Bold bid to rein in painkiller prescriptions hits roadblocks

[avcpl]

http://www.cnbc.com/2015/12/19/bold-bid-to-rein-in-painkiller-prescriptions-hits-roadblocks.html

excerpt:

Under the proposed guidelines, doctors would prescribe these drugs only as a last choice for chronic pain, after non-opioid pain relievers, physical therapy and other options. The CDC also wants doctors to prescribe the smallest supply of the drugs possible, usually three days or less for acute pain. And doctors would only continue prescribing the drugs if patients show significant improvement.

The CDC's logic: Reshaping how primary care doctors use painkillers would result in fewer prescriptions and, therefore, fewer deaths. By its estimation, deaths tied to these drugs have surged more than four-fold since 1999.

But industry-funded groups like the U.S. Pain Foundation and the American Academy of Pain Management warn that the CDC guidelines could block patient access to medications if adopted by state health systems, insurers and hospitals. Such organizations often look to the federal government for health care policies.

The CDC decision to delay its guidelines followed months of lobbying by physician and patient groups aligned with the pharmaceutical industry, who have almost always had a seat at the table in federal discussions on painkillers. As a result, they have had far more influence over federal policy than addiction activists, according to experts.

 

[S.J.B.]

As a civilization we somehow managed to survive for 50,000 years without OxyContin and I think we will continue to survive.

Well, we survived the last 3,000 (if not more) with opium and it's only in the last hundred years that we decided that it wasn't morally acceptable for people in pain to ease it with opiates.

 

[bingey]

^
yes cause we all now suffering is the only way to atone for our sins. Fucking christians worse than the taliban sometimes..

 

[cj]

Those are some outrageous guidelines.

 

[SKL]

And the heroin dealers await with bated breath what will in essence be an enormous government subsidy.

 

['medicine cabinet']

Seriously...if I was a big dope dealer I'd be like fuck yea! More clients! That sucks for people in actual pain bc junkies go in and make all drs act like detectives, same with pharmacists, God forbid your Dr fives you two types of benzos or opis, say long term d one for breakthrough, the pharmacist makes a bunch of calls and verifies everything. What's. Next fingerprints, reti al scans?

This is so crappy for the people in need of pain killers. Until something better comes along, opiates are going to be the gold standard.

 

[belligerent drunk]

As a civilization we somehow managed to survive for 50,000 years without OxyContin and I think we will continue to survive.

Yeah and we seem to have survived practically without any kind of medicine too, but what was that life like? Does that mean we should just abandon every fucking thing for the simple reason that it MIGHT have adverse effects (e.g addiction) on SOME individuals? Because out of 10 people, one might become psychologically addicted to opioids, we should deny it to all 10 of them when they really do need that medicine? It makes so little sense it makes my blood boil.

And no, geniuses at CDC, fewer prescriptions won't result in fewer deaths. As recent US history has shown us, it will result in short-term increase of deaths due to people switching to heroin and we all know how much easier it is to OD on that (because it's illegal and unregulated). In our modern world where communication is easy and information is plenty, it's not hard to find "treatment" for pain, it's just better when said treatment comes from doctors not shady dealers. There is no "greater good" in suffering pain and I believe it is every person's right to be able to treat their pain.

 

[Felonious Monk]

That's kind of bullshit to call the U.S. Pain Foundation an "industry funded group." While they do receive some money from pharma (not that much), I know the people that run it, and it's a real grassroots organization run by people in REAL PAIN who try not to take pharmaceuticals.

Saying we lived 50k years without OC is ridiculous as well, since human civilization is closer to 10k years old.

 

[cj]

So basically the CDC's strategy to combat opioid addiction is too not expose the next generation to opiates and wait for this generation of the addicted to die off.

 

[manboychef]

The CDC decision to delay its guidelines followed months of lobbying by physician and patient groups aligned with the pharmaceutical industry, who have almost always had a seat at the table in federal discussions on painkillers. As a result, they have had far more influence over federal policy than addiction activists, according to experts.

this is the statement that kills me the most. If it were not for the harrison act we wouldn't have so many OD's to begin with. There has been a sharp increase in overdoses due to demand. People are going to get what they want regardless if it is from a doctor or a dealer. After the harrison act it made it illegal for doctors to maintain their addicts. Now we have suboxone and methadone which are far more damaging to the body than non synthetic opioids.

Could you imagine fighting in the civil war, losing a limb, or being shot in a way that would cause you pain for the rest of your life and having your doctor/pharmacist "investigate" why you need pain relief because some people find that it makes them feel good? Not to mention underprescribing...which leads to overdoses because if someone is still in pain after their dose, they are going to take more, and when they are out that is when our good buddy H comes into play. It is just absurd.

The reason I quoted that though is that big pharma has such deep pockets that they can pretty much tie up any policy in so much red tape through lobbying that the people that actually understand how dependence on opiates works (bolded) pretty much don't have a say. Methadone and suboxone save so many lives, and also help those that cannot function without opiates reclaim at least some sense of normalcy. Why put more stipulations on that when there is already long waiting lists, special licenses and a lack of prescribing doctors and clinics?

 

[belligerent drunk]

Now we have suboxone and methadone which are far more damaging to the body than non synthetic opioids.

With respect, could you cite a study or two that comes to such conclusions? You know, with this being the Internet and all that.

Other than that, well said on the rest of the matter. Boggles my mind how absurd the system is.

 

[manboychef]

http://www.sciencedaily.com/releases/2012/08/120815082707.htm

hope this helps. Still trying to find the one about morphine though. Honestly morphine would be better replacement therapy than bupe or methadone. What happens when you are in an accident and you are in serious pain? Too bad your on a blocking dose of methadone or bupe...also I can't find the study about Hmt (heroin maintenance therapy). There were two....one in switzerland and one from canada.

 

[belligerent drunk]

Thanks for the link, I'll read it soon.

I have no personal experience with methadone, but does it really "block" the effects of other opioids? Methadone is a full agonist, so that means it shouldn't have the "blocking" effect buprenorphine has which is a partial agonist. I guess morphine/diamorphine is more problematic because of (relatively) short half-life, but it's better than nothing for sure. Extended-release oral morphine anyone?

 

[ro4eva]

I bet the smack dealers are collectively yelling "Bingo!"

Thanks for all but handing them the keys on a silver platter Uncle Sam.

 

[RDP89]

Thanks for the link, I'll read it soon.

I have no personal experience with methadone, but does it really "block" the effects of other opioids? Methadone is a full agonist, so that means it shouldn't have the "blocking" effect buprenorphine has which is a partial agonist. I guess morphine/diamorphine is more problematic because of (relatively) short half-life, but it's better than nothing for sure. Extended-release oral morphine anyone?

The blocking effect has to do with binding affinities, not whether or not it's a partial or full agonist.

 

[belligerent drunk]

The reason buprenorphine behaves the way it does is because partial agonists behave like agonists and antagonists at the same time, e.g they may bind to the receptor but not activate it all the time. Buprenorphine also has a really high affinity for opioid receptors, so it displaces other opioids if present, but does not necessarily activate the receptor as much. That's why you get things like precipitated withdrawal upon taking buprenorphine if you're high on something else. Full agonists do not behave in this way, not to my knowledge anyway.

Another way to put it, full agonists activate as much "receptor space" as they occupy, partial agonists activate only... a part of that "space", so the rest stays blocked/antagonized.

 

[Burnt Offerings]

"as a civilization we somehow managed to survive for 50,000 years"

lol. As a historian that opening really made me chuckle. Even without the Oxycontin remark it's completely ridiculous.

 

[manboychef]

indeed....Up until 1700's if you lived past thirty or forty you were an old man. Not to mention going under the knife meant taking your life into your hands and being in intense pain.

Opiate based painkillers are a godsend. Unfortunately, policy is based on the 20% of the population that misuse them, and not the 80% of the population that benefits from them. Puritanical american ethic anyone....its like politicians saying "hey those folks are enjoying something....better put a stop to it!"

 

[SEMPERCANUS]

Very sad that this is happening. I hope they are tracking the folks that have killed themselves because their legitimate pain medication use is being cut off. I have heard of 3 so far. I bet the OD rate will sky rocket because these folks will have no other choice. What is wrong with this country. I have been disabled since 2004. Lost my career etc. now too bad cold turkey. Guess I will be awaiting info on how to find and hope I don't get ripped

 

[bluesteyes]

From what I understand, the increase in opioid related OD's has more to do with people combining drugs they aren't supposed to. For instance, taking a heavy dose of Oxycodone IR along with a good dose of Ativan. I was listening to some pain doctor on the radio the other day, and he was saying that in most overdose cases in his area, the problem wasn't the opioids. It was all the other stuff that patients were adding into the mix that weren't prescribed by the doctor.....like Valium they had lying around the house, or even a bunch of Benadryl.