Update 6/27/18: I am overwhelmed by the positive responses I have received for this letter. I would ask that readers also take a look at all the articles and references cited in this piece, and share those as well. Those references go into much, much more detail and research than I have had space or time for here. Thank you all so much for reading and sharing, I believe we will make a difference and win this fight for our lives! #wearehere
See also: A Rock and a Hard Place, The Truth About the Opioid Crisis, and Strangulation on Medicine
Dear Dr. Kolodny,
I am one of millions of chronic pain patients in the United States who has been continually and increasingly oppressed over the past few years by progressively invasive and prohibitive laws at the state and federal levels concerning the delicate relationship between doctors and patients, particularly when it comes to a certain class of drugs, i.e. opiates.
Ever since my very real, physical condition began about 4 years ago, my family and I have been disoriented again and again by a lack of what might be termed, “help,” from doctors. We have discovered a very confused medical community, corruption, and a growing collection of laws being passed so fast and furiously hardly anyone seems to know just what is going on.
This has resulted in doctors leaving my city, doctors outright refusing to accept chronic pain patients (or, if they do accept these patients, refusing to treat them with medications that suit the patient best) or new patients, and unprecedented referrals to pain management clinics and psychiatrists. I have a detailed post planned addressing the pain management clinics, but the psychiatrist referrals were more baffling to me. My local psychiatrists even refused me as a patient about a year ago because, “we don’t see chronic pain patients.” That made sense to me as I don’t suffer from mental illness, still my providers insisted I must be mistaken.
Down the Rabbit Hole
I began researching you and your career last night out of curiosity. I wanted to answer the question, “Who is this Dr. A. Kolodny, that everyone from journalists to policy makers and bloggers keep quoting as an “expert on opiates”?” And I found out. You, sir, are a psychiatrist and board-certified addiction specialist-turned policy maker (1) and buprenorphine (Suboxone) “evangelist” (2).
Your first private clinic was a Suboxone clinic in New York City, established sometime around 2003-2005, and it appears you (and/or other health officials) felt stymied by the federal limit at the time of just 30 patients for such clinics (put in place to stem corruption), because said health officials have been in the background, quietly working away at this very limit which was amended in 2006 (called DATA), to allow 100* patients after 1 year, and is now up in the House for being overturned altogether, along with expanding legal prescribers to nurses and other non-doctor medical staff. And look what has happened as a result:
Health officials, concerned about restricted access, lobbied alongside Reckitt Benckiser for the patient cap to be raised. “Why should we bind a healer’s hands from helping as many as he or she could?” Senator Hatch said, getting an amendment passed in 2006 that allowed doctors, on request, to go from 30 to 100 patients after a year.
The stage was set for more patients, prescriptions and problems. “It’s when the limit was raised from 30 that doctors started to get commercial about it,” said Dr. Art Van Zee, whose buprenorphine program at a federally funded community health center in rural Virginia is surrounded by for-profit clinics where doctors charge $100 for weekly visits, pulling in, he estimated, about $500,000 a year.
“They are not savvy about addiction medicine, don’t follow patients very closely, don’t do urine testing and overprescribe,” he said. “That’s how buprenorphine became a street drug in our area.” https://www.nytimes.com/2013/11/17/health/in-demand-in-clinics-and-on-the-street-bupe-can-be-savior-or-menace.html (4)
“In the early days of Suboxone, with Reckitt Benckiser barely marketing its own drug, Dr. Kolodny, then a New York City health official, crisscrossed the city with colleagues to spread the word about the new medication, entice public hospitals to try it with $10,000 rewards and urge doctors to get certified.”
Since at least 2005, you have been marketing buprenorphine as if you had a personal stake in the drug, to government institutions and agencies including prisons, public hospitals, and rehabilitation facilities (2). In the fall of 2013, you were appointed Chief Medical Officer (5), of the largest chain of non-profit detox/rehab facilities in the USA (cited for questionable practices and abuse from at least 2012-2015) (6) called Phoenix House, which received $131 million in June 2013 (7), championing the use of MAT, or “Medication Assisted Treatment,” and which now funds your non-profit, policy-influencing group, PROP, or Physicians for Responsible Prescribing. I wonder which drug Phoenix House used?
Hang ‘Em High?
Since you often cite the United States vs. Purdue Pharma (2007) settlement in your interviews and writings, perhaps you saw an opportunity to expand the use of buprenorphine by targeting and demeaning chronic pain patients as mere “addicts”.
It was odd to me in researching that incident, in the official “Purdue Guilty Plea” document (8), the very words they were condemned for, claiming OxyContin to be “less addictive” and “less subject to abuse and diversion” (8), appear to be the exact words you use time and again when describing the benefits of buprenorphine (2).
Kolodny reminds his colleagues of the drug’s advantages. He stresses that bupe in the form of Suboxone is safe and almost impossible to abuse, a huge selling point at many of the clinics they will visit. Suboxone has a second active ingredient in the mix, he explains, an anti-overdose drug called naloxone.
It does nothing if you take bupe as directed. But if you sniff bupe or inject it or otherwise try to pack enough into your bloodstream to get high, the naloxone acts like a chemical booby trap, erasing the effects of any opiate, bupe included, and bringing on sweaty, nauseating withdrawal. “That’s the last time you’ll do it,” Kolodny says dryly. https://www.wired.com/2005/04/bupe/
In 2016, your organization, PROP (Physicians for Responsible Opiate Prescribing), got the ear of the CDC and helped to write the now-infamous, misinformed, and rushed guidelines for prescribing opiates. While these guidelines were fairly general in nature, they have been used as a springboard for countless pieces of state legislation and DEA investigations, which has, in turn, led to the above-mentioned abuse and abandonment of chronic pain patients and doctors, as well as opiate shortages in hospitals and ERs (The DEA, in an attempt to prevent diversion of opiates to the black market, has cut production by an incredible 45% in the past 2 years). I imagine that suits you just fine, since you have publicly stated you believe opiates should be discontinued for all but the dying and post-major surgery “for a few days” (https://www.ket.org/opioids/inside-opioid-addiction-10-questions-with-dr-andrew-kolodny/), and that “more treatment” is needed (https://www.vox.com/science-and-health/2017/8/3/16079772/opioid-epidemic-drug-overdoses), i.e. MAT/Suboxone clinics like Phoenix House.
You have hailed local municipalities and states in their further pursuit of legal action against American Big Pharma, the companies who make such things as Vicodin and Percocet, but not Suboxone/buprenorphine (which is also an opiate), which is made by an overseas company, Reckitt Benckiser, or Naloxone (Narcan), which is produced in a nasal spray exclusively by Amphastar Pharmaceuticals (10), a relatively new company founded in California in 1996 (11), whose stock (and Narcan prices) have been rising quite a bit, lately (12, 13). Are you truly against the use of opioids, or just the ones that help pain?
The Opioid Epidemic!
Although your policies, based on inaccurate data (14-15) https://www.acsh.org/news/2017/10/12/opioid-epidemic-6-charts-designed-deceive-you-11935 (15), and http://www.mdmag.com/journals/pain-management/2012/october-november-2012/just-how-responsible-is-prop, have been wildly ineffective at stopping heroin/fentanyl overdoses; although you are not a pharmacologist, opiate researcher, pain doctor, pain patient, surgeon, or even general practitioner; although you ran a private clinic for a short time in 2005 (as far as I’ve been able to learn) that dispensed buprenorphine/Suboxone, you have, for the majority of your career as far as I can tell, been a policy-maker and not directly involved with addiction patients or chronic pain patients whom you recently claimed were simply addicts who needed compassion and “treatment” (and, presumably, Suboxone).
“Many Americans are truly convinced that opioids are helping them. They can’t get out of the bed without them.”
“Policy makers were told by industry-funded pain organizations not to penalize pain patients because of drug abusers. We realized that this wasn’t true. We don’t have these two distinct groups, one for pain patients and the other for drug abusers.” https://www.kolmac.com/2015/12/qa-dr-andrew-kolodny-chief-medical-officer-phoenix-house/ (15a)
If You’re Not For Us, You’re Against Us
You are cited and quoted in an impressive number of articles and interviews as a compassionate person who wants to see people and their families heal from the devastation of addiction, which is why it surprised me to find quotes from you that didn’t seem, well, “nice.”
It is the FDA’s role to vigilantly regulate the approval, labeling, and promotion of pharmaceutical products, not that of counties or municipalities. County and municipal lawyers are inadequately qualified to make or enforce federal drug policy, and these lawsuits serve as a vehicle for local governments to seek revenue through ill-informed measures under the guise of drug abuse prevention. In a May 30,2014, interview with FDA Week, a CLAAD spokesman voiced these positions and expressed concern that these lawsuits are part of “a trend that will distract us from the real meaningful approaches to reducing prescription drug abuse.”
After reading the interview, Dr. Andrew Kolodny, president of Physicians for Responsible Opioid Prescribing (PROP)and Chief Medical Officer of Phoenix House, contacted CLAAD via telephone to condemn its comments. During this conversation, Kolodny threatened that the Internal Revenue Service would revoke CLAAD’s tax-exempt status when alerted to the comments, which he believes conflict with CLAAD’s charitable mission. CLAAD takes these false allegations and threats very seriously, and responded in a letter which is publicly available for view on our website.
Critics who categorically dispute the motives of organizations like CLAAD and its diverse coalition members are, at best, narrowly focused. Their zealotry reveals their otherwise undisclosed health insurance industry bias. At worst, they endanger the lives of people who live with pain and other conditions that can require controlled substances by stifling access to quality care. http://paindr.com/claad-and-phoenix-house-square-off/ (16)
Anyone who questions your authority, expertise, policies, or the efficacy of your pet drug, buprenorphine, is loudly dismissed by you as uneducated (17), addicted (15a), or corrupt (15a, 18), regardless of how closely they actually work with addicts and pain patients (17).
But Dr. Kolodny, I have nothing left to lose — your policies and attitudes have directly impacted my health, my freedom, my ability to be a parent, my work, my hobbies, my family, my finances, my friends, and my personhood. I have no problem announcing to the public, as loudly as I can, “The Emperor is not wearing any clothes!”
Inside Opioid Addiction: 10 Questions with Dr. Andrew Kolodny
153 thoughts on “An Open Letter to Dr. Andrew Kolodny”
Superbly written article w/true, scientific substantiating data citations. CPP’s are suffering tremendous HARMS & even DEATH as a direct result of @andrewkolodny @supportPROP @rogerchou & #antiopioidzealots biased opinions & $$ driven false narrative re: #opioidcrisis. The overhyped CRISIS is NOT due to legal/legit Rx pain meds!! Stop the #CPPGenocide #DontPunishPainRally
I am new to this movement, but not new to pain. We who have it know the symptoms that make daily life a misery… I woke myself up, moaning in pain. I told my pain mgmt that I have daily level 5-8 pain, with bouts of level 8 that seem to occur randomly and last for hours. I am (newly) on a bup patch and it does very little… the pain deepens my severe depression and anxiety and contributes to suicidal ideation. I am 57 years old and had a 20 year career as a chemical dependency therapist. I am not naive or prone to dramatics. I freaking hurt, deep in my bones, from degenerative discs, fibromyalgia, a series of traumatic brain injuries that have affected my whole body, and advanced osteoarthritis. All of these issues are documented. I was granted disability the first time I applied, which is rare and speaks to my level of pain, but I feel like I am not being respected or heard. I can quickly get real help for anything else — I have asthma and have no issue getting inhalers, etc. But they don’t seem to realize that the daily, grinding, life altering pain is killing me, bit by bit. I am astounded by the standards of pain management. I don’t know what to do.
You seem to see hope that it is getting better. I hope that you are correct. People are being gaslighted, undertreated and forced to live in unacceptable pain levels. We need help!
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Public Policy Pendulums always swing the other way…eventually. The trouble is trying to hold on with weak, pained fingers. I’m so very sorry for your pain and suffering. Please try to hold on. This will be like steering the Titanic.
You are absolutely right they are being gaslit! And I’ve learned gaslighting is typically about power and money.
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I totally agree and feel like you do as to pain levels and duration. Been like this three years.
The CDC/DEA/Kolodny lobby have been using Russian style propaganda to stigmatize anyone who uses opiates in its many forms. They have created a movement to stigmatize anyone who has ingested an opiate that I call; “Everyone hates a junkie.” Their unstated goal is to shame anyone, including those of us who have a documented medical condition that consistently causes a severe and intractable form of pain that cannot be ameliorated by any other means, to either abandon their/our use of medications to control our pain or go to jail along with the physician who prescribed that particular medication.
There is no excuse for how they are able to continue to be unchallenged by the scientific community even when it is clear that the CDC/DEA/Kolodny are using the mortality and morbidity data generated by the counties that report deaths that are due to the use of opiates that they bought on the street. They are exploiting the public’s lack of knowledge of how data can be fraudulently misused but there is no excuse for the scientific community to avoid calling out the CDC and DEA for their misuse of data to create policy that targets everyone including patients who have a clear need for a medication they/we can use to control pain. Again, Kolodny et al are fraudulently using data pertaining to the deaths caused by the opiates that China ships to Mexico, smuggled across the Mexico/US border and bought on the street to undermine and imprison both patients who have a legitimate need for a medication to control pain and their physicians.
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It boggles the mind!
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It will become their interest when they or a family member will require the Opiods someday. Very sad to see Pain Patients in the hands of misinformed People. I break bones constantly because of what my disease has done to me. I was hospitalized in December 2020 for a shattered Pelvis and fractured Sacral. The emercency room was excellent and kind. But once I was admited the Nurses avoided me like the Plague. I didn’t even recieve my daily meds for my disease. I went into that hospital on the 13th of December weighing 101 pounds. On Monday the 16th I insisted I was going home. Not one meal of food was giving to me. Not one Saline drip was giving to me. I needed an Ambulance to take me home because I couldn’t walk. When I weighed myself at home I was 86 pounds. This in my opionion was to act like I didn’t exist. Because of the uncomfortably situation with the pain medication. But you don’t give me my regular meds or food that I need to survive. They basically turned their backs on me to avoid a situation that they did not know how to handle. But they left me in bad shape. Buy this point I was throwing up atleast 7 times a day and going to the bathroom like 20. If it wasn’t for my Practitioner I probable wouldn’t be here writting this letter right now. She started me on TPN. In order for me to survive. I am still not recovered and it is a little over a year. But I am in far better shape then what I was in after that hospital stay. Very sad what has happened here. And I don’t hate easily. But this Man and his greed should be punished to the fullest extent of the law. And never be allowed an Opiod for pain in all his life. Because all of us at one time or another will need them. And they should just not be giving to him. By a Court of law. As part of his sentence. And maybe we should up that one. Not one of his family nembers or someone be loves should be allowed them either. And then let him see what that is like. Oops I forgot he is about greed and probably doesn’t even care if one of his family members will need them.
Thanks for writing the letter! It would be nice if somebody actually listened to pain patients and looked at the data without bias. Kolodny’s a liar and a fraud, far as I’m concerned he should spend the rest of his life in prison celled up with Bubba. I’ve only hated one other person in my life, that guy beat up my mother. At sometime his lies will be exposed.
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I completely understand. I was raised not to hate anyone, but it’s impossible not to hate sheer evil and corruption. Kolodny doesn’t have the ignorance excuse–I made sure of that.
When are the Disabled and Elderly going to start getting the Pain Treatment needed to live a half way normal life?
Because of the CDC guidelines Andrew Kolodny and Prop created we have seen to many people suffer because of them. It’s time to reverse course and start treating pain. Pain and addiction should have never been put in the same content.
Most these people in leadership that create pain laws don’t realize the harm they are causing. They have bought into the advertising and hype that somehow Opioid Pain medicine is associated with overdoses.
This is a lack of education. They have only absorbed info from what they have seen on TV and never actually did any real studies about Chronic or High Impact Pain.
AG Wm. Barr said back in April 2020 they now realize those overdoses were caused by illegal drugs coming across the border. But when you see a large bust you will see a picture of a pill bottle and the general public automatically thinks it pain pills from a doctor. This is part of misleading info by the media.
Newsweek also wrote an article that studies prove less than 1% get addicted to pain medication that takes it for pain. I’ve seen many studies saying 1% to 2% so my question to these lawmakers, why are you passing laws on opioid pain medicine that actually harm or kill 98 to 99% of those who suffer in horrific pain?
The answer is because you are passing laws from someone’s opinion and not looking into research or any scientific evidence. This is so wrong for you to act carelessly with over 19.6 million that suffer in high impact pain.
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Hundreds, thousands of letters, comments, phone calls, and more have gone out from pain patients to doctors, hospitals, government leaders, and mass media to shockingly little avail. I believe they are aware of the problem, but it isn’t in their interest to do anything. We must make it their interest. Maybe I’ll write a book…
Better the raise a rifle. Or letter to congress. AK gets got his voice herd at one time but I believe that is drawing to a close .Actions and Money speaks. Write your book to congress. The damn paid lobbyists are the problems and we don’t have one.
I am a member of Don’t Punish Pain Rally and also struggling with chronic pain for the past 5 years. I am not going to share my story right now but instead I would like to bring up a very important issue regarding our elected officials that we are deciding on today. This is President Trumps war on drugs that we are living in. He hired William Barr, AG who has mandated the DEA to go after the medical profession and pharmaceutical industry. Why isn’t anyone talking about this. Our only hope is that this election brings us a new admistration.
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While Trump and Barr have made things even harder, unfortunately, this is one issue our government leaders have been aggravatingly bipartisan on. It actually began under Obama, and many state leaders on all sides mandated the hardline, arbitrary laws that bind us and doctors today.
Money talks, and of course most chronic pain patients are disabled and poor, and bewildered by the complex web of corruption that oppresses us.
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That’s for sure. The problem lies in lobbyists paying 1000s of dollars to legislators. Money is just one way to influence people illegally.There is stock fraud at work too.After contacting PROP about Kolodney’s Suboxone investment a news wire went out that he had none.He and other PROP members may feel ok now but every dog has his day.Life is like a vapor, it appears for a little while and it’s gone.He’s entering the side gate, if you know what I mean.I choose the FDA guidelines on drug inserts.He and Jayne have tried to hijack FDA authority but it did not work.They did not even meet the vetting protocol for consultants. This is why he hid his stock investments. Happens everyday.
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Unfortunately, I thin Biden is going to join the war on pain meds because of his experience with his son. I plan on writing him a letter about my experiences and am hoping that his compassionate side with hear me.
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I hope so, too, Abbie. I’m so very sorry for your pain.
People think this but forget that he watched his son suffer with Cancer and I think the big question here we need to ask him is could he stand to watch his other son with something that slowly and painfully killing him, his ability to live, work, be a father, and becoming bedridden. Exhausting all other medical treatments as most pain patients have, would it be worth it to see his son FUNCTION with 4 little pills a day (at the right dosage, not the BARE minimum)
Thank you for your well written words. This doctor has abused his position long enough. By getting the information on him you took the personal aspect out or I should say the emotional aspect out of it and made it about the facts. Once again thank you, none of us have anything to loose anymore. This all has to change!
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You are welcome. I’m so very sorry for your pain. 😦