CARROLL: Opioid guidelines to inflict more pain
CARROLL: Opioid guidelines to inflict more painAuthor and advocate for chronic-pain patients, Dr. Richard A. Lawhern, communicates daily with thousands of pain sufferers on Facebook and other social media. What he hears is a chilling and deepening fear for the future as people in pain are increasingly being denied effective treatment by their doctors and lawmakers.
In March 2016, the U.S. Centers for Disease Control and Prevention (CDC) issued guidelines for prescribing opioids to adult, non-cancer pain patients. These guidelines have greatly worsened conditions for pain sufferers by driving doctors out of pain-management practice and forcing major cutbacks in pain treatment.
In ongoing legislative discussions in South Dakota, Dr. Chris Dietrich warned the Department of Health and Human Services that the new rules would put many pain doctors out of business and ruin the lives of thousands of pain sufferers.
Patients who have successfully managed on opioids for decades are being deserted, often without withdrawal assistance and with no access to effective alternative pain therapies. Many are becoming disabled altogether, bedridden and losing their capacity to sustain employment or family relationships. Many are committing suicide, overcome by agonies imposed on them by their physicians and irresponsible government agencies. More are turning to suicide as this crisis continues and deepens. A frightening example is the more than 30 military members who commit suicide daily.
The CDC acknowledges their recommendations for guidelines are grounded on weak medical evidence. Previous research in Food and Drug Administration and National Institutes of Health studies was ignored. The guidelines also ignore the reality of a substantial cohort of patients among whom opioid treatment is both appropriate and the only resort after the failure of all other therapies. Addiction is not a problem for these patients: Pain is a life-threatening problem.
Although opioid-related deaths are a serious public health issue in some places, relatively few deaths are caused by drugs prescribed to legitimate pain patients. Deaths come from illegally imported fentanyl, heroin, and opioids diverted by theft or fraud.
There is no recognition of variances in opioid metabolisms among pain patients. The hard limit on prescribing opioids in the guidelines is not supportable scientifically.
Worse, the guidelines parrot unproven assertions that drug tolerance is universally experienced among chronic-pain patients — the more you take the more you need. This assertion is neither true nor proven in the literature or in practice.
The guidelines were originally meant as advisory information for general practitioners, subject to tailoring for each individual patient, never as a mandatory, one-size-fits-all restrictive edict. If made mandatory, the 90 morphine equivalent, an upper limit on opioid dose levels, will effectively destroy the lives of many tens of thousands of chronic-pain patients who have maintained at higher and stable doses for years.
Now, the HHS Centers for Medicare and Medicaid propose to integrate the March 2016 CDC guidelines as mandatory standards of practice in insurance reimbursement. This must not be allowed to happen. The only ethical way forward is to withdraw the guidelines for a total rewrite, this time led by board-certified pain-management specialists and chronic-pain patients themselves.
Filed under: General Problems
That’s how you fix Obama care and health insurance problems non treatment . Theft of service so much for preexisting problems . I will be glad just not to be forced to pay for health coverage I can not use . If I could get treated for my chronic pain I will not be treated like a criminal and pee in a cup and have my medicines be known for all to see . Since when do you need a cop and a lawyer to get treatment ?