Nov 01, 2015
Oh No! This is more evidence in eh unofficial War against American Citizens with Chronic Pain. Just when I thought it couldn't get worse - it looks like the nightmare continues.
I'm attempting to keep us (Chronic Pain Patients) up-to-date on legislation, "guidelines" and trends in Pain Management. When I ran across the article regarding CDCs attempt to dictate how Pain Management will be administered I could not believe my "eyes"!
Wikipedia, the free encyclopedia defines the CDC's functions as follows: "Its main goal is to protect public health and safety through the control and prevention of disease, injury, and disability. The CDC focuses national attention on developing and applying disease control and prevention. It especially focuses its attention on infectious disease, food borne pathogens, environmental health, occupational safety and health, health promotion, injury prevention and educational activities designed to improve the health of United States citizens." I guess they interpreted that to cover the administration of opiates in Pain Management. How many government agencies need to involved? Pure nonsense. It's my opinion that they over-stepped their boundaries. They couldn't even mange the Ebola outbreak effectively. Their "guidelines" were dead wrong - actually helped spread the infectious disease! They have bigger fish to fry than to become involved in opiate therapy.
What made them PMPs - or experts in Pain? Am I angry - a bit - but more so I am frustrated and distressed in what I view as the continuing attack against the disabled, the injured veteran, our seniors, the sick, weak and helpless and we, America's Chronic Pain patients.
"The CDC is about to publish "Guidelines for Opioid Prescribing." The problem with "Guidelines" is they often are perceived as law. This is the very question many ppl are asking such as Pat Anson, Editor of The Pain Network News. Here are some exerts from Pat Anson's article: "When is a medical guideline voluntary and when does it become a “standard of practice” that doctors are expected to follow?"
"That is one of the key questions in the ongoing debate over controversial guidelines for opioid prescribing unveiled last month by the Centers for Disease Control and Prevention (CDC)."
"The draft guidelines recommend “non-pharmacological therapy” and other types of pain relievers as preferred treatments for chronic non-cancer pain. Smaller doses and quantities of opioids are also recommended when the drugs are used to treat acute or chronic pain." ..... A letter said, "The American Cancer Society “cannot endorse the proposed guidelines in any way” because they “have the potential to significantly limit cancer patient access to needed pain medicines.”
And there's more. Here's a link to Pat's article in the Pain Network News: http://www.painnewsnetwork.org/stories/2015/10/8/are-the-cdc-opioid-guidelines-really-voluntary
You can also find this article in The American Academy For Pain Management. Here's their link: http://www.aapainmanage.org/policy-in-the-news/are-the-cdc-opioid-guidelines-really-voluntary/
Here's what we're talking about:
The following is the draft by CDC for Opiod Prescribing:
CDC Draft Guidelines for Opioid Prescribing
1. Non-pharmacological therapy and non-opioid pharmacological therapy are preferred for chronic pain. Providers should only consider adding opioid therapy if expected benefits for both pain and function are anticipated to outweigh risks.
2. Before starting long term opioid therapy, providers should establish treatment goals with all patients, including realistic goals for pain and function. Providers should continue opioid therapy only if there is clinically meaningful improvement in pain and function that outweighs risks to patient safety.
3. Before starting and periodically during opioid therapy, providers should discuss with patients risks and realistic benefits of opioid therapy and patient and provider responsibilities for managing therapy.
4. When starting opioid therapy, providers should prescribe short-acting opioids instead of extended-release/long acting opioids.
5. When opioids are started, providers should prescribe the lowest possible effective dosage. Providers should implement additional precautions when increasing dosage to 50 or greater milligrams per day in morphine equivalents and should avoid increasing dosages to 90 or greater milligrams per day in morphine equivalents.
6. Long-term opioid use often begins with treatment of acute pain. When opioids are used for acute pain, providers should prescribe the lowest effective dose of short-acting opioids and should prescribe no greater quantity than needed for the expected duration of pain severe enough to require opioids. Three or fewer days will usually be sufficient for non-traumatic pain not related to major surgery.
7. Providers should evaluate patients within 1 to 4 weeks of starting long-term opioid therapy or of dose escalation to assess benefits and harms of continued opioid therapy. Providers should evaluate patients receiving long-term opioid therapy every 3 months or more frequently for benefits and harms of continued opioid therapy. If benefits do not outweigh harms of continued opioid therapy, providers should work with patients to reduce opioid dosage and to discontinue opioids when possible.
8. Before starting and periodically during continuation of opioid therapy, providers should evaluate risk factors for opioid-related harms. Providers should incorporate into the management plan strategies to mitigate risk, including considering offering naloxone when factors that increase risk for opioid-related harms are present.
9. Providers should review the patient’s history of controlled substance prescriptions using state Prescription Drug Monitoring Program data to determine whether the patient is receiving excessive opioid dosages or dangerous combinations that put him/her at high risk for overdose. Providers should review Prescription Monitoring Program data when starting opioid therapy and periodically during long-term opioid therapy (ranging from every prescription to every 3 months).
10. Providers should use urine drug testing before starting opioids for chronic pain and consider urine drug testing at least annually for all patients on long-term opioid therapy to assess for prescribed medications as well as other controlled substances and illicit drugs.
11. Providers should avoid prescribing of opioid pain medication and benzodiazepines concurrently whenever possible.
12. Providers should offer or arrange evidence-based treatment (usually opioid agonist treatment in combination with behavioral therapies) for patients with opioid use disorder.
This is just the tip of the iceberg. "Guidelines" from governmental agencies often are seen as the law. If you disagree with the continuing onslaught of laws intended to limit and eventually omit the use of opiate therapy in long term chronic pain - each of you need to make your voices heard.
We must write our state and federal representatives - and write them again - and contact them through Social Media or in any form you can - and continue to make your voice heard.
There will be more on this subject - but this journal is long enough for today. Please excuse it's length. I did leave additional information out to shorten this journal. I appreciate your eyes on this issue and would appreciate your support.
Thanks So Much - and Bless all of you that struggle with chronic pain every day. My heart goes out to you.
Just me ~