America’s problem with managing chronic pain and the addiction crisis
https://www.axios.com/2023/04/21/americas-problem-chronic-pain-addiction-crisis
The Food and Drug Administration’s attempts to manage the overdose crisis by reining in on the use of narcotics are weighing on patients with chronic pain, who say the result has been harder-to-fill prescriptions and heightened withdrawal and suicide risks.
The big picture: The FDA for years grappled with criticism it helped fuel the opioid epidemic by approving products like OxyContin and a tablet 1,000 times more powerful than morphine.
- Now, patient groups are concerned the agency is proposing a large study of opioids’ long-term effectiveness in treating chronic pain without enough of their input.
- Addiction experts say its clinical trial design could be tilted toward benefiting manufacturers.
- And while the FDA has encouraged the development of alternative pain control methods, safety concerns and insurer resistance to covering them have hindered adoption.
- The result is more opioids have been approved in the last five years than non-opioid options.
Driving the news: FDA outside advisers this week slammed the agency’s proposal and, without a vote, recommended the agency reconsider pursuing the study.
- Pain care specialists criticized how the plan wouldn’t address addiction potential or improve care for the millions of Americans managing chronic pain.
- The National Council of Independent Living, a disability rights organization, also noted that these decisions are being made and discussed without patients involved.
- The nine-hour meeting on Wednesday came a week after the FDA announced it’s now requiring both instant and extended-release opioid pain medicines to carry warnings about overdose risk and potential for increased sensitivity to pain.
Details: The study’s design would have participants shifted from prescription opioids to extended-release morphine while a randomly selected group would be switched to a placebo without being told.
- There would then be an eight-week period where the placebo group would be weaned off opioids — a factor agency officials acknowledged could result in high dropout rates and challenges in recruitment.
- Diana Zuckerman, president of the National Center for Health Research, questioned the ethics behind the FDA’s proposal during public comment, saying that, “In addition to withdrawal, won’t that potentially make them even more desperate and more reliant on opioids?”
- Andrew Kolodny, medical director of the Opioid Policy Research Collaborative, asked why administering non-opioid alternatives wasn’t considered.
- “Wasn’t it the practice of switching patients from [instant release] opioids to [extended release] opioids what got us into this mess in the first place?”
Between the lines: A crackdown on opioid prescribing hasn’t stopped overdoses from rising in recent years as the epidemic becomes defined more by fentanyl-laced counterfeit pills than painkillers prescribed in clinical settings.
- But some chronic pain patients say the agency’s latest moves have made physicians more likely to deny needed pain relief out of fear of regulatory scrutiny.
- In an online public comment, Earenya Chapman wrote that “this has left patients with no alternative but to suffer in silence.”
- The policies to limit prescribing have also led to “life-altering harms” including overdose, unemployment and death, said Theo Braddy, executive director of the National Council of Independent Living.
- Some studies have found chronic patients may have an elevated suicide risk following discontinuation of opioid therapy.
The bottom line: The U.S. continues to grapple with how to slow the addiction crisis while helping millions of Americans with conditions causing chronic pain, leaving both public health issues at risk of getting worse.
Filed under: General Problems
JMO,, what they have done,,is made ,”torture in the healcare setting,,” legal,,By forcible COMBINING addiction with the medical use of the MEDCNE opiates,they literally have made torture legal,,,,Every psycho-path on earth now is going to claim,,in fear of addiction,i let that cancer patient die in agony,,Because of fear of addiction i let that victim of pancreatits suffer till death takes them.They literally have brought PERSONAL psychiatric opinion into a medical decision,,It need to go back to 2 separate entities,,The medically ill in physical pain and those who claim addiction/addicts….For forcible combing the 2,,enforcing that FORCED combination via the policing of the DEA via the cdc guidelines,,ARRESTING ANY DOCTORS WHOM CHOSE HUMANE CARE,it has forced those in physical pain from ANY medical condition to forcible suffer in agony,and thats NOT HUMANE ,,thats torture in the healthcare setting.Go back to the definition of addiction that stood for 50 years+++,,ie,,”taking ANY medicine for non-medical reasons/purposes,”,,In by doing so,,it takes the prejudicial opinion of addiction out of the decision.making process.It take the ability for anyone to make the decision to torture someone out of the decision making process.Its a simple definition and IT WORKED,, FOR DECADES,,,look at the mess they have created by FORCIBLE combining mental w/medical for alll adults,,its killed people,,its tortured people,,and as a HUMAN
society ,were suppose to be HUMANE,, not act like animals who have no choice in the wild but suffer thru injuries/diseases,,,,jmo,maryw
When are they finally going to realize that the only Rx opioid crisis exists in realm of finding pain management, thanks to the screeching mouths of opioid prohibtionists, like the illustrious Mr. Kolonoscopy himself? As far as I’m concerned, he has entirely discredited himself as a purported “expert”, seeing as he has zero experience in managing pain and holds blatantly obvious biases against Rx opioids, doctors who continue to prescribe them and perhaps least fathomable and most damning of all, chronic pain sufferers. He would love to see us all on the very same “alternative therapies” that failed to provide any semblance of pain relief for the vast majority of pain sufferers to begin with. It’s particularly aggravating that he seems to like to push the patently false notion that both patients and our doctors completely skipped over that step and jumped straight to opioid pain medications to treat pain. I’ve been closely paying attention to his trumpeting mouth since 2016 and have come to the conclusion that it’s safe to say if his mouth is open, excrement is falling out of it. If anyone outside of our circle REALLY wants to know how it’s become what it has for chronic pain sufferers, with the lack of treatment, wide spread cut offs, forced tapers across the board, vilification of physicians, unwarranted accusations of perpetuating the “epidemic”, pressures to deny pain relief under very real threat of prosecution due to the door being kicked wide open in that regard, and pretty much every other element that is now preventing access to proper and adequate treatment of significant, life altering pain, they need look no further than the man himself and the cohort of head nodding comrades that surround him like a gaggle of white coats, blurting out, “I CONCUR!” on repeat. It was his factually deficient opinions on opioids, and those of the likeminded, that drove the bus over us and our doctors, making sure to hit us with every wheel, since day 1. The man’s enormous ego won’t allow him to let anyone forget that he has opinions on Rx opioids, as well as every related topic, to which the media so graciously never fails to indulge him over. In case you can’t tell, I have been able to find no evidence based use for the man. It’s almost as if he exists solely to spit in the faces of anyone involved with chronic pain and the treatment thereof. Of course, as one of his countless victims, I may be a little biased myself. I am also well aware that he isn’t the only culpable party in all of this, in the interest of fairness. He’s just the only one that has consistently made himself the most high visibility, never leaving home without his soapbox, bullhorn and flapping mouth, gushing with falsehoods that support his preferred narrative created of his own malignant, pigheaded views on these topics. So in my opinion, since he played an unmistakable role in leading the campaign against the effective treatment of chronic pain, he gets the lion’s share of the blame. It’s pretty simple. I have to wonder if we would’ve ever gotten this far without his self serving propensity to insert himself into every little aspect. Someone else may have stepped up to the task, certainly. But if I’m being honest, and I am, then I can’t help but think it may not have gotten this bad without his “brilliant” contributions. Perhaps the immeasurable dislike I have for the man, which has consequently curated a full range of negative responses in me when I see his name, has caused me to be overly critical in my opinion of him. Nah, I think I’m pretty spot on. May the light of truth one day shine on the lies he’s spun in the darkness and cause them to scatter like cockroaches!
I am one of these people who go through this and it is ridiculous that since I changed doctors for no fault of mine my pain is worse. Doctors should take care of me and not people in office who want to dictate what they want, I was better off before I changed but he moved his location and it was to far from where I live, so now I am screwed dealing with more pain, YAY. Don’t move any if you have a good