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In a recent interview with the National Pain Report, Dr. Vanila Singh, the Chairperson of the Pain Management Inter-Agency Task Force kept taking the subject back to the volume of commentary the effort received and the influence it had on the final report.
The report provides advice and recommendations for the development of best practices for pain management and prescribing pain medication.
Dr. Singh, who is an anesthesiologist who has treated pain, believes the report shows that the challenges are more than just about treating pain—that they reveal it is “a front-line health care issue.”
That is why she emphasized the importance of 200 professional organizations who commented and over 160 of them who have praised and supported report, including the American Medical Association which has strongly endorsed it.
“Many organizations came out with amazing support of the draft report with great insight,” she said. “This is very important in depicting the relevance across all health care providers and stakeholders, as well as their interest in the Task Force Report.
All told—over 9000 comments including pain patients, pain professional groups, nursing organizations and pharmacists were received.
Source: National Pain Report
Researchers who set the new guidelines for how doctors should prescribe opioids say the providers have wrongly implemented some of their recommendations. They find that some health care players use the guidelines to justify an “inflexible application of recommended dosage and duration thresholds and policies that encourage hard limits and abrupt tapering of drug dosages." Other news on the crisis comes out of Tennessee, Texas and Louisiana.
The authors of influential federal guidelines for opioid prescriptions for chronic pain said Wednesday that doctors and others in the health care system had wrongly implemented their recommendations and cut off patients who should have received pain medication. “Unfortunately, some policies and practices purportedly derived from the guideline have in fact been inconsistent with, and often go beyond, its recommendations,” the researchers wrote in a paper published in the New England Journal of Medicine. (Joseph and Silverman, 4/24)
The Centers for Disease Control and Prevention, in new guidance for opioid prescribing, said many physicians were guilty of a "misapplication" of 2016 guidelines that clamped down on the use of opioids. The new guidelines, published in the New England Journal of Medicine, was the latest federal acknowledgement that many physicians' responses to the opioid crisis went too far. Former Food and Drug Administration commissioner Scott Gottlieb, a physician, spoke out last July about the impact the opioid crisis response had on pain patients when he called for development of more options. (O'Donnell and Alltucker, 4/24)
Addiction starts before drug use
There is no shortage of news coverage on the opioid epidemic. I pay close attention, and not because I am a scientist, or a health care provider, or a legislator. Nor do I have a loved one seeking help for a substance abuse disorder. Not any more.
In Opioid Cases, Local Prosecutors Are Torn Between Empathy and Demands for Punishment
Judge Gregory Grimslid reeled off the drugs 27-year-old Tyson Kelly had consumed: OxyContin, fentanyl, morphine, marijuana.
Opioid Addiction Treatment Begins in the Emergency Room in a Camden, NJ, Hospital
Every day at Cooper University Hospital in Camden, N.J., emergency room doctors treat, on average, five to fifteen patients who have overdosed on opioids.
Adam Bisaga, MD, on Addiction, Chronic Pain, and Stigma
This is Part 2 of an interview with Adam Bisaga, MD, an addiction psychiatrist, clinician, researcher, and professor of psychiatry at Columbia University.
Adam Bisaga, MD: Referring Patients to Most Opioid Treatment Centers Is Now Unethical
Adam Bisaga, MD, is an addiction psychiatrist, clinician, researcher, professor of psychiatry at Columbia University, and author of Overcoming Opioid Addiction.
April 26th report by Shepard Smith about the harms to chronic pain patients as a result of the overarching CDC Guidelines.
Link to Video: https://youtu.be/2Jg0ZV9ftFE
Fox News' Greg Gutfeld has been reporting about our plight for several months. Watch the most recent segment about the CDC Clarification featured on "The Five"
Watch segment here:
CDC is raising awareness about the following issues that could put patients at risk:
The Guideline was developed to ensure that primary care clinicians work with their patients to consider all safe and effective treatment options for pain management. CDC encourages clinicians to continue to use their clinical judgment, base treatment on what they know about their patients, maximize use of safe and effective non-opioid treatments, and consider the use of opioids only if their benefits are likely to outweigh their risks.
This is a three-part series on the nation's struggle to address a crippling opioid crisis, and the unintended victims left in its wake.
By Elizabeth Llorente | Fox News
Dec. 10, 2018 - The national opioid crisis propelled a crackdown on prescription painkillers, causing hundreds of doctors to abruptly reduce or completely cut off their patients’ prescriptions, leaving many among the estimated 20 million Americans who suffer from daily debilitating chronic pain to consider suicide. This is the story of the overlooked victims of America's opioid epidemic.
Dec. 11, 2018 - As federal and state agencies respond to the staggering rate of drug overdose deaths -- primarily involving illegal opioids like heroin and illicit fentanyl -- doctors who maintain they are responsibly prescribing opioids are getting caught up in the crackdown. This is their side of the story to the opioid crisis and how it has impacted -- and for some -- ruined their lives.
Dec. 12, 2018 - The government has addressed the overdose epidemic with an aggressive focus on reducing prescribing practices, which has unintentionally led many doctors to cut down or cut off their patients’ pain medications altogether. This tactic has left many chronic pain sufferers undertreated, with some even contemplating taking their own life. Fox News spoke with numerous doctors, specialists and scholars to find out what the next steps should be to address these unintended consequences.
Fentanyl is now the most commonly used drug involved in drug overdoses, according to a new government report. The latest numbers from the US Centers for Disease Control and Prevention's National Center for Health Statistics say that the rate of drug overdoses involving the synthetic opioid skyrocketed by about 113% each year from 2013 through 2016.
** URGENT BULLETIN ** Please SHARE with all State& Federal Representatives and Regulatory Agencies in charge of regulating Controlled Substances/Opioid prescribing.
Re: CDC Guideline Clarification Letter & FDA Advisory Notice pertaining to Opioid Prescribing
Below is a letter from the CDC clarifying the 2016 Opioid Prescribing Guideline and an Advisory Notice issued by the FDA regarding abrupt opioid tapering.
The Guideline is not intended to deny any patients who suffer with chronic pain from receiving opioid therapy as an option for pain management. Rather, the Guideline is intended to ensure that clinicians and patients consider all safe and effective treatment options for patients.
Clinical decision-making should be based on the relationship between the clinician and patient, with an understanding of the patient’s clinical situation, functioning, and life context, as well as a careful consideration of the benefits and risk of all treatment options, including opioid therapy.
CDC encourages physicians to continue to use their clinical judgment and base treatment on what they know about their patients, includes the use of opioids if determined to be the best course of treatment. Providers should communicate frequently with their patients to discuss both the benefits and risks of opioid therapy and revisit treatment plans for pain regularly to achieve the most positive outcomes for patients.
Reports of "serious harm" in patients dependent on opioid painkillerswho suddenly stop taking the medication, or rapidly decrease the dose, have prompted a drug safety communication issued today by the US Food and Drug Administration (FDA).
Despite the opioid epidemic, health insurers are still failing to reimburse chronic pain patients for effective non-opioid treatments, including psychological counseling and acupuncture. Even coverage for physical and occupational therapy varies widely in terms of the number of visits allowed, and whether prior authorization is required.
Last week more than 100 healthcare professionals and pain advocates signed a letter urging the Department of Health and Human Services to “prohibit or minimize rapid, forced opioid tapering in outpatients.” The letter was drafted by Beth Darnall, PhD, a pain psychologist at Stanford Medical School. It addresses the plight of chronic pain patients who were prescribed very high doses of opioids in the past, but who—whipsawed by rapid changes in medical consensus about the risks and benefits of such medication—are suddenly finding that they can no longer obtain their medications at such dosages. An estimated 18 million Americans are now on long-term prescription opioid therapies.
FOR IMMEDIATE RELEASE:
Washington, DC (April 16, 2019) — In 2016, the Centers for Disease Control and Prevention (CDC) issued prescribing guidelines to reduce the risks associated with long-term opioid therapy for chronic pain. What followed, however, was widespread misapplication by physicians, as well as insurers, government agencies, pharmacy chains, and health employers, which invoked the guideline as grounds to involuntarily reduce — and in some cases cease — opioid treatment for many chronic pain patients.
AEI Resident Scholar Sally Satel, M.D., in conjunction with other physicians and members of Health Professionals for Patients in Pain (HP3), explained in an open letter to the CDC: “Patients with chronic pain, who are stable and, arguably, benefiting from long-term opioids, face draconian and often rapid involuntary dose reductions.
Often, alternative pain care options are not offered, not covered by insurers, or not accessible. Others are pushed to undergo addiction treatment or invasive procedures (such as spinal injections), regardless of whether clinically appropriate.” Consequences have included intensification of pain, relapse into a disabled state, and even suicide.
Last week, Dr. Satel and her HP3 coauthors were delighted to receive a letter from the CDC in response to their open letter. In his reply, CDC Director Robert R. Redfield assured Dr. Satel and her coauthors — and, by extension, all prescribers, pharmacists, administrators, and regulators — that “the Guideline does not endorse mandated or abrupt dose reduction or discontinuation as these actions can result in patient harm.”
“We are so grateful to the CDC for its essential clarification,” said Dr. Satel. “Now it’s time for the federal, state, and nongovernmental institutions that have invoked the CDC’s authority to push [for] . . . traumatic changes . . . to reverse course.”
The full open letter from HP3 to the CDC is available here.
The full response from the CDC is available here.
Dr. Satel’s Wall Street Journal article on the CDC’s guideline reassessment is available here.
Practical Pain Management:
April 24, 2019
Andrew Kolodny, MD, told an Rx Drug Abuse & Heroin Summit audience that it is time to close the cash pipeline that helped feed the opioid epidemic.
April 23, 2019
The federally supported Healing Communities Study could dramatically reshape the effort to address the harms caused by the opioid crisis, attendees of the Rx Drug Abuse & Heroin Summit heard on Tuesday.
April 23, 2019
Ed Thompson, president of Pharmaceutical Manufacturing Research Services, explained to attendees at the Rx Drug Abuse & Heroin Summit why he wants the FDA to start requiring substantial scientific evidence of efficacy for the intended use of new…
April 16, 2019
President Donald J. Trump and First Lady Melania Trump will address participants of the eighth annual Rx Drug Abuse & Heroin Summit on April 24 in Atlanta.
April 12, 2019
Researchers who developed a tracking system to better understand the evolution of insurance coverage for opioid use disorder will share their findings at the Rx Summit.
At its 2018 interim meeting in Maryland, the AMA House of Delegates adopted a series of resolutions that recognize the mistreatment of pain patients and call for restraint in implementing the CDC guideline – particularly as it applies to the agency’s maximum recommended dose of 90mg MME (morphine milligram equivalent units).
1. RESOLVED that our AMA affirms that some patients with acute or chronic pain can benefit from taking opioids at greater dosages than recommended by the CDC Guidelines for Prescribing Opioids for chronic pain and that such care may be medically necessary and appropriate.
2. RESOLVED that AMA advocate against the misapplication of the CDC Guidelines for Prescribing Opioids by pharmacists, health insurers, pharmacy benefit managers, legislatures, and governmental and private regulatory bodies in ways that prevent or limit access to opioid analgesia
3. RESOLVED that our AMA advocate that no entity should use MME (morphine milligram equivalents) thresholds as anything more than guidance, and physicians should not be subject to professional discipline, loss of board certification, loss of clinical privileges, criminal prosecution, civil liability, or other penalties or practice limitations solely for prescribing opioids at a quantitative level above the MME thresholds found in the CDC Guidelines for Prescribing Opioids.
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