VA to Adopt CDC Opioid Guidelines
http://www.painnewsnetwork.org/stories/2015/12/21/va-to-adopt-cdc-opioid-guidelines
By Pat Anson, Editor
The massive $1.1 trillion spending bill passed by Congress and signed into law by President Obama last week contains an early Christmas present for the nation’s veterans.
Or it could be a lump of coal — depending on your view about opioid pain medication.
Buried in the 2,009 page document is a provision requiring the Veteran’s Administration to implement a number of measures to stop the “overdose epidemic” among veterans, including adoption of the controversial opioid prescribing guidelines being developed by the Centers for Disease Control and Prevention (CDC).
Those guidelines, which discourage primary care physicians from prescribing opioids for chronic pain, have now become official government policy at a federal agency before they’re even finalized.
“To address mounting concerns about prescription drug abuse and an overdose epidemic among veterans, the bill directs VA to adopt the opioid prescribing guidelines developed by the Centers of Disease Control; to develop IT systems to track and monitor opioid prescriptions; to ensure all VA medical facilities are equipped with opioid receptor antagonists to treat drug overdoses; and to provide additional training to medical personnel who prescribe controlled substances,” Sen. Barbara Mikulski (D-Maryland), Vice Chairwoman of the Senate Appropriations Committee, said in a summary of the omnibus bill sent to colleagues.
The VA was also instructed to report to Congress within 90 days on alternative treatments to opioids, as well as “how VA can better facilitate the use of safe and effective complementary and integrative health therapies for pain management.”
The CDC, which recently delayed implementation of the opioid guidelines after widespread criticism from patients and advocacy groups, has repeatedly said the guidelines are “voluntary” and not intended for anyone other than primary care physicians.
But adoption of the guidelines by a federal agency that provides health care services to over 6 million patients is an early sign they will have a much broader impact, voluntary or not. Critics have warned that state regulators, licensing boards and professional medical societies could also adopt the CDC’s guidelines, which would likely have a chilling effect on all doctors who prescribe opioids.
“This is disturbing. It doesn’t help solve the opioid problem by codifying low evidence or no evidence recommendations,” said Lynn Webster, MD, past president of the American Academy of Pain Medicine.
“The opioid crisis is serious, requiring thoughtful interventions that are evidence based. There are many evidence based recommendations that could be promulgated but have been ignored. I am very concerned that the soldiers who have sacrificed so much are not going to receive the treatment they deserve.”
According to an Inspector General’s study, more than half of the veterans being treated at the VA experience chronic pain, as well as other conditions that contribute to it, such as post-traumatic stress disorder. Because veterans are at high risk of opioid abuse and overdose, the VA implemented the Opioid Safety Initiative in 2013 to discourage its doctors from prescribing the drugs. The number of veterans prescribed opioids fell by 110,000, but alarms were raised when some vets turned to street drugs or suicide to stop their pain.
“Veterans are now required to see a prescriber every 30 days, but at the El Paso VA, they are unable to get an appointment, so they go without, or they do something they shouldn’t — they buy them on the street,” Rep. Beto O’Rourke, (D-Texas), told Military Times. “At a minimum, these veterans are suffering and in some cases, I would connect that suffering to suicide.”
Several veterans have written to Pain News Network recently about their difficulty obtaining opioids from the VA for their chronic pain.
“The VA will only prescribe 10 mg oxycodone 3 times a day. This gives me no relief at all and now I’m very worried about what may come next,” wrote an Army veteran with diabetic nerve pain who had a toe amputated. “When I asked to have this increased my VA PC (primary care) doc raised my gabapentin script and says if that doesn’t work for my increased pain levels we may try Lyrica next . He ignores my statement that 15 mg of Oxy works in reducing my pain by 30%”
“After taking opiate pain meds for nearly 15 years, the VA has now decided to take them away. I had a decent life while on these, and now they have cut them in half, I am in constant pain. I wish some of these people that make these stupid decisions had to live like I do,” a Vietnam veteran who had a leg amputated above the knee wrote to PNN.
“The pain meds allowed me to have some semblance of a normal life. Now that is gone. I don’t know what I am going to do. I can understand now why vets turn to alcohol and other street drugs, because you have to do something to take the edge off this constant pain. But do they care? Not one whit. They practically throw this stuff at you when I first started going, now it is up to me to figure out how I am going to make it without any of it.”
The federal spending bill provides $7.2 billion in funding for the CDC, which is $278 million more than last year. That includes $70 million to support state efforts to address prescription opioid abuse – more than triple the amount included in last year’s bill.
The bill also provides $3.8 billion to the Substance Abuse and Mental Health Services Administration (SAMHSA), which is $160 million more than last year. Nearly $50 million is directed to address the “epidemic” of prescription drug and heroin overdose, $25 million is for addiction treatment in high-risk states, $12 million for naloxone distribution in 10 states; and $10 million for drug abuse prevention efforts in up to 20 states.
Filed under: General Problems
The primary problem identified with the CDC’s Guidelines is in their treating chronic pain patients like addicts rather than following them with continuing care which they need. Since the CDC rushed the initial Guidelines through without representation, Congress has demanded a thirty day opportunity for involved parties to offer feedback, and asked the CDC to supply information on why they did not meet criteria on their advisors (who were primarily from PROP, a physician group specializing in addiction, rather than all specialties which should have represented the patients being affected by this sweeping document) all other governmental groups must meet.
These Veterans deserve better care than they are being given and if are to be treated based on any guidelines, should only be treated based on the FINAL document the rest of the country will have to go by, not this flawed unbalanced self-serving document which was already rejected by the NIH.
Thank you for reading.
This is all just an increase in the activity that has already been taking place. When I say that things are going to get worse, even without the CDC’s new regulations, this is what I mean.
And Dr. Webster says that he is “concerned that the soldiers who have sacrificed so much are not going to receive the treatment they deserve”? Sounds like he’s living in the past, as vets (worker’s comp patients, and those on Medicaid) were the first line of victims in the opioid war.
The VA and state governments have created new pain “clinics” with federal dollars, but they’re really drug addiction clinics. And just like the Mayo Clinic at Duke (mentioned as a center of excellence in one of the comments), these clinics pretend like they are successful. Yet, many of the pain patients who are treated at these clinics say otherwise.