I have written before on the nefarious BS the CDC has foisted upon the public in regards to opioid prescribing. You have seen many rants against PROP and it’s snake like leader Andrew Kolodny. I had anecdotal evidence to back up my rants from talking with providers and patients I knew. Now it seems I have missed the actual evidence of a dangerous conspiracy that has led to CMS, the VA and many states making these so called “Voluntary” guidelines into law. What is worse is that this ongoing bias was picked up by the media and flashed and splashed across the nation ! There have been countless articles and news stories on the dangers of opioids and pain patients are the ones paying the price for the LIES !
First let me give you a small bit of back story. Back in 2015 the CDC brought together a group of addiction psychologists to write guidelines for opioid prescribing in response to the growing number of opioid related deaths. Pain management specialists and chronic pain patients and advocates had no place at the table. Go back and read that again. Does that seem like a good makeup for a panel that is going to be writing guidelines for opioid prescribing ? Kolodney and PROP were running the show and their overt bias was clear in the results. They found (no surprise here ) that opioids had no benefit in chronic pain patients and led quickly to addiction. Kolodny himself has stated multiple times that every single opioid user is addicted. He deliberately conflates addiction with dependence thereby giving the impression to people who don’t know any better that the two are one and the same. The media continues to use Kolodny and PROP as “Experts” on opioid prescribing when the only thing they are expert in is lying about the beneficial aspects of opioids. Oh and here is a great kicker. The group of addiction psychologists that wrote the CDC guidelines can not prescribe drugs. Have to be a psychiatrist to prescribe ( Side note, a few states allow psychologists to prescribe if they have taken a pharmacology course but only a limited number of psychiatric medications.) ! So how in the heck did this group become the go to people for the CDC ? I have no clue but even to my pain addled brain I can see a problem.
So we have a group of addiction psychologists who can’t even prescribe these drugs writing the rules. The true stakeholders in the fight were shut out of the process. Then we get to the nefarious part. They cherry picked the data to prove their own foregone conclusion. This article in MEDIUM gives us the below quote.
Can people in chronic pain expect meaningful relief from long-term opioid use? Not according to the CDC. The recommendations state there is no evidence for such use and only evidence of harm. While it is certainly true there is an absence of longer-term data, the CDC defined chronic pain as lasting longer than three months, but included only studies that lasted over one year. An independent systematic review [11] finding evidence of benefit was thus excluded.
Absence of evidence is not evidence of absence, and the CDC’s claim is also belied by direct reports from patients using long-term opioid treatment who report substantial pain and functional improvements. The CDC, in telling patients that “the benefits are transient and generally unproven,” [12] is essentially telling patients they are wrong about their pain and function. When conventional evidence is limited and suffering is high, use of clinical ethics for individual patients has been proposed as a worthwhile decision-making model. [13]
Another article I ran across in ACSH.org HERE
CDC eliminated all studies of opioids which lasted less than a year, but failed to apply the same criterion to non-opioid therapies. The disqualifying imbalance incorporated in this literature review is revealed in an extract from the abstract of the paper [Ref 2]
“OBJECTIVES:
A recent US federal review and clinical guideline on opioids for chronic pain asserted that the literature contributes no evidence on efficacy because all trials had "inadequate duration." To explore the evidence, we examined durations of studies on opioid, nonopioid drug, and behavioral therapies for chronic pain….”
“CONCLUSIONS:
No common nonopioid treatment for chronic pain has been studied in aggregate over longer intervals of active treatment than opioids. To dismiss trials as "inadequate" if their observation period is a year or less is inconsistent with current regulatory standards. The literature on major drug and nondrug treatments for chronic pain reveals similarly shaped distributions across modalities. Considering only duration of active treatment in efficacy or effectiveness trials, published evidence is no stronger for any major drug category or behavioral therapy than for opioids.”
As they now stand, the Guidelines seem designed to deliberately confuse an artificially created “absence of proof” for opioid effectiveness, with “proof of absence” for effectiveness. It appears that the CDC set out to discredit the effectiveness of opioids in long term use -- regardless of the available evidence -- using a scientifically invalid process called "cherry picking."
Then we have these other articles EDS and Chronic Pain News & Info , Pain Medicine , ACSH.ORG all show the same thing. Kind of damning to me. ( Sorry for all the links but the wealth of articles shows just how much medical community disagrees with the CDC and PROP. ) . So the CDC has given the medical community a highly biased set of guidelines and to make matters worse the VA immediately adopted them as law. CMS is currently writing guidelines for Medicare recipients based on them as well. Multiple states have stepped up to the plate a took a swing at it as well and so these “Voluntary” guidelines are quickly becoming law. We can all agree that the opioid crisis has become a problem. (Of course it has always been a problem but since it hit mostly African Americans the general public and politicians could give a rat’s ass ! ) Now it is hitting more people from all walks of life and the public is clamoring for action. Yet instead of taking steps to help those addicted, they instead go after the perceived source, pain pills. Big problem though with that kind of thinking. Pain pills are not the source of addiction and are not the greatest contributor to ODs. This article from Scientific American shows that while 80% of heroin users started with prescription pain medications, they NEVER had a legitimate pain prescription.
75% of all opioid abuse starts with scripts that were not written for them. They got them from a friend, family member or dealer. And 90 percent of all addictions—no matter what the drug—start in the adolescent and young adult years. Typically, young people who misuse prescription opioids are heavy users of alcohol and other drugs.
In fact there have been multiple studies showing the risk of new addiction from pain medication in chronic pain patients is between 1% ( This study ) and 8-12% ( This study ). Also this JAMA study of 136,000 ODs treated in the ER in 2010 only 13% had a chronic pain condition. Prescriptions for opioid pain medication has been dropping since 2010 when they peaked yet ODs from opioids has continued to rise. All the evidence points to the fact that prescription opioids are not the problem and yet all of the solutions seem to be aimed at lowering prescription pain medication prescribing even more or eliminating it completely except for cancer or end of life care.
What is even more troubling is that the current occupant of the Oval Office, Trump, wants to cut access to opioids even more while slashing the budget for addiction treatment programs nationwide. It is the age old game of finding something that sounds good and is CHEAP even if it does nothing to fix the problem. It looks like they “Care” and are trying to fix it to the population clamoring for an end to this “epidemic.” ( Sorry for the quotes on that but while it is a problem we never hear about other things being called an epidemic that cause more deaths. ). Part of the whole issue with the stats from the CDC is that they are skewed. They make no differentiation between illegal street bought fentanyl and legally prescribed fentanyl. All deaths with Fentanyl in their system go down as prescribed opioid deaths and yet the majority of them are from illegal street bought fentanyl. The CDC also has the troublesome habit of double and triple counting deaths. If you die from an OD of heroin you go into the heroin column but if you die from heroin mixed with fentanyl you go into both the heroin AND fentanyl column. Heaven forbid if you die with 3 or more drugs in your system as you will be hitting each of those columns. They also do not break out intentional suicide from accidental ODs. So if you get fed up with the pain and the lack of access to medication to lower it and decide you have had enough and OD, you hit the OD column same as the guy who bought some to get high. (Unfortunately this has been happening as more and more doctors flee pain management practices and PCPs are afraid of prescribing opioids in any amount because of the DEA. )
Then we have the FDA ! The agency that regulates new drugs is taking a harder look at new opioid drugs which means longer time before approval. Plus we can throw in the illegitimate evil offspring of Granny Clampett ad a Keebler Elf, Jeff Sessions. He has decided rather than continue the sensible marijuana policy of the Obama administration and leave states that have legalized marijuana alone, that now the justice department will enforce all Federal laws in those states and go after the sellers and growers in those states even though it is 100% legal in that state. ( So much for those State’s Rights he was always shouting about as a Senator. ) He can see no legitimate purpose for marijuana even though there is a growing body of evidence that marijuana can help some chronic pain patients relieve their pain and get off of opioids.
We are in a time where people living in chronic pain are being treated as criminals and addicts even though they have broken no laws and faithfully followed all of their doctors orders to the letter. The press and the politicians and the public all want a quick, neat and easy resolution to a problem that is complicated and has no one solution that will work for all. Politicians want a cheap solution to a problem that is going to take a boatload of cash to fix. Addiction is a disease that is hard to overcome and expensive to treat. Since this administration’s stated goal of killing the ACA ( Obamacare) we will see even more people not be able to afford any form of treatment for this disease. With their reckless budget cuts to addiction treatments in areas hard hit by the opioid epidemic they are doing nothing more than pushing people further into addiction. What we do not need is more and more attacks on people with legitimate medical conditions that will do nothing but erode what little quality of life they have and may push them to the unthinkable act of suicide to escape the never ending pain.
