Urgent Need for Comments Against 90MME Limit Urged by PROP

PROP Urges Members to Oppose FDA Opioid Strategy — Pain News Network – July 08, 2017/ by Pat Anson, Editor

The anti-opioid activist group, Physicians for Responsible Opioid Prescribing (PROP), has sent an “Urgent Action Request” to it members, asking them to oppose plans by the FDA to give new guidance to health care providers about prescribing opioid pain medication.

PROP founder and Executive Director Andrew Kolodny, MD and other PROP board members wrote a letter to the FDA, urging them to include the specific dose limit of 90mg morphine equivalents.

Today, July 10, is the last day to comment and oppose this artificial and arbitrary limit that goes against all scientific evidence of wide varieties in opioid metabolism that preclude any such dose standardization.

The contents of PROP’s letter are frightening, starting with their first main point:

1) Opioids are rarely needed for chronic pain.  

Please, please, go to the site and add a comment supporting the use of opioids for chronic pain.

Given the poor safety profile for long-term opioid therapy, indications should be restricted to those where evidence suggests that benefit predictably exceeds risk. 

There is no precise evidence at all about long-term opioid therapy (over 90 days) so this statement cannot be true.

There are many common pain conditions, particularly chronic pain conditions where a central component is dominant, for which no such evidence exists, and for which alternatives to opioids have demonstrated superior long-term efficacy, in addition to greater safety.

Again, there is no such evidence.

This includes fibromyalgia, pelvic pain syndromes, irritable bowel disease, chronic non-structural back pain, other non-specific musculoskeletal disorders and headache. Recent evidence-based guidelines for these conditions emphasize avoiding opioids.

2) ER/LA versus IR opioids.

Evidence increasingly suggests that when opioids are required

  1. A) intermittent IR opioid therapy at low doses is often sufficient,
  2. B) tolerance, dependence and dose escalation are more likely to arise with continuous (round-the-clock) opioid therapy than with intermittent therapy.

Tolerance and dependence reduce efficacy and increase risk. Many clinicians are under the false impression that physiological dependence is benign and that opioids can be easily tapered. REMS education should help correct this serious misunderstanding.

It is well established that daily long-term use and higher dose therapy are associated with greater risk, including greater risk for addiction and death.

This statement is entirely false because no clear evidence about long-term opioid therapy exists.

Higher dose therapy for pain patients has nothing to do with the increasing rate of overdose by recreational/addicted opioid abusers.

3)Evidence suggest that children and adolescents are at greater risk of developing future misuse and addiction when exposed to addictive drugs, even when the exposure is brief and for acute pain, such as after dental extraction.

This is false.  Almost everyone would have an opioid addiction if such a great proportion of people became addicted just from post-surgical opioids.

But this does not happen.

Young people have a greater range of options for treating pain without the need to resort to opioids.

Young people have the same lack of options for pain relief that older people do.

4) While close monitoring of patients using opioids is essential, due to inherent risks of overdose, physiological dependence and prescription opioid use disorder, there is no evidence that recommended monitoring practices, including risk screening, treatment agreements, urine drug screening and regular follow-up visits, are effective in reducing risks of overdose or prescription opioid use disorder.

They are basically stating that all the roadblocks being put in the way of opioid prescriptions for people in pain are NOT working for their intended purpose.

Why are we continually subjected to these invasive monitoring efforts if they have been proven ineffective?

There is evidence that reducing opioid prescribing and lowering opioid doses can reduce risks of prescription opioid use disorder and opioid overdose.

This is simply untrue.

The results of the current drive to dramatically reduce or even outright stop opioid prescriptions have not been evaluated and there are no plans to do so.

No one is taking responsibility for the swelling numbers of patient suicides as pain patients are left overwhelmed by their uncontrolled pain.

These resulting deaths are not being counted, and no one is studying the impact of these new trends,

In summary, we believe a prescriber education effort to improve outcomes for patients with pain will be ineffective unless past misinformation on risks and benefits are explicitly and forcefully corrected.

Kolodny and PROP seem to be deliberately ignoring the realities of the supposed “opioid epidemic”.

Thanks to completely unscientific drug-war propaganda-fueled calls for opioid prohibition, we now have two “epidemics”:

  1. a new “pain patient suicide epidemic”  
  2. an ever-growing “illicit opioid overdose epidemic”. 

The latest CDC data show that overdose deaths are NOT from Rx medication, but from illicit street drugs like heroin that are laced with cheaper and deadly imported manufactured opioid analogs.

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4 thoughts on “Urgent Need for Comments Against 90MME Limit Urged by PROP

  1. scott michaels

    To whom it may concern:
    THE GUIDELINES HAVE CHANGED MY LIFE DRASTICALLY. I WASA HIGH DOSE PATIENT DUE TO MY SEVERE CERVICAL STENOSIS,SPONDLYTIS, ARTHRITIS ON T4 VERTEBRAE FEOM A FRACTURE 30 YRS AGO, EXTREME FOOT PAIN AND A METABOLISM TEST I TOOK PROVED TO MY PAIN DOCTOR THAT I HAVE A HIGH TOLERANCE FOR THE MEDICATION. FOR 7 YEARS ITS WAS CONSIDERED MEDICALLY NECESSARY. THE EPIDURRALS FACET INJECTIONS AND PHYSICAL THERAPY DID NOT HELP AND ACTUALLY MADE ME VERY ILL.
    FOR 7 YEARS I FINALLY HAD A QUALITY OF LIFE THAT ENABLED ME TO TO ACTIVE, HELP MY WIFE AROUND THE HOUSE HUG MY KIDS BUT MAINLY THE FEELING IF AN ICE PICK IN MY NECK .AND LOWER BACK WERE 90% GONE. BECAUSE OF THESE GUIDELINES KAISER DECIDED IT IS NO NO LONGER MEDICALLY NECESSARY. I AM OLDER, MY CONDITIONSHAVE NOT IMPROVED BUT KAISER IS CONSIDERING ME ALONG WITH THE MILLIONS OF OTHER CHRONIC PAIN PATIENTS AND COLLATERAL DAMAGE. I HAVE ALWAYS AND STILL TAKE MY MEDICARTON AS DIRECTED, IVE PASSED EVERY URIN TEST AND IVE NEVER DOCTOR SHOPPED. MY PAIN IS NOW CONSANTLY A 7 TO 10. IF I TRY TO VACCUME OR DO ANY ACTIVITY IM BACK IN BED. MY MEDICINE LASTS A MONTH.. I AM DEPENDENT ON THE HIGH DOSE TO ENABLSE ME TO JAVE A QUALITY OF LIFE MAYBE SPEND A FEW HOURS AT DISNEYLAND AND HUG MY KIDS. I WAS PRODUCTIVE.
    PROP BELIEVES WE ARE ALL ADDICTS. WHY IS THIS? ONE REASON IS THEY ARE FINANCIALLY AFFILIATED WITH MANY REHAB FACILITIES. ISTITUTIONS LIKE KAISER AND OTHER IMSURANCE COMPANIES SAVE BILLIONS IN PRECSRIPTIONS. AS YOU KNOW EXECUTIVE BONUSES ARE BASED ON BOTTOM LINE AND TGIS ADDS A LOT OF MONEY TO THAT LINE.
    IF WE, THE CHONIC PAIN PATIENTS WERE ADDICTS, WE WOULD RUN OUT OF MEDICINE IN A DAY OR A WEEK. ESPECIALLY SINCE WEVE MBEEN CUT TO AMOUNTS WHERE SUICIDE HAS BECOME AN OPTION FOR MANY.
    THAT IS SAD AND CRUEL. I MYSELF COULDNT DO THAT TO MY FAMILY. THEREBARE DAYS I WANT TO DOUBLE MY DOSING, BUT I KNOW I WILL RUN OUT BEFORE THE END OF MONTH AND THE PAIN WILL BE INTENSIFIED.
    THOSE FROM PROP K OW THAT TO A DRUG ADDICT 90MG MME 5MG MME 1MGMME IS TOO MUCH AND 10000 MGMME IS NOT ENOUGH. THEY USE IT FOR THE HIGH.. MY DOSE WAS 80MG IXTCONTIN 3X DAILY AND 39MGBOXYCODONE 3X DAILY FOR APPROX. 6 YEARS. IT TOOK 6 months with my pain doctor to get the dosages correct. WHEN I HAD TO SWITCH TO THEY CONTINUED THAT DOSAGE FOR A LITTLE OVER TWO YEARS. I HAVE NEVER EVER BEEN HIGH FROM THE MEDICINE, JUST SLIGHT.CONSTIPATION WHICH SOFTENERS TAKE CARE OF. I NEVER MIX WITH ALCOLOL OR OTHER DRUGS LIKE VALIUM TO INTENSIFY THE OPIOIDS. WHY? BECAUSE I AM NOT AN ADDICT. MILLIONS OF CHRONIC PAIN PATIENTS ARE DEPENDENT ON THE MEDICATION FOR A QUALITY LIFE. WE WONT JEOPARDIZE IT.
    HOWEVER, THE ADDICT DOES NOT CARE. ACUTE PATIENTS SHOULD ONLY GET A SUPPLY THATS ENOUGH FOR THE DURATION OF PAIN FEOM A PROCEDURE. EXAMPLE MY DAUGHTER JUSTBHAD 4 wisdom teeth taken ouy. they gave her 5/325 of norco. 10 pills. THAT IS A DOCTOR IN FEAR. HER PAIN WAS AWEFUL FOR TWO WEEKS JUST LIKE MOST PEOPLES. HE ABOULD HAVE GIVEN HER A TWO WEEK SUPPLY THEN TAPER HER OFF OVER THE NEXT WEEK OR TWO. IF SHE CONTINUED TO COMPLAIN THEN HE EITHER DID A POOR JOB OR SHE IS ADDICTED. IMSTEAD HE GAVE HER JUST ENOUGH FOR THE NEXT THREE DAYS.
    OPIOIDS THERAPY IS THE ONLY THING WE HAVE AS CHRONIC PAIN PATIENTS, BECAUSE OF THE CDC GUIDELINES EVERY SNAKEOIL SALESPERSON IS TRYING TO BAD BILL OF GOODS. IN MANY CASES TO GOVT IS SUBSIDISING THEIR SO CALLED MIRACLE CURES.
    OVER THE LAST FEW YEARS DATA BASES PHARMACIES AND DOCTORS HAVE THE TOOLS SO SPOT TO ADDICT. THEY ALSO KNOW THAT BECAUSE OF WHAT IS VERY SMALL % OF ADDICTS TO HONEST PATIENTS MILLIONS LIKE MYSELF HAVE TAKEN SEVERAL STEPS BACKWARD. THERE IS NOT AN OPIOID EPIDEMIC THERE IS A HEROIN EPIDEMIC. THOSE THAT USED TO USE PAIN RELIEVERS TO GET HIGH CANT GET THEM WITHOUT AN ACT OF CONGRESS. hEROIN IS NOW AVAILABLE EVERYWHERE. PURE CHEAP AND EASY TO GET. WHY WOULD THEY EVEN PAY 20 TO 60$ A PILL WHEN 20$ WILL KEEP THEM HIGH FOR HOURS.
    PROP IS SMART. THEY ARE USING THE WEAKNESS OF THE PARENTSNAND OTHER FAMILY MEMBERS TO FIGHT THIS REVIEW. THEYRE NOT ALTRUISTIC. ITSBABOUT THE ALMIGHTY BUCK.
    UNLESS AN ADDICT IS READY To STOP, hit the bottom or has overdosed so many times they are sick and tired of being sick and tired. THE REVOLVING DOOR IS GOING SO FAST THEY NEED MORE BEDS. THEY REFUSE TO ADMIT
    THE SUCCESS RATE FROM REHAB IS ABOUT 3%. FREE 12STEP PROGRAMS HAVE A MUCH BETTER RATE OF SUCCESS BECAUSE YHE PERSON IS READY TO MAKE A CHANGE IN THEIR LIVES.
    MCHRO IC PAIN PATIENTS KNOW ITS A LIFETIME OF PAIN RELIEVERS BUT THEY WORK VERY WELL FOR US. ASNA DIABETIC NEEDS INSULIN DAILY FOR A QUALITY OF LIFE AO DI WE. I BEG OF YOU TO CHANGE TGIS HORRIFIC ABUSE. IF THE GUIDELINE WERENT THERE, MANY OF THESE INSURANCE COMPANIES WOULD BE IN COURT FOR UNTREATING PATIENTS.. WE ALL KNOW ITS NOT RIGHT TO TAKE SOMEONE DOING VERY WELL FOR A LONG TIME ON MEDICATION TO TAKE IT AWAY BECAUSE OTHERS MISUSED AND ABUSED THE MEDICATION.
    AGAIN I BEG OF YOU FOR MYSELF MY FAMILY AND OTHERS LIKE ME TO ALLOW US TO GO BACK TO THE DOSAGES THAT WORK FOR US AND THE DOCTORS THAT WE ABLE TO CARE FOR US WITHOUT THREATS FROM THE DEA AND THE INSURANCE COMPANIES.
    THANK YOU VERY MUCH
    SCOTT MICHAELS
    SHOEHAUSE@ GMAIL.COM
    PS..IF YOU WOULD LIKE TO OBSERVE ME
    FOR A WEEK OR MONTH TI SEE MY BEHAVIOR AND HOW FREAT THE MEDICATION HELPS SIGN ME UP

    Like

    Reply
      1. scott michaels

        please feel free to send it where ever you believe it would help. it just upsets me so much every time i read or write about this i get to depressed along with the pain its just not good for me.
        thanks

        Liked by 1 person

        Reply

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