The opioid crisis in the United States remains at the forefront as the National Institute on Drug Abuse says more than 115 people die of opioid overdose daily.
Doctors misuse the guidelines for opioid pain medications in 2016, federal officials said Wednesday, providing a clear answer to the growing complaints of chronic pain patients who claim to be overreacting to the opioid crisis.
The Centers for Disease Control and Prevention, in a new guide to prescribing opioids, said that many doctors were guilty of a misapplication of the 2016 guidelines that restricted the use of opioids. The new guidelines published in the New England Journal of Medicine were the federal's recent findings that many physicians' reactions to the opioid crisis went too far.
Former Commissioner for Food and Drug Administration Scott Gottlieb, a physician, commented last July on the impact of the response to the opioid crisis on pain patients as he called for more options to be developed.
Until then, people who are in the midst of cancer treatment, "acute sickle cell crisis," or pain following surgery, should not be affected by the previous referrals, CDC said. These patients did not fall within the scope of the guidelines for primary care physicians treating patients with chronic pain, CDC said.
Doctors abuse the opioid painkiller guidelines in 2016, federal officials say. (Photo: Thinkstock)
Doctors who set hard limits or cut off opioids also misapplied government regulations, CDC said.
Physicians should prescribe the lowest effective dose and avoid increasing it to 90 "morphine-milligram equivalents" a day or "justify" any decision to increase the dose to that level.
If physicians are already prescribing opioids in higher doses – at or above the limit of 90 MME – they should continue as needed, CDC said.
severe withdrawal symptoms such as "pain and psychological distress".
Guidelines that impose strict limits are at variance with the emphasis on guidelines for individualized assessment of the benefits and risks of opioids, taking into account the specific circumstances and individual needs of each individual patient, CDC said.
Along with Doctors who Reduce or Decline Their Dosage If you continue to prescribe opioids, many pain patients complain that they have completely lost their doctor to conviction and could not find new ones willing to treat this pain.
Lauri Nickel, 62, of Tempe, Arizona, said that too many of her pain patients were excluded by doctors due to the closure of practices or discipline.
Lauren Deluca, a disabled chronic pain patient, leads the Chronic Disease Group and Advocacy Group from her home in Wooster, Massachusetts. She announced the new guidelines she has been calling for over two years, but fears that she will not help people like her without palliative care.
She has pancreatitis and a condition that affects her arteries, forcing her to use a nasogastric tube about 90% of the time. She will never get better and will always need painkillers to "treat the symptoms".
Nevertheless, she welcomes CDC's efforts to allow high doses of opioids and to warn patients to reduce their medications against their will.
"It's a fair and balanced step to correcting what's happening, but now it needs to be widely publicized about the changes," Deluca said.
CDC said it intends to promote the guidelines with easy-to-understand language and teaching materials.
The revised guidelines can not help pain specialists who have the discipline to prescribe pain medications, says former family doctor Linda Cheek of Roanoke, Virginia. She was convicted of improper prescriptions and was imprisoned for more than two years after her conviction and imprisoned for four months
"The elephant in the room is the fact that doctors are being prosecuted for their work," Cheek said.
She now runs a website called Doctors of Courage, which includes articles on "Injustice to Doctors and Patients with Chronic Pain".
More than 50 million chronic pain patients in the US need more alternatives to opioids, said Christine Lemke, co-founder of virtual health research firm Evidation. Lemke, who suffers from an autoimmune arthritis disease that affects her entire body, said she is currently on her diet with pain and exercise. She has stopped using opioid painkillers years ago.
Her company is examining 10,000 patients with chronic pain to try to quantify the pain, which will help other companies to develop treatments. She notes that only five new painkillers have been approved in the last decade.
"I've never met anyone who wanted to be opiate," Lemke said. "There is a lack of innovation in pain, but there are no measures to properly quantify the pain."
Insurers also develop guidelines and withhold inappropriate prescriptions of opioids such as OxyContin and Percocet.
America's Health Insurance Plans, the lobby group for commercial health insurance, unveiled a new strategy that should help doctors and patients in the treatment of chronic illnesses back pain without opioids. Among the group's goals: to reach consensus on how to measure effective pain management with non-opioid therapies, and to better coordinate treatment between pain specialists and family physicians.
AHIP also says it will work to expand access to drug-based treatment treatments that help wean people from highly addictive pain medications.
Along with warning physicians about excessive caution, CDC underlined the need for multiple safety precautions. It has been recommended to physicians:
• Whenever possible, do not prescribe opioid pain medications and benzodiazepines like Xanax.
• Increase the use of non-opioid treatments – with empathy
• Work with patients who agree to reduce the level of individualization and minimize withdrawal.
• Monitor patients with high-dose opioids to prevent overdose.
Nickel struggles with back pain and multiple chronic health conditions, taking opioids as prescribed. She said that her pain level has increased, but she refuses to ask for more or stronger pain pills. For example, Tylenol was prescribed for pain relief when recovering from extensive oral surgery involving two root canals, fillings, and several crowns.
"I do not ask what I need because I do not want to draw attention to myself or my doctor," Nickel said. "They are conditioned to be treated almost like a second-class citizen."
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