In 2016 as part of the urgent response to the epidemic of opioid overdose deaths, the CDC issued new recommendations for prescribing opioid medications for chronic pain, excluding cancer, palliative, and end-of-life care. While not law or regulations which carry the weight of law, the CDC guidelines have been widely adopted by state medical boards and implemented by regulation with the force of law. The word guideline(s) is used 173 times throughout the publication. the word recommend or recommendation is used 237 times, the word should 227 times, and the word taper or tapering 58 times. Despite these cautionary words, practitioners, hospitals, and clinics abruptly terminated patient medications resulting in a rash of suicides across the U.S. with the last reported count being in excess 1,500 deaths in 2018, and they experimented in performing surgeries without the use of opioids for post-op pain management. Due to these rash actions, the CDC had to issue an erratum revision of the guidelines stressing that the guidelines were for general practitioners treating chronic pain not acute pain. The erratum provided guidelines for a staged reduction with frequent reassessments of the patient’s condition. As of 2020 it’s estimated that more than 1,000,000 individuals are no longer employed, forced into lower-paying jobs, onto welfare rolls, or into early retirement on reduced Social Security Benefits do to these actions. With the number of prescriptions written now down by more than 33% the overdose death rate continues to climb. The CDC routinely archives publications, for this reason, the entire publication has been copied here.
As early as 2013 the CDC knew opioid prescribing began dropping off, yet opioid overdose death rates were soaring to record highs, by 2016 data from the CDC identified the cause as IMF, illegally manufactured fentanyl. Yet even as the guidelines were being published, the CDC claims these are all prescription opioid-related deaths. Quoting Dr. Frieden Director of the CDC, “Today and every day this year, more than 40 Americans will die from a prescription opioid overdose in this country.” While the CDC has become more transparent on the roll IMF plays, they continue to count opioid overdose deaths from IMF as a prescription-related death.
CDC study raises questions on the need for continued efforts to reduce the supply side of prescribed opioids and the continued funding of PDMP programs.
Summary What is already known about this topic? During 1999–2017, the rate of drug overdose deaths nationally approximately tripled; approximately 70,000 overdose deaths occurred nationally in 2017, with nearly 68% involving an opioid. What is added by this report? Using toxicology data, New York City identified fentanyl in 2% of…
Policymakers in Ontario are correcting a rule that should have never been instituted in the first place. They realized that forced tapering of pain medications is “arbitrary and inappropriate,” and decreed that physicians will no longer be required to wean patients off of prescription opioids.
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.
On September 6, 2019 the CDC published updated data on it’s Injury Prevention and Control website and the major takeaway is that drug overdose deaths are continuing to rise.
So what are our healthcare professional and law enforcement agencies failing to recognize in their efforts to balance combating opioid abuse while humanely and responsibly managing chronic pain conditions for the public?
While the CDC breaks out data points for causes unrelated to mental health issues, the one category missing in its data collection efforts, and one for which they have abundant data, are the suicides related to forced tapering or termination of opioids in patients with legitimate medical needs.
In a new commentary in the New England Journal of Medicine (NEJM), authors of the 2016 CDC Guideline for Prescribing Opioids for Chronic Pain (Guideline) advise against misapplication of the Guideline that can risk patient health and safety.