New CDC Opioid Prescribing Guidelines: Only One Side of Long-Standing Clash Between Pain Relief and Addiction

New CDC Opioid Prescribing Guidelines: Only One Side of Long-Standing Clash Between Pain Relief and Addiction

BREAKING NEWS: In spite of the controversy, a vast majority of physicians surveyed say they support and will implement the new guidelines in their opioid prescribing habits, which promises big changes in opioid use across the country.
The battle lines have been drawn for decades:
  • On one side, an army of determined pain management physicians advocating for tens of thousands of Americans suffering intolerable chronic pain who need their opioid prescriptions to obtain even a minimum degree of quality of life.
  • Opposite them stands another army of physicians (with considerably more ammunition because they represent the armed forces of government) equally determined to slow the escalating epidemic of opioid addiction across the country by making it more difficult for anyone to obtain opioid prescriptions.
The shifting shape of this long-standing internecine war reveals the difficulty of either side ever celebrating an outright victory:
  • Of course, all the physicians on both sides want to end patient suffering.
  • Of course, all the physicians on both sides want to avoid contributing to addiction.
  • Many doctors on both sides of the fence, including the American Medical Association and the American Chronic Pain Association, said the guidelines appeared to be created in an atmosphere of secrecy with inadequate time for comments from all interested parties.
  • Finding a compromise solution that satisfies both conditions seems completely impossible, because pain patients and potential addicts are two completely different types of patient with completely different needs.

The CDC speaks, the two sides each hear something different

After months of anticipation in both camps, the Centers for Disease Control and Prevention (CDC) has finally released its "proposed guidelines for opioid prescribing." There's been a lot of anticipation that the guidelines might offer something of a compromise more or less acceptable to both sides.
Unfortunately, that has not turned out to be the case. On one hand, the guidelines introduce restrictions on opioid prescribing that could positively slow opioid painkiller abuse and addiction. But those same guidelines could negatively impact the pain relief field.
The CDC guidelines are aimed at reducing the horrendous death toll:
  • With more than 16,000 Americans dying of opioid overdose every year - that's something like 44 a day - there's been a lot of pressure to come up with a opioid prescribing guidelines that might help slow the epidemic. In all, 120 die every day from overdosing on some drug or other, roughly 44,000 a year.
But the guidelines go further, threatening chronic pain management, say those specialists:
  • With close to 14,000 Americans suffering what is termed "intolerable pain" day in and day out, pain management specialists have been hard pressed trying to provide relief without opioids. They were braced for trouble, and the CDC has delivered it, they say.
An editorial in Pain Management News says that the CDC guidelines are " their attempt to mitigate the real risks and dangers of addiction...and will cause real harm to a significant subset of chronic pain patients for whom opioids do not pose a threat, and who often do not have any other options to treat their pain."

Studies continue to target family doctors for addiction, not chronic pain treatment

In 2013, there were 44,000 drug overdose deaths. Nearly 23,000 were from prescription drugs, and 16,000 of those involved powerful prescription narcotic painkillers such as Vicodin and OxyContin. So well over half of all drug deaths were from prescription drugs, and two-thirds of those were narcotic prescription painkillers.
A study in the Journal of the American Medical Association last year found that most opioid painkillers are prescribed by ordinary family doctors and general practitioners, not a few so-called bad apples. And they contribute to most cases of abuse and addiction.
The CDC wants these doctors to curb their predilection for prescribing opioids. We blogged about this study last year, when CDC Director Tom Frieden said, "Health care providers need to screen for abuse risk and prescribe judiciously by checking past records in state prescription drug monitoring programs. It's time we stop the source and treat the troubled."
Other studies have found no clinical evidence to support long-term opioid therapy for chronic pain, including cancer. But the patients and their pain specialists say there's no known effective alternatives.

CDC "one size fits all" guidelines don't work for chronic pain patients

Terri Lewis, PhD, an expert in rehabilitation administration, also with experience treating chronic pain, says the guidelines are basically wrong-headed.
"To me, [they] read as a risk mitigation strategy for physicians and providers, and not as a risk mitigation strategy for patients," Dr. Lewis told Pain Management News. "If they were, we wouldn't be using an addiction model."
"The difference between a patient in chronic pain and a person who is addicted is, with addiction, we expect a cure," Dr. Lewis said. "We expect the patient will recover to the point that they can maintain some cured state-even if they're on methadone; the goal is to integrate them back into society.
"That doesn't happen with chronic pain," she continued. "Chronic pain is progressive. It's associated with a multisystem injury to the body, and it's not going to be cured. So what we want to do is give that person the most optimal tools, in spite of what has happened to them. It's a big difference in approach."
A final note, however, indicates that the general run of physicians are "on board" with the new recommendations despite the questions and controversy. A survey just completed by SERMO, a social network of over 300,000 physicians, found that 87 percent of doctors surveyed said they would "welcome or use the guidelines." So even though they are not legally binding, it appears the guidelines will have a strong impact on the use of opioids in the U.S.
At Novus, we are happy to see more and more attention on the problem and look forward to better solutions in the future, as healthcare professionals from all over the country work together to solve this.

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