As a senior citizen I am surrounded by people who live with chronic, often debilitating pain. Is it right that people with pain have to suffer because drug addicts abuse drugs? Further the Opioid Crisis really isn’t so much about opioids as it is about synthetic black market opioid substitutes such as Fentanyl. But even there we are talking about drug administered to terminally ill cancer patients.
Years ago Niel Young sang, “The Needle and the Damage Done”. The lesson I’ve learned over the years is that substance abusers abuse substances. Eliminate the safer and less harmful and they will abuse ever more dangerous substances. Prohibition didn’t work in the 1920s and the War on Drugs hasn’t worked since.
In a letter to the CDC, a group of doctors and advocates said the agency’s opioid prescription guidelines are having alarming consequences. But in the midst of an epidemic, where should doctors draw the line?
By EJ Dickson
March 9, 2019
Overall, we have every reason to believe that the opioid crisis is getting better, not worse. Since the Centers for Disease Control issued its guidelines dictating appropriate opioid prescription rates and dosages in 2016, opioid prescriptions have declined significantly. Overdose deaths have also been on the decline, though some health experts believe that effect might be temporary.
Two groups that have not benefited from increasing public health efforts to stem the opioid crisis, however, is people living with chronic pain and their health care providers. In a letter to the CDC that was published on Wednesday, a coalition of health care providers, doctors and patient representatives, writing on behalf of an organization called Health Professionals for Patients in Pain (HP3), issued a call for the CDC to “address misapplication of its guideline on opioids for chronic pain through public clarification and impact evaluation” — in short, to clarify its guidelines on opioid prescription for doctors, particularly when it comes to weaning patients off the drugs.
“Patients with chronic pain, who are stable and, arguably, benefiting from long-term opioids, face draconian and often rapid involuntary dose reductions,” the letter states. Often, alternative pain care options are not offered, not covered by insurers, or not accessible. Others are pushed to undergo addiction treatment or invasive procedures (such as spinal injections), regardless of whether clinically appropriate. Consequently, patients have endured not only unnecessary suffering, but some have turned to suicide or illicit substance use.”
“There’s no question that doctors have [historically] been too liberal in prescribing opioids,” says Sally Satel, MD, a psychiatrist and a lecturer at the Yale University School of Medicine, who coauthored the letter. “But in this pulling back, the pendulum has overshot in some instances, and it’s especially taken a toll on people who have been maintained on usually high-dose opioids for many years for excruciating chronic conditions.”
Currently, the CDC guidelines on opioid prescription recommend that doctors attempt to get patients to taper off the drugs. They also recommend that doctors avoid prescribing opioids for long-term pain management, and that any daily dosage should be below the equivalent of 90 milligrams of morphine.