12 Recommendations the CDC Should Have Made
Opioids as a treatment for chronic pain have exposed the holes in our country’s health care system in an unparalleled fashion. Now, a new guideline issued by the Centers for Disease Control and Prevention (CDC) discourages the use of opioids in treating chronic pain, excluding cancer and end-of-life care (MMWR Recomm Rep 2016;65:1-49). The CDC touts 12 recommendations targeted to primary care providers, including risk assessment, improved monitoring, avoidance of benzodiazepine–opioid combinations and choice of short- over long-acting formulations for acute pain.
Professional pain organizations have advocated for similar recommendations (Pain Med 2013;14:959-961), although it has often been like speaking to the deaf in a dark room. One major party that must open its ears is the payor community, which routinely fails to cover many safer and more effective therapies recommended by the CDC, as detailed in a 2014 position paper published by the American Academy of Pain Medicine (AAPM). Instead, the insurance system has forced a simple solution, reinforcing cookie-cutter, minimally monitored, drug-only therapy for complex medical and psychological problems in a highly diverse population.
Unfortunately, the CDC guidelines fail to challenge payors’ interests, choosing instead to push for opioid supply reduction measures that include dosing limits without regard for the necessity of individualized therapy and with very little consideration of the needs of people in pain. These needs have been urgently set forth and thoughtfully analyzed in the National Pain Strategy, which proposes a population-based approach to meeting the comprehensive, complicated care needs of people with chronic pain.
However, public statements that accompanied the release of the CDC guideline instead embraced reductionist—even superficial—views. In an interview with the Los Angeles Times, CDC Director Tom Frieden, MD, MPH, said the current opioid crisis is “doctor driven.” This partial truth is dangerous when presented so simplistically and without examination and discussion of true root causes. As far back as 2005, when the Salt Lake Tribune published a story with the headline “Fatalities Linked to Pain Pills on the Rise,” I knew that if indeed the medical profession unknowingly was contributing to the incidence of opioid overdoses, it was incumbent on the medical profession to take the lead to correct the problem. I feared that if the “epidemic” described by the newspaper was not reversed, the public would demand legal and legislative efforts to correct the problem. That fear has been realized.
Now, the CDC and others are using shortcuts and formulaic approaches that will cause people in pain more suffering. To truly reduce abuse, misuse, addiction and overdose risk from prescription opioids, clinical recommendations should acknowledge the complex challenges presented by current payor coverage, clinical reality and legislative/regulatory policy. Research into root causes of the opioid crisis indicates change can happen without worsening the lives of people with chronic pain, and payors absolutely must be part of the solution.
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Lynn R. Webster, MD, is a past president of the American Academy of Pain Medicine and author of “The Painful Truth: What Pain Is Really Like and Why It Matters to Each of Us.” Dr. Webster also is a member of the Pain Medicine News editorial advisory board. Visit him online at ThePainfulTruthBook.com. He lives in Salt Lake City.
Filed under: General Problems
This is absurd, chaotic , degrading and barbaric treatment! I have been with the same pharmacy for 35 years and never has my pharmacists blinked an eye at my prescriptions. Than again he knows me well. I am now stage 4 cancer and suffering immensely being denied adequate pain control? It was fine to allow the chemotherapy and radiation and all the devastating after effects as I fight for my life. It’s to the point of beyond disgusting. This opoid war has been a total fail.
I believe the national pain strategy has been officially released. I just spoke with Dr. Linda Porter at NIH last week and. She referred me to the new “pain strategy” agenda, even though I was calling to discuss the CDC guidelines. Specifically I am from Dr. Porter of the alarming increase in patient suicides due to abandonment and neglect by prescribing physicians. Her response to me was they are well aware of what’s going on. I thought I would just add this as a comment
Here is the problem. AMA needs to acknowledge the chronic pain epidemic. The CDC needs to retract the initial guidelines as the data is flawed and filled with mistakes. They need a section independent of addiction on treating chronic pain. We need to stop using addiction and deoendenfy interchangeably. They are distinctly different in medical terms. People that are insulin dependent are not accused of being addicts. They are depended on insulin to control their diabetes. Many people who suffer from chronic pain have diseases that cause the chronic pain. These diseases are often poorly studied, with almost zero finding for research and poorly treated. The majority of chronic pain patients are dependent on pain medication to control pain that is disruptive to quality of life. To take away, reduce, fail to treat adequately or force patients onto less effective treatments for chronic pain is inhumane, malpractice and negligent. Other controlled drugs like Adderall/Xanaxare easier to get and requires no urine screen but is equally abused and addictive . The CDC didn’t release guidelines for those drugs. It’s all suspicious. We learned nothing during prohibition. The CDC will end up finding street hustlers, drug smugglers, and cartels. They created a customer base and made opiates a high ticket item on the streets. Guess what of those deaths the CDC quoted in their guuidlines the opiates were not obtained legally. Less that 5% of chronic pain patients misuse their meds yet we are being directly targeted by these guidelines even though the CDC states the guidelines are only suggestions and folks with chronic pain should be treated accordingly. We have already seen doctors. Pharmacist and other medical entities reducing and/or refusing to prescribe opiates citing the guidelines in which the information is seriously flawed by the CDC’s open admission! Pharmacist with no ability to obtain medical records are refusing to fill scripts based on the CDC’s guidelines. They can access folks medical records to see the laundry list of diagnosis we have but can refuse our prescriptions without verifying with the prescribing Doctor. How is this not malpractice and criminal? No one would tolerate pharmacist refusing to fill blood pressure meds, antibiotics, mental health meds but it is ok to DISCRIMINATE against 100 million people who are afflicted with chronic pain that is often a symptom of a disease, illness or injury. This is like restricting vehicle usage because some people drink and drive and leaving up to car dealers to enforce the law. The millions of dollars that will be funneled into the guidelines that WILL BE totally ineffective could be going to fund research, treatment options and cures!!!
There is only one plan of attack that the federal government and the morons from the alphabet soup group can do to curb overdose deaths and addiction.
1.) Admit that addiction is an illness and stop the encarceration of those who suffer from it and start treating them.
2.) Stop arresting and taking away the licenses of the doctors who are actually trained in treating pain and let them practice their trade so that real pain patients are using opiates under the supervision of a physician. Don’t send suffering people to the streets to self medicate.
3.) Start educating children in school of the dangers of using drugs for anything but what they are prescribed for. When I was in elementary school in the 70s, I can remember police officers coming to school and doing this exact thing. My kids never once saw them do that when they were in school.
4.) Educate the public, parents and teachers what to look for in a young person who is using. Doing this will enable all of us to get help for our kids before something really bad happens.
5.) Stop the illegal drugs before they enter our country. If the DEA would have been doing their job instead of targeting doctors, counterfeit hydrocodone pills, heroin and other illegal drugs would not be endangering the lives of the addicted and prescription refused people. People who suffer from addiction will get their fixes no matter what. As long as they have a readily available source, why would they seek help to quit using?
6.) Repeal the prohibition of Marijuana at the federal level. If Marijuana was available for the treatment of minor and acute pain, the amount of opiate prescriptions would drop drastically.
Common sense and history dictates that by prohibiting a substance causes a greater demand for it. By doing this it also creates a increase in crimes like suggling, theft and murder. It’s almost like these educated idiots that we have running our law enforcement agencies have never read a history book.
Agreed with the comments by chippy.