Suicidal patients. Illegal drug use. Hoarding of pain pills. Pharmacists refusing to fill prescriptions. Doctors worried about going to jail. Chronic pain going untreated.
Those are some of the many problems uncovered in a PNN survey of nearly 3,400 pain patients, doctors and healthcare providers, one year after the release of opioid prescribing guidelines by the Centers for Disease Control and Prevention (see “Survey Finds CDC Opioid Guidelines Harming Patients”).
The guidelines were meant to be voluntary and are only intended for primary care doctors, but they’re being widely implemented throughout the U.S. healthcare system – often with negative consequences for the patients they were intended to help.
- Over 70% of patients say doctors have either reduced or stopped their opioid medication.
- 80% say their pain and quality of life are worse.
- Nearly half are having suicidal thoughts and
- some are hoarding opioids or turning to the black market for pain relief.
And hardly anyone believes the guideline has been successful in reducing opioid abuse and overdoses.
“The CDC should not have issued the guideline without a plan to measure its possible benefits and unintended consequences.”
Does the CDC even have such a plan? PNN asked the agency if one exists and also for a comment on the survey findings. We have yet to get a response.
The founder and Executive Director of Physicians for Responsible Opioid Prescribing (PROP), an anti-opioid group that helped draft the guidelines, also declined to comment on the survey findings.
“I’m not going to want to comment either way,” said Andrew Kolodny, MD, before launching into a defense of the guideline.
“Since the CDC guideline came out, the bad news on opioids for chronic pain continues to increase. The evidence keeps getting stronger and stronger that opioids are lousy drugs for most people with chronic pain,” said Kolodny, who is Co-Director of the Opioid Policy Research Collaborative at Brandeis University.
CDC Pledged to Revise Guideline if Needed
The closing words of the CDC guideline say the agency is “committed” to revising it if evidence is found that it’s not helping patients or doctors.
“CDC will revisit this guideline as new evidence becomes available,” the agency pledged last year. “CDC is committed to evaluating the guideline to identify the impact of the recommendations on clinician and patient outcomes, both intended and unintended, and revising the recommendations in future updates when warranted.”
“Instead of revising, did they instead opt to hire a PR firm? The negative outcomes, while unintended, were nevertheless foreseeable.”
The research wasn’t focused on the “intended and unintended” impact of the guidelines, but on why they were received so poorly in the pain community.
Lynn Webster thinks the CDC needs to do more than hire a public relations consultant.
Voluntary Recommendations Become Mandatory
Some believe the problem isn’t so much the wording of the guideline as the way it is being implemented by physicians, states, insurers and other federal agencies like the Department of Veterans Affairs (VA) and the Centers for Medicare and Medicaid Services (CMS). They’ve turned the CDC’s voluntary recommendations for primary care doctors into mandatory rules that all prescribers have to follow.
CMS is planning to adopt new rules to “better align” its policies with the CDC’s. Medicare’s “Opioid Misuse Strategy” not only makes the guidelines mandatory, it allows insurance companies to take punitive action against doctors, pharmacists and patients who don’t follow them
“You should take a look at the VA guideline that just came out, if you don’t like the CDC guideline,” says Andrew Kolodny. “The VA guideline is even stronger. It says don’t give opioids. Opioids are not preferred. Don’t do it.”
“This is a silent genocide aimed squarely at Baby Boomers. An expedited way to avoid paying Social Security benefits to those who are approaching retirement or are receiving benefits. I am ashamed of our country,” wrote one patient.
“Completely wrong approach which will, I believe, result in more addiction as patients experiencing intolerable suffering are forced to look outside the medical system for relief,” said another.
The online survey of 3,108 pain patients, 43 doctors and 235 other healthcare providers was conducted between February 15 and March 11 by Pain News Network and the International Pain Foundation (iPain).
To see the complete survey results, click here.