To those whom have lost loved ones to addiction, my heartfelt condolences.
Not unlike our political divisiveness in our society that has been raging for years, this division has reached into the psyche of our medical community. This is not more evident than in our “guidelines” published by the CDC in 2016. Guidelines that were written in secret from a panel whose members were kept secret until leaked noting a majority who were not chronic pain specialist with a strong “expert” opinion of opiophobia. CDC guidelines were made with no debate or public hearings but through a Webinar. Twenty-five hours was given for public comment then the guidelines were going to be put forth. It was not until the Congress stepped in and allowed for longer period of response, after a second Webinar, however, these responses, if ever considered did not change the “guidelines” we have today. These guidelines have become the knee jerk reaction to the tragic deaths of thousands of people from inappropriate opioid use. Disciplinary action from medical boards and law enforcement treating those that treat pain patients as criminals is beyond comprehension.
Let us understand what the opioid epidemic is and what it is not. The faces of those dying are all young. Some have entered into addiction because of prescription opioids initially but rapidly change to opioids laced with carfentanyl (powdered fentanyl from China), heroin, methamphetamine, cocaine, benzodiazepine abuse, alcohol abuse and/or experimental drug use of available agents from diversion into our communities to “party with”. Opioids are not forgiving of inappropriate use and mixed poly pharmacy. There are no quality controls of these drugs that dealers sell to customers. They sell death. This is unlike alcohol or tobacco addiction that kills more people in our country every year 88,000 and 480,000 respectively. The difference is that those killed by alcohol and tobacco typically kill over years of abuse. Opioids as stated above can kill with one inappropriate use. What the opioid epidemic is not?
In our zealousness to stop the train wreck of opioid abuse those with chronic pain have been the unsung victims. Without aberrant behavior related to their medication use, they are summarily stopped. With pressure from elected officials, DEA, FDA, law enforcement at local, State and Federal levels many chronic pain patients’ have been abandoned by their health care providers. To turn a blind eye to the suffering of our citizens without regard to the consequences of such actions in unethical. This has resulted in the loss of hope by those suffering and many abandoned in such a way have resulted in suicides from these ill-advised treatment decisions. Decisions to stop medication without cause results in undue suffering for chronic pain patient.
Randomly controlled trials have been done for short periods of time but, then these studies were open up and used for a year noting that 30-40% of those still using medication with improvement in functioning quality of life, and activities of daily living. Those that support the position that chronic opioid use has not been studied are disingenuous at best, lying at worse. They can say that there is no randomly controlled trial but they cannot say this has not been studied long term. Guidelines are exactly that, a guide to treatment not an absolute treatment regimen. The CDC guidelines do support appropriate opioid use in a step wise fashion. If high doses of opioids are needed then these should be prescribed by those whom are experts in pain management. This is a far cry different point of view that what we see in our political leaders, Attorney’s General for States and Federal governments.
We have lost our way. We have failed those who need our care the most. There are risks that must be discussed with all treatments. Do not conflate opioid use for chronic pain and those abusing for recreation or addiction. Having said all of this, opioids are not the long-term answer to chronic pain and non-medication alternatives are available for those interested in such. Since many of these are alternative medicine protocols, most if not all insurances will cover them.