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
- A) intermittent IR opioid therapy at low doses is often sufficient,
- 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”:
- a new “pain patient suicide epidemic”
- 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.