A public health document that counsels physicians to not overprescribe opioids would seem to be an unlikely candidate for attack. Yet the Centers for Disease Control and Prevention’s “Guideline for Prescribing Opioids for Chronic Pain,” published in 2016, has attracted constant criticism since its inception. The attacks come from two directions: groups and physicians who receive money from opioid manufacturers and patients with chronic pain.

Until the CDC began drafting the guideline, opioid manufacturers had a firm grip on what the government said about opioids. The Food and Drug Administration parroted industry messaging on chronic pain and rejected mandatory opioid-related training for physicians. Industry lobbyists orchestrated the creation of a 19-member panel at the National Institutes of Health to coordinate pain research. Many of the panelists were heavily beholden to the pharmaceutical industry.

In contrast, the CDC applied strict conflict-of-interest restrictions to the authors of its opioid prescribing guideline. When the impeccably evidence-based draft was released, the pharmaceutical-industry-funded Washington Legal Foundation accused the CDC of failing to follow administrative processes. The Academy of Integrative Pain Management demanded that Congress investigate how the CDC had developed the guideline. A probe by the House Committee on Oversight and Reform, however, found that the CDC had done nothing wrong.

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After receiving a barrage of complaints from the industry-friendly NIH panel, the FDA, and industry-funded advocacy groups that disparaged both the drafting process for the guideline and its content, the CDC delayed release of the guideline and opened a 30-day public comment period.

A 2017 analysis of the 158 organizations that submitted comments found that opposition to the guideline was significantly higher among organizations funded by opioid makers, life sciences companies, and those whose funding was unknown than among organizations not funded by industry. Notably, none of the organizations funded by opioid makers disclosed their funding.

That was exposed in a 2018 Senate report. In response to a request from then-Sen. Claire McCaskill (D-Mo.), the top five opioid manufacturers revealed almost $9 million in funding of pain groups between 2012 and 2017. According to the report, the “direct link between corporate donations and the advancement of opioid-friendly messages” is evidenced in the groups’ comments.

Some industry-friendly messages were not subtle. The American Academy of Pain Management, which received more than $1.2 million from opioid manufacturers over six years, was dismissive of opioid-associated deaths, stating “… to limit access to opioids because a small minority of people who use them develop a substance use disorder and/or suffer fatal respiratory depression, may be exacerbating the suffering of a far greater number of people whose pain goes unrelieved.”

In its comment, the American Cancer Society’s Cancer Action Network, which received $168,500 from opioid manufacturers, accused the CDC of a lack of transparency, weak evidence, and “failure to adhere to proper methodology in developing the guideline.” In fact, the guideline used a systematic approach of the best evidence available.

Maintaining pain patients on high doses of opioids is a consistent demand of both industry-funded organizations and pain patients. The American Academy of Pain Medicine (not to be confused with the American Academy of Pain Management), a recipient of $1.2 million from opioid manufacturers over six years, criticized recommendations of daily dosing limits, citing the proposed upper limit given in the guidelines as “an arbitrary dose.” The American Pain Society, recipient of almost $1 million, stated in its comment that “these thresholds are clearly arbitrary and without scientific basis.” And the American Society for Pain Management Nursing, which received more than $300,000, commented that it was “concerning to set a maximum dose.”

The assault continued after the guideline was published. Bob Twillman, executive director of the American Academy of Pain Management, lamented about “the apparent lack of response by CDC to comments submitted by the Academy and numerous other pain management organizations and advocates.” The American Academy of Pain Medicine’s president, Dr. Daniel Carr, claimed that “the CDC guideline makes disproportionately strong recommendations based upon a narrowly selected portion of the available clinical evidence.”

Fresh attacks surfaced in 2019. A letter written to the CDC called for “a bold clarification about the 2016 Guideline — what it says and what it does not say.” Penned by Health Professionals for Patients in Pain (HP3), a group created for the purpose of challenging the guideline, the letter avoided direct attacks on the CDC while bemoaning the “misapplication” of the guideline. The letter’s authors claimed, without evidence, that “draconian and often rapid involuntary dose reductions” implemented by physicians, health care systems, and insurers are driving pain patients to the street to obtain opioids and contributing to patient suicides.

A distinction between street drug users and “legitimate” users of opioids is made by both industry and pain patients. Demonizing “abusers” is an industry tactic. As Richard Sackler, the former chairman and president of Purdue Pharma, the maker of OxyContin, put it in documents disclosed in litigation, “we have to hammer on the abusers in every way possible. They are the culprits and the problem. They are reckless criminals.”

While some of those who signed the HP3 letter have close ties to industry, many of the 300 signatories were well-intentioned health care professionals who did not realize the letter echoed marketing messages. They were used by the organization in much the same way opioid manufacturers use pain patients: as cover for industry efforts to maintain chronic pain as a market for opioids. The HP3 letter, which doesn’t oppose any facts in the CDC guideline and also provides no data supporting its claims, was covered by the New York Times, the Washington Post, Rolling Stone, and other media outlets.

Curiously, when PharmedOut, the Georgetown University Medical Center project that we represent, sent the CDC a letter supporting the guideline signed by seven national organizations and 364 health care providers and allies in May 2019, it received no press coverage.

The formation of HP3 came on the heels of the publication of an article by a conflict-laden group convened by the American Academy of Pain Medicine Foundation. Both the AAPM Foundation and most of the members of what it grandly called a “consensus panel” are funded by opioid manufacturers. The article refutes nothing in the CDC guideline but instead complains about its “misapplication” and — once again — dosing limits: “Daily dosage ceilings, if implemented as hard limits, may promote abrupt dose reductions in patients on high doses, which risks withdrawal symptoms, hyperalgesia [increased sensitivity to pain], and self-medication with more hazardous alternatives.”

Three cancer organizations, the National Comprehensive Cancer Network, the American Society of Clinical Oncology, and the American Society of Hematology, protested that although cancer-related pain was specifically excluded from the guideline, some cancer survivors were being denied opioids even though their chronic pain was related to cancer or cancer treatment.

All of these critics misrepresent the guideline, which never calls for dosage limits, dosage ceilings, forced tapers, fast tapers, or limiting opioids in people living with cancer.

In response to the HP3 letter, CDC Director Robert Redfield merely thanked the organization for its concern and reiterated what the guideline states: that abrupt or involuntary tapering is not what the best evidence recommends. Absurdly, HP3 called Redfield’s letter a “bold clarification.”

Dr. Debbie Dowell, a CDC medical officer and an author of the guideline, also responded to the cancer organizations, acknowledging that previously treated cancer patients were not specifically mentioned in the guideline. Dowell and the two other guideline authors responded to critics in the New England Journal of Medicine in April 2019, again reiterating that “… the guideline does not support stopping opioid use abruptly.”

Their NEJM article does say that misimplementation of the guideline could cause harm — a statement that was immediately spun by Dr. Sally Satel, a co-founder of HP3, as a “forceful and humane variant” of the HP3 letter.

Continuing attack

Criticism of the guideline follows a consistent pattern: no evidence provided to refute any statement in the guideline and no evidence provided for the critics’ claims. The eerily similar attacks on the guideline, and the subsequent spinning of the CDC’s we-meant-what-we-said responses to critics as some kind of admission of error or inadequacy, raise the question of whether this is a coordinated attempt by opioid manufacturers to use third parties to undermine, discredit, and smear the guideline.

There’s certainly a credible motive for opioid manufacturers to do this: The CDC guideline is an effective, evidence-based tool that has helped decrease inappropriate and dangerous prescribing of opioids for chronic pain patients.

Here’s the next line of attack on the CDC guideline: a competing report on opioids and pain management by the Department of Health and Human Services Pain Management Best Practices Inter-Agency Task Force. This report opposes many of the CDC’s recommendations and devotes an entire section to criticizing the CDC guideline. The task force includes many nongovernment members financially tied to opioid manufacturers — conflicts comprehensively outlined in a letter by Sen. Ron Wyden (D-Ore.), the ranking member of the Senate Finance Committee.

Letters of protest about the task force’s non-evidence-based draft report included a strongly worded letter from 39 attorneys general stating pointedly, “While this crisis continues, it is incomprehensible that officials would consider moving away from key components of the CDC Guideline …” Nonetheless, the task force overwhelmingly voted to approve a final draft on May 9, 2019. The final report was released on May 30.

A government-funded report that opposes the CDC opioid prescribing guideline is a major coup for opioid manufacturers. The fact that organizations and individuals funded by opioid manufacturers have stepped up their protests of the guideline in recent months is probably not a coincidence.

Opposition from chronic pain patients

Chronic pain patients have also criticized the CDC guideline. Most of the more than 4,000 comments the CDC received during the open comment period were from individuals. Although most chronic pain patients are not being paid by industry, their stories may be used by organizations paid by industry to advocate for doing away with recommended limits on opioid doses or duration.

Pain patients are important to opioid manufacturers because the bulk of opioids are consumed by people living with chronic pain. A crackdown on opioid pill mills has left many pain patients without access to the opioids they depend on, and finding a new physician willing to supply high-dose opioids is difficult. So-called legacy patients who are dependent on opioids certainly need access to these medications. They also need specialized care to taper down from dangerously high doses and multimodal pain treatment. But their advocacy for unlimited access to opioids for themselves may be used to justify new, ongoing opioid prescriptions for chronic pain patients — who will then become future generations of opioid-dependent patients.

As far as real solutions for the opioid epidemic, the authors of the CDC guideline offer one in their NEJM article: “Starting fewer patients on opioid treatment and not escalating to high dosages in the first place will reduce the numbers of patients prescribed high dosages in the long term.”

It is essential that we not abandon patients on long-term opioids — but it is also important that we not create more of them. Opioid manufacturers stand to lose substantial profits with the widespread adoption of the CDC guideline. Public health, however, benefits from the guideline, and attacks on it bear industry’s fingerprints.

Ben Goodwin is a research assistant at PharmedOut, a research and education project at Georgetown University Medical Center. Judy Butler is a research fellow at PharmedOut. Adriane Fugh-Berman, M.D., is the director of PharmedOut and a professor in the department of pharmacology and physiology and the department of family medicine at Georgetown University Medical Center. She also serves as an expert witness at the request of plaintiffs in cases regarding pharmaceutical marketing practices.

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  • I’m a nurse who’s been focused on safer use of opioids for about 15 years. All of the mindsets have become familiar to me.
    I always go back to the fact that in the US “chronic pain” = “chronic opioids” but not so anywhere else in the world. Yet all human beings experience pain. And suffering about that pain.
    We are one of only 2 countries in the world which allow Pharma to directly market its products to consumers.
    I suspect that ultra-reliance on a class of drugs to treat pain, drugs which can be directly marketed to people without full disclosure, is the context for our opioid related public health crisis. Why not discuss how chronic back pain is addressed in Scandinavia or any other resourced country that isn’t losing a citizen every 11 minutes to a drug overdose? What could we learn?

  • Well first of all the person who wrote this someone who is not sick not does he deal with Chronic pain. Chronic pain is very hard to treat and yoga does not cut it. While alternatives may help some none of them allow a patient with severe arthritis or severe pain to be able to function without medication. Sorry 10 years of NSAID’s ruined my stomach with two ulcers. Chronic pain patient are suffering and committing suicide due to severe pain these limits that have been put on doctors. Meanwhile why don’t you read the research from Red Lawern because you need to. Basically what is happening is chronic pain patient are like lab rats being given medication that was never meant to help the type of pain they have and now drug like gabapentin are being abused all over the street because it was seen as the new pain control pill. Well it only works if you have nerve pain and since it is for people who have seizures you have to wonder if that is a safe drug for someone who does not have seizures. Well the side effects usually leave patient to say no and they leave the pills around. But is there any public health notices to lock up all medicationif you have guests or children around. Basically you cannot control addiction and the only way to deal with it by education of what it is. Being on a opiate means that you have to see a doctor every month, go though pill counts and pay for expensive drug test to get that prescription. A addict just goes down the street and buys Fentynal pills ( which are not legal in the US and comes from China though shopping ports and postal mail) and shots up. Basically the government is going after the sick because it is easy. Most of hurt to much to protest and are doctor hands are tied to be able to treat those who actually need these medications. Of course these people abusing these drugs most of them don’t even care if they wake up. Well I do care and I should not be stuck in bed as a 100% service connected Veteran because of these limits that have no scientific basis. Also Dr Kolodny is not a expert in Chronic pain and just pushed addicts to Suboxone. Well addicts can get opiates for there craving but I cannot take my medication as prescribed for my pain. Now that make sense. Meanwhile the death rate go up and 80 % of those who abuse opiates never got a prescription from a doctor. The CDC has lied about the number and have basically made 15,000 death from opiate prescription ( alcohol was also in the person system which greatly increases the risk of death) which as been steady for years and then combined all these drugs death and blamed doctors. Most people start abusing alcohol first but instead of looking at Americans addiction behaviors of abusing food, gambling, hoarding, sex and other addiction we center on the drug which is only a symptom of the problem. In fact the amount of people who die from prescription opiates has been steady for 15 years. The death rate from street drugs have increased considerable. Meanwhile the average addict is 20 something male. The average chronic pain patient is women In there 50 to 70s. So to compare and take away from seniors almost seem like a plot to kill them in hope they commit suicide because people do not see these people as someone mother o grandmother or sister. It is sick how are healthcare system. Politicians need to stay out of chronic pain care and so should addiction specialist. We are not the same people. BTw no matter what people like anti opiate zealot Dr Kolodny who makes over 1/2 million dollars spreading his lies about chronic pain patients I get nothing from anyone to speak about about how these limits are basically torturing people like myself who’s life has gone from volunteering with meals on wheels 3 times a week to bring home bound much of my days. Meanwhile taking my medication has not save one addict. Why because they need to hit there bottom and need to do the work for there soberity. I certainly have gone though hundreds of thousands of dollars for injections that don’t work, surgeries that just made everything in my spine much worse and see my life rapidly go down hill because people are selfish and abuse there medication by taking more then they should and then they want to blame the doctor. Meanwhile doctor Dr Kolodny charges $700.00 a hour to spread to his crap. I would be a millionaire if I got paid that for every letter I have written but just seems like a failed efforts. But who know that one letter could convince a important politicians so they look at the really reason of drug abuse and coming up with policies and programs to help keeping our youth from all addictive behavior

  • “The availability of pills on the street should not be there. This is what we are trying to stop.”
    No matter who it hurts?
    “The last two are due to overprescribing by doctors.”
    That is so false in the current opioid hysteria it borders on delusional.

  • Dr Lawhern – The study by NIH does go on to say 3 sources: prescribed by a doctor; the family medicine cabinet; friends. The last two are due to overprescribing by doctors. The availability of pills on the street should not be there. This is what we are trying to stop.

    • Janet, availability of pills on the street is partly a consequence of over-supply that goes unused, and more often an outgrowtn of rare pill mills.

      Science is simply not precise enough at present to give us rules for numbers and strength of medical opioids that will be adequate for each individual patient and medical condition, given the wide range of opioid metabolism between individuals. Another factor contributing to uncontrolled supply is unjustified fear of addiction on the part of patients, who frequently terminate use of pain medication prematurely. This represents an example of under-medication, not over-prescription.

      Two major US studies demonstrate beyond any reasonable contradiction that exposure to medically managed opioids generates very little risk to legitimate medical patients prescribed opioids post-surgery. Both studies addressed cohorts of over 650,000 patients, followed for periods up to one year in one case, and an average of 2.5 years in the other. Risk of diagnosis for opioid use disorder was a maximum of 0.6%, and likely included many misdiagnoses due to the poor training of general practitioners who most often rendered that diagnosis. In 11 common surgical procedures, incidence of chronic prescribing (continuous prescriptions over 120 days) was less than 1% overall, compared to incidence in non-surgical patients of 0.136%. Further, incidence of chronic prescribing did not rise in 4 of 11 of the procedures, and was a maximum of 0.69% in the procedure most likely to generate protracted pain (total knee replacement). It is entirely plausible that much of this chronic prescribing proceeded not from misuse of medical opioids, but from procedure failures and emergence of chronic pain.

      Thus if I may be candid: what you are proposing to do, Janet, is to damage the lives of up to 99.4% of all patients by limiting medical exposure to opioids that are rarely a cause of addiction in a maximum of 0.6% who may possibly be vulnerable. This is not a shining example of good medical practice.

    • Richard, you have explained this quite well.
      Janet- I fully support your efforts to shut down the pill mills & their criminal “doctors”. They are a scourge.
      People with chronic and/or intractable pain and cancer patients have been and are continuing to be harmed by the lies and misinformation being spread by the authors of this article,the CDC, the DEA, paid shill and self-appointed opioid “expert” Kolodny, PROP and many others.
      The PDMP’s being put in place nation wide are a gross violation of pain patients rights.
      The DEA making medical decisions is a sad joke with no punchline.
      Pain patients are being forced to go to pain clinics where dubious and dangerous procedures are being forced on them in order to get their pain medicine. Patients have to agree to urine samples, pill counts, demeaning “pain contracts” and other unnecessary rules just to receive a legal & safe medicine. No other patients are being forced to go through this idiocy.
      Addicts have access to bupe (an opioid) or methadone (also an opioid) as part of their MAT.
      Pain patients are just having their meds taken away and are offered a bunch of “treatments” that don’t work as well and are often are harmful as well as being far more dangerous than the very small risk of addiction.

  • Dan – The National Institute of Health (NIH) has research that backs up what I stated 8 of 10 heroin users started with not so innocent pain pill. “Prescription opioid use is a risk factor for heroin use” NIH. Do these facts matter?

    • Importantly, no where do they state whether the were diverted Rx’s or for the person they were prescribed for. This was also “self-reported” by addicts so it is hardly a “fact”
      Also from your NIH article-
      “Heroin use is rare in prescription drug users”
      “less than 4 percent of people who had abused prescription opioids started using heroin within 5 years”
      “less than 4 percent of people who had abused prescription opioids started using heroin within 5 years”
      “Prescription opioid abuse to heroin use, cocaine use to heroin use (to “come down”), and polydrug use (i.e., use of multiple substances) to heroin use. Polydrug use to heroin was the most common path in this study (Kane-Willis, et al., n.d.). The estimated 4 percent subset of people who transition from prescription opioid abuse to heroin use (Muhuri et al., 2013) may be predisposed to polydrug use, and the transition may represent a natural progression for them.”
      “Heroin use is rare in prescription drug users”

    • Janet, you and I may have seen different sources of the statistic you are quoting out of context. I believe that the National Survey on Drug Use and Health [SAMSA] reports that about 75% of all heroin addicts interviewed in 30-day resident detox facilities have indicated that a prescription was the first opioid they abused. But NIDA and other sources inform us that 90% of this 75% weren’t prescribed such meds by a doctor. The same people also abused alcohol or marijuana well before beginning an involvement with prescription opioids. Moreover, we know that when a prescription opioid is found in postmortem blood tox screens, perhaps 80% of the time it is found in combination with illegal street drugs, alcohol, and/or benzodiazepine drugs. And it should be obvious that drugs stolen from a home medicine closet will not be available in sufficient quantities to actually get most people seriously habituated, much less “addicted”. So this picture is much more complex and nuanced than many anti-opioid advocates represent it.

      My position, grounded on a lot of study from authoritative sources, is that we do have a drug diversion problem in the US — one that is dominated by knowing corporate diversion of pills into zip codes where there is no possible medical market. See the Washington Post and CBS 60 minutes expose’ last year on the misbehavior of McKesson and the refusal of DEA and DoJ prosecutors to aggressively pursue that company.

      As for medically managed prescription drugs somehow “leading to” heroin, get serious. It may happen in a tiny number of cases (on the order of 1% of all patients), but it is not even remotely “representative” of the core of the US addiction problem. That core expands around people being made vulnerable to substance abuse of all kinds by desperation and depression in high-poverty regions, broken families, and communities hollowed-out by economic stagnation. America’s “opioid epidemic” is one of hopelessness, not medical exposure. And it is considerably larger than a few Billion dollars in addiction treatment programs is going to solve.

      Regards,

    • Janet, that might be possible, but I am 62, a product of latchkey kids in South Memphis. I have known lots of addicts. I remember where people got their drugs.
      In the 80’s and early 90’s doctors were very careful with narcotics. But parents weren’t. Kids were bored and got into parents medicine cabinets, or got them from friends. I do not recall but 1 person ever getting addicted to their pain meds that resulted into true addiction. As I said before, addiction is mental, not a physical disease. It requires action on your part, just like any other addiction.
      I couldn’t care less what the numbers say. Anyone can manipulate numbers.
      Tylenol kills people, penicillin kills people, as a matter of fact, everything has the potential to be deadly under the right circumstances.
      My rods broke in my back in April. I had anterior and posterior instrumentation implanted in my spine 6 weeks ago. I have pain meds right now, true enough, but I have spent the day in bed crying because the pain is so bad and my meds aren’t working.
      If I am to understand you, you have no compassion for people like me? You would rather look at the numbers and make me a statistic rather than allowing me to have any kind of life at all? Especially when there is so much help for addicts right now? I never broke the law, I never stole for drugs, I never beat up my family in a drug induced rage, but my ex, the addict, did.
      I so appreciate your humanity.

    • Judie, thank you for so succinctly stating what I was thinking. People like Janet seem to only see research and numbers, which, by the way are pretty much incorrect. They forget that human beings are living with true agony, day in, day out because of all this. And unless you live this agony there is no way to communicate it to another. I wish there was. I wish there was a technology that could place people like her, who have obviously never felt real pain, into our bodies for a few days. Maybe then they would see and feel the torture they are causing. Since when did torture become legal in America? I am sorry, there will always be addicts. If they didn’t steal pain pills from their parents, they would have been introduced to that high some other way. It is a choice! I could go on and on, but I think everyone who has commented has pretty much covered it all. But shame on you Janet, and all who think as you do. You are condoning torture. And as much as I hate that I feel this way, I can only hope you will feel this agony one day soon and not have access to the only thing that would give you relief.

  • I still remember number two above and many other injuries years after like so many others, tim…people like you mention above have to be some of the most pathetic human beings alive for trying to take away opioids from suffering patients.

  • This is well known and written by pain physicians. suboxone is NOT for intractable pain nor is any formulation that has naolxone in it. Read for yourself.
    Chronic pain, intractable pain and cancer pain requires agonist ONLY. The tables in this article a valuable. It also speaks of the need for rescue meds or break through pain meds. Something no one is talking about because they lack intelligence. This fiasco needs to be kicked up a notch immediately. Kolodny and Jayne and the rest of PROP need to be in front of congress NOW.
    https://www.cancernetwork.com/palliative-and-supportive-care/alternative-algorithm-dosing-transdermal-fentanyl-cancer-related-pain/page/0/1

    • Rock solid responses Dan, Judy and many other pain patients and advocates. Something else that’s really offensive to me is how so many addiction specialists and parents of drug abusers who overdosed and/or died have shown such reckless disregard for us pain patients with their speech and actions. They have absolutely no right to disrespect us like alot of them do.

  • I have read some horrible things on behalf of mankind here towards other human beings. Here are some facts: In the latest ME report for the state of Florida. Total deaths from Oxycodone 1,282; cause of death – 610 present -672. Next Hydrocodone total deaths 732; cause of death – 226 present – 506. And Fentanyl total 2088; cause of death – 1743 present – 345. You should be able to see we still have a problem. I can tell you before the advent of the “pill mills” heroin and fentanyl was almost non-existent in Florida. 8 of 10 heroin users start with the not so innocent pain pill. Read the book STOPPNow. You might learn something.

    • The problem here is we each have our own agenda. I take it you are totally anti-opiate because you are looking at one group of people. Those people are important and there are millions of them: addicts who cannot control their impulses to get high and they are killing themselves.
      Society says someone must be blamed! Someone must pay the price! So if you get rid of all the opiates, people won’t be able to OD. But that isn’t true.
      Addiction is a mental illness, not a physical one.
      I know this because I had to taper myself off all opiates, I didn’t have a problem, and no one told me how. I am not special. I just do not feel euphoric when I take pain meds; they make me sick, but I thank God I have them every day.
      We people with intractable pain can no longer enjoy any kind of life. Lock yourself in your house for just 1 week. Imagine every waking minute something in your body hurts to the point it brings you to tears. But people who you trust to heal you laugh at you, scoff at you, call you a drug addict, doctors won’t see you and everyone questions your motives.
      All I am asking is you consider both groups of people. Because at the rate we are going, more and more people are going to die, and either way it’s going to be horrible. And it already is.
      I am truly sorry you have so little compassion for people in pain. If you were in our place, you would think quite differently.

    • 1. Below are the Florida stats from the same report. These are deaths where only 1 opioid was present (like the Rx’s for pain medicine that most chronic pain patients have). Please note how low those numbers are compared to the “total deaths” numbers you’ve provided.
      Deaths with Oxycodone Only
      106 29 77
      Deaths with Hydrocodone Only
      108 11 97
      Deaths with Fentanyl Only
      163 126 37
      Deaths with Morphine Only
      96 28 68
      Deaths with Heroin Only
      9 9 0
      2. As I and many of the commenters have noted, most drug OD’s are poly drug related.
      btw ethanol is listed as present in 5,258 deaths, by far the leading drug present
      3. The report does not break deaths down by Rx meds USED AS PRESCRIBED or used for suicide
      4. As terrible as these deaths are, they provide zero justification for treating chronic pain and cancer patients like criminals or for taking away their medicine that works. Even the anti-opioid CDC states that addiction occurs in .62% to 2% of all patients prescribed opioid medicine
      5. Overdose death rate for patients with Rx opioids taken as prescribed is almost zero
      6. Kolodny & PROP are addiction “specialists” . They aren’t involved in pain care. Jane Ballantyne of PROP has said that pain patients need to stop opioid medicine and just get “used to” their pain.
      7. I could go on but I and others have made it clear why they have no love for these unqualified people interfering in the doctor/patient relationship & attempting to demonize safe and effective pain medicines
      8. Lastly, you stated ” 8 of 10 heroin users start with the not so innocent pain pill”. This is not true.

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