I’m going to use an analogy to make my case. I remember from plane & solid geometry that it takes 3 points of support to a horizontal solid plane to make it stable. For those of you who never had to take a plane & solid geometry course, think how easy/hard it would be to sit on a stool that only had one or two legs supporting it compared to a stool that would have three legs.
Both versions of the CDC guidelines (2016 & 2022) is primarily based on three medical premises that has – at best – very poor/inadequate medical evidence supporting their processes and/or conclusions.
First is the fact that the CDC guidelines used in both versions, studies that were mostly rated “3” or “4” in the quality of the data used to come to the conclusion of the study. A study with a rating of “1” is considered highly reliable and those rated “3” or “4” is consider poor and/or unreliable regarding the data used and the conclusions.
After the 2016 guidelines were published I have seen numerous times where other professionals have questioned the use of such poorly rated references used to support the conclusions for the 2016 guidelines.; Yet, it would appear that the FIVE “experts” seemingly chose to use the same references for the 2022 guidelines. Does this mean that using more reliable references would not support the desired conclusions to support the 2022 guidelines ?
No one seems to questions that FIVE “experts” are given credit for the creation of this 200+ page set of guidelines, and of the 20 +/- pages of references and footnotes, ONE WHOLE PAGE has abt 12 references with the first name on each referenced article being the same person who is “ONE OF THE FIVE EXPERTS” who created the 2022 CDC dosing guidelines. Is that a blatant conflict of interest or just self-serving ?
“The Guideline recommendations are still primarily based on “Type 3” and “Type 4” evidence ”
Earlier this year Chuck Dinerstein, MD, MBA published a article that is basically the genealogy of the MME system. Clearly documenting that this system has no science nor double blind clinical study supporting its conclusions.
https://www.acsh.org/news/2022/03/01/true-story-morphine-milligram-equivalents-mme-16154
One of the oldest internet published MME conversion programs https://globalrph.com/medcalcs/opioid-conversions-calc-original-single-agent/
has the following footnotes:
Published equianalgesic ratios are considered crude estimates at best and therefore it is imperative that careful consideration is given to individualizing the dose of the selected opioid. Dosage titration of the new opioid should be completed slowly and with frequent monitoring.
Factors that must be addressed during the conversion process include: Age of the patient or presence of coexisting conditions. Use additional caution with elderly patients (65 years and older), and in patients with liver, renal, or pulmonary disease.
Conversion ratios in many equianalgesic dosing tables do not apply to repeated doses of opioids.
The amount of residual drug in the patient’s system must be accounted for. Example: fentanyl will continue to be released from the skin 12 to 36 hours after removal of the patch. Residual effects from discontinued long-acting formulations should also be assessed before converting a patient to a new opioid.
The use of high but ineffective doses of a previous opioid may result in overestimation of the converted opioid.
Ideally, methadone conversions (especially patients who were previously receiving high doses of an opioid) should only be attempted in cooperation with a pain specialist or a specialist in palliative medicine.
Meperidine should be used for acute dosing only and not used for chronic pain management (meperidine has a short half-life and a toxic metabolite: normeperidine). Its use should also be avoided in patients with renal insufficiency, CHF, hepatic insufficiency, and the elderly because of the potential for toxicity due to accumulation of the metabolite normeperidine. Seizures, confusion, tremors, or mood alterations may be seen. In patients with normal renal function, total daily doses should not exceed 600mg/24hrs.
I found no mention, in the either sets of guidelines, that pharmacogenomic DNA testing, to determine if the pt is a fast/ultra fast metabolizer which would be valid justification of the pt’s in need of higher single doses, more frequent dosing and/or higher total mgs/mcgs per 24 hrs.
Third, everyone needs to watch this video https://stanford.zoom.us/rec/share/F6IC_Sitiu4lmGQgBbD9wVvOb5iG9Eal7fnJrqC2G2lMMEjDM8H4mv4D_hOjD6mY.jqBbyLkUm9RvzhKS
The presenter, attorney Dr. Jennifer Alva indicates that the PDMP/Narxcare reports contains a high percentage of unreliable data points on pts that results in bad/false Narxcare score, resulting in a pt being falsely labeled as having a “high score” of being at risk of overdosing or dealing with OUD.
She also suggests that most states have turned their PDMP record keeping over to Experian/Bamboo Health/Narxcare. I recently read where all of the medical databases that Bamboo Health maintains has been mover “off-shore “. Somewhere “across the pond”, where our HIPAA rules are not applicable. Apparently leaving this company to be able to sell our health data to any entity willing to pay for it. I guess that the DEA no longer needs a court warrant to search PDMP’s databases and they can go on a “data fishing expedition” all they want, without the constraints of our legal system and our laws.
Here is a post on my blog displaying a typical Narxcare report format Images from a Narxcare report – PLEASE SHARE
Please note that apparently Bamboo Health is using a LME value ( Lorazepam Milligram Equivalents)
In doing some research… appears that an association of Pharmacists: The American Association of Psychiatric Pharmacists may have created this LME system. appears that it may have been first published in Aug 2014
and here is a hyperlink to a full chart of LME’s https://deprescribe.web.unc.edu/wp-content/uploads/sites/20194/2020/04/Benzo-Equivalency-Table_UNC.pdf
It seems that the entire prescribing/dosing of opiates seems to be supported not much better than trying to sit on a stool with legs being made out of “cooked spaghetti “. Yet, it seems like a lot of various entities in healthcare and law enforcement puts a lot of faith & creditability in the reliability of this poorly design system. As well as the QOL of pts that is having this applied to their medical care with seemingly no follow up as to how the guidelines are applied and/or pt’s outcomes are affected.
Filed under: General Problems
They allowed,,the very people who stood to make a HUGE,HUGE , financial gain,,to redefine long standing definition to trump up their data for their brand of addiction and make up a whole new unit of measure to sell their brand of ,”addiction psychiatry,”,to trump up the ###’s”’Essentially,,the allowed the very people who had everything to gain financially from selling their ,”brand,”,,,,,,just like any snake based business!!!Dahhhhhhhhhhhhhhh,,,which IS WHY,, in all other countries,,forcible combining psychiatry w/government POLICED policy is forbiden,,and lets not forget,tamperring w/the chemical formulas of ALLL opiates to make them weaker,,then turning around and calling these poor souls addicts,when they TRUTHFULLY complain,,my medicine isn’t working anymore,,THATS DEMENTED/SICKENING!!!!ONLY a kolodny could come up w/something soo sick!!!,,Why over 10 shrinks were charged in Nuremberg, I can’t believe ,”our” government and the kool-aiid drinkers were that niave!! ITS
CALLED LEGALLY ”A HUGE CONFLICT OF INTEREST,”’dahhhhhhhhh,,,maryw
Hey! That “expert” is Roger Chou. Apparently COI’s do not matter to him or the CDC! The facility he runs at the U. of Oregon has received over $2 Billion from the govt. in research grants, many from the CDC. If it hadn’t wrecked so many lives, mine included, it would be laughable!