Addendum:

a snippet that belongs here somewhere. OR. This is a dupe. Goodnight! :-)

You and Tami and axe (Hey axe!) and Tara get a Forum together, and I'll finally close this site to new comments and let people discuss it all on the Forum - Forums really are nicer discussion sites than blog comments.

You'd be doing me a big favor; but regardless my focus has shifted. I want to practice music 3 hours a day for a year and see if I can be a regularly working musician. I lucked into the best most perfect for me upright bass teacher and first lesson tomorrow noon. yea! I don't have time for this - even just the Comments part.

The end of my public, working medical life. Very fully lived, not many regrets, and put a fork in it, it is over. It is a good feeling. I have grokked the drugs/docs/pain debacle in progress fully to my own satisfaction, and it is US. I'm not going to repeat myself for another five years (god, that *would* be sad.) Nothing more to say. So ahh, -cue Lenny Cohen, 'I've seen the future. It is murder.' :-)

For my next obsession ~ bring on the double bass. This is gonna be a stretch in several ways. ha! I'm gonna just have a lie down on this tracks and let this next train hit me. Don't worry - that's how I've always done it. Gee, this turned into a goodbye letter. I'll try and tidy up a little before I lock up; the keys'll be under the porch in the usual place. :-)

love, ..alex...

And no, we were both wrong: it is M.B. Robinson and R.G. Scherlen - Lies, Damned Lies and Drug War Statistics; 2007. It's always on the shelf directly over the computer. :-) Think they still have a fab website full of great charts and graphs that I used to haunt before they summarized it all in the book. [email me a mailing address, Ian - I'll send you a copy.]

I don't think my replies are getting through, and i'm not going to figure out why tonight.

but yup, what you said is pretty much what i understand, too.

..alex...

hi spindoc99

gee, only 103 weeks to get a response; I am so toast.

for anyone with a similar question, suggest check out www.moderation.org - pretty sure they'll have a fairly current list of what cities have face to face meetings. And if you post a question like this on their (very active) online forums/meetings, you will get a lot of responses.

..alex...

Yeah, all that. It all stems from, and works if, you see people who use drugs everyday (which would include chronic pain patients *mostly* as they *far* outnumber "recreational" daily opioid users,) really so small a group that is would be insane to focus this entire Industrial Complex on them. Of course THEM is a myth - the boogie-man we scare propaganda addled adults with... for like a century now. This crossing of trend lines is anything but subtle. It isa obscene. Perhaps you've just forgotten? The graphics don't show well in many browsers in the HTML version; review the "Drugs are Bad. Compared to What? section of the PDF version of "War on Drugs, War on Doctors, and the Pain Crisis" - http://www.doctordeluca.com/Library/WOD/WOD-PCA06... -- graphs speak for themselves (so why do I go on and on?)
Table of Contents / Index - http://www.doctordeluca.com/Library/WOD/WOD-PCA-T...

I think it time to sort of mothball/archive this site. I'm not adding to much anymore. But it covers my 2 1/2 'careers' as a physician. *Lots* of still relevant info here about abstinence vs harm reduction, pharmacotherapy for substance misuse disorders with especially strong collections of full text articles about disulfiram (Antabuse), naltrexone (Trexan, Revia, Vivatrol), and combination of meds with various psychotherapies, really good in depth stuff about inpatient and outpatient detox (really my core medical skill - developed a really very cool outpatient heroin dependence ---> naltrexone blockade in less than a week with minimum discomfort - seriously; I had patients eating lunch on days 2 and 3, and most people could only needed one or two days in the hospital if they needed any. ) See, all that was online before I was too terribly aware of or concerned with the war on docs. Chiefs, medical directors, and division heads of substance abuse services of major academic medical centers in NYC are not targets of DEA investigations. Not in modern times. (Though you can read about the bad as usual old days in the 'Big Lies and Bullies Trump Research in the War on Drugs' section that same paper - the part about the LaGuardia Commission. The last paragraph of that part of the paper was my dad favorite. -smile-)

Anyway, lots and lots and lots of really good full text articles which are oddly still relevant; which is sort of shocking until you understand that stunted rates of academic growth are the rule, as in normal as in the way they want it, in medical fields distorted by DEA's/DOJ defacto regulation of medicine. I was fired for violating, get this, a "philosophy" of treatment. HUH? "-)

"I wish I could afford a book..." - well, in part that was why I made the effort to find the full text of my source references... almost no private individual could afford to buy the coherent collection of articles and reports I have, even though they PAID for the research (*mostly* directly govt funded.) I mean seriously - are we dumb asses or what? :-)

I always thought this was one of the best essay's I'd ever written... -mutter- the Times shoulda published it. ha! - 'Abstinence vs Harm Reduction - a False Dichotomy' - http://doctordeluca.com/wordpress/abstinence-vs-h... Has that youthful righteous-anger tone. This site has all the papers I didn't want to misplace - posted the abstract linked to full text, and usually with only the very briefest comment from me. So it needs an outline/index - some way people can tell at a glance (has to fit on a screen) what's available. It's all already loosely organized into 'Libraries' - won't be too hard to resurrect them for browsing by some sort of TOC on the main page. You and Tami and axe (Hey axe!) get a Forum together, and I'll finally close this site to new comments and let people discuss it all on the Forum - Forums really are nicer discussion sites than blog comments. Be doing me a big favor. I want to practice 3 hours a day - I lucked into the best most perfect for me upright bass teacher and first lesson tomorrow noon. Don't have time for this - even just the Comments part. The end of the medical part of my life. Very fully lived, not many regrets, and put a fork in it, it is over. It is a good feeling. I have grokked the drugs/docs/pain debacle in progress to my own satisfaction, and it is US. I'm not going to repeat myself for another five years (god, that *would* be sad.) Nothing more to say.

For my next obsession ~ bring on the double bass. :-)

Siobhan and I discussed this many times. I believe "medical marijuana" was not the best strategic wedge issue to push, if what you wanted to accomplish was a dramatic decrease in drug-war-related (prohibition related) death, disease, and the distortion of the doctor patient relationship and the chilling effect on ethical medical care and the pain crisis that the predictable, unavoidable consequences of a national drug policy that we all vote and pay for it (we all vote - yes, if you've ever voted or paid taxes it is your fault too) - a policy that quite simply prioritizes catching "criminal addicts" (a govt-media-prison-addiction treatment industrial complex cartoon) over rational public health priorities.

We aren't stupid; we are venal. America works this way because a whole lot of people, almost everyone, is benefiting in some way - all those Found/Socks, the massive expansion of police armaments nation wide (whether your burg needs a Drug Swat Team complete with tanks or not!) Radley Balko has written a lot about this, among a number of others. Anyway, the only cannabis consumers I am concerned with are those lives are made materially and socially (and maybe spiritually) better by using it. That it, it relieves some pain or psychological symptom such that the people is a happier, more productive, more fulfilled, better parents, etc. Those people should be identified and offered cannabis if that is the safest (best positive benefit / negative consequences or side effects ratio) med for the particular case. Everyone else? Who cares? Oh, you "care about The Children?" Hey, me too! All substance we like and sometimes like too much ultimately alter the poorly named "pleasure centers" of the brain (limbic system, nucleus accumbens - and the evil twin, the amygdala.) It makes A BIG DIFFERENCE whether these chemicals are applied to growing brains or to finished developing brains; the former SHOULD be left alone - you really do want to minimize psychoactive drug/etoh use by still developing brains. Here is the simple truth about that: Regulation = Social Responsibility; Prohibition of mutual beneficial economic commerce between consenting adults is impossible; Prohibition and criminalization makes it certain that you (a hypothetical rational caring society) will have close to zero leverage, close to zero control, of the market = you are making sure you WILL NOT BE ABLE TO protect The Children. The Children have been reduced to a cynical propaganda slogan; the truth is we hate our children. If we loved them, we'd actually study them and understand them and best help those who needed help. Oh what a lovely war.

Well bless you and Tami and whomever else of the old core is still around. There is a major need for a chronic pain patient forum that isn't affilated with one of the pain 'found/socks' (Foundations and Societies - hey, not bad ..alex... -smile) all of whom, I think, are big pharma or big corporate or, more likely, govt funded academic/research orgs - NIH (who also do lot of good research) which includes the, very unfortunately, despicable NIDA (National Institute of Drug Abuse) which gets lots of millions (billions? ouch!) of perfectly good dollars that could be used to actually study substance abuse and addiction. Over the decades, and yes I've been paying attention that long, it has become an embarrassment to real researchers, and to anyone who gives it even a moderate amount of study. Highly recommend: "Lies, Damned Lies, and Drug War Statistics" - by Scherling and Robinson which came out ahh, late 2007, I'm pretty sure. [I'm already way off topic, but bottom line BILLIONS (like 18 recently) dollars a year funnel through the Druz Czar's (ONDCP) Office, who doles it out based on priorities set in the yearly White House Drug Strategy. One might assume that with all that money, flowing big time through fat times and thin, for just about exactly FOURTY YEARS, that SURELY by now we'd have TONNAGE of long term prospective studies - the very best, and yeah really expensive - but christ, we've got all this money BEING SPENT, 'cause the drug crisis is so effin... ahh, oh yeah, terrible, horrible, -- why there are so many herion addicts that... Oh well, thats a slightly inconvenient truth; according to the best studies, and not to my knowledge challenged by any study of any quality, there exactly ZERO herion addicts in the American workforce. No silly, surely there are a few who get the sniffles when their one suburban dealer goes on vacation for a week, but the point is they are statistically UNDISCOVERABLE.

omg - what have I done with the past odd eight years of my life -sigh- I've written this and said it in interviews and gotten as many of the full source documents linked to straight from the inline citations or reference sections. Makes it easy to see if I'm just making it up or whether you agree my my interpretation of the data or not. Here: pretend this is like a classified ad:

"Want a low paying, highly depressing and angering life as a drug policy expert and pain relief advocate? You do?? Well, friends, this IS your lucky day!!
From now until perpetuity (or until the planet become uninhabitable - whichever comes first) ONLY, on an everyone served till they choke basis ONLY, we are offering you a once and a lifetime opportunity. Why? Because we are so burnt out with the senseless, unnecessary suffering, killing and jailing of sick poor people, their doctors, and a far smaller number of "criminal drug addicts." Brothers and sisters, substance abuse is a huge problem. Why percentage of the population with this soul eating socially contagious EPIDEMIC is, brace yourselves, is literally HALF -gasp!- what it was circa 1972. [1 moment of being serious: rates dropped at a dramatic slope in the seventies. A normal response to the excesses of their elders - normal, reasonably well adjusted, happy people with families and jobs don't have the time to be serious drug addicts - not for long; and being a serious daily hard drug user is not "fun" not glamorous. ONLY people who are very damaged are compelled to pay the sort of price our society demands, for we are ruthless. While the usage rates were going dramatically down, the death rate from substance abuse related causes was going geometrically up. HUH? Thats right, you pay more and more to make it more and more dangerous for people who are so sick and crazy they'd rather bore themselves to death than live. The usage rates are stable'ish since like the late 1980's. Remember the zero heroin addicts in the workplace? Who is left committing their lives (i'm not talking about you had a few wild years, got a little scuffed up, and then settled down to a life not much affected by drug abuse) just killing time? SICK PEOPLE, sillies; obviously. And instead of spending 18 billion actually studying what leads to wasted lives and trying to intervene and stablize and save them, we pay instead to abuse them and hound them so they die at ever increasing rates. Way to go compassionate America! USA! Pathetic. /serious] OK, OK - so all you got to to become an effin NINGA at this stuff, for the limited time (see above: 'perpetuity' clause) offer of absolutely FREE - i know hard to believe - but it is true. All you have to do is... (read the next comment when I get around to writing it - but it is so EZ you'll be like, gee can I have a one of those Make Me a Drug Policy Wonks tee shirts too? No. No tee shifts till you complete the course. Stay tuned!)

..alex... Part two of what I promise will not be entirely useless effort, I promise, coming soon.

Steve. We are friends, known each other for a while. I know you hurt, a lot, and I know some of the hoops you've been put through, how you've been jerked around by the medico-legal establishment wherever it is you live. I know you have suffered tremendous losses.

HOWEVER, because other sufferers will straggle along and read this some day, I cannot let your comment be the 'last word' on this subject. I am referring to: "... that completely ineffective OTC crap" which you categorically state doesn't work. You are incorrect.

I have NEVER prescribed or recommended "completely ineffective OTC crap" in lieu of readily available effective medicine because I was afraid of DEA. I treated patients by a very simple and ancient principle of medical ethics: the patient's interests (not the policemans') are to be held highest.

And when I became so afraid I could no longer practice to that standard - having watched the likes of Billy, Deborah, Frank, Walter, Jeri, William, several guys named John, and many many others whose first names I can't at the moment recall, being convicted as drug criminals and marched off to prison their lives and families destroyed because they tried to help hurting people --- when I got too scared to work, I I quit practice, became an advocate, and defended pain docs at trial and advised many many others caught in the govt's gotcha! game. [see doctordeluca YouTube channel: 'Why I Don't Practice Medicine, anymore']

I did not play that shell game with "deserving" patients (a category you correctly place yourself in) NOR did I with the many many so-called "addicts" and people with personality disorders that make them difficult and often unpleasant to treat, but whom I sincerely cared about and for. But then I reject the entire "deserving vs undeserving patient" distinction as medically wrong --- good vs bad patients is a social-legal distinction that has nothing to do with suffering and the relief of suffering; it is an a-medical, a-moral strategy/myth/meme, imo, used by drug warriors and a propaganda addled citizenry to divide and conquer us.

I responded with information, above, to a sufferer without immediate good options. I linked to a thorough discussion that included trusted people with a lot of experience using that "crap" to good effect. I am pretty sure you have never done that regimen for withdrawal; so you cannot really testify to the ineffectiveness of it, can you?

*I* know what you meant, Steve; but it didn't come out right. You meant to express your outrage that in 2012, in a society with enough docs, enough quality medication, tonnage of science, and enough wealth to adequately treat everybody properly --- that we'd be reduced to suggesting what amount to 'home-remedies' to people makes you 'see red.'

Me too, brother, but there it is.

I had to inject this correction, lest we throw the baby out with the bath water. ..alex...

Thank you, Dr. Cheek, for checking in and sharing. It is an honor to have you here.

Dr. Cheek, like Dr. Rosa Martinez, is a good example of a physician who practiced to the standard of care for pain management, only to be punishished because the community norm for physicians is below the medical (aka textbook, aka 'reasonable physician') standard of care.

See: "The Distortion of Medicine and Confusion of Standards" - http://doctordeluca.com/wordpress/archive/distort...

Thank you, Dr. Cheek.

..alex...

Very sorry, Kathleen, to be so long in replying. I reply to very few Comments - I am no longer very actively maintaining this website, but keep it going as an information resource and allow Comments so people can vent and share info; but this isn't a Forum. But I was reading through the Comments on this page and saw your Comment and wanted to clear up one thing.

You wrote: "I just wish both could be used without throwing you into withdrawal."

This is a very common area of confusion. First of all, this business about Subutex (buprenorphine withOUT naloxone) throwing people into withdrawal if they are already on opioids is mostly spouted by American docs who have never once seen this happen. In Europe where buprenorphine is the #1 med for chronic pain, they do not describe this happening.

Nevertheless, the theoretical problem is when a patient on chronic opioids starts buprenorphine. Adding a pure mu agonist opioid (morphine, oxycodone, methadone, fentanyl, hydrocodone, hydromorphone, etc) to a patient on daily buprenorphine is NOT a problem - the patient will not (even theoretically) go into withdrawal.

..alex...

Dear Mr. Willet,

Apologies, but I am not able to do more than barely maintain the website as an archival resource at this point. PRN was forced out of existence and closed in December. Then, over the holidays, Siobhan Reynolds and Kevin Byers (who had very recently left Comments) died in a small plane crash. I am devastated.

I allow comments to give people a place to vent and connect, but this is in no sense a "Forum" of any sort. For now, this site is an archival resource. This site contains a lot of the beautiful mind that was Siobhan. She was brilliant; she entirely understood the drug war and pain crisis, and she had a plan. She was in no way "done" or "retired" from her pain advocacy. We are all diminished by this loss.

I have been majorly distracted by life events over the holidays; I will try and review/approve comments on a weekly (or better) basis, going forward.

Sincerely,

..alex...
Alex DeLuca, M.D., MPH