Acknowledging the suffering caused by “misinterpretation” of the opioid prescribing guidelines it published in 2016, the U.S. Centers for Disease Control and Prevention (CDC) yesterday sought to clarify that it never recommended imposing involuntary dose reductions on chronic pain patients.
In a letter to physicians who had objected to that widespread practice, CDC Director Robert Redfield emphasized that his agency “does not endorse mandated or abrupt dose reduction or discontinuation, as these actions can result in patient harm.”
The CDC may not “endorse” them, but they deliberately looked the other way for 3 years while this was happening.
Redfield described several steps the CDC is taking to research the impact of its guidelines and correct misunderstandings that have led to abrupt withdrawal, undertreated pain, denial of care, and in some cases suicide.
“I have seen many patients harmed by widespread misapplication of the Guideline,” said Stefan Kertesz [our hero!], a University of Alabama at Birmingham pain and addiction specialist who helped organize a March 6 letter on the subject that was signed by hundreds of health professionals.
We’ve been blessed with some incredible doctor-advocates like Dr. Kertesz.
Kertesz welcomed the CDC’s response, which came the same day that the Food and Drug Administration (FDA) issued a warning about the risks of involuntary or fast opioid tapering.
the CDC did not say that patients who were already taking daily doses higher than 90 MME, many of whom have been functioning well for years, should be forced below that threshold.
Instead it said “clinicians should work with patients to reduce opioid dosage or to discontinue opioids” if they determine that the risks outweigh the benefits.
Furthermore, “the Guideline alsorecommends that the plan be based on the patient’s goals and concerns and that tapering be slow enough to minimize opioid withdrawal, e.g., 10 percent a week or 10 percent a month for patients who have been on high-dose opioids for years.”
Really? That’s not how the DEA read it.
They went after any doctors prescribing more than what they, the macho government bureaucrats allowed to carry guns, deemed “appropriate” for patients’ multiple complex comorbidities.
And because they are such geniuses, they were able to figure out the “appropriate dosage” just by looking at the number of milligrams prescribed to a patient: no history, diagnosis, or consultation necessary.
The CDC is also conducting “systematic reviews of the scientific literature that has been published since the Guideline was released” and sponsoring “four extramural research projects that are examining unintended consequences of tapering and discontinuation.”
Acknowledging the “personal testimonies from patients across the country,” Redfield said, “We agree that patients suffering from chronic pain deserve safe and effective pain management.
Then why did they wait so long to issue this “clarification”?
It’s been obvious for three long years that horrible damage was being done to legitimate pain patients. Many had no recourse but to commit suicide.
“The CDC is committed to addressing the needs of patients living with chronic pain while reducing the risk of opioid-related misuse, overdose, and death.” [..blah, blah, blah]
This is pure public relations BS.
Their callous indifference and delay in clarification make their true attitude painfully clear: they just don’t care.