PHARMACIST STEVE

I just realized that the CDC guidelines – both 2016 and the new proposed 2022 – do not follow how our healthcare systems works. A pt goes to the practitioner and they if they have obvious symptoms, the practitioner typically will run some lab test (blood/urine)… they get back the values of numerous of substances in those tests and if they are outside of what is considered an acceptable range. If one or more is out of the normal range… the pt ends up getting one or more medications to try and get those labs back into “normal range”.  The CDC with their opiate dosing guidelines, there is no reference as to the intensity of the pt’s pain… they focused on the amount of medications that the practitioner can prescribe.  No reference to getting the pt’s pain back to a “normal level”…  I am not sure if this mind set is UPSIDE DOWN – or – ASS BACKWARDS…  In many incidents, it prevents the practitioner from being a HEALER

I find it curious why the CDC has proposed both in the publish 2016 Opiate dosing guidelines and the 2022 proposed opiate dosing guidelines, that they are stating that chronic pain should be treated in an entirely different manner than what medical science does in treating just about any other chronic disease state. It doesn’t make any difference if the pt has been diagnosed with high blood pressure, diabetes, COPD, high lipid/cholesterol and on and on… Typically the diagnosis is done from some urine/blood lab test value that is outside of what has been a predetermined range that is safe. A good example is a pt being diagnosed with having diabetes, a type II diabetic will typically be initially prescribed Metformin with a starting dose of 500 mg BID. If the pt’s blood sugar does not come down to “normal range” the dose can be increased up to 2550mg/day in divided doses. If the pts blood sugar still does not reach “normal range” the practitioner could add a few other meds in combination up to three different meds. If the pt’s blood level doesn’t reach “normal level” the practitioner can add insulin. For decades the standard of care with insulin, insulin potency was standardized at 100 units/ml, but now there are also now 200 units/ml and 500 units/ml. There appears to be NO UPPER LIMITS OF UNITS/DAY for individual pts – dose is determined by their blood glucose or A1C readings returning to what is considered a “normal range” Same thing applies to pts diagnosed with hypertension, the final goal is to get the pt’s BP into normal range no matter the dose or the number of different meds are needed. The CDC previous opiate and proposed opiate dosing guidelines has turned what has been the traditional chronic disease treatment process ON ITS HEAD. First the MME equivalence process has ABSOLUTELY NO BASIS IN SCIENCE. It has been reported that these ratios were developed with opiate naive people with mechanically induced pain (Heat or Cold) and using a SINGLE DOSE. At a time when medical science had no knowledge of CYP-450 opiate metabolism rates and/or PGx opiate metabolism rate. As well as the ratio were determined on the “subjective opinion” of the people involved in this study and the results have no application to the use in treating chronic pain issues. Since studies have demonstrated that treating chronic pain pts with opiates will result in a 0.6% to 2.0% becoming addicted. So this proposed guidelines is prohibiting >98% of chronic pain pts getting treatment with opiates that will optimize their QOL, while there is no proof that those up to 2% will not be abusing some other substance(s). The LD50 of opiates is highly variable and will decrease on those pts who have taken opiates long term. I have had first hand experience with end stage CA pts being given 20mg to 30 mg/hr Morphine via IV without fatal respiratory suppression. In theory, that would be equivalent of 200mg to 300mg of Morphine PER HOUR. Every other chronic disease is treated to get the pt’s vitals into what is considered an acceptable range, The 2016 and 2022 proposed opiate dosing guidelines does not address getting the pt’s vitals to a acceptable range, only limits – in theory – a particular MME max dose and the pt is expected to live/exist in a intensity of pain that many could consider a torturous level of pain, and many other biological/physiological functions are outside of acceptable ranges because of under/untreated pain. The attached chart will demonstrate the possible complication of a pt’s comorbidity issues and/or cause the pt to develop additional comorbidity issues. Practitioners are suppose to be “healers”, but creating opiate dosing guidelines that does just the opposite is basically inhumane. I communicate regularly with pts whose practitioners have taken their pt’s opiate doses down to meet the arbitrary MME limits. Their blood pressure is in “stroke range” , typically north of 200/100 – even when taking four or more blood pressure meds, under/untreated pain has caused their adrenals to fail, in trying to compensate for the stress on their system, and the pt now is diagnosed with Addison’s disease. Pts are dying from premature deaths from all of these unnecessary biological stressors or and many more are committing suicide because they can no long tolerate the intensity of pain that they are being forced to live/exist in. The CDC, needs to rescind/revoke the 2016 guidelines and pull the proposed 2022 guidelines and turn the practice of medicine back to the FDA and the various state medical licensing boards. To do otherwise and proceed with these inappropriate opiate dosing guidelines, would strong suggest that the CDC is confirming that the CDC’s position that putting/leaving chronic pain pts in a torturous level of pain is acceptable and what should be considered “ a normal/acceptable range” for pt dealing with chronic pain.

Filed under: General Problems