Doug Hughes: As nation cracks down on pill abuse, chronic pain sufferers left to die

Posted on August 18, 2018 by Pharmaciststeve

Doug Hughes: As nation cracks down on pill abuse, chronic pain sufferers left to die

https://www.wvgazettemail.com/opinion/gazette_opinion/op_ed_commentaries/doug-hughes-as-nation-cracks-down-on-pill-abuse-chronic/article_3a6fcd7d-8776-59e9-b8da-d352caa3fba4.html

I have had Chronic Intractable Pain Syndrome for 29 years. For 23 years, I was treated to a functional ability level. Twenty-nine years with no aberrant behavior. I have seen what has gone on, and I need some answers.

When the Centers for Disease Control issued its “Alert” around 2012 that advised doctors to be careful in treating anxiety, sleep disorders, PTSD and depression simultaneously with pain medications, did they think that the embattled pain clinic physicians (the specialists for the complex treatment of Chronic Intractable Pain Syndrome) would do nothing short of stopping all such co-morbid treatment?

The CDC already know that Chronic Intractable Pain Syndrome is co-morbid with these conditions and anything that Valium helps. How many sufferers did that harm? Do they care?

When the Drug Enforcement Agency first forced pain clinics to severely cut pain treatment to all patients, from 2010 to 2016, did anyone think for one moment that it would force legitimate sufferers into low-dose medications?

Did the CDC turn an eye when someone mentioned the most severely injured disabled people in the nation were also having to endure the egregious suffering of under-treatment, souls who were mangled in a car wreck, or crushed in a coal mine, like me?

Did the CDC even flinch when the overdose deaths increased shortly after each pain clinic’s closure? Does anyone care, even a little?

The CDC noted West Virginia as the “Opioid Epidemic’s Epicenter,” but was there any difference between West Virginia and the rest of the nation?

West Virginia leads the nation for decades with the most industrial injuries that caused Chronic Intractable Pain Syndrome. However, the last pain clinic in West Virginia was closed by the DEA on Feb. 22, 2018.

How many people with Chronic Intractable Pain Syndrome with no treatment were forced into self-medicating with street drugs? How many into suicide? Can you say “epicenter”? Is it just apathy?

The DEA cut treatment at all pain clinics, then closed almost all pain clinics and the death rates accelerated. The death rates were accelerated higher by the DEA, and they blamed it on the opioid epidemic.

The CDC issued the 2016 “Guidelines for Prescribing Opioids for Chronic Pain.” What result did they plan by having all “drug control professionals” on that panel? Why did the range of opinions result in the rigid limit of 120 morphine milligram equivalent?

If they had done any research, surely they had to know that patients leaving pain clinic treatment had been consumed by the opioid epidemic. Did the forced under-treatment to the point of suicide not keep anyone up even one night?

The CDC’s last words in the draft Guideline said that “it was in most cases.” Why then, did they issue it without accommodations for legitimate patients of Chronic Intractable Pain Syndrome, patients who had been treated for decades like me, and had never become addicted?

A 2017 study by a WVU professor and an international panel found that suicide deaths in the nation increased 34 percent between 2000 and 2016. They said the type of suicides studied were drug-related suicides that could have been as much as 75 percent listed as “undetermined deaths.” Why was that study not followed up on?

Medicare sent a letter in January 2018 to all doctors treating with “high dose opioid pain medications.” How could anyone know what high doses are, when any of the outstanding chronic pain physicians have been destroyed?

Doctors will not lose their approved Medicare Provider Status by going above the guideline of 120 morphine milligram equivalent (MME).

Did causing a few hundred thousand suicides or overdose deaths of the most disabled in the nation feel good? Did Medicare’s most costly group for lifetime expenditures get decimated? Did someone get credit for service to the fiduciary concerns of Medicare?

Anatomical and physiological diversification among individuals makes standardized treatment for Chronic Intractable Pain Syndrome sufferers a great placebo for those who do not have it. Has “ignorance become confidence,” as the saying goes?

Now with Medicare standardizing pain treatment at the worst estimate of 90 MME on Jan. 1, 2019, will the CDC tell us the limit applies “in most cases,” or will the CDC keep letting people die?

Has anyone been to any funerals for former pain clinic patients who suffered from Chronic Intractable Pain Syndrome and who passed away suddenly?

Is the widespread suffering and dying of the most disabled in the nation a situation to be proud of?

Doug Hughes, of Logan, is a former coal miner and retired from the DEP.

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Chronic Pain Survey Reopened

Posted on August 18, 2018 by Pharmaciststeve

Chronic Pain Survey Reopened

www.nationalpainreport.com/chronic-pain-survey-reopened-8837011.html

By Ed Coghlan.

In a week when the DEA announced it is going further reduce the supply of opioids in 2019, a leading chronic pain activist has reopened her survey of chronic pain patients.

Dr. Terri Lewis pointed that while the argument continues to rage between those who want to strangle the supply of opioids and those who argue that only chronic pain patients are being hurt by the reduced supply, no one is really is talking to or about chronic pain patients.

Her survey, which already has attracted more than 2,000 respondents from across the country, is designed to hear what is happening to the chronic pain patients (and their families) in this war on opioids.

“We are finding out that many people are being negatively impacted in this opioid controversy,” she said. “The results of reducing supply are not reducing opioid overdoses or even deaths from overdoses, but it does seem to be hurting chronic pain patients who use the opioid therapy to manage their conditions.”

Need More Rural Response

Dr. Lewis pointed out that she is trying to get at least 30 respondents from each of the 50 states and has mostly attained that goal. Thus far, only rural states like Montana, Wyoming, the Dakotas, Kansas and Nebraska are under the 30 response minimum, so if you live in those states in particular, we urge you to fill out survey.

Here’s a link to the survey.

“We’ve been developing some interesting in-state data that we are sharing with state leaders and chronic pain advocates which can help them make the case that the states need to create their own pain policies that have patients in mind,” she said.

Meanwhile, the DEA is continuing its efforts to restrict access to more commonly prescribed schedule II opioids, including oxycodone, hydrocodone, oxymorphone, hydromorphone, morphine, and fentanyl.

“We’ve lost too many lives to the opioid epidemic and families and communities suffer tragic consequences every day,” said DEA Acting Administrator Uttam Dhillon. “This significant drop in prescriptions by doctors and DEA’s production quota adjustment will continue to reduce the amounts of drugs available for illicit diversion and abuse while ensuring that patients will continue to have access to proper medicine.”
Reducing supply is beginning to reveal the consequences of current regulatory approaches.  Hospitals increasingly report shortages of essential opioids and are resorting to the rationing surgeries, replacing standby medications with less effective alternatives, and implementation of opioid sparing regimens. A recent survey by the American Society of Anesthesiologists (ASA) survey found that 95 percent of those who responded reported that shortages have affected the way they treat their patients.
The top five opioid medications in the shortest supply are hydromorphone(Dilaudid), fentanyl and morphine, the local anesthetic bupivacaine, and the lifesaving allergy drug epinephrine.  Recent efforts by the federal government to curb the opioid crisis — by cutting back on the raw materials used to make opioids — may partly explain why.  Another factor is the delay of production capacity for drug manufacturing plants located in Puerto Rico. 
Notably, many states are reporting that prescriptions are decreasing, overdoses and suicides are increasing, and the drug most correlated to overdoses are heroin and carfentanyl, both imported from abroad.

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Trump administration proposes production quota cuts for six opioids

Posted on August 17, 2018 by Pharmaciststeve

Trump administration proposes production quota cuts for six opioids

https://www.reuters.com/article/us-usa-opioid-manufacturing/trump-administration-proposes-production-quota-cuts-for-six-opioids-idUSKBN1L11XD

WASHINGTON/NEW YORK (Reuters) – The Trump administration on Thursday proposed that U.S. drugmakers cut production quotas of the six most abused opioids by 10 percent next year to fight a nationwide addiction crisis.

In a statement, the U.S. Justice Department and Drug Enforcement Administration (DEA) said the proposed cut would be in keeping with President Donald Trump’s effort to cut opioid prescription fills by one-third within three years.

Trump on Thursday also pressed U.S. Attorney General Jeff Sessions to sue drug manufacturers over the opioid crisis.

“I’d like to bring a federal lawsuit against those companies,” Trump said during a meeting of his Cabinet at the White House. He did not name the companies.

Addiction to opioids – mainly prescription painkillers, heroin and fentanyl – is a growing U.S. problem, especially in rural areas. According to the Centers for Disease Control and Prevention, opioids were involved in more than 49,000 deaths in the country last year.

The Justice Department and the DEA said they are proposing to cut production quotas for oxycodone, hydrocodone, oxymorphone, hydromorphone, morphine, and fentanyl by 7 percent to 15 percent, depending on the compound, in 2019.

Hundreds of lawsuits have been filed by states, counties and cities against opioid manufacturers including Purdue Pharmaceuticals LP, Endo International Plc (ENDP.O), Mallinckrodt Plc (MNK.N) and Johnson & Johnson (JNJ.N) seeking to hold them responsible for contributing to the epidemic.

Endo International PLC15.64
ENDP.ONasdaq
-0.31(-1.94%)
ENDP.O
  • ENDP.O
  • MNK.N
  • JNJ.N

Those companies were not immediately available for comment.

In March, Trump unveiled a plan to get tough on opioids, including cutting opioid prescriptions by changing federal programs, funding for other initiatives and stiffer sentencing laws for drug dealers.

He also suggested the death penalty for dealers, a proposal that has gained little support from drug abuse and judicial experts.

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DEA Wants More Marijuana Grown And Fewer Opioids Produced In 2019. Really.

Posted on August 17, 2018 by Pharmaciststeve

DEA Wants More Marijuana Grown And Fewer Opioids Produced In 2019. Really.

https://www.forbes.com/sites/tomangell/2018/08/16/dea-wants-more-marijuana-grown-and-fewer-opioids-produced-in-2019-really/#7359782214cb

The Drug Enforcement Administration (DEA) isn’t exactly known as big fan of marijuana. But in a new Federal Register filing set to be published soon, the anti-drug agency is moving to more than quintuple the amount of cannabis that can legally be grown in the U.S. for research purposes—from roughly 1,000 pounds in 2018 to more than 5,400 pounds next year.

MUJAHID SAFODIEN/AFP/Getty Images

At the same time, DEA is also pushing to reduce the amount of certain opioid drugs—such as oxycodone, hydrocodone, morphine, fentanyl and others—that are produced in the U.S.

“We’ve lost too many lives to the opioid epidemic and families and communities suffer tragic consequences every day,” DEA Acting Administrator Uttam Dhillon said in a press release. “This significant drop in prescriptions by doctors and DEA’s production quota adjustment will continue to reduce the amount of drugs available for illicit diversion and abuse while ensuring that patients will continue to have access to proper medicine.”

U.S. Attorney General Jeff Sessions, a longtime opponent of marijuana legalization, added that “the opioid epidemic that we are facing today is the worst drug crisis in American history… Cutting opioid production quotas by an average of ten percent next year will help us continue that progress and make it harder to divert these drugs for abuse.”

The proposed quotas for cannabis and other drugs “reflects the total amount of controlled substances necessary to meet the country’s medical, scientific, research, industrial, and export needs for the year and for the establishment and maintenance of reserve stocks,” DEA said.

The 2,450,000 grams of marijuana the narcotics agency wants grown in the country in 2019 is a significant bump up from the 443,680 grams the agency authorized for 2018.

In addition to the huge increase in marijuana cultivation, DEA is also proposing to allow production of 384,460 grams of tetrahydrocannabinols (THC) in 2019, the same amount the agency cleared for this year.

Since 1968, a farm that the University of Mississippi has maintained a monopoly on the production of cannabis that can legally be used for research in the U.S. But scientists have long complained that it is sometimes hard to get approvals to obtain marijuana from the facility and that its product is often of low quality.

In response to these concerns, DEA moved in the waning months of the Obama administration to end the monopoly and create a process for the National Institute on Drug Abuse (NIDA) to license additional cultivators. But while more than two dozen facilities have filed proposals to become licensed to legally grow marijuana for research, Sessions’ Justice Department has blocked DEA from acting on the applications.

Members of Congress have repeatedly pressed Sessions on the issue, during hearings and most recently in a letter signed last month by eight senators.

“Research and medical communities should have access to research-grade materials to answer questions around marijuana’s efficacy and potential impacts, both positive and adverse,” the lawmakers wrote. “Finalizing the review of applications for marijuana manufacturing will assist in doing just that.”

During a Senate hearing last October, Sessions said that adding new facilities that could compete with the University of Mississippi would be “healthy.” Pressed again in April, he told senators that movement on the issue was expected “soon.”

But no announcements on authorizing more cultivators have been made.

The DEA’s huge increase in marijuana production quotas for 2019 could be a sign that it anticipates eventual approval of some of the additional grower applications, or it could just indicate that reserve stocks at the Mississippi farm are getting low and that it’s time to re-up the federal cannabis stash as interest in marijuana’s medical benefits and other effects increases among the public and scientists who wish to study it.

“While the drastic increase in requested production of marijuana by the DEA is a positive sign, significant barriers still exist including but not limited to the NIDA monopoly on cultivation and undue hurdles for researchers to qualify for a permit,” NORML Political Director Justin Strekal in an interview. “It’s time that Congress look at the 28,000 plus peer-reviewed studies currently hosted on the National Institute of Health’s online database and reform federal law by removing marijuana from the Controlled Substances Act all together.”

Once the DEA quota notice officially runs in the Federal Register, members of the public will be able to submit comments for a period of 30 days, after which time the agency may seek to amend and finalize the proposal.

Tom Angell publishes Marijuana Moment news and founded the nonprofit Marijuana Majority. Follow Tom on Twitter for breaking news and subscribe to his daily newsletter.

I’m a 15-year veteran of the cannabis law reform movement, and I know where to look to spot the most interesting legalization developments. I’m the editor of the cannabis news site Marijuana Moment, and I founded the nonprofit Marijuana Majority. Follow me on Twitter

Here is the DEA’S definition of a C-I drug under the Controlled Substance Act;

Schedule I Controlled Substances

Substances in this schedule have no currently accepted medical use in the United States, a lack of accepted safety for use under medical supervision, and a high potential for abuse.

Some examples of substances listed in Schedule I are: heroin, lysergic acid diethylamide (LSD), marijuana (cannabis), peyote, methaqualone, and 3,4-methylenedioxymethamphetamine (“Ecstasy”).

That was the DEA’S opinion back in 1970… should “opinions” become “legal facts”… now the DEA has decided that it wants more RESEARCH to prove or disprove this opinion/fact after nearly 50 yrs ?  Could it be that after over HALF of our states have legalized Marijuana in some form… the DEA has been forced to do research to try and validate that their “facts” of 50 yrs ago was correct and what is going to happen if they are proven wrong ?

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Thyroid medication recalled: Chinese manufacturer’s failed inspection leads to recall

Posted on August 16, 2018 by Pharmaciststeve

https://www.cnbc.com/2018/08/16/thyroid-meds-chinese-manufacture-fails-inspection-leads-to-recall.html

A medication used to treat hypothyroidism has been voluntarily recalled due to quality concerns.

Westminster Pharmaceuticals, LLC has instructed wholesalers to stop distributing specific products labeled “Levothyroxine and Liothyronine (Thyroid Tablets, USP),” according to an August 9 release. Levothyroxine and Liothyronine are synthetic hormones contained in the thyroid tablets.

The voluntary national recall alert says there have been no “adverse events” associated with the recalled products. It says patients should continue taking the drugs.

“Because these products may be used in the treatment of serious medical conditions, patients taking the recalled medicines should continue taking their medicine until they have a replacement product,” the release says.

More than 4.5 percent of the U.S. population over the age of 12 suffers from an underactive thyroid or hypothyroidism, according to the National Library of Medicine’s MedlinePlus.

The release instructs patients to speak with their physician before discontinuing use of the medicine.

The recall follows a June 22 warning letter from the Food & Drug Administration to a Chinese pharmaceutical company which manufactured active ingredients in the recalled drug. The letter cited a number of failures, including ones relating to “established standards of quality and purity.”

The recall alert says issues cited in that warning letter “could represent the possibility of risk being introduced into the manufacturing process.”

A full list of recalled products is available from the FDA.

Patients with questions or information about an issue relating to the recalled products can contact Westminster at: 888-354-9939.

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Opinion: The Battle Against Opioids Could Mean Misery for Patients in Pain

Posted on August 16, 2018 by Pharmaciststeve

Opinion: The Battle Against Opioids Could Mean Misery for Patients in Pain

www.westernjournal.com/opinion-battle-opioids-mean-misery-patients-pain/

While the United States is distracted by politics, a human rights battle to the virtual death is being played out in Oregon and no mainstream media outlet is covering it. The ramifications of ending Medicaid coverage of prescribed pain medication for chronic illness except for a very narrowly defined list in Oregon will affect every American whether they realize it or not within the next decade. The effects will be disastrous if it goes the way the bipartisan players desire.

Please consider the following:

You have been taking an antidepressant for over a decade with success. One day, you go to your physician for a refill and are informed that you are receiving one 30-day supply of the drug and no more, because people have been using it recreationally, so your physician is discontinuing writing prescriptions. You are dumbfounded. You didn’t do anything wrong. You always took your antidepressant as prescribed. You recall the horrible days before medication — agoraphobia, black thoughts, suicidal ideation  — and you feel sick with dread. You ask the doctor what his treatment plan is. He says you should exercise more, lose weight and get out in the sun at least 30 minutes a day.

If that doesn’t work, there is another drug you could try, but it’s used for epilepsy and has some nasty side effects, hasn’t really worked well for depression, however, several depressed people have had little choice but to try it. You leave the appointment feeling dazed and sick.

After your prescription runs out, withdrawals begin. You knew this was coming and had tried to taper off the medication you had left, but 30 days is not long enough to taper off an antidepressant. Anyone who takes a medication long term will go through withdrawal without a planned long taper. Dependence is a far different animal than addiction. People go through withdrawal when they start a ketogenic diet and stop eating sugar and carbs, commonly called “carb flu.”

Brain zaps, insomnia, muscle aches, diarrhea, weepiness and the depression comes roaring back. You try supplements recommended online, but they are little help. You knew they wouldn’t help. Your sense of helpless futility is mounting because you already tried everything before asking for an antidepressant because of the stigma of depression.

One dark, hopeless night, in desperation, you go to the ER. The physician rolls his eyes and can’t mask his disdain when you explain yourself. You hear him clearly telling the nurse in the hallway that you are a drug seeker trying to score depression meds. You leave empty-handed.

You are forced to quit working. You lose friends because of your decline, have to move into a very different neighborhood because of finances. A 12 week trial of the epilepsy drug proves disastrous — horrible side effects, no help with your depression and it triggers another incredible round of withdrawal. Your physician is indifferent to your deterioration. Other conditions emerge, hypothyroidism and high blood pressure.

Suicide begins to become a very real and appealing option. One year ago, you had a bustling, thriving life, full of vitality. Now you exist. You did nothing wrong except require medication that others have abused. Your medical needs were weighed and determined to be of less value than those of an imaginary group of potentials who could become recreational users of medication you require to be a participant in your own life and do not abuse.

Replace the word antidepressant with opioid and depression with painful disease, and this is the true story of more than one patient I have spoken to this year in the United States.

Now Oregon is preparing to make thousands of people face this exact scenario.

We must step away from this rhetoric and wonder how and why the word opioid became weaponized.

Opioids are simply a class of medications to treat moderate to severe pain. They bring life and function to hundreds of thousands of people who suffer incredibly painful chronic diseases. You pass by people every day who use opioid therapy. You have people in your workplace who use opioid therapy. They do not advertise it and they are not addicts.

Opioids used by a chronic painful disease patient do not cause a high or euphoria as they do recreational users who are not in pain. They do bring moderate to severe pain down to a manageable level so that patients can work. They can take care of their children. They can clean their homes. They can have something that approaches normalcy.

Why do politicians, the media, and certain incentive-driven physicians strive so very hard to stigmatize and downgrade a large population that requires a medication to manage their chronic conditions? We all fall for the rhetoric. “Opioid” as it stands has successfully been negatively engineered to mean addict, dirty, unclean, bad parent, prisoner, felon, lawbreaker, thief.

In reality, over 95 percent of people who use prescription opioids prescribed to them by their physicians are responsible adults who have productive lives, only because they have their opioid therapy. Those statistics deservedly give opioids a positive name for thousands.

Keep this in mind as one looks into the players and machinations moving behind this opioid crisis and how politicians, drug companies, and very evil people are using this manufactured crisis for social engineering, profiling, records search without a warrant, certainly in part as a test drive for the implementation of socialism. After all, one of the pillars of socialism is one gives up theirs for the “good” of all.

That is exactly what chronic pain patients are being told to do — give up their prescribed pain medication for the good of society. These patients did nothing wrong to deserve having their medication taken away. Yet they are expected to willingly give up their pain medications for the common good.

Practitioners shame them, telling patients they have no compassion for their neighbor when they protest the loss of their life-saving prescribed medication.

The common good has shown that the forced compliance of giving up pain medication to stave off prescriptions on the loose is clearly not helping stop the rise of overdoses.

The views expressed in this opinion article are those of their author and are not necessarily either shared or endorsed by the owners of this website.

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Pt sues doc & Pharmacist over rare but serious drug interaction causing pt to rob stores

Posted on August 16, 2018 by Pharmaciststeve

Robber blames doctor and pharmacist for crimes, sues them for $49,000

https://www.oregonlive.com/portland/index.ssf/2018/08/robber_claims_she_wasnt_hersel.html

A 46-year-old woman who donned a ski mask and wielded a fake gun when she robbed a Southeast Portland bookstore has filed a $49,000 lawsuit against her doctor and pharmacist, claiming they gave her a dangerous mix of prescription drugs that caused her to spiral out of control.

The lawsuit filed by Hilary Leah Bishop is virtually unheard of in criminal justice and medical circles: Convicted felons rarely if ever sue their medical providers for the crimes they’ve committed.

Bishop is serving a three-year prison sentence at the Coffee Creek Correctional Facility in Wilsonville for robbing Wallace Books on Southeast Milwaukie Avenue in the Sellwood-Moreland neighborhood on Aug. 15, 2016. She also was convicted of robbing Clogs-N-More on Hawthorne Boulevard the previous day.

Police said Bishop also was a suspect in a robbery at Palio Dessert and Espresso House on Southeast Ladd Avenue a week earlier. She wasn’t convicted of that crime, but a plea deal forbade her from having any contact with that business.

At the time of the heists, Bishop was a divorced mother of a 14-year-old daughter who shared custody with her ex-husband. In the past she worked as a licensed practical nurse and a licensed massage therapist. She told authorities that she’d been diagnosed with depression.

Bishop’s lawsuit claims her naturopathic doctor, Vanessa Esteves, and an unidentified pharmacist for Safeway prescribed and dispensed to her the mind-altering combination of drugs a few days before police say she frightened employees at the shoe store and bookstore and made off with the cash.

A message seeking comment from Esteves and the Pearl District clinic where she works, Oregon Integrated Health, wasn’t returned. Jill McGinnis, a Safeway spokeswoman, declined comment.

Bishop also is suing Tiffany McClean, a psychiatric nurse practitioner who worked at the same clinic as Esteves. McClean couldn’t be reached for comment.

According to Bishop’s lawsuit, she was prescribed a long list of drugs, including duloxetine and tramadol. The pair can lead to a rare but serious drug interaction, causing hallucinations, confusion and other symptoms, according to the website drugs.com. Bishop claims she experienced a “euphoria” and a “dissociative state.”

An August 2016 piece by Oregonian columnist Steve Duin said that Bishop’s friends were shocked by her robberies. Bishop’s ex-husband, Dewey Mahood, described the book-loving Bishop as the “most peaceful, animal-loving vegetarian” and “very anti-gun.”

Mahood also said his ex used to live four blocks from Clogs-N-More and it was her favorite store.

A probable cause affidavit said Bishop was arrested after she bungled the Wallace Books hold-up by wearing all black and removing her ski mask as she exited the store in full view of a parole and probation officer who happened to be in the area. He immediately became suspicious and followed her to her Mitsubishi Mirage and jotted down the license plate.

Police who were on the lookout pulled her over half an hour later.

Court records show Bishop had been convicted once in a 2006 impaired driving incident. She was allowed to enter a treatment program and a judge dismissed the charge of driving while under the influence of intoxicants. But a misdemeanor reckless driving charge stuck. She had no other criminal history.

Lake Oswego attorney Jose Cienfuegos filed Bishop’s lawsuit Friday in Multnomah County Circuit Court. In addition to $49,000 for her pain and suffering stemming from her prison sentence, Bishop also is seeking a yet-to-be determined amount in lost wages.

Read the lawsuit here.

— Aimee Green

agreen@oregonian.com

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CDC opioid guideline is causing harm to people in chronic pain

Posted on August 16, 2018 by Pharmaciststeve

http://thehill.com/opinion/healthcare/402083-cdc-opioid-guideline-is-causing-harm-to-people-in-chronic-pain

On March 15, 2016, the Centers for Disease Control and Prevention (CDC) published its Guideline for Prescribing Opioids for Chronic Pain. The recommendations were designed for primary care clinicians who are prescribing opioids for chronic noncancer pain. Its purpose was to lower the supply of prescription drugs and decrease the number of opioid overdoses.

Pain advocacy groups were concerned that the CDC Guideline for Prescribing Opioids for Chronic Pain could have unintended negative consequences when they were introduced. For example, the Cancer Action Network‘s president, Chris Hansen, published a statement called “Final CDC Opioid Prescribing Guideline Could Have Unintended Consequences for Cancer Survivors Living with Chronic Pain.” It read, in part, “We are disappointed that the CDC guideline released today did not address our previously stated concern about needed access to opioid analgesics for cancer survivors who experience severe pain that limits their quality of life.”

The CDC positioned the guideline as voluntary. But, five months after the guideline was published, the CDC was cautioned by a public relations firm they hired, “Some doctors are following these guidelines as strict law rather than recommendation, and these physicians have completely stopped prescribing opioids.” The CDC ignored the warning.

Even worse, last month, the Oregon Health Authority proposed denying access to opioids for most people with chronic non-cancer pain. The Oregon Health Authority has lost sight of the fact that the amount of opioids prescribed is only one factor — and may not be the primary factor — contributing to the opioid crisis. Lack of access to adequate mental health and addiction treatment has also contributed to the problem.

Oregon is not the only state that is limiting access to opioids. Michigan, Florida, and Tennessee are among other states that have also passed laws restricting physicians’ ability to prescribe opioids. Utah-based Intermountain Healthcare has implemented forced tapering to achieve their goals of lowering prescriptions by 40 percent in 2018. In other states, health-care plans and insurers, such as Cigna and Aetna, have similar goals.

The assumption that denying prescription opioids to those in severe pain regardless of the diagnosis will stop abuse is foolhardy and harmful. As states and insurance companies begin to implement similar restrictive prescribing policies for the treatment of chronic pain, we will see at least two negative effects:

First, people with a substance abuse disorder (SUD) who are using prescribed opioids for the wrong reasons are not going to suddenly stop using drugs because they aren’t readily available. Instead, they will seek other sources of drugs. They will turn to the streets for their opioid replacements. This may contribute to more deaths, because the streets are where the most dangerous drugs are found.

 

This is illustrated by what occurred when the abuse-deterrent OxyContin was introduced. Abusers began substituting heroin when OxyContin became more difficult to obtain and abuse. The National Bureau of Economic Research’s published 2017 report, “Supply-side Drug Policy in the Presence of Substitutes: Evidence from the Introduction of Abuse-Deterrent Opioids,” explains how supply-side strategies alone are inadequate for dealing with drug abuse.

Second, people in pain who have been functioning on their medication without signs of abuse may be at an increased risk for suicide. Without adequate pain treatment, they may lose significant quality of life. In some instances, people will feel abandoned and hopeless.

It is not an exaggeration to suggest that some people in severe pain who are denied access to opioids will view suicide as the only way to escape their severe pain. Inadequately treated pain is a risk factor for overdoses and suicides. Recent research suggests as many as 30 percent of unintentional opioid-related overdose deaths may be suicides.

Certainly, opioid abuse is a significant problem and must be addressed. But policies to force opioid tapering as a way to mitigate the opioid crisis are ill-conceived. To set arbitrary dose limits without consideration of patients’ needs is malevolent.

The CDC needs to respond to the unintended harm the guideline has created. They should follow the lead of Canadian physicians. The College of Physicians and Surgeons of British Columbia (CPSBC) revised the guidelines that they adopted from the CDC following consultation with physicians in the Province and patients who were being denied care, abandoned, or forced to decrease doses to 90 mg morphine milligram equivalents (MME) or less suggested by the CDC guideline.

By contrast with the CDC, the CPSBC recognized the harm that the guidelines were producing for some patients, and they had the courage and leadership to clarify their previous recommendations. They announced, “Physicians cannot exclude or dismiss patients from their practice because they have used or are currently using opioids. It’s really a violation of the human rights code and it’s certainly discrimination and that’s not acceptable or ethical practice.”

The nonprofit New York-based Human Rights Watch (HRW) organization that typically tracks and exposes war crimes apparently agrees with the CPSBC, because they recently expressed concern about the CDC guidelines’ potential consequences for pain patients. HRW is investigating whether people’s right to receive appropriate health care when they are in pain has been violated if they have been forced to reduce their medication. They expect to produce a report later this year.

It is important to find answers to the drug crisis, but the solutions must not create more harm than benefit to both people in pain and people with addictions. The current implementation of the CDC’s Guideline for Prescribing Opioids for chronic pain does not achieve this end and is not patient-centered. Hopefully, the CDC will assume the responsibility to clearly state their guideline is not being implemented as they intended.

The CDC should issue a public statement similar to the one published by the CPSBC clarifying that physicians should not dismiss patients or deny them access to pain care because they are on opioids, even if the dose they need is above 90 mg MME. This is not advocating for opioids but, rather, advocating for patients. It respects the human right to receive compassionate care.

Lynn R. Webster, MD is a vice president of scientific affairs for PRA Health Sciences and consults with Pharma. He is a former president of the American Academy of Pain Medicine. Webster is the author of “The Painful Truth: What Chronic Pain Is Really Like and Why It Matters to Each of Us.” You can find him on Twitter: @LynnRWebsterMD. 

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Make your voice heard! Last chance to comment on proposed opioid prescribing rules

Posted on August 16, 2018 by Pharmaciststeve

https://wsma.org/Shared_Content/News/Membership_Memo/20180808/Last_chance_to_comment_on_rules_impacting_the_way_you_prescribe_opioids

Make your voice heard! Last chance to comment on proposed opioid prescribing rules

The WSMA is urging members to review and provide feedback on the Washington State Medical Commission’s final proposed rulemaking establishing opioid prescribing requirements for physicians and physician assistants in our state. Don’t delay; your comments are due by Aug. 16. This is your last opportunity to provide input before the rules are finalized by the Medical Commission later this year.

While the current proposal is drastically improved over previous iterations, the WSMA remains concerned about the volume of administrative burden and liability these rules would place on physicians and physician assistants during the limited context of a patient encounter and the resulting impact on access to appropriate care. Learn more about these concerns by reviewing our formal comments on the rulemaking, submitted on behalf of the WSMA and Washington State Hospital Association joint opioid safe practices task force.

In addition to your own thoughts, your feedback to the Medical Commission may be as simple as endorsing WSMA and WSHA’s comments. Send your feedback on the draft rules to the Medical Commission at medical.rules@doh.wa.gov before Aug. 16.

For those available to attend in person, the Medical Commission will be holding a public hearing on the proposed rule on Aug. 22, beginning at 2 p.m. at the Hotel RL Olympia located at 2300 Evergreen Park Drive SW in Olympia.

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Americans Rationing Insulin As Prices Skyrocket | NBC Nightly News

Posted on August 15, 2018 by Pharmaciststeve

26-year-old Alec Smith couldn’t afford the $1,300 a month insulin he needed to control his diabetes, so he tried rationing it — and died. His mother is now speaking out, telling NBC News she lost her son “because of pharmaceutical greed.”NBC News is a leading source of global news and information. Here you will find clips from NBC Nightly News, Meet The Press, and original digital videos. Subscribe to our channel for news stories, technology, politics, health, entertainment, science, business, and exclusive NBC investigations.

 

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