Surgeon General Call to Action Falls Short | Huffington Post by Lynn R. Webster, MD Author of “The Painful Truth”
Law-enforcement seizures of illicit fentanyl have soared, changing the face of drug-related deaths and necessitating new public health strategies to meet the evolving threat.
The Centers for Disease Control and Prevention (CDC) reported an 80 percent increase nationally in synthetic opioid deaths from 2013 to 2014, an increase that coincides with a 426 percent rise in the number of drugs containing fentanyl seized by law enforcement.
The country is being overrun with truly deadly drugs that are killing increasing numbers of people, yet the CDC remains focused on prescriptions for pain patients.
The mortality increase isn’t all linked to fentanyl, but much of it appears to be.
Illegal channels in China and Mexico are funneling the powerful and deadly drug into the United States from clandestine labs
At the same time, the quantity of prescriptions written for fentanyl and other opioids to treat pain are flat or falling.
Yet, rather than warning physicians of the growing illicit market, a new call to action from the U.S. Office of the Surgeon General targets instead the prescribing of opioids for pain
Hello CDC: Illicitly produced fentanyl is killing people right and left and has NOTHING to do with prescription opioids.
See the Surgeon General’s letter sent to ALL doctors in the US: Anti-Opioid Letter from Surgeon General to All Doctors
The pocket guide entitled “Turn the Tide: Prescribing Opioids for Chronic Pain” contains some good instructions but, unfortunately, also perpetuates the CDC’s one-size-fits-all dosage limits that may not suit all patients and sets criteria for continued prescribing — “clinically meaningful” improvement of 30 percent from baseline in pain, pain interference and activity scores — that appear mostly opinion based and lacking in solid underpinning science.
See the scientific evidence that the CDC is hiding: CDC Guidelines Refuted with Scientific Evidence
The truth is patients differ in medication requirements due to genetic and other factors, and chronic pain, by its very nature, fluctuates.
The CDC’s fixed dose limits are absurd in the light of common knowledge about variations in pain and effectiveness of opioids.
How could tapering patients from medications that are helping them and which they did not misuse be seen as progression toward societal harm-reduction goals?
If every exposure to an opioid resulted in addiction, just as if every drink of alcohol led to an alcohol-use disorder, no one would be free from the disease of addiction.
That is not how the disease of addiction works: exposure is necessary but not sufficient to trigger it.
Apparently, the CDC understands little about addiction and knows even less about pain.
Furthermore, if merely reducing the quantity of prescribed opioids across-the-board also reduced opioid-related overdose deaths, the numbers of the latter should be dropping, but they are not.
This is proof positive that the drug war’s method of trying (and not succeeding) to limit the supply of addictive drugs simply does not work.
No matter how long the DEA tries to deny this truth, historical and current data show their approach is ineffective, triggers even more death and violence, and does nothing to reduce addiction.
These problems are complex and need precisely targeted measures. Commonly prescribed opioids are still associated with more deaths than synthetic opioids. But cutting out or reducing needed medications to patients who are suffering is not a sufficiently targeted response.
Making the target too broad could double the harm, not only in denying access to necessary medications, but in failing to acknowledge the shifting sources of the illicit drug threat, causing more people who suffer from addictions to fall through the cracks.
It is past time to treat chronic pain as the illness it is, not a moral failing, and that includes not blaming patients for all of society’s problems with opioid misuse, particularly when the evidence indicates otherwise.
The DEA and CDC show little interest in evidence and insist on promoting ineffective policies and laws that are contrary to even common knowledge.
Author: Lynn R. Webster, MD, is a past president of the American Academy of Pain Medicine and author of the award winning “The Painful Truth: What Chronic Pain Is Really Like and Why It Matters to Each of Us.” Visit www.thepainfultruthbook.com.