Is Suicide a Consequence of the CDC Opioid Guideline?

http://www.painmedicinenews.com/Commentary/Article/08-16/Is-Suicide-a-Consequence-of-the-CDC-Opioid-Guideline-/37442/ses=ogst

By Lynn R. Webster, MD

The law of unintended consequences states that the actions of people, and especially of governments, always have effects that are unanticipated, as when legislation and regulation aimed at righting a problem go wrong in other ways (Unintended consequences. http://tinyurl.com/?8p8g). An example may be the guideline issued by the Centers for Disease Control and Prevention (CDC) discouraging the use of opioids in treating chronic pain, excluding cancer and end of life (MMWR Recomm Rep 2016;65:1-49).

The guideline was not intended to be mandatory; yet, as I predicted in a previous roundtable discussion, the stature of the CDC appears to have resulted in it being viewed by many as more than a guideline (“Draft CDC Opioid Guideline: Pain Medicine Experts Discuss,” Pain Medicine News January/February 2016). A growing number of reports suggest that the guideline is responsible for people with chronic pain throughout the country being tapered or withdrawn from opioids or dropped entirely from physicians’ practices, even if the patients have been on stable doses of opioids for years with attendant improved pain and quality of life (Chronic pain patients are suffering because of the US government’s ongoing War on Drugs. Quartz. http://qz.com/?694616).

Pain News Network reports that dozens of patients have contacted the editor since March, when the guideline was made public, to say that their doctors have “fired” them on flimsy excuses, or that their doctors suddenly are weaning them off opioids or abruptly cutting them off from the medications (Are CDC Opioid Guidelines Causing More Suicides? Pain News Network May 27, 2016).

Worse is that some patients are so despondent and in so much pain that they have given up and looked to suicide as a way out. As Pain News Network reports, nearly 43,000 Americans committed suicide in 2014, more than twice the number of deaths that have been linked to overdoses of opioid pain medications. Anecdotal reports that chronic pain contributes greatly must not be dismissed. I am certain this is not a consequence intended or anticipated by the CDC, but tragically it is playing out.

‘Everyone Has a Breaking Point’

The following are passages from a message I received from a person in pain, in response to one of my blogs. (They have been edited for clarity.)

“After this Easter, my life turned off a cliff and nosedived. My best friend in the world, who suffered with chronic pain, checked out because he was tired of living with pain, doctors and judgment. He was just tired of it all. So many people are disgusted with the CDC’s guidelines—as am I—as they cast far too wide of a net and caught a lot of innocent victims in it.”

This man, a veteran, goes on to write of his personal involvement and knowledge of the opioid crisis as a sufferer of chronic pain and father who lost a 21-year-old daughter to—as he puts it—“the OxyContin Express that roared through Florida.”

“Persons in power too often see the world in black and white. They forget there is a gray area where most of us live—reality.”

The Department of Veterans Affairs is adopting the guideline, which was written to be voluntary, “as law,” he writes, “ripping 12-year–compliant patients off meds.” He is one of those patients with many years of passed urine drug screens and prescription drug monitoring checks behind him.

“This is the kind of foolishness that pushed my pal to the point he felt backed in a corner, put a gun to his chest, and pulled the trigger. I knew this man 35 years. … Everyone has a breaking point.”

This friend had shared his fears of having his treatment taken away.

“He asked me if I would forgive him if he took his own life. I told him I would. This has been a heavy burden to carry. But loving someone unconditionally comes with a heavy load.”

Now 58, the man who wrote this letter said he flinches now when he hears of anyone taking his or her life due to untreated pain. Further, he is steeling himself to deal with his own pain issues as changes to his medical treatment appear inevitable and also—as he puts it—impersonal.

“So now at 58 years old, here we go again. … The way my medical conditions were being treated for the past 12 years was about to change. … I’m no doctor, no pharmacist, no rocket scientist, but even I know you can’t do that to a human being without reprisal. So here I am picking up the pieces. I hope and pray others make it through the changes OK. I hope I make it OK.” Making it through is all he wants.

Innocent Victims

Undeniably, the country is experiencing a serious opioid crisis, which must be addressed. However, the steps to reverse the opioid crisis should not cause greater harm to the innocent and those hurting the most in our society. Our politicians and policymakers must be advised that their actions have unintended consequences. If the unintended consequences of the guideline cause greater harm than the intended positive consequences, then the only rational and compassionate path forward is to change the focus and direction. Perhaps it is time to recognize the needs of people in pain with an urgency equal to that for people with opioid addictions.

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Frieden to Resign as CDC Director

www.painnewsnetwork.org/stories/2016/12/31/frieden-to-resign-as-cdc-director

Frieden has an extensive background in epidemiology and infectious diseases, and his tenure at the CDC was marked by major efforts to combat outbreaks of the Ebola virus, fungal meningitis, influenza and the Zika virus. He also doggedly pursued a controversial campaign to put prescribing limits on opioid pain medication, an area traditionally overseen by the FDA.

“One of the most heartbreaking problems I’ve faced as CDC director is our nation’s opioid crisis,” Frieden recently wrote in a commentary published by Fox News. 

“This crisis was caused, in large part, by decades of prescribing too many opioids for too many conditions where they provide minimal benefit and is now made worse by wide availability of cheap, potent, and easily available illegal opioids: heroin, illicitly made fentanyl, and other, newer illicit synthetic opioids. These deadly drugs have found a ready market in people primed for addiction by misuse of prescription opioids.”

thomas frieden, md

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I have created a Twitter account @painedlives and intention is to use this to send out information to Congress, media that seldom get to them. Because all that gets sent to them is what the DEA press release machine puts out…  https://www.dea.gov/pr/news.shtml

Below is a – cloud based – google spread sheet that I have created – I need people to go to the website and use the link before www.usnpl.com/ to create a database of twitter names for media. The spread sheet can be worked on by a number of people at the same time and it is automatically updated in real time.

We have a new President and Congress as of Jan 23 2017 and the only way that we can get their attention and hopefully cause change is to communicate with them.  Twitter is the first attempt into getting their attention.. without cooperation of those within the chronic pain community to get this database together.. IT WILL NOT GO FORWARD… and most likely the politicians, bureaucrats, and the bureaucracy will continue on the path that it is on and your ability to get adequate pain management and optimize your quality of life will continue to be compromised and deteriorate.

https://docs.google.com/spreadsheets/d/1DpY4MNPiHxFUdVJPpnQxdq7wCduIHC9Y5AOmm0ZPgc0/edit#gid=0

www.usnpl.com/

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CDC Spending $4.8 Million to “Raise Awareness” about Prescription Opioid Abuse

nationalpainreport.com/cdc-spending-4-8-million-to-raise-awareness-about-prescription-opioid-abuse-8832374.html

One would think that the massive amount of attention to prescription opioids and the sweeping changes to guidelines and law that have come this year would be enough to raise awareness in the US. But the CDC thinks that is not enough. It recently awarded a task order of $4.8 million to ICF (NASDAQ:ICFI) develop a large scale advertising program.

According to a press release, “ICF will oversee the development of a large-scale, targeted communications campaign designed to raise awareness about the risks associated with prescription opioid abuse. Among its responsibilities under the task order, ICF will oversee development and placement of digital and social media advertisements and maintain an active social media presence for the campaign. Additionally, ICF will create online, mobile-accessible training for providers. ICF also will develop tools, training and outreach to promote adoption of CDC’s Guideline for Prescribing Opioids for Chronic Pain by physicians and other healthcare providers. This work supports the U.S. Department of Health and Human Services’ commitment to address the opioid crisis as a top priority and intensify its efforts to reduce opioid misuse and abuse.”

“Prescription drug overdose affects a vast number of Americans and their families each year,” said Frances Heilig, vice president for ICF International. “Our communications work on the risks of illicit drug use has given us a solid understanding of the impact of prescription opioid abuse on our society. We look forward to working with the CDC to help dissect and communicate this complex issue to increase its visibility across a variety of audiences and reduce the incidence of drug-related deaths in the United States.”

With access to opioids becoming an increasing problem for pain sufferers who do not abuse their medication, one can expect that the onslaught of ads and promotion of the CDC’s restrictive guidelines will simple amplify the problems many face around the country.

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CURRENT DEATH TOLL
from Jan 1, 2016 – Dec 31, 2016 (2:49:32 PM)

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Someone just died by:

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Where Synthetic Opioids Really Come From

http://www.attn.com/stories/13807/where-synthetic-opioids-really-come-from

President-elect Donald Trump’s plan to combat the opioid crisis largely focuses on drug trafficking from Mexico. But in terms of synthetic opioids such as fentanyl and carfentanil — powerful narcotics that have contributed to mass overdoses across the United States in recent years — the problem appears to originate in China, according to an Associated Press investigation.

AP/Paul Faith – apimages.com

Last week, Chinese officials dismissed claims by U.S. drug enforcement officials that the country was behind the surge in synthetics. In a letter to the Drug Enforcement Administration (DEA), China’s National Narcotics Control Commission said the claims “lack the support of sufficient numbers of actual, confirmed cases.”

But according to the DEA, Chinese labs remain the primary manufacturers producing synthetic opioids that are sold online and mailed to the U.S., Canada, or Mexico. DEA spokesperson Melvin Patterson told ATTN: there were two factors driving the distribution channel.

“The main reason there’s a lot of synthetics [in China is] that those [drugs] are controlled in the United States,” Patterson said. “You’re going to face some sort of prosecution if you have those illegally [in the U.S.], and they’re not all controlled in China.”

Ralf Hirschberger/picture-alliance/dpa/AP – apimages.com

But Patterson added that synthetic trafficking out of China likely wouldn’t be an issue were it not for American demand. “Our appetite for those illegal substances fuels the drive in China to supply that,” he said. “You get really, really basic into supply and demand. If we didn’t have the demand, they wouldn’t supply that to us.”

There has been progress on the synthetic opioid front. In 2015, the DEA worked with Chinese officials to enact bans on 115 chemicals — including several other synthetic drugs such as K2, Spice, and Flakka — and since then, law enforcement agencies have seen dramatic declines in the use and trafficking of these substances, CNN reported. But the problem persists because chemists continue to alter the chemical makeup of synthetic opioids, temporarily avoiding prosecution until regulators enact bans on those too.

Fentanyl and carfentanil, synthetic opioids that can be significantly stronger than heroin, represent some of the most pressing challenges for drug enforcement agencies. The Centers for Disease Control and Prevention (CDC) reported this month that fatal overdoses from these substances shot up 72 percent from 2014 to 2015.

The Washington Post – washingtonpost.com

But as drug policy officials continue to collaborate on enforcement strategy, there’s hope that what happened to synthetics like K2 and Flakka will happen to fentanyl and carfentanil after China imposes new bans. It’s a temporary solution, but at least in the short-term, it could mean less deadly drugs on the streets.

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Online Petitions Take Citizen Participation to New Levels. But Do They Work?

www.nytimes.com/2016/12/28/us/online-petitions-activism.html

Online petitions are all over the place.

Some are political (like one asking members of the Electoral College to vote for Hillary Clinton as president instead of Donald J. Trump); others are unearthly (like one asking that “Star Wars: The Old Republic” series be shown on Netflix).

That first petition drew 4.9 million signatures on Change.org. Nonetheless, members of the Electoral College voted for Mr. Trump on Dec. 19. The second petition drew over 123,000 names.

There has been a proliferation of these petitions — Change.org has more than 100 million users in 196 countries — but are they effective? Do the intended recipients, often policy makers or elected leaders, pay attention?

Worldwide, Change.org users claim one victory per hour, A.J. Walton, a spokesman for the online petition forum, said in an interview.

Among them: persuading Arlington National Cemetery and other military cemeteries to bury members of the Women Airforce Service Pilots, female aviators in World War II, and getting Florida transportation officials to install barriers between roads and lakes, ponds and canals to reduce the number of crashes that result in drownings.

In the case of the Electoral College petition, Mr. Walton said the person who started it, Daniel Brezenoff, was able to generate widespread interest and raise more than $250,000 for his cause.

That a petition did not produce the desired outcome does not mean it failed, he added.

“Was he victorious? No,” Mr. Walton said, referring to Mr. Brezenoff. “Was he successful? I would say yes.”

Those who start a petition can deliver printed copies to the intended recipient. Those targeted do not receive emails every time a person signs, but they are often alerted by email that there is a petition directed at them.

The biggest benefit from a petition is raised awareness, Jason Del Gandio, a professor of communications and social movements at Temple University in Philadelphia, said in an interview. “In some ways it’s just the updated version of the letter-writing campaign to a representative that has been going on for years,” he said.

Successful petition drives do not exist in a vacuum, he added in an email.

“No president is going to do an about-face on a major policy because of 20,000 signatures,” he wrote. “But coupling that petition with other tactics like protests, rallies, phone calls, face-to-face lobbying, a well-organized media plan and community outreach creates an environment in which the goals of the signatories can become reality.”

Beyond seeking change, petitions serve other important functions, such as mobilizing supporters and reinforcing views, Gerald Benjamin, a political scientist and director of the Benjamin Center for Public Policy Initiatives at the State University of New York at New Paltz, said in an interview.

The effectiveness of a petition drive depends on how many signatures are collected, who is signing and whether those being petitioned are in a position to make changes, he said. A petition with 300 signatures, for instance, would carry greater weight if it was aimed at a city council member, who would have fewer constituents than a member of Congress.

Mr. Payne, who also worked as an organizer for NationBuilder.com, a software company that among other things helps clients gather supporters and donors, said congressional staff members knew that if petitioners did not get a response, they could take their case to the news media.

A decade ago, when he worked for Representative John Hall, a Democrat from the Hudson Valley, the office received 5,000 emails and letters a week. Online petitions can take that level of communication to a larger scale by amassing signatures quickly and easily.

“Congressional offices are seeing a river of mail coming into their offices,” Mr. Payne said. “Petitions add a garden hose to that.”

Digital petitions are popularly used to build databases of names, emails and phone numbers of those who can be called on to act or donate. “It’s moved from an organizing effort to an intelligence-gathering operation,” he said. That granular level of detail also allows organizations to direct ads to supporters on Facebook.

Jeb Ory, chief executive of Phone2Action, which relies on technology to help those who want to reach their lawmakers, said digital participation has helped amplify the voices of citizens.

“All it takes is a handful of tweets and Facebook posts for lawmakers to realize there are real people in the community who care about these issues,” he said. “I think technology has done an amazing job of making these decision-makers and policy-makers accessible to the average person.”

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