Medicare May Adopt Flawed CDC Guidelines

Medicare Takes Big Brother Approach to Opioid Abuse — Pain News Network

Just the thought of this makes my stomach lurch.

Politicians, bureaucrats, and financial interests are determined to control how much pain we must suffer by restricting access to the most effective relief.

Various industries which stand to gain from opioid restrictions (addiction-rehab, pharmaceutical, medical device, drug-testing) are colluding with political powers to pass legislation restricting opioid dosages to arbitrary limits.

Investigations of abuse or inappropriate prescribing would be shared with insurers enrolled in the giant Medicare/Medicaid system, even if the allegations are never proven. 

CMS (Centers for Medicare and Medicaid Servicescontracts with dozens of private insurance companies to provide health insurance to about 54 million Americans through Medicare and nearly 70 million in Medicaid.

“The results of these projects are provided to plan sponsors so that additional actions can be taken, including

  • initiating new investigations,
  • conducting audits, or
  • terminating physicians and pharmacies from their network.”

“Pharmacists are going to be even more paranoid than they already are,” Martin wrote in an email.

Retail pharmacists don’t have time for this. They aren’t the police. Nevada has a PDMP. It already shows a significant decrease in prescribing patterns over the last several years, so it is working.  

With the CMS, just who decides what are appropriate quantities and proper prescribing habits?”

The CDC insists it knows what the appropriate doses are for every single pain patient in America.

CMS Using CDC’s Prescribing Guidelines

In developing its strategy, CMS is relying heavily on prescribing guidelines released in 2016 by the Centers for Disease Control and Prevention, which discourage doctors from prescribing opioids for chronic pain

CMS says it will use the “evidence-based guidelines” to determine what constitutes inappropriate prescribing.

But they are NOT evidence-based. These guidelines have proven to be

  1. scientifically wrong,
  2. based on obviously cherry-picked data, and
  3. promoting questionable treatments backed by slim scientific evidence.

They were instigated and promoted by a group of “addictionologists” without pain management experience or consideration. Several scientists have already picked them apart and found glaring errors:

The guidelines include a recommendation that opioids be limited to no more than 90 mg of morphine equivalent milligrams a day, a dose that many patients in severe chronic pain consider inadequate.

The CDC maintains the guidelines are “voluntary” and intended only for primary care physicians.

However, when more and more government and insurance organizations use them as an overall rule for all patients, the CDC is making no effort to prevent the misguided adoption of their guidelines as iron-clad rules for all patients at all times.

However, under the CMS strategy, the guidelines would apply to all prescribers, except those treating cancer or patients in palliative care.

“I just hate to see something that CDC itself said was voluntary, was a recommendation, and really isn’t all that specific if you really read it, get turned into something that creates bright red lines. And if you step across the line, you’re going to get yourself in trouble. I don’t think that’s right,” said Bob Twillman, PhD, Executive Director of the Academy of Integrative Pain Management, the nation’s largest pain management organization.

CMS says the additional scrutiny of doctors and patients is needed because “the Medicare population has among the highest and fastest-growing rates of diagnosed opioid use disorder,”

Because “opioid use disorder” can be diagnosed in anyone taking opioids for more than 3 months and most people experience increasing pain as they get older, finding this “disorder” among older people this is exactly what you would expect.

It looks like they are creating a disorder that serves two purposes:

  1. Generate more clients for addiction recovery clinics (with a 90% failure rate)
  2. Generate the need for more expensive drugs for pain (with unknown long-term effects) 

It serves everyone in the medical supply chain except the “end user: the patient.

2 thoughts on “Medicare May Adopt Flawed CDC Guidelines

  1. Mary Anne Butler

    I am an RN of 49 years and a chronic pain patient for close to 30 years. I had a renal transplant in 8/87 which I promptly lost only to receives another transplant in 12/87. I have had my kidney for 29 + years. Along with the kidney I have severe AVN affecting many joints with many other diseases for the past 29 years. I began seeing a pain management physician in in 1987. Early on I started having multiple hip implants (19), shoulder replacements, back fusions(hereditary disease), revisions of the transplant, with many other surgeries. The total surgeries are now over 70. My last right hip and right shoulder were done by an oncology surgeon because I wanted to stay active and out of a wheel chair- the Ortho surgeons did not want to do surgery anymore because it was so detailed and of course my health was fragile. My R hip required my Gluteus Maximus be taken down and placed around my hip joint to stabilize it. I didn’t know that pain could be so horrible. Shortly after my hip surgery I fractured my right humerus below the stem My Orthopedic surgeons tried several surgeries to stabilize my R shoulder. Finally the options were amputation of the arm or removal of the shoulder, humerus and part of the elbow. My arm was left 4 to 5 inches shorter than my L arm and of course without a rotator cuff so I had a great deal of limited movement in my arm. I worked for about 15 years after my transplant as this was going on. I traveled throughout the US educating State Medicaid programs and any and all types of Medicaid providers on policy. I was on many types of opiods until I met the most wonderful PA. She and I have stabilized my opiod narcotics to 90 mg of Methadone a day ( from 150) with oxycodone/apap 10/325 up to 8 a day for break through pain. My pain is not controlled but I can cope with it and no one knows I am on the pain meds unless I tell them.

    I have been on Medicare Part D since it became available. I usually have to get PA for my meds for the amount I take but have never been denied. Two days ago I went to the pharmacy with my scripts only to be told I could not fill both scripts because of the Morphine Equivalency Dosage guidelines. They did not say that – the pharmacy had no idea what was going on. They kept spouting out that I was above 360 mg but they had no idea what they were talking about. I’ve had my scripts filled there for the last 10 years and they were not prepared for this “guideline”.

    I was asked what script I needed most – the answer was both since I always use my 30 day supply. I had just visited my Ortho surgeon who feels my spinal stenosis is so bad it need to be operated on now. I chose my Part D plan because the plan allowed QL on both of the narcotics I’m on but they were both 360 tabs a month and I was well under for both drugs. The said nothing about PA so I had not prepared for this so I will be out of meds this weekend. I have worked with the pharmacy, the Physicians office and the plan for the past 2 days and I am about ready to drive off a cliff. I appreciate your info on the Blog. You have helped me understand what is going on. I have no idea what to do. I feel the plan misrepresented itself and would like to get a new plan. The pharmacy and plan act as though they have no responsibility in getting me scripts that I have been in for the last 30 years. I am functioning as best I can. What will be done to the folks with chronic pain next. To make it worse my generic Percocet has gone from a cost of $5 to the plan ($3 to me) to $84 to me until I reach the $400 deductible then to $27 for the cost. What happened? I’m sorry for ranting but I can’t sleep because of the pain that is basically everywhere but I don’t want to take my meds- I only have 4 left. Things can always get worse. Good luck to everyone and God Bless.

    Liked by 1 person

    1. Zyp Czyk Post author

      Your comment makes me even more furious about what’s going on. My own pain isn’t as bad as yours must be, but I also wonder if life is worth living without effective pain control.

      It seems “they” assume we never tried any other ways of managing our pain besides opioids, that we are all suffering from the same kind of low-grade chronic pain that has no organic cause. If only that were true!

      I cannot understand how any real doctor can allow us to be tortured this way, but America is legitimizing torture in general again so perhaps this is part of it. Could you try a phone call to your congressperson? Then again, the chance of getting a legislator on the phone is probably miniscule.

      I have also giving this a lot of thought over the last years and have made it clear to my husband and friends that if I lose access to pain medication I may have to take an early exit. I tell them that my best years are behind me and that if I stop living right now, they should know I have no regrets, that it would be a relief to me, and that they should be happy I was spared a miserable, and very painful, old age.



Other thoughts?

Fill in your details below or click an icon to log in: Logo

You are commenting using your account. Log Out /  Change )

Google photo

You are commenting using your Google account. Log Out /  Change )

Twitter picture

You are commenting using your Twitter account. Log Out /  Change )

Facebook photo

You are commenting using your Facebook account. Log Out /  Change )

Connecting to %s

This site uses Akismet to reduce spam. Learn how your comment data is processed.