Tag Archives: CDC-Guidelines

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

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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.”

CDC Releases More Faulty Research About Opioids

CDC Releases More Faulty Research About Opioids — Pain News Network – September 19, 2017 By Pat Anson,

A new study by researchers at the Centers for Disease Control and Prevention estimates that opioid overdoses have shaved two and a half months off the average life span of Americans – a somewhat misleading claim because the study does not distinguish between legally obtained prescription opioids and illegal opioids like heroin and illicit fentanyl.

We can thank the ingenious folks of PROP, who were the first to raise the alarm with data that added together prescribed pain medication (opioid tablets) with illicit street drugs (injected heroin).

This combination of legal and illegal drugs created the fantastic and scary numbers of the “opioid crisis”.  Continue reading

CDC Ignored Warning About Opioid Guidelines

CDC Ignored Warning About Opioid Guidelines — Pain News Network – September 05, 2017/ Pat Anson

The CDC spent our tax dollars to hire a high-profile public relations firm to help whitewash their unreasonable cruelty. Part of the job was to create propaganda to make their awful opioid guidelines more appealing to healthcare providers.

A consulting company hired by the Centers for Disease Control and Prevention warned the agency last year that many doctors had stopped prescribing opioid pain medication and that chronic pain patients felt “slighted and shamed” by the CDC’s opioid guidelines.

Some doctors are following these guidelines as strict law rather than recommendation, and these physicians have completely stopped prescribing opioids,” PRR warned in a report to CDC in August 2016, five months after the CDC released its guidelines.  Continue reading

Excellent Critique of the CDC’s Guidelines

Below is a 5-part series authored by Dr. Myron Shank, MD. Ph.D. on his blog. You can find the full details in the links provided for each part of his post.

Critique of the CDC’s Draft Guidelines on the Use of Opioid Analgesics for Chronic Pain Part One | Dr. Shank | 12/31/15

(Note: The endnotes which provide the references for this critique have been collected into the final part of this document.)

The recently released Centers for Disease Control and Prevention (CDC) draft guidelines for the use of opioid analgesics[1] make a mockery of the National Academy’s Institute of Medicine’s (IOM) standards for clinical guidelines.[2]  Continue reading

CDC Checklist for Prescribing Opioids for Chronic Pain

CDC Checklist for Prescribing Opioids for Chronic Pain.pdf – from https://www.cdc.gov/drugoverdose/pdf/pdo_checklist-a.pdf

Below is the “official” checklist from the CDC for opioid therapy.

Nowhere does it say that doctors cannot prescribe opioid doses above 90MME, and if your doctor is telling you this, they are misinformed.

High opioid doses only require more caution and more documentation, which should already be the case due to the complexity of our care.   Continue reading

The Dangers of Guidelines & Recommendations

Guidelines are wonderful. Guidelines are dangerous – KevinMD.com – ROBERT CENTOR, MD | July 2017

Over the past decade, I have thought often about the benefits and the problems of clinical guidelines. The first concept that attracted my attention was reading about conflicting guidelines.  

Given the same data, different guideline committees would have significantly different recommendations.  At the least, this problem raises questions about guideline validity.

It makes clear that committee perspective could influence recommendations.  

This is exactly what happened when the CDC opioid prescribing guidelines were ghost written by addiction specialists from PROP.   Continue reading

Updated Opioid Guidelines for State Medical Boards 

Updated Opioid Guidelines Released for State Medical Boards – June 23, 2017 – By Kelly Rehan

“Guidelines emphasize individual treatment as opposed to rigid standards.”

The Federation of State Medical Boards (FSMB) released updated guidelines for using opioid analgesics to manage chronic, non-cancer pain. 

The updated document, which stresses safety through an individualized treatment approach, aligns with recent opioid advisories from the Centers for Disease Control and Prevention (CDC) and the US Food and Drug Administration (FDA).   Continue reading

Will Limits on Opioid Rx Duration Prevent Addiction?

Will Strict Limits on Opioid Prescription Duration Prevent Addiction? Advocating for Evidence-Based Policymaking: Substance Abuse:  , MD, MPH,  , MD, MPH &  , MD, MSc –  Jun 2017

Quick answer: NO!

In 2016, the Centers for Disease Control and Prevention (CDC) issued the first national guideline in the United States regarding opioid prescribing for pain.

The guideline included the recommendation that patients treated for acute pain should receive opioids for no longer than 7 days, prompting at least five states to implement laws requiring prescribers not to exceed this threshold when providing initial opioid supplies.

The rapid conversion of this guideline into policy appears to reflect an underlying assumption that limiting initial opioid supplies will reduce opioid consumption, and thus addiction.   Continue reading

CDC Guidelines Could Cause Problems for VA Patients

CDC Opioid Guidelines Could Cause Problems for VA Patients, Clinicians : U.S. Medicine By Annette M. Boyle – February 2016

Even though this is from a few years ago, it’s still valid in 2017.

Congress Is Forcing VA to Comply With ‘Voluntary’ Document

VA clinicians and their patients might find themselves in a difficult position related to proposed opioid prescribing guidelines from the national Centers for Disease Control and Prevention (CDC).

The CDC did a limited initial release of the guidelines in September with a two-day comment period and was immediately criticized for placing greater emphasis on reducing opioid abuse than relieving pain.
Continue reading