Opioid Guidelines California


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Opioid Guidelines for Chronic Pain

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80 mg Morphine Equivalent in California

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Maximum

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That’s about 50 mg Oxycodone

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Change is inevitable. It is about deaths from opioids, addiction and misuse, not about pain control. It is a done deal. Acceptance is required. CDC will set 90 mg morphine equivalence maximum nationwide soon. There is no legal alternative. A wake up call.

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Let’s now make the best of every best tool we have. This is going to be a very tough year. We can get through this together.

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With 18,000 plus deaths from opioid misuse, that is equivalent to a jumbojet crashing every 10 days and killing every passenger.

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I have advised my patients of the maximum 80 mg morphine equivalent that is required in California. The CDC will soon limit maximum dose to 90 mg morphine equivalent nationwide. This is a done deal. We must all accept it, and adjust ourselves to all the benefits of a rational approach to pain management that may have been overlooked many years since your started treatment for chronic pain and came to rely on the easy things like pills rather than changing our behavior – painful as it is for me and all of us.

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Housecleaning: Reassess opioid consent, opioid rules, cognitive behavioral therapy to teach coping skills, physical therapy for the mechanics, and other treatment as required. It does not count if you went through these steps 10 years ago or 5 years ago. This is now. Reassess thoroughly,  to see if we can correct or improve whatever we can.

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The good news is that everything will be reassessed and updated in order to maximize everything that can be done to help your pain. You may feel the brain feels clear on lower doses and you may even have less pain as long as you, together with your doctor, can work out a plan for your best needs.

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And no matter if you are thin, fat or just the right weight, the foods you eat will determine your body’s inflammatory response.

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This will be nationwide in weeks. There is no alternative. We can do this together.

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Don’t forget injured veterans are being completely taken off opioids to get them active and back to exercise. And research from 25 years ago showed 90 year old seniors can strengthen muscles with exercise. If the rest of the world gets by without opioids, so can we.

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Finally, it is very possible to get better pain control using compounded medications once you taper completely off opioids.

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Case:

One of my patients with neuropathy had complete loss of sensation and intense neuropathic pain below wrists and ankles despite high dose methadone – methadone helped better than all other opioids. There was no dose that brought his pain down to moderate. Since pain was severe on any dose of any opioid, I am not sure why they are prescribed at all – brain fog from severe pain, poor sleep, opioids. We may delude ourselves that we are helping.

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He had complete remission using oxytocin, a hormone the body makes. Oxytocin was affordable as long as his insurance paid for it. This allowed him to discontinue all opioid and he came alive again, depression and brain fog completely resolved when pain resolved 100%. He was able to rejoin life for the first time since 1991. Tragically his medicare disability does not cover compounded medications – no insurer does. He was not able to afford the oxytocin (hormone) and had to resume methadone though it gives poor pain control – it is better than other opioids for his pain.

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Not everyone responds to alternatives but they can be tried. I have spent the last 15 years applying new science to the understanding of mechanisms of old drugs, FDA approved decades ago for other purposes. We need to repurpose old safe drugs – invest in research to determine if they modulate pro-inflammatory cytokines. Drug discovery decades ago revealed basic mechanisms that still exist. Now, let’s find out if many safe existing medications work on the new science of the brain: the innate immune system.

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Opioids create pain. They create opioid induced hyperalgesia.

They stimulate pro-inflammatory cytokines in brain and spinal cord (CNS) that create pain.

My focus is on research and medications that modulate the cytokines and restore balance.

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Investment in research has not accompanied the radical cut in opioids. Work for change. Do not allow this to color your mood. Be strong. Get help. We can do this.

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Correction 2-23-16: California Guidelines (pdf) are not law. They are dead serious threats.

page 14: going over 80 mg morphine equivalent is yellow flag warning

 And here

page 3:

Clinicians should conduct semiannual attempts to wean patients whose dose has been 80 mg/day MED or higher for at least six months to lower than 80 mg/day MED.

 

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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.

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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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Please be aware any advertising on this free educational website is

NOT advocated by me and NOT approved by me.

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3 Responses to “Opioid Guidelines California”

  1. Bob Schubring Says:

    As the Nazis taught their prisoners in the death camps, “Arbeit Macht Frei”.

    We have to keep nice and busy making the best attempt we can, at surviving this “done deal” for as long as we can. Genocide takes time, and those of us who outlive it, may survive.

    Meanwhile, it is equally important that we are clear about this “done deal”, being an unacceptable deal. 18,000 suicides and acetaminophen overdoses are called “opioid-related deaths”, because the planners who seek the genocide of 111 million Americans with chronic pain, have seized the power to lie to us all, and are doing precisely that. We can’t fight them at all if we’re dead. Our best hope is to survive as long as possible, on whatever combination of therapies we can muster, until the scheme of Genocide is fully exposed and defeated.

    It is essential to remember…chronic pain sufferers who have killed themselves, are victims of the mindset that gave rise to these odious Guidelines. They died from Inadequate Pain Relief. Not from too much medicine.

    We have nothing to be ashamed of.

    The politicians who are promoting genocide, should be ashamed and are not. They are waging war against us…and every day we survive, is a loss to them. We must defeat them, by hanging together and helping one another.

    • Nancy Sajben MD Says:

      There is science behind this as well. Just not quite enough research.

      Opioid induced hyperalgesia is real. We do not know the dose at which opioids begin to cause pain in each person.

      Research in recent years has shown that 1/3 of patients on opioids in one Utah clinic had central sleep apnea. That is often untreatable and creates enormous burden on heart and brain, not to mention creating brain fog from severely interrupted sleep and lack of oxygen. One patient’s oxygen low was 52 – they had to call EMT’s to take him to hospital.

      Do we know what harm we have begun by introducing opioids to tens of millions of people including pregnant women?

  2. Advanced Pathways Hypnosis Says:

    As a CRPS patient for 6+ years – I have been fortunate enough to get into remission. I know that many chronic pain patients feel that opioids are the answer, but there are other treatment options out there that are evidence based and they work. Dr. Sajben offers a fantastic program. I myself reached out to her when I was in the midst of my CRPS for a consult.

    The reality is more needs to be done to open the doors for drug-free, non-invasive treatment options that are working. The majority of chronic pain patients do not hear about these treatment by their treating physicians.

    I see patients with CRPS, fibromyalgia, neuropathic pain, chronic migraines, PTST, etc… getting better on a consistent basis with Hypnosis Combined Therapy. Each patient needs to find a treatment plan that is right for them as nothing is a one size fits all.

    Please realize that opioids, spinal cord stimulators, pain pumps, etc… are not always the answer. When you don’t get the relief you are seeking regardless of the method then it is time to find something that will decrease your pain and allow you to regain your life.


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