Turn the Tide Campaign Brings Unintended Consequences 

It began just about a year ago, when the CDC Guideline for Prescribing Opioids for Chronic Pain provided “recommendations for primary care clinicians who were prescribing opioids for chronic pain outside of active cancer treatment, palliative care, and end-of-life care.” The emphasis is mine. The goal, as the CDC’s web site stated, was to improve “… the way opioids are prescribed through clinical practice guidelines” and to “ensure patients have access to safer, more effective chronic pain treatment while reducing the number of people who misuse, abuse, or overdose from these drugs.”

On August 24, 2016, soon after the CDC had shared its guideline, then-U.S. Surgeon General Vivek H. Murthy sent a personal letter to more than 2.3 million health care practitioners and public health leaders asking them to “turn the tide” of opioid addiction, and he touted the CDC guideline as a “good place to start.” In other words, his letter suggested that cutting back on the number of opioid prescriptions was a priority for ending the opioid epidemic.

Chronic Pain Patients Speak Out

Dr. Murthy’s Turn the Tide campaign was his attempt to improve the opioid crisis and lower the number of overdose deaths. However, the government’s push to adopt the CDC guideline and the Turn the Tide campaign has had the unintended consequence of making it harder for some chronic pain patients to get the treatment they need.

Following these interventions, I received an immediate increase of emails from people in pain from everywhere in the country who were desperate for help after their pain management physicians found themselves unable to provide their patients with the care they had relied on. Here are excerpts:

• I am a chronic pain patient. I have been on opioid pain medication for over 5 years now. I recently had my pain management doctor (I saw her for close to 3-4 years) abruptly drop all her pain patients. I and many other patients were left scrambling to find another pain management doctor. They are nowhere to be found now. Right now, I am looking to find another doctor but I have to tell you they are fleeing from pain management. If I am stuck in a situation where I cannot find relief and have had my pain medication completely taken away from me, then I too have considered suicide as a possible option, because I don’t want to live with this horrible pain knowing that I won’t be able to function and have a life.

• I can’t understand why the FDA is hurting doctors who genuinely care and patients who try to work and survive through unbearable pain. Do they want people to turn to dealers to keep from suicide? I get there’s abuse of all meds, but why punish everyone? Educate people to lock up meds and protect them from teens, children, etc. It’s awful. It will increase crime and turn things upside down.

• I lay in bed crying with a heat lamp on me researching painless ways to commit suicide. Those idiots pushed me over the edge. My mental health has rapidly declined as all I see before me is a sea of untreated pain. I was treated as if I was “seeking drugs!” I have NEVER abused a painkiller! What gives the people at the DEA the right to deny me relief and push me into ending my life?

Medical Professionals Face Increased Scrutiny

According to the Post-Gazette, state medical boards issue and regulate medical licenses. However, “doctors must register for a [Drug Enforcement Administration] DEA license to prescribe controlled substances.” The Post-Gazette reports that, “Thousands of medical professionals have quietly signed away their rights to prescribe narcotics — and, in many cases, their careers — in recent years in a little-discussed part of the federal crackdown on prescribing that has some doctors’ advocates crying foul.”

The federal crackdown didn’t begin with the CDC Guideline for Prescribing Opioids for Chronic Pain. In fact, the Post-Gazette says, “From 2011 to 2015, the Drug Enforcement Administration accepted the surrender of 3,679 prescribing licenses nationwide, and revoked another 99.”

The Post-Gazette explains how the process works. “When federal agents rush into the office of a physician accused of prescribing too many pain pills, they often offer up a one-page form through which the doctor can surrender his right to prescribe many drugs.” That means the physician is no longer able to provide the opioids their pain patients may rely on.

People in Pain Lack Compassionate Care

Overprescribing has been a major problem, particularly in acute pain care where large amounts of an opioid are prescribed when only a few days of treatment with opioids is necessary. Other physicians have been caught up in egregious illegal activity, usually for profit. The former group should be educated to prescribe more appropriately. The latter group should not be allowed to prescribe.

Increased prosecution, excessive opioid prescribing, and government’s interventions to curb prescribing have created the perfect storm that is leaving millions of people in pain without compassionate care.

Many doctors are feeling forced to choose between trying to help patients with complex medical problems and possibly losing their license, or having to refuse to treat them all together. There is something seriously wrong when these are the only two options physicians feel are available to them.