Accurate Education -Politics of Pain- Consequences

The Politics of Pain

Consequences of Regulatory Reaction

 

As described in Politics of Pain,” our society is now in the midst of an “Opioid McCarthyism” in which the medical and regulatory communities have reacted to the problem of opioid abuse by engaging new “guidelines” and regulations intended to reduce opioid-related deaths but which have, in fact, created unintended, though not unpredicted, consequences.

 

In it’s struggle to reduce opioid-related deaths, the pain community has become polarized regarding the use and benefits of opioids with some arguing that there is no role for long-term opioid pain management while others are firm in their belief that opioids are indeed not only effective in long-term pain managment but, in fact, represent the essential backbone of effective pain control that allows millions of pain sufferers the possibility of maintaining a productive quality of life. The political pendulum of response to problems with apparent opposing solutions keeps on swinging….

See below.

 

To identify and contact your state senators and congressmen:

www.legis.la.gov/legis/FindMyLegislators

 

pendulum

 “Just Say Know”

 – Ram Dass

Unintentional Consequences of Regulatory Reaction 

As a result of the alarming growing numbers of unintentional opioid-related deaths over the last few years in this country, regulatory agencies are responding in a number of ways to reduce these numbers. Doctors and others have argued that opioids are greatly overprescribed; in March 2016 the Center for Disease Control (CDC) issued guidelines recommending stricter standards for prescribing opioids. Those standards were meant to be recommendations only —but inevitably they have influenced insurers, state legislators and doctors.

 

Consequences: Deaths – Overdose

Ironically, the restrictions haven’t yet significantly reduced the number of US overdoses and, in fact, there is some concern that they may have increased them, by pushing opiate abuse of prescription medication to heroin. The number of heroin overdoses has significantly increased, in part due to contamination of heroin with fentanyl, an extremely potent opioid that contributes to greater risk of overdose deaths.

 

Consequences: Deaths – Suicide

Many chronic pain patients become so depressed and are in so much pain that they give up and look to suicide as a way out. A recent federal government report indicates that 42,773 Americans committed suicide in 2014, up from 41,149 suicides in 2013 and more than twice the number of deaths that have been linked to overdoses of opioid pain medications.

 

A 2014 study showed a high rate (28%) of suicidal ideation in a chronic non-cancer pain population. To what extent does the role of inadequately controlled pain play in this number of suicide deaths? It isn’t known. A 2006 study reported that patients with major depression are significantly more likely to report chronic pain, as compared with those without major depression (66% vs 43%). More recent studies of depression in specialist pain settings have yielded prevalence estimates ranging from 12.1% to 87%.

 

The federal health agency’s last major report on suicide, released in 2013, noted a sharp increase in suicide among 35- to 64-year-olds. But the rates have risen even more since then — up by 7 percent for the entire population since 2010, the end of the last study period.

 

Review of suicide statistics does not provide any answers to the extent to which chronic pain contributes to suicide. A review of CDC reported suicides in the U.S. in 2015 do not provide any numbers related to chronic pain. The American Foundation for Suicide Prevention lists chronic pain as a health risk for suicide but does not provide any statistics related to chronic pain. Truthfully, due to the social stigma of suicide we do know that suicides are under-reported but we simply have no idea to the extent that chronic pain plays a role in suicides. But we do know that suicides reflect a “part of the larger emerging pattern of evidence of the links between poverty, hopelessness and health,” said Robert D. Putnam, a professor of public policy at Harvard.

 

Consequences: Inadequate Control of Pain

A growing number of reports suggest that the CDC guideline is “responsible for people with chronic pain throughout the country being tapered or withdrawn from opioids or dropped entirely from physicians’ practices, even if the patients have been on stable doses of opioids for years with attendant improved pain and quality of life.” Physicians, fearful of regulatory intervention or of being seen as contributing to the opioid “epidemic,” or just not wanting to be bothered by the increased level of effort required to meet opioid-prescribing documentation guidelines, have simply cut back on their willingness to treat pain patients.

 

Unfortunately, the unintended consequence of these actions has been diminished access to adequate pain management by many pain patients.

 

Hydrocodone

In October 2014, the DEA changed the classification of Vicodin and other hydrocodone products from Schedule III to Schedule II drugs. This means that hydrocodone prescriptions can no longer be called in; patients have to physically go to a pharmacy to get it filled. Prescriptions for hydrocodone also can’t be refilled; patients have to get a new one each month. And pharmacies cannot fill partial hydrocodone prescriptions or transfer hydrocodone prescriptions from one pharmacy to another. This has also resulted in increased pricing and greater costs to patients who are already frequently compromised financially.

 

In a report released by the American Academy of Pain Medicine in September, 2016, An Online Survey of Patients’ Experiences Since the Rescheduling of Hydrocodone: The First 100 Days,” it is reported:

“6,420 chronic pain patients completed the survey. Most (82.5%) had been prescribed hydrocodone for more than 1 year. Only 39% reported no changes in access to hydrocodone, while the majority experienced some barriers. Of those who could no longer get hydrocodone, 18.1% borrowed pain medications, 17.1% turned to marijuana, 13.1% used alcohol, and 2.3% used illicit drugs. Most patients had to visit their healthcare providers more often (64.2%) and 30.3% reported some type of issue interacting with their pharmacy.”

 

“Most felt that the rescheduling was neither a fair nor appropriate solution to the abuse of hydrocodone (88.3%). For those still working, 46.2% reported that they had missed work because of the stricter regulations. 27.2% reported having thoughts of suicide since the rescheduling.”

It is clear that “the unintended consequences for people with chronic pain that have been caused by the rescheduling effort to impede hydrocodone abuse are negatively impacting thousands. These consequences include suffering from being placed on less effective drugs, increased cost, inconvenience, and negative influence on physician-patient and pharmacist-patient relationships.”

Unfortunately, this is just the beginning of a disturbing trend for 100 million people with chronic pain in this country.

 

“The ultimate, effective solution to the opioid problem is education, not legislation and regulation.” 

– eemd

 

More Editorial Comments by EE MD:

  1. Opioid Abuse and Misuse
  2. The Myth of Morphine Equivalency

 

Comments by others:

  1. CDC Opioid Prescribing Guidelines Misguided, Docs Say – Medscape 4-8-16
  2. 12 Recommendations the CDC Should Have Made – 5-5-2016
  3. No, cracking down on painkillers won’t save lives | New York Post 5-17-16
  4. Montana Pain Refugees Leave State for Treatment 4-25-16
  5. Chronic pain patients are suffering because of the US government’s ongoing War on Drugs — 2016
  6. Is Suicide a Consequence of the CDC Opioid Guideline? – 2016
  7. CDC Issues Final Guidelines for Opioid Prescribing -2016
  8. The-medd-myth: the-impact-of-pseudoscience-on-pain-research-and-prescribing-guideline-development-2016
  9. stop-attacking-chronic-pain-patients
  10. Treated like addicts – Vice News 2016
  11. An Epidemic of Undertreated Chronic Pain – 2017
  12. Researchers Warn Against Opioid Backlash – 2017
  13. Survey-opioids-stopped-or-reduced-for-most-patients
  14. Strict limits on opioid prescribing risk the ‘inhumane treatment’ of pain patients – 2017
  15. Pain Management Rx opioid mortality and CDC – 2017
  16. Opioid Crisis Continues to Pressure Physicians, But Patients Bear the Pain – 2017

 

Consequences of Regulatory Efforts to Limit Patient Access to Opioids:

  1. an-online-survey-of-patients-experiences-since-the-rescheduling-of-hydrocodone-the-first-100-days-pubmed-2016-ncbi
  2. Is Suicide a Consequence of the CDC Opioid Guideline? – 2016
  3. Chronic pain patients are suffering because of the US government’s ongoing War on Drugs — 2016
  4. are-cdc-opioid-guidelines-causing-more-suicides-pain-news-network

 

Reference Articles

Pain and Depression

  1. depression-in-chronic-pain-patients-prevalence-and-measurement-2009
  2. depression-in-patients-with-chronic-pain-attending-a-specialised-pain-treatment-centre-prevalence-and-impact-on-health-care-costs-2016
  3. comorbid-depression-chronic-pain-and-disability-in-primary-care-2006
  4. prevalence-of-suicidal-ideation-in-patients-with-chronic-non-cancer-pain-referred-to-a-behaviorally-based-pain-program-2014
  5. assessing-suicide-risk-in-patients-with-chronic-pain-and-depression-2014

 

Pain Statistics

  1. Chronic Pain In America: Roadblocks To Relief – 1999
  2. Pain An Epidemic, statistics – 2001
  3. AAPM Facts and Figures on Pain – 2011
  4. NIH Analysis Shows Americans Are In Pain | NCCIH – 2015
  5. Health-united-states-2015-the-39th-report-on-the-health-status-of-the-nation

 

Suicide Statistics

  1. national-vital-statistics-reports-for-2014-reported-in-2016
  2. increase-in-suicide-in-the-united-states-1999-2014-cdc
  3. u-s-suicide-rate-surges-to-a-30-year-high-the-new-york-times
  4. cdc-statistics-on-suicides-in-us-2015

 

Pain Management – A Human Right

  1. Pain management: a fundamental human right. – PubMed – NCBI
  2. AMA drops pain as vital sign

Emphasis on Education

 

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