What do you think about the way the opiate crisis is being handled?
No one will argue that we are having an epidemic of opiate overdose deaths. Nor is there any doubt that the medical community had a big role in getting this whole thing started 1.
But my question for you is, what do you think, now that we’re here? Let’s put aside the finger-pointing of whose fault it is. That ship sailed a long time ago and we’re abandoned on the dock with the city burning behind us.
How should we be handling the mess that’s been left behind?
Our state leaders made sure we knew they had set up task forces, consulted experts and enacted policies. Major hospital systems were also quick to get in line. Narcan became widely available, as was patient education, both of which I strongly agree with. The problem that I saw was overreactions. Like toddlers caught with their hands in the cookie jar state leaders and hospital CEOs started blubbering apologies and promises to ‘never do it again’.
In Ohio this really seemed to take hold after the CDC issued their ‘Guideline for Prescribing Opioids for Chronic Pain’ in 2016 2, a good policy that recommended benchmarks for assessing treatment and sound suggestions for monitoring. But the State Medical Board of Ohio went one better and issued a new rule (supposedly) based on these guidelines but implemented with an iron fist. I’ve heard too many stories, from patients, friends, and family members about the fear of the SMBO driving providers to just completely stop writing controlled meds altogether – despite the fact that this is tantamount to abandonment and dramatically adding to the problem 3,4. These providers and their employers excuse themselves by offering referrals to Pain Management – never mind the Pain Management providers are now swamped and are booking 6-8 months out; are themselves backtracking many of their treatments; or that there is little incentive for new doctors to get into the field to replace the ones getting out.
Now add the DEA forcing supply reductions 5,6. 13% down in two years is a chronic pain patient going without their meds for a half a week every month. People use these meds to function, so what now? Cutting work hurts the economy. Cutting out family life creates more problems than I can begin to address. Is this what we really want 7? The DEA has petulantly wailed ‘it wasn’t me!’ 8 but others disagree and aren’t afraid to call them out in federal court 9.
Pain Management’s goal is to help people function and it takes a lot of different approaches to work: psychology, physical therapy, multiple types of meds, alternative medicine… all have their role to play. But removing an entire class of meds and terrorizing prescribers so they are afraid to do the job they’ve trained years for is not an answer. The DEA is made up of law enforcement officers. They’ve been known to ‘reach out’ to the medical community here and there 10, but I haven’t found any doctors actually on staff.
Like it or not, right now many people are addicted, whoever’s fault it is. Leaving them writhing in pain, sweating through withdrawal, or desperately buying unregulated or fake percocets probably laced with fentanyl, just so we can look like the good guys, flies in the face of our ideals and in my opinion is morally criminal.
To its credit the CDC recognized the posturing by these lesser groups and tried to put a stop to it 11,12,13. It’s anyone’s guess, though, how long it will take for a little compassion to seep back into the pain management world. Being able to tell the public you’re doing something – anything – is an addiction all its own.
Tell me what you think in the comments below. I’d love to hear your thoughts.
Dr. Arnold
References:
1. CDC (n.d.). Understanding the Opioid Overdose Epidemic. Centers for Disease Control and Prevention. Retrieved March 24, 2024, from https://www.cdc.gov/opioids/basics/epidemic.html#:~:text=The%20first%20wave%20began%20with%20increased%20prescribing%20of,rapid%20increases%20in%20overdose%20deaths%20involving%20heroin%204.
2. Dowell D, Haegerich TM, Chou R. CDC Guideline for Prescribing Opioids for Chronic Pain — United States, 2016. MMWR Recomm Rep 2016;65(No. RR-1):1–49. DOI: http://dx.doi.org/10.15585/mmwr.rr6501e1.
3. Kennedy MC, Crabtree A, Nolan S, Mok WY, Cui Z, Chong M, et al. (2022) Discontinuation and tapering of prescribed opioids and risk of overdose among people on long-term opioid therapy for pain with and without opioid use disorder in British Columbia, Canada: A retrospective cohort study. PLoS Med 19(12): e1004123. https://doi.org/10.1371/journal.pmed.1004123
4. Harm Reduction Ohio (2024, March 8). Ohio overdose deaths decline about 6% in 2023. Retrieved March 25, 2024, from https://www.harmreductionohio.org/ohio-overdose-deaths-decline-in-2023/
5. Anson, P. (2022, December 13). DEA Finalizes Cuts in 2023 Opioid Supply. Pain News Network. Retrieved March 24, 2024, from https://www.painnewsnetwork.org/stories/2022/12/13/dea-finalizes-cuts-in-2023-opioid-supply
6. Anson, P. (2023, November 3). DEA Plans Further Cuts in Rx Opioid Supply in 2024. Retrieved March 24, 2024, from https://www.painnewsnetwork.org/stories/2023/11/3/dea-plans-further-cuts-in-rx-opioid-supply-in-2024
7. Anson, P. (2023, October 16). Drug and Medical Supply Shortages Impacting Patient Safety at 'Alarming Rate'. Retrieved March 25, 2024, from https://www.painnewsnetwork.org/stories/2023/10/16/drug-and-medical-supply-shortages-impacting-patient-safety-at-alarming-rate
8. Dodge, B. (2019, October 14). DEA Says It Doesn't 'Regulate Practice of Medicine' Amid Patient Backlash to Proposed Opioid Prescription Cuts. Retrieved March 25, 2024, from https://www.newsweek.com/dea-responds-chronic-pain-victims-opioid-prescriptions-1465090
9. Anson, P. (2023, October 9). Lawsuits Accuse DEA of ‘Incompetence’ in Regulating Drug Supply. Retrieved March 25, 2024, from https://www.painnewsnetwork.org/stories/2023/10/9/lawsuits-accuse-dea-of-incompetence-in-regulating-drug-supply
10. United States Drug Enforcement Administration (2022, March 23). DEA’s Commitment to Expanding Access to Medication-Assisted Treatment. DEA. Retrieved March 25, 2024, from https://www.dea.gov/press-releases/2022/03/23/deas-commitment-expanding-access-medication-assisted-treatment
11. Centers for Disease Control and Prevention (2019, April 24). CDC Advises Against Misapplication of the Guideline for Prescribing Opioids for Chronic Pain. CDC. Retrieved March 25, 2024, from https://archive.cdc.gov/#/details?url=https://www.cdc.gov/media/releases/2019/s0424-advises-misapplication-guideline-prescribing-opioids.html
12. Stone, W., & Huang, P. (2022, November 3). CDC issues new opioid prescribing guidance, giving doctors more leeway to treat pain. GBH: What Matters To You. Retrieved March 25, 2024, from https://archive.cdc.gov/#/details?url=https://www.cdc.gov/media/releases/2019/s0424-advises-misapplication-guideline-prescribing-opioids.html
13. Centers for Disease Control and Prevention (2022, November 3). Summary of the 2022 Clinical Practice Guideline for Prescribing Opioids for Pain. CDC. Retrieved March 25, 2024, from https://www.cdc.gov/opioids/patients/guideline.html