Opioid Restrictions for Safe Prescribing – CDC Solicits Comments on Guidelines


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The CDC has issued a draft of guidelines for safe opioid prescribing that will soon go into effect for chronic noncancer pain.

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The CDC is soliciting your comments before January 13 – only a few more days to send in your comments to the CDC before the guidelines become the new standard without regard to need.

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I posted on the coming opioid restrictions for chronic noncancer pain after a DEA conference a few weeks ago with content that was mandated by the FDA. The focus is on the epidemic of deaths from prescription opioids and limiting the daily dose to the equivalent of 100 mg per day morphine, maximum.

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Prescription opioids killed almost 18,000 patients in 2014 — NOT street drugs, NOT heroin, but ***prescription***opioids.

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See several posts since then. Pain a malefic force. Pain kills. Insurers refuse to cover more than this arbitrary dose limit that may be safe but may not be an adequate dose.

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To my knowledge, there is no research justifying a rationale for the CDC dose limit, what seems an arbitrary dose limit for treatment of severe pain. Rather, the  emphasis is on addiction and reducing the epidemic of deaths from prescription opioids.

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Since opioid induced hyperalgesia is a concern, where is the research showing what exactly is the opioid dose that causes hyperalgesia in humans?

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Medicine is now practiced by one-size-fits-all guidelines/spreadsheets, not by physicians, not by specialists, and not individualized care.

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Pain management is not just opioid management.

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There is no emphasis on teaching pain management in more than 3% of American medical schools.

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What about the devastating and completely inadequate lack of research funding for nonopioid treatment of chronic noncancer pain?

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Severe chronic pain in 17.6% of the US population – 40 million adults. Data ignores children disabled with pain for years.

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The material on this site is for informational purposes only.

It is not a substitute for medical advice, diagnosis or treatment provided by a qualified health care provider.

Relevant comments are welcome.

If any questions, please schedule an appointment with my office.

This site is not for email.

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For My Home Page, click here:  Welcome to my Weblog on Pain Management!

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2 Responses to “Opioid Restrictions for Safe Prescribing – CDC Solicits Comments on Guidelines”

  1. Jon Wheeler Says:

    Hello,

    Thank you for your information regarding new restrictions on opioids and the prescribing of them for non-cancer related chronic pain. I have searched the government website you had in your article and found only cases from 2015. Nothing regarding their attempt to receive feedback from the public in our current year.
    I’ll try to get a letter written today and send fed-ex overnight in hopes of my voice being heard.
    Although I am currently managing my chronic pain due to degenerative discs, 3 bulging and two herniated discs that were never treated properly after an injury suffered a decade ago, I worry that,
    1: our voices, the ones in pain, are not being given due process, or the fair amount of time to have any useful input regarding a directive that appears to already have been decided.
    2: I am currently able to manage my pain through diligent physical therapy, other, non-narcotic drugs, and a small amount of low dose hydrocodone (Norco) for breakout pain, but I know my condition can only deteriorate to more painful levels in the future.
    3: I worry for many others I have met in all the countless hours in doctor’s waiting rooms who are trying to manage pain from such injuries as crushed pelvises, destroyed and reconstructed spines using pins, rods,screws etc. and other, much more severely painful situations.
    4: Just because someone isn’t a cancer patient does not make their pain less severe.
    5: my pain management Doctor controls my opioid use carefully and checks the pharmacy database each month to verify that his patients are not getting more drugs from another doctor. He gives random urinalysis to verify I am not cheating. I am being carefully “babysat” by my government with the cooperation of my pain specialist. ( I lean towards a Libertarian view of “it’s my body, as long as I’m not hurting others, leave me alone”).
    5: If someone is really looking for a “fix” or to get high, they will find a way. I understand street drugs, especially heroin, are being used now at a much higher rate, many by people just trying to escape horrible, legitimate, pain. Restrictions on trained practitioners just drive the sufferer of chronic pain away from the managed care and into a non-managed, black market situation which is where the majority of overdoses were happening to begin with.
    6: Anectotally, my late girlfriend’s sister who was severely injured in the incident that killed my loved one had a crushed pelvis, destroyed vertebrae from s1 up to T11, along with an arm injury that was so severe they were about to amputate rather than repair the carnage suffered from the car wreck that took my loved one’s life. 24 1/2 years later she suffers INCREDIBLY debilitating pain from the injuries as well as the pain from 17 separate operations. Is her chronic, life changing agony any less important than a cancer patient? (No disrespect to cancer sufferers, my family has a long history of cancer and I am currently living with my parents in order to give them both full-time assistance during recoveries from prostate cancer surgery and thyroid cancer.

    Dr. Sajben, with all due respect to new discoveries and advancements in pain treatment, some sufferers need some way to manage that “breakout” pain that leaves them debilitated and crying in agony. Your new approaches have some great potential, but let’s be realistic. Insurers, even the best plans, are VERY resistant to your new treatments and Medicare patients on fixed income have virtually no hope at all of receiving these new forms of relief (i.e. Ketamine spray or clinical administration of Ketamine through I. V.)

    Thank you for taking so much time and effort to help us.

    Jon Wheeler

    Just my input, for what it’s worth.
    I’ll send my letter today for whatever little good it may do.

    • Nancy Sajben MD Says:

      Mr. Wheeler, CDC has a weblink where you can make comments – I have highlighted the word *comments* in blue on my post. Just click and it opens a page that has a rectangle at top right that contains the word COMMENTS above due date January 13 2016 at 11:59 pm. Click on that. It opens a box for comments. They have received 1,862 so far.

      Thank you for speaking up on behalf of so many.


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