Posted on 10/19/2015 8:01:02 PM PDT by Tolerance Sucks Rocks
Healthcare industry groups are launching a preemptive strike against soon-to-drop federal guidelines meant to tamp down on the prescription of powerful painkillers.
The forthcoming guidelines from the Centers for Disease Control and Prevention are meant to combat the abuse of drugs like Hyrdocodone, Oxycontin and Percocet, which many medical experts believe are dangerously overprescribed.
Prescriptions for the drugs, known as opioids, increased by 300 percent from 1999 to 2013, according to the CDC, which cites statistics showing 16,000 people died from overdoses during that time. As currently drafted, the guidelines recommend physicians use opioids as a last resort after non-pharmacologic therapies like exercise and a lower level pain reliever like Ibuprofen have been tried, according to a copy obtained by The Hill. They do not, however, pertain to treatments for end-of-life care.
But the American Cancer Society Cancer Action Network (ACS CAN) is pushing back against the effort, contending that the guidelines were developed with insufficient evidence and questioning the methodology and the transparency of the entire process.
“Our concerns are so serious that we cannot endorse the proposed guidelines in any way and suggest suspending the process until the methodological flaws are corrected and more evidence is available to support prescribing recommendations,” ACS CAN’s President Christopher Hansen wrote in a letter to the CDC earlier this month after the group was asked to weigh in.
Mark Fleury, policy development principal on emerging sciences for the group, said the guidelines might ultimately make it more difficult for people, like cancer patients who have legitimate pain, to get the opioids they need. He said insurance companies will likely use the guidelines to set policies on when opioids will and won’t be covered.
He said they could even be used in litigation. If a patient, for example, sues a healthcare provider, the court might turn to the guidelines as the defacto expectation for treatment.
Though Fleury said he’d love to see doctors prescribe painkillers that aren’t as addictive or harmful as opioids to address chronic pain, they just don’t exist.
“This is what we have,” he said.
Other groups, like the American Academy of Pain Management, are raising concerns about conflicts of interest among the experts CDC used to draft the guidelines.
Bob Twillman, the group’s executive director, said some of CDC’s experts are members of Physicians for Responsible Opioid Prescribing (PROP), a group that advocates for more cautious opioid use.
“I don’t mind if people against opioids help draft the guidelines, but there needs to be a balanced representation of those against them and those that use them on a daily basis to treat patients,” he said. “They are dangerous, but it’s also true that there are many people who benefit from them and couldn’t live their lives if they didn’t have them, including many people with cancer.”
PROP, however, said its board members were asked to be part of the expert panel because they are experts in opioid use.
“The story here is how the opioid lobby is using the Cancer Action Network to discredit a public health effort to limit opioid prescribing,” Dr. Andrew Kolodny, the group’s executive director said.
The goal behind the guidelines is to recommend a more cautious approach to prescribing opioids, he said, not to try and take opioids away from the 10 to 12 million people who are taking them for chronic pain.
“There’s a lot of fear mongering that’s making these people panic and think that CDC wants to take opioids away from them and that’s not at all true,” he said.
In a statement to The Hill, CDC Spokeswoman Courtney Lenard said the core expert group members and peer reviewers were asked to disclose any circumstances that could represent a potential conflict of interest, meaning any interest that may affect, or may reasonably be perceived to affect, the expert's objectivity and independence.
“Peer Reviewers disclosed no financial interests or other promotional relationships with the manufacturers of commercial products, suppliers of commercial services, or commercial supporters,” she said, adding that those who did report interests related to intellectual property, public statements and positions were “carefully” reviewed by the CDC’s guideline development staff.
Other pain experts said the guidelines are good, but only for treating patients who have never been prescribed opioids before.
“I don’t think a single policy will adequately deal with people currently taking opioids and those newly put on opioids,” Dr. Daniel Clauw, a professor of anesthesiology at the University of Michigan Medical School, said “They’re good guidelines for the latter.”
From a public health standpoint, Clauw said the federal government needs to do something, but it should be careful in taking a one-size-fits-all approach.
“I think the rules are really spot on for new opioid starts, but I think we need a different set or rules for people already on opioids,” he said.
The CDC said the guidelines are currently in development and are not intended to be use by clinicians until reviews are complete and the guidelines are released publicly. The agency said the final report will be published in CDC’s Morbidity and Mortality Weekly Report in early 2016.
“Prescription drug abuse and overdose is a serious public health issue and improving the way opioids are prescribed through clinical practice guidelines can ensure patients have access to safer, more effective chronic pain treatment while reducing the number of people who misuse, abuse or overdose,” Lenard said.
This story was updated at 10:42 a.m. on Monday, October 19.
Nanny State PING!
might save a few lives from wack-job killers, or then, might set ‘em off from withdrawal
Doctors are the biggest drug pushers out there. Entire industry getting people ready for heroin.
Right now people are turning to heroin because it is easier to get than opiods. That brings in all sorts of problems in and of itself.
They crack down on painkillers, that require a prescription from your doctor along with follow up periodic visits with your doctor, yet the government has no problem with marijuana being available in some states. What a crazy country we live in.
Vicodin (hydrocodone) is the only medication that relieves pain for me. It does so in about five to ten minutes.
I get no high from it. I get no euphoric sensation. When I'm done using it after a few days, I stop taking it, with no problems whatsoever.
If these expletive deleted take that medication away from me, I will be very angry about it.
I hardly ever use it, once in two and a half to seven and a half years, but when I need it, I need it.
I can have a jaw to crown of my head tooth ache, and it will be gone in five minutes. Think I want to give that kind of relief up?
Aspirin
Excedrin
Tylenol
Tylenol # 3
Motrin
Nothing does anything even remotely helpful, when I have pain. Vicodin is where it's at for me.
Several of my family members can't take it. It makes them sick.
Works for me, and when I need it, I need and want it.
This is nonsense. Since some people, a very few, are susceptible to becoming hooked on these drugs, the rest of society must live with pain. Some people simply have addictive personalities or maybe addictive metabolisms or psyches.
I have had all these medications after surgeries or because of bone breakage. I have never experienced a ‘high’ from them, but they made the pain tolerable. Even after tonsil surgery when I was in my thirties, ask around it is among the most painful things an adult can have done, and was issues morphine in the hospital and liquid codeine for use at home I didn’t have an issue.
Boy it still hurt, I just didn’t care about the pain.
My wife got them after every pregnancy and after breast cancer surgery for the pain after surgery. Neither one of us have ever finished a full prescription. We actually have several left and will take one when in real pain.
Once again we are being nannied by Big Government, even over the best knowledge and intentions of medical professionals simply because some people are irresponsible.
“yet the government has no problem with marijuana being available in some states.”
Believe me when I say that I am not one of those people that thinks that marijuana is the be all end all of human existence. Having said that, marijuana is completely tame when compared to all of that opium based garbage out there. I actually wish they’d make *that* in a pill form for various pain relief instead of oxycodone and its ilk. Opioids are *highly* addictive and ridiculously dangerous when abused. I am NOT suggesting nanny state measures for these higher level narcotics ... I’m merely stating that marijuana might be a better form of relief as it is nowhere near as addictive as something like oxycontin.
“better form of relief”
I forgot to include “in some cases” after that statement :-).
Me, I don’t get addicted to any of that drug crap except for nicotine :-). I love nicotine :-). I can vape that though :-).
I’ve just seen MANY people get crippled by opium based pain pills for things like back pain and the like ...
got a stuffy nose?....they demand an antibiotic....
a sore back?...PT and hydrocodones to start...
HA?...why surely it must be a sinus infection so here comes more antibiotics......
how does most of the world live without all these meds?....
“Entire industry getting people ready for heroin.”
Good. It’s the most effective opiod pain reliever known to mankind.
L
Then what do they have to put in place of narcotics that will work on pain. And lets get real Lyrica and Gabapaentin are so side effect riddled very few can take them.
Then you have what works on 1 type pain doesn’t work on another, then the constipation, and addictive problems that the current batch of narcotics carry. I have to take 2 other meds to take their stinking NORCO.
Their OA drugs ruined my GI tract, their PPI’s ruined my bones, and now they want me to take the FLAGGED OP drugs that have jaw degeneration, A FIB and Bone Cancer warnings on them. Just found out I have a leaky heart valve to go with the irregular BP and pulse rates that can cause a heart attack. L 5/S 1 is totally collapsed with a Annular tear, deemed NOT fixable. Which means I can barely walk any more with out severe pain.
Since all our meds come from the Military Base dispensary or Express Scripts they have already made it rough to get pain meds. You need a new script every month and it must contain the wording for “CHRONIC PAIN” not severe or any other wording or they will only fill for 2 weeks, instead of a whole month.
If I took them as the stupid sub for my sick Primary directed, I’d be a Zombie with no pain relief during the day, and NONE at night. Unless I wanted to turn into an alcoholic, as a couple of good shots of Scotch and water o the rocks does better at pain relief than the lousy 5 mg of NORCO I get to take every 6 hrs And wear off in 4.
And POT.
“how does most of the world live without all these meds?.... “
Most of the world dies before they’re 40. If you want to love like that you go right ahead.
L
In a pinch, combine Advil and Excedrin at the same time.
2-3 of each, depending on the severity of pain, with a little food.
I got this from an ER nurse for migraines.
It works.
The government wouldn’t mind people using painkillers if painkillers were not associated with euphoria. It’s the euphoria that the DEA wants to stamp out. This has always been the motivation behind these laws.
“There’s a lot of fear mongering that’s making these people panic and think that CDC wants to take opioids away from them and that’s not at all true,” he said.
Then why all of a sudden do I need a script monthly that clearly states CHRONIC PAIN, and am limited to the amount I can have? What works on the spine pain does not work on the muscle pain, or the colon pain! Each takes a different med. And the side effects are not pleasant. I have to take a anti-puke pill and a Nexium to control the GERD NORCO causes.
I got a shot, that did not help.
I got therapy. That helped some.
I got painkillers that were so weak I was better off taking tic tacs. Those at least would freshen my breath.
Regulations say I could not be provided with effective painkillers until it was proven I had an injury.
To prove an injury required an MRI.
Regulations say I can not get an MRI until I had done the therapy with no improvement for 90 days.
I got a MRI.
Torn tendon, bursa and muscle. Gee, no wonder it hurt.
Finally some painkillers that knock the pain down to a tolerable level so I can sleep.
The dang things may be over proscribed by some doctors.
Fine. Go after those doctors and leave the rest alone. My doc has known me for years. He knows that I don't ask for pain pills unless I need them. In his judgment I needed those pills months ago, he also thought that I needed a MRI months ago.
Unable to proscribe.
Against regulations.
OA
PPI
FLAGGED OP
FIB
I understand L5, what is S1?
And you have my deepest sympathy and prayers for the pain you are in.
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