After 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.
“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.”
About the Author Reprints
maybe all these people making medical judgement should have back pain for a while and try and live and work maybe they would feel different about making it so hard to get some releaf from very day all day PAIN!!!!!
I have so much pain. It started with lower back, which if I have it fused,plates and screws it will my Radiopathy WORSE and I cant thinķ of it right now, then Neuropathy in feet & hands, Plantar fasciitis, arthritis in hips, hands, left knees, tenñis elbow, right shoulder bone spurs and more. I can not stand in one spot for more than 5 minutes
I can’t sit or lay down without constantly moving because of pain. I was a meat cutter for 25+ years and finally had to file for disability because I could not stand long or cut meat with then pain in my shoulder and my hands mostly right hand cant grip things and they go numb and RIP turn white. There is so much more wrong with me but my hand is has gone to sleep twice now. I take oxycodone 10mg 180ct 1 every 4 hours and now my Dr. Wants to cut me back to 120ct. If. Drs. are going to cut you down slowly not just suddenly take 60 away. I don’t even want to think about the withdrawals. They might as well just shoot me.
All these gov. People need to spend a day a me and let them kñow what pains is. What it is for all of us who HONESTLY NEED IT. I Pray God can get me through this.
Laura Meyn: Find an experience chiropractor. I’ve practiced now for nearly 40 years and have seen hundreds of people just like you who never needed a fusion in the first place and now are in more pain. Forget the chirophobia you’ve been taught and seek the help of a chiro who uses Cox flexion-distraction technique or equivalent decompression tables. You can be helped!
The one thing all of us chronic pain patients need to do is tell the news stations, reporters, Congress everyone that they are backlashing on us! Everyone needs to take a stand and state they are causing chronic pain suffers to be removed off the pain meds that allow us to be able to function. Including causing suffering to those who have never abused and followed there contract. Unless chronic pain suffers take a stand and fight for what is being done then they will never listen. So please everyone write to your congressman contact the news and start making a stand for our right!!
I too have been taking oxycodone for over ten years. I do not seek drugs, I stay at my daily dosage, I suffer quietly through my flare ups, as I know my Doctor can’t do anything to help. I have not ever taken a pain med that was not prescribed for me. For me, it too was a failed surgery. It left me in severe low back pain and severe leg pain. I also suffer from facet joint syndrome. I have taken myself off of them a few times through the years, to only have to get back on them. I read about Suboxone, it sounded wonderful. They claimed it would take care of the pain and give me my life back. I was excited! I went to my Doctor and asked him to put me on it. For me, it was a big mistake, I am in that 5% that it does’t work for.
I agree that there is a terrible drug problem, I would hate to be in the shoes of those fighting it. But they are going after the wrong people. I would never go on the streets for relief if they took my meds away. I too would have to go…… Please go after the real problem!
I’ve been on some sort of pain meds since the late 1980’s and have always kept the dosage to the minimum. I was up to 75 mcg fentanyl patch and 5 mg oxycodone 3-4 x daily for breakthrough plus Gabapentin, 2 mg Klonopin and 40 mg of Citalopram daily for pain & related depression. Through counseling, mild activity, dropping 40 lbs over 2 years I was able to reduce my Fentanyl patch to 50 mcg per 48 hrs, reduce oxycodone 5 mg breakthrough to 2 x daily and my Citalopram and Klonopin in half. My family Dr of 13 years closed his practice forcing me to a pain specialist as many primary or family doctors do not want to deal with the Feds. I had been treated by two pain specialist previously over the past 13 years. Now with the new CDC laws or guidelines they want to reduce me to 37.5 mcg patch (costs $25 more month than the 50mcg patch) and eliminate my breakthrough all together. There’s allegedly a new formula they MUST use and say I’m at 140 now ? and must get me down to 90-100. I do not understand how they calculate it. Anyway, this week they told me they were going to stop prescribing the breakthrough altogether next month. I’m all for not taking them if I could but the 37.5 patch doesn’t cut it now after 24 hours. I’m sick and tired of politicians taking away my freedoms by using their false war on drugs narratives and statistics to harm, possibly drive us to black market and perhaps die from these laws to cover big Pharma lying to us to oversell to many who may not have had the same needs as others. As a veteran and former officer in the federal prison system, I will tell you our government, ( FBI, CIA, Big Pharma, MILITARY) are the drug runners. They are the criminals not me and am sick of being made to feel like one by being forced to sign contracts, carry empty bottles or boxes to each appt and getting drug tested. All because of them and a few bad apples. Rant over!
I have been on opiates since 1999 due to a botched surgery causing intractable (never ending) pain. I have NEVER sold or given away my pills, my pills have never been changed to another pill or increased in dosage since I began, even though I feel they should, because I am still in pain every day. I don’t drink or smoke or do other drugs of ANY type nor have I EVER had the urge. I have tried epidurals, injections, radio frequency ablation, many many PT’s, water therapy, tens unit, cranial sacral therapy, pain patches, anti convulsants, anti depressants, signed and followed pain agreements with my Drs, took urine tests whenever required, had pills counted, physically drive over 80 miles each mo to pick up my written prescription and then take it to get it filled. What else am I supposed to do when I can barely get out of bed as it is? I am tired of hearing that opioids don’t work-they are the only things that DO help me. If I couldn’t get my narcotics I would not resort to heroin or anything else. I would choose to no longer live. Somebody needs to start looking out for chronic pain patients, those who follow the rules, just to get by everyday, instead of blaming us for everything. Go after the patients who don’t follow the drug contracts with their Drs, go after the ones who fail their drug tests and the ones who go drug shopping. Go after the Drs who prescribe outrageous amounts of narcotics like Michael Jacksons dr. Go after the Drs who cause the botched operations and surgeries. Leave the people alone who follow the rules. You don’t put someone in jail who licenses their vehicle, drives the speed limit and stops at stop signs.
Just one problem with your comment… When you suggest the government (DEA) “Go after the doctors who prescribe “outrageous amounts of narcotics”, what do you consider to be an “outrageous amount”? And what about those patients with higher tolerances, or proven Cytochrome P450 defects? Should they be expected to just get by on inadequate amounts? When the CDC created their “suggested” Prescribing Guidelines (read: de facto law), they completely and intentionally ignored this subgroup of patients. Those with a Cytochrome P450 defect don’t metabolize opioids normally and need much more than the average person for the same effect to control pain. For these chronic pain patients who indeed may need “outrageous amounts”, limiting them to the completely fabricated, non-scientific, absurdly low CDC limits that PROP invented is no doubt torturing them and pushing them to what should be called “forced suicide”.
And what you and others may not realize is that this situation with the govt “going after” doctors and pharmacists is already happening, is part of the problem, and is making things much worse for Chronic/Intractable Pain patients. Every time it happens, it just spreads the terror to even more doctors and pharmacists, who then just clamp down even more and don’t prescribe or fill anything at all, assuming that every pain patient is “just another addict” or “opioid abuser”.
The DEA already persecutes Pain Management doctors who prescribe ANY amount, and then extorts them out of business, simply for doing what they were trained to do and have always done. The DEA realizes that after 47 years of the War on Drugs that it’s a huge failure… but admitting this would cause lots of job losses since so many work for agencies like the DEA, have healthcare and pensions they wouldn’t get anywhere else, and would be a huge embarrassment for the govt as well. So they do all they can to protect their careers and the status quo by making it seem like they’re the good guys in a war against profligate doctors who “over-prescribe” pain medications. One bad example like Michael Jackson’s doctor should not be an indicator of all the other practicing pain specialists out there.
Moreover, the DEA also makes a lot of money by being able to legally take everything a doctor owns under drug trafficking laws and Civil Asset Forfeiture statutes which were put in place to take assets from drug traffickers, not physicians. But physicians usually have a lot more money than drug traffickers, so now they’re going after the pain doctors, especially since Jeff Sessions started his program using special “strike teams” to raid doctors’ offices & pharmacies — all based on the false assumption that pain specialists are flagrantly over-prescribing opioids (this is what they did to Dr Tennant, even though they didn’t find anything – though the torture they inflicted on his patients is incalculable).
They ignore the illegal fentanyl analogues and heroin coming in from China and Mexico, but then they’ll try to find one little insignificant mistake where a doctor forgot to cross a “t” or dot an “i”, and then they’ll basically say “Give us everything you own and voluntarily relinquish your medical license, or we’ll prosecute you for drug trafficking and you’ll go to prison for the rest of your life”. Civil Asset Forfeiture laws let them take everything a doctor owns since they’ll claim it was acquired through “drug trafficking”. They’ll also say “Give us everything you’ve made in the last 5 years too, or we’ll also prosecute you for Medicare and Medicaid fraud” as well.
If they choose to fight it, then not only will they still be left broke, but also bankrupt and in debt due to defense attorneys’ fees. And with the continual tsunami of propaganda, lies, and disinformation that the PROP-controlled CDC has been putting out about opioids over the past few years along with the assistance of a complicit news media and running every ten minutes on TV, good luck finding an impartial jury who doesn’t think opioids are the “Devil’s drug” and that any doctor charged with “over-prescribing opioids” must surely be guilty… right? They’ll also be frog-marched in handcuffs out in front of a local TV news crew who was notified in advance that a “pill pusher” who runs a “pills mill” would be marched out in front of them so that they can put it on the evening news too. Situations like this always make for a good “scare story” to get the public overly frightened. If you want to see just how bad this situation already is, please see http://www.DoctorsofCourage.org.
And besides claiming that a doctor was “overprescribing opioids”, they’ll totally ignore important facts like whether some people have higher tolerances than others and legitimately need a higher dose. These dosage differences have now become totally ignored ever since the PROP-controlled CDC put their absurdly inadequate, pro-torture, ridiculously low limits in place and re-defined anyone who takes any more than these low amounts as an “Opioid Abuser” or “Extreme Opioid Abuser” (120mg MED/240mg MED, respectively) — which not only allows insurance companies to refuse to pay for anything above these amounts, but also allows pharmacists the ability to refuse to fill them as well, on top of allowing the government to claim that a doctor who prescribes more than this was “knowingly prescribing opioids to ‘Opioid Abusers’” too. See how this all works for them? They all benefit from it – all at the expense of torturing Chronic/Intractable Pain patients. And then for those severe chronic pain patients who don’t succumb to suicide and instead choose to buy illegal street drugs… if they should overdose or die from them, then the govt will claim that it’s due to doctors still over-prescribing and that even much stricter limits must be enacted. Higher demand for illegal heroin will keep going up, and it’ll all just be a vicious downward spiral, which is what the statistics prove is already happening right now.
And will the government (DEA, PROP-controlled CDC, etc.) be held accountable for all the pain, suffering, torture, overdoses, and deaths they’re responsible for? Highly doubtful. When PROP wrote the CDC’s 2016 “Suggested” Opioid Prescribing Guidelines, since they’re only “suggested”, they will simply say that any pain patient could have gone to another doctor to get the medication they needed (ignoring the fact that they could also then be accused of “doctor shopping”), and this will give them plausible deniability (even though in reality the “suggested” Guidelines are actually a de facto law).
Legitimate pain patients are being harmed daily due to the lies of the CDC. Only a very small percentage of people with prescribed pain medications die from overdoses. It is the illegal drug using community that pain patients are classified and it is a serious injustice to deny these people treatment. The CDC needs to be investigated to find who and where the funds are coming that encourage the agency to be complicit to the killing of this group of people.
Way do some U.S.states get to sale pot to anyone who wants it and the government does not do anything but let me need something for pain and not be able to get it,THAT’S NOT FAIR.
I know these people who are claiming that there is no evidence of opioids being effective at reducing pain over a long period of time are mistaken. People have been using them for centuries. I have been affected by this war on opioids as a legitimate patient who needs them for pain relief. First they went after Opana, which was very effective for me. I took it for over 5 years. Then I was taking Oxycodone ER and now my insurance company has decreased the amount they will pay for in half, and that is only if they accept a plea from my pain management Dr. I’m going to have to find a cheaper medication and pay for it myself. That is what they are really after! The money they will save. It’s shameful, greedy corporations who don’t care about people who suffer with pain continuously. Without medication I can barely keep myself from crying due to the pain. How ironic the company’s name is CAREmark. They really don’t care about anything but the money.
Please reconsider a revision of your new pain law. I am sure that those of you that drafted this law did not intend to put people with intractable pain to suffer and to have their quality of life away from them. There is nothing worse than lying in bed all day too sick and in too much pain to be a productive citizen. It is hard enough on ones’s self esteem to be handicappedby pain every single moment of the day,without feeling shamed and treated like an addict. I have a ruptured tendon in my hip and degenerative disc disease and fibromyalgia. My doctor had me on opioids that controller my pain for many years. I was not harmed by these medications in the least nor did I ever ask for my meds to be filled early. I always took my medicine as directed by my doctor. This allowed me to function and have some quality of life. Alcohol takes more lives than drugs. Please don’t punish us that suffer with legitimate pain because their are people that misuse those drugs and get them illegally. Pain medication is meant for those who truly need it. It is truly inhumane to deny proper psin management. Give our doctors back their integrity and right to treat their patients as they see fit. This law has grouped everyone together and that is just wrong.
Are the idiots the CDC insane pr just cruel? I suffer from one of the most painful disease process on earth. RSD type 1 , along with sever orthopedic injuries from being a lic medical practitioner. Opiates are the only truly effective pain killers so anti seizure medication in low doses can help . By with drawing opiates from pain managment patients you will cause more suicides. No one deserves to live in pain . Stop vilifying opiates! I live with intractable pain. You try it. Cancer is not the worst pain. Please stop trying to idiot proof the world. The CDC should be considered a bunch of control freaks. Shame on you!!!
But it’s ok to drink and smoke to death???
The people who do not abuse them, who have not increased there dose , have not given to others, who have not set out to see docs for more prescriptions These folks should not be made to feel like criminal drug addicts flagged on a list, a list others pass around etc. Shame on these people who cannot figure out who should be watched!!! Where are the patients rights???