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Doctors told (by CDC) to avoid prescribing opiates for chronic pain

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avcpl

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The nation's top federal health agency urged doctors to avoid prescribing powerful opiate painkillers for patients with chronic pain, saying the risks from such drugs far outweigh the benefits for most people.

The Centers for Disease Control and Prevention in its first ever guidelines for dispensing the morphine-like, addictive drugs, such as Vicodin and OxyContin, said it took the action Tuesday to combat the nation's deadly prescription painkiller epidemic.

The guidelines carve out an exception for patients receiving cancer treatment or end-of-life care. When doctors determine that such drugs are necessary in other situations, the CDC advises doctors prescribe the lowest possible dose for the shortest amount of time.


http://www.usatoday.com/story/news/...-prescribing-reduce-abuse-overdoses/81809704/
 
Booo

Does this mean they're going to try to titrate 3,000,000+ people off of chronic pain management?
 
What's their alternative for people who suffer from chronic pain?
 
My mother was recently suffering from terrible back pain. She was prescribed slow-release morpheme so her body was getting some continuously for about 6 weeks.
When it came time to stop because her back was better, her doctor told her not to stop all at once - do it more slowly. That is all that he said. My mom is old and knows little about drugs, and she cut down her dose too quickly (thinking it was sufficiently slow) and suffered terrible withdrawal symptoms for 3-4 days (full-blown, with hallucinations, sweats, etc). She didn't know what was happening - because the doctor never explained the possibility of such a thing - and was praying for death to take her until the symptoms eased.

So, maybe the problem is with the doctors, and how they prescribe such pain killers, not with the drugs themselves?
Maybe, if people were free to use such medications, or if doctors prescribed them but also had to educate patients about their use, the problems would be reduced significantly.

Also, my mom is dying from cancer. If she wants to cultivate a morpheme addiction because her back pain is too intense, shouldn't it be her choice? Is there anything morally wrong with covering her pain with an addictive drug until she dies? (I will answer this one: nope, not at all.)

If opiates (and similar) are the best medication for dealing with pain, is it moral to keep them from patients who are suffering? (Again: no)

Sheer lunacy for the government to control the people's medicines.
 
To be fair, the evidence for opiates and opioids being effective long term for the management of chronic pain is not robust.

But that said, this class of drugs is the best option for certain patients with certain genetic profiles and certain types of chronic pain. What we need are cheap and effective ways for determining whether any given patient would likely get more benefit than detriment from being chronically on mu opioid agonists.
 
The evidence suggests that constant ongoing prescription of opioids for chronic pain isn't effective long term. There's been next to no study on the effectiveness of occasional use of opioids for flares of pain in episodic chronic conditions.

This attitude that leaving patients with untreated chronic pain is preferable to any risk of drug dependence is monstrous. My chronic pain is episodic and nowhere near the level that some people live with, but I can totally understand why some people are willing to risk dependence for a little relief.

If your attitude is that you (general you) don't want chronic pain patients to access opioids in any circumstances, what you are saying is that you don't care if chronic pain patients die.
 
If the evidence for long-term opioid pain management effectiveness is not there, what is the alternative?

And how do they determine dependence? Do they stop the medication periodically and see how you react? If your pain is chronic wouldn't you always need the medication anyway?

What are the health concerns if a stable dosage is used and no increase is needed and no significant side effects are experienced? why couldn't that continue indefinitely if it's working?
 
Before the 1920s doctors were allowed to maintain their opiate addicts. These addicts were able to function normally in society. It was the choice of the patient whether they stopped using the meds and not the DEA. This worked. The people that needed to be maintained led normal lives that most people would never know they were hooked on morphine. Maintenance with methadone and bupenorphine works to an extent, however with methadone you need to be their daily and if you miss it, the chance of relapse is incredibly great, and with bupenorphine it blocks other opiates so if you are hurt in a car accident, or some other misadventure you just have to deal with the pain. Not only that, it is on your medical records which will make being prescribed medications you may need next to impossible, as well as making doctors treat you differently.

How do you combat this? You give the doctors a little more credit, and a little more leeway to do what they have been trained to do. Not only would they be able to do their jobs better without the DEA and Medical board breathing down their necks, but they would be more likely to take on addicts as patients.
 
I always find it difficult to get involved with opioid discussions here but for my own reasons, nothing critical of others.

The one thing I'll say is this - I've been without insurance for most of my adult life and so if something happens Ive gone to the hospital (sliding scale but I do pay). Between an injury at work and just multiple 'for the hell of it' instances I've ventured in and left with a script....same hospital each time and with one exception I was never questioned....the one time I was it was the doctor saying "so pretty much everything you do you end up getting hurt" and I laughed and snapped back that it certainly seems that way.

I still left there with one.

A few seizures left me with bad teeth and I've had a few extractions. I found out that I could leave with a generic vicodin script, call that night saying I didn't realize APAP was in it, go in the next day and pick up a second script. I've done that several times not just at the dentist.

This stuff is all in my past but it showed me how easy it really is (or was) to get these addictive drugs. I'm on suboxone now and although I've dealt with addiction all of my visits to the er or dentist were back when it was still very much casual use to me. They were spread by at least a month each and I never bought dope or scripts off the street....I was a pothead who dabbled regularly.

This was random but whenever I read these crackdown-type articles I'm torn.
 
MushroomRyder25 said:
I always find it difficult to get involved with opioid discussions here but for my own reasons, nothing critical of others.

The one thing I'll say is this - I've been without insurance for most of my adult life and so if something happens Ive gone to the hospital (sliding scale but I do pay). Between an injury at work and just multiple 'for the hell of it' instances I've ventured in and left with a script....same hospital each time and with one exception I was never questioned....the one time I was it was the doctor saying "so pretty much everything you do you end up getting hurt" and I laughed and snapped back that it certainly seems that way.

I still left there with one.

A few seizures left me with bad teeth and I've had a few extractions. I found out that I could leave with a generic vicodin script, call that night saying I didn't realize APAP was in it, go in the next day and pick up a second script. I've done that several times not just at the dentist.

This stuff is all in my past but it showed me how easy it really is (or was) to get these addictive drugs. I'm on suboxone now and although I've dealt with addiction all of my visits to the er or dentist were back when it was still very much casual use to me. They were spread by at least a month each and I never bought dope or scripts off the street....I was a pothead who dabbled regularly.

This was random but whenever I read these crackdown-type articles I'm torn.
Click to expand...

The landscape is very different now my friend. Now that you have suboxone on your medical record you will nearly never be able to get a script again unless you have a compassionate doctor.
 
TheBlackPirate said:
This article from The Journal of the American Medical Association is worth a read.

Lower Opioid Overdose Death Rates Associated with State Medical Marijuana Laws
Click to expand...

Medical marijuana is legal in my state (CA), however pain management (through Kaiser HMO) still makes me submit a urine test and if I test positive for it I could be cut off my meds. So even though I would like to try to lower my dosage by supplementing with MM, I can't. There's some real compassion for you.
 
SixBuckets said:
The evidence suggests that constant ongoing prescription of opioids for chronic pain isn't effective long term. There's been next to no study on the effectiveness of occasional use of opioids for flares of pain in episodic chronic conditions.

i.
Click to expand...

There are actually decades or research on opiates and chronic pain, published in medical journals. and a quick search on google scholar shows hundreds of scientific studies that support the use of opioids in managing chronic pain here are just a few citations:

Randomised crossover trial of transdermal fentanyl and sustained release oral morphine for treating chronic non-cancer pain; BMJ 2001;322:1154; Laurie Allan directora,
Helen Hays, associate clinical professorb,
Niels-Henrik Jensen, head of departmentc,
Bernard Le Polain de Waroux, staff anaesthesiologistd,
Michiel Bolt, anaesthesiologiste,
Royden Donald, specialist anaesthetistf,
Eija Kalso, head

Long-Acting Opioids for Chronic Pain: Pharmacotherapeutic Opportunities to Enhance Compliance, Quality of Life, and Analgesia; American Journal of Therapeutics:
May/June 2001 - Volume 8 - Issue 3 - pp 181-186; McCarberg, Bill H. 1*; Barkin, Robert L.

chronic use of opioid analgesics in non-malignant pain: Report of 38 cases; Pain Volume 25, Issue 2, May 1986, Pages 171–186; Russell K. Portenoy, Kathleen M. Foley







Opioids and the Management of Chronic Severe Pain in the Elderly: Consensus Statement of an International Expert Panel with Focus on the Six Clinically Most Often Used World Health Organization step III Opioids (Buprenorphine, Fentanyl, Hydromorphone, Methadone, Morphine, Oxycodone; Pain Practice
Volume 8, Issue 4, pages 287–313, July/August 2008; Joseph Pergolizzi MD, Rainer H Böger MD,, Keith Budd MD; et al.
,




Long-term oral opioid therapy in patients with chronic nonmalignant pain Original Research Article

Journal of Pain and Symptom Management, Volume 7, Issue 2, February 1992, Pages 69-77
Michael Zenz, Michael Strumpf, Michael Tryba



Neuropsychological effects of long-term opioid use in chronic pain patients; Journal of Pain and Symptom Management
Volume 26, Issue 4, October 2003, Pages 913–921; Robert N Jamison, PhD, Jeff R Schein, DrPH, Susan Vallow, RPH, MBA, Steven Ascher, PhD, Gary J Vorsanger, PhD, MD, Nathaniel P Katz, MD










Effectiveness of Opioids in the Treatment of Chronic Non-Cancer Pain; Pain Physician 2008; 11:S181-S200; Andrea Trescot, MD1 , Scott E. Glaser, MD2 , Hans Hansen, MD3 , Ramsin Benyamin, MD4 , Samir Patel, DO5 , and Laxmaiah Manchikanti, MD




You're just repeating an old saying that came about when the drug war started and most scientific research that received grant money was aimed at demonizing opioids and saying they were not effective but since research money is allotted more based on merit instead of agenda nowdays its easy to find tons of science supporting opioids in long term pain managment.
 
@lucid: You are right about the grant money when it comes to drugs. They give the money to those that hypothesize ideas that support their puritanical views on drugs. It is a good thing that opiates are not schedule one which allows independent scientists to do their own studies if they have the funding. Cannabis studies have been stymied for so long because it is schedule one. If you have the money to study cannabis, you as a scientist still have to worry about federal charges if you publish.
 
LucidSDreamr said:
You're just repeating an old saying that came about when the drug war started and most scientific research that received grant money was aimed at demonizing opioids and saying they were not effective but since research money is allotted more based on merit instead of agenda nowdays its easy to find tons of science supporting opioids in long term pain managment.
Click to expand...

I'm not really invested in arguing with you and I'm actually quite happy to possibly be wrong on this one. The research I did when I was referred to pain management for my chronic/episodic condition - as well as the anecdotal evidence of most of the long-termers I met through my pain management clinic - suggested that long term, ongoing, continuous dosing of opioids wasn't a great plan for chronic pain due to tolerance and reduced sensitivity to the medication. But, as my pain management doctor won't prescribe me opioid pain relief, I have no personal experience to back up an opinion one way or the other.
 
There are many research papers published supporting the notion that opioids are not effective in treating long term non-cancer pain. They are mostly older as I said and done with the purpose in mind of securing additional money from govm't agencies for additional research.

In all of my reading I have found NONE that provide a biochemical mechanism explaining why opiates magically stop working on the brain at some point (but not in cancer pain!) , as these clinically in nature studies all "point towards"....and none that discuss the major factors that may explain why the pain continues to worsen....like getting older and wear and tear on the body and the conditioning worsening like chronic conditions do with time.....because the condition is getting worse doesn't mean the drug is ceasing to work...this is why patients you speak to say the drugs stopped working....if you find someone whose condition remained constant for a few decades (which is rare) they probaly would say that the drugs still work.

does weed stop working when people smoke it everyday for long periods of time?

then in modern times doctors decided that there was no point in letting people suffer until they committed suicide from the pain when we have perfectly good drugs that will prevent the pain....once this common sense practice was normalized the research supporting that it works (a few of which I cited above) started to flood in.

Organizations like PROP (physicians for responsible opioid prescribing) which are controlled by the suboxone lobby and drug war lobby and are aimed at totally eradicating opioids in pain treatment from medicine despite just claiming to only want more strict prescribing guidlines, love to push the notion that opiods "stop working" after long term use.


However what I find a joke is that people pushing this bullshit have always including the disclaimer that, "for Cancer pain" opiate still work and are ok to give to patients. Like its ok to ease a cancer patients pain....but get your spine snapped in half and have to life with it for 40 years and tough shit. There is no difference in the perception of cancer pain vs normal pain. Cancer pain is often mechanical in nature, caused by tumors pressing up against organs, have anything else pressing up against an organ and the drugs magically don't work anymore?

Cancer patients are apparently the only sick people deserving of sympathy I guess, its such a joke that these people can even say this shit and show their face in the profession.
 
Yeah there are quite a few different non-cancer situations that result in serious, chronic pain (like, for example, patients with gastroparesis). I think that opiate remain the best route to deal with such disorders, although I'm no doctor & unfortunately I'm not sure how well they work to treat neuropathic pain (which I suffer from)
 
LucidSDreamr said:
There are many research papers published supporting the notion that opioids are not effective in treating long term non-cancer pain. They are mostly older as I said and done with the purpose in mind of securing additional money from govm't agencies for additional research.

In all of my reading I have found NONE that provide a biochemical mechanism explaining why opiates magically stop working on the brain at some point (but not in cancer pain!) , as these clinically in nature studies all "point towards"....and none that discuss the major factors that may explain why the pain continues to worsen....like getting older and wear and tear on the body and the conditioning worsening like chronic conditions do with time.....because the condition is getting worse doesn't mean the drug is ceasing to work...this is why patients you speak to say the drugs stopped working....if you find someone whose condition remained constant for a few decades (which is rare) they probaly would say that the drugs still work.
Click to expand...

Well, no, that's not how neuropathic pain works, necessarily. Sometimes it's a degenerative/steadily worsening condition (especially if there's physical damage to go with it) but not always. Some of the people in my pain management group had been stable for years in terms of their condition, but continuous dosing with opioids had led to very high tolerance and some drugs becoming ineffective. But I acknowledge that this is anecdotal evidence from a small sample group with very specific diagnoses.

does weed stop working when people smoke it everyday for long periods of time?
Click to expand...

Are you saying that tolerance to cannabis and opiates/opioids doesn't exist?

I would absolutely say that people who smoke cannabis daily for very long periods of time develop a tolerance compared to people who rarely smoke it.

However what I find a joke is that people pushing this bullshit have always including the disclaimer that, "for Cancer pain" opiate still work and are ok to give to patients. Like its ok to ease a cancer patients pain....but get your spine snapped in half and have to life with it for 40 years and tough shit. There is no difference in the perception of cancer pain vs normal pain. Cancer pain is often mechanical in nature, caused by tumors pressing up against organs, have anything else pressing up against an organ and the drugs magically don't work anymore?
Click to expand...

I had always interpreted the "cancer pain/non-cancer pain" distinction to be about longevity - ie clinicians made exceptions for cancer pain because, frankly, dependance and tolerance aren't such a big deal when you have a terminal illness. Cancer pain can also be entirely chemical, rather than the result of physical masses, which might make it more responsive to opioid medication than neuropathic or physical injury pain? That's wild speculation on my part, though.

The distinction between cancer pain and non-cancer pain has never really made sense to me.
 
^ the distinction makes total sense to me and I'll tell you why it exists: the anti opiate people know that they are full of shit saying the drugs stop working and they feel sorry enough for people living with cancer to not infringe on their right to ease suffering.....but they don't have any sympathy for people suffering from migranes, fibromyalgia, chronic back pain, etc......since these people aren't in danger of dying they should just "toughen up" and suffer through the next several decades of life without painkillers....because easing their suffering isn't worth the risk that a 20 year old kid might get his hands on an oxycodone pill and pass throught the "gateway drug to heroin" and then become a heroin addict.

Basically the suffering of the pain patient is much less important than the suffering of a heroin addicts parents who are sad their kid became a junkie. Suffering of a cancer patient though?....well they deserve the relief for some abstract reason no body can really put their finger on. Why don't the heroin addicts parents just "man up" and deal with the fact their kid is a junkie and stop blaming it on a different population of people that exists outside of their skid row type heroin world.
 
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