Hello, thank you for taking the time to hopefully read my email. I have had chronic back pain for 4 years now. What I have experienced with trying to get answers and treatment through this process is beyond disturbing to me. The medical field discriminates and is down right abusive to chronic back pain. The first thing I would like to address is being forced to have procedures or refusal of treatment of any kind. If you go to a pain management in this state with chronic back pain you are automatically pushed to do spinal injections. I am going to paste below what the FDA has on the website and encourage you all to look it up for yourself. The U.S. Food and Drug Administration (FDA) is warning that injection of corticosteroids into the epidural space of the spine may result in rare but serious adverse events, including loss of vision, stroke, paralysis, and death. The injections are given to treat neck and back pain, and radiating pain in the arms and legs. We are requiring the addition of a Warning to the drug labels of injectable corticosteroids to describe these risks. Patients should discuss the benefits and risks of epidural corticosteroid injections with their health care professionals, along with the benefits and risks associated with other possible treatments. Injectable corticosteroids are commonly used to reduce swelling or inflammation. Injecting corticosteroids into the epidural space of the spine has been a widespread practice for many decades; however, the effectiveness and safety of the drugs for this use have not been established, and FDA has not approved corticosteroids for such use. We started investigating this safety issue when we became aware of medical professionals’ concerns about epidural corticosteroid injections and the risk of serious neurologic adverse events.1 This concern prompted us to review cases in the FDA Adverse Event Reporting System (FAERS) database and in the medical literature (see Data Sum Now when I state this to doctors I am told this is a lie. That these injections are FDA approved. When I say we'll I don't feel comfortable and don't want to do them. I am met with aggression and am automatically treated like a drug seeker. First of all lieing to a patient is not right! I should be able to trust my providers and know the risks of procedures that are being pushed on me. Now let's get to the second thing that is pushed on back pain patients in this state. Cymbalta- if you do not know much about this medication I would again encourage you to do your research. It is being pushed by all your providers. Cymbalta has has hundreds of law suits filed against it. For severe withdrawal symptoms that last months. It literally causes brain zaps. There are literally rehabs to get off this medication and support groups. Again when I state this to the pain doctor I saw he got hostile. Told me that chronic pain support groups were for bitter people. Said he would never prescribe something that would cause such things. Again please do your research on this medication. Treatment for chronic back pain. When I started PT they spasmed and threw my back out so bad I was stuck hunched over couldn't move without severe pain. I called my primary care which was booking out over a month. So me not knowing what do do went to my normal urgent care where I have been taking my kids for years. The provider walked in and her exact words were why are you here what do you want me to do for you we don't give meds! I was confused I went here because I had no idea what was going on what the physical therapist had done to me and was scared. She told me to go home and wait for my primary care appointment. Within 3 days the pain got worse I couldn't shower myself my left side was going numb so I then went to the ER. Again I got a lovely greetings from a provider that started to lecture me. He told me I was not allowed to go to the ER unless I was peeing myself or could not control my bowels. Said they won't do an MRI otherwise and they don't give meds. My mother who is a nurse case Manager in DC had to fly down to help me take care of my children and bathe me while I waited for my primary care appointment. I has a person had never felt so helpless in my entire life. I learned really quick that I was no longer treated as a person but a chronic pain patient. I learned to research everything that was being pushed on me. I am going to counseling for PTSD like symptoms now anytime my pain hits a level 6. I know I will be left bed ridden screaming in pain when my back goes out. Imagine having pain as bad as labor pains for a month and just having to lay like that knowing if you take all the strength you have left to try and see a provider you will get screamed at. I don't want to be on any medication daily all medications have side effects and withdrawals Nerve meds, antidepressants, steroids, anti- inflammatory, pain meds, muscle relaxers. I should be able to have pain medication for acute flare ups and severe back pain. I have had chronic pain for Four years now I have learned to live with it and except this is what life has thrown at me. I love my life even with the things I cannot do but I want to be able to live it. I need to work remotely as I cannot stand walk or sit for more then 1-3 hours at a time. Yet I cannot get pain control to even go do in-person training to get a remote position. If I'm in a bad flare up and my kiddos have a sport tournament or dance recital I should be able to have pain control to attend the event. Those are the little things that make the struggles worth it. Yet I have to either leave earlier or go to the bathroom and cry instead of injoy seeing my kids grow. If my back goes completely out I should not be left unable to move shower for days dress myself. It's unhuman and down right wrong. I understand that pain meds when taken long term can make you think your in more pain then you actually are. I understand when taken daily they cause withdrawal just like everyother med given for chronic pain. You guys set up the rules so we are forced to have monthly injections or have to take daily meds like Lyrica or cymbalta with dangerous withdrawal there even known to cause brain damage. Instead of being able to take 5 to 10 low dose pain meds a month to manage bad days and give a better quality of life. I have now lived on aleve and Tylenol daily for 4 years do you know what that is doing to my body my stomach my liver. How can you really promote what you are doing. You are causing depression, you are causing more health issues by restricting and taken away pain medication. Thank you for listening and I really hope you create a change. I fight as my son has identical back issues as I do. I hope to help change things before he hits 30s and has my issues. I could never imagine my child being left to suffer as I have and pray daily things will change. Kind Regards, Savanna

Sorry if I missed it... Do these rules for PAs and MDs exclude the prescribing of a long acting opiate e.g. methadone, or a schedule iii medicine such as buprenorphine, when used in the treatment of opiate addiction in an outpatient facility that complies with the SAMHSA regulations for distribution? Otherwise in agreement. Thanks.

Washington patients suffering from rare diseases and medical conditions that cause intractable pain have suffered tremendous harms because physicians fear legal retribution for treating pain patients. Patients have been abandoned or forced tapered and unable to find new practitioners willing to treat them. Many pain patients feel they only have few choices, to live suffering in pain with no quality of life, to move to countries that treat pain, go to the streets and obtain dangerous street drugs or commit suicide. Obviously the best choice is that patients are treated with empathy and compassion and remain under the watchful eye of physicians who treat them.

Why is it we have to suffer due to the ones choosing to take a medication not subscribed to them by their physician? Your cutting

Why is it we have to suffer due to the ones choosing to take a medication not subscribed to them by their physician? Your cutting off legit pain patients causing them to commit suicide because they have no quality of life left or forcing them to live in extreme pain! The 90MME is rediculious! The limit and milligram should be up to the physician that actually spent years upon years in college to learn how to safely prescribe. You try an go above an beyond protecting the criminal choosing to take things not prescribed at the expense of legit pain patients, when did their life become so much more valuable than ours?? Your sanctioning physicians for doing their jobs.

5 yrs ago The Human Rights Watch team did a year long investigation into how badly pain patients are being treated (mistreated) in this country. This mistreatment has only gotten worse since that report. This country’s current overdose crisis is due to illicit and illegal drugs. Prescribing long ago stopped being the problem, yet politicians and the media keep feeding the false narrative. Physicians are afraid to treat patients, they face being arrested and prosecuted. Many have quit practicing, others have closed their clinics. Large health organizations forbid their “employees “ (physicians) from doing their job, which is to “do no harm” So patients are left to suffer agonizing pain, facing limited choices, suffer, commit suicide, move to another country or go to the streets and likely die from laced illicit drugs. When do patients right’s become important again? We definitely need to provide services to those suffering from addiction, but this can be done without causing harm to patients, who by no choice of their own, suffer from diseases and conditions that cause pain America is a great country, but it can do better, treat patients fairly

Recently, my clinic had me sign a waiver agreeing that I am ok with being cut off from opioid meds, without notice and informed me that withdrawal is not life threatening. Frightening, that they would even mention such a thing. My pharmacy will not fill my full prescription and makes me pickup every 2 weeks instead every 28 days. 28 days is the standard, so I have the extra costs of transportation along with having to make the extra time. Even my Dr. askes me what is up with my pharmacist. The contract I am required to sign looks like something that a felony prisoner being released on parole would have to sign. It includes that "I must get better". That is odd due to people my age don't get better with a degenerative disease. I don't think anyone gets better with degenerative spinal stenosis. In a nutshell, I am treated like a criminal and undertreated for pain and my treatment is not individualized. An example for that is take meds as needed with a daily limit. Instead, it is take 1 every 4 hours. a lot of the criminalizing of pain patients comes from NARX scoring. I recently had to purchase needles for intramuscular injection of hydrocortisone, due to having Addison's Disease. I did notice a difference in treatment at my pain clinic and at my pharmacy right after that. I had to go to a different pharmacy to get the meds and the needles and that because my regular pharmacy told me they couldn't get what I needed. Using more than one pharmacy goes against a person. The reason doesn't matter. Having injectables goes against a person. Living in pain 24/7/365 goes against a person. People living with chronic pain are treated like criminals..., and what looks to me like lab rats in some sci-fi experiment.