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.
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.
My Dr. is not the same. He forced me off 1/3 of my meds in 3 months citing CDC requirements. I’m in constant pain and used to be stable with quality of life. No one even knew about my meds. This travesty is the biggest infringement of government in my lifetime. My privacy and quality of life are for me to decide. Ethanol is in every grocery store yet I’m required to deal with my pain by folks who aren’t even physicians.
“Although most chronic pain patients are not being paid by industry, their stories may be used by organizations paid by industry” I am a member of several grass roots FB groups that ARE NOT paid by the pharmaceutical industry. Even the authors of CDC guidelines acknowledge they’ve been misapplied. Is the CDC funded by opioid industry? The 2016 guidelines must be rewritten. They were written by addiction therapists without even one doctor of medicine that specializes in pain management. Prescribing has been falling for years, but overdoses from illegal opioids are still rising because of illegal drugs, heroin, fentanyl and meth, not prescription drugs. They are not working. More people are dying. Just go to the CDC web site. Linking patients with pharmaceutical groups is irresponsible and immoral. And here you are dismissing the stories of chronic intractable pain patients from terrible unimaginable painful suffering and disparaging those advocacy groups who fighting for them, saying they have ties to industry, because they are advocating for chronic pain patients. Patients that were on effective dosages that keep them working, able to take care of themselves and play with their grandchildren, are now bedridden from force tapering AND these patients are treated like dirt. They are profiled, called addicts and denied life saving medications and are committing suicide. This is FACT. Everyday someone else says they want to die in the groups I am in. Suicidal ideation by the thousands. Pain patients are committing suicide because doctors are too scared of the DEA to write prescriptions for them. Of course attorney generals don’t want HHS to change the guidelines. States are making millions off of suing Purdue and pursuing pain management doctors. Chronic pain patients must sign contracts, do pill counts and urine tests to prove they are not misusing their medications, and still they are discharged or their doctors leave. Pain management is in shambles and still others are saying doctors are creating addicts and here you are saying patient stories might be used without ANY proof. A statement like that only stigmatizes them more. What more regulating do you think needs to be done on them? done to them by the government bodies that have never seen them or examined their cases. It is akin to medical malpractice to tell a doctor what and how to treat a patient they have never seen. So why don’t you just say everyone opposing the 2016 guidelines is in one way or another TIED TO INDUSTRY. That is one way to keep people from listening to what is happening to chronic pain patients and how cruel it is. How irresponsible can you be? A real factual study found less than 2% of chronic pain patients under the care of a doctor become addicted to their opioids. When these pain management doctors are found innocent the DEA STILL KEEPS all of the assets they took from the doctor’s practice and the doctor’s good name is ruined. Doctors that are still “do no harm” and are humane enough to treat difficult cases correctly have been determined to be innocent in court, but still these DEA raids are going to occur according to testimony by Attorney General William Barr. He said so under oath. And you are saying doctor’s are being paid by industry ” groups and physicians who receive money from opioid manufacturers” Do you think that because the AMA said the guidelines were being misapplied and misinterpreted, a criticism, that they are being paid? They are after all one of the two groups you refer too. The CDC’s 2016 voluntary guidelines for PCP only, are now being used as an excuse to pass legislation and policies denying chronic pain patients the medications they need! Theyand you do not go back on this claim! that even chronic pain patients not paid by industry, are telling their stories to anyone who will listen and implying that that since their stories may be, perhaps, could be used, that they should do, what? Not tell them? Or are you trying to say to those that hear them, that it is industries that produce opioids behind them being told. Are you saying fighting against something that is wrong, critizing it that their stories are used to advocate for unlimited opioids? I never heard one patient say they were for unlimited opioids. How dare you link everyone fighting against the guidelines are all tied to industry. It sounds to me like you just want people to dismiss their stories for other reasons.
The CDC key witness, Dr. Andrew Kolodny, had been railing against opioids while promoting the use of Suboxone. They called him to testify against Johnson and Johnson as well as Purdue Pharma stating their opioids were marketed as more effective and less addictive when they weren’t. And in the midst of all his testimony we discover Suboxone, also an opioid, is just as addictive as the very drugs Kolodny vilified. He is also NOT a pain management specialists but an addiction therapist whose reports to the CDC included heroin and illicit Fentanyl overdoses into the opioid overdoses to dramatically elevate the statistics. Every time some idiot like Demi Lovato ODs on heroin it counts against legitimate chronic pain patients.
I am currently below the recommend 90mme daily, I am also aware that I have a genetic disorder that gets progressively worse with age and that, at some point, my dosage will need to be increased. My pain never drops below a 6 on my best day and averages an 8. Until a safer replacement for opioids is created it is inhumane to set an arbitrary limit on dosages.
I have Ehler-Danlos Syndrome, a defect in collagen production that causes severe hypermobility, dislocations, and subluxations daily. The pain of this condition has been compared to bone cancer, sickle cell anemia, or end stage renal failure. Because it’s a rare disease it doesn’t get the exposure and recognition the others do. Am I supposed to just suffer and lose my functional quality of life and become a burden to my family and friends because my body is deteriorating and there is no cure or treatment for this disease OTHER THAN opioid pain management or suicide, as we do not make good surgical candidates due to Papyraceous scarring and slow recovery.
There HAS TO BE some compromise for those of us in special circumstances. Not everyone fits your statistical narrative!
What a bunch of nonsense. The CDC guidelines are based on politics pure and simple and discrimination against a class of people, namely those in chronic pain. Far from being evidence based, they show a profound misunderstanding of pain. I’ve had acute pancreatitis and now have chronic pancreatitis. In my experience, when you are in severe pain, the best way to get it under control is treat it with strong medications. Once it is under control, the medications should be tapered or switched to a non-narcotic. My reading of the “guidelines” is that they say the exact opposite. And, I do suspect the pharmaceutical industry may well play a part in this whole mess. Most of the “opiate” medications have been around for years and cheap generics are available. You can’t make gobs of money off cheap generics. Better to scare everyone into taking a new medication such as Vioxx, Celebrex, or whatever while prescriptions are filled for $300 (due to no generics being available) for a single script compared to the older, more effective medications which are cheaper and available as generics. To suggest that chronic pain patients are in cahoots with the pharmaceutical industry is ridiculous. I have read of many cases of suicide where individuals in legitimate pain were cut off from their medications amid all the hysteria. Were their unnecessary deaths also the result of collusion with pharmaceutical companies? The current overdose crisis is being fueled by illicit Fentanyl analogues being imported from China and elsewhere and not primarily due to prescription medications. There is a legitimate drug problem in this country and no “one-size-fits-all” solution will resolve the complex issue of misuse and abuse of narcotics and other drugs. For example, in states where first responders are now required by law to carry Naloxone, overdose deaths are down. Also, educating people about the dangers of mixing drugs will result in fewer overdose deaths, since many of these deaths are the result of mixing several drugs as several studies have suggested.
FYI , Myself , I need 360 MME of opiods to kill my pain to a decent level. I was just been told I am not a addict and believe that people need more than 90 MME to kill their pain. Once I got to this 360 MME level my pain subsided to a acceptable level and I have lived at that level for over 8 years without requiring more medicine. I believe the medical community has a lot to learn about this stuff and how it effects people. I just hope they stop this reduction and put me back to where I was before I kill myself because life has been bed ridden for me the past year and wish the CDC would call me and I would like to ask them some questions because something is wrong. I know there are many people in my position.
Now the truth comes out and the jig is up: Justice Department Obtains $1.4 Billion From Reckitt Benckiser Group in Largest Recovery in a Case Concerning an Opioid Drug in United States History. So what will you do now Pharmed Out, PROP, Shatterproof, Kolodny, ALL of you, now that the illegal promotion of Suboxone on the backs of the seriously ill who were legitimately prescribed routine standard medication for pain that YOU demonized, has been revealed to be a hoax? And during the entire time you sought to cater to the legal settlement industry by extorting certain pharma corps and certain opioids, while pushing your preferred pharma corp and preferred opioid, you demonized patients with bigotry and lies, lobbied for regulations limiting pain relief, saw the suicide rate rise in the sickest and in veterans who had pain analgesics cruelly ripped from them, persecuted doctors and destroyed access to the medications required for an aging and dying population who need them more than ever for some dignity in sickness and in dying. You limited prescribing using law enforcement in the exam room no matter what the medical necessity of the patients, and drove the overdose death rate sky high, a complete and total failure. You created two crises out of one, artificially inducing a mass public health ‘epidemic’ by creating newly disabled patients from once functional and working patients, from untreated and undertreated pain which in too many cases fed formerly stable responsible patients to the streets for relief for their symptoms from injury and incurable painful disease, or the gun shop and the morgue from being medically destabilized, their lives and families turned upside down. Worst of all you ignored utterly the true cause of overdose deaths: the southern border and the Cartel Drug War which has been raging since 2006, causing mass displacement of people, and fueling a trillion dollar a year illegal economy of illegal deadly street drugs and the criminals who distribute them. You were amply assisted by your allies in Big Media who love to hype ‘epidemics’ of anything, because if it bleeds it leads, tapping into anti-corporate sentiment from your partisan friends in government convincing them to demonize this company, but ignore our friendly company, who happened to be committing the exact same crimes! Special interest lobbyist groups PROP, Shatterproof, Pharmed Out enabled the exploitation of and profit from the horror of illegal drug addiction, NOW WHAT? What will you do for a follow up? Circular firing squad? A Logan’s Run policy for anyone getting ill, injured, or old, lest they require analgesics? Maybe it is past time to delve into the funding behind your own ‘attacks’ on humane routine standard modern medicine and your promotion of a return to medieval medical care, maybe there is something you are hiding.
You dropping my pain meds is making me bed riddin. Dropping my opoid dose has affected me to the point of lying here in pain. I cant take acetamenaphin and I vant take Aleve or ibuprofen because of water retention. You took my livelihood and made me a person that dont even leave the house now be cause of my pain level. I just feel like ending this pain because nothing to look forward to but pain.
Oops I meant to include the link to Dr. Padmanabhan’s article:
http://valleypatriot.com/a-million-lawsuits-are-coming-and-about-time-too/
Dear Dr. Goodwin: Your statement it is essential we not abandon patients on long term opioids (specifically I believe higher doses) is unfortunately not being followed by most internists, let alone most pain physicians or pain specialists Patients who are on more than 100 MME daily of morphine or not willing to taper rapidly or exhibit any “aberrant” behavior are simply fired or will not be taken care of by pain specialists. If these patients who suffer from chronic pain are in essence abandoned by “pain specialists” who refuses to care for them, who will? Why is this? The DEA uses this figure 100 MME as a “radar” to target “over prescribers.” If there is a bad outcome with the opioid, pain specialists fear losing their license to prescribe. Unfortunately there are too few pain physicians who are willing to take care of these people, especially those who have any “aberrant” behavior or addiction. The lack of access to pain medicines by people who already on them and at higher doses is a real public health crisis created in essence by the CDC’s well intentioned efforts. We must acknowledge that their document has lead to a real public health crisis and until this is addressed, the crisis will continue.
Some have commented to the effect of all this being an attack on baby boomers. It seems very sadistic to think about and does appear like they are trying to ‘remove us’, so to speak. I always found it unusual how they never make statements on how responsible and unproblematic 99% of pain patients have been in using their prescribed opioids. Something is very wrong here.
My name is Michael Springer. I am 70 years old. Most of my more troubling symptoms were steadily increasing in their severity while I was working with a Special Agent to expose criminal activities and corruption in State government. I have been diagnosed with a constellation of rare diseases but none of them are related to lifestyle choices. Individually they are some of the most difficult conditions to diagnose and treat. The combination of rare diseases and medications I have to take create a broad range of additional symptoms. Some of the medications I have to take pose significant health risks, others can interfere with attempts to control another disease or manage my symptoms. Some of the procedures and medications can aggravate existing symptoms and damage vital organs but since my mid 20s pain has always been present.
I hold a graduate degree from UC Davis, was licensed as a registered nurse in 1973 and nurse practitioner in 1977, provided clinical services for over 30 years in underserved rural and urban settings, for and with local public health programs, worked as a Consultant for the California Department of Health Services for nine years and trained in epidemiology. Over the years I have testified as an expert witness for the Office of the Attorneys General, before two Grand Jurys, State administrative law judges and in criminal and civil proceedings.
I have no affiliation with big pharma but have worked with and within the US public health system for over 40 years. I find the diatribe; “Industry-funded attacks on the CDC’s opioid prescribing guideline are eroding public health” to be trite and a weak defense in response to the justifiable blow back that should have been anticipated before releasing the poorly thought out “Opioid Prescribing Guidelines”. This is by far the greatest debacle that CDC has ever embarked on in the past 40+ years.
For the past 4 decades I have worked with people who have dedicated their lives to finding solutions to public health problems. Over the years I have developed a great deal of respect for the CDC – that was until I read the “Guidelines”. The “Guidelines” uses the data for deaths related to opiates such as fentanyl and heroin that are bought on the street and uses that information to justify CDC’s war on clincians who provide opiates and other medications to patients who suffer from chronic, intractable, stabbing, burning, grinding, shocking, bone-on-bone pain. Pain causes loss of sleep, increased risk for heart disease, cancer, divorce, job loss and burdening other family members are just some of the outcomes that are not mentioned by the CDC.
There are a few clinicians who may possibly over-prescribe opiates to their patients but citing the thousands of deaths that are related to the use of illegal opiates from China, Pakistan, etc. is dishonest. I wrote to the CDC several months after the “Guidelines” were published. I actually got a call from a CDC employee! She was very pleasant and articulate but after I told her that the “Guidelines” pose an undue burden on people who are tormented by pain day and night she told me that there will be no changes to the “Guidelines”.
This classification of medication is only used when nothing else will help control a patient’s pain. Patients go through many years of palliative care, physical therapy, dorsal column stimulators, oral anti-inflammatory medications, exercise, over the counter medications, surgeries and sessions with psychologists. When these interventions fail to stop the unrelenting, grinding, intense stabbing and burning associated with peripheral neuropathies and the radicular pain associated with the impingement of the nerves between two vertebra or secondary to spine surgery or shingles they are given a prescription for an opiate because there is little more that can be done to relieve the patient’s pain.
Unfortunately the “Guidelines” do not reflect an understanding of how to apply the long standing scientific evidence that has been derived from expert clinicians who help patients manage pain in a clinical setting. In addition to the purposely misleading scientific “facts” that supposedly provide the rationale for disseminating the “Guidelines” nation wide without taking the time to create multiple focus groups made up of patients and their physicians . The “Guidelines” offer no viable alternative to the opiates that patients desperately need to manage their pain. Six months ago I was told that pain is just part of life and patients should just accept it. Whoever the puppet master might be, they have no idea of what they are doing.
As an example I will use my own experience in attempting to control the various kinds of pain I have lived with for over 30 years. I have Stage II renal disease. It was caused by the high doses of aspirin and ibuprophen I had taken almost every day since my mid-20s. If I want to avoid renal dialysis I can no longer take any of the NSAIDs. If I am forced to use NSAIDs the cost for dialysis will be enormous but that could have been avoided if I was allowed to use other pain medications.
Between 2000 and 2012 my creatinine and BUN were trending upward. After a consultation with a nephrologist in 2012 I began taking codeine. The physician I was seeing prescribed 240 tablets of acetaminophen with 30mg of codeine. At first I took only one every 4 hours. Since that dose did not decrease my pain he told me to take two tablets of the 30mg of codeine every 4 hours. I did what he told me but after a year it was obvious that I needed something else to manage my pain. Four years ago I was given a prescription for 15mg tablets that contained morphine. Because it did nothing to blunt my pain I was told to increase the dose to 60mg every four hours. Eventually we came to the conclusion that I am non-responsive to opiates.
Approximately two years before my morphine trial, a new medication was approved for the treatment of pain. The name of the medication is Nucynta. I was given a prescription for tablets that contained 50mg of Nucynta. For no logical reason Nucynta is classified as a Class II opiate but it has none of the attributes that others to use them for. The fact is that Nucynta has no extrapyramidal effects such as euphoria, it is still listed as a Class II drug. Because it is a Class II medication I have to submit to monthly evaluations and treated like some kind of street junkie.
One of the absurdities is that I am 70. Given my medical history I will be lucky to live to the age of 80. Why would the CDC want to stop the elderly in the US to live through their sunset years in pain? And lastly the “Guidelines” were so poorly conceived and written that it has created opportunities for attorneys to file law suits against institutions like Kaiser Permanente, Renown, the VA, and many others. Retract the “Guidelines” now before anyone else gets hurt.
Michael Springer, RN, PHN, NP, MHS
WEll put Michael. Please see Calif. Penal Code Section 368 conquering abusive and neglectful injuries to disabled adult s and the elderly. I’m in Texas now but lived in California for 40 years. Texas Penal Code Section 22.04 is supposed to protect vulnerable people- Injury to a Child, Elderly Person or Person with Disabilities.
Please see California Welfare and Institutions Code Section 15600 ET SEQ for abuse, neglect and exploitation laws. Most states have similar law.
Please also see the Older Americans Act, the Americans with Disabilities Act and the related Supreme Court OLMSTEAD decision, as well as the Elder Justice Act. These laws stress that “community inclusion” is the intent of these laws and decision and states are responsible for keeping vulnerable adults in their own homes allowing us to interact with non-disabled people, among other t activities that non-disabled and non-elderly people enjoy such as family, friends, community events, owning a home, working, etc.
I am 66 and have been disabled with osteoarthritis since 1997. My pains are so pervasive high I can’t live without pain medicine. I’ve been mostly cut off recently due to the hysteria, irrationality and paranoia created by the CDc Guideline. The Veterans Administration seems to be worse about pain meds.
Millions of pain patients have safely take these drugs for years and sometimes decades. The CDc and FDA admitted this in their April and May press released about the “misapplication” and “misinterpretation ” of the Guideline “harming responsible pain patients. There is hope if we all speak up as you have done. We can’t save the lives of addicts by harming responsible pain patients and driving some of us to suicide as the “final pain relief option”.
Abuse, neglect, exploitation and discrimination ;awds may further save pain patients from the hooligans masquerading as objective scientist and experts. You may contact me at @justitiadebiles. I won’t give up too easily. Keep up the excellent writing and advocacy Michael. Bless you.
well stated Michael. I tried Nucynta and it was the best pain medicine I had ever tried. After 3 days, I developed a massive headache and could not take it. I was then put on Fentanyl patches with Oxycodone for breakthrough pain. Over the course of all this changing I was badgered at each visit by the nurse practitioner and MD to purchase a Spinal Cord Stimulator. Being a chemist my entire life I looked up the SCS data on the FDA database and under MAUDE – manufacturer and user devise experience I read many horror stories of infection, paralysis and death from all manufactures of these devices.
Since I would not buy in to the SCS I was ejected from the clinic after 4 years of clean Urine drug screens and no tablet shortages. This was in Tennessee but I live in Georgia.
I then sought the advice of the Head Of Neurosurgery and professor at Emory University. He looked at all my data including images and the 5 models and brands of the SCS units I was offered. His verdict was: “These are all junk, designed to make money but most importantly you cannot get one because you have chronic meningitis caused by to many steroid injections and the myelogram you had at a L5-S1.
Fast forward to April of this year a young orthopedic surgeon wrote me Amitriptyline for nephropathy and did not check my current list of medications I filled out. I wound up in the ER with Serotonin Syndrome and was almost dead. I spend 48 hours on an ER gurney with doctors working on me around the clock.