Were Consequences of CDC Guideline Unintended?

CDC Opioid Prescribing Guideline: Unintended Consequences? – July 2018 – an angry essay by yours truly, Angelika Byczkowski (Zyp Czyk)

I’m sick and tired of reading over and over how all the entirely predictable consequences of the CDC Opioid Prescribing Guideline were “unintended” and “unforeseeable”.

The broad misinterpretation of the guideline as establishing fixed limits on opioid prescribing has stranded hundreds of thousands of pain patients in agony without the effective relief they had achieved with opioids.

Yet we are expected to believe that these consequences were “unintended” and “unforeseeable” by the guideline authors. Most pain patients realized right away that the guideline’s suggestions would become codified rules, no matter how little evidence supported them.

And we were right – more than we ever imagined… 

Considering the public positions of the anti-opioid addiction specialists who were allowed to write the guideline, their intentions were clear to anyone familiar with their fervent anti-opioid beliefs and opinions.

When the guideline so strongly discourages opioid prescribing and insinuates a risk threshold at 90MEDD, was it “unintended” that it would lead to the conclusion that opioids are unacceptably dangerous and should never be prescribed over 90MEDD?

The use of this guideline to standardize doses of medication for all Americans is a radical retreat from the modern trend toward individualized medicine. It makes no sense to stipulate standard doses to treat such an ill-defined and variable symptom as pain. 

Legitimate opioids doses can vary by a factor of more than 100 (yes, literally) between individual patients in their individual situations, with their individual body chemistry, individual metabolic abilities, and individual health histories. It is for this reason that the medical literature has rightfully abstained from identifying standard dosing or an upper dose limit for opioids.

Was it unintended to insinuate a significantly higher categorical risk at a certain number of milligrams?  (see Impact of High-Dose Opioids on Overdoses)

In the otherwise ambiguous and indeterminant realm of pain and its relief, the guideline writers did what researchers and doctors have never been able to justify with current evidence. The guideline specified a standard number of milligrams, a mostly fabricated but measurable data point, for risk ranking.  (see The MEDD myth: pseudoscience in guidelines)

Was it unforeseeable that bureaucrats, politicians, and even doctors would immediately latch on to this number to use as an upper limit of permissible opioid prescribing?

~~~~~~~~

It was PROP, Physicians for Responsible (and restrictive and punitive) Opioid Prescribing, that instigated and lobbied for the writing of the CDC’s guideline, portions of which were cribbed right from the PROP organization’s own PROPaganda, anti-opioid to the extreme, and without sufficient evidence.

PROP’s leader, A. Kolodny, equates our best, and sometimes only, option for true pain relief with an illegal street drug, calling our pain medications “heroin pills”. His position is that opioids are not effective for chronic pain, that we are taking them only to avoid opioid withdrawal symptoms, not to treat the pain that started us taking them.

He advocates for forced opioid dose reductions across the board, ideally to zero, but at least to below the 90MME “magic number” mentioned in the guideline as requiring more careful consideration. This number has been widely, and wrongly, interpreted as conferring a threshold of increased risk for overdose.

Mr. Kolodny sees no value in opioids for long-lasting pain, only for acute pain of at most a few weeks. He cannot begin to comprehend the reality that chronic pain patients live in.

~~~~~~~~

Misled and inflamed by the flood of anti-opioid hysteria in the media, most of the public believes the crisis of overdoses is from opioid medications, possibly diverted or scammed, but prescribed by doctors.

Thus, the anti-opioid crusaders are convinced they must reduce the amounts of opioids prescribed. They firmly ignore all other possibilities, deaf to our cries of agony and blind to our subsequent suicides. They doggedly pursue their drug-warrior fantasy: pain management without opioids, except very rarely, very briefly, and very reluctantly.

Even today, there is little mention of the real culprit in the rapidly rising number of overdoses: illicitly manufactured fentanyl.

Cheap, ultra-potent, and deadly even in tiny amounts, fentanyl has already contaminated much of the black market drug supply. Drug users purchase what they believe to be their “normal drug and dose” but the concentrated power of added fentanyl sends them into respiratory depression and death.

That’s what’s causing the overdoses, not prescribed medications. (see Overdoses are still increasing while opioid prescriptions are at 10-year low.)

This is not an “opioid crisis” – it’s a heroin and fentanyl crisis. And to make matters even worse, the CDC recently admitted that it has been over-counting prescription opioid overdose deaths by erroneously categorizing street fentanyl as a “prescription opioid”.

~~~~~~~~

It is as though the anti-opioid crusaders cannot quite believe that “real” chronic pain exists, leading them to conclude that patients are complaining about pain only to get the drugs we need to feed the inevitable addiction we’ve developed.

By denying patients this effective treatment of last resort, the only one that makes our painful lives bearable and worth living, they believe they are rescuing us, setting us free from the nightmare of addiction.

And when we are finally forced “off” opioids and established in one of the unregulated and insanely profitable addiction recovery centers sprouting all over the country, they believe we will “see the truth” and finally recognize these cruel zealots as the virtuous heroes they believe themselves to be.

I think not.

Because the prevailing winds of the cultural “war on opioids” (and pain patients) have been blowing into their sails for so long, these anti-opioid crusaders are unaware that their driving cause is only hot air and based on popular click-bait memes, not reality.

To correct the errors and gross bias of the CDC Opioid Prescribing Guidelines, which would only heap more convoluted and imprecise conditions onto what is already scientific garbage, let’s throw them out and start over.

As they say:

“Adding a spoonful of wine to a barrel of sewage makes more sewage, but
Adding just a spoonful of sewage to a barrel of wine still makes sewage.”

~~~~~~~~

A slightly different version of my essay previously appeared in the National Pain Report on July 12, 2018.

7 thoughts on “Were Consequences of CDC Guideline Unintended?

  1. Kathy Cooper

    Since day one, the Sackler family’s marketing of Oxycontin, which they claim is the beginning of the so called opioid epidemic, the consequences are as expected. The industry came up with a counter narrative, blaming pain patients for the so called addiction “crisis.” They targeted a vulnerable groups of patients, that were already socially isolated, and stigmatized. The insurance, medical and pharma industries came up with a false narrative that benefited them all, and kept profits rolling in.

    1996 is the same year the laws were changed to allow pharma marketing directly to patients. Sackler was a Psychiatrist who created a niche for himself in the telemarketing industry.

    https://www.newyorker.com/magazine/2017/10/30/the-family-that-built-an-empire-of-pain
    “But the brothers made their fortunes in commerce, rather than from medical practice. They shared an entrepreneurial bent. As a teen-ager, Mortimer became the advertising manager of his high-school newspaper, and after persuading Chesterfield to place a cigarette ad he got a five-dollar commission—a lot of money at a time when, he later said, “even doctors were selling apples in the streets.” In 1942, Arthur helped pay his medical-school tuition by taking a copywriting job at William Douglas McAdams, a small ad agency that specialized in the medical field. He proved so adept at this work that he eventually bought the agency—and revolutionized the industry. Until then, pharmaceutical companies had not availed themselves of Madison Avenue pizzazz and trickery. As both a doctor and an adman, Arthur displayed a Don Draper-style intuition for the alchemy of marketing. He recognized that selling new drugs requires a seduction of not just the patient but the doctor who writes the prescription.”

    The marketing was so good that they are still conflating Oxycontin with Oxycodone. They are still misreporting the facts to protect the marketing industry. The media is still using term opiates, to describe everything from legitimate prescription pain medication to street level heroin, fentanyl and even crystal meth. They are deliberately targeting people with pain, blaming them for everything just as the Sacklers intended. They gave money to prestigious academic institutions to “Study” and directed the research in order to conflate chronic pain with addiction, generally confuse the pubic about the incidence of chronic pain and addiction. Psychologist were quick to come up with alternate theories about pain, in order to undermine pain patients, and mislead the general public. After all if everyone knew their chances of developing chronic intractable pain, they might alter their lifestyles or work less.

    The mass media misreported the statistics, originally to help the Sacklers, and perpetuate the “Market Driven Healthcare” false narrative. They ran articles on miracle cures,in mice, content marketing on alternative medicine, and misreported the Epidemic of Despair as millions of Americas were driven into poverty. They had to downplay pain and cast doubt in the existence of pain. They enlisted psychiatrists and psychologists to create doubt, and cast pain patients in a negative light. https://www.theguardian.com/us-news/2018/jan/27/universities-sackler-family-purdue-pharma-oxycontin-opioids

    The medical industry found this narrative was profitable, they could pick their patients, and not let the ACA force them to provide healthcare to the undesirable, ie under insured, or uninsured. They ran thoughtful articles questioning the motives and morals of people reporting pain. They even got pain psychiatrists to ask about pending litigation, just in case their patients had a financial payoff for reporting pain. They never did any research to find out how common that was. The industry that paid for that research did not like the outcomes, or they would have been spread across all media.

    The Sacklers merely expanded their market share, by marketing their products to people with short term pain conditions, and post operative pain. The generically available Oxycodone and other opiates they had used for over a century were not marketed, so there was no problem misreporting the effectiveness. There was no competition.. Even with this so called epidemic no one is looking at how the deceptive marketing of all pharmaceuticals and health products is negatively impacting our health, and costing the system billions. Pharmaceutical and other health related marketing is ramping up. Industry insiders at the FDA, FTC, and CDC are not only allowing this, they are encouraging even more. The pharma industry is lobbying to remove the side effects warnings from their non stop TV commercials,and newspaper and magazine ads. This is as they enlist internet influencers, and content marketers to sell their products.

    No other developed nation has a market based healthcare system, and only New Zealand allows pharmaceutical marketing. The US has the most expensive least effective healthcare system in the developed world, and they want to keep it that way. The latest topic of pharma profiteering was Insulin, and the industry created a marketing and PR campaign to cast doubt on their activities. They ran high profile ads touting their beneficial research, in prime advertising slots, just like the oil industry. They have effectively silenced any mass media reporting on key topics. https://energycommerce.house.gov/committee-activity/hearings/hearing-on-priced-out-of-a-lifesaving-drug-the-human-impact-of-rising Even the number of Americans dying from rationing their Insulin did not motive any real change. These slick CEOs were allowed to spout industry lies, misstatements and propaganda at the hearings. The researchers who discovered Insulin gave away the patent, so no one would do without the lifesaving medication.

    Liked by 2 people

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