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A new study reported in the November 1, 2019 Annals of Emergency Medicine pours more cold water on the false but persistent narrative that the opioid overdose crisis was caused by doctors prescribing opioids to patients in pain.
This prospective cohort study by researchers in the Department of Emergency Medicine at Albert Einstein College of Medicine followed 484 “opioid naïve” patients prescribed opioids for acute pain upon release from the emergency department during a six month period. The statewide prescription drug monitoring program was employed in addition to regular follow up telephone interviews. One percent (five patients) met the criteria for persistent opioid use by the end of the follow up period. Four of the five patients still had moderate or severe pain in the affected body part six months after release from the emergency department.
The study comes after a much larger retrospective cohort study reported in the BMJ of more than 568,000 opioid naïve patients prescribed opioids for acute postoperative pain between 2008 and 2016. Investigators found a total misuse rate of 0.6 percent. The researchers defined “misuse” as follows:
The primary outcome was an ICD-9 (international classification of diseases, ninth revision) diagnosis code of opioid dependence, abuse, or overdose…Opioid misuse was defined as the presence of at least one of these ICD codes after discharge and encompasses a composite of a wide range of forms of misuse. We included only diagnosis codes related specifically to prescription opioids.
As previously reported here and here, there is no correlation between opioid prescription volume and non-medical use or opioid use disorder among persons age 12 and over. But policymakers and law enforcement continue to pressure health care practitioners into undertreating patients in pain. At a recent international breast cancer conference experts stated the under-prescribing of opioids to breast cancer patients in the U.S. is now comparable to treatment in third world countries.
Recently the Centers for Disease Control and Prevention, in a written clarification, stated that policymakers and legislators are misapplying and misinterpreting its 2016 opioid prescribing guidelines. The CDC statement pointed out that its guidelines were never intended to be “prescriptive,” but were meant to serve as a rule of thumb, recognizing that providers know their patients’ situations best, and should weigh risks and benefits when treating individuals in pain.
Despite the recent exhortation from the CDC, most states and many pharmacies maintain the limits on the dose and number of opioids that can be prescribed to patients that were put into effect in response to the 2016 CDC guidelines.
Meanwhile, as prescription volume precipitously drops, the overdose rate continues apace, with fentanyl and heroin now making up the overwhelming majority of overdose deaths. And now methamphetamine is making a comeback as a major cause of drug deaths—15 years after Congress addressed the “meth crisis’ with the Combat Methamphetamine Epidemic Act.
Until the war on drugs comes to an end and the focus shifts to harm reduction, the only thing that will change going forward will be the particular drug responsible for the latest “overdose crisis.” That should be the narrative.
Source: Cato Institute
More from Cato: Myth of an Opioid Prescription Crisis
This excellent summary of the points of our argument against the CDC Guidelines was created by Stefan G Kertesz, MD, who also wrote the thoroughly researched paper, The Changing Opioid Epidemic: Not from Rx, proving that our opioid prescriptions are NOT the problem.
This briefing was presented personally to U.S. Surgeon General Vivek Murthy on January 17, 2017. He was receptive to the points offered here.
This commentary presents the case that the CDC manipulated the data it used as a basis for its opioid prescribing guidelines.
By imposing an arbitrary non-standard constraint and excluding some studies that were included in earlier reports, the CDC created a different interpretation by using a different set of data.
Objectives. A recent US federal review and clinical guideline on opioids for chronic pain asserted that the literature contributes no evidence on efficacy because all trials had “inadequate duration.”
Neat, Plausible, and Generally Wrong: A Response to the CDC Recommendations for Chronic Opioid Use – Stephen A. Martin, MD, EdM; Ruth A. Potee, MD, DABAM ; and Andrew Lazris, MD
Finally, someone is standing up for the truth about opioids and pain patients. These three courageous M.D.s expose the CDC guidelines for the fraud […]
Turning the Tide or Riptide? the Changing Opioid Epidemic – Stefan G. Kertesz – 18 Nov 2016
This rigorously sourced paper illustrates the absurdity and futility of the crackdown on prescribed pain medication.
Dr. Kertesz meticulously lays out the facts (backed by 50 references to scientific research) proving that opioid prescriptions to patients are not the primary driver of the increasing numbers of overdose deaths.
Restricting such prescriptions has only caused a crisis of untreated pain while doing absolutely nothing to treat the addiction and abuse at the root of most overdoses.
“Research” Behind the CDC’s Opioid Guidelines – August 2016
Tracking Down the “Research” Behind the CDC’s Opioid Prescribing Guidelines – National Pain Report – Aug 2016 – By Richard “Red” Lawhern, PhD
I have tracked down some of the “research” behind the so-called CDC practice guidelines published in March 2016. And the research is an absolute CROCK! Particularly astounding is the biased and unscientific […]
Opioids, Pain and the CDC’s Guideline: Needs Improvement – January 24, 2016
Opioids, Pain and the CDC’s Guideline: Needs Improvement | by Stefan Kertesz Physician researcher
These arguments against the CDC’s guidelines are specific, logically argued, and carefully thought out, explaining some aspects that seemed muddled, but are clear to a practicing doctor. The Centers for Disease Control report that 2014 saw a record of 18,893 deaths related to opioid […]
Professional Criticism of CDC Guidelines – April 25, 2016
CDC Issues Final Guidelines for Opioid Prescribing: PPM Editorial Board Responds
This is a 6-page article, with some thoughtful criticism of the guidelines, addressing some of their striking shortcomings. The initial draft guidelines were met with sharp criticism from a number of medical organizations, including the American Academy of Pain Medicine (AAPM), American Medical Association […]
Issues With the CDC Guidelines – October 3, 2016
The Issues With the CDC Guidelines on Opioids for Chronic Pain, According to AAPM’s Director by Florence Chaverneff, Ph.D. September 26, 2016
This article is noteworthy because of where it appears (in a publication mostly dedicated to parroting the CDC’s ideas) and who is speaking (BobTwillman, president of the American Association of Pain Management) In […]
CDC Opioid Guidelines–A Threat To Pain Patients’ Lives – September 27, 2015
These guidelines were designed to further curb opioid abuse. But in fact, they seem to be about arbitrarily curbing treatment.
CDC Opioid Prescribing Guidelines–A Threat To Pain Patients’ Lives | Intractable Pain Journal
CDC Guidelines Use Pseudoscience – April 17, 2016
How Opioid Prescribing Guidelines Use Pseudoscience — Pain News Network – By Michael Schatman and Jeffrey Fudin, Guest Columnists – March 30, 2016
Recently, we (along with our colleague, Dr. Jacqueline Pratt Cleary) published an open access article in the Journal of Pain Research, entitled “The MEDD Myth: The Impact of Pseudoscience on Pain Research […]
Long List of Flaws with CDC Guidelines – April 5, 2016
National Pain Strategy 0; Drug Wars 1 | Terri A. Lewis, Assistant Professor, Rehabilitation Counseling & Intern’l Prgms Cnsltnt at National Changhua University of Education | Mar 20, 2016
Ms. Lewis has organized the salient points of the current denigration (assault) of pain patients. Her bullet points help my frazzled mind understand what has happened […]
Below I’ve tried to limit this long discussion to its most meaningful statements. I spent much time highlighting and commenting on the most pertinent phrases, so I hope you find this post informative.
This discussion gives an interesting view of how pain and pain […]
FDA Endorses Biased and Unscientific CDC Opioid Guidelines – February 14, 2016
FDA Endorses CDC Opioid Guidelines | February 04, 2016 | By Pat Anson, Editor
In a move that may have more to do with politics than healthcare, the U.S. Food and Drug Administration has set aside the advice of its own experts by endorsing the CDC’s controversial guidelines for opioid prescribing The move is part […]
A Reviewer’s Analysis of the Draft CDC Guidelines – January 9, 2016
A Former Federal Peer Reviewer’s Analysis of the Draft CDC Guidelines | National Pain Report | December 30, 2015 | Brooke Lee Keefer
In my former life prior to chronic pain and illness I had many important and fascinating jobs. One was as a peer reviewer for the United States National Institutes for Health (NIH), Center for Mental […]
CDC Opioid Guidelines: Good, Bad, and Ugly – May 22, 2016
New CDC Opioid Guidelines: The Good, the Bad, and the Ugly – Charles E. Argoff, MD – May 13, 2016
In this article, Dr. Argoff picks apart the guideline and explains which parts are relatively sound, and which are spurious. The guideline’s purpose is to: “improve communication between clinicians and patients about the risks and […]
Response to CDC Guidelines by FMS Assoc. – March 27, 2016
NFMCPA Response to CDC Opioid Prescribing Guidelines | March 13, 2016 | Jan Favero Chambers, President/Founder | National Fibromyalgia & Chronic Pain Association
Today at noon I could hardly breathe. Hot tears fell on my cheeks, and a deep heartache filled my soul. The U.S. Centers for Disease Control Guidelines for Prescribing Opioids 2016 was […]
Professional Criticisms of CDC Guidelines – March 24, 2016
Responses and Criticisms Over New CDC Opioid Prescribing Guidelines | March 18, 2016
In their statements, both the American Academy of Pain Medicine (AAPM) and the American Medical Association (AMA) first cautiously express approval of the CDC’s intentions (obviously intimidated) before diving into the glaring problems with the guidelines. I feel the worst part is the fixed […]
Docs Say CDC Opioid Guidelines Misguided – April 13, 2016
CDC Opioid Prescribing Guidelines Misguided, Docs Say | Brandon Cohen | April 08, 2016
Recent guidelines handed down from the Centers for Disease Control and Prevention (CDC) concerning the prescription of opioids have made waves among healthcare professionals. The CDC condemned the practice of prescribing these drugs in the vast majority of cases. Furthermore, these guidelines […]
Contradictions in CDC Guidelines – Jan 2016
Upon review of the Proposed 2016 CDC Guideline for Prescribing Opioids for Chronic Pain we find various contradicting statements based on the presented evidence and the recommendation strength
According to the National Guideline Clearinghouse, “level A rating requires at least two consistent Class I studies”.
However, all of the 12 recommendations provided are based on case series (level 3 evidence) or expert opinion (level 4 evidence) yet assigned a grade A recommendation.
Harms Associated With Conflation of Data – Feb 2017
By Stephen Ziegler, PhD
The research letter, like many articles authored by those who are rightly concerned about addiction and overdose, begins by asserting that an association exists between increases in opioid prescribing and “large increases in addiction and overdose deaths in the United States.”
However, there are several problems with such a statement. First, association is not causation.
Further, it is misleading and harmful to lump all opioids, prescription and illicit, together.
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The mission of the National Institute on Drug Abuse (NIDA) is to advance science on the causes and consequences of drug use and addiction and to apply that knowledge to improve individual and public health. In this regard, NIDA addresses the most fundamental and essential questions about drug abuse — from detecting and responding to emerging drug abuse trends and understanding how drugs work in the brain and body, to developing and testing new approaches to treatment and prevention. NIDA also supports research training, career development, public education, public-private partnerships, and research dissemination efforts. Through its Intramural Research Program, as well as grants and contracts to investigators at research institutions around the country and overseas, NIDA supports research to:
In line with these goals, NIDA works to ensure that the following cross-cutting themes are addressed across institute programs and initiatives:
Setting the Stage - Monetizing the Opioid "Crisis"
The "ANTI OPIOID" Lobby's Strategy to Discredit & Demonize the Responsible use of Prescription Pain Medications for Legitimate Medical Purposes.
Opioid Stigma and Cancer
Efforts to limit opioid prescribing may have unintended consequences
Can Blocking Kappa Receptors Reduce Opioid Dependency?
Researchers look at targeting pain-related anhedonia
Kids' Chronic Pain and Life Challenges Go Hand-in-Hand
Risk factor for poorer school function, as well
Heroin Use in Pain Patients Signals Something Badly Amiss
Tied to other illicit drug use, non-adherence to prescribed opioids
Sensitivity Heightened with Chronic Low Back Pain
Catastrophizing is also a common feature
Cannabis Not a Pain Aid for Opioid Users
Sleep quality also not influenced by use
Parents Play Big Role in Child's Chronic Pain
Self-blame from parent seen as particularly important factor
Pain News Network
By Pat Anson, PNN Editor
Article by Dr. Shactman: