Docs Say CDC Opioid Guidelines Misguided

CDC Opioid Prescribing Guidelines Misguided, Docs Say | Brandon Cohen | April 08, 2016

Recent guidelines handed down from the Centers for Disease Control and Prevention (CDC) concerning the prescription of opioids have made waves among healthcare professionals.

The CDC condemned the practice of prescribing these drugs in the vast majority of cases. Furthermore, these guidelines characterized the widespread abuse of opioids as a “doctor-driven epidemic.”

A Medscape news article on this topic prompted fierce opposition from many healthcare professionals against what they saw as the uninformed overreach of a government agency.

If only that “fierce opposition” could make itself be heard the way the opiophobic message is: be covered and exaggerated by the media, be promoted by self-designated experts, and be parroted by legislators .  

The pushback began immediately. One physician turned the blame away from doctors and back on regulatory agencies:

The opioid epidemic was created by the government and the media under the direction of their bosses in the pharmaceutical companies. Physicians were demonized if they did not compassionately prescribe potent, newly branded extended-release opioids for chronic pain.

Concern for the Consequences

A pain management physician picked up on this idea and predicted dire consequences:

I see a huge chill on opiate prescribing followed by a massive increase in heroin deaths.

Addiction care needs to be funded before the storm. Things are going to get way worse before they get better.

Addiction is the true problem, not the specific substance.

A colleague saw another potential danger:

[Have the government agencies] considered the number of patient suicides that have occurred as a result of unrelieved chronic pain?

Get ready for a big increase, there cannot be a more tragic situation.

It’s alarming how few people grasp the helplessness, and hopelessness that chronic pain brings on, even some who are dealing directly with pain patients

A registered nurse was clear and blunt:

Perhaps the government needs to look in the mirror before it blames providers for opioid addiction …

We all went to school for a long time and worked hard to get where we are.

We should be allowed to make appropriate medical decisions without fear of administrative sanctions tied to satisfaction.

A retired orthopedic surgeon agreed, recalling years of practice:

It has been my clinical and personal experience that patients treated for true traumatic and post-surgical pain rarely, if ever, become dependent.

Data backs up the above statement: see Rate of Addiction in Chronic Pain Patients < 3.27%

I certainly saw my share of drug seekers, disability fraudsters, and street addicts who were not very difficult to recognize and were properly dealt with.

And a nurse offered powerful personal testimony suggesting that the CDC’s recommendations were missing the real sources of addiction:

When my daughter became addicted to oxycontin at 16 years old, it was supplied by another 16-year-old who was stealing it from his grandmother with cancer. That was obviously not a doctor-driven issue.

As an ED nurse, most of the overdoses that I see are not patients taking prescribed amounts, but diverted meds or [patients] taking way more than what was prescribed.

This seems obvious to many of us but is ignored by opiophobes – as is so much other information they refuse to consider.

Is CDC on the Right Track?

The final word goes to a registered nurse who coupled work experience with personal anguish:

“CDC, take my pain for a month; you would be on the streets trying to get your next fix. Let the doctors be doctors.”  

This nurse is just verbalizing the silent plea in all our hearts: let the rule makers experience what they are making rules about.

---

I admit that there were also a few opposing views included in the Medscape article, but I chose not to annotate them.  We all know the tired old arguments against opioids.

What’s refreshing is to discover that there are *real* doctors out there willing to speak up and defend pain patients. This shows true courage in these days of DEA opioid-witch-hunts.

However, I do notice their quotes are not attributed, thus keeping the identity of their authors unknown. After all , they are not stupid,