What Will People in Severe Pain Do Now? – The People’s Pharmacy – March 17, 2016
The CDC has issued new guidelines (JAMA, March 15, 2016) that strongly urge doctors to stop prescribing narcotics to patients with chronic pain.
This public health organization believes its mandate will reduce deaths from opioid overdose.
The language used here in this unusually pain-patient-friendly article clearly contrasts with the pervasively biased language used in almost all other media stories on this issue.
- They write that the CDC “believes its mandate will reduce deaths“, which clearly expresses skepticism.
- They did NOT write that the CDC “created the mandate to reduce deaths“, which already assumes it will be an effective strategy.
Until I saw this, I also superficially assumed that reducing opioid prescriptions would have some effect on lowering overdoses, and I only questioned how much of an effect it would be.
Now I realize “it has been assumed” by almost everyone that a reduction of opioid prescriptions would lower overdoses.
But this has never been tested and proven (and probably never will be.)
What the feds have not considered is the impact on people with long-standing severe pain, especially if they are disabled.
The Drug Enforcement Administration Changed the Rules:
In the last couple of years there has been a huge effort to make it harder for doctors to prescribe opioid pain relievers.
In the fall of 2014 the DEA made it much harder for patients to obtain hydrocodone combination pain relievers (HCPs such as Lortab, Norco, Vicodin, etc).
The new DEA scheduling change has made it much more challenging for a patient who is disabled or in severe pain to access an opioid medication.
Here are just a few stories from hundreds of readers who responded to our post on the DEA decision.
- Stefany in Maryland shares:
“While I completely understand the DEA’s reasoning behind their new laws, all they are accomplishing is making people like us live in hell and for the drug seekers to turn more to heroin.
You cannot control the people who are drug addicts.
To punish people who do not abuse pain medicine and need them to live a more functional life than one of severe depression due to pain is really unjust.”
- John in College Station, TX writes:
“I’m only 55 yrs old, and I’m scared to death what the rest of my life may become.
I do not wish harm to anyone but if the people passing these laws ever experience the pain I have they would never have never passed such a law which amounts to ABUSE OF THE ELDERLY.”
- Jake the Vet:
“I am a 28-year-old army veteran. I have a spinal cord tumor located in my nerves and am consistently in extreme pain–8 out of a possible 10 points on a 1 to 10 point scale.
“All I can get from my pain management doctor is a back brace, anti-inflammatories and acupuncture in my ears or gabapentin, which makes me feel awful.
I have seen three neurosurgeons, none of whom will touch me. What am I suppose to do? Things need to change in this country. It’s an outrage!”
- Carolyn in Nevada:
“I too have been taking hydrocodone for many years for chronic pain. Today I went to the pharmacy and was told I can no longer have it.
My doctor prescribes it but the pharmacy says no. I’ll be spending my days in bed, I guess. May as well be dead.”
- Charles in Ft. Worth:
“The new laws have caused more damage than you can imagine. My mobility is very limited. I can no longer get out of bed or carry on my daily duties as I was able to before the laws changed last October. I feel my life is over. I can’t live with this pain. I don’t know what to do.”
The CDC’s New Guidelines:
In essence, the new federal opioid guidelines state that narcotics should not be prescribed for chronic pain patients.
Instead, doctors should recommend acetaminophen (Tylenol) or NSAIDs like aspirin or ibuprofen. Other suggestions include cognitive behavioral therapy, exercise therapy or antidepressants.
For acute pain, such as after surgery or an accident, the CDC recommends that doctors prescribe opioids for no more than three days. Really? Some “acute” pain lasts substantially longer than three days!
The CDC acknowledges that cancer treatment may require opioid medication during the active phase of therapy. What the CDC has not taken into account is that cancer survivors may have to deal with chronic pain.
This begs the question:
When does pain transition from “cancer pain“, which is treated aggressively with opioids, to “chronic pain” that does not need to be treated with opioids?
The president of the American Cancer Society Cancer Action Network said it eloquently:
“Pain does not end when an individual completes treatment.
Most often, cancer patients deal with lasting effects from their disease or treatment including pain for a significant period of time or indefinitely.”
The CDC guideline does not seem to take this into account.
Walking the Tightrope:
We have not seen convincing evidence that making it harder for chronic pain patients to access drugs like hydrocodone will make a huge difference in abuse or overdose deaths.
We also believe that it is virtually impossible to generalize about the most appropriate treatment for people with severe, chronic pain. Some people will do well with cognitive behavioral therapy; others can only function on opioid medications.
Each patient needs to be evaluated individually and treated with respect.
This is the BIG overarching truth about all medicine that is becoming more and more obvious to intelligent people: different people need different treatments.
Disease (and pain) treatments that are effective for some leave others untouched or damaged, and genetics are assumed to make that critical difference. This is exactly why the Precision Medicine Initiative was launched just last year.
The Precision Medicine Initiative is a research project created by Barack Obama in 2015 with $215 million in funding that aims to make advances in tailoring medical care to the individual. (Precision Medicine Initiative homepage at the National Institute of Health)
It is our belief that the CDC should not tell physicians how to practice medicine, especially when it comes to something as complex as chronic pain.
I’m shocked that nonmedical people are being allowed to make medical decisions for me.
I feel this is either “malpractice” or “practicing medicine without a license”.
The new guidelines will likely scare many doctors away from prescribing potent pain killers for longer than a few days or weeks.
That could mean some patients will live in agony with no acceptable treatment through no fault of their own.