This video appears to be a video made by a parent of a 16 y/o that had back surgery and the surgery was done in the Duke University healthcare system. I had a heard a couple of years ago that Duke U had implemented a little/no opiate policy.

I can’t imagine a surgeon only willing to talk to a 16 y/o pt and won’t speak with the Mother. And according to this Mother the surgeon – or someone from the staff – would return a call after a couple of days from leaving a VM.

I suspect that if a parent – or anyone – intentionally inflicted pain or harm a child, I would expect that child protective services or cops would be looking for them… but… medical professionals seems to be exempt from being held responsible for a child being intentionally abused.

When is our society going to stop accepting/tolerating that pts being intentionally put in or left in pain without any consequences.. At least back in the 19th century, pts got a tree branch to chew on and bottle of WHISKEY.

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We opened our independent pharmacy in 1976, back then the PBM industry was a minor part of paying for prescriptions, the vast majority of prescriptions were paid by cash/check/credit card.

In the early 80’s as the DRG reimbursement was implemented in the hospital system. Basically, when a person was admitted to a hospital, the hospital was given a fixed $$$ based on the pt’s diagnose and if the hospital spent less than the budgeted $$$ they made money… if they spend more than the budgeted $$$ the hospital LOSS MONEY.

The phrase quickly coined discharged “quicker and sicker”… The need/demand for various hospital equipment for the pt recuperating at home grew dramatically.  So we began being a supplier for home medical equipment.  Providing hospital beds, wheelchairs, walkers, crutches/canes, bedside commodes and the like.

As we got requests for items we did not normally stock, we expanded into new areas including home oxygen and related respiratory equipment & supplies, Home IV’s, Enteral feedings, T.E.N.S unit and both Barb and I got certified as prosthetic and orthotic fitters. Which allowed us to provide custom fitted back braces and Jobst custom compression stockings. Eventually we expanded adding a Mastectomy Center and Barb became our master fitter/trainer for women who had breast cancer and mastectomy surgery.

We had moved from our little 1200 -1400 sq ft pharmacy to a 5000 sq ft pharmacy, home medical equipment and Mastectomy center and a off site 2800 sq ft warehouse.  We went from a one pharmacist and one full time and one part time pharmacy tech to a total staff of 18 employees.

We also moved from being primarily a cash/check/credit card business to one doing a great deal of billing to Medicare part B, Medicaid and numerous other insurance companies.  To survive, we had  to become experts in billing and dealing with all the different rules and regulations of all those various insurance entities.

During those years, we went to DC with two of national associations that we belonged to… when they had multi day legislative meetings and we would meet with our elected members of the House and the Senate to lobby them on some legislative changes that was up for discussion and changes to regulation that affected our business and the pts that we cared for.

What was pretty common is that – especially large – proposed changes would not be addressed or final posting would not happen until after Labor Day on years when there was a Federal Election.  They would finalize the proposed rules then because all 435 members of the House and 33-34 members of the Senate would be out on the CAMPAIGN TRAIL…  When the election was over the first week of Nov… Congress would come back to DC…  those that did not get re-elected would start packing their office up… those who gained seniority because of the election would start jockeying for new/better office based on their new seniority.

Before you know it… it is time for Congress’ Christmas break…  before the new Congressional session starts the first of Jan.. Then there is orientation for the new ‘freshman” members of Congress. So the bureaucrats have several months to implement their proposed regulation changes to implement… because no one in Congress is around to try to get them to intervene.

If history repeats itself, the CDC will finalize the 2022 proposed opiate dosing guidelines around Labor Day and the DEA will latch on to them and start their indoctrination of various entities that have DEA licenses to prescriber or dispense controlled meds and most likely, they will have been working on their “new standard of care and best practices” to start their intimidation of many as possible within the healthcare system… that 50 MME/day is – IN THEIR OPINION – is where a prescriber prescribing greater than 50 MME/day will constitute providing opiates outside of “valid medical need” – per the DEA’s medical expertise

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Tennessee governor won’t consider clemency for RaDonda Vaught

https://www.beckershospitalreview.com/legal-regulatory-issues/tennessee-governor-won-t-consider-clemency-for-radonda-vaught.html

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It would seems that the Federal bureaucracy gets more and more contradictory… a number of years ago our Supreme Court ruled that the 8th Amendment only applies to prisoners

Treatment for opioid addiction often brings discrimination

https://apnews.com/article/covid-business-health-opioids-discrimination-5462560a707d7c27b71ed4773d9ba82c

PHILADELPHIA (AP) — Danielle Russell was in the emergency department at an Arizona hospital last fall, sick with COVID-19, when she made the mistake of answering completely when she was asked what medications she was on.

“I said yes, I was taking methadone,” said Russell, a doctoral student who also was in recovery from heroin use. “The smart thing to do, if I wanted to be treated like a human, would be to say no.”

Even though her primary doctor had sent her to the ER, she said she was discharged swiftly without being treated and given a stack of papers about the hospital’s policies for prescribing pain medications — drugs she was not asking for.

“It becomes so absurd and the stigma against methadone especially is so strong,” she said, noting that other people in recovery have had it worse. “You’re getting blocked out from housing resources, employment.”

It’s a problem people in the addiction recovery community have dealt with for decades: On top of the stigma surrounding addiction, people who are in medical treatment for substance abuse can face additional discrimination — including in medical and legal settings that are supposed to help.

This week, the U.S. Department of Justice published new guidelines aimed at dealing with the problem: They assert that it’s illegal under the Americans with Disabilities Act to discriminate against people because they are using prescribed methadone or other medications to treat opioid use disorder.

The guidelines don’t change federal government policy, but they do offer clarification and signal that authorities are watching for discrimination in a wide range of settings. The Justice Department’s actions this year also show it’s taken an interest in the issue, reaching multiple legal settlements, filing a lawsuit and sending a warning letter alleging other violations.

One of the government’s recent settlements was with a Colorado program that helps house and employ people who are homeless. A potential client filed a complaint claiming she was denied admission because she uses buprenorphine to treat her addiction. As part of the settlement, Ready to Work is paying the woman $7,500. Stan Garnett, a lawyer for the organization, said Thursday that the organization’s staff is being trained to comply with the law.

FILE – In this Nov. 14, 2019, photo, Jon Combes holds his bottle of buprenorphine, a medicine that prevents withdrawal sickness in people trying to stop using opiates, as he prepares to take a dose in a clinic in Olympia, Wash. The U.S. Department of Justice made clear, Tuesday, April 2, 2022, that barring the use of medication treatment for opioid abuse is a violation of federal law. (AP Photo/Ted S. Warren, File)

PHILADELPHIA (AP) — Danielle Russell was in the emergency department at an Arizona hospital last fall, sick with COVID-19, when she made the mistake of answering completely when she was asked what medications she was on.

“I said yes, I was taking methadone,” said Russell, a doctoral student who also was in recovery from heroin use. “The smart thing to do, if I wanted to be treated like a human, would be to say no.”

Even though her primary doctor had sent her to the ER, she said she was discharged swiftly without being treated and given a stack of papers about the hospital’s policies for prescribing pain medications — drugs she was not asking for.

“It becomes so absurd and the stigma against methadone especially is so strong,” she said, noting that other people in recovery have had it worse. “You’re getting blocked out from housing resources, employment.”

It’s a problem people in the addiction recovery community have dealt with for decades: On top of the stigma surrounding addiction, people who are in medical treatment for substance abuse can face additional discrimination — including in medical and legal settings that are supposed to help.

This week, the U.S. Department of Justice published new guidelines aimed at dealing with the problem: They assert that it’s illegal under the Americans with Disabilities Act to discriminate against people because they are using prescribed methadone or other medications to treat opioid use disorder.

The guidelines don’t change federal government policy, but they do offer clarification and signal that authorities are watching for discrimination in a wide range of settings. The Justice Department’s actions this year also show it’s taken an interest in the issue, reaching multiple legal settlements, filing a lawsuit and sending a warning letter alleging other violations.

One of the government’s recent settlements was with a Colorado program that helps house and employ people who are homeless. A potential client filed a complaint claiming she was denied admission because she uses buprenorphine to treat her addiction. As part of the settlement, Ready to Work is paying the woman $7,500. Stan Garnett, a lawyer for the organization, said Thursday that the organization’s staff is being trained to comply with the law.

“It’s terrifying to be told by some authority — whether it’s a judge, or a child welfare official, or a skilled nursing facility — someone who has something you need is telling you you have to get off the medication that is saving your life,” said Sally Friedman, senior vice president of legal advocacy at the Legal Action Center, which uses legal challenges to try to end punitive measures for people with health conditions, including addiction.

Friedman said advocates and lawyers will cite the new guidelines when they’re making discrimination claims.

Dan Haight, president of The LCADA Way, which runs addiction treatment programs in the Cleveland area, said a suburb where they wanted to put a clinic at one point nixed the idea because of a moratorium in place on new drug counseling centers.

“We’re not looked at as another medical facility or counseling office,” Haight said. “We’re looked at because we do addiction.”

The new guidelines suggest that such broad denials could be violations of the ADA.

Overdoses from all opioids, including prescription drugs containing oxycodone, heroin and illicit laboratory-made varieties including fentanyl, have killed more than 500,000 Americans in the last two decades, and the problem has been growing only worse. That has frustrated advocates, treatment providers and public health experts who see the deaths as preventable with treatment.

Even as the crisis has deepened, there have been glimmers of hope. Drugmakers, distribution companies and pharmacy chains have announced settlements since last year to pay government entities about $35 billion over time plus provide drugs to treat addictions and reverse overdoses. Most of the money is required to be used to fight the epidemic.

It’s still to be determined how the money will be deployed, but one priority for many public health experts is expanding access to medication-based treatments, which are seen as essential to helping people recover.

But there’s still a stigma associated with the treatment programs, which use the medication naltrexone or drugs that themselves are opioids, such as methadone and buprenorphine.

Marcus Buchanan used methadone from 2016 through 2018 to help end a decadelong heroin habit. During that time, he was looking for work near his home in Chouteau, Oklahoma — mostly at factories — and could never land one.

“I can nail an interview. It would be the drug-screen process” when he’d explain why the results showed he was using methadone, said Buchanan, who is now an outreach coordinator for an opioid prevention program. “Every job, more than 20 probably, during those two years, was a door shut in the face.”

Dr. Susan Bissett, president of the nonprofit West Virginia Drug Intervention Institute, said people who are in treatment programs often hide it out of fear that they could lose their jobs.

She said she wants to reach out to business leaders and encourage them to hire and retain people who are using the medications.

“The next step is helping employers understand this is a disease instead of a moral failing,” Bissett said. “We don’t think about substance abuse disorder the way we think about diabetes, for example.”

One of the places where medication-assisted treatment is sometimes restricted or banned is in state drug diversion court programs, which are intended to get people help for addiction rather than incarcerate them.

Fewer than half the states have specific language that prohibits judges from excluding people who are taking the medications from participating in diversion programs or requires that they allow its use as part of the programs. That finding is based on an Associated Press review of legislation, administrative court orders and drug court handbooks that guide state drug diversion court programs.

Some states allow individual courts to make their own rules, while others only include language saying people can’t be excluded. Judges in some states still require defendants to taper off the medications and allow the diversion programs to decide whether the medications are appropriate for each person enrolled.

The Center for Court Innovation is trying to steer the drug courts into creating policies and programs that support people taking those medications instead of incentivizing them to stop.

“It can be frustrating, because nobody needs to tell a judge they need to allow someone to take blood pressure medication,” said Sheila McCarthy, a senior program manager for the Center for Court Innovation. “But for some, there is just a disconnect about the real effect these medications have on a person’s daily life.”

Veronica Pacheco has been off methadone for nearly a year after being on it for more than six years to treat an addiction to pain pills.

She said some people in the medical field — a physician, a dentist, a pharmacist — seemed to treat her differently after they learned she was on methadone treatment. They sometimes assume she was going to ask for new prescriptions for pain medications.

“I felt like I had a sign on my forehead saying, ‘I am a methadone person.’ The minute someone has your medical record, everything changes,” said Pacheco, who lives in the Minneapolis suburb of Dayton. “Now that I’ve been off it, I can see the night-and-day difference.”

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Some kids in pain need opioids. For doctors, that means walking a tightrope

https://www.statnews.com/2019/11/04/kids-pain-opioids-pediatricians-tightrope/

As a physician who works in a pediatric emergency department, I see the downsides of trampolines, monkey bars, coffee tables with sharp corners, and even hot soup — all common sources of children’s injuries. No matter what the trauma, many of my patients are in pain. And with all of the publicity around opioids, treating injured children’s pain has become a complicated, and often emotional, issue.

Pain can often be eased with acetaminophen or ibuprofen. But broken bones, burns, and other severe injuries that cause excruciating pain usually require something stronger, like an opioid.

In the era of opioid abuse and the overdose crisis, conversations around using medications such as morphine and fentanyl to control pain can be difficult to have with patients and parents. No one wants to become part of the grim statistics, such the 70,000 Americans dying from drug overdoses in a year or the nearly 9,000 children and adolescents who died from prescription and illicit opioid poisoning in the United States between 1999 and 2016.

Yet untreated or inadequately treated pain can harm children, both immediately and in the long term. It can also affect their development, their reactions to future painful experiences, and may cause post-traumatic stress disorder.

Since pain is a subjective experience, the best way to gauge it is by asking the person experiencing it how he or she feels. That usually works with older children, but doesn’t with infants and young children who can’t verbalize what they are feeling. For them, several behavioral scales can be used to assess and estimate pain.

Opioids work by binding to receptors in the brain that control pain and emotions. Taking opioids many times diminishes the brain’s sensitivity to the drug, making it hard to feel pleasure from anything besides the drug. That can lead to dependence and addiction. Taking a single dose to immediately control severe pain in the emergency room, and then quickly moving on to non-opioid pain control, does not cause dependence. It can temporarily depress breathing, which is why doctors determine the dose based on a child’s weight and carefully monitor his or her breathing.

My colleagues and I must walk a fine line between alleviating a patient’s pain while allaying fears and concerns of parents regarding the side effects and unclear potential for addiction from one or two doses of an opioid.

When I begin treating a child with a severe burn or broken bone, I start gearing up for the conversation about pain control, knowing I might get a response from his or her parents like, “I don’t want my child getting hooked on those drugs,” or, “Are you trying to make my child an addict by giving her those drugs?”

I usually start slowly, and say to parents something like, “It’s great you gave your child ibuprofen or acetaminophen at home, but I think she needs more than that.” Most parents know what opioids are and have opinions about them. I can see worry on their faces the second I mention the word.

Some say, “I trust your judgment.” Others immediately say no. When that happens, I suggest trying more ibuprofen or acetaminophen and seeing if that helps. If it doesn’t, I’ll once again recommend an opioid.

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As a pain specialist, I may have caused more harm by under prescribing opioids+

https://www.statnews.com/2022/04/12/underprescribing-opioids-can-also-cause-harm/

A reporter recently asked me about what harm I may have caused as a pain management physician who prescribes opioids. As I reflected on my last 10 years in this field, my response was that the harms I may have caused were because I underprescribed these drugs, not overprescribed them.

I thought of a 25-year-old patient, I’ll call him John, whose sciatic nerve was crushed in a motor vehicle accident, causing excruciating pain in his leg. We knew this would be a life-long injury, and that he would likely have to live with chronic pain.

We tried everything I could think of — nerve medications, mindfulness techniques, desensitization, rehabilitation techniques, cognitive therapy, nerve blocks, and spinal cord stimulation — except opioids. John continued to suffer immensely from the debilitating pain, and eventually died by suicide.

Did he die because I undertreated his pain due to my own fear of prescribing chronic, potentially high-dose opioids in a young patient? I cannot know, but I worry and fear that this may be true.

In 2016, the Centers for Disease Control and Prevention published prescribing guidelines for opioids. Though intended to encourage best practices in opioid prescribing, these guidelines fueled providers’ fears of opioids and led to many clinicians abandoning patients who relied on opioids for pain relief. Although even pain specialists like me share fears and doubts about what role these medications play in managing chronic pain, so-called legacy patients are not the same as those who have never taken opioids before, as a colleague and I explained in The New England Journal of Medicine.

Despite a precipitous drop in opioid prescribing since the guidelines were published, drug overdose deaths have surpassed 100,000 in the U.S. in 2020-2021. In response to the unintended consequences of its 2016 guidelines for legacy patients with chronic pain, in February 2022 the CDC proposed revised guidelines that are currently open for public comment.

To be sure, there are many ways to manage pain, and opioids should not be the first approach offered. Pain care can include exercise, physical and occupational therapy, mind-body techniques, coping skills, group support, mental health care, surgical treatment, dietary modifications, and other alternative approaches such as acupuncture and chiropractic care.

Opioids do have a place in pain control and can be safely prescribed, even at high doses, by following best practices while monitoring for risks and side effects. There is no one-size-fits-all approach to opioid therapy or pain management. The revised CDC prescribing guidelines provide a framework for these best practices and alternatives to pain care. It is now up to doctors and other prescribers, along with educators of health care students, to advance the concept of a personalized toolbox to improve the quality of life and function of people living with pain.

People with pain need to know that not treating it — especially chronic pain — is bad for the brain. The brain on pain shrinks in volume over time, but this is reversible when pain is treated.

I sometimes wonder if John would still be alive if I had prescribed opioids earlier for him. I’ll never know. But I do know that although opioids are not my first-line treatment in managing chronic pain, pain care is individualized. There is so much more to managing pain than just the drugs I can prescribe. Understandably, we may fear opioids. But doctors and patients must not be afraid of managing pain.

Antje M. Barreveld is a pain medicine physician, medical director of pain management services at Newton-Wellesley Hospital in Newton, Mass., an assistant professor of anesthesiology at Tufts University School of Medicine, and advisor for Lin Health, an online program for mind-body approaches to managing pain. The opinions expressed here are those of the author and do not necessarily reflect those of her institutions.

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This is a little 12 y/o (Jennie) that Bob Sheerin started  advocating for at Vanderbilt Hospital in Nashville… a few months ago, unfortunately she recently died from her Leukemia.  Vanderbilt is one of those DAMN  NON-OPIATE hospital corporation.  After Bob got involved, Jennie started getting some opiates to help her deal with her pain.  Here is a page from her dairy

10-2-2021 Today I met Bob. Finally my mom got one right. He got me medication that actually worked. He’s such a dork and tried making me laugh all day with dorky faces. He even went into the hospital with me and you can tell he’s in a lot of pain. He’s kind and funny and he got the doctor to do everything he said. The way he did it was funny. Mom used to ask and they would say no because it was dangerous. Bob made them believe it was their idea in such a way they thought it was. Doctors aren’t as smart as I thought. Meds are making me feel better and I was invited to Bob’s to play with his daughter. Can’t wait. Bob gave me his daughter Millys text number and she invited me to trick or treat, hope mom lets me go.

Bob is the “front man” when it comes to advocating…  I think that the doctor got a little intimidated that when Bob got a little over his head when the doctor started talking about medication therapy and Bob said that he would have to reach out to APDF’s Pharmacist…  the doc apparently asked  “you have a Pharmacist ?” and Bob replied “we have a doctor also..” So Jennie got her pain med prescription that the doc had been refusing the parents for some time.

Bob posted:  She was thrilled that Steve was on the actual phone telling doc what meds she needed lol it was like a movie star helped her

Bob shared:  her mom made me laugh as she was @Steve Ariens. Biggest fan lol She would read his blog at breakfast and wrote the government over Steve getting kicked off FB lol she messaged me 10 times to make sure he was gonna keep doing them Sweet little thing got no shot to live a full life and even got ripped off because she died in the wrong era … wow I will return with a fu#### vengeance

The really sad thing is that Bob is just now sharing this with me 🙁  I wish Bob would have shared that info with me earlier, I could have done one or more “shout outs” directed to her, might have brightened her day.

She was big into writing poems… and here is one that is undated, but given the tone .. she realized that “the end ” was near

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https://www.acsh.org/news/2022/03/01/true-story-morphine-milligram-equivalents-mme-16154

The True Story of Morphine Milligram Equivalents (MME)

By Chuck Dinerstein, MD, MBA — March 1, 2022

They are the foundation of the CDC’s 2016 opioid guidelines, resulting in legislation that limits opioid prescribing in 36 states. Morphine milligram equivalents, or MMEs, are used to set arbitrary prescribing limits for opioids by physicians, since many state legislators fail to understand – and translate into policy and law – the ‘16 guidelines. If we had all known the history of MMEs, perhaps we would not have been so eager to embrace them.

Image courtesy of qimono on Pixabay

What exactly is a Morphine Milligram Equivalent (MME)? The CDC defines it as

“The amount of milligrams of morphine an opioid dose is equal to when prescribed. Calculating MME accounts for differences in opioid drug type and strength.” [emphasis added]

MMEs are used in pain management. Clinically, to help transition patients from an ineffective treatment choice to a more effective dosage, form, or medication. Researchers have also used MMEs in attempting to standardize data on medications and prescribing habits when using varying datasets.

The Source of MMEs – Not at all what you’d think

The origin of MMEs seems to be shrouded in the mists of history. The earliest reference to comparing one opioid to another was in a 1974 JAMA article treating the acute pain of myocardial infarction, “Meperidine hydrochloride in parenterally administered doses of 75 mg provides effective analgesia of the same duration as does 10 mg of morphine sulfate.” Two months later, that view of equivalence was rebutted as

“… counter to that of standard texts and journals of pharmacology and is not consistent with our own experience. While it is accepted that the meperidine dose equivalent to 10 mg of morphine is 75 to 100 mg, duration of analgesia by meperidine may be as little as 50% that of morphine. …in chronic or sustained pain, such as occurs in malignant invasion of bones or in sickle cell crisis, the difference is readily apparent to the alert physician and nurse. It has been suggested that physicians are undertreating patients in pain.” [emphasis added]

All the hallmarks of today’s concerns were there.

• Clinical experience
• Equianalgesic dosage (the amount to provide the same level and duration of pain relief)
• The distinction between acute and chronic pain
• Undertreatment of patients in pain

The next reference I found was published in 1984, coming from a study of 38 patients receiving opioids for chronic, non-malignant pain at Memorial Sloan Kettering’s pain clinic.

“A 25-year-old man developed severe left calf pain associated with swelling and tenderness. He was admitted to hospital in June 1975, taking approximately 28 morphine equivalent mg/24 h for pain.” [emphasis added]

There was no citation. The authors relied on their expertise or some unreferenced work to draw that equivalence.

A paper in the journal Pain from 1996 begins to unravel the underlying scientific studies performed in 1936.

“The morphine dose equivalents for hydromorphone and other opioids derive from single dose studies, all of which involved intramuscular or oral administration and measured pain reduction as the therapeutic endpoint.”

But the authors settle for an even more unsettling definition, based on a 1975 paper in the journal Anaesthesiology. The use of this paper to define MMEs is nothing short of astounding:

“Subjective responses to nurse-observer questions were used to quantitate analgesia for postoperative pain. Hydromorphone is more potent than commonly believed: approximately 0.9 to 1.2 mg is equianalgesic with 10 mg of morphine, with a similar incidence of side effects.”  [emphasis added]

It is scientifically illiterate to use this subjective casual observation to form the basis of policy. Yet, this paper is used as a reference by the CDC in its 2016 Opioid Prescribing Guide.

The CDC’s MMEs – Lost in Translation

The CDC explanation of their MME conversions references this paper, Defacto Long-term Opioid Therapy for Non-Cancer Pain, so let’s take a brief look at this study.

It looked at opioid use of adults in two healthcare plans, between 1997 to 2005, reflective of their regional demographics. There is exactly one sentence in the paper that you need to pay attention to:

“The conversion factors were based on information from multiple sources. After reviewing published conversion factors, consensus was reached among two physicians with clinical experience in pain management and a pharmacist pharmacoepidemiologist.” [emphasis added]

The basis of the CDC recommendations comes down to two physicians and a pharmacoepidemiologist. Not overwhelmingly “established” science. Let’s leave those subjective MME conversions to the side for a moment and consider the researchers’ quest to identify a “threshold” to long-term opioid therapy.

In their study, the overwhelming majority of patients took them for less than a month; 80% used opioids for less than a week, 14% took opioids, on average, for only a month. Only 5.5% of the patients receiving opioids took them for longer than a year; they became the focus. In searching for even longer-term use, a possible marker of “addiction,” the researchers found that half of those patients continued therapy into the next year – they were those most likely “to continue frequent use of opioids in future years.” [1] They identified a boundary or signal that an individual’s opioid use might be problematic.

“By setting a clear boundary between acute and episodic use on the one hand, and long-term use on the other, it may be possible for physicians and health plans to establish a check point ….”

There is no mention of MMEs. The variation in the amount of MMEs prescribed or taken among that 6% was too variable [2] to be a threshold; not surprising, given the subjective nature of their calculation. The researcher’s boundary line was the duration of prescribing – a year, the point that would identify that half of the 5.5% they felt to be “at risk.” Most importantly, their boundary was a call to reconsider therapy, not a limit on MME.

Other researchers with similar studies sought their bright line defining those at risk. But quietly, the risk changed from a concern over addiction, as a threshold based on length of treatment would suggest, to a concern over the risk of “overdose.” See the difference in the focus of a 2016 review which concluded

“A clear cut-point in opioid dosage to distinguish between overdose cases and controls was not found. However, lowering the recommended dosage threshold below the 100 MME used in many recent guidelines would affect proportionately few patients not at risk for overdose while potentially benefitting many of those at risk for overdose.”

Somewhere along the way, lost in translation, the concern of addiction morphed to concern over overdose. Despite a lack of “a clear cut-point in opioid dosage,” MMEs replaced fuzziness with pseudo-certainty.

If the ambiguity of what a threshold MME means is insufficient, MME suffers from two additional problems: its calculation and what is being measured. Topics we will address another day.

[1] This does not answer the question of whether their chronic pain had been adequately managed or whether some form of “addiction” or misuse was present.

[2] Among that 6%, there was a greater than 2-fold difference in prescribed amounts and a nearly 4-fold difference in amounts consumed.

Have you ever noticed that “they” always state that non-opiates are “very effective” in treating just about any/all pain, but NO ONE has seemed to use the processes that was originally used to develop the MME’s for all opiates… the basics behind the MME system is – in theory – to compare different “pain meds” ..  but .. apparently no one bothered to include non-opiates when making the MME system comparisons.  Motrin was first marketed in 1975 & Naprosyn was first marketed in 1976 and Aspirin & Tylenol has been around “forever”..

Does anyone, other than me, find it strange that NO ONE has bothered to include these “pain meds ” in the MME system, unless “they” know that the MME ratios would be so pathetic that no medical professional would even consider “prescribing” or recommend a pt taking them for pain.  Not to mention the potential liver and kidney damage that these non-opiates can cause.

Tomorrow is the last day to make a comment on the proposed 2022 CDC opiate dosing guidelines. Should everyone be concerned that the “experts” behind the 2016 & 2022 CDC opiate dosing guidelines were based on and around the MME system that those experts knew or should have known that the MME system was based on NOTHING IN SCIENCE nor any double blind clinical studies.

Here is the link to CDC comment page on the proposed 2022 opiate dosing guidelines https://www.regulations.gov/commenton/CDC-2022-0024-0001  all everyone needs to do is copy the hyperlink to the article  https://www.acsh.org/news/2022/03/01/true-story-morphine-milligram-equivalents-mme-16154 and I suggest that you copy/paste the text of the article as well..  Just request that the CDC rescind/revoke the 2016 guideline and withdrawal the 2022 guidelines…  because both are based on a MME system that has no science and/or double blind clinical studies behind them and in support of them.  You can make comments anonymously !

 

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