Category Archives: Opioid Debate

Pain Patients Angry and Fearful about Govt. Interference

Charges against pain doctor reveal undercurrent of anger, angst among patients at federal government – cleveland.comBy John Caniglia, The Plain Dealer – Jul 2020

For more than 25 years, patients suffering in pain sought out Dr. William Bauer. They had crippling injuries from car crashes and work accidents, chronic headaches and debilitating spine issues. At 83, Bauer had a practice in Sandusky that cared for many of the same patients for 10 to 20 years.

Federal prosecutors have accused the neurologist of illegally prescribing thousands of opioid pills between 2015 and 2018. 

But realistically, “prescribing thousands of opioid pills” for pain patients is medically appropriate. These drug-warriors should do the math before they toss around meaningless phrases like this just to create drama. Continue reading

Neuropathic Pain & Wind-Up Phenomenon

Managing Difficult Pain Cases: Neuropathic Pain & Wind-Up Phenomenon – WSAVA2013 – VIN – 2013

I was looking for information on the “pain wind-up” phenomenon and found this veterinary paper that explains it well – and without any special fuss about opioids, treating them the same as any other pain-relieving medication. What a refreshing change!

And with animals, there are no “biopsychosocial” factors to blame for increasing pain, so vets take it seriously and don’t just discount it as an attitude problem.

The options for analgesia are ever increasing as our understanding of pain physiology improves.

Yet for humans, there is still little understanding of chronic pain and few new treatments significantly different from the old.  Continue reading

Illicit opioid use after loss of access to opioids for pain

Illicit opioid use following changes in opioids prescribed for chronic non-cancer pain. PLOS ONE. May 4, 2020.

Here’s a finally a study showing the potentially hazardous actions taken by pain patients when their pain relief is cut off. I’m surprised they found the same thing with increasing the dose – if anyone can think of an explanation, please let me know.

In a retrospective study of more than 600 patients in San Francisco receiving opioid pain relievers (OPR) for chronic, non-cancer pain, the researchers found that

  • [l]oss of access to prescribed OPRs was associated with more frequent use of non-prescribed opioids and heroin, and
  • increased OPR dose was associated with more frequent heroin use.

In addition to being cautious with increasing OPR dose, care providers should consider the potential unintended consequences of stopping OPR therapy when developing opioid prescribing guidelines and managing practice.

AMA recommends specific changes to CDC guideline

The full AMA letter and each recommendation to revise the CDC guideline – (continued from yesterday’s post)

…the CDC Guideline could be substantially improved in three overarching ways.

  1. First, by incorporating some fundamental revisions that acknowledge that many patients experience pain that is not well controlled, substantially impairs their quality of life and/or functional status, stigmatizes them, and could be managed with more compassionate patient care.
  2. Second, by using the revised CDC Guideline as part of a coordinated federal strategy to help ensure patients with pain receive comprehensive care delivered in a patient-centric approach. And
  3. Third, by urging state legislatures, payers, pharmacy chains, pharmacy benefit management companies, and all other stakeholders to immediately suspend use of the CDC Guideline as an arbitrary policy to limit, discontinue or taper a patient’s opioid therapy.

Continue reading

AMA urges CDC to revise opioid prescribing guideline

AMA urges CDC to revise opioid prescribing guideline | American Medical AssociationJun 18, 2020

Finally! I’m still outraged that the AMA stood by silently for 5 long years as more and more pain patients were deprived of legitimate medical opioid treatment.

They remained silent as law enforcement second-guessed doctors’ decisions and essentially dictated our treatment. I didn’t hear a peep of protest when appropriate medical care was decided by the DEA and enforced by SWAT teams.

So pardon me if I’m not giving the AMA adulation or kudos or praise for doing what they should have done 5 years ago. Their inaction led directly to the suicides of so many pain patients who were deprived of pain relief on the basis of these appallingly arbitrary and misapplied CDC guidelines.  Continue reading

Misperceptions about ‘Opioid Epidemic:’ Exploring Facts

Misperceptions about the ‘Opioid Epidemic:’ Exploring the Facts – ScienceDirectPain Management Nursing – Feb 2020

Here is the full article I posted about yesterday:

A plethora of statistics and claims exist concerning the rise in prescription opioid use and the increase in opioid-related deaths.

Eleven misperceptions were identified that underlie some of the growing national concern and backlash against opioid use.

Misperceptions include

  • the number of opioid overdose deaths,
  • the quality of government-sponsored data and guidelines,
  • the impact of opioid dose escalation on overdose risk,
  • postoperative opioid use associated with long-term use, and
  • the link between prescription opioid use and heroin initiation.

Continue reading

Analysis Explores Misperceptions About Opioid Epidemic

Analysis Explores Misperceptions About Opioid Epidemic – Pain Medicine News June 2020

The common belief that more people die from prescription drug overdoses than motor vehicle accidents, and other conventional wisdom regarding long-term opioid use, are not supported by evidence, according to a new review (Pain Manag Nurs 2020;21[1]:100-109).

“We were asked by the board of the American Society for Pain Management Nursing (ASPMN) to craft an advocacy statement about the use of opioids for chronic pain,” said co-author Cathy Carlson, PhD, APRN, FNP-BC, RN-BC.

As usual, nurses see the reality of our healthcare system much more “up close and personal” than doctors. So they are not as easily fooled by “prestigious leaders” making announcements from lofty perches of wishful thinking that runs contrary to the daily reality of patient care.  Continue reading

Opioid Metrics Ignore Patient Care

Clear thinking about opioid metrics: Twitter Thread by @StefanKertesz: 

With the callous form letter below, a patient’s doctor’s office announced they simply wouldn’t be treating chronic pain anymore and would only offer 2 more months of tapering before essentially “kicking them out”.

While I understand that doctors are under tremendous pressure around prescribing pain medication, I’m shocked that such a dismissive move isn’t malpractice.

  Continue reading

Study Shows Surgery Reduces Chronic Opioid Use

Surprising Finding: Study Shows Surgery Reduces Chronic Opioid Use – Pain Medicine Newsby Michael Vlessides – May 2020

Among chronic opioid users, having surgery seems to be associated with a faster time to opioid discontinuationcontrary to popular belief.

I’m very curious about what they consider “contrary to popular belief”. It doesn’t make much sense to believe that having surgery leads to a “longer time to opioid discontinuation.”

“Of patients coming to our operating rooms, 23% will already be on an opioid by the time they see you on the day of surgery, and 3% will be chronic opioid users,” said Naheed Jivraj, MD.   Continue reading

HHS Guide for Clinicians on Opioid Dosage Reduction

HHS Guide for Clinicians on the Appropriate Dosage Reduction or Discontinuation of Long-Term Opioid Analgesics.pdfSeptember 2019

This is the federal document mentioned in the previous post.

This HHS Guide for Clinicians on the Appropriate Dosage Reduction or Discontinuation of Long-T erm Opioid Analgesics provides advice to clinicians who are contemplating or initiating a reduction in opioid dosage or discontinuation of long-term opioid therapy for chronic pain.

More judicious opioid analgesic prescribing can benefit individual patients as well as public health when opioid analgesic use is limited to situations where benefits of opioids are likely to outweigh risks.

This guide reiterates that benefit/risk calculation over and over as though it’s a special procedure for opioids when it’s what doctors have always been doing.  Continue reading