Pain Specialists Denounce CDC Opioid Guidelines

Pain Specialists Pile on CDC Opioid Guidelines | MedPage Today – by Elizabeth Hlavinka, Staff Writer – Sept 2019

It’s infuriating that three solid years of professional medical criticism, even from some of the people involved in the original writing, hasn’t resulted in the withdrawal or “rewriting” of the CDC guideline.

In the 3 years since the guidelines were published, at least 33 states have enacted legislation that limits opioid prescribing, and although half of these states specify that the new limits are intended for patients with acute pain, many physicians have stopped prescribing opioids to chronic pain patients as well, according to Gary Jay, MD, of the University of North Carolina in Chapel Hill.

In April, the authors of the guidelines stated that the recommendations were not intended to force hard limits of opioid doses, abruptly taper or stop opioid use, or be applied to patients outside the guidelines’ scope, such as patients undergoing active cancer treatment or, in some cases, patients with chronic pain.  

Around the same time, the FDA also advised against rapidly tapering or ceasing opioid use based on the known harms of doing so.

But these announcements came as “too little too late,” Jay said.

In effect, the guidelines have left many high-impact chronic pain patients, who commonly have difficulty accomplishing work and self-care activities, “essentially function-less,” Jay said.

Thomas Kline, MD, PhD, a known advocate for chronic pain patients, has compiled a list of 40 patients who have died by suicide associated with forced tapering of opioids.

Meanwhile, the discontinuation of prescription opioids may lead other chronic pain patients to turn to the street to obtain heroin or other illicit drugs to control their pain, Jay said.

While overdose deaths from any opioid have increased dramatically since 2009, the number of prescription medication overdose deaths has remained low, Jay said

The number of opioids being prescribed is also decreasing, despite the increase in opioid-related overdoses, he added.

We have been told the ‘opioid crisis’ was secondary to the ‘prescription opioid crisis’ and an ‘addiction crisis,’ but these statements have never been backed up with evidence,” he said.

“It is clear that the overdose deaths were the result of polypharmacy and illicit fentanyl or other illicit or illegally obtained drugs.”

I’m astonished that the CDC can so resolutely ignore what they are being told by increasing numbers of medical experts when even the evidence itself shows that prescription opioids are NOT the problem.

But while the National Institute on Drug Abuse reports that 8-12% of patients on long-term opioid therapy develop an opioid use disorder, the evidence supporting this association is mixed, Jay said. Other reports show rates of opioid abuse following long-term opioid therapy to be as low as 0.6%.

Addiction, a complex condition with a genetic basis, also differs from tolerance and physical dependence, Jay noted.

Source Reference: Jay G “The gang that couldn’t shoot straight: reconsidering the CDC guideline” PAINWeek2019; SIS-03.

4 thoughts on “Pain Specialists Denounce CDC Opioid Guidelines

  1. canarensis

    “But while the National Institute on Drug Abuse reports that 8-12% of patients on long-term opioid therapy develop an opioid use disorder, the evidence supporting this association is mixed, Jay said. Other reports show rates of opioid abuse following long-term opioid therapy to be as low as 0.6%.”
    If nothing else, it shoulda been glaringly obvious that spreads of such ludicrous extent indicate severe problems with methodology, definitions, bias…something or all those things. I think definitions have a lot to do with it. If you concatenate physiological dependence & addiction (the In Thing to do at the Church of Opiophobia), then of course you’re going to get insanely high numbers. Those biased folk should do a similar study of coffee “addiction” prevalence in the general population; that’d make the 12% high limit look like small beans. So to speak. (sorry, couldn’t help myself)

    Liked by 1 person

    Reply
    1. Zyp Czyk Post author

      When the fraction of pain patients who supposedly have OUD varies by a factor of 20x, it seems pretty clear that the definition of OUD varies just as much, depending on the personality (or financial interests, or self-delusion) of whoever is doing the counting.

      Obvious facts don’t seem to accomplish a single thing for us. Opiophobia blinds people who have experience with addiction to the critical use of these drugs and I don’t think facts will change any minds.

      I keep thinking about a campaign to “walk a mile in my shoes (if you can tolerate the pain)”. I imagine a bunch of pain patients sending their shoes to the idiots in charge of opioid policy – perhaps a visual/tactical image would be more powerful than any number of words. Plus, there’s the Middle Eastern custom of throwing shoes at someone considered lying & incompetent, like someone did to Prez Bush in Iraq, giving the gesture a second appropriate meaning.

      Liked by 1 person

      Reply
      1. canarensis

        Oohhhh, I like the shoe idea! i have a cloth-topped pair of sneakers that are about sole-less that I’d love to send. I’d wear the same pair of socks for a month, then bag ’em with the shoes for a while so the stench really sinks in, then send the shoes. Just to underline how much I think the recipients stink.

        A large part of my brain still can’t understand how someone who claims to be science-based (which we’d hope would include all medical professionals) can be so blind to things like a 20x factor being a flashing red light indicating, “PROBLEM HERE!!” I make no claims to being free of bias or wishful thinking or mistakes or any such things, but…I really try to question my convictions, hold them up to facts & data, look for red flags, etc. I don’t always succeed, but I try.

        Liked by 1 person

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