When a group of doctors, public health officials and members of Physicians for Responsible Opioid Prescribing (PROP) submitted a petition to the FDA to restrict the approved uses of opioid medications, the shockwave that rocked the chronic pain patient community was overwhelming.
The petition asks the FDA to limit the approved use of opioids to severe non-cancer pain; to limit the dosage to the equivalent of 100 mg of morphine a day; and to limit the length of prescriptions to 90 days. The current approved use of opioids to treat moderate pain would end under the petition.
Patients were outraged, with many claiming that they had tried numerous treatment options for pain, and opioid medications were the only thing that allowed them to function. Some patients already face extreme difficulties in obtaining their pain medications due to the government crackdown and their stress levels have gone through the roof. For them, this petition from PROP couldn’t have come at a worse time.
The FDA has asked for public comments on PROP’s petition, and the response has been continuous from both patients and the medical community. Health care providers across the country are divided on the issue, with some in complete agreement with the limitations that PROP is proposing, while others are vehemently against it, saying there is no legitimate scientific evidence to support the claims of the petition.
As a direct result of this controversy, a new organization of medical professionals was formed, called the Professionals for Rational Opioid Monitoring & Pharmaco-Therapy ( PROMPT) and quickly set out to draft a response in rebuttal to PROP’s petition.
PROMPT’s Chairman is Jeffrey Fudin, a doctor of pharmacy who has been treating and advocating for chronic pain patients for many years. He currently works in a hospital-based pain clinic in Albany, NY and says when he first read the PROP petition, he was “appalled to say the least.” Dr. Fudin worked quickly to contact other medical professionals to get their take on the situation, and upon finding many were in agreement with him, PROMPT was formed.
According to Dr. Fudin’s blog, PROMPT members include clinicians, researchers and academicians from various fields of pain management. PROMPT states that they have “serious concerns about the safety of chronic opioid use; we are therefore in favor of mitigating these risks by employing reasonable and validated interventions intended to benefit patient care and public safety. We advocate for clinician education, proactive risk stratification, and appropriate therapeutic monitoring.”
The first order of business for PROMPT was to draft a letter supporting the one that the American Academy of Pain Medicine submitted to the FDA opposing PROP’s petition. According to Dr. Fudin, PROMPT is building momentum and professionals are rapidly coming on board in support of their efforts.
The next step was to open up commentary to chronic pain patients, which shows PROMPT’s commitment to the patients they provide care and advocate for. There has been a positive response from the patient community, and PROMPT is asking patients to keep the comments coming by posting their comments here.
“I want to get as many patient stories as possible so that a group of professional people can advocate for the patients,” Dr. Fudin wrote to me in an email.
PROMPT also encourages chronic pain patients to contact the FDA directly in regards to PROP’s petition and how if implemented, it would affect their level of care and way of life. Patients can do this by going to the FDA’s website.
Dr. Fudin has also engaged PROP’s president, Dr. Andrew Kolodny directly in conversation, in an attempt to get PROP to withdraw the petition and work with PROMPT in finding a more balanced, scientific approach to opioid prescribing that won’t leave patients without cancer out in the cold. So far, no compromises have been made.
In the end, it is the patients that have the most to lose in this debate. It is the sincere hope of the chronic pain patient community that these medical professionals can come together with a willingness to cooperate, and work towards a solution that keeps their patients’ best interests and physical health in mind.
Editor’s Note: Mary Maston suffers from a rare, congenital kidney disease called Medullary Sponge Kidney or MSK. She is an advocate for MSK patients and others in chronic pain, and writes from the perspective of a patient who has been “caught in the crossfire” of the War on Drugs.
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