The war on opioids inadvertently became a war on severely ill patients. The “war” had to be declared. There were reactions from all fronts to the realization that deaths rose from 21,088 in 2010 to 47,600 deaths in 2017.
According to a recent article in The People’s Pharmacy, the CDC had been monitoring the increase in opioid abuse. The agency issued guidelines effective March 18, 2016, that limited the number of narcotic prescriptions that could be issued.
Much of the blame for the increased number of deaths was aimed at fentanyl, oxycodone, and hydrocodone. Fentanyl is well known to be mostly counterfeit and manufactured abroad.
Blame was also directed at doctors by indicating that overprescribing pain medication led to misuse of opioids resulting in death. The CDC and the DEA as well as insurers urged extreme caution in prescribing opioids. Patients were urged to question their doctors about their need for opioids.
The doctors were somewhat intimidated by the government’s restrictions. Patients complained that they were treated as if they were drug abusers.
The CDC’s Message Was Effective
Doctors became much more cautious when prescribing drugs.
The CDC stressed that opioids should only be used in cases of acute pain resulting from a serious accident or a surgical procedure. However, there were few available substitutes for chronic pain.
The CDC guidelines were developed out of dire necessity. However, the “war on drugs” became a hardship for many patients with chronic pain. These patients were denied access to drugs that relieved pain that was caused by their very serious illnesses.
The People’s Pharmacy received over 700 letters from desperate patients who felt they were unable to live with such debilitating pain.
For example, a woman wrote that she had a degenerative bone disease, arthritis, peripheral neuropathy, and spinal stenosis. She has had over twenty surgeries and her last back surgery brought a higher degree of pain. She had previously managed with fentanyl patches and oxycodone. At her last checkup, her medication was stopped abruptly and no alternative was offered.
An 89-year-old man described his back pain as “chronic.” He explained that he has tried various treatments, but only hydrocodone gives him a few hours of relief. He is now only allowed one or two tablets each day and finds little relief at such a low dose. He believes that people in the same situation may resort to purchasing narcotics illegally. The result would be a resurgence of opioid abuse.
One man wrote that his father, a cancer patient, attempted suicide recently because his pain medicine had been cut off. He said that he understands that not all cancer patients would make such a drastic decision, but he hopes that the governing agencies would give these patients the compassion they deserve.
The CDC listened and realized that a new approach would help patients who may have had problematic surgery or serious injury or even pain that is difficult to treat. There was a new appreciation for allowing doctors to determine the best and least disruptive combination to alleviate chronic pain.
In 2018 the FDA held hearings. At their July 9th meeting, the board listened to the concerns of patients who were denied the pain medication they had relied upon. The patients spoke of being cut off from their medications even though they had adhered to the doctor’s instructions.
The CDC’s New Guidelines May be More Compassionate
The CDC is now aware that its stringent guidelines for prescribing opioids caused extreme hardships and unintended consequences for many patients.
Its new approach, issued with caution, encourages health care providers to work with pain management on an individual basis. The guidelines allow prescribers to determine the appropriate dosage they believe to be in the best interest of their patients. Doctors will now have the opportunity to help their patients find the optimum combination to minimize their stress.
A Word of Caution
The CDC still reminds doctors that opioids must not be the first line offered to patients for chronic pain. It urges doctors to begin therapy with non-drugs and/or physical therapy, heat therapy, acupuncture, or supervised exercise. Substitutes for opioids would be ibuprofen, gabapentin, or acetaminophen.
The CDC adds that doctors who must prescribe opioids for patients with chronic pain should begin by drug testing and then continue the testing as needed. By using drug testing, the clinician could continually check for prescribed medications and other illicit drugs.
Conclusion
Opioids are powerful analgesics that were used for almost 5,000 years to relieve pain. Opioids have been used as surgical analgesia for centuries.
The ideal scenario would have drug companies develop safer and more effective alternatives. Until then, the government and the medical community must recognize that opioids may be the only solution for some patients with chronic pain.
