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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 



Doctors Have Swung The Pendulum Too Far And Are Under Prescribing Painkillers To Needy Patients, Experts Warn

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.

Stat: The Authors Of The CDC’s Opioid Guidelines Say They’ve Been Misapplied

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)

USA Today: CDC: Doctors Were Too Cautious About Opioid Pain Pill Prescribing

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)


News Updates June

Source: Opioid Watch

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.

Stanford’s Lembke: Most high-dose opioid patients should be tapered down—even involuntarily.
When Anna Lembke first became a psychiatrist, addiction was an area she avoided.

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.

Drug Policy Expert Robert DuPont: The Opioid Crisis is Now About Synthetics and Polydrug Use
Psychiatrist Robert L. DuPont, MD, has been campaigning against opioid addiction for half a century.

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.

Pain New Network


National News Coverage About Harmful effects on CPP'S

April 26th report by Shepard Smith about the harms to chronic pain patients as a result of the overarching CDC Guidelines. 

Link to Video:


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:


Urgent Press Release from CDC

CDC is raising awareness about the following issues that could put patients at risk:

  • Misapplication of recommendations to populations outside of the Guideline’s scope. The Guideline is intended for primary care clinicians treating chronic pain for patients 18 and older. Examples of misapplication include applying the Guideline to patients in active cancer treatment, patients experiencing acute sickle cell crises, or patients experiencing post-surgical pain.
  • Misapplication of the Guideline’s dosage recommendation that results in hard limits or “cutting off” opioids. The Guideline states, “When opioids are started, clinicians should prescribe the lowest effective dosage. Clinicians should… avoid increasing dosage to ≥90 MME/day or carefully justify a decision to titrate dosage to ≥90 MME/day.” The recommendation statement does not suggest discontinuation of opioids already prescribed at higher dosages.
  • The Guideline does not support abrupt tapering or sudden discontinuation of opioids.  These practices can result in severe opioid withdrawal symptoms including pain and psychological distress, and some patients might seek other sources of opioids. In addition, policies that mandate hard limits conflict with the Guideline’s emphasis on individualized assessment of the benefits and risks of opioids given the specific circumstances and unique needs of each patient.
  • Misapplication of the Guideline’s dosage recommendation to patients receiving or starting  medication-assisted treatment for opioid use disorder.The Guideline’s recommendation about dosage applies to use of opioids in the management of chronic pain, not to the use of medication-assisted treatment for opioid use disorder. The Guideline strongly recommends offering medication-assisted treatment for patients with opioid use disorder.

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.


Mainstream Media is Finally Reporting Our Side of the Story

Fox News 3 Part Series

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

Part One:


As doctors taper or end opioid prescriptions, many patients driven to despair, suicide


Treating America's Pain: Unintended Victims of the Opioid Crackdown, Part 1 – The Suicides

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.

Part Two:


Doctors caught between struggling opioid patients and crackdown on prescriptions


Treating America’s Pain: Unintended Victims of the Opioid Crackdown, Part 2 – The Doctors

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.

Part Three: 


Health experts offer solutions for unintended consequences of opioid crackdown


Treating America’s Pain: Unintended Victims of the Opioid Crackdown, Part 3 – The Solutions

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.

CNN REPORT: Fentanyl is the deadliest drug in America, CDC confirms

Fentanyl is the deadliest drug in America, CDC confirms

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. 

Link to Clarification Letter from the CDC: CLICK  HERE

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. 

Link to FDA Announcement CLICK HERE  

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).

Opioid Watch


Insurers slighting claims for non-opioid pain treatments

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.

Pain doctors, advocates urge curbs on “forced opioid tapering”

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.

Nora Volkow on prescription opioids, chronic pain and ‘hype’

Research psychiatrist Nora Volkow, MD—the director of the National Institute on Drug Abuse for the past 15 years—is one of the world's foremost authorities on opioid and other addictions.

Can Virtual Reality Relieve Chronic Pain? A Controversial Pain Doctor Thinks So.

Some hospitals today try to lessen the pain of patients, especially children, by having them play virtual reality games during agonizing procedures.

News Roundup: June 8, 2018: Pain Refugees

We Opioids present a unique medical problem, Lewis Nelson told me last week.

Stanford’s Lembke: Most high-dose opioid patients should be tapered down—even involuntarily.

When Anna Lembke first became a psychiatrist, addiction was an area she avoided.

Q&A (Pt 2): Addiction Expert Discusses Hate Mail and Why Opioids are “Lousy” Drugs for Pain

Andrew Kolodny is co-director of the Opioid Policy Research Collaborative of the Heller School for Social Policy and Management at Brandeis University.

News Roundup: March 30, 2018: Medicare Reg Scaring Pain Patients

In the most alarming story of the week, the New York Times reports that a new Medicare regulation threatens to halt reimbursement of opioid medications for 1.6 million chronic pain patients.

Marijuana Boosts an Opioid’s Painkilling Power, Allowing Lower Dose: Study

The evidence of cannabis’ potential value as an opioid substitute continues to mount.


Chronic pain patients to benefit as Centers for Disease Control and Prevention reexamines opioid prescription guidelines

Health Care


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.



Kolodny: Opioid Makers' Deception Merits Dramatic Responses

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.

Communities Ready to Take on Bold Initiative to Slash Fatal Overdose Numbers

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.

Pharmaceutical Executive Explains Decision to File Lawsuit Against FDA

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…

President Trump, First Lady to Address Attendees at Rx Summit

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.

Rx Summit Spotlight: Researchers Bring Clarity to Coverage of OUD Treatment

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.


The AMA is on Our Side


Urgent News

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.

Links To Articles: 


AMA: ‘Inappropriate Use’ of CDC Guideline Should Stop

AMA Delegates Back Physician Freedom in Opioid Prescribing
CDC guidelines are well-intentioned but shouldn't restrict prescribing, they say

DEA War-on-Drugs ‘Failure’

Crackdown on Opioid Prescriptions Called Another War-on-Drugs ‘Failure’


The federal crackdown on opioid prescriptions has led to needless deaths and threatens to exacerbate an epidemic that continues to kill thousands of Americans, warns an Arizona physician.

Comparing government efforts to limit the supply of opioids or opioid prescriptions to what he calls the “failure” of the war on drugs, Dr. Jeffrey A. Singer says the policy “only serves to drive non-medical users to heroin, with increasing numbers of non-medical users initiating their opioid abuse with that substance.”

Singer, in a policy analysis written for the right-of-center Cato Institute, calls instead for policies that emphasize “harm reduction” rather than prohibition.

“Drug prohibition has proved a failure,” he wrote. 

“People are dying largely because of drug prohibition.”

He called for policymakers to implement public health options aimed at helping substance-abusers wean themselves from dependence on drugs.

The options include medication-assisted treatment, needle-exchange programs, safe injection sites, heroin-assisted treatment, deregulation of naloxone, and even the decriminalization of marijuana—all of which he said have produced positive outcomes for substance-abusers.

“Though critics have dismissed these strategies as surrendering to addiction, jurisdictions that have attempted them have found they significantly reduce overdose deaths, the spread of infectious diseases, and even the non-medical use of dangerous drugs,” wrote Dr. Singer.

The alternative approach, largely spearheaded by the federal Drug Enforcement Administration (DEA), not only undermines the legitimate use of opioid analgesics but leads “many physicians to practice in fear,” he wrote.

“Worse, it may be driving desperate pain patients to the illegal market, with all the risks that entails.”

See also: “Are Pain Doctors Wrongly Taking the Blame for the Opioid Crisis?”

Although there have been indications that the opioid epidemic has begun to wane, Dr. Singer noted that preliminary figures released in August show the opioid overdose rate increasing in 2017—mainly as a result of a 37 percent increase in deaths involving fentanyl.

Overdoses in 2017 from prescription drugs actually dropped 2 percent and overdoses from heroin dropped 4 percent over that period. But the reduced availability of common prescription drugs like hydrocodone and oxycodone has been driving up the use of heroin.

In 2015, more than 33 percent of heroin addicts entering treatment initiated their non-medical opioid use with heroin, up from 8.7 percent in 2005, according to figures cited by Dr. Singer.

Dr. Singer, a Cato Institute research fellow, is the principal and founder of Valley Surgical Clinics, Ltd., the largest and oldest group private surgical practice in Arizona. 

According to his biography, he served as treasurer of the US Health Freedom Coalition, which lobbies against what it calls “restrictive health practices.”

Most attention on the opioid crisis has focused on its impact on Americans in the U.S. heartland.  

But a Washington Post investigation says opioid overdoses have been responsible for a wave of deaths among African-Americans in the nation’s capital, in a development it says is largely ignored by local DC officials.

Cato Institute


Harm Reduction: Shifting from a War on Drugs to a War on Drug-Related Deaths

By Jeffrey A. Singer December 13, 2018

The U.S. government’s current strategy of trying to restrict the supply of opioids for nonmedical uses is not working. While government efforts to reduce the supply of opioids for nonmedical use have reduced the volume of both legally manufactured prescription opioids and opioid prescriptions, deaths from opioid overdoses are nevertheless accelerating. Research shows the increase is due in part to substitution of illegal heroin for now harder-to-get prescription opioids. Attempting to reduce overdose deaths by doubling down on this approach will not produce better results.

Policymakers can reduce overdose deaths and other harms stemming from nonmedical use of opioids and other dangerous drugs by switching to a policy of “harm reduction” strategies. Harm reduction has a success record that prohibition cannot match. It involves a range of public health options. These strategies would include medication-assisted treatment, needle-exchange programs, safe injection sites, heroin-assisted treatment, deregulation of naloxone, and the decriminalization of marijuana. Though critics have dismissed these strategies as surrendering to addiction, jurisdictions that have attempted them have found they significantly reduce overdose deaths, the spread of infectious diseases, and even the nonmedical use of dangerous drugs.


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