balance the need to treat the millions in chronic pain along with government’s desire to control the flow of illicit substances.

That must change if we are to survive this.  And it is a matter of survival.


The Human Rights Watch recognizes that pain has a profound impact on the quality of life and can have physical, psychological and social consequences. Under- or un-treated, it can reduce mobility result in a loss of strength; it compromises the immune system and interferes with a person’s ability to eat, concentrate, sleep, or interact with others.

It also causes muscle wasting and brain loss.  Unmitigated, it causes cardiac and drives legitimate pain patients to suicide.  It is all-consuming.  This level of absolutely unnecessary agony tears apart communities and creates collateral damage of our children and families who suffer along with us.

The right to be free from torture, cruel, inhuman and degrading treatment or punishment is a fundamental human right that is recognized in numerous international human rights advocacy organizations.

Besides prohibiting such human rights violations, governments also have an obligation to protect their people from such treatment.  In other words, they must take steps to protect people from unnecessary pain related to a health condition under recognized, international standards.  In the U.S., that starts with the Government not attacking its own citizens.

The only ones unclear on the right pain treatment are the Government and anti-opioid zealots who either do not know there are millions suffering these human rights abuses or simply do not care.

Some of these entities have willfully and knowingly chosen not to believe what scientists and the best pain management physicians have been telling them for years, thereby violating the international human rights agreements and ignoring the scientific certainty that opioids are essential for the effective management of pain and that the vast majority do not abuse or become addicted to their medications, including many who require high doses.

“Governments [must] protect people under their jurisdiction from inhuman and degrading treatment. Failure of governments to take reasonable measures to ensure accessibility of pain treatment, which leaves millions of people to suffer needlessly from severe and often prolonged pain, raises questions whether they have adequately discharged this obligation.”

-UN Special Rapporteur on Torture, Cruel, Inhuman and Degrading Treatment and Punishment

(in a joint letter with the UN Special Rapporteur on the Right to Health to the Commission on Narcotic Drugs, December 2008).

Senator Says “Ensuring Patient Access” Continues to be a Problem – Still, DEA Wants to Repeal Protections

-Kelly F. Merrill

Members of the Senate Judiciary Committee met Tuesday, December 12, 2017, to provide Oversight of the Ensuring Patient Access and Effective Drug Enforcement Act.

The bill expanded required elements of an “order to show cause” issued by the DEA before it denies, revokes, or suspends a registration for a Controlled Substances Act violation. Specifically, DEA must now state the legal basis for their action and notify the registrant of the opportunity to submit a corrective action plan.

Since Washington Post and 60 Minutes pieces shed criticism upon the law, there has been controversy. Sen. Chuck Grassley (R-IA) expressed frustrations with with vocal critics’ conflicts of interest; and with the DEA, who he suggested had long-been involved but now wanted to repeal a law that was passed with unanimous bipartisan support. Critics claim the law effectively stripped DEA of its enforcement power.

In response, Grassley pointed out that the figures seem to indicate the converse is true; that DEA’s efforts haven’t been hindered but have instead increased.

Sponsor Sen. Orrin Hatch (R-UT) reminded members that the impetus for the law was to address the the growing issue of restrictions hindering legitimate patient access to necessary, opioid pain-relieving medications. The bill passed with overwhelming bi-partisan reports.

Jan Favero Chambers of the National Fibromyalgia & Chronic Pain Association testified regarding her own patient experience with regard to trends and policies that have had negative effects upon the pain community since 2005.

Hatch reminded participants that fear of enforcement actions coupled with lack of guidance created the imperative for the law, stressing that DEA’s attitude toward registrants was “downright antagonistic.” A well-informed and deeply critical Hatch applauded the patient advocate from Utah for informing him of the issues.

Co-sponsor Sen. Sheldon Whitehouse (D-RI), expressed frustration that the “backstop” built into the law to assess any unintended consequences of the Act, was months overdue from the Health and Human Services Department (HHS).

No release date has yet been issued for the HHS report, which is mandated by law and continues to be a source of frustration moving forward.




-Kelly F. Merrill


I’m a veteran 15-year pain patient who’s been on the front lines of the war against opioids, developing the advocacy skills to survive a hostile and near-deadly maze of institutional and regulatory hoops, bias and ignorance, as an intractable pain patient and a rapid-metabolizer of opioids.


The challenge of being a chronic pain patient whose pain cannot be adequately treated with NSAIDs, like Tylenol and Motrin, has gotten infinitely worse in response to the current socio-political environment, fueled by fear-mongering and “one-minute media’s” addiction to sensationalism.


However, while public health policies did succeed in reducing the numbers of opioid prescriptions, such reductions did not have the intended effect.
Instead of helping stem the tide of death brought on the wings of fentanyl-laced heroin, these misinformed health policies have reaped their own destruction, adding an exponentially-growing list of suicides due to under- and un-treated pain and patient abandonment.


Meanwhile, the death toll has continued to rise as we patients, as well as our families, march toward a terrifying and torturous end.


Oh, and those with substance use disorder, who were intended to be served by the recent rash of Draconian public health policies, are still dying in the streets of fentanyl-laced heroin and unable to find treatment for their illnesses either.


There is a war being waged against the pain community in America; against pain patients and doctors alike.



Authorities have had the community in an uproar, scrambling, reacting to the incomprehensible news that the foremost intractable pain specialist in the country had been raided by the DEA, who kicked down Dr. Forest Tennant and his wife Miriam’s door…while Tennant was out-of-state providing testimony at another doctor’s trial for murder, a witch-hunt no courtroom should ever bear witness to.


And during all this, fear- and hysteria-driven anti-opioid McCarthyist rhetoric is being perpetuated in the media without a single consideration or musing regarding the pain patient point of view.


How is it that Government Agencies tasked with protecting the public health have managed to create window-dressing policies that serve neither the substance use disorder community nor the over 100 million Americans suffering the chronic, pathological pain of incurable and life-robbing illnesses.
They’ve poorly used the substance use disorder community with promises to take pity, be compassionate and care that the youth of our society were dying in huge numbers by creating legislation to stop the death toll of .  of recovery centers and social support; a failed endeavor without money or meaning for the people it was intended to help.  People are still dying in the streets.
Myself? I want my very complex healthcare decisions to lay between me and my doctor, who must consider my genetic profile, be familiar with my illness and the dangers associated not only with pain medication, but with NOT treating the life-threatening symptoms of my illness.


I know myself to have been incredibly fortunate to be one of the illustrious patients of Dr. Forest Tennant; his cases are  I learned more about managing my illness in those visits to his small office in West Covina, California, than I had in the previous decade.


It was a family affair. My son waited throughout intense days of study, education, medication trials and the logistical nightmare of being a pain patient in today’s socio-political climate; content in the knowledge that someone was finally taking care of his mom. I found a home away from home and the stories of people whose lives had been transformed by this man.


If the DEA can so blatantly smear the reputation of this illustrious physician, what would it take to destroy a lesser practitioner?


Tennant, who has done more to further the advancement of pain management than any single person or entity in the United States, recently won a lifetime achievement award from his fellow doctors. How can the rest of the medical community even hope to combat these cruel and unusual injustices perpetuated against pain patients while retaining the freedom to treat pain patients without fear of reprisal?


I nearly died many deaths when I moved from the D.C. Metro Area to New England; I was a pain refugee for three years, in a desperate search for relief from Maine to California and back again, to Maryland and Massachusetts and the places in between.


The environment had become more contentious, more mistrustful and contentious than it had ever been. The Government had pitted pain patients against doctors and pain patients against people with substance use disorder.


Fantastical figures were used to mislead the public and generate the fear necessary to drive one-size-fits-all public health policies condemning both pain patients and those in recovery; neither problems addressed, neither population served.


I was floundering within the constraints of a flawed system that does little to address chronic illnesses and is eroding medical freedoms at an alarming rate. These tools are quickly being stripped away.


The stress of extended periods of severely under-treated pain caused me to lose 30% of my body weight and caused muscle-wasting, narcolepsy and cognitive dysfunction so severe I nearly committed myself to an institution with pain-induced dementia.


But a combination of Kratom and cannabis changed all that, recalling me to life and allowing me to be a strong advocate for my teenaged son and the pain community. I reinvented myself and our lives without wasting a moment.


And now DEA would like to take my life again; this time by trying, for the second year in a row, to schedule Kratom as a dangerous drug with no therapeutic value after having received 23,000 comments to the contrary the year before. They want to protect me from a plant related to coffee.


Even now, as its touted as a safe and effective alternative to opioids during the opioid crisis. Even as patients are dying in unfathomable pain.



I’ve suffered, lost the most productive years of my adult life, and was subjected, along with my son, to a long and dark road of stigma attached to opioids, the patients who must take them and the physicians who manage these complex cases.


Pain patients and their doctors must have an arsenal of tools to treat the disabling symptoms of many chronic pain patients. Opioids are appropriate for chronic pain that is resistant to other treatments, including interventional pain medicine, physical therapy, nerve root injections, trigger point injections, yoga regimens, Cognitive Behavioral Therapy and the like. It is appropriate for the treatment of tenacious pain that cannot be managed by NSAIDs.


If you feel indifferent to the suffering of pain patients and their families or the plight of those seeking treatment for substance use disorder, consider your own health and the health of your family. Chances are, you’ll be visiting the emergency room eventually and good luck when you do.


Public health policies are changing the landscape of Medical Establishment by imposing the biases and judgements of a long list of mediators who police a pain patient’s ability to get medication, even if they find a pain management doctor willing to prescribe it; even if they are a legitimate pain patient, have a well-documented pain-generating illness, take regular toxicology screens and jump through all the hoops our current environment dictates.


Corrosive opioid-bias has also begun to dictate acute pain control in hospitals; many being routinely denied opioid pain-relievers for acute pain events such as post-operative pain, kidney stones, tooth abscesses, broken bones and the like.


This is no longer just the plight of intractable pain patients. This is about the obligations we have to our fellow man to relieve human suffering and wanton misery, the right to pain relief and human dignity.



Please join the Chronic Pain Advocacy Alliance in partnership with “Doctors of Courage” to raise awareness about CVS Pharmacy policies that will hurt millions. Come join us 12pm, Saturday, Dec. 2 at 510 Congress Street in Portland, Maine, the Arts District, in protest of public health policies that are devastating millions.

#painfultruth #chronicpain #painalliances #intractablepain #painpatient #doctorsofcourage #freetennant #boycottCVS #CPAA #ATIP #opioidphobia #opiophobia #opioidcrisis

Divide and Conquer – Government “Health” Policies Pit Pain Patients Against Those Suffering Addiction

-Kelly F. Merrill


The problem isn’t addicts.

Here’s some food for thought.  First off, the overdose “epidemic” isn’t an epidemic at all according to Josh Bloom in an October 30 interview with Cameron English to take a critical look at a wave of cruel opioid-related public policies – based upon statistics that are largely fabricated.

The numbers estimated aren’t in the tens of thousands, says Bloom, they’re about 5,000; not an epidemic any more than death by bicycle is an epidemic (6,000 deaths per year), he said.

Bloom, Senior Director of Chemical and Pharmaceutical Sciences at the American Council on Science and Health, says the overdose deaths themselves are being caused by a new and lethal kind of street fentanyl.

It’s easy to make, smuggle into the US and dogs can’t sniff it out, says Bloom. In 2014 overdose deaths spiked.  That’s when fentanyl hit the states.  Bloom claims the reason for the increase in death “[isn’t] necessarily because people are taking more heroin, but because heroin is a death sentence now.  Because eventually you’re going to get a vial which has too much simulator – and it can be a milligram – and that’s all it will take to kill you.”

It’s why, for example, one pain patient from Canada, who’d safely taken opioids for 30 years to control a pain-generating disease, overdosed twice in six months.  When new prescriptions limits were instituted he was abandoned by his doctor and resorted to finding pain relief in the streets.  The last time he overdosed, it took 9 doses of naloxone to revive him.

And of course you’ve heard about the controversial efforts to limit the number of life-saving naloxone application someone dying of an overdose can have.  Before you say, “so what,” remember that it could be any one of us.  Every person is just one injury, one step away from being desperate, from needing to face impossible choices as a pain patient in today’s climate.

Would you just give up, lay down and die, abandon your families and children or would you take the risk?

I know what my answer is.

That source material for that story, by the way, has been shared 2,257 times.  Pain patients are suffering on a scale that has never been seen before.

Addicts didn’t “do” this.  They’re dying just like pain patients.  The government is getting away with terrorizing patients and the doctors who treat them and NOT helping the issue meant to be addressed by the recent rash of Draconian public “health” policies; instead they’re creating an entirely new epidemic of suffering tantamount to torture…of people who are infirmed and disabled and riddled with pain.

Again, these public health policies have not served their intended purpose.  Though numbers of opioid prescriptions have been reduced drastically, overdose deaths continue to rise.  And pain patients, who have enough challenges to contend with, are now being abandoned to their diseases.

They have been thrown out the door without the tools to combat life-threatening symptoms.  Unable to endure around-the-clock, agonizing pain, patients are killing themselves due to the unending agony of untreated illnesses, the inability to find a physician willing to treat them or a pharmacy willing to fill their prescriptions…for medications that have treated their illnesses effectively for decades.

Many patients turned to plants for relief, utilizing cannabis and Kratom, a safe and effective alternative or adjuvant therapy for treating pain.  And now the FDA and DEA are working in tandem trying to ban the leaf, related to the coffee plant, saying it’s claimed 36 lives worldwide over the span of five years.  Thirty-five of the 36 involved other substances, like alcohol and benzodiazepines.

And in some areas, the exodus of pain management physicians from practice has left tens of thousands displaced without treatment.  Though the CDC Guidelines (“The Guidelines”) that started all this were recommendations intended only for Primary Care Physicians, fear-mongering and media-hype have fed the illusion that the Guidelines are not voluntary.

In practice, the overwhelming majority of pain management physicians, physiatrists and physical medicine and rehabilitation specialists, pharmacists and nurses alike are feeling intimidated and terrified of losing their practices and livelihoods.  They are being unjustly held responsible for circumstances beyond their control and are now expected to sacrifice the wellness of all their patients for the poor decisions, or even the whisper of scandal, of one.

It seems every politician has taken up the anti-opioid mantle.   Nothing gathers support like a good ol’ witch hunt.  And media have run with sensational stories that have eclipsed the invisible casualties of the war on opioids…not just pain patients, but their families, communities and the doctors who treat them.

Pain patients are the most marginalized patient population this country has ever borne.  But all patients should beware.  Our civil liberties are being trampled on by the opportunistic and the ignorant; by politicians and authorities alike…our liberties as patients and the liberties of doctors to fulfill their Hippocratic oath and treat their patients based upon years medical school training and applied science.


We should take a look at the HIV/AIDS movement for inspiration.  They too were severely underserved, marginalized, vilified and dying for years before gaining ground.  We should take a look too at the Tea Party Movement for the speed and efficiency with which it proliferated.

And we should band together with all the advocates who can fight this because we are too sick to fight for ourselves.  We are too sick to stand alone.  We need each other…pain patients, physicians, those in recovery and the American public.

Change their minds about the treatment of pain patients and opioids.  Change their minds about Kratom.  Educate them and inform them that their civil liberties are being trampled on; and that your healthcare is no longer in the hands of your doctor.   The landscape of healthcare has been forever changed.

Who is to say where this ends?  Who decides what American patients are deemed worthless?  Who decides which conditions are too complicated and expensive to treat?

No one should.  And that is the point.

Keep Government out of the doctor’s office.  Keep corporate greed from assigning a dollar value to a person’s life.