This weekly column offers opinions on the latest pharmaceutical industry news.
Every day, 44 Americans overdose and die after taking opioid painkillers. Every year, 2 million people abuse or misuse the drugs. And as addictions and deaths mount nationwide, authorities are struggling to cope.
State lawmakers are introducing bills to restrict prescribing. The Food and Drug Administration is pushing pharmaceutical companies to develop more tamper-resistant products. And in one dramatic move, the police chief of Gloucester, Mass., posted a plea on Facebook urging the public to contact drug company executives to help curb the crisis.
But arguably, the most sweeping initiative comes from the US Centers for Disease Control and Prevention, which has prepared preliminary prescribing guidelines for primary care physicians. The recommendations, outlined in a webinar in September and subsequently leaked online, call on doctors to prescribe opioids only after other therapies have failed.
This is a crucial effort. Family doctors write the vast majority of prescriptions for painkillers. And with 14 million Americans suffering severe pain each day, ensuring that these health care providers have useful guidance is critical to stemming the tide of painkiller addiction.
Yet there is considerable opposition to the guidelines — and much of the reproach comes from organizations that represent patients suffering from cancer and pain.
These critics — which include the American Cancer Society and an umbrella group of leading pain societies — say the CDC guideline process was flawed and, as a result, some patients will be denied much-needed pain relief. But experts counter that it’s the drug industry, not patients, that has the most to gain by blocking the CDC initiative.
“The criticism is hollow and comes from people who are heavily conflicted,” said Dr. David Juurlink, a clinical pharmacologist at the Sunnybrook Health Sciences Centre in Toronto and a member of Physicians for Responsible Opioid Prescribing, a nonprofit group based in New York.
Juurlink is referencing the fact that many of the professional associations and patient advocacy organizations that have been most critical of the CDC receive funding from the manufacturers of top-selling opioid narcotics. These companies — Purdue Pharma, Endo International, and Johnson & Johnson — have all been accused of marketing their pills without fully disclosing the potential for addiction.
A key complaint is that some cancer patients, especially those in remission, will be denied relief under the new CDC guidelines. “They may curb some of the abuse,” conceded Christopher Hansen, president of the Cancer Action Network, the American Cancer Society lobbying arm. “But I think there will be other problems,” he said. Last month, Hansen’s organization asked the CDC to scrap the guidelines before they are completed early next year.
“The criticism is hollow and comes from people who are heavily conflicted.”
Dr. David Juurlink, Sunnybrook Health Sciences Centre
The American Academy of Pain Management, meanwhile, wrote to the Energy and Commerce Committee of the US House, asking for an investigation into the CDC process for developing the guidelines. The group said the CDC never publicized its deliberations. It also charged that the agency relied on weak data, while failing to recruit pain specialists for its expert panel.
The CDC, through a spokeswoman, said it used a “rigorous peer review process” that included input from outside experts.
The patient groups, which contend industry funding is a small part of their budgets, do make one good point. It’s true that the CDC should have had more pain specialists among the 17 outside advisers. This might have helped blunt suspicions the agency was aligning itself with Physicians for Responsible Opioid Prescribing, where Dr. Jane Ballantyne, one of the panelists, is president. Ballantyne, a retired anesthesiologist at the University of Washington, is also a paid consultant to a law firm involved in challenging drug makers on opioid marketing. (This was disclosed to the CDC.)
But the patient groups miss the mark elsewhere. According to Dr. Lewis Nelson, an emergency medicine specialist at the New York University Langone Medical Center and one of the CDC advisers, cancer sufferers who are in remission count as chronic pain patients under the guidelines. And while acknowledging that the underlying data used to make the recommendations are weak, Nelson said that’s because there isn’t a lot of evidence available to evaluate long-term use of opioids or compare them with other options, not because of any omission by him or his fellow panelists.
“This complaint is a straw man,” he told STAT.
Guidelines are needed. Right now, there is a distinct lack of direction for safe and effective opioid prescribing. After incorporating any comments, the CDC should proceed and issue its recommendations as planned in January. Blocking their release would be a mistake and lead to still more pain across the country.
About the Author Reprints
I was a very healthy and productive citizen that served my country well, I did my job, gave to charity, voted and helped anyone that I could. I was very athletic and in excellent shape from my teeth to my toes and wouldn’t even take a Tylenol or Ibuprofen after a filling so no drinking or drugs and UPS was big on random drug tests where the Dr. watches you go so you’re UPS guy is a clean living individual. I was injured so bad it ended my UPS career after 14 years of a job and my identity which I loved ,and some may say I love my job or career but I loved being the UPS guy. I looked forward to doing my job the best possible way and getting paid well in the process. I can’t stress enough that being part of UPS was a dream come true for me and I would often think to myself that there isn’t anyone or anywhere else I want to be, my life was perfect. When I was told by the UPS Doctor that I couldn’t do the job anymore I cried and then went on to tell my wife I wouldn’t be able to pay the mortgage or be intimate with her anymore or play with the kids so that is how bad my injuries are. I lost everything & my wife found a man that could take care of her & the kids financially but I don’t hold any bad feelings towards UPS or her as I can understand that bad things happen and folks get hurt. I was bed ridden for most of my days until I seen a Doctor that ordered MRIs on my injured back and shoulder then came up with a pain management plan along with stretching and core strengthening, manual manipulation and all of a sudden I had something to look forward to since I could get out with a managed pain. So my Dr. worked on a treatment plan for MY personal pain level and injuries to give me the best quality of life possible and this was done with oxycodone which I felt bad about taking because I never even put a Tylenol in my mouth for my 39 years of life. So my Dr. didn’t just give me a pile of pills and say bye bye see you next month but he came up with a dose and list of things for me to work on to help me actually feel like a human being again. I was able to engage in some everyday activities again the activities I had taken for granted like do my laundry or sleep more than 2 hours in a row or get out of bed without having to roll and fall to my hands and knees. It wasn’t living the good life but I was living again and it was great even though I make in a month what I took home in a week at UPS so material things are a thing of the past and I need help from my parents to see a dentist since dental is NOT covered by SSD so 22 years of a W2 and employment caused me to make $600 too much a year to get dental. Now after 5 years and my Dr. has me on the perfect dosage of oxycodone and I have some quality of life, you come to grips with a new bar for quality of life when in chronic pain but I look back at those days as the good old days. Here I sit 2 years later and due to morons and youngsters using the medicine that gave me life as a high has caused bureaucrats (not doctors) at the CDC and DEA have closed meetings with insurance companies then come up with a milligram limit for my injuries and pain level. Oh did I mention that I am a veteran of 6 years with a damned high tolerance for pain? well I am but the VA will only prescribe .5 milligram of hydrocodone 3 times daily to my 70 year old dad a veteran of 2 wars 2 bronze stars and on oxygen in bad pain so no help there and brutal to see him like this. My medication has been cut 66% and I barely leave the house which is dirty because I can’t clean it, I feel every crunch of my bones in my back and shoulder is brutal. The worst part for me is mentally I know there are people worse off than me and it kills me to imagine that possible. These bureaucrats claim to be concerned with overdoses but they lump heroin in with pain patients so that shows the brilliance of bureaucrats to lump overdose stats from heroin users and the folks that die from mixing opiates with other drugs and booze. My Doctor is treated like Pablo Escobar and just so he can continue to practice medicine is forced to comply with the bureaucrat’s of the CDC and DEA which means patients must suffer. Pain patients should have been left out of this new war on opiates which smells bad if you take a little time to research this issue. I can’t bring myself to wish my pain on the monsters of the CDC or DEA but if the decision makers in these agencies did have my injuries and pain my bet is they would be able to get the proper oxycodone dosage to manage their pain. I assure you these bureaucrats CDC, DEA along with insurance companies are not worried about overdose deaths because the suicide rates are skyrocketing for pain patients that are cut off or medication limited by bureaucrat’s rules, and we are not happy that the CDC has used heroin death and addiction numbers to deprive good people of the right to have some quality of life. What will the next crisis include? you may see this as not your problem or acceptable losses when pain patients take their lives or worse but you may find yourself in our position someday or your medication taken away because some idiots misuse it then it will be your problem so I urge you to see this as all our problem and I know many of you know someone affected by this so don’t let this slide, this will not have a pretty ending if pain patients are kicked aside as part of a problem.
I was a model pain patient, never needed early refills, never lost my medication and took my medication as directed so no chance of overdose.
Your supposition that these new guidelines will not have a detrimental effect on patients is terribly flawed and at best naive. How can I say this? Through personal experience. My physiatrist (pain management specialist) has begun titrating me off the ONLY medications (opiates) that have proven effective in reducing the pain I suffer with EVERY day of my life. The reason? Clearly stated by him with this comment in his office: “The CDC has issued new guidelines for opiate prescribing. Due to this I am taking you off them. Its the writing on the wall. I guess we will help those we can and the rest…….well….”.(Said while looking down and unable to meet my eyes). When I then asked him what other alternatives there were his answer “None.” The highlighted statement that criticism is coming from highly conflicted sources can be said of those who came up with these slanted guidelines. A group consisting of members who have publicity stated and published the desire to see opiates removed from use by any doctors except those treating end of life patients. Most of these credentialed individuals are not specialists in pain management and have little real world experience in the treatment of chronic long term pain patients. The report clearly states that they have no evidence with regards to the efficacy of opiates in the treatment of pain with opiates longer than six to twelve weeks or slightly longer. Nevertheless, they make sweeping statements based on opinion rather than fact and more disturbingly, ignore the evidence right in front of them via actual patients reporting and discourse showing the exact opposite of their unsupported views. With societal views on addiction and anyone using opiates in general it is no surprise that they can do so. Is my pain management doctor a primary care physician? No. Is he giving these “recommendations” the force of law? Apparently so. Am I alone in this treatment by my doctor? Absolutely not. Chronic pain patients are being thrown under the bus by those who have little understanding, or care for, what we face. Pain. Unrelenting and decimating. Are there risks with these drugs? Yes. Can procedures and policies be put in place that can remedy the situation we face in a responsible and compassionate manner? Yes, but not in this manner and not with such disregard for the millions of Americans who face life with unrelenting chronic pain. Do not punish we who seek relief for the actions of irresponsible doctors and the actions of those who were not followed through with after being prescribed these medications resulting in full-blown addiction. Public frenzy, fueled by the media, compounded by the inability of many to see the reasons behind why opiates are prescribed to chronic pain suffers….Because the pain we face is a disease in itself, and the public looks no further than the words “opiate” and “addiction” while being lead to believe any use leads to 100% full-blown addiction and heroin use every time. This is untrue and abuses paitints rights to have even a moderate level of comfort and relief of pain. The CDC’s recommendations of antidepressants and cognitive behavioral modification therapy is frankly bordering on the outright ludicrous. It looks very much as if they want pain patients shuffled off to psychiatric care as if pain is nothing but a mental failing of some sort. Or, could it be that they actually realize that the result of these recommendations would cause many chronic pain patients to seek relief in the only way they are leaving open to them. Suicide. Or, best case, a version of life spent in horrid pain.
So it depends on who the possible suffering patient is and then the government will be concerned about the innocent patients becoming collateral damage. But when it’s chronic pain patients prescribed opioid pain medications & they are crying out we are being hurt. We are being discriminated against we have become the collateral damage. It doesn’t matter! No one will listen, no one cares, that pain patients have become the collateral damage, in the governments failed war on drugs. All done to stop drug addicts & O.D. deaths, but then want to give them stronger opioids and giving them safe places to do their Heroin. Mind you that I don’t begrudge them that. Maybe, it is time to make it all legal like other countries have done successfully and stop all this craziness. I think it is a good idea & safer for everyone, but & the big huge giant BUT is mean while legitimate pain patients that weren’t that aren’t abusing their medications are being left to the streets to die! They are dying everyday due to being left untreated for their pain! Patients that will live in misery the rest of their lives suffering in horrific pain, and the Government has the audacity to act like they wonder why drug O.D. deaths are rising! They wonder why suicides are rising? So yet again honest responsible non-abusing chronic pain patients are being discriminated against because of the abusers, but with everything so fixated on addicts chronic pain patients needs continue to be ignored. The result of this incredible lack of empathy for chronic pain patients that have done nothing wrong. They are victims of their own bodies from chronic illness. In taking away their only medications to relieve pain meds they were taking correctly just trying live as normally as possible is mind boggling! HELLO !! People are suffering in HORRIBLE UNRELENTING PAIN & ARE DYING!!! They are abandoned by their doctors after years of care, without a second thought or a “I’m sorry I can’t help you anymore” because non medical people knowing nothing of your medical history your severe constant pain & they don’t care too! They have decided pain patients no longer need the pain relief they were receiving that only opioid medications provided. Medicines that made life worth living, because of the pain relief you received, So pain patients could be able to live a life with some quality to it. Patients abandoned by the medical community that has been taking care of them for years said they understood the agony and torture of a life in pain but a sudden change of mind and C.P. Patients are tossed aside like yesterdays garbage. They are left with no way to relieve their pain & kill themselves because of it & then their loss is used to fuel the drug wars own fire by calling it a drug O.D. ! The other chronic pain patients that can’t exist in their torture of pain without some relief go to the streets to self medicate & risk death. Because, of China’s toxic Fentanyl coming into the country conveniently when all these honest law abiding pain patients are dumped & left to suffer in their pain alone. Go out in desperate attempts to relieve their pain end up with lethal imposter medications looking like a lower dose NORCO O.D. & die or get very ill! All this is for what? What is being served by taking responsible patients off working medications? All so we can suffer more then we already have is futile so we can die horribly pain-filled deaths leaving behind destroyed families all because other people weren’t responsible or became addicted? I am ashamed of the callousness the lack of empathy and compassion in the people in our government and worse the public willing to allow chronically ill people to suffer needlessly.
I have multiple forms of inflammatory arthritis, facet joint fusions in my back, knees that have no cartilage and horrific feet and toes. If one thing is not hurting ,they are usually three other problems flaring.I have taken METHOTREXATE which is also being fazedDarvocett,tramadol and more recently injections into the spine. Yes, I am treated like an addict even though I take one at night to help sleep. I don’t go out or exercise much. I meditate, try mindfulness, and try to forget about the pain. It doesn’t work for me at 68 and very depressed by the isolation the pain causes. I have been on methotrexate, which has helped bring my markers down. Now they say methotrexate will kill me and I need to start biologics, which in my insurance coverage is way too expensive. No profit in methotrexate. I have no quality of life . Reports especially peer to peer, are untrustworthy, as the autism study was, even the Lancet got it wrong. Many paid for by Big pharmacy and their paid scientists. For people in my age and pain bracket, life can be hell. I think there is elder abuse by not treating pain. I stopped most hydrocodone overnite. I have lost all faith in those who never understood the Hippocratic Oath. First do no harm.