Watch Claudia interview Bev Schechtman about her experience in the hospital when she was denied pain medication for kidney stones due to being a victim of sexual abuse.  

"Everything is looked at as drug-seeking.  No matter we do, they think we're drug-seeking." ~ Bev Schechtman

NPR's show, 1A, had our VP, Bev Schechtman on a panel on November 11, 2021. The name of the segment is "Against The Pain: The Opioid Crisis and Medication Access." NPR became interested in the show after reading Maia Szalavitz's article about NarxCare in Wired.  Listen to the recording of the show.  You don't want to miss this!  

"We have these people who have been on these meds for 20-30 years and doctors are under extraordinary pressure to get their numbers down" ~Maia

"In a criminalized environment where doctors are not only afraid of losing their license, but of going to prison, and where patients are being squeezed because they're being told 'you can only have x amount because otherwise my numbers are too high,' you end up with a lot of untreated pain." ~Maia

"I'd like to see context added (to these algorithms), if someone moves 3 times in 2 years, it needs to not look like they're 'doctor shopping,' I'd like to see a return to individualized care and stop these arbitrary guidelines where people are having a hard stop on what they can and can't have and they're not looking at what's actually going on with the patient." ~Bev

"I was treated like a criminal; I was mocked, laughed at, scolded, I was embarrassed...I felt revictimized." ~Bev

"There are tremendous gender and racial bias in these algorithms and in this false narrative." ~Bev

"No one should ever be denied care, that's just cruel and unusual punishment." ~Dr. Dombrowski

"Electronic Health Records are just a billing system, not to make patient care better...if you hit something by accident like malingering, next thing you know it's in the chart permanently. It's dangerous." ~Dr. Dombrowski

Dr. Mark Ibsen, who is a fierce advocate for the CPP community, recorded the show with running commentary.  

Please follow us on TikTok and YouTube to watch all of our videos!

Listen to this informative and riveting interview.

Learn all about the anti-opioid zealots and how their lies have caused suffering and deaths.

"Americans have been bamboozled into believing that prescription opioids are causing the opioid epidemic." ~Claudia Merandi

This article contains the following information:

• Why would CPP's want this information?
• What is illicit fentanyl?
• What are some myths about illicit fentanyl?
• What are illicit fentanyl testing strips?
• Are illicit fentanyl testing strips legal?
• Where can I get them?
• How do I use them?

Why Would CPP's Want This Information?

• I want to be clear that we at The Doctor Patient Forum do not encourage anyone to obtain pills on the street, from a friend, or from anywhere other than your pharmacy.
• We are aware that some chronic pain patients (CPP's) who have been medically abandoned have been so desperate for pain relief that they've either gone to the street or taken a pill from a friend.
• Since up to 42% of all pills on the street contain illicit fentanyl, we want to provide Harm Reduction information so if you are getting medication from somewhere other than your pharmacy, you know what to do to try to keep yourself safe.
• Please understand that when you take a pill that you obtained from someone other than your pharmacy, even if you use illicit fentanyl testing strips, there is no guarantee that the medication is safe for you to take. Even if you test your medication, we highly recommend you have Naloxone available (I will be adding content on this shortly, and I will link the information here) and that you don't ever take the medication when you're alone. In case you don't have anyone who can be there with you, there is a never use alone hotline 1-800-484-3731.  

What is Illicit Fentanyl?

Illicit Fentanyl is not the same as prescription fentanyl. It is often made in labs in China and then smuggled in the the USA through Mexico. Illicit fentanyl is the leading cause of all drug-related deaths in the USA. Many who end up taking illicit fentanyl don't even realize it's in the medication or drugs they ingest. Due to this fact, we prefer to call it a poisoning instead of an overdose. Those who sell it often use pill presses so it looks identical to prescription medication. It is made to look like hydrocodone, oxycodone, Xanax, and other prescription drugs. It has also been found in other illicit substances such as heroin, meth, or cocaine. One reason drug dealers are using illicit fentanyl is due to its potency. A tiny bit goes a long way, but that is also the reason it kills so many people. The last statistic I read was that 42% of all street pills tested has illicit fentanyl in them.

What Are Some Myths About Illict Fentanyl?

• A very common myth is that prescription grade fentanyl is what's killing so many people. This is absolutely false. Media and even addiction specialists often conflate prescription fentanyl with illicit fentanyl analogues. Illicit fentanyl, not prescription fentanyl, is what's killing so many people.
  • A recent toxicology study showed "Out of 18,393 deaths that were confirmed, probable, or suspected heroin deaths (including 2678 with morphine listed as cause of death on the DC) and 404 as probable pharmaceutical morphine deaths, among deaths with fentanyl detected, 89.3% were defined as probable or suspected IMF (illicitly manufactured) and 1.0% as probable pharmaceutical (prescription) fentanyl."
• There is a false narrative that's widely spread in media and repeated often that just touching illicit fentanyl or being in the same room as it can cause an overdose/poisoning. You see images of police in hazmat suits. This doesn't happen. It's important to understand this fact because if you by a pill off the street and test it for illicit fentanyl, and it turns out your pill contains illicit fentanyl, merely touching the substance will not cause an overdose/poisoning.

Ryan Marino MD often addresses the myths surrounding illicit fentanyl. He has shared the following image with permission to share it:

What Are Illicit Fentanyl Testing Strips?

Illicit fentanyl testing strips are part of Harm Reduction that assist in overdose prevention. They are actually FDA approved to detect fentanyl in urine, but are also increasingly being used as a Harm Reduction drug-checking strategy.

Are They Legal?

• Sadly, they are illegal in some states because they are considered drug paraphernalia. In the states they're illegal, Harm Reduction groups are fighting to change those laws. Josh Bloom wrote about this issue in an article called Fentanyl Test Strips Are Illegal. This Is Obscene

•  Please check hereTo find out if they're legal in your state.

Where Can I Get Them?

• For individual or small orders, you can get them at Dosetest. They cost about $1.00 each. 
• For larger orders (like if you want to order in bulk for yourself or to hand out) you can get them at BTNX. For more information about how to order them in bulk, please e-mail Michael@btnx.com.They sometimes offer a discount for new customers.

How Do I Use Them?

• Here is a Brochure from NYC Dept. of Health showing how to use illicit fentanyl testing strips. Here is a PDF of the Brochure.

• One important point to note is the results are opposite from other tests like pregnancy tests.
  • One tine = positive (+) result (meaning there is illicit fentanyl present).
  • Two Lines = negative (-) result (no illicit fentanyl detected).
  • The following graphic explains how to read results:

• Remember, a negative test result is not a guarantee that illicit fentanyl is not in your pill.

• Most how to videos and information are geared toward PWID (people who inject drugs). We know that most CPP's who go to the streets won't inject the medication. When testing a pill that you are not intending to inject you have two options -both are explained in the following video:

1. 1. Dissolve the entire pill in water and test it (this is the most reliable method). Once it tests negative for illicit fentanyl, you can still swallow the liquid, or you can put it in a capsule to avoid tasting the dissolved pill.
      • Here are two websites to purchase gel caps which are specifically made for liquid such as essential oils: 
        • Amazon
        • Azure Standard
      • How to fill a gel cap with liquid according to these websites:
        • Pull apart the capsule. One side is larger than the other, allowing the smaller end to fit inside the larger one
        • Draw your liquid supplements into a medicine dropper. Place the end of the dropper over the smaller side of the gel capsule.
        • Carefully squeeze the dropper to fill the capsule. Slide the larger end on to enclose the liquid inside the capsule.
        • Store in an airtight container in a cool, dry place. 
   2. You can scrape off part of the pill as Amanda shows in the following video. Just know there is no guarantee that the composition of a counterfeit pill is uniform throughout. So, it's possible that the small sample you test will be negative for illicit fentanyl, but other parts of the pill will be positive.

• If you bought more than one pill, testing one of the pills does not guarantee that the other pills will have the same composition.

Here is a how to video by an amazing Harm Reduction advocate, Amanda Mazur. Check out her Tik Tok videos for more information about Harm Reduction. In addition to teaching about Harm Reduction, Amanda also fights for the rights of CPP's to have access to prescription opioids.

As always, if you have any questions feel free to contact us through our contact page. 

This content was written by Bev Schechtman and Carrie Judy for The Doctor Patient Forum. Updated March 3, 2022

This article contains the following information:

• What is Harm Reduction?
• What is Harm Reduction in relation to drugs?
• What does Harm Reduction have to do with pain patients?

We cover the following Harm Reduction information/resources:

• Illicit Fentanyl testing strips
• Never Use Alone Hotline and Information
• Naloxone (Narcan)
• Kratom

What is Harm Reduction?

There isn't one standard definition, but I asked Maia Szalavitz, a Harm Reduction expert who wrote the first comprehensive book on the history of Harm Reduction and drugs called Undoing Drugs , how she would define it. She said "It's policy that focuses first on stopping people from getting hurt, not stopping them from getting high or engaging in other risky behavior. Importantly, that definition doesn't exclude abstinence approaches for those who seek them." The concept of Harm Reduction has been used for years in this country.

For example:

1. Seat belts - We know people will drive carelessly and there will always be car accidents. So, we use seat belts to reduce harm of the accidents.
2. Condoms - We know people are going to have sex and teaching abstinence only won't prevent unwanted pregnancies and STD's. So, we have things like condoms to try to prevent pregnancies and STD's.
3. Designated Driver - We know some people will drink when eating dinner out. So, there is the recommendation to have a designated driver who won't drink to prevent driving while intoxicated.

What is Harm Reduction In Relation to Drugs?

 National Harm Reduction Coalitionexplains it like this: "National Harm Reduction Coalition works for the Harm Reduction movement built on a belief in and respect for the rights of people who use drugs. Our strategies include building leadership among people who use drugs and supporting communities in reducing the negative consequences associated with drug use." So, basically it means instead of telling people to not use drugs (like Nancy Reagan's just say no movement) Harm Reduction acknowledges that people are going to use drugs, so they do what they can to keep them  safe and alive by using different strategies and techniques. In the last year, there have been over 100,000 drug related deaths in the USA, so clearly what we are doing (the war on drugs) isn't working. As Maia mentioned, if people choose abstinence like with a 12 step program, that is included in Harm Reduction. Although Harm Reduction has been accepted in USA in relation to cars or alcohol, Maia explains that "it's a very old idea, but in drug policy it is radical because we've always focused on stopping drugs, not on harm and we cause lots of harm trying to stop drugs." There are many techniques used in Harm Reduction in drug use. I'll list some examples, and then will add content about each one. As we add each category listed below, we will link each one to the information we add. This isn't an exhaustive list.

1. Illicit Fentanyl testing strips
2. Never Use Alone Hotline and Information
3. Naloxone (Narcan)
4. Kratom
5. Lock Boxes/Safe for controlled substances
6. Safe or safer supply
7. Needle exchange (syringe service programs)
8. Safe Injection Sites

What does Harm Reduction Have To Do With Pain Patients?

You might be asking how this relates to pain patients and why this information is even on our website. As more and more pain patients are cut off from their medication, many are going to the streets to purchase pain medication out of desperation for pain relief. Since up to half of the supply of medication on the street is actually counterfeit containing illicit fentanyl, we feel it's very important for pain patients to know how to access Harm Reduction techniques so they can test their medication and not die from drug poisoning. I didn't know much about Harm Reduction (HR) until last year. Several prominent CPP advocates have been trying to join the CPP community with the HR community for a few years. Lelena Peacock, Carrie Judy (a researcher with our org), and D. S. Nelson were the first CPP advocates I saw who understood early on how HR and CPP's need to be working together and not against each other. 

• What is Kratom?
• What can Kratom treat?
• How do I take Kratom?
• What do the different strains mean?
• What dose to I start with?
• What happens if I take too much?
• What happens if my dose is too small?
• Where should I buy Kratom?
• How does Kratom help chronic pain patients?
• Will it help my pain as much as opioids do?
• Will my pain doctor test for Kratom in a UDT?
• Is Kratom legal?
• Other info. about Kratom

Help American Kratom Association fight to keep Kratom legal.

"A well-organized, coordinated campaign from the FDA and Big Pharma is threatening access to the supplements you depend on. Using the false premise that supplements are unsafe, the FDA is working to gain more power over the regulation of supplements in order to further solidify Big Pharma’s monopoly over medicine. These efforts must be opposed.

If this passes, the FDA would have the power to ban kratom by denying supplement registrations.

Please write to your Congressional representatives and tell them to oppose efforts to establish a "mandatory filing" for supplements."

We are not doctors and we aren't giving out medical advice. We are patient advocates who are passing along valuable information and we hope it helps you.

We've received many questions about Kratom. Many of you have been cut off of your pain medication or have been tapered to a dose that no longer helps. Kratom can be a good option for some, but we know it can be overwhelming to figure it all out. We've included information and links to help you get started in case Kratom is an option you'd like to explore.

Throughout the article, we will link to several websites about Kratom. Kratom IQ and American Kratom Association are two of the main sources we will cite. 

What is Kratom?

• From Kratom IQ: "Kratom is a leafy plant native to Southeast Asia, namely Indonesia, Thailand, Malaysia and Bali, that’s actually part of the coffee family. The leaves can be chewed (what Thai workers do to work long hours in the heat) but for the typical end user, the leaves are most commonly crushed and processed to form a fine powder."
• From American Kratom Association: "Kratom is not a drug. Kratom is not an opiate. Kratom is not a synthetic substance. Naturally occurring Kratom is a safe herbal supplement that behaves as a partial mu-opioid receptor agonist and is used for paiWn management, energy, even depression and anxiety that are common among Americans. Kratom contains no opiates, but it does bind to the same receptor sites in the brain. Chocolate, coffee, and exercise hit these receptor sites in a similar fashion."

What Can Kratom Treat?

Please understand Kratom is not FDA approved, but there have been some studies done. People have claimed Kratom has helped them with the following:

• Pain
• Opioid Withdrawal
• Anxiety/Depression
• Lack of Energy
• Insomnia

How Do I Take Kratom?

• There are three main ways to take Kratom:
  • Steep the powder in tea-this is why you sometimes hear it referred to as "tea."
    • Watch this tutorial by Kratom IQ
    • "You boil up the powder with some water for 30 minutes or so, let it sit, then strain off the liquid. Some people feel this results in better and more consistent effects but it’s obviously more time consuming to produce. The taste isn’t too bad and you can drink it hot or cold. It’s quite nice chilled actually."
  • Take the powder straight, also called "toss and wash."
    •  Some tips on how to do this by Kratom IQ
    • The steps are pretty simple
      • Measure out power (it can be helpful to use a measuring spoon so you know exact amount of dose)
      • Put it in your mouth
      • Swallow it using something to drink.
  • Taking them in capsules
    • You can purchase capsules from a vendor
    • You can encapsulate them yourself as explained by Kratom IQ

What Do The Different Strains Mean?

• There are three main strains:
  • Red- This is usually best for pain and relaxation. It's also recommended for those going through opioid withdrawal. It can make some people sleepy. Not everyone is the same and some people actually get energy from red stains.
  • Green- This is usually best for anxiety. Some greens are relaxing and some energizing. Again everyone responds differently to different strains.
  • White- This is usually best for energy. Often people will take a little white with red when they need pain relief but need to counteract the sedating effects of a red. Not everyone is the same and some people get sleepy from whites or even anxious.
• It is ok to mix the strains, and each strain also has many different varieties. Kratom is a lot of trial and error to find what dose and strain work for you.

What Dose Do I Start With?

This varies from person to person. It does take time to find the right strain and the right dose for your body. Don't give up after trying a few times. Keep at it, and you should be able to find a therapeutic dose for you. This dose is often referred to as the "sweet spot."

Most vendors and Kratom organizations will suggest you weigh your kratom instead of measuring it with a spoon because it's more exact. One teaspoon is approximately 2-2.5 grams of kratom. The following are the steps we suggest you take when beginning Kratom taken from Kratom IQ. Keep in mind a typical beginner dose of Kratom is anywhere from 3 grams (1 tsp) - 10 grams (about 1 tbsp):

• Step 1: Take 2 or 3 grams (or I suggest 1/2-1tsp). You should start to feel some relief after 20 minutes or so.
• Step 2: Assess how you feel after 30 – 45 minutes. If you think you need some more, take another 1 to 2 grams.
• Step 3: Assess how you feel after 15 – 30 minutes. Remember you might have a bit of a higher tolerance if you've taken daily opioids.
• Step 4: If you still don't feel relief add another 1/2 tsp.
• Step 5: If you don't feel relief yet, wait another 4-5 hours to try again. 
• Step 6: After 4 or 5 hours have passed and you want to take more, repeat this process with the SAME strain you used earlier in the day (starting with the dose you ended with).
• VERY IMPORTANT to remember that just because you found your dose with one strain it doesn't mean it will be the same with all strains. Any time you start a new strain, always repeat this process.

What Happens If I Take Too Much?

• You'll know if you take too much Kratom because you may feel nauseated or even throw up. This is why we suggest starting small and taking it in increasing small increments until you find your "sweet spot." Many pain patients start out with too large of a dose out of desperation for pain relief, they end up vomiting, and then think they're allergic to it.
• There is also something Kratom users refer to as "the wobbles."
  • What is it?: You may feel dizzy, have brain fog, feel like you can't focus your eyes.
  • How can I avoid it?:  It's pretty easy to avoid. Don't take huge doses of kratom. Follow the instructions we've listed and you should be fine.
  • How can I treat it?:  There are varying opinions on the internet on how to treat this. Mostly, just know it's not dangerous and it will pass. Drink a lot of water and lie down if you can.

What Happens If If My Dose Is Too Small?

Nothing. You'll get little to no relief. So, keep trying increasing your dose slowly until you find the right dose for you.

Where Should I Buy Kratom?

We highly suggest you don't buy Kratom at a local smoke shop, but instead use a reputable online vendor. Here are some tips on how to pick a vendor:

• Talk to other CPP's and ask them what they use.
• Read reviews.
• Some vendors test their product and list what is in it. This is always a positive thing to look for.
• American Kratom Association has the following programs:
  • GMP standard program (Good Manufacturing Practice Standards Program). 
  • Truth in labeling program. "The AKA strongly opposes unscrupulous vendors who use illegal health claims to increase sales of kratom products. This new self-regulation program will encourage consumers to report potential marketing violations so that the FDA can investigate and, when appropriate, take needed enforcement actions against kratom vendors who use impermissible health claims to mislead consumers about the actual benefits of using this otherwise safe food product. This new program is a valuable addition to the current AKA vendor GMP program that requires participating vendors to adhere to good manufacturing practices (GMPs) and to submit to an independent 3rd party audit to verify compliance."
  • Here is a list of vendors that qualify for these programs with American Kratom Association

How Does It Help CPP's?

• Pain- Kratom can help treat pain. It varies from person to person how much it actually helps, but it definitely can help some people manage their pain.
• Opioid withdrawal - Many CPP's are being abandoned, cut off their opioid medication completely, or quickly tapered causing not only increased pain but also horrific withdrawal. Kratom can definitely help mitigate some of the symptoms of withdrawal.

Will It Help My Pain As Much As Opioids?

For some people it will and for others it won't. It's worth trying to see if you can get some relief using Kratom.

Will My Doctor Test For It At The Pain Management Clinic?

We have heard of some doctors testing for Kratom in their UDT's. Check your pain contract to see if it's listed. Depending on how much you trust your doctor, you may want to discuss it to see what their policy is on Kratom. Since Kratom is considered a supplement and isn't a controlled substance, it shouldn't be against a pain contract unless it's specifically stated. That isn't to say a doctor won't consider it a breach of contract. We've heard of that happening. 

Is Kratom Legal?

Kratom is legal in most states. There are currently 6 states where Kratom is banned, and some others with varying laws.

• The states as of 2022 where is is completely banned are:
  • Alabama
  • Arkansas
  • Indiana
  • Rhode Island
  • Vermont
  • Wisconsin
• Check to see what Kratom laws are in your state.
• Kratom has a strong lobbying presence. To find out how to get involved with efforts to keep Kratom legal, please contact the American Kratom Association.

Other Important Information About Kratom:

• Since Kratom interacts with receptors in the brain, it's suggested that you put about four hours between taking Kratom and prescription opioids. Some people who don't get enough prescription opioids to treat their pain use Kratom in between doses of medication. It won't be dangerous to take with opioids, but if you don't leave enough time between taking opioids and Kratom, they can cancel each other out.
• It's important to make sure you stay hydrated by drinking extra water while taking Kratom.
• You can build a tolerance to Kratom if you take it daily. 
• Less seems to be more with Kratom. If your dose stops working, instead of taking more, try to cut your dose a little. For some reason this seems to work well.
• Rotate strains so you don't develop tolerance as quickly.
• Kratom is considered a Harm Reduction resource since it can prevent patients from purchasing medication illicitly to self-treat their pain or withdrawal.

NPR's show, 1A, had our VP, Bev Schechtman on a panel on November 11, 2021. The name of the segment is "Against The Pain: The Opioid Crisis and Medication Access." NPR became interested in the show after reading Maia Szalavitz's article about NarxCare in Wired.  Listen to the recording of the show.  You don't want to miss this!  

"We have these people who have been on these meds for 20-30 years and doctors are under extraordinary pressure to get their numbers down" ~Maia

"In a criminalized environment where doctors are not only afraid of losing their license, but of going to prison, and where patients are being squeezed because they're being told 'you can only have x amount because otherwise my numbers are too high,' you end up with a lot of untreated pain." ~Maia

"I'd like to see context added (to these algorithms), if someone moves 3 times in 2 years, it needs to not look like they're 'doctor shopping,' I'd like to see a return to individualized care and stop these arbitrary guidelines where people are having a hard stop on what they can and can't have and they're not looking at what's actually going on with the patient." ~Bev

"I was treated like a criminal; I was mocked, laughed at, scolded, I was embarrassed...I felt revictimized." ~Bev

"There are tremendous gender and racial bias in these algorithms and in this false narrative." ~Bev

"No one should ever be denied care, that's just cruel and unusual punishment." ~Dr. Dombrowski

"Electronic Health Records are just a billing system, not to make patient care better...if you hit something by accident like malingering, next thing you know it's in the chart permanently. It's dangerous." ~Dr. Dombrowski

Dr. Mark Ibsen, who is a fierce advocate for the CPP community, recorded the show with running commentary.  

Season 2 Episode 1 - 12/9/22

Link to Episode

When our VP, Bev Schechtman, was denied adequate pain medication when hospitalized for kidney stones due to having been a victim of sexual abuse, she became obsessed with researching how this could happen. She learned about NarxCare and the Opioid Risk Tool. We, at The Doctor Patient Forum/Don't Punish Pain, have been researching these topics for the past four years. We've reached out to countless investigative journalists only to be shot down. Thankfully, Maia Szalavitz, an author and leader in harm reduction, was interested in telling the story of NarxCare and other risk tools. This was our first piece of national media, and we are so excited to share it with you. We suggest holding on to this article and sharing it with your local legislators.  About half of the states use NarxCare, and this article can help you fight against it. Read about how our country has tried to help the "opioid crisis" by using a risk score algorithm, yet it seems they're only making matters worse.

"Where's the Patient's Voice in Evidence-based Treatment & Research?"

Our VP, Bev Schechtman, was a guest on Pharmacy Podcast Network.

Part 4 in the series "Pharmacist and Physician Opioid Collaborative" on Pharmacy Podcast Network.

Listen as Todd Eury, from Pharmacy Podcast Network, asks Bev a question that is long overdo..."What is the patient's perspective?"

"No one ever asks the patient what we think, we are kind of shoved out of it." ~Bev Schechtman

"But what they're missing, Bev, is they're missing the empathetic bedside manner to look you in the eye and give you a sincere little smile, showing they're there for me as a patient." ~Todd Eury

"We feel like everyone around us is going to treat us as though everything we say is a lie, that we're going to try to get out of whatever it is they think they're trying to catch us in, and we can't trust any of them." ~Bev Schechtman

"The way they set up the system patients can't be honest with our providers." ~Bev Schechtman