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CDC Becoming Involved in Opiate RX Guidelines. Bad News for Chronic Pain Patients.

Nov 01, 2015 - 15 comments
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CDC in Pain Management



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 ~
~Tuck

Comments
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317787 tn?1473362051
by Dee1956, Nov 09, 2015
Thank you Tuck, I appreciate this information.  My husband goes to a pain specialist and I think he already has to jump through so many hoops to obtain his pain medicine.  It is ridiculous and expensive
Thank you, Dee.

6708370 tn?1471493810
by hepcandme, Nov 09, 2015
I understand the reasons why this is an issue for those with advanced liver disease but it also seems so unfair to ask someone to breathe through the pain
When I had breast cancer surgery, I was told to take pain pills Before the pain began, at least for the first 3 days, otherwise, the pain is much worse
That seems the better approach. I stopped taking them after a week and biting on a bullet while curled in a fetal position doesn't help one's recovery
This is crazy to put people through agonizing pain and do nothing about it
~ Linda

547368 tn?1440545385
by Tuckamore, Nov 10, 2015
Dee - Thanks for your comment. I am sorry that your husband has chronic pain too. Sadly no one seems to "get it" until they have been there - how can they when they have little to no experience to draw upon. My heart goes out to him.

Chronic pain is not only challenging, with difficult days and nites to struggle through - as you said, it's expensive. Quality of life is what's important in living - not quantity. Many ppl do not understand that concept when it applies to Chronic Pain.

Linda, Your comments are also appreciated. I'm sorry to hear that you had to undergo breast cancer surgery - and without proper pain management. Imagine living with that on a daily basis!

I believe it's important to be educated in the laws that govern out health care. You are correct. I am sorry that ppl with advanced liver disease have fewer choices when it comes to medications.

Warm Wishes to you both!

Avatar universal
by remar, Nov 11, 2015
My dear Tuck.
Thank you so much for posting this. I don't even know what to say. Of course you know me and I'll find some words. Ha ha!
I can't understand why all of this started in the first place. I know I've told you that I read an article in the New England journal of medicine. This was a few months ago. It said that abuse of pain medications has steadily went down since 2009. So why in the world did they think we even needed these laws? It makes no sense at all. What it's doing is making street drugs more "popular". Addicts will get high no matter what and they will indeed turn to street drugs that can be so incredibly dangerous. In the mean time, true CPP's are left to suffer. Our primary Drs have dropped us and forced in to pain clinics where we have no rights over our own health care. I told you about that pain contract I went over yesterday. Well, I told you in your post in the pain forum. It said that if they call you for a urine test or pill count you are required to be there within 24 hours. What happens if we need to go out of town? One of my aunts passed away yesterday. Her funeral will be only about an hour away from me but what it was many hours away and I got that call? Are we supposed to find a flight to get back home only to have a pill count and urine test? I realize not all pain clinics and pain Drs are this strict but too many of them are.
My sister had open heart surgery back in May. She was not in pain management yet but still the hospital only gave her 15 extra pills after the surgery. She does take Morphine for her RA pain, bulging discs, spinal stenosis and fibro. I was just shocked! This surgery has got to be one of the most painful surgeries in the world and she gets sent home with only 15 5 mg pills when she normally takes the 15 mg. Because of the incredible pain she had it took her forever to start feeling better. She could not sleep or eat. No position was comfortable. I practically begged her Dr to give her more medication and he said, 15 5 mgs is plenty and she will be just fine. This is from a heart Dr who does this surgery every day. He has to know that if your pain is out of control it's going to take much longer to heal. What has happened to our compassionate Drs?
And now we have the CDC involved. Why? They are the center for disease control and should have nothing to do with pain medications.
You're right Tuck, things just keep getting worse for us. I feel so defeated right now. I know it's just a temporary feeling and I will continue to fight. I just don't know what everyone wants out of us? Will they be happy when there are no more pain meds and the only thing that will be available will be street drugs? This is what they need to be working on. Leave us alone because all we want is to have some quality of life. We only go around once and it's inhumane to make us suffer needlessly.
I told you I would have something to say. Ha ha! All kidding aside, I'm so grateful for MH and the friends I have here. All of you have been so wonderful and have helped get through so many hard times. Tuck, you are an angel and I feel so blessed that I found you and we've become such great friends. Keep doing the wonderful job you've been doing because we need you. We're all so lucky to have you as our CL over the pain forum.

Avatar universal
by Idratherbesleeping, Nov 11, 2015
WOW! Really?? I'm so glad I found this site tonight! I just wanted to know why my pain gets so bad at night.
Thank you very much for sharing this information. The CDC has no more business in the use of opiate treatment than they do telling me what color I should paint my kitchen! The new guidelines being enforced right now seem to be extensive enough in my book. You know of course your going to become physically dependant on them if taken long enough, however, not everyone is a drug addict! And you know what else? Even if you do have a history of problems in your past and your diagnosed with some type of chronic pain disease, does that mean you now have to suffer because of it!!! It's just not right! Chronic pain is no laughing matter,as many of you know, and I wouldn't wish it on my worst enemy. If it weren't for my pain medications I probably would end up doing something terrible or turning to the street's for something, anything, to ease my pain and suffering!
Obviously the idiot at the CDC who came up with this has never had any type of ongoing chronic pain! Opiates are not the only prescription medications that pose health risk. Have you heard the list of side effects they tell you when they are advertising medications on television?!!
Psshhh!
Oh I'll write letters to all of the representatives in my state and federal level as well. Why create something that helps people cope and live as pain free as possible, and then say" no, I'm sorry you can't have any"?!
Still sleepless in Dayton!
~Cricket

317787 tn?1473362051
by Dee1956, Nov 12, 2015
Really good comments from everyone. It is true regular GP's are afraid to treat chronic pain so they push you into pain management. Dear so sorry for the super restrictive contract. That is ridiculous that you have to show up within 24 hours for pill count and urine. That is humiliating. My husband has a contract but not as bad. So sorry, Dee


547368 tn?1440545385
by Tuckamore, Nov 12, 2015
Cricket, thanks for your comments. I wholeheartedly agree and I am so sorry that you have chronic pain too. My heart breaks for you - all the millions of other chronic pain patients. No one hears us - or maybe they hear us but they don't want to listen. Sleep? Sometimes I don't even know what that feels like anymore. I know - you know. I hope you'll be active in our Pain Management Community - we need more that get it - that can offer good suggestions and information on our board. If you haven't found us - here's the link: http://www.medhelp.org/forums/Pain-Management/  If you've been by and I missed you please excuse me. It's been tough recently.

Dee, As always, thank you. You're understanding and support is greatly appreciated. I'm sorry your husband has chronic pain. He's lucky his contract doesn't say he has to produce his meds at any time for counting. I haven't been called but each and every appointment I take them in to be "viewed."  My last PMP's staff counted each and every tablet. They were not contend with just looking at them and estimating that the count was about right. I felt like a criminal - someone that was not to be trusted - all because I am not lucky enough to be healthy? It feels like discrimination in the worst way.


317787 tn?1473362051
by Dee1956, Nov 12, 2015
My word above Dear was supposed to be Remar, that darn auto correct again

Oh Tuck I am so sorry I would be so upset if my husband had to do that, other people puttin their hands on your medications is truly heat breaking.

Not saying it has been easy for my husband, he was at one pain clinic where one day the doctor just did not show.  It took me a long time to find a reputable pain management specialist. There was a news article about him.  It went well for several year,s then he had to stop for personal reasons.  Luckily he transferred my husband to another pain specialist.  It is a trip every month and he does have a contract but so far so good.  
People I know ask why he doesn't just go to a regular doctor.  It no longer works that way for many people the doctors must be pain specialists or eventually the DEA gets involved.  Regular doctor, that I know of, don't manage chronic pain.

Many many years ago there was a doctor in Virginia who was helping pain patients.  Unfortunately he was turned in for prescribing to someone who was selling.  There was a huge court case.  There were patients in court laying on the floors in intractable pain begging for him to be allowed to continue his practice.  He lost his license.  There were pictures in the news of all of these people who had no one to help them.  So true one bad apples ruins it for everyone.

I feel very lucky that right now Advil works for me but if the day comes that it doesn't I fear what will happen.  These pain doctors want hundreds of dollars for the first visit.  We don't have it.

I feel bad for every person who is in pain who can not find a pain doctor, Thank you for starting this, it is very informative.


Avatar universal
by remar, Nov 13, 2015
Dee. You are right. It does not work that way any more. It used to be that we could have a personal relationship with our family Drs. They knew what was best for us and we knew what was best for our own selves too. We were treated with the respect we all deserve.
What I meant about the contact. I haven't actually seen this Dr yet. I went to his website to check him out and they had the pain contract there. I will be seeing this new Dr Dec 4th and I do plan to go over this contract very carefully with him. I highly doubt he will change anything in it that I don't like so I'll most likely be forced to sign it if I want to be his patient.
I just hate to hear stories like that about the Dr in Virginia. He put his trust in someone and they ruined his career and the lives of his patients. I hope this person paid dearly for what they did.

547368 tn?1440545385
by Tuckamore, Nov 13, 2015
Remar I missed one of your comments on this journal - sorry. I just read it. You are so right when you say, "Addicts will get high no matter what and they will indeed turn to street drugs...." You close one hole and the addicts will find another. We need to treat the addicts and imprison the dealers. Neither happens. Instead the government attacks the weakest and most frail in our society, the sick and dying. It doesn't say much about "us" as a country - or our medical providers that could rebel. Instead they cower under the DEAs pressure. They are frightened of losing their license. License that they worked extremely hard to obtain and they also spent hundreds of thousands of dollars to even be eligible for state boards. For some medical providers they feel this is their  "calling" - for others it's their life's work.  Can we blame them? Even those that are empathetic of our plight don't want to risk the lose of their license to practice medicine.

I have read that the ultimate goal is to stop - yes stop opiate prescribing all together for pain management. Its pretty close to that when a cardiologist prescribes fifteen 5mg opiate tables post-op for open heart surgery. Pretty close!!  

You asked what happens when you are out of town and a PMP calls for a pill count. it doesn't matter. If you are summoned you must come. Our PM community just had a question about this very issue about a month or so ago. The chronic pain patient said she didn't have transportation and was out of town for some important function. The PMP said it didn't matter. She had 24 hours to bring her bottle in for a count. So yes, if that meant you had to fly back, spending hundreds of dollars that is what you would be required to do. It's up to your PMP how much leeway he/she is going to allow in a given situation. Sadly you have to treat everyone the same. I never heard the end of the story from the poster that asked if that was legal - could they make her do that? She said she was going to be terminated from the clinic if she could not get back in that time frame.

The horror stories are mounting - and will continue to mount. Who cares? No one cares -  until it happens to them or someone they love. The average person has no clue what chronic pain is all about let alone how tough, often to the point of ridiculous the laws have actually become.

Passionate? Use I am passionate about what is happened to the underdogs in our society - and extremely saddened that there is no out-cry for them - accept for the few of us that get it.

I'm delighted that you care Remar, and you care Dee and you care Cricket! Now we have to find ways to make our voices heard! Bless y'all!

547368 tn?1440545385
by Tuckamore, Dec 18, 2015
UPDATE

An astute member messaged me to say the draft is ready in the CDC's proposed Opiod Treatment.  It's titled, "CDC Guideline for Prescribing Opioids for Chronic Pain — United States, 2016"

I'll forewarn you - it's long, about 56 pages - as are most governmental "guidelines" or regulations. To be honest I haven't waded through all of it as of yet. It appears to be very restrictive. I've been told - and read that the final goal of our governmental agencies is to stop opiate prescriptions - except for immediate post-op patients and terminal cancer patients. Isn't it sad they even want to greatly limit the opiate dosages on our dying!!

There's the links:

Draft Guideline:
http://www.regulations.gov/#!documentDetail;D=CDC-2015-0112-0002

Link to adding comments:
http://www.regulations.gov/#!docketDetail;D=CDC-2015-0112

Hang tough my friends in pain. This can't/won't last. The pendulum will swing back.

Blessings,
~Tuck

547368 tn?1440545385
by Tuckamore, Jan 01, 2016
One of MedHelp's astute Community Leaders found this update on the proposed CDC's Guidelines before I did and shared it with me. It's very interesting. It has been meant with much scrutiny.

According to the article, "The CDC was roundly criticized for the way it prepared and handled the initial release of the guidelines..."  AND   "After getting feedback from critics, the CDC said it would make changes in its recommendations, but only a few changes can be found in the dozen guidelines released today"

It did not come as a surprise to me to learn from where the CDC gathered it's information. As this article states, " The CDC also came under fire for secretly consulting with “experts” that included special interest groups and addiction treatment specialists, but few pain patients or pain physicians."  

Here's the link: http://www.painnewsnetwork.org/stories/2015/12/14/cdc-made-few-changes-in-opioid-guidelines

If y'all don't know - this article is was written by Pat Anson, Editor on the Pain News Network. This Network is a good source for those of us with Chronic Pain. Among other things it is fighting for fairness and understanding of Chronic Pain. They are our ally.

Thanks all for your interest. And and many thanks to the CL that shared this update with me!

~Tuck

547368 tn?1440545385
by Tuckamore, Jan 01, 2016
And now our Military Vets are facing even more obstacles in Health Care in regards to Pain Management - thanks to the CDC Guidelines. The actual title of this article is "VA to Adopt CDC Opioid Guidelines."


I will edit my original Journal on this subject - but for now I'm adding this as a comment. Here's the link:

http://www.painnewsnetwork.org/stories/2015/12/21/va-to-adopt-cdc-opioid-guidelines#at_pco=smlrebh-1.0&at_si=568701a7c74e0ebf&at_ab=per-2&at_pos=0&at_tot=5 .

I know the link address is long. If it doesn't come up as is, copy it into your Search Engine this will come up.

In short the CDC Guidelines, which discourage primary care physicians from prescribing opioids for chronic pain, have now become official government policy at a federal agency before they’re even finalized.

I encourage you to read the article. This is at best troublesome for our Vets. These brave men and women that fought and fight for you and me - to protect our liberties and freedom will all be but denied opiate therapy for pain management.

There are no words to express my sadness and alarm at what's occurring in Pain Management. Now this will include our Vets! Our governmental officials should be ashamed - very ashamed!

~Tuck

317787 tn?1473362051
by Dee1956, Aug 27, 2016
Hi I was gong to place this on the Pain Management Forum but did not feel it was my place.  I am adding this to Tuck's journal in the hope everyone will see it.  This is a letter from the Surgeon General to every physician in the US.

http://www.aol.com/article/2016/08/26/the-surgeon-general-just-sent-a-worrisome-letter-to-every-doctor/21459520/

317787 tn?1473362051
by Dee1956, Aug 27, 2016
Oh, the link didn't highlight, I'll get a better one

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