Category Archives: Opioid Debate

Opioid Epidemic: 6 Charts Designed To Deceive

The Opioid Epidemic in 6 Charts Designed To Deceive You – By Josh Bloom — October 12, 2017

In this article, Josh Bloom eviscerates Kolodny’s arguments showing the unrelenting anti-opioid bias and disregard for opposing evidence.

Dr. Kolodny, a psychiatrist, is the executive director of Physicians for Responsible Opioid Prescribing (PROP)—a group that played a significant role in creating the disastrous CDC Guideline for Prescribing Opioids for Chronic Pain (2016).

The CDC ended up incorporating much of PROP’s recommendations, which were supposedly designed to help the US mitigate the damage done by opioid drugs, despite the fact that the “evidence” contained in the recommendations had been carefully scrutinized and found unsupportable by FDA scientists.  

Continue reading

Advertisements

Conundrum of Opioid Tapering Without Reason

The conundrum of opioid tapering in long-term opioid therapy for chronic pain: A commentary – Ajay Manhapra , MD,Albert A. Arias , MD Jane C. Ballantyne , MD

In response to the opioid epidemic and new guidelines, many patients on high-dose long term opioid therapy (LTOT) for chronic pain are getting tapered off opioids.

As a result, a unique clinical challenge is emerging: while many on LTOT have poor pain control, functional decline, psychiatric instability, aberrancies and misuse, these issues may often worsen with opioid tapering. 

Is she saying that all these detrimental effects of sudden opioid tapering should just be ignored because they are due to neuroplasticity? Continue reading

Prescribed Opioids After Surgery Often go Unused

Study: Many Patients Don’t Use Prescribed Opioids After Surgery – Pain Medicine News – Oct 2017

A new study found that over two-thirds of patients did not use opioids prescribed to them postoperatively.

If opioids were as addictive as advertised, we wouldn’t be seeing opioids unused. The fact that patients may take only a few of their prescribed opioids contradicts the assertions that merely a taste of opioids causes almost everyone to become addicted.

How does the anti-opioid leader of PROP, Kolodny, explain that?  Continue reading

Underlying Factors in Drug Overdose Deaths

Underlying Factors in Drug Overdose Deaths | Substance Use and Addictive Disorders | JAMA | The JAMA Network – October 11, 2017
JAMA Viewpoint:  Deborah Dowell, MD, MPH; Rita K. Noonan, PhD; Debra Houry, MD, MPH

This is the “viewpoint” of the very influential Dr. Houry,  the Director of the National Center for Injury Prevention and Control (NCIPC) at CDC, who has been instrumental in restricting prescription opioids.

Since 2010, overdose deaths involving predominantly illicit opioids (heroin, synthetic nonmethadone opioids, or both) have increased by more than 200% (Figure).

Continue reading

Increased use of heroin as an initiating opioid of abuse

Increased use of heroin as an initiating opioid of abuse. – PubMed – NCBI – Addict Behav. 2017 Nov;

Note to CDC: data now clearly show that prescribed opioids are *not* the initiating drugs for addiction and fatal overdoses, so stop harassing pain patients!

Given the relatively recent growth in access to heroin and a more permissive atmosphere surrounding its use, we hypothesized that an increasing number of persons with limited experience and tolerance to opioids would experiment with heroin as their first opioid rather than more common prescription opioid analgesics. 

Spoiler alert: their hypothesis was proven true. Continue reading

Optimal Opioid Prescribing Based on Type of Surgery

Seeking an Optimal Opioid Prescribing Pattern Based on Type of Surgery – October 2, 2017

Guidelines for prescribing opioid pain medication with regard to acute pain recommend the lowest dose possible for the shortest duration needed to relieve pain, but specific guidelines for outpatient pain relief following surgery are still lacking.

Now, an analysis of more than 200,000 patients who had one of eight common surgical procedures may offer more clear guidance for this much needed pain management population. The study was published in JAMA Surgery.  

“Optimal” prescription lengths varied widely, according to senior study author Louis L. Nguyen, MD, MBA, MPH, associate professor of surgery at Harvard Medical School and a vascular surgeon at Brigham & Women’s Hospital in Boston.   Continue reading

Public-Health Experts Are Skeptical of the CDC’s New Anti-Opioid Campaign

Public-Health Experts Are Skeptical of the CDC’s New Anti-Opioid Campaign – Pacific Standard – Oct 2017

Last month, the Centers for Disease Control and Prevention (CDC) launched an advertising campaign aimed at reducing addictions and deaths that are linked to prescription opioids

The campaign suggests the government wants Americans to eschew opioid prescriptions altogether. Its tagline is, “It only takes a little to lose a lot.” 

In his featured ad, Duggan says, “One prescription can be all it takes to lose everything.

This is the biggest lie of all because addiction is in the person,  not the drug.

The videos are incredibly moving—and yet, according to nearly every public-health researcher Pacific Standard consulted, they probably won’t do much. Why not? 

Everyone pointed to the same fatal flaw: The ads tell viewers that prescription opioids are a big problem, but don’t tell them what steps to take.

What were they asking people to do?” clinical psychologist Craig LeFebvre asks me, rhetorically, when I interview him.

As LeFebvre and others point out, telling Americans to avoid prescription opioids altogether just isn’t feasible. 

The drugs may, in many cases, be a good choice to treat pain.

I’m heartened to see the truth stated so clearly. Now, if only the rest of the media would catch on.

In fact, advising people not to use opioids at all contradicts the CDC’s own “Guideline for Prescribing Opioids for Chronic Pain,” which was published last year.

The guideline recommends caution, not abstinence.

This has been the problem all along: doctors are being told (ordered, if they are employees) to stop prescribing opioids without any alternatives for their patients. 

All other methods of pain control are either much less effective or too expensive for insurances to cover. 

Alternative medicine usually involves on-going treatments, often weekly, for the rest of the patient’s life.

The video ads do show a URL at the end, cdc.gov/RxAwareness, but it disappears quickly and there’s no indication of what the site offers.

In addition, campaigns that tell people to just not do something, without offering alternatives, don’t typically work, argues Bill DeJong, a professor of community health sciences at Boston University. 

DeJong offers the example of efforts in the United States to reduce drunk driving, which got off to a slow start until a suite of changes in the late 1980s, including the invention of the idea of a designated driver. “It wasn’t until there were changes in policy and enforcement, changes in the law, coupled with offering steps you could take to avoid it, like the designated driver, that we got some real change,” DeJong says.
Psychological theory explains why “Just say no” doesn’t work. 

It’s thought that, before they’ll change their behavior, most people need to feel empowered to do so. The technical name for the feeling is self-efficacy. 

Without that self-confidence, the CDC’s opioid campaign just makes viewers sad and afraid, emotions they may deal with unproductively.

Some of the experts Pacific Standard talked with took the stance that the CDC ads would be at least somewhat effective,

DeJong, however, has a harsher opinion. “The campaign isn’t going to make a damn bit of difference,” he says.

I’m relieved to hear this and, for all our sakes, hope he’s right.

The CDC is one of America’s major science agencies. It employs scientists of many stripes, including epidemiologists who do crucial work in tracking drug use in America, which helps doctors and officials stay on top of a fast-changing epidemic. 

Why, then, would it sponsor an ad campaign that health psychologists don’t think will work? 

The agency’s press office didn’t fulfill requests for a phone interview about the campaign, nor did it answer questions sent over email. 

This is because the CDC’s missteps on the opioid epidemic are indefensible.

DeJong speculates the problem might be the federal government approaching public service announcements as advertising problems, rather than health-behavior ones. 

This is because PROP and the recovery industry *are* using overdose deaths as advertising for their ineffective “recovery” programs, trying to scare us all by telling us that opioids can turn anyone into an addict instantly.

In the past, the government has hired (or received pro bono services from) ad firms to try to discourage Americans from drunk driving and drug use.
America’s ad men can indeed be effective at persuading people to change their behaviors—for example, to use body wash instead of soap, or to spritz the toilet before sitting on it.

 But getting people to be healthier is different. 

As DeJong puts it: “We don’t tell people that you’re going to die if you don’t use Crest toothpaste.”

The Myth of an Opioid Prescription Crisis

The Myth of an Opioid Prescription Crisis – Oct 2017 – by Jeffrey A. Singer

…many have called for stricter regulations on prescription opioids. But are doctor-prescribed drugs truly the cause of the increase in overdoses?

At a Capitol Hill Briefing in June, Arizona surgeon and Cato senior fellow Jeffrey A. Singer argued that regulators, in their rush to interfere in the patient-doctor relationship, are actually causing more problems than they’re solving.

This is something pain patients know only too well, as our pain relieving drugs are taken away even while overdose rates are skyrocketing.  Continue reading

Patient Advocates Call on Brandeis to Fire Kolodny

Patient Advocates Call on Brandeis to Fire Kolodny — Pain News Network – October 03, 2017 – By Pat Anson, Editor

A coalition of physicians, patient advocates and pain sufferers has written an open letter to Brandeis University asking for the dismissal of Andrew Kolodny, MD, a longtime critic of opioid prescribing who is co-director of opioid policy research at the university’s Heller School for Social Policy and Management.

Kolodny is the founder and Executive Director of Physicians for Responsible Opioid Prescribing (PROP), an anti-opioid activist group that has lobbied politicians and regulators for years to enact stronger measures to limit prescribing of opioid pain medication.   Continue reading

CVS Defends Rx Opioid Policy

CVS Defends Rx Opioid Policy — Pain News Network – Sept 28, 2017 – bu Pat Anson

I don’t like the idea that some corporation, in business purely to make profits, can make decisions about my medical care and, without a medical reason or even exam, limit the pain relief my doctor prescribes for me.

And if these limits don’t provide me the pain relief I had previously, if the actions of the drugstore corporation in reducing my prescription to some “standard” causes a deterioration in my quality of life, and if I then become despondent and suicidal… who will answer for my distress?

…Asked to comment on these and other concerns, CVS Health emailed a statement to PNN answering a series of questions we had about its new opioid policy.  Continue reading