Opioid Guidelines By Patients For Patients

How Would Opioid Prescription Guidelines Read if Pain Patients Wrote Them? – National Pain Report – April 10, 2017 – By Richard A. Lawhern, Ph.D.

A CDC Guideline for prescribing opioids in chronic pain was published in March 2016.  It has become clear that this Guideline is generating horrendously negative results for both chronic pain patients and their doctors.  

Many doctors are choosing to leave pain management rather than face possible prosecution by State or Drug Enforcement Agency authorities for over-prescription of pain relieving opioids.  Tens (if not hundreds) of thousands of patients are being summarily discharged without referral and sometimes without management of opioid withdrawal.  

There are increasing reports of patient suicides. 

Many professionals in medicine have published sharply critical reviews of the problems of the CDC Guideline.  

Also of deep concern are proposals by the US Centers for Medicare and Medicaid to make the Guideline a mandatory standard for insurance reimbursement.   

Many believe that the Guideline was deeply influenced by an anti-opioid bias on the part of key writers on the CDC Working Group which authored it.  

Even more damaging have been revelations that medical evidence assembled in support of the work was manipulated to discredit opioid reliability and over-magnify risks.  

As one group of medical professionals phrased the issues, the CDC Guidelines are “neat, plausible, and generally wrong.”   Inarguably, so also is most of the dominant public narrative on opioids and chronic pain

The public narrative has become mired in an avalanche of hype, conflicting claims and financially self-interested posturing on the part of addiction treatment specialists, insurance company partisans and pharmaceutical company marketers.  

Especially important in any rewriting process must be the inclusion of stakeholder voices that were largely unheard in the first writing of the Guidelines.  

Chronic pain patients themselves should be among this list, as should board certified pain management specialists active in community practice outside hospitals

The following is not a “standard” of medical practice. The present state of validated medical evidence is inadequate to produce such a standard with reliability.

While the CDC even admitted the evidence it found was weak, they still went ahead and dictated a standard dose limit of opioids for ALL pain.

This summary of principles is instead, a good faith effort to capture both the state of medical evidence and the experience of many thousands of patients who support each other online and in social media — too often in the absence of support from medical professionals and government policy communities.

The article continues with the text of a patient-oriented guideline for opioids that makes much more sense:

Guidelines on Prescription of Opioids in Chronic Pain

Please read and comment to show your support.

This article has benefitted from review and input by a correspondence group of 25 chronic pain patients and by medical professionals qualified in pain management. 

 

About the Author:
Richard A (“Red”) Lawhern, Ph.D.  is a non-physician writer, research analyst, patient advocate, and website moderator for chronic pain patients, families, and physicians.
His wife and daughter are chronic pain patients.  His 20 years of experience has produced many articles and critical commentaries.
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