Are the new opioid guidelines too little, too late for chronic pain patients? – Orange County Register
Jessica Layman estimates she’s called more than 150 doctors over the past few years in her search for someone to prescribe opioids for her chronic pain.
“A lot of them are downright insulting,” said the 40-year-old, who lives in Dallas. “They say things like, ‘We don’t treat drug addicts.'”
Layman has tried a host of non-opioid treatments to relieve the intense daily pain caused by double scoliosis, a collapsed spinal disc and facet joint arthritis. But she said nothing works as well as methadone, an opioid she’s been taking since 2013.
The last phone calls came late last year after her former doctor closed her pain medicine practice, she said. She hopes her current doctor won’t do the same. “If anything were to happen to him, I wouldn’t have anywhere to go,” she said.
Layman is one of millions of people in the United States who live with chronic pain. Many have struggled to get opioid prescriptions written and filled since 2016 Centers for Disease Control and Prevention guidelines inspired laws cracking down on physician and pharmacy practices. The CDC recently updated these recommendations to try to lessen their impact, but doctors, patients, researchers and advocates say the damage is done.
“We had a huge opioid problem that needed to be fixed,” said Antonio Ciaccia, president of 3 Axis Advisors, an advisory firm that analyzes prescription drug prices. “But the federal crackdowns and directives created collateral damage: Patients stayed dry.”
Born out of an effort to tackle the country’s overdose crisis, the advice has led to legal restrictions on doctors’ ability to prescribe painkillers. The recommendations left many patients struggling with the mental and physical health consequences of rapidly tapering the dose or abruptly stopping medications they had been taking for years, which carries the risk of withdrawal, depression, anxiety and even suicide.
In November, the agency released new guidelines, encouraging doctors to focus on individual patient needs. While the guidelines still state that opioids should not be the go-to option for pain, they do facilitate recommendations on dose limits, which were widely considered hard and fast rules in the CDC’s 2016 guidelines. The new standards also warn physicians of the risks associated with rapid dose changes after long-term use.
But some doctors worry that the new recommendations will take a long time to bring about meaningful change – and may be too little, too late for some patients. Reasons include a lack of coordination from other federal agencies, fear of legal consequences among providers, state policymakers reluctant to change laws, and widespread stigma surrounding opioid medications.
The 2016 guidelines for prescribing opioids to people with chronic pain filled a void for state officials seeking solutions to the overdose crisis, said Dr. Pooja Lagisetty, assistant professor of medicine at the University of Michigan Medical School.
The dozens of state laws limiting how providers prescribe or dispense these drugs, she said, had one effect: a drop in opioid prescriptions even as overdoses continued to rise.
The CDC’s early guidelines “got everyone up to speed,” said Dr. Bobby Mukkamala, chair of the American Medical Association’s Substance Use and Pain Management Task Force. Doctors have reduced the number of opioid pills they prescribe after surgeries, he said. The 2022 revisions are “a step change”, he said.
The human toll of the opioid crisis is hard to overestimate. Opioid overdose deaths have risen steadily in the United States over the past two decades, peaking at the onset of the COVID-19 pandemic. The CDC says illicit fentanyl has fueled a recent increase in overdose deaths.
Taking into account the perspective of patients with chronic pain, the latest recommendations attempt to reduce some of the harms for people who had benefited from opioids but were cut, said Dr. Jeanmarie Perrone, director of the Penn Medicine Center for Addiction Medicine and Policy. .
“Hopefully we’ll just continue to spread caution without sowing too much fear of never using opioids,” said Perrone, who helped craft the latest CDC recommendations.
Christopher Jones, director of the CDC’s National Center for Injury Prevention and Control, said the updated recommendations are not a regulatory mandate, but only a tool to help physicians “make informed, patient-centered decisions.” person regarding the treatment of pain”.
Several studies question whether opioids are the most effective way to treat long-term chronic pain. But the gradual decrease in drug use is associated with deaths from overdose and suicide, with the risk increasing the longer a person has been taking opioids for a long time, according to a study by Dr. Stefan Kertesz, professor of medicine at the University of ‘Alabama-Birmingham.
He said the new CDC guidelines reflect “an extraordinary amount of input” from chronic pain patients and their doctors, but doubts it will have much impact unless the FDA and Drug Enforcement Administration change the way whose federal laws they apply.
The FDA approves new drugs and their reformulations, but the guidance it provides on how to start or wean patients might prompt clinicians to do so with caution, Kertesz said. The DEA, which investigates doctors suspected of illegally prescribing opioids, declined to comment.
The DEA’s search for doctors has put Danny Elliott of Warner Robins, Georgia in a horrific situation, his brother, Jim, said.
In 1991, Danny, a representative of a pharmaceutical company, suffered an electric shock. He took painkillers for the resulting brain damage for years until his doctor faced federal charges of illegally dispensing prescription opioids, Jim said.
Danny turned to out-of-state doctors — first in Texas, then in California. But Danny’s last doctor had his license suspended by the DEA last year, and he couldn’t find a new doctor who would prescribe those drugs, Jim said.
Danny, 61, and his wife, Gretchen, 59, committed suicide in November. “I’m really frustrated and angry that pain patients are being cut off,” Jim said.
Danny became an advocate against drug abatement before he died. Chronic pain patients who spoke with KHN highlighted his plight, calling for better access to opioid medication.
Even for people with a prescription, it is not always easy to get the drugs they need.
Pharmacy chains and drug wholesalers have settled lawsuits worth billions of dollars for their alleged role in the opioid crisis. Some pharmacies have seen their opioid allocations limited or cut, noted Ciaccia, with 3 Axis Advisors.
Rheba Smith, 61, of Atlanta, said in December her pharmacy stopped filling her prescriptions for Percocet and MS Contin. She had taken these opioid medications for years to manage chronic pain after her iliac nerve was mistakenly cut during surgery, she said.
Smith said she visited nearly two dozen pharmacies in early January, but couldn’t find one that would fill her prescriptions. She eventually found a local mail-order pharmacy that filled a month’s supply of Percocet. But now that drug and MS Contin are no longer available, the pharmacy told her.
“It’s been three horrible months. I’ve been in terrible pain,” Smith said.
Many patients fear a future of constant pain. Layman thinks of the efforts she would make to get medicine.
“Would you be willing to buy drugs on the street? Would you be willing to go to an addiction clinic and try to get pain treatment there? What are you willing to do to stay alive? she says. “That’s what it’s about.”
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