Opioids: Under Fire
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Wednesday, February 20, 2019 04:19 PM

Patients with chronic pain are suffering from ham-handed efforts to curb opioid overdoses, a series of witnesses told the Senate Health, Education, Labor and Pensions (HELP) Committee.  In particular, the CDC's 2016 guidelines for opioid prescribing came under heavy fire, as even a self-described supporter of its recommendations admitted the evidence base was weak.

Cindy Steinberg, national director of policy and advocacy for the U.S. Pain Foundation, argued that well-intentioned efforts to address the epidemic -- particularly strategies to tamp down overprescribing -- have stoked a "climate of fear" among doctors.

Thousands of patients with chronic pain have been forcibly tapered off their medications or dropped from care by their physicians, said Steinberg. Physicians in California, under threat of medical-board sanction if patients die from overdoses, have reported similar reactions.  Such decisions are “inhumane and morally reprehensible,” she said.

She was especially critical of the CDC’s opioid guidelines, which included recommendations regarding the number of days and dosage limits for certain pain patients.  "When opioids are used for acute pain, clinicians should prescribe the lowest effective dose of immediate-release opioids and should prescribe no greater quantity than needed for the expected duration of pain severe enough to require opioids. Three days or less will often be sufficient; more than seven days will rarely be needed,” notes a CDC fact sheet.  These recommendations have been “taken as law," she said. 

Because of the CDC's reputation, "people think that those [guidelines] are based on strong science and they're not," Steinberg said. Pain consultants were not involved in the development of the guidelines, she said.  Steinberg said, "I think we need public education about pain and the fact that pain is a disease itself. ... Pharmacists are not getting proper training in that, I don't think anyone is getting proper training in pain." She asserted that veterinarians get nearly 10 times as many hours of pain management training as do medical students.

Insurance coverage can be a barrier to non-opioid alternatives. For example, the Mayo Clinic has a Pain Rehabilitation Center staffed by specialists in pain medicine, physical therapy, occupational therapy, biofeedback, and nursing that aims to treat pain without opioids. But Medicaid won't pay for it, she testified.

Source:  https://www.medpagetoday.com/primarycare/opioids/77996