Pain treatment

Can the Damage Done by the CDC's Opioid Guidelines Be Reversed?

The agency’s acknowledgment of the suffering caused by its prescribing advice may be too little, too late.


When the U.S. Centers for Disease Control and Prevention published its opioid prescribing guidelines in 2016, the American Medical Association worried about "unintended consequences," including "the potential effects of strict dosage and duration limits on patient care." Since then those consequences, including needless suffering, despair, and suicides caused by involuntary dose reductions and patient abandonment, have become painfully clear, as the authors of the guidelines finally acknowledged last week.

Writing in The New England Journal of Medicine, the guidelines' authors said their advice has been "misimplemented." But they took no responsibility for the unintended yet foreseeable results of their recommendations, and their warning may be too little, too late for the innocent victims of the government's cruelly misguided fight against opioid-related deaths, the vast majority of which involve illicit drugs rather than prescription analgesics.

The NEJM article echoed an April 10 letter in which CDC Director Robert Redfield emphasized that his agency "does not endorse mandated or abrupt dose reduction or discontinuation, as these actions can result in patient harm." Redfield was responding to a March 6 letter in which more than 300 health professionals and addiction specialists, including three former drug czars, expressed concern about the fallout from the CDC's guidelines.

The letter included reports from hundreds of patients around the country who have suffered as a result of policies and practices based on the guidelines. "Undertreated pain is killing me!" wrote a Syracuse, New York, patient with osteoarthritis and tethered spinal cord syndrome. "You don't know me, you don't walk in my shoes, you don't have my nerve damage, and you don't have to live with the thought of will today be the day that I kill myself because I can't take the pain anymore," said a patient in Washington, D.C.

"This policy is just cruel," wrote a woman in Albany, California. "Every patient is an individual and should be treated with care and respect so they can live a functional life—and not given inappropriate or ineffective medication."

When a document is as widely misconstrued as the CDC's guidelines have been—by insurers, regulators, legislators, pharmacists, and law enforcement agencies as well as clinicians—it is fair to ask how the authors left themselves open to misinterpretation. According to the guidelines, doctors "should avoid increasing dosage" above 90 morphine milligram equivalents (MME) per day "or carefully justify a decision to titrate dosage" above that level.

The implication is that doses of 90 MME or more per day are rarely, if ever, medically justified. It is hardly a stretch for physicians with patients who exceed this arbitrary threshold, including patients who have been functioning well on high doses for years, to worry that they will be perceived as practicing outside the bounds of proper medical care.

Given the scrutiny that regulators and law enforcement agencies have been applying to doctors in recent years, prescribing practices portrayed as extreme and dubious by the CDC are apt to attract unwelcome attention that could jeopardize a physician's livelihood and liberty. In this context, forced tapering and abandonment were predictable outcomes, even though the CDC guidelines say doctors should reduce doses only when the risks outweigh the benefits and describe the process as collaborative and consensual.

"We all warned of this outcome when the 'guidelines' were issued," says Mark Ibsen, an emergency medicine physician in Helena, Montana. "The CDC guidelines have been as harmful as predicted, and the silence over three years has been criminal."

Patrice Harris, the AMA's president-elect, worries that "the guidelines have been misapplied so widely that it will be a challenge to undo the damage." Lynn Webster, a former president of the American Academy of Pain Medicine, is even less optimistic.

"I am afraid that cultural attitudes, fears, misinformation, and prejudices are baked into the system," Webster says. "It may take a generation before a more sensible and compassionate approach to treating people in pain with opioids is established."

© Copyright 2019 by Creators Syndicate Inc.

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  1. Would it really kill the CDC to focus on infectious diseases?

    1. No. But if they focus on infectious disease like they focused on opioids, it could kill all of us.

  2. Here that boomers? Enjoy your dotage.

  3. And I misspell hear.

    1. Well, here this, Wally!

      Chemical painkillers are for pussies and pansies! Real manly-men and womanly-women superheroes just pray their pain away! PRAY with all your heart, mind, and spirit, to Government Almighty, that Government Almighty will take your pains away!!! If it's not working for you, you're not praying hard enough! You need to work on having more FAITH in Government Almighty!!!

      This idea that Government Almighty does NOT love you personally, dearly, more than we can ever know? It is the WORST of "fake news"! To those that spread this fake news, I ask, WHEN has ANYTHING ever happened that was bad, because people had TOO MUCH faith in Government Almighty?!?! LOOK within your heart!
      See? It has never happened! It can NOT happen!

      So anyway, from my Deep Faith in Government Almighty, from my Deep Compassion, I say unto you... Let all who have ears, listen... PRAY your pain away; have FAITH in Government Almighty!!!

  4. It’s only going to get worse now that the trial lawyers are involved suing pharmaceutical companies for “lying” about opioids, and states and municipalities across the country jumping on the lawsuit bandwagon like they did against the tobacco companies. One county here in New Jersey recently posted a solicitation for lawyers want to serve as “opioid counsel” the lawsuit the county is intending to file.

    I do not see the damage done by the CDC going away anytime soon.

  5. "CDC Director Robert Redfield"

    Ohh, I just loved him in that movie with Paul Newmorn.

    1. You're going to need opioids to deal with The Sting of this policy.

  6. "But they took no responsibility for the unintended yet foreseeable results of their recommendations"

    Foreseeable results are NOT unintended.
    Just another federal agency destroying the fabric of American individual choice.
    Welcome to the revolution.

    1. You sure got that right!

  7. Sometimes I think the only thing that will change the minds of some people about opioids is a hammer to the kneecaps. Deal with THAT pain without any painkillers before you tell others they have to do without.

    1. Finrod...Thanks, for expressing my thoughts exactly!

  8. How could it be baked into the system for a generation after only a few years? Could someone please explain that? The only way I could see this is if the field has always been tilted that way, such that it's much harder to move one way than the other. But we have the evidence from the loosening just a few years previous, after many years of strictness, that health professionals responded then, so why wouldn't they again?

    1. Surely you cannot believe that the federal government will just stop destroying individual choice in health care or healthcare insurance?
      So as long as the democrats and republicans enforce their death grip on the political process, it is baked in.

    2. In many states, laws were passed limiting the amount that could be prescribed, mandating "pain treatment centers" for long-term management, and generally treating people as felons and addicts the moment they took a tylenol 2 tablet. Laws are easier to pass than to repeal.

  9. I injured the large nerve radiating out of L2/L3 in the lower back last sept. I suffered the torments of the damned waiting for it to heal for two weeks.... nope, no vicodin or codone for me... they said that if the pain persisted for 90 days or more, they might prescribe pain meds. Until then, just take nsaids and bear it. I took vicodin for two months several times a day back in 2007 after a disc blew out... It took two months to heal, off work on disability. The meds didn't make me an addict in 2007, but they didn't care. Grit your teeth, they said. No meds for you.

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