Pain Patients Get Relief from War on Opioids

Pain Patients Get Relief from War on Opioids

U.S. agencies warn doctors not to abruptly cut off the medications for long-time users

Ever since U.S. health authorities began cracking down on opioid prescriptions about five years ago, one vulnerable group has suffered serious collateral damage: the approximately 18 million Americans who have been taking opioids to manage their chronic pain. Pain specialists report that desperate patients are showing up in their offices, after being told by their regular physician, pharmacy or insurer that they can no longer receive the drugs or must shift to lower doses, no matter how severe their condition.

Abrupt changes in dosage can destabilize patients who have relied for many years on opioids, and the consequences can be dire, says Stefan Kertesz, an expert on opioids and addiction at the University of Alabama at Birmingham School of Medicine. “I’ve seen deaths from suicide and medical deterioration after opioids are cut.”

Last week, after roughly three years of intensive lobbying and alarming reports from the chronic pain community, the Food and Drug Administration (FDA) and the Centers for Disease Control and Prevention (CDC) took separate actions to tell clinicians that it is dangerous to abruptly curtail opioids for patients who have taken them longterm for pain. The FDA did so by requiring changes to opioid labels specifically warning about the risks of sudden and involuntary dose tapering. The agency cited reports of “serious withdrawal symptoms, uncontrolled pain, psychological distress, and suicide” among patients who have been inappropriately cut off from the painkillers.

One day later, CDC director Robert Redfield issued a clarification of the center’s 2016 “Guideline for Prescribing Opioids for Chronic Pain,” which includes cautions about prescribing doses above specific thresholds. Redfield’s letter emphasized that these thresholds were not intended for patients already taking high doses for chronic pain but were meant to guide first-time opioid prescriptions. The letter follows another recent clarification sent by the CDC to oncology and hematology groups, emphasizing that cancer patients and sickle cell patients were largely exempt from the guideline.

Taken together, these actions represent a significant victory for the chronic pain community. “The combination of the FDA and CDC speaking out reconfigures the conversation going forward in a very, very helpful way,”  says Kertesz, who was one of five doctors associated with the advocacy group Health Professionals for Patients in Pain (HP3) who received Redfield’s letter.

Tougher rules on opioid prescriptions from federal and state authorities, health insurance companies and pharmacies, were an understandable response to the nation’s “opioid crisis,” an epidemic of abuse and overdose that led to a 345 percent spike in U.S. deaths related to legal and illicit opioids between 2001 and 2016. Since 2016, most fatal overdoses have involved illegally produced fentanyl sold on the street, according to CDC data, but past research has shown that many victims got started with a prescription opioid such as oxycodone.

The CDC’s 2016 guideline was aimed at reining in irresponsible prescribing practices. (The agency’s own analysis showed that prescriptions for opioids had quadrupled between 1999 and 2010.) The guideline stressed that the first-line treatments for chronic pain are non-opioid medications and non-drug approaches such as physical therapy. When resorting to opioids, the guideline urged doctors to prescribe “the lowest effective dosage,” to carefully size up risks versus benefits when raising doses above 50 morphine milligram equivalents (MME) a day, and to “carefully justify a decision” to go to 90 MME or above.

That advice on dosage was widely misinterpreted as a hard limit for all patients. Kertesz has collected multiple examples of letters from pharmacies, medical practices and insurers that incorrectly cite the guideline as a reason to cut off long-term opioid patients.

Frank Gawin, a retired psychiatrist in Hawaii, is one of many chronic pain sufferers ensnared by that kind of mistake. For 20 years he took high-dose opioids (about 400 MME daily) to manage extreme pain from complications of Lyme Disease. Gawin, an expert on addiction himself, was well aware of the risks but notes that he stayed on the same dose throughout those 20 years. “It helped me profoundly and probably extended my career by 10 to 15 years,” he says. About five months ago, his doctor, a pain specialist he prefers not to name, informed Gawin and other patients that she would be tapering everyone below 80 MMEs because she was concerned about running afoul of medical authorities. Gawin has not yet reached that goal, but his symptoms have already returned with a vengeance. “As I am talking to you, I am in pain,” he said in a phone interview. “I’m having trouble concentrating. I’m depleted. I’m not myself.”

Last week’s federal actions could go a long way in informing physicians not to cut off patients like Gawin. Of particular value, say patient advocates and experts, is the emphasis on working together with patients on any plan to taper the drugs. “It’s finally about patient consent,” says Andrea Anderson, former executive director of the Alliance for the Treatment of Intractable Pain, an advocacy group. She notes that the FDA urged doctors to create an individualized plan for patients who do wish to taper and that the agency stated that “No standard opioid tapering schedule exists that is suitable for all patients.”

The CDC is relying on pain advocacy groups to get the word out about its clarification. Any formal update to the guideline will await the results of a systematic review of chronic pain research currently underway, said Debbie Dowell, chief medical officer of the CDC’s Injury Center, in an email; Dowell is the lead author of the 2016 guideline.

Gawin hopes the federal actions will persuade his doctor that forced tapering is wrong for him. “The only way I can see getting back to normal,” he says, “is to get back to the medication that worked for me.”


9 Responses

  1. Included is the monthly Black Psyops Torture manifesting PTSD, Mental Hell th, and Associated Microwave and profounlpr perverse Targeted EMF and Intrusive Nano Attacks

  2. They would have to shout this like they shouted “opioid (opiate) crisis”, …until every doctor and doctor’s insurer moved on it with a will, like they did with the cutting off and accompanying outrageously bad excuses and CDC and PROP lies.

    If all the public hysteria were reduced to zero today…

    1. Doctors or whoever will never prescribe pill #1 for those of us already cut off – not now with “opioid crisis” hanging in the air and stuck onto everything like nuclear fallout or the plague all for doc liability insurers to worry half to ‘death’ about.

    2. Anyone prescribed after cut-off can now cry “addiction!”, true or not, at any time and win a massive lawsuit instantly and effortlessly and THAT doctor imprisoned. (That’s why it was essential that all doctors should have instantly stood against all of this when it began as it was the first and last hope. They didn’t, still haven’t and never will as long as they have good spines. No I don’t mean our Doctors of Courage)

    3. It will be equally hard to get the shaking pharmaceutical manufactures out from under the desk, the DEA and Medicaid to go away and parents still crying ‘YOU killed my child!’.

    4. Junior will start stealing pills again just like before and with determined and fatal clumsiness certainly kill himself with the prescription opiates too.

    5. It would take a full realization of what opiates are good for and why and so a complete re-educating of EVERY warm body on this planet to get us back to where we were.

  3. Great how will this assinine, extremely tardy response that is absolutely not just an oversite, not just unintentional, not just harm (try torture) going to help anyone like myself who was cut off cold turkey 2 years ago and is tortured in pain every second of every day.? Hel# I can’t even find a PCP within 50 miles. Suicide?? No Maybe they should be assessing for homicidal thoughts towards the sadistic, self serving instigators of this ongoing theater of tragedies and obvious moral and social entrepreneurship phonies leading the way. This is nothing more than a really empty gesture for Public RELATIONS purposes.

  4. Great news…….but for those of us that have suffered with chronic pain for whatever reason to “justifiably” reduce medication,to one dose fits all issues was simply a forced health risk with now documented harm, suicide included. If ANY ‘expert had to live like the millions of patients forcibly, involuntarily tapered to a dosage that no longer allows any quality of life even with documented success in excess of 90 mme dot/gov has overstepped its’ authority and removed the need or our pain management physicians……..period.

  5. I went to my pcp last Thursday with all of the reports and letters from last month. He refuses to stop tapering my meds because of fears of the DEA. Nothing will change until the laws are changed on how the doctors are arrested.


    I went through it too and did a messed up detox to be free

  7. Come on, Steve. When are you going to wake up and smell the coffee and understand that following this rabbit hole will get us nowhere? Read this article. And if it doesn’t scare the heebie-jeebies out of you for what the future holds, nothing will. Doctors beware. Death penalties are ahead for treating pain.

  8. “past research has shown that many victims got started with a prescription opioid such as oxycodone”

    • Or got triggered for true addiction. I doesn’t even matter if a Severe Pain Patients does trigger, PAIN comes FIRST. And I would have to say that the true narrative should and MUST now say that opiates are the very very very WORST choice for a party drug because withdrawal IS true misery, …STILL not a CSPP concern!!!.

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