O

nce again, a bill has been introduced that would require companies to pay a tax on the amount of opioids they make or import, and the funds would be used by the federal government to establish abuse prevention and treatment centers.

The latest bid is from Rep. Michelle Lujan Grisham (D-N.M.), who first introduced such a bill last December, and follows similar moves by Sen. Joe Manchin (D-W. Va.), whose most recent bill arrived in March. Their initial efforts went nowhere and it is unclear if these latest attempts will fare any better.

Nonetheless, the idea is provocative, and comes as a growing number of city, county, and state governments sue drug makers to recover money spent on pills and treatment.

advertisement

The tax is estimated to raise about $2 billion, which one expert says would be a good start. Dr. Andrew Kolodny, who heads the Opioid Policy Research Collaborative at Brandeis University, estimates $6 billion is needed to “clean up the mess” made by drug makers and to ensure adequate treatment.

“Given the profits made from selling these products, despite the known risks, having the companies cover a portion of the harm is sensible,” added Dr. Lewis Nelson, who chairs the Department of Emergency Medicine at Rutgers New Jersey Medical School.

Not everyone is so sure. Dr. Jonathan Gavras, chief medical officer, at Prime Therapeutics, a pharmacy benefits manager, warned that a tax “adds more cost to the system, and [the companies] will pass that on [to payers and consumers] at some point.”

What do you think?

Leave a Comment

Please enter your name.
Please enter a comment.

  • With respect, I’d suggest that this paper makes the entire “opioid epidemic” idea moot.
    “The MEDD myth: the impact of pseudoscience on pain research and prescribing-guideline development”
    https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4809343/
    A recurring theme in the war on chronic pain patients is the MEDD value, a concept which this paper shreds. As the authors say, “the concepts of MEDD and daily limits are grossly flawed” and wholly unreliable. “Simply put,” they say, “it is scientifically, ethically and morally inexplicable.” In the hands of impressionistic lawmakers and antiopioid zealots, it “could adversely affect positive outcomes for legitimate pain patients.”
    Bob Haagensen

  • Carol’s comment Sherry Sherman (a few posts below) is highly pertinent, as is Ms Sherman. Steve Ariens has suggested that the misinterpretation and misuse of CDC guidelines could be a basis of lawsuits against hospitals and medical practices. As both these commentators note, there is simply no excuse in the guidelines to justify forcible withdrawal of opioid pain relief from a patient who has long been stable and well managed on this class of medications.

    For anyone who follows this thread, I would offer an additional resource. National Pain Report published one of my papers last Friday titled “Stop the War Against Pain Patients — A Point Paper for Lobbying Legislators”

    See http://nationalpainreport.com/34176-8834176.html

    Feel free to print out this article and take it with you when you schedule face to face appointments with the chiefs of staff or healthcare legislative assistants of your US Representative and Senators. It should also be useful in lobbying the staff of your Governor, State Assembly person and State Senator. The bottom line to each of these figures can be “I want your boss to introduce legislation forcing withdrawal of the CDC guidelines and rewriting by an experts group led by pain management specialists and pain patients. He/she should also schedule public hearings immediately.”

    Keep on advocating. Get into their faces. These idiots don’t read your correspondence or your petitions. They don’t care how many emails they get. But they cannot avoid putting a human face on this issue when you go in person.

    • Hi Dr. Lawhern,
      Thanks for your note. I was away for the past week and just seeing this now.
      I understand the concerns expressed here, but would like to point out that the CDC guidelines do not “force” any particular action. These are simply guidelines with recommendations. I understand how this may be interpreted – and the legal implications you mention – but physicians are still allowed to use independent judgment.

      All best
      ed at pharmalot

    • Ed Silverman: I don’t want to seem obnoxious, but I do not find your argument at all credible — and very few chronic pain patients do either. The US Congress directed the Veterans Administration to make CDC guidelines mandatory practice in the December 2015 budget reconciliation bill — four months before publication. The CDC knew quite well what the impact of that action would be, but chose to publish anyway. The VA is now enforcing policies intended to force ALL veterans off opioid analgesics. Vets now commit suicide every day, unable to tolerate the agony forced on them by VA policy.

      I communicate every week in social media, with pain patients and family members who relate that their doctors have told them they can no longer prescribe opiates “because of the CDC guidelines”. Hospital and corporate practice boards are fearful of both the prevailing DEA witch hunt against doctors, and the possibility of legal liability for over-prescribing.

      Robert Dean Rose Jr (comment below) also talks with such patients in the multiple groups he administers on Facebook. One of the more poignant and horrifying groups is “American Holocaust”, which chronicles the stories of families who have lost a member to suicide from exactly these trends.

      You are correct that the CDC guidelines do not explicitly enforce a maximum opioid daily dose. But they recommend that all doctors conduct a risk versus benefit analysis for any patient whose daily dose exceeds 90 MMED. And they do not make clear that there is no medical reason to taper down ANY patient who is on ANY dose of opioid analgesics, when the patient is stable and well managed.

      Tens (if not hundreds) of thousands of patients are being coerced to give up the only effective therapies they have received, which have maintained some quality in their lives by providing partial pain relief. Some of them are dying, and the CDC guidelines are clearly at fault.

      The only ethically sound way forward from the present debacle is for CDC to immediately retract its guidelines for a ground-up rewrite conducted by a consultants group led by board certified pain management doctors in community practice — rather than the largely closed process which occurred two years ago, which was dominated by addiction therapists. This time around, patients or their advocates should be among the voting members of the writers group, as well as a qualified medical ethics expert.

      A new CDC writers group should be explicitly directed to consider the natural variability in opioid metabolism which occurs in huge numbers of medical patients. If done on a basis of science rather than financially self-interested opinion, such a consideration must inevitably conclude that there is no one-size-fits-all maximum dose threshold which can reliably be imposed as a protection from addiction or dependency risk. The variability in individual patients is simply too large. There are published case reports of patients who function well at manageable levels of pain and no real risk of addiction on 2500 MMED rather than the ridiculous 90 MMED proposed by the CDC.

      Thus I must repeat my plea: it is time to stop the war against pain patients!

    • Hi again Dr. Lawhern,

      For what it’s worth, there is a problem out there in that some physicians apparently do not, or sometimes may not, carefully consider alternatives or reduced use of opioids.

      This is not an all-or-nothing situation, though, nor did the CDC guidelines suggest that. In any event, the VA/DoD noted some differences with the CDC guidelines even while including those in its own clinical practice guidelines (pages 18 and 19).

      https://www.healthquality.va.gov/guidelines/Pain/cot/VADoDOTCPG022717.pdf

      In closing, I am not propagating a ‘war against pain patients,’ nor did I indicate that I support those who might. I’m simply pointing out there is debate about what, if anything, to do concerning the drug makers.

      Regards
      ed at pharmalot

    • Ed, at the risk of seeming a persistent pest, I must suggest that at the present state of medical knowledge, for millions of chronic pain patients there ARE no credible alternatives to opioid analgesics. I have talked with thousands of people in severe pain, hundreds of whom were placed on opioids by a doctor as one element of a pain management strategy. Just about all of those on opioids have been through multiple previous therapies under the World Health Organization three-step analgesic treatment ladder. They are placed on opioids when other alternatives don’t work for them. This is largely what we mean by “intractable” pain.

      Non-opioid analgesics have risks too (33,000 patients using Tylenol are hospitalized with liver toxicity every year and 1500 of them die, just to mention one). I have yet to talk with ONE patient with severe pain who has been helped more than marginally by behavioral therapies like RCT or acceptance therapy. And insurance rather uniformly refuses to pay for such measures.

      A military boss of mine in years past trained all of his analysts in a basic rule of writing for policy makers: the objective is not merely to write for clarity. It is to write in such a way that readers who have a political axe to grind are denied the opportunity to misinterpret. Under this criterion, the CDC writers failed unequivocally. Now CDC needs to retract their biased and weakly supported document before it can be used as an excuse to deny any more patients adequate treatment for agony.

      On one issue I think you and I can agree: there is a pressing need for more funds and better outcomes and protocols in addiction treatment and community reintegration. That’s real. But to propose that some of these funds be extracted from pain patients as a tax on their medications, is simply appallingly bad policy and morally offensive. Pain patients did not create the vastly over-hyped “opioid epidemic”. And solutions for addiction cannot be built on the backs of people in agony.

      Regards

  • This is nothing but pure discrimination. People with incurable diseases and inoperable injuries which cause them severe, debilitating pain that never stops can’t help the fact that they are ill and in pain. They also can’t help the fact that they rely on these medications for some quality of life.

    Also, why is Suboxone and other MAT opioid medications like Suboxone exempt? Suboxone contains buprenorphine, which is an opioid said to be about 8 x’s as powerful as morphine. This “tax,” which is basically punishing those in pain for merely wanting relief, will be passed on to the patient, regardless of how it’s applied.

    Wake up, America. Each and every one of you are at risk of being severely injured with disabling severe pain, as horrific vehicle accidents happen every second of the day. Who do you want to be in charge of your health care options, including options in relieving severe pain? Your doctor who is familiar with your medical history or cold, corrupt elected bureaucrats with no medical background whatsoever?

  • Robert D. Rose Jr.
    1310 Imperial Court
    Gray, Tn 37615

    I was pain med compliant for 20+ years. Never popped positive on any mandatory drug screens or messed up a pill count. I was able to continue teaching, sponsoring a club, coach soccer, basketball, and little league baseball. While working full time as a school teacher and sponsoring a high school very involved in community service, I returned to a Christian college, Milligan College for my Masters in Education. I graduated with a 3.95 GPA; all while taking pain medication for injuries sustained in the Marines. I was able to take my sons fishing and hiking all because of pain meds… Unfortunately, my spine did not stop deteriorating and the VAMC has done nothing to fix the damage… instead I have been refused repeatedly for surgery as the damage and scar tissue is too severe and too old. The Mountain Home VAMC doc I had was awesome as we worked together to manage the pain meds with my pain and other medications. Then he retired and after a series of kooks, I ended up with a nurse practitioner, Christina Craft, state of Tennessee License Number #21419, who told me that I had the normal back of any other 50 year American male and that the VA had adopted the new “opioid safety initiative” and would be denying 90% of veterans being served there all pain meds. She did this by phone!!! No discussion with other physicians, pharmacists, psychologists, physical therapists (even Senator Corker’s request for new PCP was denied). I have been through every pain management program offered to include chiropractors, acupuncturists, yoga and even aroma therapy for my spine before this NP decided to deny pain meds without even bothering to read my chart (for which I have evidence).

    In October 2016, I was at 180mg Morphine Sulfate (60mg tablet 3x daily) and by December 29, 2016 I was completely cut off. Since 12/29/2016, I have had nothing but Tylenol and Motrin I have had to purchase myself… I am going CRAZY because of the pain and burning up with ANGER at the VA, the CDC and DEA for what they are doing to so many Americans and veterans. Occasionally, I am an obnoxious asshole which has gotten worse since being denied pain MEDICATIONS. A sad side effect to untreated INTRACTABLE PAIN from disease and injuries sustained from service in the United States Marines. Still, it is a title I proudly hold and whenever I see injustices, I get upset and the asshole rears its ugly head. When I am attacked or someone I care for such as veterans or the American people, I strike back with the speed of a rattlesnake and the ferocity of a Devil Dog! Please visit FB page Vets & Civilians Fight Back for more important information for CIVILIANS and VETERANS.

    Teufelshunde

    Respectfully,

    Robert D. Rose Jr.,
    BSW, MEd., USMC
    Semper Fidelis

    We defended your freedoms…
    Will you help defend ours?

  • The problem is is that you guys have tooken it away from the customers and are making it harder to get the opiate not to mention you guys started the opiate epidemic knowing what was going to happen as far as illegal pills being made with fitnah and heroin flooding the streets it was plan y’all knew it the whole time so now they need to fix it greedy bastards

  • The problem with these opioid taxes as proposed is that it will create financial pressure on the payers (who pay the cost of the tax in the end) to use stronger opioids rather than moving patients to weaker opioids. If the payer had the choice of using 60mg of codeine or 5mg or oxycodone tablets in their plan the savings is significant. It’s also would push hospitals to use more Hydromorphone (or even fentanyl) than morphine since it may become cheaper in bulk due to the taxes.

    This all sounds like an easy fix, but someone will be picking up the $2 billion dollar price tag and behind that someone (most likely the payers) are accountants figuring out ways to avoid paying that $2 billion dollars.

  • Maybe we should tax cell phone companies to pay for the damages of distracted driving since it is SIX TIMES more dangerous than drunken driving.. Taxing people who have a medically necessity for certain medication because some others – who suffer from the mental health disease of addictive personality – and have opted to self medicate the demons in their head and/or monkeys on their backs.. is a very slippery slope. If they look hard enough bureaucrats/politicians could find a large number of cause and effect to tax one group to pay to treat or pay for damages to another group.

  • I’m 100% with Richard Lawhern, Ph.D and some others, but hope to show both Drs. not only Kolodny.
    1. States suing pharmaceutical companies have a very slim chance at winning per several prominent attorneys.
    2. Same commission stated “We’ve 91 deaths from legal/illicit opioids and 121 suicides daily. Where’s the suicide epidemic?”
    3. Parents admitted sons/daughters started with Alcohol, Cocaine and do Heroin by high school. Not ONE who OD’d many times only to die of Heroin saw a Dr. for pain medication. They want the government to decriminalized drugs, but it WON’T. Hmm 😒 “Why?”
    4. 4 out of 5 who ABUSED opioids went to Heroin (ABUSED) is key word.
    5. Opioids stolen from clinics, pharmacies, dark web and sold on streets. ‘Pill City’ with short video
    https://www.c-span.org/video/?422641-2/kevin-deutsch-discusses-pill-city
    6. On 12/26/16 the CDC admitted it’s illicit drugs and NOT legal RX’d opioids for chronic pain patients, but have a chronic illness, chronic pain, (DISEASE). They’ve done all CDC’s recommendations, but DENIED pain relief.

    Too MANY have been reduced or abandoned by ‘so called’ CDC’s Voluntary Guidelines. Not one board certified pain management Dr. was there. Too MANY have committed suicide due to under treated or NOT treated pain, including cancer patients.

    It’s time to end the WAR ON PAIN PATIENTS!

    A question for Andrew Kolodny from chronic pain patients is in closing.

    Dr. Lewis Nelson should know – NJ had lowest opioid prescriptions. http://www.nj.com/politics/index.ssf/2017/05/nj_tied_for_the_lowest_rate_of_opioid_prescription.html

    Why is Andrew Kolodny everywhere you look? Here, YouTube, many articles, TV shows, or Medscape with his anti-opioid PROPanganda? A true, worthy, but long article with Dr. Saxon, Dr. Kolodny, CDC, HHS is below. I hope you read it and ask “Why Andrew Kolodny is the most hated figure in pain medicine?”

    ‘States Consider Mandatory Treatment for Opioid Abusers’ Mar 28, 2017. http://www.medscape.com/viewarticle/877839
    Lawmakers in several states are advancing proposals to force individuals who abuse opioids into treatment via involuntary commitment statutes as a means of coping with the rapid rise in overdose rates. Some experts say that the proposals, while commendable, so far are not perfect. Bills have been offered in New Hampshire, Pennsylvania, and the state of Washington. The simplest proposal Senate Bill 220-FN, in New Hampshire would modify state involuntary commitment laws to change the definition of mental illness to include “ingestion of opioid substances.” Andrew J. Saxon, MD, professor, Department of Psychiatry and Behavioral Sciences, University of Washington, in Seattle, told Medscape Medical News that adding substance use disorder to the mental illness statute is “a positive step in most ways,” because experts in the field already view such disorders as a mental illness. Individuals who are dangerous to themselves or others whether it’s because of a mental disorder or a severe substance use disorder should be treated the same, agreed Andrew Kolodny, MD, codirector of opioid policy research at the Heller School for Social Policy and Management, Brandeis University, Waltham, Massachusetts. “The courts should handle it the same way,” he told Medscape Medical News. But proposals should not single out a particular drug, said Dr Kolodny, who is also executive director of Physicians for Responsible Opioid Prescribing. Involuntary commitment proposals “should be for severe substance use disorder, regardless of the drug.” The New Hampshire law’s language is flawed, said Dr Kolodny. “Simply ingesting an opioid doesn’t mean you have a use disorder,” he said. Proposals also should ensure that people with opioid use disorder get the specialized treatment they require, said Dr Saxon, who is a member of the American Psychiatric Association’s Council on Addiction Psychiatry. Someone with an opioid use disorder may not be ready to be discharged after 72 hours a common time frame for involuntary commitment laws he said, noting that after acute withdrawal, the resulting lower tolerance puts them at higher risk for an opioid overdose. Follow-up treatment is crucial. New Hampshire is one of 24 states that has excluded substance use disorders and alcoholism from its statutory definition of mental illness, and it is one of eight that do not have any involuntary commitment provisions for substance use disorders, according to the National Alliance for Model State Drug Laws, a congressionally funded organization that drafts model drug and alcohol laws, policies, and regulations with the White House Office of National Drug Control Policy.
    Treatment Demand Outstripping Capacity
    New Hampshire has been hard hit by opioid use and drug overdoses. The state saw a 31% increase in drug overdose deaths from 2014 to 2015, according to the Centers for Disease Control and Prevention.
    The New Hampshire Drug Monitoring Initiative is predicting an 8.6% increase in drug overdose deaths from 2015 to 2016. An estimated 385 people died from overdoses in 2015 — 183 from fentanyl, and another 107 from fentanyl combined with heroin or another drug. An additional 85 overdoses are still being investigated, so the toll will likely increase. Treatment admissions in January 2017 were at the highest level in the past year for heroin and fentanyl, at 20.2 per 100,000 residents. Admissions for prescription opioids had declined to 1.95 per 100,000, down from a high of 4.4 per 100,000 in November 2016. The New Hampshire bill reportedly has bipartisan support, but questions are being raised about the ability to treat an influx of opioid addicts. In an analysis attached to the bill, the state’s Department of Health and Human Services said it is not clear how many people would “meet the standards for involuntary emergency admissions under the proposed legislation,” and added, “designated receiving facilities currently lack the capacity and staff skills to care for opioid users.” Similar discussions about capacity and skills should be held in Washington and Pennsylvania, said Dr Saxon. “It’s premature for states to make these new laws without the resources in place to deal with it,” he said. The Washington state proposal, Senate Bill 5811, lays out specific criteria some taken from the DSM-5 for involuntarily commitment, but it’s still “a very poorly crafted, unrealistic piece of legislation,” Dr Saxon added. On the one hand, it casts a very narrow net and sets a high bar, limiting who might be eligible for commitment; on the other hand, for those who do meet those criteria, the proposal does not address opioid-specific treatment, he said. Under the bill, “opioid use disorder” is characterized as “active use of heroin,” but it does not include the use of prescription opioids, fentanyl, or other opioids, he noted. “I view it as the legislators wanting to make a statement,” said Dr Saxon.
    Need to Protect Civil Liberties
    Dr Kolodny took issue with the Washington bill’s premise. Establishing a diagnosis is not as relevant for involuntary commitment as the individual’s actions as a result of the disease, said Dr Kolodny. “The question is whether or not that condition, brain disease, is making you dangerous to yourself and others,” he said. “If so, the family members, courts or medical personnel should be able to hold you for a brief period of time to stabilize that condition,” he said. Dr Kolodny added that appropriate safeguards still need to be in place, because the state would be denying the individual’s civil liberties. Pennsylvania lawmakers have advanced two proposals that would address involuntary commitment and opioid use. In the Senate, Bill 391 would let families petition for treatment. The individual with the disorder would have to appear at a healthcare facility for a hearing conducted by a mental health review officer, and the attending physician would determine the necessary length of stay. The House proposal, House Bill 677, targets those who have overdosed on heroin or other opioids. According to this proposal, it is in the public interest to ensure that those users “are not immediately released, and to ensure that assessment is completed to protect them, their children who are minors, other members of their family, and their communities.” If someone has overdosed and requires immediate intervention to prevent death or serious bodily injury, a hospital or healthcare provider can commit the individual for involuntary emergency treatment of not more than 48 hours, during which they will also be assessed to determine what caused the overdose, according to the bill. Dr Saxon said that he is not completely opposed to involuntary treatment, noting that some users “respond to external contingencies.” The “idea is good in theory, but what would make a lot of sense if this is a big problem is, let’s make treatment more available,” he said. Both have disclosed no financial relationships.

    Where’s chronic pain patients Civil Liberties Dr. Andrew Kolodny?

    • Dr. Kolodny is the most hated figure in pain medicine, not only because of his blatant financial conflicts of interest, but also because he was the one who tried to force the CDC to eliminate access to pain medications for everyone – even those with cancer and HIV. The CDC, bless their little pea-pickin’ hearts, decided that was a tad too extreme. The sheer fact that Kolodny hides behind his position at Braindeis University pretending he’s some kind of expert on pain, is enough to turn my stomach. Also, he had no qualms in appointing one of his colleagues on the original 15 member advisory panel to the CDC, Dr. Ballantyne, as President of his beloved PROP – an obvious pay-back for siding with him on his outrageous recommendations to the CDC.

      Ironically, the original CDC recommendations did not exclude providing pain medications to chronic pain sufferers – it’s just conveniently overlooked by everyone including the government, the insurance companies, the media, the doctors, the drug makers, etc., for their own benefit. On page 34 of the 2016 guidelines, the CDC provides specific directions to in its summary on how to determine when to initiate or continue opioids for chronic pain sufferers. Here is the quote:
      “1. Nonpharmacologic therapy and nonopioid pharmacologic therapy are preferred for chronic pain. Clinicians should consider opioid therapy only if expected benefits for both pain and function are anticipated to outweigh risks to the patient. If opioids are used, they should be combined with nonpharmacologic therapy and nonopioid pharmacologic therapy, as appropriate.
      2. Before starting opioid therapy for chronic pain, clinicians should establish treatment goals with all patients, including realistic goals for pain and function, and should consider how therapy will be discontinued if benefits do not outweigh risks. Clinicians should continue opioid therapy only if there is clinically meaningful improvement in pain and function that outweighs risks to patient safety.
      3. Before starting and periodically during opioid therapy, clinicians should discuss with patients known risks and realistic benefits of opioid therapy and patient and clinician responsibilities for managing therapy.
      4. When starting opioid therapy for chronic pain, clinicians should prescribe immediate-release opioids instead of extended-release/long-acting (ER/LA) opioids.
      5. When opioids are started, clinicians should prescribe the lowest effective dosage. Clinicians should use caution when prescribing opioids at any dosage.
      should carefully reassess evidence of individual benefits and risks when increasing dosage to ≥50 morphine milligram equivalents (MME)/day, and should avoid increasing dosage to ≥90 MME/day or carefully justify a decision to titrate dosage to ≥90 MME/day. 6. Long-term opioid use often begins with treatment of acute pain. When opioids are used for acute pain, clinicians should prescribe the lowest effective dose of immediate-release opioids and should prescribe no greater quantity than needed for the expected duration of pain severe enough to require opioids. Three days or less will often be sufficient; more than seven days will rarely be needed. 7. Clinicians should evaluate benefits and harms with patients within 1 to 4 weeks of starting opioid therapy for chronic pain or of dose escalation. Clinicians should evaluate benefits and harms of continued therapy with patients every 3 months or more frequently. If benefits do not outweigh harms of continued opioid therapy, clinicians should optimize other therapies and work with patients to taper opioids to lower dosages or to taper and discontinue opioids.
      8. Before starting and periodically during continuation of opioid therapy, clinicians should evaluate risk factors for opioid-related harms. Clinicians should incorporate into the management plan strategies to mitigate risk, including considering offering naloxone when factors that increase risk for opioid overdose, such as history of overdose, history of substance use disorder, higher opioid dosages (≥50 MME/day), or concurrent benzodiazepine use, are present.
      9. Clinicians should review the patient’s history of controlled substance prescriptions using state prescription drug monitoring program (PDMP) data to determine whether the patient is receiving opioid dosages or dangerous combinations that put him or her at high risk for overdose. Clinicians should review PDMP data when starting opioid therapy for chronic pain and periodically during opioid therapy for chronic pain, ranging from every prescription to every 3 months.
      10. When prescribing opioids for chronic pain, clinicians should use urine drug testing before starting opioid therapy and consider urine drug testing at least annually to assess for prescribed medications as well as other controlled prescription drugs and illicit drugs.
      11. Clinicians should avoid prescribing opioid pain medication and benzodiazepines concurrently whenever possible.
      12. Clinicians should offer or arrange evidence-based treatment (usually medication-assisted treatment with buprenorphine or methadone in combination with behavioral therapies) for patients with opioid use disorder.

      Furthermore, the CDC issued a follow up three-page report on March 18, 2016, which specifically stated: “This guideline provides recommendations for primary care clinicians who are prescribing opioids for chronic pain outside of active cancer treatment, palliative care, and end-of-life care. The guideline addresses 1) when to initiate or continue opioids for chronic pain; 2) opioid selection, dosage, duration, follow-up, and discontinuation; and 3) assessing risk and addressing harms of opioid use. CDC developed the guideline using the Grading of Recommendations Assessment, Development, and Evaluation GRADE) framework, and recommendations are made on the basis of a systematic review of the scientific evidence while considering benefits and harms, values and preferences, and resource allocation. CDC obtained input from experts, stakeholders, the public, peer reviewers, and a federally chartered advisory committee. It is important that patients receive appropriate pain treatment with careful consideration of the benefits and risks of treatment options. This guideline is intended to improve communication between clinicians and patients about the risks and benefits of opioid therapy for chronic pain, improve the safety and effectiveness of pain treatment, and reduce the risks associated with long-term opioid therapy, including opioid use disorder, overdose, and death.

      Within the above document, the CDC provided a checklist when considering long-term opioid therapy for chronic pain patients (http://stacks.cdc.gov/view/cdc/38025).

      Well, what do you think about that??

  • I’m glad that most who have commented on the taxation scheme referred to above do not use the imperial “We” (as in “Let’s”) when suggesting that Kolodny should be “put aside” in comments related to the article above. It isn’t possible to “put Andrew Kolodny aside,” at all, as Ed Silverman insists, especially since the author was remiss in covering Kolodny’s motives for suggesting dollar figures. However, I’ll put Andrew Kolodny aside for a moment and work my way back around to him.
    First, the article above deals with raising taxes on NON-abusers to fund a subsidy to individuals who did abuse. Anyone who favors that type of taxation-run-amok should run for Governor of New York City, where such approaches are regularly proposed. Since the disbursement of those tax funds will not be accomplished in a direct commercial exchange, it could take forever to ascertain how much waste and fraud was involved, if such abuse could ever be discovered. Yet, the tax proposed would fund another government program, on a massive scale, to be implemented without adequate justification, without clear goals, and without concern for strict evaluation methods to be applied to such an undertaking.
    Second, since the tax would most directly benefit a health care industry, desperate for other federal money pipelines since the demise of Obamacare, the financial benefits to that industry are obvious, yet they are not dealt with in the article above.
    Now (despite Ed Silverman’s admonition), I’m ready to go back to Kolodny, before he feels neglected. If Kolodny, or anyone else with such an obvious conflict of interest, is quoted for his or her expertise in an article which considers the enactment of a tax directly benefitting the person quoted, wouldn’t it be important to discuss the financial connections of such a research source?!! Where in the article above was Kolodny’s entrepreneurial connection to drug rehab facilities reported?
    Finally, the article doesn’t bother to include information from a plethora of well written articles which have appeared in a variety of respected publications. Many of those articles present thoroughly researched evidence which disputes claims that opioid drugs carry a high propensity for addiction. Such sources provide valuable foundation and background information which would have added dimension and credibility to the article. Maybe there was just a space limitation involved. Perhaps STAT will soon publish another article, which will provide more in-depth research and reporting related to opioids, to addiction caused by substance abuse (rather than legitimate medical use), and to Andrew Kolodny’s motives, as well.

    • Hi MJ,

      Thanks for the note. I suggested putting Kolodny aside, because I could have run the same article and simply quoted Lewis Nelson as a pain expert who similarly supported the notion of the tax. Why not criticize Nelson?

      At the same time, I also quoted the CMO at Prime, who would prefer to pour cold water on the tax idea.

      STAT has run many stories about the opioid problems, including those confronting patients. This post was deliberately brief in order to quickly note that a tax is being proposed, gather a couple of views (for and against) and then asking readers to vote and chime in, as you have done.

      I understand your concerns about Kolodny. If you have broader concerns about the tax, perhaps you might consider contacting your representatives to ensure the legislation goes nowhere. I don’t have a position on it, myself.

      Regards,
      ed at pharmalot

    • To Ed;
      I think we bash Kolodny rather than Nelson because of the obvious conflicts of interest with Kolodny. Kolodny is the founder of PROP and they are the ones that started this whole mess by insisting that opioids are evil and anyone who uses them for any length of time has an ‘opioid use disorder’ ( a term I believe PROP has coined) or is addicted.

    • Hi Jojordan,

      I understand the point, although there are others out there who are concerned about over-prescribing. The larger issue I hoped to address here is whether taxes would make a positive difference somehow.

      thanks for writing in,
      ed at pharmalot

  • I hope that “D” stops by to comment more often. At least s/he doesn’t use the imperial “We” (as in “Let’s”) when suggesting that Kolodny should be “put aside” in comments related to the article above. It isn’t possible to “put Andrew Kolodny aside,” at all, as Ed Silverman insists, especially since the author was remiss in covering Kolodny’s motives for suggesting dollar figures. However, I’ll put Andrew Kolodny aside for a moment and work my way back around to him.
    First, the article above deals with raising taxes on NON-abusers to fund a subsidy to individuals who did abuse. Anyone who favors that type of taxation-run-amok should run for Governor of New York City, where such approaches are regularly proposed. Since the disbursement of those tax funds will not be accomplished in a direct commercial exchange, it could take forever to ascertain how much waste and fraud was involved, if such abuse could ever be discovered. Yet, the tax proposed would fund another government program, on a massive scale, to be implemented without adequate justification, without clear goals, and without concern for strict evaluation methods to be applied to such an undertaking.
    Second, since the tax would most directly benefit a health care industry, desperate for other federal money pipelines since the demise of Obamacare, the financial benefits to that industry are obvious, yet they are not dealt with in the article above.
    Now (despite Ed Silverman’s admonition), I’m ready to go back to Kolodny, before he feels neglected. If Kolodny, or anyone else with such an obvious conflict of interest, is quoted for his or her expertise in an article which considers the enactment of a tax directly benefitting the person quoted, wouldn’t it be important to discuss the financial connections of such a research source?!! Where in the article above was Kolodny’s entrepreneurial connection to drug rehab facilities reported?
    Finally, the article doesn’t bother to include information from a plethora of well written articles which have appeared in a variety of respected publications. Many of those articles present thoroughly researched evidence which disputes claims that opioid drugs carry a high propensity for addiction. Such sources provide valuable foundation and background information which would have added dimension and credibility to the article. Maybe there was just a space limitation involved. Perhaps STAT will soon publish another article, which will provide more in-depth research and reporting related to opioids, to addiction caused by substance abuse (rather than legitimate medical use), and to Andrew Kolodny’s motives, as well.

    • Just so a site administrator knows, a response which I was told could not be posted, because it was repetitive, actually was posted. So, two nearly identical versions of my response were posted. Someone might want to remove the 2nd nearly identical comment; that is, the one Mr. Silverman did NOT respond to. That post begins with “I hope “D” stops by…” Maybe that will save a little scroll space.

Sign up for our Morning Rounds newsletter

Your daily dose of news in health and medicine.

X