Here’s the document we’ve been waiting for:
New Version of CDC Guidelines – just like the old version.
Taken literally, the guidelines avoid making any absolute pronouncements. Sprinkled throughout are imprecise words like “should” and “avoid” and “generally”, which technically allow prescribers some leeway.
However, it’s clear that many medical organizations will adopt these guidelines as requirements, not suggestions, and then deviations from the new standard will be suspect. If followed, these rules also shield doctors by providing a “safe” standard to follow, no matter how unreasonable it is.
Recommendation #5 still contains arbitrary dosage limits, pressures doctors to remain below 50 MME/day, and “suggests” they avoid giving doses of 90 MMD/day. For the current population of pain patients, these numbers are very low and many of us use significantly more that 90 MMD/day.
We take such high doses because repeated benefit/harm evaluations show that opioids increase our quality of life without intolerable side effects. And pain patients only experience pain relief, not euphoria, even at high doses.
Considering how the “dangers” and “harms” of opioids are being trumpeted everywhere, I’m sure folks would be surprised to meet a “real” pain patient taking these drugs: a highly productive and highly paid software engineer at a high tech company who spent her free time on competitive outdoor activities.
That was me for over 10 years, opioids making it possible to continue working even with my pain, until its relentless increase and other symptoms forced to me to stop.
GUIDELINE RECOMMENDATION #5: When opioids are started, providers should prescribe the lowest effective dosage. Providers should use caution when prescribing opioids at any dosage, should implement additional precautions when increasing dosage to 50 or more morphine milligram equivalents (MME)/day, and should generally avoid increasing dosage to 90 or more MME/day.
The CDC still promotes a “one size fits all” standard, despite clear evidence that patients vary widely, especially in their reactions to medications. Some patients metabolize opioids in such a way that much higher doses are required. Some patients would be in a state of perpetual groggy misery at even the lower doses.
This guideline isn’t about how to prescribe opioids,
it’s about how to avoid prescribing opioids,
as though this will prevent potential addiction.
Meanwhile, all this arguing over the guideline diverts our attention away from the real cause of the “opioid overdose crisis”, which is the lack of effective addiction treatment.
Legitimate patients are being used as scapegoats and distraction while the recovery industry rakes in the dough. The industry makes even more money because the treatment is usually ineffective and clients often have to attempt (and pay for) a program multiple times.
Almost everyone agrees that addiction is the problem, not pain management or opioids, so why are we trying to “fix” opioid prescribing, and why aren’t we making guidelines for effective addiction treatments?