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The criminalization of opioid medications has made it all but impossible for pain patients to receive adequate treatment in the United States for more than one hundred years. In 1996, the pain medicine community of doctors attempted to expand the treatment to include patients with severe pain from diseases other than cancer or sickle cell disease. This movement of compassionate care ended definitively in 2016 when a small group of doctors who call themselves Physicians for Responsible Opioid Prescribing (PROP) convinced the Center for Disease Control to take an unusual step to publish new draconian prescribing guidelines. As implemented, current prescribing enforces a hard limit for prescriptions to all patients, regardless of their disease. Furthermore, the new guidelines have not improved either addiction or opioid-overdose rates. Meanwhile, the leaders of PROP are profiting from their role as consultants and expert witnesses for the law firms suing the opioid manufacturers. The book delves into the neurobiology of pain and addiction to explain why pain specialists believe that compassionate care can work. The movement was hijacked by opioid pharmaceutical companies that aggressively marketed opioids to doctors and government agencies that permitted their illegal practices to proceed. This book poses the question: Precisely, how is the massive reduction of prescription medications going to reduce the 80% of the overdose fatalities due to heroin and fentanyl? Instead of curtailing prescription medicine, the appropriate reform would be to treat addiction as a medical condition and include services to prevent and treat addiction as part of pain medicine. Patient Z is a pain patient whose treatment exposes deficiencies in the practice of pain medicine. The story of Patient Z is common to millions of people who have had their pain medication cut in recent years. Persistent pain can affect anyone. Anyone could become Patient Z.
