3 Reasons the New CDC Guidelines May Contribute to the Cost of Addiction
In the September 13 issue of Vice, Maia Szalavitz challenges the myth that the U.S. can solve the opioid crisis by reducing the supply. According to her biography published in Wikipedia, “[Szalavitz] has been awarded the American Psychological Association’s Division 50 Award for Contributions to the Addictions, the Media Award from the American College of Neuropsychopharmacology and the Drug Policy Alliance‘s 2005 Edward M. Brecher Award for Achievement.”
Szalavitz is an informed and highly accomplished neuroscience journalist who applies common sense to the opioid epidemic. She says, “If America really wants to reduce the death toll from its opioid crisis, we need to focus on reducing demand, not supply.”
Also in the Vice article, Dr. Stephen Martin, associate professor at the University of Massachusetts Medical School says, “What has happened to pain patients and their doctors since the new CDC guidelines dropped has been ‘chilling.’ ” I’d agree with him. The situation since then certainly has been chilling. In fact, it has become downright frigid, and the people who are suffering the most are the people who can least afford to: those with chronic pain.
Dogmatic Use of the CDC Guidelines
As many people feared, the CDC guidelines are being used dogmatically. Although the CDC intended the guidelines to only be used as guidelines, physicians are using them as mandates without regard for the individual needs of people in pain. As an example, West Virginia University Health System — including all seven of its system hospitals and their clinics — has adopted the CDC guidelines. How they will implement them remains to be seen.
Guidelines Are NOT Reducing Deaths
Ironically, while the CDC guidelines are being widely adopted, they’re not helping to reduce the number of opioid-related overdose deaths. Since 2012, there has been a decline in the number of overdose deaths from prescription medications. Yet the deaths from opioids has increased. Almost the entire increase has been due to heroin and illegal synthetic opioids like fentanyl, according to the CDC.
Denying opioids to people who have a physical dependence, whether they use the medication for pain or addiction, forces those who need painkillers to look elsewhere for the drugs. People will go to the street to obtain opioids to avoid withdrawal for opioids, feed an addiction, medicate a mental health disorder, or seek relief of their pain. They will do whatever it takes to get opioids, with or without the support of their doctors.
That is why, if we reduce the supply of legal opioids without working to decrease the demand for them, we will see more overdose deaths. That’s where our focus needs to be.
Focus is on Reducing Opioid Supply Only
Instead, there is almost exclusive focus on reducing opioid supply with little-to-no acknowledgment there is a demand, legitimate or not. This problem can be attributed to a knowledge deficit combined with an earnest desire for a quick fix.
However, there is no quick and easy solution to the opioid crisis. The problem is complex, and resolving it will require a set of targeted interventions.
Addiction Solutions
Unnecessary prescribing must be curbed, but reducing the amount of opioid prescriptions and doses based upon capricious and arbitrary limits suggested by the CDC seems to be contributing to the rise of overdose deaths.
This number can be reduced if we stop forcing people to the streets, and address the demand for treatment. The additional funding Congress has authorized to treat opioid addiction should be tied to mandating treatment upon request. No person should be denied access to treatment by anyone who receives federal funding. We also must not deny people in pain access to opioid treatment without providing them an equally effective alternative. There are real solutions if there is the will to find them.
Let compassion lead us forward while science lights the way.
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
If only they had any idea what they’re doing to good people in America. 116 million chronic pain patients across America, and despite the CDC’s recommendation that people be titrated off opioids, many physicians are taking the dangerous stance that they will suddenly, and without medical observation, discontinue pain meds which have worked successfully for people for decades. These are people who rely on opioids for quality of life because there is no other treatment known to man that will enable them to have enough pain relief to go about their daily activities in whatever capacity they can. I am an advocate for chronic pain patients, so I hear their stories every day. People with brilliant minds and talents have gone from functioning to bedbound. Many believe their lives will never change. This all, of course, leads to the cycle of anxiety and depression which worsens with every passing day. It’s not as though our lawmakers and policy makers don’t know this. They DO know it. They CHOOSE to ignore it. How else can they show “progress” towards their stated goals? They haven’t made a dent on the heroin overdoses, yet they choose to let innocent victims suffer alone and live a life of struggle, just to get through the day. They can no longer attend family and social functions due to pain. With pain medicine, they were at least able to get enough relief to attend such functions and pretend that they’re better than they really are. The government has now taken that away from them. The government needs to get some balance in their system where they can put policies into effect where some Americans aren’t hurt, losing all quality of life, while still helping those who abuse legal and illicit opioids for recreational purposes. There are two different segments of society. Those who take opioids for legitimate purposes, who do not abuse and who follow doctor’s orders to a tee – and the group who lie and abuse … those who will steal from parents, aunts, uncles, everyone who might have anything in the medicine cabinet to “get high” on. These same people will take their family’s milk and bread money to buy $10 worth of heroin to get high, even for just a little while.
From the very beginning of this attack on chronic pain patients’ medications as a method of reducing the numbers of those dying from opioid related overdoses, I have maintained the stance that my medications, locked in my house, have never and will never cause one misuse of an opioid medication.
I feel the same is true for nearly all chronic pain patients who rely on opioids for some semblance of quality of life. Taking medications from those who are following all the rules, as is being done now and has been done starting in 2012 when “Pill Mill Bills” were first enacted in Florida and Kentucky, has absolutely no hope of stopping those who are victims of the disease of addiction. Trying to affect one group of people who are using opioids inappropriately by depriving a completely different group of people in need of medication to treat chronic intractable pain, is a fool’s errand. It’s been proven by the numbers that it does not work.
Instead of taking the data and coming up with a new plan, the method chosen by the CDC, DEA, and anti-opioid zealots is more of the same. Even more restrictive guidelines, laws, and regulations coming from all directions. Along with the constant barrage of attacks from the media against chronic pain patients, it’s become incredibly scary to be a pain patient when you’re in constant fear of having your medications reduced or completely stopped.
Here’s to hoping sanity steps in at some point and ends this craziness before we lose even more people to the war on chronic pain patients as those in near constant pain seek some refuge from the government-mandated torture so many are suffering needlessly from in a misguided attempt to save the lives of another, unrelated group of people, who, by the way, are not seeing any improvement in their lot in life either.
The CDC and organizations like The University of West Virginia and the Oregon Opioid Prescribing Guidelines Taskforce which have adopted or plan to adopt the CDC Guidelines appear to be oblivious to the suffering that is being inflicted on chronic pain patients already. Groups like these seem to think that the only pain and suffering that they genuinely need to concern themselves with is that of addicts, their families, and families who have lost loved ones to overdose. This is real suffering indeed, but measures to help those with Opioid Use Disorder should not harm chronic pain patients who take medication as directed and derive functional benefit from it. Jayne Ballantyne and her colleagues support measures that teach patients to live with and accept pain. It’s true that not all pain can be eliminated and most patients recognize this. What bothers me most is the fact that she and her supporters act as though pain is benign and not harmful. Uncontrolled long term pain contributes to immobility and produces endocrine changes that adversely affect the heart, brain, and almost every other system of the body. Beyond the physiologic consequences of uncontrolled pain, they also fail to consider all the years of life that became chores rather than a joy because pain interfered. I don’t wish chronic pain on anyone, but I do wish that some of these policymakers who essentially hold MY FUTURE in their hands could spend a day in my body so they could understand how much these medications can help the right patients. I’m 35 and there’s so much left that I want to do.
I’ve seen a lot of things in my life and the obvious tactic of addiction against pain patients is horrible. I say that both the writer and Lana Kirby do make some very good points. Treating addiction without also treating the underlying cause is futile. What I mean is, if a person with an addiction cannot get pain management, even if it is an opiate, they will more than likely fail. Can you treat an addiction but not say Bi-Polar? It would be folly! Humans and the combinations of problems we can have will never be medically treated correctly by cookie cutter thinking. I can tell everyone through my lifes experiences that addiction is not a once you have it, you will always be one! I know to much to fall for that lie! Another point, I’ve known mothers that sold their food money for drugs so they have the numbness to go do tricks to feed their kids. To many preconceptions about all addicts are the same flying around. My point is, when physical pain goes on long enough, it will break you just like someone being tortured. I know, it’s broken me twice! That being the case, why would the medical community see it as safer psychologically and physically to live in pain! Does the healthcare community see that when it flip flops, people don’t trust or have a belief that the answer to their health issues are better served by going to the dealer! Lets think about that and what is happening! As far back as 2013 and maybe before, they were seeing a more pure heroin hitting the streets in USA! Did that stop the Gov. from issuing it’s Do or else guidelines, no! They admittedly knew about the heroin and yet off they went with ideologically based guidelines anyway. It’s like they are trying to make things worse and they have willing accomplices in the medical community to do it!