#OurPain: Opioid prescriptions go down, deaths continue to rise

LAS VEGAS - As many as 100 million Americans have experienced chronic pain, and about 30 million of those have relied on opioid medications to ease their pain. 

The number of opioid prescriptions has been dropping for the last few years, even as the number of opioid deaths keeps going up.

One of the main reasons pain prescriptions are dropping is because of guidelines promoted by the Centers for Disease Control. Critics say the CDC has created the guidelines behind closed doors and that these so-called voluntary standards should never have been adopted as law.

The terrible events of Oct. 1 not only saw the murder of 58 innocent people, but potentially created more than 500 pain patients, many of whom will need opioids for months or longer to ease their suffering.

As it stands though, they along with millions of others with chronic pain patients won't get what they need.

President Trump, his wife, his advisors, and just about everyone else in public life has weighed in on the so-called opioid crisis.

For more than a century, American politicians have scored points by declaring war on various drugs -- heroin, cocaine, marijuana -- all of which are still widely available but the new drug war has already made a huge dent because its target is legally prescribed.

The impetus started about 15 years ago when doctors, pharmacy chains, and drug companies unleashed a new generation of pain medications. Pill mills flourished,  patients died. But the pill mills have been shut down.

"All the records show the prescribing hit its peak in 2010 and the amount of opioids prescribed has been in decline ever since then," said Pat Anson, editor of Pain News Network.

Anson says opioid deaths are up because of illicit drugs like heroin and fentanyl. He thinks the crackdown on legal pain meds is misguided, which is why the CDC created the policy in secrecy. 

"They knew right away. They knew right away and they did it illegally, without holding public hearings like they were supposed to," Anson said.

"In March 2016, the CDC issued what it called voluntary guidelines, suggestions for general practitioners about how to reign in opioid prescriptions, including a proposed cap on daily dosages, called a morphine equivalent standard. 

"The notion of a morphine equivalent daily dosage is just absurd," said Dr. Michael Schatman, a pain expert.

He says, there is no science at all behind a morphine equivalent standard, and that it is preposterous to declare that when it comes to pain medication, one size fits all.

In a scathing paper recently published, Schatman and his co-author pummeled CDC for creating its guidelines in total secrecy. The identities of the expert committee were not revealed, even when six members of Congress wrote to ask what was going on, and when the names leaked, they were widely regarded as radically anti-opioid crusaders. CDC used exaggerated data to justify its guidelines, Schatman said, and his paper noted that CDC has never even mentioned chronic pain on its website prior to issuing the guidelines. Worst of all, the guidelines were adopted as law by states all over the U.S.

"Unfortunately, insurance companies, state regulators, health insurance quality organizations, have all decided to ignore the specific content of the CDC guideline and to kind of weaponize it. So, they've taken some dose thresholds and said, look we're going to force the dose down whether the patient likes it or not, whether the doctor likes it or not," said Dr. Stefan Kertesz, University of Alabama at Birmingham.

Thirteen different medical organizations including the American Cancer Society complained about the lack of transparency in the CDC process and the likelihood that patients in extreme pain would be denied treatment.

CDC responded by hiring a public relations firm to promote the guidelines. Pain doctor Forest Tennant thinks this sends a loud message.

"The federal government is giving the message, we don't care if you die. We don't care if you suffer. We don't care if you lose your doctor. We don't care anymore," Dr. Tennant said.

A document obtained through the Freedom of Information Act shows the public relations company hired by the CDC advised its client that the voluntary standards were causing chaos for pain patients across the country.

CDC has given no indication it plans to change those standards. Pain patients are bracing for another cut in medication supplies in the coming year.

 


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