Will the New Opioids Restrictions Help to Reduce Overdoses?
New CDC Opioid Guidelines
Politicians and some government officials tell us that the new CDC opioid guidelines will reduce deaths due to overdoses. But, based on the evidence we’ve seen so far, that is unlikely.
The latest CDC report shows a continual increase in opioid-related overdose deaths despite about a 25% decrease in the number of opioids prescribed. This data demonstrates that an absolute reduction in opioid prescribing hasn’t resulted in the intended outcome–so far, at least. It may be counter-intuitive, but I think you’ll understand why in a moment.
Overdoses: A More Complex Problem
The problem is more complex than the lawmakers, CDC, and regulators would have us believe. Simply reducing the amount of opioids prescribed will not necessarily affect overdose death rates as you might expect. In fact, it might do just the opposite.
What happens is that, when we reduce the amount of opioids that are prescribed, we force many of those with opioid addictions to switch to illegal opioids such as heroin and synthetic fentanyl, which are far more dangerous than prescription opioids.
If the amount of opioid prescribing were reduced dramatically, it would likely reduce the number of deaths from prescription opioids. But there would almost certainly be a significant increase in abuse of other drugs. That could result in more overdoses than we’re seeing now. We’ve already seen more deaths due to the increased use of heroin, but heroin is only one of many illegal drugs that can be abused.
Reducing the supply side of the addiction problem does not address the demand for opioids, nor does it help address the needs of people with the disease of addiction.
Of course, additional “collateral harm” can occur with people in pain who benefit from opioids, and it is unacceptable to any person with compassion. Denying prescriptions to people who have been benefiting from opioids is a misguided attempt to save the lives of people with opioid addictions at the expense of people with pain.
People with pain will suffer, and that suffering won’t save the lives of people with addictions who turn to illegal substances. Additionally, in all likelihood, we will see an increase in suicides from people who just cannot live with their level of pain.
Chronic Pain Contributes to Deaths by Suicide
There are about 104 suicides per day (compared to 44 opioid-related overdoses per day). In my opinion, intractable pain is a contributing factor in many of these suicides. I suspect that, as we see more and more people denied opioids for their pain, we will see an increase in the number of suicides. I base this on my experience of seeing many patients commit suicide in my practice despite having access to all of the available treatments.
Severe pain is not always compatible with choosing to live.
Reducing deaths related to over-prescribing opioids would be a good thing and must be a priority. But, if we want to reduce the amount of opioids prescribed for people in pain, then we must provide them another, safer way to handle their pain.
Trading opioid-related deaths for either deaths related to illegal drugs, or to suicides because of pain, is not an acceptable solution. We need something better to offer people in pain, and we need it soon.
Purchase my book The Painful Truth: What Chronic Pain Is Really Like and Why It Matters to Each of Us (available on Amazon) or read a free excerpt here.
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Copyright 2016, Lynn Webster, MD
I wish I could send you my heart, now that’s full of pain. After this Easter my life turned off a cliff and nose dived. My best friend in the world, who suffered with chronic pain, checked out because he was tired of living with pain, doctors, judgement, and was just tired of it all. So many people are disgusted with the CDC’s guidelines, as am I, as they cast a a far to wide of a net, and caught a lot of innocent victims in it. I contacted Dr. Tom Frieden, CDC director, in the aftermath of my friends suicide. His reply lead me to believe he is a well meaning person who doesn’t REALY understand what is happening. Persons in power to often see the world in black & white. They forget theirs a grey area where most of us live. REALLITY. I am a chronic pain patient caught up in sweeping guidelines. I am also a father who lost a 21 year old daughter to the OxyContin express that roared through Florida. I know this issue personally. The V.A. I go to has adopted these guidelines as law, ripping 12 year compliant patients off meds. So I do understand. I truly believe after the high profile deaths of Michael Jackson and others many doctors got very nervous. Well meaning physicians were now being prosecuted and stripped of their livelihood. It is a complex issue. There is way to many dogs in the CDCs fight. Well meaning intentions have gone awry. If it means living with pain and misery I will be as compliant off meds as I am on them. I to am growing tired of the bullshit. Do it this way, no, I mean this way, oh wait, we changed our mind, do it this way. This is the kind of foolishness that pushed my pal to the point he felt backed in a comer, put a gun to his chest, and pulled the trigger. I knew this man 35 years, a relationship older than some psychologist that have counseled me about the matter. Everyone has a breaking point. Every time I hear of anyone taking their life due to untreated pain I flinch. This pain responds to no drug. Time is my enemy and my best friend. I find more solace writing to people like you on the internet more satisfying than listening to a psychologist who is not yet seen their 40 th birthday try to tell me how I have to move on, get over it ! I’m getting, as fast as I can get. The only friend I had to talk with about emotional issues and pain has been stripped from my life. I’m sorry if I seem judge mental, but when you put in that much time with someone, they get you, you get them. Unconditionally, for better, or, for worse. So now at 58 y/o here we go again. I know change is part of the deal, but, when they put you on meds for 12 years your brain chemistry changes. They are taking away meds. and not addressing that issue. I’ve done the research, it matters. This crackdown is very impersonal. Especially in the V.A. system. Don’t get me wrong, I have met some fine physicians in the V.A. healthcare net. Very caring, very efficient. I was given a heads up, just before the CDC guidelines were about to hit. That still didn’t stop me from being caught off guard.
The way my medical conditions were being treated for the past 12 years was about to change in roughly 3 years. I’m no doctor, no pharmacist, no rocket scientist, but even I know, you can’t do that to a human being without reprisal. So here I am picking up the pieces. I hope and pray, others make it through the changes o.k, I hope I make it o.k.
The Dr’s are afraid of losing Lic., and instead of saying so they accuse you of being a ‘drug addict’ and tell pain patients to go to rehab, which is abusive and leads to many suicides. It happened to my 87 yr old mother. Now she wants to go to a state that allows physician assisted suicide, because of her under treated pain, at Hospice. My father died in excruciating agony this past spring, now my mother. It is a huge disgusting disappointment, absolutely deplorable. I see why Trump got elected, legalizing drugs is the only thing that will stop this tragedy.https://www.painnewsnetwork.org/stories/2016/3/26/pain-patients-fed-up-with-hospital-treatment
it is a planned genocide of people disabled and in pain, and on disability. I guess they couldnt care less about working parents who cannot work w/o the pain meds. such a disgraceful obamanation.
No I believe it will get worse. From being a Addict for over 30 year’s. I couldn’t live without it and went to extremes to get it. People need to want to quit and have a Stable environment to recover in.
I’m very frustrated with the whole thing. I’ve used Hydrocodone for 7 years. I’ve had no problem taking them as prescribed, following all doctors orders, etc. Before trying the opioid route, I was prescribed Lyrica and other neuropathic pain meds. All of them gave me extreme vertigo. The opioid worked. (I have a combination of issues that cause chronic pain).
The other problem is that I have no insurance. I’m retired, but am not yet eligible for Medicare, nor have any options for “Obamacare” made any difference. Plus, I now have to see my doctor every month to get my refills and today he told me I will now have to go to “Pain Management” at least once or twice a year. This will drive my office visits to a doctor up by nearly $500 a month.
If I knew where and how to order these meds from Pharmacies overseas I would do it. It would all still be cheaper.
The federal government needs to stay out of the business of medicine. It has made my situation nearly impossible and I have no idea what I’m going to do. The FDA/CDC and DEA rules need to be reversed. Thank you for speaking out.
The system is broken,and exhausting.
move to a different country, that is what I am doing, otherwise it is suicide
or get it illegally, which a friend of mine did and got caught, he killed himself when the crazy laws were going to put him in jail. A graduate of Cornell and a productive citizen, such a waste.
I write as a 20-year patient advocate for people who live with the worst pain known to medical practice: trigeminal neuralgia and neuropathic pain, both affecting the face. I have seen people literally struck down to lie in a foetal heap on the floor, holding their faces and trying to avoid crying for the fear that the pain might get even worse. I talk with such people in social media almost every day.
I believe we are seeing the unfolding of a major public health debacle, and potentially a massive reaction by pain patients to the abuse being piled on their heads by the CDC and DEA. One such reaction is well stated by Jamie Reed in “Stop Attacking Chronic Pain Patients”, in the Pain News Network. http://www.painnewsnetwork.org/…/stop-attacking-chronic-pain-patients/. I offered the following commentary to that article. Hopefully Dr. Webster will consider it appropriate to re-post
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I have recently been talking with a few people about founding or finding a Non Profit Organization and raising a ten million dollar legal fund war chest, to sue the Centers for Disease Control and the DEA. One might call such a campaign “The National Pain Patients Defense Fund”. Grounds for suit may focus upon medical negligence and material harms to patients, in the publication of unbalanced and overly restrictive “voluntary guidelines” on prescription of opioids in chronic pain conditions.
In reality, the new CDC guidelines are neither voluntary nor guidelines. They are becoming a de facto restrictive practice standard which is driving pain management specialists out of practice and many pain patients into unremitting agony. Even the “Observations Presented to the National Center for Injury Prevention and Control’s Board of Scientific Counselors” (January 2016) reveal a considerable lack of unanimity among medical professionals charged with addressing a balance between the needs of chronic pain patients and a perceived need to reduce the number of prescription-opioid-related deaths by overdose. Some participants voiced concern that the guidelines were overly restrictive. Others voiced significant doubts concerning the research which is said to justify these restrictions.
One of the GLARING notes buried deep in this text is that the consultants’ group was unaware of any published studies that establish the effectiveness of opioids in long term management of chronic pain. Literally, the scientific community doesn’t know because it hasn’t studied, the balance of concerns between risk of addiction and benefits of long term pain relief.
Likewise, the qualifications of the consultants working group are also suspect. I do not believe that the working group included even ONE board certified specialist in pain management. And although the spouse of one patient who overdosed was among the group, there was no representation by chronic pain patients.
Before anyone can be effective in advocating for the withdrawal and revision of the CDC guidelines, we must first understand what is in them and who wrote them. To aid in that objective, I urge that those of us who can devote the attention should visit http://www.cdc.gov/injury/bsc/meetings.html, and review the several applicable documents there.
I am not myself a chronic pain patient. I have analyzed published medical research, advocated for and provided support to thousands of chronic neuropathic face pain patients for the past twenty years.
Sincerely,
Richard A. Lawhern, Ph.D. (Systems Engineering, UCLA 1977)
I’m in. How can we follow you so we know if/when the class action happens?
After two auto accidents and cancer, 7 years of countless meds, injections, physical therapy, injections, and everything else my pain specialist has thrown at me (don’t get me wrong, I love my Doc), I’m terrified the CDC guidelines will strip me of the one med that works to keep me functional.
Sincerely,
DJR
what a great blog Dr. Lynn Webster! Thank you for leading me here through twitter. We need more doctors like you.
Richard, You may be on to something. Where do I sign up?
I did read most of the CDC’s so called research. I could have done a better job.
Living with chronic pain isn’t easy. I’ve been doing it since 1988. Looks like we all had better start looking into Cannabis.
I am very interested in bringing a law suit against the CDC. I am a R.N. and have suffered chronic nerve pain down my right leg. I have been on opioids and lyrics for a year. I went through injections, oral steroids, etc… and nothing worked. It took a while to find the cause of the pain, which was bone on bone in my L4/5-S1 back. Physicians should not be afraid to treat their patients for pain. I do feel that If patients can”t be treated for their chronic severe pain issues, there will be increases in suicides,and heart attacks.
Medical system is btoken.
My pain management dr is reducing the dosage of every pain medication that I have been on. I can’t take the pain that I am experiencing now. My life wasn’t too good before but now I’m in the bed 95% of my days. I can’t function because of the pain! I am not addictive to the meds. I’ve never asked for more than I’ve been given nor have I dr hopped or hit the streets trying to get drugs. What am I supposed to do?
Lenita I urge you to write your two Senators and Representative and explain what is happening to you. You can find your Congressman addresses on my other website LRWebsterMD.com You should also send a letter to the head of the CDC Dr. Tom Frieden and explain what is a happening. It is in the hands of politicians so the only way to change what is happening to you and others like you is to control the political narrative. Speak up.
I am an opioid advocate for non-cancer chronic pain patients.
Please read the link about my letters to the CDC and especially the
response from Dr. Houry at the CDC who oversaw the development of the
Guidelines for opioid prescribing.
I believe hundreds of thousands of chronic pain patients are being thrown
under the bus because of the CDC’s guidelines. Yes, we should do all we
can to save the tens of thousands overdosing BUT not at the expense
of all the suffering the non-cancer chronic pain patients are now enduring,
I being one of them.
Please feel free to use anything in the article and please contact me if
I can be of any help.
We are suffering needlessly. Please help us.
Sincerely,
RIchard L. Martin, BSPharm, retired due to pain.
http://www.painnewsnetwork.org/stories/2016/7/19/cdc-opioid-guidelines-not-rule-regulation-or-law
Yes. I agree with all the comments above! I’m 65 yr, worked for 30 yrs in the government while prescribed oxycodone for degenerated discs in upper and lower back. At the time, Kaiser, Portland OR, prescribed the meds for me so I would have some type of quality of life and be able to work and support my daughter w/Lupus. I have moved to a very small town now, been kicked onto Medicare and had to go on the only medical group in this area, Samaritan, and the first thing they did was cut off my pain meds because of cannabis in my UA (cannabis is legal in Oregon). My new dr here who doesn’t know me at all, immediately sent me to a “pain clinic” (what a joke) because she “didn’t know what to do with me” and they immediately cut me off, gave me Lyrica and the idiot actually said there was nothing they could do right now and to go home and smoke marijuana!!!! I had to come off the oxycodone w/o anything to help me….no meds…no support groups…NOTHING!!! If I hadn’t had paxil, sleeping pills and flexeril from my previous Kaiser dr., I really don’t know what I would have done!!!! Plus I had cannabis to relax me at night. The craving for someone having pain meds taken away after being on them since 1980 is unbearable and I guess I would have had to go down to University of Oregon or Oregon State Univ and look for a heroin dealer to help me!!!!! Now I’m trying to get my paxil and zocor refilled and they are refusing to do it until I see them eventho it is on the computer records they have from my Kaiser Dr that I need this! They won’t prescribe me any regular meds until I see them and I can’t see a new Dr until Nov 14 which is over a month away. I’m also out of Lyrica which I think has really helped me and he won’t give me more unless I come in to see him and he is over a 2 hr trip! I have never seen such upset and unorganization! Kaiser Drs and organization were kind, understanding and helpful. These people in Samaritan are evil, really don’t care, unhelpful and really suck! I have complained to the Samaritan office but I may as well blow it out my ass!!! Nothing good from them and no help. When the pain clinic cut me off my pain meds, they set me up for a back xray at the hospital and when I immediately went there, I talked to the staff and a lady called the pain clinic and the nurse mgr there told them to tell me to go to the ER. So I went to the ER to get help getting off the oxycodone and was told they will not give narcotics to anyone nor would they help me with something to get off so I left. When I read his report afterwards his only comments were “patient was trying to get opiates”!!!!!!!! I went in to get help to get off and they offered nothing also!!!!! No meds and no support groups!!!!!! WTF??!!???!!!! These people don’t know which end is up!!!!! I get NO help!!! I feel like I want to kill myself but thank God I know better!!!! I worry for all the others that are cut off and have nothing in their med cabinet at home to help them going out for heroin or anything to stop the craving. What the hell is goin on? The feds obviously never thought this out! Big drug companies should have made something to curb the withdrawals before this crap took effect! NO ONE THOUGHT THIS OUT and there must be millions going thru what I have been through….. This is shameful. It is a big shame on the entire medical community and the DEA. I feel so bad for all of you experiencing pain and are being put through pain clinics, classes on How To Live With Chronic Pain and the whole bullshitting mess!!!!! I went through all those classes in the 80’s learning how to walk, bend, sleep, not to carry a heavy purse, not to wear high heels, stretches, blah, blah, blah. This stuff does not take away the pain of degenerative discs! Now I’m on Lyrica (this is what I was given to replace the oxycodone) and it helps somewhat but not totally. Somedays I live the whole day on an ice pad…oh, that’s real fun and a great quality of life! Some days nothing helps. I’m scared to vacuum or mop the floor because I don’t want to live a week so painful I cannot move! They have really taken away any quality of life I did have…..