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Articles, References, & Studies

Overview of New Studies Re: Opioids - Article by Jeffrey Singer

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Evidence Pours More Cold Water on The False Narrative That Prescriptions Caused the Opioid Crisis

By Jeffrey A. Singer Twitter LinkedIn Reddit Facebook



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 

https://www.cato.org/blog/more-evidence-pours-cold-water-false-narrative-prescriptions-caused-opioid-crisis


More from Cato:  Myth of an Opioid Prescription Crisis 

Download the Policy Report

cpr-v39n5-4.pdf

Evidence Against the CDC Guidelines for Prescribing Opioids for Chronic Pain

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Source:  https://edsinfo.wordpress.com


Articles Against the Legitimacy of CDC Guidelines


  1. Opioids, Addiction, and Pain: Briefing for Policy Leaders
  2. CDC Manipulated Data to Deceive
  3. CDC Guidelines Refuted with Scientific Evidence
  4. The Changing Opioid Epidemic: Not from Rx 

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.


2. CDC Manipulated Data to Deceive – November 29, 2016

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 […]


4. The Changing Opioid Epidemic: Not from xR  – November 22, 2016

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.


More Professional Critiques of the Guidelines


“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 […]

Draft CDC Opioid Guideline: Pain Medicine Experts Discuss – March 3, 2016

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.


An Excellent Source of the Latest, Most Comprehensive Collection of Articles and Reference Materials Regarding Chronic Pain and Illnesses 

EDS INFO WEBSITE 

(CLICK BELOW TO VISIT THE WEBSITE)

National Institute on Drug Abuse (NIDA)

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National Institute on Drug Abuse (NIDA)



Mission

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:


  • Identify the biological, environmental, behavioral and social causes and consequences of drug use and addiction across the lifespan;
  • Develop improved strategies to prevent drug use and its consequences;
  • Develop new and improved treatments to help people with substance use disorders achieve and maintain a meaningful and sustained recovery;
  • Increase the public health impact of NIDA research and programs


In line with these goals, NIDA works to ensure that the following cross-cutting themes are addressed across institute programs and initiatives:

Politics of Pain

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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. 


POLITICS OF PAIN





Political Attempts to Solve Opioid Crisis 


House Tackling Opioid Crisis + Much More 

http://www.speaker.gov/general/house-tackling-opioid-crisis-much-more


The Hill: House’s opioid response will not include new funding, aide says http://thehill.com/policy/healthcare/277036-houses-opioid-response-will-not-include-new-funding-aide-says


Speaker Ryan: ‘We Can Win This Battle’ against Opioid Addiction http://www.speaker.gov/general/speaker-ryan-we-can-win-battle-against-opioid-addiction


WP: Some fear House playing politics with painkiller bills https://www.washingtonpost.com/news/powerpost/wp/2016/04/13/some-fear-house-playing-politics-with-painkiller-bills/?tid=sm_tw


Leader McCarthy: This Epidemic Sent More Than 100 Of My Constituents To The E.R., But Congress Is Fighting Back http://opinion.injo.com/2016/04/254920-160-of-my-constituents-have-overdosed-on-opioids-since-2010-were-taking-action-to-stop-the-epidemic/?utm_content=bufferd9fe5&utm_medium=social&utm_source=twitter.com&utm_campaign=buffer


Markey Commends Obama Administration Efforts to Expand Treatment and Education for Opioid Addiction http://www.markey.senate.gov/news/press-releases/markey-commends-obama-administration-efforts-to-expand-treatment-and-education-for-opioid-addiction


FDA Press Release: FDA announces enhanced warnings for immediate-release opioid pain medications related to risks of misuse, abuse, addiction, overdose and death http://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm491739.htm


The Hill: Senate GOP blocks emergency funding for opioid epidemic http://thehill.com/blogs/floor-action/senate/271533-senate-gop-blocks-emergency-funding-for-opioid-epidemic


Medical News

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Articles


ACSH


A Tale of Two Treatments


It's Not Wrong To Ask Your Doctor For Opioids


Reader's Digest 'Advice' On Drugs Is Biased And Ignorant


Doctors and Legislators:  Listen to Patients, Not the CDC


Overprescription or Recreation: What Is Driving the Opioid Epidemic?


Medpage Today


Escalating Opioid Doses in Chronic Pain
Prospective study looks at outcomes of long-term opioid use
13 COMMENTS


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
7 COMMENTS

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
13 COMMENTS

Sensitivity Heightened with Chronic Low Back Pain
Catastrophizing is also a common feature
8 COMMENTS


Cannabis Not a Pain Aid for Opioid Users
Sleep quality also not influenced by use
21 COMMENTS

Parents Play Big Role in Child's Chronic Pain
Self-blame from parent seen as particularly important factor


Pain News Network 


March 22, 2019

By Pat Anson, PNN Editor


Biden: ‘A Little Pain Is Not Bad’
Read More →

More Overdoses Blamed on Kratom

More Overdoses Blamed on Kratom
Read More →

CDC Director Says Agency Will ‘Clarify’ Opioid Guideline

CDC Director Says Agency Will ‘Clarify’ Opioid Guideline
Read More →

CDC: Guideline ‘Not Intended to Deny Any Patients Opioid Therapy’

CDC: Guideline ‘Not Intended to Deny Any Patients Opioid Therapy’
Read More →

FDA Warns About Fast Opioid Tapers

FDA Warns About Fast Opioid Tapers
Read More →



REASON:






Studies & Reports

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Opioids



  • Centers for Medicare & Medicaid Services (CMS) Opioid Misuse Strategy 2016 Show summary    Open resource [pdf]   (open full abstract) Centers for Medicare & Medicaid Services (U.S.)  2017-01-05


  • Combatting the Opioid Epidemic: A Review of Anti-Abuse Efforts in Medicare and Private Health Insurance Systems Show summary    Open resource [pdf]   (open full abstract) United States. Congress. Senate. Committee on Homeland Security and Governmental Affairs  2016-10-04


  • Continuing Progress on the Opioid Epidemic: The Role of the Affordable Care Act Show summary    Open resource [pdf]   (open full abstract) United States. Department of Health and Human Services  2017-01-11


  • Executive Order 13784: Establishing the President's Commission on Combating Drug Addiction and the Opioid Crisis Show summary    Open resource [pdf]   (open full abstract) United States. Office of the Federal Register  Trump, Donald, 1946-  2017-03-29


  • Facing Addiction in America: The Surgeon General's Report on Alcohol, Drugs, and Health Show summary    Open resource [pdf]   (open full abstract) United States. Public Health Service. Office of the Surgeon General; United States. Substance Abuse and Mental Health Services Administration  2016


  • Families in Crisis: The Human Service Implications of Rural Opioid Misuse Show summary    Open resource [pdf]   (open full abstract) National Advisory Committee on Rural Health and Human Services (U.S.)  2016-07


  • Federal Response to the Opioid Abuse Crisis, Hearing Before the Subcommittee on Labor, Health and Human Services, Education, and Related Agencies of the Committee on Appropriations, U.S. House of Representatives, One Hundred Fifteenth Congress, First Session, April 5, 2017 Show summary    Open resource [pdf]   (open full abstract) United States. Congress. House. Committee on Appropriations  2017-04-05


  • Final Report: Opioid Use, Misuse, and Overdose in Women Show summary    Open resource [pdf]   (open full abstract) United States. Department of Health and Human Services. Office on Women's Health  2017-07-19



  • Heroin Trafficking in the United States [August 23, 2016] Show summary    Open resource [pdf]   (open full abstract) Library of Congress. Congressional Research Service  Finklea, Kristin M.  2016-08-23




  • Opioid Epidemic and Federal Efforts to Address It: Frequently Asked Questions [October 18, 2017] Show summary    Open resource [pdf]   (open full abstract) Library of Congress. Congressional Research Service  Sacco, Lisa N.; Bagalman, Erin  2017-10-18


  • Pandemic Vaccine Distribution Policy for the Twenty-First Century Show summary    Open resource [html]   (open full abstract) Naval Postgraduate School (U.S.). Center for Homeland Defense and Security  Russo, Tom  2012-02


  • Patient Characteristics of Opioid-Related Inpatient Stays and Emergency Department Visits Nationally and by State, 2014 Show summary    Open resource [pdf]   (open full abstract) United States. Agency for Healthcare Research and Quality  Weiss, Audrey J.; Bailey, Molly K.; O'Malley, Lauren . . .  2017-06


  • President's Commission on Combating Drug Addiction and the Opioid Crisis, Final Report Show summary    Open resource [pdf]   (open full abstract) United States. President's Commission on Combating Drug Addiction and the Opioid Crisis  2017-11-01


  • Recommendations on Selection and Use of Personal Protective Equipment and Decontamination Products for First Responders Against Exposure Hazards to Synthetic Opioids, Including Fentanyl and Fentanyl Analogues Show summary    Open resource [pdf]   (open full abstract) InterAgency Board  2017-08


  • Serial No. 114-34: Combating the Opioid Abuse Epidemic: Professional and Academic Perspectives, Hearing Before the Subcommittee on Oversight and Investigations of the Committee on Energy and Commerce, House of Representatives, One Hundred Fourteenth Congress, First Session, April 23, 2015 Show summary    Open resource [pdf]   (open full abstract) United States. Government Publishing Office  2015


  • Serial No. 114-38: What is the Federal Government Doing to Combat the Opioid Abuse Epidemic? Hearing Before the Subcommittee on Oversight and Investigations of the Committee on Energy and Commerce, U.S. House of Representatives, One Hundred Fourteenth Congress, First Session, May 1, 2015 Show summary    Open resource [pdf]   (open full abstract) United States. Government Publishing Office  2015

  • Serial No. 114-46: What are the State Governments Doing to Combat the Opioid Abuse Epidemic? Hearing Before the Subcommittee on Oversight and Investigations of the Committee on Energy and Commerce, U.S. House of Representatives, One Hundred Fourteenth Congress, First Session, May 21, 2015 Show summary    Open resource [pdf]   (open full abstract