HHS opioid prescribing guidelines reverse course on strict restrictions

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ABC News Oct 11, 2019:

ABC has run an article sighting DHHS has reversed course on its opioid guidelines. They now advised doctors that cutting off pain patients’ prescriptions suddenly could do more harm than good.

DHHS stressed that that an abrupt change to long-term pain patients’ medication regimens could “put the patient at risk of harm,” because of the significant chance that a sudden switch could throw the patient into opioid withdrawal.

In addition to withdrawal, the guide lists anxiety, depression, self-harm, suicidal ideation, ruptured trust and pain exacerbation as side effects of sudden prescription changes.

“We need to treat people with compassion,” Adm. Dr. Brett Giroir, assistant secretary for health at HHS, said in a statement. Giroir noted that clinicians were tasked with the dual goals: effective pain management and reducing addiction risk. Outside of life-threatening situations, HHS does not recommend that clinicians rapidly taper or suddenly discontinue patients’ prescriptions.

Despite the fact that the CDC has retracted its original recommendations for chronic pain management with opioids and cautioned prescribers about misinterpreting them, the original guidelines continue to be sighted as the justification for forced tapering or termination of opioids used in chronic pain management.

These new recommendation from DHHS emphasize and reinforce the CDC’s revised position which originally focused on judicious prescribing and emphasized that opioids were not a first-line treatment, nor were they an appropriate routine therapy. Following the issuance of those guidelines many clinicians thought the guidelines went too far and resulted in unintended consequences.

In a letter to the agency earlier this year, doctors described patients in pain who were cut off from opioids and not offered alternative pain care. Some suffered. Others turned to illicit drugs for relief.

The CDC guidelines as originally published led many health care providers to perceive patients as a significant category of vulnerable patients who represented institutional and professional liability concerns, a threat to be contained or eliminated, rather than as people needing care.

More than 68,000 people died of drug overdoses in 2018 and the CDC estimates 63% of those are a direct results of IMF (illegally manufactured fentanyl) a drug imported across our boarders from Mexico and in some cases, China.

Due to a focus on prescription opioids as the presumed cause, by 2017, prescriptions for opioids fell to 191 million prescriptions dispensed, down from a peak of 225 million prescriptions in 2012. In hind sight this now appears to be a massive error in judgement as opioid overdose deaths from IMF continue to set new records each year.

“What’s good about this guidance is that it calls for care to be individualized and tailored for the patient,” said Dr. Stefan Kertesz, lead author of the letter to the CDC and a professor of preventive medicine at the University of Alabama at Birmingham.

Despite the growing evidence that prescription opioids have played a less role in the opioid overdose crisis,  “There is a tremendous amount of pressure on doctors from every possible agency, including the federal government itself,” Kertesz explained.

That pressure can take the form of limits on opioids prescribing, or evaluating providers’ quality of care based on the number of patients they treat with high opioid doses.

“The effect of all these pressures is to force doctors to reduce doses or to get rid of the patients altogether,” Kertesz said.


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