Where’s the Evidence?

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By R Carter

It’s summer, and like everyone else, I have a lawn that needs to be mowed, limbs that need to be collected and disposed of, weeds in the flower beds, shrubs that need trimming and other sundry outside duties.

My first fourteen years as a chronic pain patient, I used to be able to do these things with minimal difficulty. I even held down a fulltime job and did some private consulting work on the side, working 55 hours a week. On a weekend I used to be able to spend the entire day outside working on my home and property. But now, after the government decided how much pain medication was appropriate, for me and 10 million other chronic pain patients, I’m unemployed and just mowing the lawn is a two day effort. The other tasks, well they have become optional because after about three hours, my pain is such I can’t even stand on two feet much less bend, stoop, lift and carry items, or push a lawn mower.

As I made a second attempt today to get some yard work done, all along cursing the difficulties I face because I have been forced tapered to half of what I used to take, I started thinking, where is the evidence to back up the government’s claims that a chronic pain patient of seventeen years, like myself, is likely to end up seeking drugs on the street or overdosing on the medications which have been prescribed? 

I’ve been following the so called prescription drug crisis since 2010 and I keep looking for evidence that will connect the dots between prescribed opioids and overdose deaths. Evidence to back up the claims the government makes, but so far I can’t find any, so let me get specific about this.

I’ve read hundreds of publications that zero in on individuals coming out of drug treatment centers, survey type research that collects data after someone began taking a prescribed opioid then turned to street drugs. I’ve read reports based on data from the National Inpatient Survey, Poison Control Center, CDC, Vital Statistics, hundreds of medical research articles on addiction. I’ve followed the CDCs mortality reporting on overdoses, I’ve dug deep into how all the data is collected and reported, most of which is a joke because it in no way represents chronic pain patients on long term opioid treatments. One of the best overviews on this topic is this article published August 2019 from the CATO Institute.

And that’s the problem, there are no studies directed at chronic pain patients who have been prescribed opiates for one year or longer. There is literally no data of any substance or quantity on this group of individuals, yet they have been targeted and labeled as a high risk group of people. Why and where is the evidence? The CDC in regards to their 2016 Guidelines for Chronic Pain Management admitted as much, there is no reliable data on the long term use of opioids. So, where’s the evidence that justifies restricting opioids in long term chronic pain?

The government and public health officials keep patting themselves on the back about their evidence based studies and efforts at addressing an opioid crisis, Yet the one report the CDC issues on the that topic, admits that there is no evidence? WTF?

I don’t disagree that there is evidence which indicates there is an opiod problem, but what little data we do have on Opioid Naive patients indicate there is only a 0.6% addiction rate for first time users of a prescribed opioid. Compare that to a 6.5% addiction rate for first time users of alcohol. So why do we ignore alcohol and put so much attention on opioids? It’s irrational. I just don’t believe chronic pain patients with more than one year of compliance in their use of opioids for chronic pain are at risk as much as the anti-opioid zealtors keep claiming. This opinion has some evidence to support it, in a survey done by Dr. Pooja Lagisetty, from the University of Michigan Medical School and the VA Ann Arbor Healthcare System, found that less than 25% of chronic pain patients abuse their medications and 90% don’t become addicted. If a large scale study could get done, I’m willing to bet the addiction, overdose and death rates for chronic pain patients would be closer to 0.09%.

Nearly every state in the US now has a Prescription Drug Monitoring Program and the data could easily be made available for answering this question. How many long term chronic pain patients taking opioids, are ending up overdosed or dead from prescription opioids? Secondly, how many of those individuals are turning to the street and buying heroin and or Fentanyl laced street drugs? Ohio published some data which hints at what these number might look like. see the second chart in this post.

We’re collecting the data, so why is it not being published? Why are we continuing to black ball chronic pain patients with data collected from street addicts instead of going straight to the data which would tell us exactly what role prescription opioids are playing in the opioid overdose problem? Why won’t States, the DEA and or the CDC who collects this data, release it, stripped of any personally identifiable elements. The taxpayers pay for this effort, when are the taxpayers going to be allowed to see it? How long is the anti-prescription opioid rhetoric of our government going to go on? What are they afraid of? Have they been honest and correct, or is this just another example of a rush to judgement that just so happens to be the wrong conclusion?

Better yet, why isn’t the chronic pain community speaking up and demanding answers to the same questions and demanding access to this data which will for the first time, connect the dots between prescription opioids and overdose deaths? Instead we keep trying to get legislators to act on our behalf, to speak up for our point of view and all they do is ignore us. And why, because there is no data that supports our point of view. They’re buying into the picture which gets painted with the bastardized data the CDC serves up, so why would they think anything different? 

No legislator is going to want to step up and speak to the issues which plague the chronic pain community until there is evidence to support  what we keep claiming. Which is, chronic pain patients with more than a year of successful compliance with opioid use, have a very low incidence of overdose and death.

If we can establish this as a fact and I believe we can, then we can call for prescribing exception in the CDC guidelines, exceptions which reflect the facts. Then doctors need only produce documented evidence of patient compliance with medication use, urine drug screens which confirm that compliance and improved functionality which is relative to the dosages prescribed. We can inessence define a better standard of care for chronic pain patients, one which is backed with evidence. There will be no more guessing at or assuming the worst, chronic pain patients can go back to having their dosage tailored to their medical problems and doctors can prescribe without fearing accusations of over prescribing. 

My God people, it is not that difficult, the tools are available, the PDMP data is already being collected, we should be demanding the release of this information. Then, the only justification for using fixed caps and limits on chronic pain patients would be stupidity, prejudice or bigotry. 

 

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3 thoughts on “Where’s the Evidence?

  1. Question: Would a Freedom of Information Act (FOIA) request to the CDC possibly provide access to Prescription Drug Monitoring Program data that would conclusively prove that long-term chronic pain patients (with more than a year of successful compliance of opioid use) have a very low incidences of overdoses and deaths?

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