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fter months of controversy, the Centers for Disease Control and Prevention Tuesday published prescribing guidelines to address the epidemic of deaths and overdoses attributed to opioid painkillers.

The guidelines, which focus on chronic pain except for cancer and end-of-life care, arrive amid intensifying concern over the widely prescribed drugs. Every day, more than 40 Americans die from overdoses of opioid painkillers, according to the CDC. And each year, 2 million people abuse or misuse the drugs.

Many state lawmakers have responded to the crisis by introducing bills to restrict prescribing. And the Food and Drug Administration is pushing drug makers to develop more tamper-resistant products. But the CDC guidelines, while voluntary, arguably represent the most sweeping effort to address the problem.

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“Management of chronic pain is an art and a science. The science of opioids for chronic pain is clear — for the vast majority of patients, the known, serious, and too-often fatal risks far outweigh the unproven and transient benefits,” wrote CDC Director Dr. Tom Frieden and Dr. Debra Houry, the director of the CDC’s National Center for Injury Prevention and Control in an essay today in the New England Journal of Medicine.

The guidelines are targeted at primary care physicians, in particular, since family doctors write the vast majority of prescriptions for painkillers. Notably, the agency recommends doctors prescribe opioids only after other therapies have failed and rely on the lowest possible doses.

The CDC also suggests that short-term treatment — typically, just three days, but sometimes seven days — is far more preferable than long-term use. The overriding concern is that patients who take opioids for extended periods are much more likely to become addicted.

“We don’t want people getting more opioids than needed,”  said Houry in an interview. “We want people to have a proper course of treatment, but still want patients and health care providers to use caution.”

To what extent the guidelines will be adopted is uncertain. Although the opioid epidemic has received substantial publicity and policy makers are more aggressively trying to combat the problem, the CDC recommendations are just that — recommendations. Another unknown is whether more people will turn to heroin if opioids are harder to obtain, said Alison Insinger, editor of Alcoholism & Drug Abuse Weekly.

Nonetheless, the effort was welcomed by the Physicians for Responsible Opioid Prescribing, an education and advocacy group, whose president was a member of an expert working group that helped draft the guidelines.

“It’s the first time the federal government has clearly communicated to the medical community that widespread and routine practice of treating long-term chronic pain with opioids is inappropriate,” said Dr. Andrew Kolodny, the group’s executive director, who is chief medical officer at Phoenix House, a nonprofit that runs drug abuse treatment and prevention programs.

The opioid epidemic has been fueled by what some say is improper marketing by drug makers.

Nearly a decade ago, Purdue Pharma and three former executives pleaded guilty to fraudulently marketing OxyContin as less addictive than other pain medications and paid $634 million in fines. More recently, Purdue and other drug makers have been sued by some local governments for allegedly misleading consumers about the risks of their opioid painkillers.

The guidelines were more than a year in the making, and the CDC encountered considerable pushback from some patient groups after a preliminary version of the guidelines was leaked online last fall. The groups argued that the agency relied on weak evidence to generate its recommendations. They also feared that some patients would be denied needed pain relief, an issue they continue to press.

“We’re concerned that rather than trying to understand the nuance involved, many clinicians will simply implement suggested dosing and duration recommendations as de facto limits, (instead of) thresholds that trigger additional actions,” said Bob Twillman, who heads the American Academy of Pain Management, which receives financial backing from the pharmaceutical industry.

Some groups voiced considerable opposition to the guidelines at a meeting last December of the Interagency Pain Research Coordinating Committee. However, the meeting itself became controversial because some of the groups also receive financial support from drug makers that sell opioid painkillers. Their involvement prompted US Senator Ron Wyden (D-Ore.) to ask the US Department of Health and Human Services to conduct an inquiry.

The kerfuffle prompted the CDC to ask the National Center for Injury Prevention and Control’s Board of Scientific Counselors to review the guidelines. In the end, the board supported the CDC, and the agency tweaked its initial version of the guidelines. The CDC maintains that its critics are misguided because there simply isn’t sufficient evidence available to evaluate the long-term use of opioids or compare them with other treatments.

Most placebo-controlled, randomized trials of opioids have lasted six weeks or less, and CDC officials are not aware of any study that has compared opioid therapy with other treatments for more than one year and produced outcomes related to pain, function or lifestyle, wrote Frieden and Houry in their essay. “In fact, several studies have showed that use of opioids may actually worsen pain and functioning.”

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  • These restrictions on people who actually need these pain Meds is totally REDICK! I’ve been in pain management for 2 1/2 years and every damn time I “REPORT” to my pain Dr. my heart rate is through the roof. Do you know why??? Because I’m sick of worrying about the pharmacy not having it or it’s to soon to refil or I’m (the temp) not authorized to call other pharmacies (all total bullshit)! This past Friday my pain Dr. Re-did my RX because my liver was not happy with the Tylenol! Well…of corse my Pharmacy didn’t have it and were not authorized to call others (again bullshit)! So, I went to another and they have it but cannot fill it because THEY CANNOT FILL THIS RX ON THE WEEKEND! Only during business hours! Are you freakin’ serious??!!!
    I’ll tell you why people are turning to “street drugs”… it’s because they cannot get their own damn RX filled! It’s stupid and infuriating!!! Who is behind these regulations and why can’t they see they are the ones responsible for ALL OF THE CRAP THEY THINK THEY ARE TRYING TO STOP!!!

  • As a one of many living with severe pain (mine is due to spinal cord damage from a severe back injury), I am deeply concerned about the rising campaign against opioid prescription. I hate being dependant on opioids to remain self sufficient and have a quality of life that is tolerable. But, I have switched to non-narcotic medications numerous times in the past in order to remove this “ball and chain”. The results were ineffective and nearly fatal due to physical damages caused by the sustained use of NSAIDs and similar analgesics. I now have permanent stomach damage along with my chronic pain. The stomach damage is directly due to my prescribed use of Toradol for less than a year. Other non-opioid medications caused liver damage and other serious side effects.
    It should be noted that long term use of opioids, even illicit ones like heroin, have shown little to no physiological damage to the human body. Although there are many other undesirable side effects from long term opioid use–addiction and physiological dependance for instance–it is still one of the safest to prescribe for long term use. It is true that opiates are dangerous in many ways, but so are most medications–especially when used improperly. Opiate addiction and overdose is not a problem to take lightly. But, in my opinion, the prescription of it should be determined on an individual basis and not regulated enmass.

  • I have been in pain management since 2005. For approximately 6-7 years I was prescribed Oxycontin. Four years of that I received 180 80mg Oxycontin, 270 30mg roxicodone, and for some period 10 100mg Fentanyl patches. Now I have been cut down all the way to 90 30mg Morphine ER, 90 10mg oxycodone. I am the first to admit it was a good deal of medication I was taking and I have been trying to deal with the major adjustment but I am not sure if I can do it because my pain level is so high and is never ending. One Neurosurgeon told my pain doctor that it was NOT an option to do surgery because the scar tissue along would cause as much if not more pain. You see, I have approximately 14-15 herniated or ruptured discs in my neck and back with cord compression and pinched nerves in 7-8 different areas. I AM IN VERY BAD PAIN AT ALL MOMENTS OF MY LIFE NOW. How am I expected to function and be a part of my family’s life when I am not going to get off the couch or out of my bed due to the never ending pain? My doctors are not going to be able to do anything for me to get my pain level back down to the point to where I can do the things that Im expected and should be able to do with my family and friends. It has drove me almost to the point of suicide already and there’s no relief anywhere in sight now. What are we supposed to do with the pain PROBLEMS when the doctors are literally afraid to try and get back to a dosage that actually makes me feel like I have the ability to be able to get off the couch and walk to the store or thru the grocery store. It’s bad when you’re in so much pain all the time you’d rather be hungry than get out of bed and walk thru the grocery store. Please if you have any idea how to get the help I need please contact me at your earliest convenience at 678-246-6243

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