Buried deep in a new federal inter-agency task force report, which recommends a new national pain management policy, is a stinging rebuke of the 2016 Centers for Disease Control (CDC) opioid prescription guidelines.
The report also calls for major improvements in the 50 widely varied state prescription drug management programs (PDMPs).
Titled “Draft Report on Pain Management Best Practices: Updates, Gaps, Inconsistencies, and Recommendations,” the report, released by the Department of Health and Human Services (HHS), expressed concern that the wide acceptance of the CDC guideline as a de facto rule may have led to a spike in suicides by patients cut off from opioid painkillers.
The report was written by a 29-member Pain Management Best Practices Inter-Agency Task Force, set up by the Comprehensive Addiction and Recovery Act (CARA) of 2016. It is to be sent to Congress after a public comment period which runs until April 1.
The section of the lengthy report on the CDC guideline begins with damningly faint praise, saying, “The CDC guideline provides useful general guidance for prescribing opioids.” Then, it adds:
“A commentary by Busse et al.identified several limitations to the CDC guideline related to expert selection, evidence inclusion criteria, method of evidence quality grading, support of recommendations with low-quality evidence, and instances of vague recommendations,” the new draft report says. The cited Busse commentary ripped into the CDC for allowing its guideline to be designed solely by individuals who had already spoken up critically of opioids, and for leaving pain-suffering patients entirely out of the process for developing the guideline.
The report also accuses the CDC of illogically condemning opioid painkillers: “In addition, the CDC used the criterion of a lack of clinical trials with a duration of one year or longer as lack of evidence for the clinical effectiveness of opioids, whereas Tayeb et al.found that that was true for all common medication and behavioral therapy studies.“
The task force also criticized the CDC for saying new opioid prescriptions should be limited to three days or fewer and that more than a seven-day supply is rarely necessary. “A more even-handed approach would balance addressing opioid overuse with the need to protect the patient-provider relationship by preserving access to medically necessary drug regimens and reducing the potential for unintended consequences.”
Chronic Pain and Suicide Worries
The task force also expressed concern that the CDC guideline, which was supposedly aimed only at new prescriptions for opioids, has been routinely used to boot chronic pain sufferers from, or taper down, long-term opioid prescriptions while offering no alternatives.
The task force noted that CDC’s own studies, before the 2016 guideline was issued, showed that “the percentage of people who died by suicide who also had evidence of chronic pain increased from 7.4% in 2003 to 10.2% in 2014.”
That finding “leads to the rising concern that a recent trend of health care professionals opting out of treating pain has contributed to an existing shortage of pain management specialists and is leaving some patients without adequate access to care.”
“An unintended consequence of the guideline is the forced tapering or patient abandonment that many patients with chronic pain on stable long-term doses of opioids have experienced. The Task Force received public comments indicating that many patients have experienced access issues related to provider fears and concerns with how the guideline would be interpreted and have caused some to consider obtaining opioids from illicit sources or suicide.”
The report says physicians and other caregivers cited the CDC guideline, “along with concern about undue burdens of investigation and prosecution by drug enforcement…when deciding to limit or not to provide pain treatment.”
I have endured chronic pain since 2009 due to a rear end collision on an interstate highway. After my third back surgery I was informed by my surgeon I would need to take morphine for the rest of my life. I had great care and enough pain meds to recover, eventually reduced my intake to 2 30mme morphine and 2 30 mme ir morphine tablets. My pain Dr. cited a “new” law that required a reduction in my medical regimen, and immediately reduced me to 90 mme per day, a 25% decrease. I went into a detox that lasted nearly two months. I have had ten additional surgeries (rotatoar cuffs and torn muscles in my both shoulders, torn labrums in both hips, knee scope surgery, knee replacements of both knees) and deal with a great deal of pain on a daily basis since my regimen has been reduced, even though I was able to function at an acceptable level with what I had been described for years. After my last surgery, knee replacement, I was one day away from suicide. If I woke up the next day in as much pain as I had been suffering, I was ready to go. I’m still here, bit I am disgusted by the process, misapplication of CDC regulations by my pain doctors, and most of all, the DEA involvement in what should be a patient/doctor relationship. ADDRESS THESE FAILURES NOW, AMERICANS ARE SUFFRING NEEDLESSLY, NO QUALITY OF LIFE.