Editor’s Note—This letter was submitted to the Oregon Health Evidence Review Commission (HERC) in advance of its August 9 meeting to consider opioid forced taper guidelines.
People outside of Oregon are free to comment. To submit your comment of 1000 words or less, email them to firstname.lastname@example.org as soon as possible.)
Oregon Medicaid program could cut off chronic pain patients from opioids – STAT – By Lev Facher @levfacher – August 15, 2018
There is little Laura Dolph has not tried to escape her physical pain. Tylenol, occupational therapy, oxycodone. A chiropractor. Transcutaneous electric nerve stimulation. Methadone, Advil, physical therapy, Tylenol with codeine. A prescription fentanyl patch that didn’t work because its adhesive made her break out in hives.
For almost two years, heroin. Twice, in the mid-1990s, suicide.
But after decades of drugs and appointments and surgeries, mercifully, Dolph says she has found pain management that works, that keeps her stable. When she first wakes up, a methadone pill. When the pain wells up in her lower back and begins its creep down to her legs — left, then right — an oxycodone pill, and sometimes another as needed. Continue reading
Oregon makes a bad proposal to “fix” the opioid problem – By Bob Twillman, Ph.D., FACLP, Executive Director, Academy of Integrative Pain Management, Tuesday, July 31, 2018
As I’ve said many times, to solve the complex problems of opioid misuse and overdose, policymakers across the country are blindly and blithely reaching for the simplest solutions.
Typically, these solutions focus on reducing opioid prescribing to–or beyond–the bare minimum.
Because these policies often are enacted with very little forethought and very little concern for the unintended consequences…
I argue that these consequences were neither unintended nor unforeseeable. Continue reading
Latest review of Opioid-Induced Hyperalgesia in the Nonsurgical Setting: A Systematic Review. – PubMed – NCBI – Am J Ther. – Jan 2018
Opioid-induced hyperalgesia (OIH) is a phenomenon that causes an increased pain sensitization and perception of pain to noxious stimuli secondary to opioid exposure.
While this clinical effect has been described in the surgical setting, it is unclear if OIH occurs in the nonsurgical setting.
Yet, some doctors are quick to blame any pain patient’s increased pain on this mythical phenomenon. Instead of prescribing more opioids, they use your additional pain as an excuse to cry “OIH!” and taper you down. Continue reading
What Makes Buprenorphine Risky for Pain Patients — Pain News Network – October 17, 2017 – By Jane Babin, Guest Columnist
Buprenorphine is the darling of the addiction treatment industry, rapidly replacing methadone as the “medication assisted treatment” of choice for opioid use disorder (OUD) and addiction.
As a class III controlled substance, prescriptions for buprenorphine can be phoned or faxed in, and scripts can be refilled up to 5 times in 6 months without a new prescription.
Class II controlled substances, like hydrocodone, oxycodone and morphine, require a new prescription each month and can neither be refilled nor phoned in. Continue reading
Cancer pain remains a feared consequence of the disease and its treatment. Although prevalent, cancer pain can usually be managed through the skillful application of pharmacologic and nonpharmacologic interventions.
Come on, just say it: “cancer pain can usually be managed through opioids.” Continue reading
Opioid stigma is keeping cancer patients from proper pain control – Stat News – By Sara Ray and Kathleen Hoffman – July 6, 2018
History is repeating itself. Twenty years ago, a pain management crisis existed. As many as 70 percent of cancer patients in treatment at that time, or in end-of-life care, experienced unalleviated pain.
And we’re heading back to that situation as fast as we can, with one rule after another being rushed to implementation to prove its sponsors are “doing something about the opioid crisis”.
But now that even cancer patients are being affected, I hope the rest of the country can see that withholding pain relief is simply torture and has no place in a modern-day healthcare system. Continue reading
CDC Opioid Prescribing Guideline: Unintentional Consequences? – July 2018 – By Angelika Byczkowski
I’m sick of reading how all the horrible and entirely predictable consequences of the CDC Opioid Prescribing Guideline were “unintentional” and “unforeseeable”.
The broad misinterpretation of the CDC’s Opioid Prescribing Guideline as establishing fixed limits on opioid prescribing has stranded hundreds of thousands of pain patients in agony without the effective relief they had achieved with opioids.
Yet we are expected to believe that these consequences were “unintentional” and “unforeseeable” by the guideline authors. Most pain patients realized right away that these “suggestions” would become codified rules, no matter how little evidence supported them–and we were even more right than we ever imagined. …Continue reading article on National Pain Report
Tapering Long-term Opioid Therapy in Chronic Noncancer Pain – June 2015 – 2015 Mayo Foundation for Medical Education and Research.
This is an official document from Mayo Clinic to execute a medically proper opioid taper. While it strongly implies that *all* patients prescribed opioids have OUD and they *all* must stop taking them…
- Nowhere does it say it’s OK to simply stop prescribing and abandon patients.
- Nowhere does it say all patients must be tapered to zero.
Cancer Patients Face Difficulties in Getting Opioids – Alicia Ault – June 26, 2018
Cancer patients have found it more difficult to receive opioids since the opioid epidemic has been in the news and since new policies to stem abuse have been introduced.
During the past year and a half (from late 2016 to May 2018), cancer patients and survivors have experienced increasing barriers to getting opioid prescriptions, a new survey has found.
Letting patients be eaten alive by cancer without providing effective pain relief qualifies as torture. Continue reading