Category Archives: Opioid Debate

Argument Against Present Supply-Side Opioid Policy

New Study from American Action Forum Adds to the Argument Against Present Supply-Side Opioid Policy – April 12, 2018 – By Jeffrey A. Singer

On April 11 the Washington Post cited a new study from the American Action Forum that reinforces arguments I have made here and here, that despite a dramatic reduction in the opioid prescription rate—a 41 percent reduction in high-dose opioid prescriptions since prescriptions peaked in 2010—the overdose rate continues to climb, as nonmedical users have simply migrated to more dangerous substitutes like fentanyl and heroin while the supply of diverted prescription opioids suitable for abuse continues to come down.

four researchers working in the CDC’s Division of Unintentional Injury Prevention reported in the April 2018 American Journal of Public Health that the CDC’s method for tracking opioid overdose deaths have over-estimated the number due to prescription opioids, calling the rate “significantly inflated.”   Continue reading

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Patient-Focused Drug Development meeting with FDA

Patient-Focused Drug Development meeting with FDA – Twitter Conversation sent by Scott Gottlieb, the FDA Commissioner from:

Scott Gottlieb, M.D. @SGottliebFDA   
#FDA will be hosting a Patient-Focused Drug Development meeting July 9 to obtain patients’ perspectives on the impacts of chronic pain, views on treatment approaches and challenges or barriers to accessing treatments.

This sounds promising to me. It seems like big step forward for pain patients, for the FDA Commissioner to publicly acknowledge that we exist and that opioids are necessary for some of us… quite a daring move in today’s opiophobic political atmosphere. Continue reading

CDC Rx Opioid Overdoses Over-Reported by Half

CDC Opioid Overdose Death Rates Over-Reported by Half – Apr 2018 – A PPM Brief

Agency says inflated estimates were caused by blurred lines between prescription and illicit opioids.

The CDC is supposed to be an evidence and science-based agency, yet they published their opioid prescribing guidelines based on their own erroneous data.

Many laypeople and even their own authors have known for years that illicit fentanyl was causing overdoses, yet the CDC is just now starting to admit it.  

Continue reading

Doctors (finally) bristle at push for opioid Rx limits

Doctors bristle at push for opioid prescription limits – /thehill.com/ – By RACHEL ROUBEIN – 04/11/18T

An increasing number of states and entities in the health industry are putting curbs on the amount of opioids that doctors can prescribe, a controversial move aimed at combating the opioid crisis.

These limits have garnered support from various stakeholders and are now being considered in Congress, with a bipartisan group of senators proposing to set a cap on first-time prescriptions for acute pain.

So now the United States Congress wants to legislate our healthcare.  Continue reading

FDA, AAPM on Evidence-Based Opioid Prescribing

FDA, AAPM Open Talks on Evidence-Based Opioid Prescribing & Increased Naloxone Availability – April 13, 2018 – By Angie Drakulich

In a follow-up statement to an announcement by FDA Commissioner Scott Gottlieb, MD, the American Academy of Pain Medicine (AAPM) has issued its support for the development of evidence-based opioid prescribing guidelines.

The federal agency’s announcement seemed to mark a shift in approach from the 2017 declared opioid public health emergency and the administration’s “avoid opioids at all costs” mentality, not to mention its alleged temporary retreat from “evidence-based” medicine.

This implies a retreat from the CDC guidelines, thank goodness!   Continue reading

Court Rules Chronic Pain Is A VA Disability!

Court Rules Chronic Pain Is A VA Disability Military.com – Apr 2018 By Jim Absher

A recent ruling by the U.S. Court of Appeals for Veterans Claims may have a major effect on the outcome of many veteran’s disability claims. On April 3, the court ruled that pain, without any underlying disability, may be a valid reason for awarding VA compensation benefits.

This seems like a momentous change, yet I’ve only seen this one announcement buried on a site for military members.

Such a ruling by this huge government agency could affect many other healthcare organizations and be the beginning of a return to reason.  Continue reading

It’s time to reconsider the CDC’s guidelines

Some doctors say it’s time to reconsider the CDC’s guidelines on opioid prescribing – Apr 2018 – by Allison Maass

The Center for Disease Control (CDC) published guidelines on opioid prescribing in 2016, but some doctors think it is time to re-examine the guidelines because they say they might have been influenced by inaccurate data.

“It was obvious from the get-go that they were inflating the numbers,” said Dr. Dan Laird, pain management physician and medical malpractice attorney in Las Vegas.  

Even I was doubting that so much of the “opioid crisis” was with prescription drugs. There aren’t enough pills in granny’s medicine cabinet to have fueled the surge in “opioid use” when millions of pills flooded the black market.  Continue reading

Semi-Deliberate Overdose as Suicide

Tweet from  Christopher Moraff (@cmoraff):

5:15 pm South Philly:

Me: “yo ya’ll get any Narcan down here?”

Dude who just copped [bought street drugs]: “Nah not really.”

Me: “i have a few, can I give you one?”

Dude: “no I don’t want any Narcan.”

Me: “why? What happens if you go out?”

Dude: “I *hope* I go out.”

This could be quite common and lead the CDC to count suicides as overdoses.

The CDC is trying to quantify the “opioid crisis” by counting anything that has a definite number attached to it.

They count milligrams of prescribed opioids instead of finding more significant data, like the type of drug used in overdoses (not prescribed opioids), to make effective public health policies.

European position paper on appropriate opioid use

European Pain Federation position paper on appropriate opioid use in chronic pain management – O’Brien – 2017 – European Journal of Pain – Wiley Online Library

From Europe, where there is no “opioid crisis”, this is what a reasonable opioid policy looks like when it is not driven by anti-opioid hysteria:

Poorly controlled pain is a global public health issue.

Not in the U.S.A. – here pain is regarded as a nuisance symptom, to be sidelined and treated as a mental health issue more than a physical problem. (see “catastrophizing“) Continue reading

Cautious but Compassionate Approach to Opioids

This is a wonderful article and a pleasure to read. The author, Carlyn Zwarenstein, puts into words what it’s like to live with chronic pain and how opioids allow her to have a life that ankylosing spondylitis would steal from her.

I’ve only skimmed some excerpts from what is a thorough and clear-headed article:

Let’s Have a Cautious but Compassionate Approach to Opioid Prescribing A patient’s perspective on living with chronic pain in the midst of an opioids crisis – 4/4/18 – by Carlyn Zwarenstein   Continue reading