Why Chronic Pain Is Under-treated in the USA | The Saving Dose Ep. 06 Ft. Kevin James

In the sixth episode of The Saving Dose, Dr. John Hsu and William Pedranti are joined by Kevin James, a chronic pain patient, advocate, and member of Chronic Pain Australia, speaking from Brisbane, Queensland. 

Kevin has lived with chronic pain for years. He has navigated the Australian healthcare system, fought for access to treatment, and watched the fear campaign around opioid prescribing export itself from the United States to the rest of the world. He is not speaking as a physician or a policy expert. He is speaking as someone who has sat on the other side of the desk and has been told his pain was not real, or was manageable without medication, or was something psychological exercises could fix.

This episode covers what chronic pain actually looks like from the inside, why global overcorrection on opioid prescribing is leaving legitimate pain patients without treatment, what holistic pain management actually means when it is done correctly, and why Kevin's message to every prescriber, policymaker, and clinic operator comes down to one sentence: holistic care is the biscuit.

In this episode:

What it is like to be a chronic pain patient navigating a healthcare system that has been reshaped by fear rather than evidence, and why access to adequate pain treatment has become harder even for patients with documented, diagnosed conditions.

Why the opioid fear campaign that originated in the United States has spread globally, what it is doing to pain management practices in Australia, and why Kevin believes America's prescribing overcorrection is being imported by countries that did not need it.

The difference between opioid dependency and opioid use disorder from a patient's perspective, and why conflating the two has caused legitimate pain patients to be treated as addicts when they are not.

What holistic pain management actually requires: not just psychological exercises and pain reprocessing therapy, but medication, individual treatment, and a care plan built around the whole person rather than a protocol designed to reduce prescribing liability.

Why imaging technology misses the majority of pain causes at the microscopic level, and what happens when clinicians assume that what the scan cannot find must be psychological.

John's take on post-surgical pain management in America: what it means when hospitals advocate for Tylenol-only pain protocols after total knee replacement, and why that trend concerns him as a practicing anesthesiologist.

The patient advocacy landscape in Australia: what Chronic Pain Australia is doing on the ground with peer support groups and at the federal government level in Canberra to have chronic pain recognized and funded as a chronic disease in its own right.

What Kevin would say to every prescriber, policymaker, and clinic operator if he had one sentence: treat the individual, treat the whole person, and do not assume that because you cannot find a physical cause the pain is not real.

About the Hosts

John Hsu, MD is the Founder and CEO of iPill and a practicing anesthesiologist with 25 years in pain management and addiction medicine. He has taken multiple products through FDA approval and commercial launch. Connect with John: https://www.linkedin.com/in/john-hsu-md-300a8b2a/

William Pedranti is the COO of iPill, a Georgetown Law graduate, and co-founder of PENG Life Science Ventures. He has taken a biotech company from founding through FDA approval, commercial launch, and exit. Connect with William: https://www.linkedin.com/in/williampedranti/

About the Guest

Kevin James is a chronic pain patient and patient advocate based in Brisbane, Queensland, Australia. He is a member of Chronic Pain Australia, the only organization in Australia providing face-to-face peer support groups for people living with chronic pain, and is involved in advocacy efforts at the federal government level to have chronic pain recognized and funded as a standalone chronic disease. He speaks in a personal capacity.

Website: thesavingdose.com

This podcast is for educational purposes only and does not constitute medical advice. Consult a qualified healthcare professional before making any treatment decisions.

#ChronicPain #OpioidUseDisorder #PainManagement #AddictionMedicine #BehavioralHealth #TheSavingDose #HealthcarePodcast #ChronicPainAwareness #OpioidCrisis #PatientAdvocacy #PainPatient #MOUD #AddictionRecovery #SubstanceUseDisorder #PublicHealth #HolisticHealth #ChronicPainAustralia #GlobalHealth

Transcript

SPEAKER_01 0:00

The death toll actually went up from 2019 to 2022, and the life expectancy actually went down. So people were dying. In fact, you know, for us in the United States, we've had these issues with veterans. We can't get the veterans treated, the people who fought for the United States symbol of freedom. And it's so sad because there's 6,500 patients who are treated, but 418,000 veterans need treatment and they can't get it. And so they commit suicide and have drug overdoses in the parking lot of the VA hospitals.

SPEAKER_02 0:33

And believe it or not, 44 people die a day.com where our website is, or your favorite podcast platform or YouTube, you can find us anywhere on the Saving Dose. And our focus is all things addiction recovery. So whether you're a patient or a caregiver or a nurse or a doctor or somebody who works in administration at an addiction treatment center or somebody who's just interested in learning more about addiction, you've come to the right place. Because we're going to talk about all the things about addiction recovery of this tough, tough crisis we're dealing with here in the United States and globally, where we try to have really good in-depth discussions about how what more we can do to try to tax addiction recovery. I'm Will Pedranti. I'm one of the co-hosts of the The Saving Dose podcast. I got Dr. John Sue here as my co-host. Dr. John, how are you doing? Good, Will. How are you? I'm doing great. I'm doing great. So real excited today. We have a special, special guest here today. Very excited. We are going global. We are going down under. We've got a clinician joining us here today to talk to us about chronic pain management and addiction recovery. This is going to be a tremendous episode. So dial in, get seated, get ready to listen because this is going to be a great discussion. I want to introduce you to Kevin James. He is from Australia. He's a clinician, a former, a retired now, registered nurse who was and himself dealt with chronic pain for many, many years before he, in the last number of years, got into advocacy, trying to help people that are dealing with this drug zone addiction recovery. So really excited to get this thing started. I want to start off by Kevin. Welcome. Thank you so much for being here on the podcast. John and I are really excited to talk to you today about chronic pain management and addiction recovery and what's going on in Down Australia. We'd love to start it off. Our listeners just want to get to know you. So if you don't mind, just introduce yourself and we'd love to talk about your background, where you're from, hear more of your accent, which we're excited. People are excited to hear about. Where you're from in Australia, how you got into nursing, what you practice, how you got your chronic pain, how you've been treat how it's treated that, and advocacy. So we'd love to just get that background before we dive in with some exciting questions and conversation. Welcome.

SPEAKER_00 3:14

Yes, and uh thank you, uh Will and John for having me on your program. And I'll try and dial down my Aussie accent just a little bit, but yes, I am from the land down under. I'm on the east coast in a capital city called Brisbane in the state of Queensland. We have six states and two territories in Australia, and at the moment it's winter time, but it's a nice mild 11 or 12 degrees. We're reasonably tropical in the state of Queensland, and we don't get a lot of sub-zero temperatures. Currently I'm 62 years of age, and as Will said, I'm a retired or medically retired registered nurse, and I began my training as a registered nurse fairly late in life at the age of 25 or 26, and it was due to family influences and probably because I'd been a volunteer worker for many, many years in a first aid organization, a training organization called St. John Ambulance. I'm not sure whether they're very big in America, but they're all over the Commonwealth countries and started in Great Britain. So I became a nurse in 1989 or started my training, finished it in 1992. I didn't have chronic pain at the time, but it developed perhaps due to an injury I suffered while I was a registered nurse, because as you're probably well aware, nurses at least 35 years ago, there was a lot of lifting to be done, and unfortunately we didn't have a lot of help in those days with hydraulic beds and lifts and all those sorts of things, so it was a lot of manual labor, and I developed a musculoskeletal lower back injury and probably a prolapse disc at the time, which I worked through, but after many many years I found that I could no longer work in that industry. My focus wasn't particularly with addiction recovery as a registered nurse. As I mentioned to John in my email, I've actually been a nurse involved in all departments: emergency, surgery, neurosurgery, and a lot of general medical issues with older people who end up in hospital. So I also have an interest in aged care, and I'm involved with the very small not-for-profit as well as my chronic pain advocacy. I uh deal with social isolation and loneliness in aged care for men. That's another topic which I'll get into maybe, but uh in Australia only 10% of our nursing home residents are males and they need a lot of extra support. But uh as far as nursing in my chronic pain story goes, I've always had a little bit of lower back pain, which developed into quite a serious incident in 2009 where I couldn't get out of bed, and that's when the journey began, and the chronic pain began to be 24-7. So I deal with a situation with uh neuropathic pain and some musculoskeletal pain, which is present every day, and that's quite difficult to explain to people who don't have chronic pain, who don't understand, or who may have a post-operative procedure and they say, Oh yeah, I've had chronic pain before. I had a broken ankle and I was fine in two weeks. And uh it's very difficult to uh explain to them that the mental strength you require to deal with chronic pain is a lot different to the horizon you see in two weeks' time when you know all the tissue damage will be healed. But my chronic pain journey was quite rough initially, mental health, and I had to learn a lot of techniques with regard to what the uh buzzwords are these days or the three-letter acronyms. We have ACT, CBT, uh PRT, pain reprocessing therapy, and I've worked extensively on my mental health in the last ten years, and that's how I got involved with chronic pain advocacy, because I know that a lot of people struggle in those initial stages and they may not have any support. I've got good family support from my lovely wife and all my other friends who understand my condition, but it's very difficult to get into that right headspace when you're first starting that whole hard, difficult, complicated, lonely journey. So thanks for that question, Will. Yeah.

SPEAKER_02 7:36

Thank you. Thank you. No, thanks for being on here, James, and thanks everything you're doing, first off. The advocacy you're doing, the efforts you're doing on behalf of pa chronic pain patients, which is a struggle every day. And it's a struggle why unfortunately we have a lot of suicide around the world because the people can't get a hold of their chronic pain and the challenges, though. So thank you so much for doing. I'm excited about our conversation here today. Hey, listen, I'll let Dr. I know uh Dr. Sue here's uh England to jump in and ask some questions to get this conversation started. So uh Doctor, get us get us kicked off here and uh in the conversation.

SPEAKER_01 8:11

Well, Kevin, thank you for ha being on the podcast. I really appreciate it. Thank you, John. Well, one of the biggest things about chronic pain patients is that you know they take opioids for a number of years, and many develop opioid use disorder. So is opioid use disorder OUD what you call it in Australia?

SPEAKER_00 8:33

Yes, we we would call it opioid use disorder, and it's quite common in some areas where opioids may be used recreationally and not medically. But uh my main perspective as a chronic pain patient is working with those of us who have difficulty with tolerance, for example. So a lot of patients with their opioids develop tolerance and they need a higher and higher dose, of course. But myself, I've been very fortunate. I've been on the same dose of a synthetic opioid since 2016, and that's been remarkably good for me in that time. I don't believe I've developed any typical opioids, opioid uh use disorder or need to increase my dose. And uh I believe it still controls my pain fairly well. There are difficult days, but we actually had a change in policy in America in Australia based on the American 2016 opioid guidelines. We tended to follow what uh happened in America at that stage, and there were uh policies brought out by what we call our federal TGA, which stands for the Therapeutic Goods Administration. If I were to compare that, that would be similar to your FDA or DEA. They control the uh drugs federally and what is allowed to be prescribed to patients. And on a state-based level, as I mentioned, we have six states and two territories, and they each then develop their own state policies, which means our general practitioners, which you would call, I believe, PCPs or primary care practitioners, we call them GPs here, they need to get a state license or authority to prescribe. However, when it becomes chronic pain, there's new legislation that was brought in here around 2018 and again in 2020, which means long-term use of opioids for medical use for chronic pain need to have extra approvals done after usage of two to eight months. It's actually quite complicated in America, as I understand it. You've got many more states than we have, and the interpretation based on our federal legislation then can get slightly lost when it's spread out across all the other states. They're recommendations, but sometimes they're taken as compulsory factors, and different time frames are put in place as to how long you can have your opioids for medical care for pain. It's generally 28 days now, which came in, as I said, around 2018, and then new legislation we had came in in June 2020, which said that we've now got to go to our primary care physician or GP every 28 days, face to face. Now that's a huge waste of resources in my time for many doctors who spend all day seeing patients just for scripts. And with the advent of COVID in 2021, it became possible, which is I'm very fortunate, I still get my telehealths done every month because I'm on a government benefit. A lot of people who have a higher income who are full-time employed, they still have to go and see the doctor every 28 days for a simple opioid script. And that's the harsh regulations that were brought in to follow what I believe happened in America in 2016. If I may just add to that slightly, I am aware that the American situation, they modified their CDC guidelines, opioid prescribing guidelines in 2022. Six years after the initial opioid crisis developed in America. However, a lot of the damage, I'm in daily contact with many American chronic pain advocates, and I've heard that many people were tapered or unnecessarily removed from their opioids because they took your opioid guidelines in 2016 as concrete policy. Taper, reduce, take them off, which I believe we've followed too much in Australia, and oversight has become quite difficult. I'm fortunate. I get my opioids every three, I'm able to get a three-monthly script or a two a script of two repeats. But not everybody's so fortunate in Australia with regard to chronic pain in that respect. And I know many, many patients in Australia who have been force-tapered, who have been tapered. Myself, it happened to me in 2019 actually. I was reduced in my dose and I developed a withdrawal syndrome known as post-acute withdrawal syndrome. And I actually suffered with mental health issues for two years, and it took me a long time to recover from that. So I'm well aware of what happens to people who have OUD who suffer from addiction. And those people in America, particularly, I've heard in your state of Philadelphia, where they go into withdrawal, and to escape that they have to then get the drug. And it's not a very good drug, I've heard in Philadelphia. It's that crocodile drug which is mixed with uh fentanyl illicit and also um tra horse tranquilizer. Fortunately, we don't have that situation in Australia. It's very rare for a patient in Australia to overdose on illicit fentanyl. We're lucky geographically in that respect. We don't have horse tranquilizer either.

SPEAKER_01 14:12

Really, that's kind of surprising because you guys are very close to to China, right? And a lot of the precursors for fentanyl are made in China. And I think right now there's more people on GLP ones than fentanyl uh in the in Australia, and a lot of the illicit drug manufacturers in China are going to making the peptide for GLP ones instead of fentanyl now. So that could be something that the American uh politicians have really pushed, and you know, it it it could be something that's good for the United States. I mean, everything you've talked about has been occurring in the United States. In fact, people from that 2016 CDC mandate which said that no patient should be on greater than 90 MMEs of morphine, we lost a lot of patients. The death toll actually went up from 2019 to 2022, and the life expectancy actually went down. So people were dying. In fact, you know, for us in the United States, we've had these issues with veterans. We can't get the veterans treated, the people who fought for the United States symbol of freedom. And it's so sad because there's 6,500 patients who are treated, but 418,000 veterans need treatment and they can't get it, and so they commit suicide and have drug overdoses in the parking lot of the VA hospitals. And believe it or not, 44 people die a day. Do do the people in Australia have the same issue with veterans?

SPEAKER_00 16:05

Not not specifically with regard to pain control. If I were to mention veterans, I would just put them into the general population across the board. All of our chronic pain population have issues with access to opioids for medical care these days. Um I've actually done a lot of research on this and as I mentioned, spoken to some other advocates in America, and I'm aware of the huge increase in overdose deaths in America from 2016 onwards when that legislation took toll. And I've read that up to 80,000, 100,000 people uh a couple of years after that introduction was what your national toll was in opioid deaths. And I've also read that your CDC, Centre for Disease Control, we don't have one of those, stated that most of them were for prescription opioids. But I have the have a feeling there's a little bit of a fight back on that from chronic pain patients and people like yourself who know that 90% of that was from illicit fentanyl. So uh in Australia, as I said, we have very rarely find illicit fentanyl in people's bloodstream, and it's uh it does happen, but we just don't have the uh import from China of that situation. Most of our fentanyl deaths, and we don't have that many, is due to diverted prescription opioids, stolen prescription opioids. So they're using the legal form, shall we say, illegally. So we we do have an opioid problem in Australia, but it's not proportionately anywhere near the death toll in America, purely because of that illicit fentanyl influx and uh perhaps different state rules that you have. I don't know the scenario there whether different states are better than others.

SPEAKER_01 17:56

You know, we've had 1.1 million opioid overdose deaths since 1999. And you know, that's a huge amount. And you know, it's cost the country this year two point seven trillion dollars. Trillion. Not billion, trillion. You know, it's amazing because the drugs are not that expensive. Yeah, they're in the hundreds of dollars, whereas the amount we're spending for the the treatment of patients with o d is in the trillions. What do you guys spend in Australia for opio use disorder treatment? Because you guys have a socialized medical system, right? What just uh repeat that word again? You guys have a socialized medical system. Everyone in Australia gets free health care?

SPEAKER_00 18:45

Well, no, not free health care per se. What I will say is I can talk with some knowledge of my own state of Queensland. We actually have a public health system here, so you are correct in that respect, but I'm uncertain as to our other states. I believe it's private health fair, but we have uh government subsidies and also other medical clinics for purely addiction purposes. We um our GPs, as I said, and other drug clinics, if they do extra training, our GPs are allowed to prescribe uprenorphine and methadone. Our typical general practitioner may not have the extra qualification, but it's all devolved onto the power of the primary care physician in Australia. So, yes, everybody that needs OUD treatment in Australia can get it, but uh there are gaps and shortfalls, obviously, but you're right, it's it's the benefit for the benefit of the GPs to give it to the patients. I don't know the system in America very well, but I believe it's quite different.

SPEAKER_01 19:52

It is. I mean, you know, w the medications for opioid use disorder treatment can reduce opioid overdose deaths by greater than 50 percent. But 75% of people who have opioid use disorder in the US can't get treatment, both in medications and also you mentioned earlier, the mental treatment ACT, um, CBT, PCT, contingency management. Well, we're not we're not getting treatment. We're just sort of watching people overdose. And it's costing our country a tremendous amount. You mentioned earlier about Philadelphia, you know, and those other drugs. We've had a decrease in the overdose test recently because we uh the illicit drug supply is now cutting it with horse tranquilizer, um, Tranc or xylazine. They're using netazines, they're using uh gas station heroin, cratom, they're also using a new drug called dexatominine, which actually i it's really quite strong in giving you a very negative withdrawal symptom. And actually, I heard you know, lately in the last two years, there's a very strong tricyclic antidepressant that if you take in very high doses gives you a small high. In fact, there's a drug um that we use to treat diarrhea, and that drug is a small opioid as well. And many people they take a lot of opioid uh well, they take a lot of this antidiar medication to get that opioid high. I mean, they're plugged up, but they're high.

SPEAKER_00 21:49

Very interesting. Yeah, I hadn't heard of that one. Uh as I said, I'm aware of the uh horse tranquilizer xylosine with the illicit fentanyl. And uh yeah, I was in terms Of treatment here, I think we're ahead of America in terms of IUD treatment because my understanding is the US restricts methadine dispensing to very regulated specialized clinics rather than your primary healthcare system at the grassroots level. And uh in Australia, if I could mention a couple of statistics, we actually, as I mentioned, you you've had very high uh deaths from opioids. We have a particular institution in Australia called the Pennington Institution. Uh they're a private or government subsidised research uh place, and they do a lot of research on all overdoses, but they also put out a report on opioids. There's a new one coming out in um August this year, but the most recent one I've read from 2024 or 2025, just to give you the context, as I said, it's not proportional to the US. We don't actually have an opioid crisis despite a lot of the media headlines in Australia and the uh focus on prescription opioids, it's not that bad. The stats I've read from uh two years ago, the institute I mentioned, they say that we've only had four hundred and four deaths involving pharmaceutical opioids from a couple of years ago. That's that's not a lot. And if you dig deeper on that 404, a lot of those pharmaceutical opioids uh were stolen, and we don't know exactly how many were pain patients. I mean, a lot of them would be people who were opioid naive or post operatively, postoperatively they've developed a an addiction problem, and they continue to use them even though the tissues healed. And I believe we call that uh chronic primary pain, where it's perhaps uh more psychosomatic or developed in the mind, and um that's the issue, neuroplasticity sometimes has to be addressed, and uh in fact polypharmacy is the biggest problem in Australia. If I dig I actually dug a lot deeper, and in that particular year in Australia that I mentioned, 2024 was when the report came out, there was something like forty-eight overdoses in Australia across the board, from prescription opioids only. Once we add in the other pharmacy, it's not that it's not that big. We have forty-eight in one day in one city. There you go. We have uh forty-eight or fifty, if you average it over the last five years, it's about fifty a year. Ours was actually uh going up for a little bit after 2018-20, and I believe ours may come down soon if they address the problem with chronic pain patients, because as you mentioned, the suicide rate from chronic pain in America is terribly high in OUD, pain patients, and I've read in research a couple of years ago, which shocked me, that in America it's something like second the overdose or suicide rate to mental health as a disease. And that shocked me because I believe it was number eight or number nine years ago. We've had the same issue in Australia. I've actually read another report in Australia which tells me that our suicide rate in chronic pain patients and perhaps veterans has increased drastically too, but it's not second behind mental health, but it's still moving up. And I can only think that's because a lot of us have been denied our prescription opioids and we've had to refer to other illicit drugs or just despair.

SPEAKER_01 25:44

Do you think the reason why there's a minimal, I want I want to call it minimal, but a small number of opioids versus the United States is because the treatment access is better in Australia than it is in the United States. I mean, I'm not trying to say the United States is bad, but it just seems like what a huge difference.

SPEAKER_00 26:05

That that would be my personal anecdote or story to you. I can only tell you what I know from the people I speak to online and elsewhere, and in the last 17 years since I've had chronic pain, I've literally met hundreds, if not thousands, of people online who uh have chronic pain. And of course, there's that overlap, but I believe you may be right. I don't have any statistics. I don't believe there are any statistics in Australia which tell us why we're more successful than America. But my observation would be we handle our people with opioid use disorder differently, and they're covered a lot better. But we do have issues with a lot of oversight, too much oversight on chronic pain patients who are caught in the crossfire, I believe, between the media hype and the anti-opioid bias that's tends to be drummed up because of uh the fear. There's a lot of fear about opioids in America and in Australia because, as I said, we adopted your 2016 guidelines virtually word for word, but we haven't updated our opioid guidelines, and a lot of people here in Australia are just not aware that the major issue with your opioid crisis is illicit, not legal. People over here tend to think it's from legal opioids, but we don't have that problem, and at such a low rate. Every death's a tragedy, but I believe uh we've been more successful and perhaps geographically lucky in that respect.

SPEAKER_01 27:40

Do you think that um with uh opioid use disorder and patients with high dose opioids, like those patients in chronic pain or patients with cancer, people just are confused. Just because you're on a high dose of opioid, that doesn't mean you're an opioid use disorder OUD patient. It just means you're on a high dose. You know, if you look at the social cost of opioid use, it's not very high. You know, most patients, 70% of patients, actually stop prescription opioids after 20 days. There's a paper that came out in JAMA that talked about you know, the number of people who use opioids greater than 90 days, which is virgil, which is acute pain transitioning to chronic pain, yes is very low in the 10 to 15 percent. But the problem is that um there's many people who begin to divert, begin to like the feeling of using opioids, and people just have stigma against people who are on opioids. And I to me as a physician and as a person who understands what it means to treat patients who are hurting, because you need to treat patients with something for their physical ailment and something for their mental ailment as well, and it's it's very, very difficult in the United States to do that. People believe that you can just give a pill and their pain should go away. But they have they have a high degree of I don't know, there's no better term than post-traumatic stress syndrome, PTSD for pain.

SPEAKER_00 29:29

Yes, I I agree with that. Uh I often use the word uh PTSD or medical PTSD because uh a lot of people, clinicians, the general public, the media in Australia, whenever you hear of over overdoses with opioids, it's always a medical bottle of pills that you see. It's not actually a syringe or something else. There seems to be this undue focus on opioids, this stigma on prescriptions. And we um we also have um, as I mentioned, a lot of problems with oversight. People have to go into their doctor every month. So every month or every twenty eight days, if you're going to your doctor, you've got to prove again to them that uh you you don't have any addictive behaviors or OUD. And we get checked. Every 12 months you've got to see a second physician every 12 months now that you're on this long-term opioids. And most of the people I know are not on a high dose anymore because, rather like the 2016 guidelines, I'll mention them again, the 90 MME you mentioned before, we've taken that on board in Australia. So, to the best of my knowledge, most of the people I know, with few exceptions, have had to be force tapered against their will quite often to below 90 MME. They were very successful in managing their life and daily activities of living and working on, let's say, a hundred or a hundred and ten. But because they've been reduced by ten or twenty MME, they've actually had to take part-time work. I know of someone who's had to give up their job and they're now bedridden at home purely because they've been reduced and they were tolerant or or successful on that higher dose. I believe in Australia we should get rid of those ninety MME limits, and in some states they've taken it even further in Australia to sixty MME. I'm aware of one particular state where they've reduced the dose to sixty MME, and it's actually impossible to get opioids in that state for chronic non-cancer pain, because that's been ruled out until you're perhaps over seventy or something like that. And uh it's just a crazy system where they interpret it differently in different states. They forget that our overarching legislation, the federal legislation we have from the TGA, it actually says opioids can be used as part of the management of chronic pain in circumstances where all other pharmacological and non-pharmacological treatments have been used, and the poorly controlled pain is still needing treatment. But a lot of physicians have not read that exception or that extra phrase. They just see the recommendation at the top that says no opioids for chronic non-cancer pain, only for cancer pain. And I've always said, and I still don't understand, the difference between chronic non-cancer pain and cancer pain. And I know people who've had cancer in Australia who have recovered. They're in remission. And they've got chronic pain from another disorder or from the effects of the chemotherapy, and the doctor says, Oh no, you could get them when you had cancer pain, but you can't have them now, it's actually uh non-cancer pain. So there's a lot of um exceptions to the rule which uh I think should be uh made, and no one size fits all. I'm a believer in patient-centered care, and that should be done, and I'm not saying this doesn't happen across the board, but I know enough people who are in a small subset who don't get treated very well, and they're mostly chronic non-cancer pain patients.

SPEAKER_01 33:23

Yeah, you know, in the United States in the last decade, the n the amount of prescription opioids given to acute pain patients has dropped by 44%, and it's dropped by 40% for patients with terminal cancer pain. So in the United States, it's it's it's it's really apparent that pain and it is undertreated, and that's left patients struggling and forces them to go to illicit drugs. And you know, it's really disappointing because we're having all these policies made for the population that really ignore the individual. And when you do that, you know, many individuals will suffer.

SPEAKER_00 34:11

Yes, I I totally agree, and I can see how that's happened. In fact, I read some research on the situation in America which indicated exactly what you've just said. I've forgotten the author now or the magazine it came from, but the stat I read was that forty percent uh uh prescriptions have dropped by forty percent in America. I don't believe there's been any um research in Australia specifically to define that, but I have read some statistical analyses in Queensland and my own state, and since our own more stringent oversights came in with monthly scripts and yearly checks, since 2020. I believe in my state prescription opioids across the board, not necessarily for acute or chronic, but they've dropped by twenty percent since 2020. That's what I've heard. And they and they the government marks that as their KPI, their key performance indicator is getting prescription opioids down. And I say, well, why is that so? Because all you're doing is harming chronic pain patients who need it, and I refer them to the American example and say they've all turned to the illicit market. We don't want that happening in Australia. I understand that people who have a genetic predispos treat predisposition, I'll say the word properly, Kevin, or have uh uh trauma in their past. There's a lot of research on trauma and how people develop addiction. But we we need to know that chronic pain patients have already been successful for many years on their dose, and they often need a higher dose than an acute pain patient. So why do we have these MME limits of ninety or sixty or whatever it may be? It it's very difficult to explain this to people unless they're actually dealing in the industry as you are in America and uh know what happens to people who don't get the care they need.

SPEAKER_01 36:05

You know, what it's really interesting because I do a lot of I've done a lot of different things in my life. And one of the things that I do uh that I did is I used to b build fences. Concrete fences. And if you have a concrete fence that's uh six foot high, you need to go down at least three feet. So that means that if a person is taking opioids for a number of years because they have the cancer pain, you can't just stop the opioid because they're gonna go into withdrawal. And that withdrawal can kill. And not only that, that that is gonna take years to taper off. Not just two months, not three months, but years. Because right now, many of the fentanyl that we're we see in jails i is laced with dexatominy. So that causes horrendous withdrawal. So in jail, they put these uh people who use drugs, illicit drugs, in jail, and they don't give them any medications to treat the withdrawal or the OUD. And because they've been using drugs cut with dexatominine, they have extremely poor uh response to withdrawal. They end up with heart attacks and strokes. It's horrible. The way we're treating people with pain, chronic pain, OUD. I really feel for these patients, and it re we really need to do something more.

SPEAKER_00 37:45

Yes, uh I I've I've heard of that situation. I can't comment about our own corrective services, but I'm quite familiar with how serious the withdrawal syndrome can be when you're on a high dose, whether you've got cancer pain or non-cancer pain, to be suddenly removed from that. It's a long-acting opioid, and the withdrawals are horrible. And I can remember what happened to me five years ago with that post-acute withdrawal syndrome, and that was because my dose was reduced by 25%. And I'll say that was not successful for me because I was told at the time, oh, you'll just feel uncomfortable for a few days, and then your body will acclimatize to your 25% dose. I hadn't studied up on that in those days. I'm now familiar that you should taper very, very slowly when it's a long-acting opioid, and it's very difficult. You should go down 10% every month, every six months, or every year for some people. And for me, that was the wrong solution. And I try to explain to people that you can die from withdrawal. They don't understand that. And I've also told a lot of people with chronic pain who are very unwell, their blood pressure's extremely high, and that's usually because of the systemic effect it has on their adrenals and all their body systems. And I can tell you when I was suffering from that acute syndrome for several years, my blood pressure was 220 on 120, and that would spike during the middle of the night, and I had several presentations to the emergency department because my pain was not controlled. Now that I've done all the work, which involves the pain reprocessing processing therapy and looking after my mental health, and I'm on a reasonable dose of opioids, I don't have as high blood pressure. I've changed my diet completely, but not everybody can do that. And my blood pressure is now normal for my age, about 140 on 90. So there's a lot of things that can kill you about chronic pain, whether it's the withdrawal or the chronic pain itself that is undertreated. If I can just mention one more thing on that topic, we had a survey in 2022 or 23 with chronic pain called the National Pain Survey. And about the crackdown on opioids here, we found, and this is a volunteer organization that did this, that uh legitimate patients, as I said, were caught in the crossfire, and there were many challenges, and something like one-third of people who answered this survey in Australia reported experiencing challenges obtaining prescription opioids due to the fear of a non-existent opioid crisis in America, but seeing all the negative press from America.

SPEAKER_01 40:27

Yeah, you know, you're you're you're totally on base. I uh you know it it's it's awful because there's a doctor in my city that got um jailed for second-degree murder because there were a lot of opioids written for some patients, and some patients just it took too many. I'm not blaming the patient, but you know, when you are under the influence, you really can't control yourself. I mean, we don't drive our cars under the influence. We can't even text while we drive because we're our attention is on something else. I mean in the United States we have stigma. Is is stigma really big in in um Australia?

SPEAKER_00 41:17

I wouldn't say it's to the degree it is in America, and again I can only talk about my own personal experiences. But I'll tell you about a conversation I had with somebody recently, and I was talking to them about chronic pain, and I might have mentioned this before, and they'd had some surgery, and they said, Oh, I had some surgery on my ankle or knee or hip, I've forgotten what it was, and they said they gave me these terrible endone drugs, and I was away with the birds, and I'd never have them again because they're so addictive. And I said, Well, they may have been a problem for you because of your genetic uh code, your enzymes in the liver may not have been appropriate for them or whatever, and your side effects caused you hallucinations. But for most chronic pain patients, there is no particular high because it actually treats our pain. And for me personally, when I take an opioid or a short-acting one, I'm not allowed any anymore, unfortunately, because of the changes. I only get my long-acting opioids now. I used to have endone or oxycodone PRN, no longer. But all I have is a reduction in my pain levels where my body can relax and my blood pressure goes down, and I can then deal with the activities of living to get out of bed and do some positive stuff during the day for a few hours, which is volunteer work. I can no longer nurse. But they didn't understand. So the stigma is they think that everybody who takes an opioid is going to get addicted because the drug is chemically addictive of itself. And I say, no, you will find in Australia, again, I've read much research on this, something like three to eight percent of people are perhaps prone to opioid use disorder across the board, including opioid naive people. And I agree with that. But I've also seen if you just examine the chronic pain population who have to uh continually advocate for themselves, it's less than one percent because we've already gone through all those hoops years ago, and we know how our pain is controlled, and we know what opioid dose is best for us, and we don't get high on the drug. So, yes, the stigma is that a lot of people believe because you're a pain patient, a long-term pain patient, that you're having a wild old time, a fantastic time, drugs and alcohol and all of the above, and having a party. And I say, No, it's not like that at all. We do it for functionality. That's it.

SPEAKER_01 43:50

You know, one of the things that there was a study um a few years back, you know, they there were uh fifteen to twenty percent of the Veterans who fought uh the soldiers who fought in the Vietnam War came back to the United States, they're heroin addicts. Fift fifteen to twenty percent of them uh the soldiers who fought in Vietnam were heroin addicts. But eighty-five to ninety percent of them stopped using heroin when they after they came back. So there's not only just an environmental issue, there's a genetic issue, there's a mental issue, there's a physical issue. Opio use disorder treatment is very complicated. Pain is very complicated. And I have one last question to ask you. Where would you rather live if you had chronic pain?

SPEAKER_00 44:43

The United States or Australia? I would rather live in sunny Brisbane, Queensland, Australia, where I am, where we have public health, and while we have a lot of oversight, that's not welcome. I'd rather live right here. And I do recall one of your questions right at the end, and I will uh perhaps just address that, you were saying if um you could say one thing to a pain patient or clinician, I'll just drag out what I had said, and what I would say, yeah, was if you could put one idea in front of every prescriber, policymaker, etc., what would it be? And I would say this to them if a nosyceptive or neuropathic cause of pain, chronic pain, can't be found, because we all know that x-rays and CT scans 60, 70, 90% of the time can't tell at the microscopic level what's going on with inflammatory processes or nociceptive processes. Don't assume it's gnosyplastic. Don't assume it's all in the mind. Don't assume that by giving the person psychological exercises and pain reprocessing therapy that you've given them a hundred percent cure. I mean, people who don't have mental health issues or fear or catastrophizing, I class myself in that category, we've done all the psychological work, we still need medication, we still need to be treated as an individual, and that that would be my message to everybody. Uh holistic care is the best care.

SPEAKER_01 46:17

Yeah, I completely agree with that. In fact, after total a total knee surgery, where you break the bone and you put in metal into the knee, there's some people who advocate for just Tylenol. For pain. And you know, if we're gonna just give Tylenol for pain, my grandmother can do that. You don't need me anymore.

SPEAKER_00 46:43

Right. I've heard of that in America about these uh I was reading it online the other day about these uh knee knee uh operations and hip operations and these uh paracetamol only hospitals. That just horrifies me, actually, and I don't believe we're that bad in Australia yet, but there is a lot of, as I mentioned, uh interest in getting people tapered off their post-operative drugs. And I believe in that, if they've healed, if the tissue's healed, sure, you need to have a course of action which is designed to help you psychologically uh get back to a normal life. But if you've got a disease process, a degenerative process, what we call secondary pain, you will still need for some people some pharmaceutical help. It's all part of the pie chart, all part of the overall uh pain management plan. And a lot of the time that's forgotten in the haste to get people off opioids because of this fear campaign we've inherited from America, sadly. So I I wish your country all the best, and I wish you all the best. Yeah.

SPEAKER_01 47:48

Well, thank you for joining us. Yeah, really.

SPEAKER_02 47:52

I'm sorry, John. No, absolutely, Kevin. This has been great. I love this discussion between the two great clinicians in the chronic pain management space. Been very informative for me. I can tell you, as a non-clinician on this phone, big take-home for me was we need to better continue good treatment of chronic pain management. And there's obviously, as you guys know, a lot of factors that play in why somebody ends up, you know, in addiction, an addiction to opioid use disorder and and and having opioid use disorders, lots of factors. You guys mentioned some PTSD and trauma and these kinds of other things, you know, that could be. But one of them clearly it can be is if we're if that patient is not being properly treated and getting access to good treatment for chronic pain management. So I that's the takeaway. I love that we focused on this because that's hopefully what the message we want to get out there is chronic pain is real and it needs to be treated that way. There needs to be access. Doctors need to have all the tools in their toolkit to be able to adequately treat somebody who's doing chronic pain management. And so I love that. I love that that feedback and that message. And and just because we're just about out of time, I'll maybe I'll say last for you, Kevin. I don't know. You're doing you things on advocacy out there in Australia. Are there any organizations? You know, anything any anything we can tell our listeners about to help support you and what you're doing in Australia? I'll give you kind of a a last message if there's any shout-outs or call-outs or anything you want to Well, yes, uh, thank you for that opportunity.

SPEAKER_00 49:27

I'll keep it to 30 seconds or a minute. We do have a couple of not-for-profit organizations in Australia, and I belong to one called Chronic Pain Australia, and we're the only organization in Australia for chronic pain patients that have peer support groups on the ground, face to face. Once a month I deal with people who have chronic pain in a local environment, and we come and just talk about our challenges. I also facilitate another online group, and we do have a lot of good uh people at the moment in our organization advocating at our head office of parliament in uh Canberra, which is our federal government, to help us get more treatments, more money, more awareness, and to uh allow chronic pain to be statistically counted as a chronic disease in its own right, because until now there's been no funds allocated to that because it's not recognized in Australia as such. Wow.

SPEAKER_02 50:31

So again, just so we got or listeners that it's Chronic Pain Australia. Is that the name of the non-profit?

SPEAKER_00 50:36

That's the name of the not-for-profit I'm associated with. I'm speaking on behalf of myself today, but uh Chronic Pain Australia is the not for profit, which is helping people on the ground at the grassroots level and at the policy and research level in Australia.

SPEAKER_02 50:52

Awesome. Awesome. Well, well, thank you for that work. So if you're interested, if you're listening to us today, whether you're in the United States or Australia or anywhere else in the world, and you're interested in trying to help, look that up. Search Chronic Pain Australia for the nonprofit, maybe ways that people can give or other ways to help support you. God bless you for doing that. Thank you so much for all that you're doing to support patients in chronic pain management. So, and again, I want to thank you, John, thank you, Kevin, for this. It's been a great discussion. And thank you for the listeners that are listening today. Again, we appreciate all the support. So wherever you are, please follow us, subscribe to us, like us, any kind of feedback, please provide comments and feedback. Uh, that's always helpful for us. We read those comments and feedback as we continue to go out there. Thank you so much for following and listening to the Saving Dose Podcast, and have a great day.