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My wife and daughter are chronic pain patients. On behalf of them and others like them, I have spent 22 years moderating social media support groups and analyzing medical literature so non-doctors can understand it. My degree is in engineering, not medicine, though I’ve learned a great deal about pain, pain relief, and health care in the United States.

In the 50+ Facebook groups I support, I hear from people in agony every week. To protect identities, here are some paraphrases from online posts:

  • My doctor forced me to taper down opioid therapy below a level that had for years given me relief from pain and good quality of life for years. Now I’m totally disabled and in constant pain.
  • My doctor’s practice says they will no longer prescribe opioids to anyone. But no other pain center in our area is taking new patients.
  • My doctor wants me to take Tylenol and learn to meditate.
  • I can’t take much more of this.

Doctors should have gotten the message by now that deserting patients is a violation of medical practice standards, not to mention human rights. But they haven’t. To the contrary, they’ve been hearing about other doctors who got raided by Drug Enforcement Agency swat teams, their patients terrorized, medical records seized, and practices ruined by announcements in local news media. Compounding such brutal tactics, chain pharmacies have compiled high prescriber lists, blacklisting “top prescribing” physicians and denying prescription pain medication to their patients.

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Much of the mess described by patients stems directly from the 2016 Centers for Disease Control and Prevention’s “Guideline for Prescribing Opioids for Chronic Pain.” In it, the CDC urged practitioners to avoid increasing opioid doses for new patients above daily doses of 50 morphine milligram equivalents (MME). For patients maintained on doses above 90 MME, doctors were told to conduct and document risk and benefit reviews.

The CDC guideline became controversial almost immediately after it was published. Despite major criticism, it was widely interpreted by physicians, hospitals, insurance providers, state legislators, medical boards, and the DEA as a mandate for hard limits on prescribing opioids — even for so-called legacy patients for whom long-term or high-dose opioids had already proven safe and effective.

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Since the publication of the guideline, the American Medical Association, the American Association of Family Physicians, and other organizations have repudiated the science, logic, and conclusions of the CDC guideline and of the DEA’s witch hunt. But nobody in government is listening to medical professionals any more than they are listening to patients.

In November, 2018, the American Medical Association’s House of Delegates issued its groundbreaking Resolution 235. It reads in part:

“… no entity should use MME (morphine milligram equivalents) thresholds as anything more than guidance, and physicians should not be subject to professional discipline, loss of board certification, loss of clinical privileges, criminal prosecution, civil liability, or other penalties or practice limitations solely for prescribing opioids at a quantitative level above the MME thresholds found in the CDC Guideline for Prescribing Opioids.”

In April 2019, under fire from medical professionals across the country, the CDC advised against “misapplication” of the guideline. Writing in the New England Journal of Medicine, three authors of the guideline said it was never intended to become a mandated standard, even though more than 30 states had incorporated it into legislation in the three years since its publication. At about the same time, the FDA issued a safety warning against rapidly tapering individuals off opioids or suddenly stopping their administration, based on known harms to patients.

As many patient advocates said at the time, the CDC and FDA announcements were too little too late. Tens of thousands of patients had already been deserted by their doctors or forced to give up the pain medications that had allowed them to function.

Physicians have been stepping up their criticism of the CDC guideline and the DEA’s presence in their medical practices. Last month, the American Academy of Family Physicians and five other professional groups representing 560,000 physicians and students called on politicians to “end political interference in the delivery of evidence based medicine.” As they noted, “physicians should never face imprisonment or other penalties for providing necessary care. These laws force physicians to decide between their patients and facing criminal proceedings.”

On June 10, the AMA issued Board of Trustees Report 22 which, among other things, condemns the use of “high prescriber” lists by national pharmacy chains to blacklist high-prescribing physicians and prevent their patients from having pain prescriptions filled. Pharmacies aren’t the only ones using this tactic: Regional U.S. attorneys are also sending intimidating letters to “high prescribers,” warning them that their “prescribing practices may be contributing to the flow of prescription opioids into illegal markets and fueling dangerous addictions.” This claim, however, is not substantiated by medical evidence.

Against this background, there is an inconvenient fact that no one in government wants to hear: almost the entirety of the public narrative that shapes federal and state opioid policy is wrong. Using data published by the CDC itself, a colleague and I have shown that there is no relationship between state-by-state rates of opioid prescribing by doctors and overdose-related deaths from all sources of opioids, including legal or diverted prescriptions and illegal street drugs. In other words, there’s no cause and effect between prescribing rates and overdose deaths — and historical charting of the data reveal that hasn’t been the case in 20 years.

Opioid prescribing and opioid overdose deaths
Data from CDC Wonder

Even as rates of opioid prescribing dropped by 25% between 2011 and 2017, opioid overdose deaths continued to rise.

As opioid prescriptions decline, overdose deaths increase
Data from CDC Wonder

The central assumptions of government policy regulating medical opioids are directly contradicted by data on prescribing, mortality, and demographics. The implications are profound and obvious: regardless of the greed and misdirection of a few bad apple doctors, government restrictions on prescribing opioids to pain patients are based on mythology, not fact. And overreach by the DEA is destroying tens of thousands of patients’ lives for no good reason. I hear every day the stories of pain patients victimized by over-regulation. You can read some by scrolling through the comments on this STAT article, or this one.

Government policy for opioid pain relievers is now a vast tangle. Patients, families, and their doctors need somebody to cut this bureaucratic Gordian knot and end the madness. That somebody is Congress and the time is now — before governments lapse into even deeper paralysis during the 2020 election campaigns.

It is time for Congress to direct the CDC to withdraw its guideline for a ground-up rewrite by an agency like the NIH or FDA that actually knows what it is doing. Likewise, the Veterans Health Administration must be directed to withdraw its closely related “Opioid Safety Initiative.” Veterans tell me that medical practice standards embedded in the initiative are driving vets to suicide by denying them treatment with opioid pain relievers. Finally, the DEA must be told to stand down and stop persecuting doctors who are legitimately prescribing opioids to their patients with chronic pain for “over-prescribing,” something for which no agency has yet created an accepted definition.

There ought to be a law … and I volunteer to help write it. AMA Resolution 235 (described earlier) must become mandatory policy for all federal health care and law enforcement agencies: the CDC, FDA, NIH, DEA, VA, the National institute on Drug Abuse, and the Department of Justice, to name just a few. Then state-level drug regulators and law enforcement need to be informed of the policy change — pointedly.

It is time to end the madness!

Richard A. “Red” Lawhern, Ph.D., is a non-physician patient advocate, moderator of online patient communities, and co-founder and former director of research for The Alliance for Treatment of Intractable Pain.

  • Attention to everyone,. You should know that medicine has been placed here on Earth to relieve pain and suffering to all mankind, or to control that the suffering to those whom can’t take even stronger meds to comfort them until death. I’ve been diagnosed with a super rare blood disease, less than two present of today’s worlds population has. The only thing that helps me is A-phereses, but since doctors don’t to do the paperwork, or don’t make any money from this process, well should I say anymore? I was on super high doses of opiates,. The worse thing about it was coming off those was the withdraws yes they were helpful. I will continue later please E-mail me. [email protected]

  • Dear sir so glad that you are a advocate, have been taking pain medication for many of years 15 miligrams 4xa day and has kept me functioning at a good level now that i have been cut and dosage reduced i am in much chronic pain, have been diagnosed recently with a lot of problems in my cervical spine which has exaserbated my pain more I’m 65 years old had bad car accident in 1986 I’m not a drug user nor do i drink or even smoke, so when my pain becomes accute i go through the emergency and i get my shots of Toradol and the dilaudid so i can go home with some relief and get a little sleep, what’s funny about this is i dont even get checked for drug use, so in the end why are people like me being punished for trying to get pain relief.

  • I would be very appreciative if you would be involved in the writing of AMA resolution 235. As an RN for many years, with severe pain from degenerative scoliosis, my previous doctor prescribed oxycodone for me and saw me each month. This opiate allowed me to focus on my work…not on my pain. After 20 years the DEA put enough pressure on him that he closed his practice and retired. My new doctor (who is in his 60’s) now will not prescribe anything except Tylenol #4, 2 per day. Each day I have to choose which 4 hours I need to have a tiny amount of pain relief…since it only lasts 4 hours. My life is without direction or function. I cannot even walk around the block. My newer doctor states that pain is largely psychological. I just finished seeing him and told him of my frustrations about lack of appropriate pain control. He sited his fact that 30,000 people die each year due to overdose because they increase their dose due to psychological issues like anxiety, stress, etc. I told him I had never increased by dose and had never run out of a prescription in 20 years. He included me and everyone else who had been taking opiates, including those who use opiates illegally in the same group…he said he could refer me to a psych therapist or physical therapy. I like this man…he’s a very good doctor…but he’s been convinced by CDC and other government agencies that opiates must be tapered down and at some point deleted as a chronic pain solution.

  • I to am now a couch potato,because they cut off my pain Medication for no reason,I will always be in pain due to multiple illnesses,when I was on them I was able to work and be a responsible and now I can do very little,

    • Bed to recliner. Recliner to bed. Repeat day after day. Sad isn’t it. I used to go on very healthy short walks around our lake. Do very lite house and yard work which I enjoyed . I considered this my exercise. I couldn’t go out for long, sit through a movie for 2 hrs. Stand over a sink or in the shower for twenty minutes ,no way. Pain meds don’t fix you , you push yourself and your bedridden. I’m 70 now, the time I have left should be Quality time . I worked all my life to get here. Wonderful family, grandchildren, very lucky and blessed I’d say. But spending my days as I explained, indoors and becoming a recluse. This wasn’t the ending I dreamed.

  • Im a chronic pain sufferer. I need a stronger pain med than Tramadol but I dont know what to do. I feel hopeless.

  • I moved to Indiana to be near my sister who wasn’t doing well in northern Indiana. I thought surely with all my documentation from 2003 til now who be sufficient and obvious as to the opioids I’m on. I found a PM an his idea of PM is to force taper me since I’m over the 90mm that the CDC SUGGESTS. He wants me gone and I can’t find another PM to take me anywhere. My sister died suddenly on Dec 31 from pneumonia and I’m trying to get back to the state I came from and the clinic I used that compassionate prescribes the evil opioids for me. If I don’t get out of this state soon I will be wheelchair bound. Wish these Drs I’m dealing with felt like you instead of treating me like a pill seeking junkie.

  • I’ll continue to prescribe opioids to those I feel are benefitting from it for pain and functional improvement and are at a reasonable doses until I’m no longer allowed to. These studies that show no difference between being on an opioid for pain and being weaned off it doesn’t represent every patient.

    • After 5 years of OTCs, destroying my liver, I finally gave up and went to my family doctor. This was 1993. Started with Tramadol, ended upon Duragesic every 48 hrs as the only 1 that helped turn down the pain monster. During that year was tried on multiple meds, PT, biofeedback, chiropractor, exercise and settled on what helped. Was on stable meds through 2008 when Aetna decided to no longer pay for Duragesic. The PM I was at switched to methadone which I tolerated, however my constant GI issues caused another surgery, ileostomy with reversal leaving me with chronic diarrhea and after a long hospitalization was discharged on now 2 more opioids, codeine and lomotil to try to lessen my living in my bathroom. Sadly these 2 we’re stopped in 2010, along with Restoril, and Soma. I had been on these other 2 since 1994 without issue, cut off cold turkey but no major withdrawal. Through this I moved 3 times finally ending in Viriginia in 8/2016. Since 9/2016 I’ve lost everything. I can’t get to a doctor as pain and GI issues keep me homebound. As a retired RN I am appalled at our so-called medical care. We are supposed to care for people, not fear government influence in a medical office. The state boards, ( pharmacy and medical), Congress, and the CDC along with the DEA have interjected themselves in a field where they are not qualified to be at all. Despite writing and calling our pleas fall on deaf ears. Big Pharma and assets forfeiture collect tons of cash on the lives they destroy. Yes procedures are very expensive, it didn’t work for me as I’d been through 4 PM clinics. Pain education a long with the codeine and Lomotil helped me live. Now, continually losing weight, continually in pain I wait endless days suffering until I leave this world.

  • I was on pain management 10 years ago. Was able to get off all opioids with medical marijuana. BUT d/t C.O.P.D. I can no longer use and the editables aren’t effected.
    Now I still have the auto immune issues and a large cyst pressing on L 4&5.
    I can’t get ANYTHING and have been waiting 6 weeks to get insurance approval for injections in my back, and if that’s not effective then surgery!! I was given no say, no choice.
    There may be a decline in the overdoses but suicidal rates will go up!!!
    I’m a retired RN
    What can I do?

  • l’m a retired R.N. & suffer daily with no medication due to doctors being threatened. This is a human rights issue .

  • I had emergency gallbladder surgery. I was sent home with nothing for pain. I could not think, sleep and food was tasteless. I lost 15 pounds during the 5 month recovery.
    The surgeon would not prescribe any medication and told me to take a walk or Tylenol. Then told me to see my Primary Physician if the pain was to bad! He put me on antidepressants. Now my husband is having severe back pain, you guessed it exercise and Tylenol. We need to write and call our congressmen repeatedly and the other greater than you organizations and tell them to back off! We are Americans and no one should be made to suffer and our good doctors should not be told how to care for their patients.

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