Opioid Overreaction – NYTimes.com – By David Leonhardt – Mar 2019
I’m encouraged to see this very reasonable article in the New York Times, which has previously published some anti-opioid pieces of questionable accuracy.
Some Americans suffering from chronic pain have recently lost access to medicines that helped them live normal lives.
Other patients have had to turn to invasive and dangerous treatments, like spinal injections.
“Consequently, patients have endured not only unnecessary suffering, but some have turned to suicide or illicit substance use,” more than 300 medical experts, including three former White House drug czars, wrote in a letter this month.
The C.D.C.’s crackdown on the overuse of opioids — though overdue and necessary — is also too uniform.
It has ignored the fact that many people receive huge benefits from opioids and use them safely.
The crackdown, which began with new guidelines for doctors issued in 2016, is denying medications to people who need them.
Clearly, the overuse of opioids is a national emergency, having caused more than 200,000 deaths over the past two decades.
But too much of the discussion about this issue treats opioids as an unalloyed evil, as opposed to a valuable medication that is terribly overused.
It’s the goal of PROP to make everyone believe our medications are actually “heroin pills” and thus instantly addictive. They are relentless in hammering home of the story about “evil opioids”, which shuts down any constructive discussion about using them for intractable pain.
Some pain patients can benefit equally from other treatments, but many do not. They function well on opioids and can barely function without them.
Even worse, the main public health problem today doesn’t appear to be over-prescription of opioids but rather a class of synthetic drugs, including fentanyls, often sold on the street.
Reducing opioid prescriptions is important. But it needs to be done in a smarter way.
If only our government agencies would start exhibiting the same common sense that this New York Times reporter does.
A case study
The Washington Post ran a good op-ed on the subject this week, written by John Heubusch, the executive director of the Ronald Reagan Presidential Foundation and Institute and himself a sufferer of chronic pain
Many doctors, Heubusch writes, “have turned away from their patients in chronic pain.” The real problem, he says, is not excess pills that happen to be prescribed by well-meaning doctors. It is “the illegal trafficking of opioids on the street where you live.”
This fact is becoming more and more obvious, and I don’t understand why most news organizations and publishers refuse to see it.
Those that keep pushing the long disproven and by now indefensible trope that “prescription opioids = addiction” should have to answer for the suicides they indirectly caused by their activism designed to do away with opioids even for pain management.
He continues: “The C.D.C.’s intended audience should have been small; a limited number of bad actors and a minority of doctors overprescribing for short-term pain were the C.D.C.’s real target.
But the guidelines were ambiguous and short-sighted.
That’s the “cover story” that the guideline writers are hiding behind, that the horrific fallout was “unintended and unforeseeable” – I call BS: Were Consequences of CDC Guideline Unintended?
The immediate result:
confusion at major medical conferences, inside hospital boardrooms and, most troubling, in just about every doctor’s office.”
In his own case, Heubusch writes, “I’ve had to undergo countless unsuccessful procedures and near superhuman efforts to be granted barely enough medication to try to live a normal life.
Even those doctors with the courage to prescribe them for chronic pain sufferers are finding the hurdles established by federal and state reporting requirements so onerous that they are simply turning patients away.”
It’s possible to reduce the horrific toll of opioid misuse and overuse without causing so much harm to people like Heubusch. And there are a lot of people like him.
It seems incomplete to say that “it’s possible to reduce the horrific toll” without even a hint at how this might be accomplished.
EDS and Chronic Pain News & Info 
So true, too many of us in crippling pain are being forced off opioid pain relievers. This is leavi g millions bedridden and unable to function. The pills were made for us not drug addicts. Why are we being punished. 12000 suicides do to undertreared pain over the last 12 months. This govt just sucks
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“It’s the goal of PROP to make everyone believe our medications are actually “heroin pills” and thus instantly addictive.” I *still* can’t figure out why almost no one outside the CPP community hasn’t noticed that the numbers on this BS assertion are so far off as to be ludicrous. If everyone who took any opioid immediately got addicted, nearly everyone in the entire country would be staggering around, stoned to the gills. Most people have at least had some injury, accident, or minor surgery (even wisdom teeth!) that resulted in them getting some pain meds…I know most people don’t “get” statistics, but how in the world can these multiple millions of morons not notice that they & everybody they know aren’t out buying oxy or heroin or whatever on the street? Even my low opinion of the IQ of ‘the masses’ can’t grok it. (& yeah, I know that sounds incredibly elitist, but….I still remember, say, what it was like to watch tv, & the dreck level of most of the most popular programs is mind-boggling).
But you are right: it is nice to see such a story in such a major media place as the NYT. Now let’s hope this thinking goes viral (even tho it still repeats the a priori assumption that “Reducing opioid prescriptions is important”).
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A lot of small town newspapers pick up these articles from NYT or the AP but I doubt they will run this one. They all picked up the titillating article “Opioids no better than acetaminophen” though. The so called opioid epidemic has been great for marketing, that is why they have done nothing meaningful in 20 years. They used the fear of opioids, to sell those dangerous procedures, and then misreported the negative side effects. These injections were really profitable to the so called pain clinics.
There was a huge crop of older people with bad hips, arthritis, and back and knee pain they could victimize. These injection clearly did no work,and added a serious level of mental distress to the people with these condition, but they were profitable. Physicians gas lighted their patients for profit, even though some of them committed suicide or turned into gibbering basket cases, due to the untreated pain, it was all in a days work. After all opioids were “dangerous’ and these people did have insurance to pay for these dangerous and expensive procedures. When these “low value” patients reported that the injections did not work, they were told to “try” alternative medicine. It was not as if it cut into the physicians salary, the ares they work in have a physician shortage anyway.
The psychologists who were marketing their skills as an alternative to pain management, gave them an easy out too. They have repeatedly claimed that pain is a psychological issue, that way any patient that got angry or complained was either mentally ill, or addicted to opiates. They marketed a lot of expensive pain pumps, and other dangerous or useless devices. The FDA hid the complaints and death reports because they could be embarrassing for the device industry, and lead to a loss of profitability.
The NYT ran an editorial written by a physician who claimed that opioids have no medical use. They have run a lot of nonsense over the years, stories about placebos and miracle cures, but mostly fluffing pharma and the device industry in the business section. They did not run anything about how the FDA has been Gas Lighting us on the medical devices, at the behest of the industry lobbyists.
Vox ran and article about physicians marketing on social media. They did not mention that sick people could be vulnerable to this kind of misinformation. Nor did they cover the “Groups” and information sites, set up by physicians and alternative practitioners to sell products.
https://www.vox.com/the-goods/2019/5/10/18535853/doctor-instagram-nurse-doctor-mike-influencer They only covered plastic surgery, but could have dug deeper into “pain” doctors.
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Reblogged this on The War on Chronic Pain Patients.
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Another statistic unforeseen the government caused? There are now 1 million EXTRA heroin users on the streets, because they used to be chronic pain opioid users that got cut off and turned to heroin because it’s cheaper, works faster, and much easier to get!!! This was on a documentary just about 2 days ago that we watched!!! So the government’s trying to PREVENT opioid use???!! HAHAHAHA!!! They’re just driving it to the streets, THAT’S ALL!!!!!
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That is a well-balanced article, Zyp.. I continue to see stories saying high-dose patients, especially long-term, high-dose patients should be left alone and put back on the medication that helped them so much. I can dream, can’t I?
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I really think you will be able to get more medication eventually, though I suspect they’ll only do it reluctantly and still try to keep you at a lower dose than before. The insidious effects of the CDC guideline have permeated our healthcare system and won’t be undone easily.
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My dose could be significantly reduced if I could get compounded Oxycodone extended release without the abuse proof formula that Purdue Pharma uses. When they changed the formula, I had to double my intake of OxyContin to receive the same relief. Wow, that would take me from 3000MME to approx. 1500MME, lol!
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And I thought it was just me!
I thought I noticed the new version not working as well, but I guess it’s a common problem. I’ve heard of others that noticed the same diminished efficacy too – yet these issues never percolated up far enough for doctors to notice.
And if you tell your own doctor that the new version doesn’t work as well, they just assume it’s because you were trying to “get high”. Sigh…
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at the risk of sounding like a ditto-head…me three. I figured it was my messed-up digestive system (& this was before the unknown GI thing). I always wondered if taking a pill that felt like it was encased in heavy plastic was the most efficacious thing to do…If I’d still been in a lab, I wanted to make up a mock ‘digestive soup’ to see the if things even dissolved.
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When first titrated onto OxyContin it was already a high dose. I took three 80mg Oxycontin in morning, another three in mid-afternoon, then three more B4 bed. Within just a few weeks the formula was changed and I was re-titrated to double that dose. Then, I spent eight plus years on the same dose – no increases were ever needed after that. In other words, within 1 month I went from a low-dose that was not even therapeutic to high-dose, to ultra high dose. Whenever the idea of trying other meds came up, I always told Dr. Tennant that I was doing so well on the status quo and then he agreed that I was doing very well that “if it ain’t broke let’s not fix it.” If one could strike that very-high dose out of the picture, I could have been a poster boy for how effective this treatment could be. I went from a non-functional person to one with excellent pain relief and a high QOL. I could, once again, even do light yard work like mowing my lawn and limbing trees (I have 16+ acres of land and much of the road into my house is through the woods). Now, I have to pay someone else to do the work and that is very frustrating to me when I KNOW it does not have to be the case. In closing, it was such a short time frame when these changes were made. Many people think that my dose was escalated over a long time period – WRONG. I do not understand why I required such a high dose other than I consider myself to be a ‘statistical outlier.’ If graphed on a bell curve, most pain patients would be clustered near top-center; whereas myself and a handful of others would be on the tail end of the bell curve.
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