The CDC Opioid Guidelines Violate Standards of Science Research
http://acsh.org/news/2017/03/25/cdc-opioid-guidelines-violate-standards-science-research-11050
If you follow healthcare news, you know that millions of US pain patients are experiencing a world of troubles. If their pain itself wasn’t enough, the US Centers for Disease Control and Prevention added to their agony in March 2016 by issuing a restrictive “Guideline” to primary care physicians on prescription of opioid medications to adults with long-lasting non-cancer pain.
The Guideline was phrased as advisory rather than mandatory. But that distinction quickly got lost as the US Drug Enforcement Administration ramped up disciplinary proceedings and prosecution of doctors for “over-prescribing” opioids like OxyContin and hydrocodone. Even before final publication, Congress made the Guideline mandatory for the Department of Veterans Affairs. More recently, the US Centers for Medicare and Medicaid Services are seeking to turn the Guideline into a mandatory restrictive practice standard for insurance reimbursement.
The new CMS standard will impose legal limits on the maximum amount of opioid pain relievers that a doctor may prescribe to a patient who isn’t actually dying of cancer. A maximum of 90 Morphine Milligram Equivalents per Day (MMED) will be imposed retroactively on patients who have done well on much higher doses for years, with no evidence of addiction or overdose risk. This despite the fact that the methodology of MMED is itself considered a meaningless medical mythology by many experts in the field.
Consequences of these changes are predictable. Even more physicians will leave pain management practice, throwing thousands of patients into the street without medical referral or support when they go into opioid withdrawal. Whole areas of US States are already no longer served by any pain management center. Potentially millions more patients will be forcibly tapered down or cut off cold-turkey, plunging them into agony and disability when they can no longer work or maintain family relationships due to under-treatment of their pain. More patients will be turned away by emergency rooms and family doctors. Suicide rates — already on the increase — will soar.
A deceptive bureaucratic maze adds deep insult and possibly criminal intent to this obvious injury.
Many of the core assumptions of the CDC guidelines are supported by only the weakest medical evidence – and others are clearly contradicted by the evidence. Medical professionals have published sharp criticisms of the CDC guideline and of the anti-opioid biases of consultants who wrote the document. A recent paper in Pain Medicine [ref: Pain Med (2016) 17 (11): 2036-2046] offers analysis that shows the writers of the Guideline deliberately distorted the evidence they gathered.
CDC consultants performed a literature review on the effectiveness and risks of three classes of treatments for severe chronic pain: opioids, non-opioid medicines like Tylenol, and behavioral therapies like rational cognitive therapy. Based on this review, they declared that there is very little evidence that opioids work for pain over long periods of time. But they neglected to inform readers that they had rejected any study of opioid medications that hadn’t lasted at least a year, then declaring that there was no proof that opioids are effective over the long term. But they did NOT reject studies of non-opioid medications or behavioral therapies that were similarly short.
As the Pain Medicine paper states, “To dismiss trials as “inadequate” if their observation period is a year or less is inconsistent with current regulatory standards… Considering only duration of active treatment in efficacy or effectiveness trials, published evidence is no stronger for any major drug category or behavioral therapy than for opioids.”
This didn’t keep the writers of the CDC Guideline from recommending that non-opioid treatments be favored over opioids, despite lack of evidence that they work. Nor did it keep the writers from exaggerating opioid risks – using the term “overdose” no less than 150 times in their biased and unscientific practice standard.
It is time for the CDC to withdraw its misdirected “opioid guideline” for a major rewrite. This time, the effort should be led by pain management specialists, not addiction psychiatrists. Pain patients or their advocates should be voting members of the writers group.
Where are the personal injury attorneys, the class action attorneys and the ACLU on these issues… medical corporations dictating medication prescribing limits to their employed prescribers. Targeting mostly pts that are suffering from subjective diseases and have a legit medical necessity for being prescribed controlled substances.
Insurance companies indirectly denying opiates across the board by mandating PRIOR AUTHORIZATION and then denying the filed requests.
Filed under: General Problems
Something Assertive and Transformational has to be done soon, as I find myself becoming increasingly Agitated and ill by the offensive and threatening language I interpret to be addressed by the CDC.
I am a mature woman with a long history dedicated to healing from patriarchal abuse, I find both the subject matter, and tone-of the CDC to be offensive and threatening, especially the repeated assumption of dominance-over, and disregard for human pain.
Does someone know something I don’t, because as far as I’m concerned, this is still America, and I still have rights, and will not be subjected to condescending language which is consistently loaded with pain evoking assertions.
The well-staged and strategized series of Shock & Awes from the former administration, along with covert and illegal stealing of both basic-human and civil rights, has nearly destroyed me. And no-one I know, has disgusted this and the fact that a war was committed on America’s most vulnerable; the elderly and people on dissed-ability. I am mostly dead from 3 heavy metals that are in my fraudulent and deadly countless “medications”; I am not the only one. If these murders, and attempted murders are not addressed ASAP, there isn’t any point in continuing this HELL. I can’t DIE LIKE THIS ANYMORE
I can tell u about state ACLU’S… they claim,,,,they don’t have enough money to go after thee federal government..I was personally referred to thee National ACLU,,, WHICH,,, i will be following up with,,,,I/WE,,,, HAVE BEEN SAYING THIS allll along,,,, THIS IS EXACTLY THE LEGAL DEFINITION OF WILLFUL TORTURE AND GENOCIDE BY A GOVERNMENT ENTITY….All our governors/senator’s have had letters sent,to them about our death rates sky rockeing from,,the torture they have created but the just keep adding to the suffering and death w/more regulation,,,,I read a man state,,, this is thee BIGGEST CIVIL RIGHTS ISSUE OF OUR TIME,,, and the state ACLU’S COWARD,,, wth,,,when 22,000 death can be attributed to the government abuse of power,,,that is genocide,,,,in any other country,,,why not the U.S.A.????there is no shadow of doubt we all have been harmed,,,but that is not torture in the u.s.a.??????IT IS EXACTLY THAT,,,AND ANY GOVERNMENT EMPLOYEE WHO HAS CONTRIBUTED IN ANY WAY FASHION OR FORM TO THIS TORTURE AND GENOCIDE AS THE LAW DICTATES SHOULD SPEND,,,,THE REST OF THEIR LIVES IN PRISON,,,, perfect sentence for any government employee,,as they have done thee exact same to all CPP’S,,,, forced them to be imprisoned in a body full of physical pain w/denial of timely,effective medical care,,,,”LIFE IN PRISON FOR ALL GOVERNMENT EMPLOYEE’S,”” FOR THE WILLFULL CRIME OF TORTURE AND GENOCIDE ,,, onto the medically ill,,,,mary