Is Suicide a Consequence of the CDC Opioid Guideline?
By Lynn R. Webster, MD
The law of unintended consequences states that the actions of people, and especially of governments, always have effects that are unanticipated, as when legislation and regulation aimed at righting a problem go wrong in other ways (Unintended consequences. http://tinyurl.com/?8p8g). An example may be the guideline issued by the Centers for Disease Control and Prevention (CDC) discouraging the use of opioids in treating chronic pain, excluding cancer and end of life (MMWR Recomm Rep 2016;65:1-49).The guideline was not intended to be mandatory; yet, as I predicted in a previous roundtable discussion, the stature of the CDC appears to have resulted in it being viewed by many as more than a guideline (“Draft CDC Opioid Guideline: Pain Medicine Experts Discuss,” Pain Medicine News January/February 2016). A growing number of reports suggest that the guideline is responsible for people with chronic pain throughout the country being tapered or withdrawn from opioids or dropped entirely from physicians’ practices, even if the patients have been on stable doses of opioids for years with attendant improved pain and quality of life (Chronic pain patients are suffering because of the US government’s ongoing War on Drugs. Quartz. http://qz.com/?694616).
Pain News Network reports that dozens of patients have contacted the editor since March, when the guideline was made public, to say that their doctors have “fired” them on flimsy excuses, or that their doctors suddenly are weaning them off opioids or abruptly cutting them off from the medications (Are CDC Opioid Guidelines Causing More Suicides? Pain News Network May 27, 2016).
Worse is that some patients are so despondent and in so much pain that they have given up and looked to suicide as a way out. As Pain News Network reports, nearly 43,000 Americans committed suicide in 2014, more than twice the number of deaths that have been linked to overdoses of opioid pain medications. Anecdotal reports that chronic pain contributes greatly must not be dismissed. I am certain this is not a consequence intended or anticipated by the CDC, but tragically it is playing out.
‘Everyone Has a Breaking Point’
The following are passages from a message I received from a person in pain, in response to one of my blogs. (They have been edited for clarity.)
“After this Easter, my life turned off a cliff and nosedived. My best friend in the world, who suffered with chronic pain, checked out because he was tired of living with pain, doctors and judgment. He was just tired of it all. So many people are disgusted with the CDC’s guidelines—as am I—as they cast far too wide of a net and caught a lot of innocent victims in it.”
This man, a veteran, goes on to write of his personal involvement and knowledge of the opioid crisis as a sufferer of chronic pain and father who lost a 21-year-old daughter to—as he puts it—“the OxyContin Express that roared through Florida.”
“Persons in power too often see the world in black and white. They forget there is a gray area where most of us live—reality.”
The Department of Veterans Affairs is adopting the guideline, which was written to be voluntary, “as law,” he writes, “ripping 12-year–compliant patients off meds.” He is one of those patients with many years of passed urine drug screens and prescription drug monitoring checks behind him.
“This is the kind of foolishness that pushed my pal to the point he felt backed in a corner, put a gun to his chest, and pulled the trigger. I knew this man 35 years. … Everyone has a breaking point.”
This friend had shared his fears of having his treatment taken away.
“He asked me if I would forgive him if he took his own life. I told him I would. This has been a heavy burden to carry. But loving someone unconditionally comes with a heavy load.”
Now 58, the man who wrote this letter said he flinches now when he hears of anyone taking his or her life due to untreated pain. Further, he is steeling himself to deal with his own pain issues as changes to his medical treatment appear inevitable and also—as he puts it—impersonal.
“So now at 58 years old, here we go again. … The way my medical conditions were being treated for the past 12 years was about to change. … I’m no doctor, no pharmacist, no rocket scientist, but even I know you can’t do that to a human being without reprisal. So here I am picking up the pieces. I hope and pray others make it through the changes OK. I hope I make it OK.” Making it through is all he wants.
Innocent Victims
Undeniably, the country is experiencing a serious opioid crisis, which must be addressed. However, the steps to reverse the opioid crisis should not cause greater harm to the innocent and those hurting the most in our society. Our politicians and policymakers must be advised that their actions have unintended consequences. If the unintended consequences of the guideline cause greater harm than the intended positive consequences, then the only rational and compassionate path forward is to change the focus and direction. Perhaps it is time to recognize the needs of people in pain with an urgency equal to that for people with opioid addictions.
Filed under: General Problems
It’s a result of malpractice
Suicide, the CDC, denial of adequate and authentic opiate pain medication, Absolutely a fast-track to suicide. I guarantee you, that the same “pain protocol” does not exist for those in the upper “hierarchy”
Do not be fooled or disillusioned, the study of torture, powerlessness, the human brain and nervous system are very well known in this year of 2016.
The more people who are debilitated, the more who can’t resist and protest, the easier it is for us to lose our most sacred of human rights. The only way I can grasp this, is to believe that those maling these sadistic decisions ARE NOT HUMAN. Or else there would be genuine compassion, and positive human regard for ones neighbor.
I am disgusted with the over-abused word “ADDICT”….[what does this word really mean anyway ?]
I have more love and compassion for a person labeled an “addict”-than I do sadistic and dangerous sociopaths; of which we have too many leading the country.
We must be BRAINWASHED to even consider where these brutal, torturous, and inhumane ideas and practices have brought us.
WE are in an EMERGENCY !!! One which requires a HIGHER COURT OF GOD. All medicinal plants, herbs, and means are on this earth for a reason. Not to have the drug companies and politicians play executioner with our families and all those we love.
This is nothing more than the horrific abuse and betrayal of those “we” put in power.
speaktruthweb, you nailed it!
I fear that even if they call off this stupidity those of us who have either had our medication severely cut or completely taken away will have to start all over with all the things that didn’t work before,hopefully, we get our medication back to where it was. Also the damage done to us, both physically and emotionally, cannot be undone.
Well dahhhhhhhhhhhhhhh,,,,seriously,,,,I don’t mean to be soo brash but come on Doc,,,,,where is your BASIC understanding of basic humanity??Nooo normal humanbeing would want to live the rest of their life in FORCED PHYSICAL PAIN,,,,ITS JUST NOT NATURALLY NORMAL!!!!I would think that u would already know,,that it is impossible for another man to physically feel the physical pain of another..Thus,,NO-ONE has thee rite to decide who suffers in physical pain and who does not…Its called arrogance to think u have thee rite to decide who suffers in physical pain and who does not,,for it truly is a impossibility to physically feel the pain of another..As a so-called HUMANE society thee only correct answer is to lessen that physical pain of another thru what=ever means works for them,,,not what works for u?!.
Sorry to disagree w/u but this is/was NOT unintended consequences!!We warned them,,,over 4,000 times,,,u put these guidelines in,,u forced the rescheduling down our throats too,,,there will be more ,”suicides ,” as u define it..For us chronic pain humanbeings its not suicide,,,,People whom commit suicide want their life to end,,,We chronic pain people just want our physical pain to end,,,not our lives,,,but we have been forced into such DESPOTISM by our own government by taking away thee only medicines that lessen’d our physical pain,,,that thee only way we can stop our physical pain is thru death…We want to live,,,,but not in constant FORCED physical pain,,,again,,,we warned them,,,and THEY DID IT ANYWAYS!!Why do u think the U.N calls what has happen’d to us TORTURE AND GENOCIDE!!I THINK YOUR MISSING THE BOAT HERE DOC,,,,,,THIS WAS NEVER A UNINTENDED CONSEQUENCE,,,,,”THEY FULLY WERE AWARE WHAT THEIR ACTIONS WOULD CAUSE,,,,DEATH TO ALL CHRONIC PAIN PEOPLE WHO MEDICINES HAVE FORCIBLE TAKEN OR LESSEN’D TO INEFFECTIVE DOSAGE,,,,Ask any patient,,they will tell u the same,,,they told their doctors,,,u take away my meds,,,im dead,,there was NOTHING unintended about,,,
The klondyns,,freidmens,,and ur government has once again created the Pennhursts of thee year 2000…..where the crippled,medically ill w/painful medical condition are forced into warehouses w/no effective medicines,as guinie pigs,and force to suffer in physical pain…The player may have changed,,but thee ideology is the same,with the sam4e consequences,,,forced endurement of physical pain..U give klondyn long enough,,he’ll be doing lobotomies on alll of,us,,now that HE claims he has located the part of the brain responsible for physical pain and heroin abuse are 1 in the same,,,,,he’s the true definition of a psychopath,,,Thank god,,1 of his comrades in arms has quit the cdc,,,only to moist likely re-open another PENNHURST somewhere,,,,paid for by our government,OUR DIME,AGAIN..See someone has gotta set-up 41 million dollars worth of our tax dollars just funded for ,”addiction centers,” don’t they!!!!maryw