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.

AMA urges CDC to revise opioid prescribing guideline

AMA urges CDC to revise opioid prescribing guideline | American Medical Association – Jun 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. 

Misperceptions about ‘Opioid Epidemic:’ Exploring Facts

Misperceptions about the ‘Opioid Epidemic:’ Exploring the Facts – ScienceDirect – Pain 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.

Guidelines Written and Manipulated by Insiders

Professional Societies Should Abstain From Authorship of Guidelines and Disease Definition Statements – John P.A. Ioannidis – Oct 2018

Guidelines and other statements from professional societies have become increasingly influential. These documents shape how disease should be prevented and treated and what should come within the remit of medical care.

Changes in definition of illness can easily increase overnight by millions the number of people who deserve specialist care. This has been seen repeatedly in conditions as diverse as hypertension, diabetes mellitus, composite cardiovascular risk, depression, rheumatoid arthritis, or gastroesophageal reflux.

Similarly, changes in prevention or treatment options may escalate overnight the required cost of care by billions of dollars.

For example, if we accept PROP’s argument that we’re all addicted to our “heroin pills”, we’d all suddenly need “addiction-recovery programs/clinics/residential treatment centers/resorts” for our  “substance abuse” instead of “chronic pain”. 

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.

 

HHS Guide for Clinicians on Opioid Dosage Reduction

HHS Guide for Clinicians on the Appropriate Dosage Reduction or Discontinuation of Long-Term Opioid Analgesics.pdf – September 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. 

Guide to tapering opioids seeks balanced prescribing

A new guide to tapering opioids seeks a balanced approach to prescribing – By Andrew Joseph @DrewQJoseph – October 10, 2019

Federal health officials on Thursday released a guide for clinicians who are considering tapering patients’ opioid prescriptions, highlighting the benefits of safe reductions in dosages while warning against abrupt drops for people who have been on the drugs for long periods.

The recommendations come amid concerns that some chronic pain patients’ dosages have been unsafely pulled back and that providers have sometimes abandoned patients.  

Some experts and advocates have warned that overly aggressive reductions or forced cutbacks have led some patients who are dependent on the drugs to seek out illicit sources of opioids or consider suicide.

Flaws Found in Interventional Treatment Guidelines

Flaws Found in Interventional Treatment Guidelines – Pain Medicine News – by Harry Fortuna – Mar 2020

Assessors were unable to give full votes of confidence to any of the four recently evaluated interventional guidelines created by major North American pain medicine societies.

Of further concern,

• only half of the sample studied was found to be of high methodological quality, and
• none of the guidelines surveyed adeptly involved all stakeholders such as patients, providers and payors.

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.  

How CDC Guidelines Hurt Patients

How CDC Guidelines Hurt – Not Help – Pain Patients – by Dez Nelson – The Mighty – Feb 2020

The National Academies released a new consensus report on December 19, 2019, and the Federal Drug Administration (FDA) released an announcement the same day communicating their intention to “develop the evidence” for a new practice guideline for the treatment of acute pain.

This announcement comes on the heels of an ongoing public health disaster that the Centers for Disease Control & Prevention (CDC) caused by implementing recommendations from the National Academy of Medicine and ignoring dissenting specialists in the field, and that the Drug Enforcement Agency (DEA) has perpetuated via SWAT-style raids on doctor’s offices across the country.

This article sums up exactly what I’ve been complaining about.