CDC Will Create New Injuries & Suicide with Unprecedented Experiment in Sudden Opioid Changes – Prediction


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Tapering patients without sound and attainable alternatives

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Tampering with patient autonomy

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Failure to provide informed consent

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Avoidance of coercion

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Nonmeleficence – Do No Harm – Primum non nocere

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Treating patients like numbers not individualized

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Intellectual and academic dishonesty

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Anti-opioid zealots supported by zealous insurers? 

Containment of drug costs, not pain

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Failure to assess risk vs benefit

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Chronic pain has long term consequences including

brain atrophy and memory loss

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We have a duty to preserve life, and relieve suffering.

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Is it morally wrong to do nothing when almost 18,000 Americans died of prescription opioids in 2014?

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Is it morally right to radically chop the opioid dose of everyone in severe pain?

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Are we relying on drugs rather than coping skills and physical therapy?

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CDC will profoundly limit opioid doses to 100 mg/day morphine maximum or its equivalent for severe pain.  Is this safe? Ethical? See several previous posts on the dosage limits and CDC proposal.

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Michael E. Schatman, PhD, who edited “Ethical Issues in Chronic Pain Management,” lectures nationally on optimal treatment for chronic pain when ethical principals collide, has published “The role of the health insurance industry in perpetuating suboptimal pain management.” Medical ethics is not a business model of “cost containment and profitability.” His essay “addressed some of the insurance industry’s efforts to delegitimize chronic pain and its treatment as a whole.” He examined the industry’s “self-serving strategies, which include failure to reimburse services and certain medications irrespective of their evidence-bases for clinical efficacy and cost-efficiency; ‘carving out’ specific services from interdisciplinary treatment programs; and delaying and/or interrupting the provision of medically necessary treatment.”

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Many of the above ideas are taken from the course on ethics he taught May 2015 at the American Pain Society annual meeting.

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I have spent 15 years developing alternatives to failed opioid treatment for chronic intractable pain and writing about that on these pages since April 2009. When patients have failed all known treatments, low cost  alternatives to opioid medications become unaffordable when not covered by insurance – cost may be $300/month out-of-pocket rather than a $30 copay for opioids costing $17,000/month. How many can afford $300/month for the rest of their lives when they are on disability with severe chronic pain?

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When there are no options, opioids are the last resort.

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There is no argument opioids are often misused when there are better choices of treatment but resources are lacking, even more so in rural and under-served communities. And studies show lack of evidence of benefit with opioid treatment — but my patients would not be able to work or care for themselves if not on opioid therapy.

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Opioids cause pain by creating inflammation in the innate immune sytem (brain/spinal cord).

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There is no argument that opioids can cause central sensitization – that means higher doses cause worse pain which is misinterpreted as requiring more opioid when instead pain would improve with less. Opioids cause increasing numbers of deaths (almost 18,000 deaths in USA in 2014 from prescription opioids, NOT street drugs). Opioids may lead to addiction and diversion. Efficacy of many drugs is often compromised by some form of toxicity or need to add drugs to treat side effects, often denied by insurers.

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Likewise there is misuse of surgery, procedures, nerve blocks, spinal cord stimulators, pumps which can lead to paralysis, anxiety, depression, insomnia and death. How many billions are spent on spine surgeries done simply for pain that is not surgically treatable?

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Opioids may be treating anxiety, mental health problems or addictions, but they also serve an important function in relieving pain. They may be the only option many patients have. Opioid taper can uncover or cause PTSD, depression, anxiety, insomnia, fear of withdrawal symptoms, inability to cope. Poorly managed or sudden opioid withdrawal can lead to severe hypertension, stroke, heart attack and/or intolerable side effects of substitute drugs.

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The disabled insurance system has shut down patient autonomy, by closing more than 1,000 interdisciplinary pain programs — now only 70. And are those truly interdisciplinary? or are they strictly procedure oriented with $50,000 pumps and spinal cord stimulators that have failed to work for my patients? Have they ever shown long lasting efficacy for 5 years? Have you seen the

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“Chronic pain a malefic force”

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“Pain kills”

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John Liebeskind, MD

Past President American Pain Society

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Tapering opioids in chronic pain is very different from tapering opioids in addicts and much more difficult than treating cancer pain.

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Unlike cancer pain, severe chronic intractable pain is endless, lifelong, day and night, often associated with depression, insomnia, anxiety, PTSD, hypertension, and disability caused by severe pain.

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Having taught cancer pain at an 800 bed cancer hospital, cancer pain may be easier to treat simply because most cancer pain is acute pain which responds better to opioids than chronic pain. Cancer is often treatable and pain resolves. And insurers are not battering doctors by denying medications for pain every couple months as they do for chronic pain. Stress! Denials nonstop! Paperwork instead of practice of medicine. Doctors cannot take the constant battering and leave.

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This unprecedented radical frightening cut in medication comes from the CDC National Center for Injury Prevention and Control.

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The CDC excluded cancer patients from this new chopping block.

Will that come next?

Sequoia wildflower

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QUESTIONS FOR THE CDC & ANTI-OPIOIDISTS

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 Where is the data? What is the risk/benefit ratio for this radical cut in dosage? There is no evidence upon which to base their chosen dose.


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40 million Americans have severe pain, 17.6% of the adult population, not counting children with severe pain or adults with moderate pain.

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Will the CDC monitor the increase in auto accidents that occurs from untreated pain? People with incident pain have slowed reaction times due to pain. Despite normal strength and cognitive function, they may not be able to move muscles quickly due to untreated pain. They may not be able to move at all when severe pain clouds even the ability to think.

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Will CDC monitor risk of suicides from untreated pain? Columbia University recently published on suicide in only one pain syndrome, but there are many forms of severe pain, not just one.

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When will NIH and CDC fund research on medications besides opioids for treatment of pain?

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Will CDC monitor how many days of lost work, lost jobs from opioid withdrawal?

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Will CDC monitor how many new injuries occur from untreated pain? My patients may be perfectly strong, but cannot prevent falling if sudden pain prevents them from stabilizing their hips, legs, or spine.

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How suddenly do they demand this be implemented? Insurers have already been cutting opioids for months and allow 30 days on the last prescription. What then?

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Will CDC recommend that insurers provide medications for opioid withdrawal?

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Will CDC recommend that insurers allow payment of  medications such as Wellbutrin to replace dopamine for the depression malaise that occurs after opioid withdrawal that may last for one year or more?

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Will CDC recommend admission to hospital programs when patients are unable to suddenly drop opioid dose to the magical 100 mg without supervised inpatient care?

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Will CDC have nationwide training programs for doctors to teach how to deal with and study the sequellae of this unprecedented population experiment in suicide, new injuries, depression and hopelessness in patients and even physicians?

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Will CDC recommend anything for untreated pain after opioid reduction?

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Emily Dickinson

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Pain has an element of blank;

It cannot recollect

When it began, or if there were

A day when it was not.

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It has no future but itself,

Its infinite realms contain

It’s past, enlightened to perceive

New periods of pain.

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HamiltonFallsSequoiaHighSierraTrail

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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 call the office to schedule an appointment.

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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Please be aware any advertising on this free website is

NOT advocated by me and NOT approved by me.

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2 Responses to “CDC Will Create New Injuries & Suicide with Unprecedented Experiment in Sudden Opioid Changes – Prediction”

  1. J. Rae Says:

    I don’t understand your comment, “…cost may be $300/month out-of-pocket rather than a $30 copay for opioids costing $17,000/month.” How is the figure of $17,000 per month calculated? Am I missing something? I certainly don’t dispute the fact that out-of-pocket costs can add up, but $17,000 might be a bit high even if multiple alternatives were used each month.

    Also, I’d like to read more of your website, but reading text that is double-spaced is difficult for many readers. Single-spaced lines with appropriate paragraph breaks would be much better.

    Thanks for letting me provide input. I only mean it to be constructive input, not meant as criticism.

    • Nancy Sajben MD Says:

      Look up costs of Actiq or Subsys used 6 times per day ~ $17,000 for one month, one drug – not both. Patient cost $30 copay. Never looks or cares to see what insurer pays.

      Four effective compounded medications may cost $300/month, cash out of pocket – no insurance will cover any compounded meds.


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