FDA Commish: “More Forceful Steps on Epidemic of Opioid Addiction”

FDA Commish: “More Forceful Steps on Epidemic of Opioid Addiction”

This week the US FDA commissioner, Scott Gottlieb, M.D., issued a press release noting his immediate steps to reduce the scope of the “epidemic of opioid addiction.”

Specifically, he announced the creation of “an Opioid Policy Steering Committee that will bring together some of the agency’s most senior career leaders to explore and develop additional tools or strategies FDA can use to confront this crisis.”

He says the “committee will solicit input, and engage the public.” Continuing, “I want the Committee to go in whatever direction the scientific and public health considerations leads, as FDA works to further its mandate to confront the crisis of opioid addiction.”

National Pain Report wonders if “engaging the public” will look a little like what the CDC did in engaging the public in its development of opioid prescribing guidelines.   Could the FDA now be rubber stamping the CDC guidelines, but carrying with it, its regulatory power?

We don’t know, but we’d like to hear your thoughts on the matter.

Here is the FDA’s press release in its entirety:

As Commissioner, my highest initial priority is to take immediate steps to reduce the scope of the epidemic of opioid addiction. I believe the Food and Drug Administration continues to have an important role to play in addressing this crisis, particularly when it comes to reducing the number of new cases of addiction.

Today, I sent an email to all of my colleagues at FDA, sharing with them the first steps I plan to take to better achieve this public health goal. With this, my first post to the FDA Voice blog, I also wanted to share my plans with you.

I believe it is within the scope of FDA’s regulatory tools – and our societal obligations – to take whatever steps we can, under our existing legal authorities, to ensure that exposure to opioids is occurring under only appropriate clinical circumstances, and for appropriate patients.

Patients must be prescribed opioids only for durations of treatment that closely match their clinical circumstances and that don’t expose them unnecessarily to prolonged use, which increases the risk of opioid addiction. Moreover, as FDA does in other contexts in our regulatory portfolio, we need to consider the broader public health implications of opioid use. We need to consider both the individual and the societal consequences.

While there has been a lot of good work done by FDA to date, and many people are working hard on this problem, I have asked my FDA colleagues to see what additional, more forceful steps we might take.

As a first step, I am establishing an Opioid Policy Steering Committee that will bring together some of the agency’s most senior career leaders to explore and develop additional tools or strategies FDA can use to confront this crisis.

I have asked the Steering Committee to consider three important questions. However, the Committee will have a broad mandate to consider whatever additional questions FDA should be seeking to answer. The Committee will solicit input, and engage the public. I want the Committee to go in whatever direction the scientific and public health considerations leads, as FDA works to further its mandate to confront the crisis of opioid addiction.

The initial questions I have tasked the Steering Committee to answer are:

  1. Are there circumstances under which FDA should require some form of mandatory education for health care professionals, to make certain that prescribing doctors are properly informed about appropriate prescribing recommendations, understand how to identify the risk of abuse in individual patients, and know how to get addicted patients into treatment?
  2. Should FDA take additional steps, under our risk management authorities, to make sure that the number of opioid doses that an individual patient can be prescribed is more closely tailored to the medical indication? For example, only a few situations require a 30-day supply. In those cases, we want to make sure patients have what they need. But there are plenty of situations where the best prescription is a two- or three-day course of treatment. So, are there things FDA can do to make sure that the dispensing of opioids more consistently reflects the clinical circumstances? This might require FDA to work more closely with provider groups to develop standards for prescribing opioids in different clinical settings.
  3. Is FDA using the proper policy framework to adequately consider the risk of abuse and misuse as part of the drug review process for the approval of these medicines? Are we doing enough when we evaluate new opioid drugs for market authorization, and do we need additional policies in this area?

These are just some of the questions I will be asking this new Steering Committee to consider right away, given the scope of the emergency we face. In the coming days, I’ll continue to work closely with the senior leadership of FDA. I want to know what other important ideas my colleagues at FDA may have, so that we can lean even further into this problem, using our full authorities to work toward reducing the scope of this epidemic.

Despite the efforts of FDA and many other public health agencies, the scope of the epidemic continues to grow, and the human and economic costs are staggering. According to data from CDC and SAMHSA, nearly 2 million Americans abused or were dependent on prescription opioids in 2014, and more than 1,000 people are treated in emergency departments each day due to misusing prescription opioids.

Opioid overdose deaths involving prescription opioids have quadrupled since 1999. In 2015, opioids were involved in the deaths of 33,091 people in the United States. Most of these deaths – more than 22,000 (about 62 people per day) – involved prescription opioids.

We know that the majority of people who eventually become addicted to opioids are exposed first to prescription opioids. One recent study found that in a sample of heroin users in treatment for opioid addiction, 75% of those who began abusing opioids in the 2000s started with prescription opioid products.

This March, a study published in CDC’s Morbidity and Mortality Weekly Report, found that opioid-naïve patients who fill a prescription for a one-day supply of opioids face a 6% risk of continuing their use of opioids for more than one year. This study also found that the longer a person’s first exposure to opioids, the greater the risk that he or she will continue using opioids after one, or even three years. For example, when a person’s first exposure to opioids increases from one day to 30 days, that person’s likelihood of continuing to use opioids after one year increases from 6% to about 35%.

Working together, we need to do all we can to get ahead of this crisis. That’s why we’ll also be soliciting public input, through various forums, on what additional steps FDA should consider. I look forward to working closely with my FDA colleagues as we quickly move forward, capitalizing on good work that has already been done, and expanding those efforts in novel directions. I will keep you updated on our work as we continue to confront this epidemic.

Scott Gottlieb, M.D., is Commissioner of Food and Drugs


FDA Press Office Contact: FDA Office of Media Affairs, 301-796-4540, fdaoma@fda.hhs.gov

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Brett Husebye

.03 percent of people in pain od’d wonder how many prescription opiod users there were total of the supposed people that acutally died. We will never know because the Feds twist everything to their advantage. We are too stupid to use our medications so we have to stay in pain 24/7. Makes sense. I hope whatever fake one sided physicians that thinks this is helping us has fun on his pile of money because if I have to go to hell to jump up and down on their spines for eternity it will be well worth it.

Linda Godowsky-Bilka

This is my frustration also, when reading everything online and watching everything on tv ; NO DISTINCTION EVER MADE. It’s a critical distinction too that is RARELY mentioned.

It’s critical to me, because it makes no common sense whatsoever to lump all together. And that’s just ONE area that’s turned people just plain ignorant. How can any progress get off the ground when a pact mentality of stupidity has taken afoot.

I feel so angry that this aspect of lumping us all together is OUT of MOST conversations. IT’S WHAT LEADS THE IGNORANT DOWN THE PRIMROSE PATH!

Tim Mason

These people need to define “opioid addiction” every time they open their mouth or write an article. Opioid addiction covers the following:
Heroin addicts
Drug seekers
Methadone abusers
Fake pill manufacturers
Wall Street
These idiots erroneously put the elderly and elderly chronic pain patients in this class.
Real pain management doctors know this fact and are not falling for this foolish reporting like the media if fond of doing.
What happened to the Methamphetamine problem?
What they really want to say is that prescribing is epidemic but they won’t because it isn’t.
This is a HOAX perpetrated by those not educated by social sciences, mathematics and medicine.

I believe that a law suit brought about by all of those in the chronic pain community would be possibly worthwhile. The entire pain community sueing the CDC, FDA,DEA, because what they are trying to do to us is wrong! Many people will die, they will just give up and die, by their own hand, because they can not live without treatment for there horrible pain they suffer from day and night, 24 hours a day. I know I can’t! I’d be willing to throw in a $100 or so dollars, not that i can afford it because i live on disabilty, but we can force ourselves to come up with it, when it comes to fighting for our right to be treated for our diseases that cause us to live in chronic pain

David Cole

Never one word of protecting chronic pain patients! The DEA is a law enforcement agency. They have no business in medicine! Chronic pain patients are suffering horribly, from pain, anxiety, depression, constantly thinking of suicide, committing suicide. There is tens of thousands of us out here suffering. We need this in a court of law if we all throw in a hundred bucks or so we could hire a constitutional lawyer. We need to be a protracted to group. The evidence of chronic pain patients committing suicide is overwhelming. LET’S GO TO COURT! If anybody has a good idea on how to get this started, email me. I’ll do whatever I can. Coonbear4@gmail.com

Tim Mason

I see a struggle between the FDA and DEA for funds. The opioid epidemic is actually an opiate epidemic. HEROIN.
The advertising is what I despise. We have all seen it. A photo of a spilled bottle of what looks like Percocet, some power in a spoon and a 10cc syringe.
It reminds me of a song on a children’s afternoon program. It was during a time when we only had three major channels and then UHF was added. The programing was on UHF and the song went like this:
“One of these things is not like the other, one of these things doesn’t belong”
Banning or greatly restricting opioid prescriptions for chronic pain sufferers is like banning gasoline to stop drunk driving.
The people that write these tabloid-ish articles are very young and their knowledge base of the material written about is on a fifth grade level.
There is simply “No Accuracy” in media. It does not exist.


William Dorn,
I’d rather Trump NOT get involved. He’s a wrecking ball. He hates the people he serves. He’d see chronic pain patients as being “weak.” I’m saying this nicely.

Jean Price

I have a really bad feeling that supposed 75% of addicts who this say started out with using “prescription” meds…DID NOT use their OWN prescriptions! But rather used SOMEONE ELSE’S prescription ILLEGALLY! So once again, THE INFORMATION IS SKEWED! And biased! No one is likely to look further than what is misstated! So theses lies will continue to become some kind of fake truth to support banning opioids! Until they get it into their heads that those who are in pain are NOT the main ones becoming addicted….nothing else will turn this sickening tide!! Yet with stats like this and all the hype and skewed references being put out by people like themdimissioner….that’s not going to happen! Nope! Nothing new here, people!! Move along!


William Dorn, Trump doesn’t see letters he is sent. Why do you think Trump cares about chronic pain patients ? If he doesn’t care enough to ensure they have health insurance and can see their doctors. Why would he care if they aren’t prescribed pain meds ?

William Dorn

HJ we need all firefighter and police organizations who have so many members in chronic pain from job injuries to speak for us. Goverment would listen to them. How do we contact them.

William Dorn

Bob get this letter to president Trump.Everyone who writes comments needs to send copies to the FDA AND CDC. Speak out now before its to late.


Due to the fact that the majority of overdoses are from illicit fentanyl, I haven’t seen one thing the FDA, CDC, NIDA, SAMSHA, NIH or any Federal agency has done that has improved this situation other than those that damage the structures of the cartels. Cutting back on opioid medications to people in pain as a solution, is the kind of utopian response too this issue I would expect from Fabian Progressives, not people who believe in the dignity of Liberty! You guys haven’t moved past kindergarten psychiatry or at the very least, the very thing you accuse others of, denial! Your in denial that reformulating, cutting back or denying pain medications to people in pain will achieve anything but pain and making the overdose and suicide rate climb. Throwing out labels of brain diseases and treatment centers for solutions to addiction hasn’t been working for decades, go ahead and put the reputation of the FDA behind that, you will fall some more! Just like a Fabian Socialist would want you too! You’ve been set up! If I can see it, where are your experts? Oh, sorry, they are in denial! With the arrogant doctors who say they created this “epidemic” by over prescribing pain medications you want us to trust you now? Now that you already created the problem in the first place? Unless, it really is that very powerful synthetic opioids caused this all along. I figured it out, why are you still being anal zealots about grannies pills? The utopian world without opioids will never exist! I and many others voted that sheet out of office, time for you to catch up at the FDA!

Carla Cheshire

Is it possible to hire a lawyer or call the ACLU to start a case on behalf of those who are suffering unjustly or have committed suicide due to intractable pain that was once treated successfully using opioid medications? If writing to the CDC, FDA and Congress has no effect, where are we to turn? These people do not want to hear from us. We are the 2M dependent on opioid medications, to them were considered addicts. They claim 25% of patients who receive opioids from a PCP become addicted. I just read the study they cited where 705 out of 2139 people responded. It was done at 12 outpatient clinics in PA. In the study 39.3% of people had previously used illicit drugs, and 22.5% had a history of substance abuse treatment. What kind of sample is this? How can you draw conclusions from such a small, convoluted group? The study is blown way out of proportion. Of the 1000 a day who are in the ER because of misuse of opioids in 2014, the study sighted went up to 2011 and states that opioid visits to the ER were 420,040 for 2011. That comes out to 1151 a day but divide that into a population of 350,000,000+M and it seems minuscule. They are creating data and using it to fit their agenda.

What the FDA is saying to me is if you cannot handle your pain without opioid medication that’s just tough. You don’t deserve to live as your use of these drugs is jeopardizing the health of other Americans. I believe the conservative mindset is this: If people are no longer what they deem productive citizens, then they are a burden on society that it can not afford. This point was made with the Trump budget calling for cutting SSDisability and cutting Medicaid because if you can’t afford health care then you don’t deserve it.


Ive had it! This attack on INNOCENT LAW ABIDING CHRONICALLY ILL CITIZENS IS KILLING LEGITIMATE CHRONIC INTRACTABLE PAIN PTS!! I have lost five people that I knew this past week who took their lives to end the pain as they were abruptly cut off from LIFESAVING PAIN MEDS, meds they were on for many years. stage four terminal cancer pt cut off, forced to suffer for months until he was called home last weekend,. Every day I beg God to take me, id bever hurt myself, I wouldn’t do that to my kids, but boy what good am I to them if i cant even function!?!? I was dropped by my dr of five years nearly 2 months ago, cant find another and I am in a torturous hell!! Hey heres a thought, how about targeting the drug cartel, and getting the dam DEA/government out of our medicine cabinets!!! I bet most of them take some form of pain meds, or they consume alcohol, or whatever their thing is,. I can’t believe this is America, where its own government is intentionally inflicting pain, suffering, harm and suicide onto the pain community. They all need to be held accountable for the many lives lost to suicide by those who took their life to end the pain, or those who turned to the streets for relief, got god knows what and od’d. Where are the stories of the pain pts who are being abandoned by the medical community daily. I wouldn’t dare go back to an ER. i went months ago and was treated like a pill seeking drug addict, It was horribke and very embarrassing as they left me in the hallway with other pts, talking about my drug problem loud for he to hear, I stood up and b,asted the er dr telling him i am not a drug addict. I winded up walking out, Legit pain pts can no longer find the help they need, and yes when one is a chronic intractable pain pt, chances are they have been suffering for years, chances are those pts already know what medications work for them, chances are they have been thru the many alternative therapies, injections, surgeries, every non opiod medication, etc. but when we get dumped by our drs thru no fault of our own and have to start all over again, God forbid we shoukd be honest with the new dr and tell them what meds worked for us, bam flagged as a pill seeker, im so sick of all these terms and labels being put in the backs of the suffering, I wish every single POS scumbag who has his hands in the anti-opiod cookie jar a lifetime of horrific pain!!


The CDC, FDA, DEA, Big Pharma, Many of our own doctors, and our too big for their britches GOVERNMENT…..DO NO CARE about YOU OR ME. It’s all about the money…..
We the people are losing our rights …..what ever happened to “life, liberty, and the pursuit of happiness”? I guess if we haven’t yet committed suicide, we technically still have “life”….but NOT the quality of life we deserve as human beings.. It’s a sad state of affairs that continues to get worse & worse. Guess these big shots are just waiting for all us pain sufferers to just “off ourselves and end it all”.

I don’t trust the FDA to do anything….look how many drugs they’ve approved as “safe & effective” only to years later call them under question or recalling them totally. Their decision to “approve” a drug is based entirely on $$$$, not on what might actually be “good medicine”. EVERY prescription drug I’ve taken long term, NSAID’s,
Anti-depressants, Osteoporosis meds, Acid Reflux meds……..ALL had side effects that have caused other health issues. Most are now considered not so safe……all except the pain meds, which didn’t “cure” my chronic pain (we all know chronic pain is uncurable), but it did help me “function better”. Of course, I’m no longer taking pain meds because my doctor told me to “learn to live with the pain”……(isn’t part of his oath “first do no harm”?) I truly believe prescription pills approved by the FDA is the reason my mother died from internal bleeding & kidney failure at the young age of 61.

Anyhow, that’s my rant….and it’s over now.

Mark Ibsen MD

Ohhh noooo!
Here’s a clue:
Heroin use leads to heroin addiction.
Many heroin addicts used breastbmilk at some point, shall we outlaw that?
Quotes of article that say
Patients who use more opiates are likely to use more opiates are simplistic attempts to blame doctors for treating pain.
Pain afflicts 100,000,000 million Americans.
$ 600 billion impact on the economy.
See the 2011 IOM report.

Blaming the heroin and illicit pill epidemic
On doctors
Is like blaming car crashes on sellers of cars.
Hypoglycemic reactions on pharmacists who dispense insulin.
Let’s get to the true source of all this
With solid evidence.
I know in Montana, OD deaths have dropped 600% since the prescription drug registry went online.
Massachusetts found that 92% of OD deaths had no Rx for their pills
They were being killed by illicit counterfeit imported and stolen pills.
It may be true that many addicts start with pills.
We have proof that these pills are not coming from doctors Rx pad. They come from the street
Now we know these are also illicit.
Let’s put a marker on pills
Trace them like a VIN, lot number, fingerprints, or Ringling pattern on a bullet.
The forensics
Find out the source of illicit drugs.
Stop scapegoating pain patients and doctors.

Linda Godowsky-Bilka

Well Scott, have a therapist read your article here and it doesn’t take much of one to figure out some key items. First, as you wrote this, you were projecting your own personal desired results from whom addressed to. Yes you threw in a few “wherever this may lead” statements to make it appear open minded, but I say again, you’ve answered the exact questions yourself, that you say is the purpose of this letter. Talk about letting people know what you EXPECT to get back in the way of responses.

Second, not ONE WORD OF CHRONIC PAIN DISEASE PATIENTS. Not one word of the death rate from OPIOD WITHHOLDING. Not one word of the emergency room statistics from chronic pain patients SUFFERING FROM LACK OF PROPER OPIOD MEDICATION who are in severe pain from under treatment.

This period in the history of our Country will be memorialized as a time when the government took over and left it’s people with no medicine to relieve suffering. It will be written about at length – how the mentality of one affected a few, and then more, and manipulated the data, then were able to bring about a pact mentality in the medical community to such a degree that it made almost every physician disregard their oath of – do no harm. , as in the end they ended up doing great harm, causing immense suffering amongst the American people, for many decades.

It’s like one political over another…


The VERY FIRST THING they need to do is to STOP using the CDC’s admittedly inflated stats which lump illicitly manufactured fentanyl (i.e., a STREET drug) in as a “prescribed” medication — it’s NOT prescribed in that bastardization & should actually be given a NEW NAME ENTIRELY (like “Russian Roulette” perhaps) if they are truly sincere on educating the general public, which I cannot believe they are given that this is a physician who damn well knows better yet still penned this letter. Then they need to stop ignoring the fact that prescriptions have steadily decreased over the past few years & yet the heroin/mock-fentanyl problem not only persists but continues to grow!! Since they cannot possibly be dumb enough not to see what the rest of the world sees, one can only assume there’s another agenda here – & it almost certainly involves a money trail. I can’t help but think that trail will lead to one of three places, or all three even, one being those who benefit from for-profit prisons, the other being the targeting of doctors to use civil asset forfeiture before they’re even found guilty, and thirdly the addictionologists/rehab industry that is currently booming (why, even the founders of PROP had their hands in that cookie jar, most notably Kolodny). Seems it’s about time for a revolution in this country that has strayed so very far from what our founding fathers intended!!


I’m feeling queasy about this.

This is a GREAT opportunity for groups like PROP to insert themselves as the authoritative body. Their anti-opiod stance is NOT suggested by their organization name “Physicians for Responsible Opiod Prescribing.” That’s how we lost out on the CDC Guidelines, if I understand correctly, because doesn’t everyone want Responsible Opiod Prescribing?

I do. But my stance is that “Responsible” doesn’t mean that you deny patients who need the medication to have a better quality of life and who are taking their medications as prescribed.

SO, my point is, OTHER pain patient advocacy organizations need to get their foot in the door the way that PROP did!!! AND FAST! We need an organization that represents us… actively. I pray that’s what you intend to do.


Because individual chronic pain patients sent a flurry of letters and comments to the CDC… and we were swept aside in favor of an ORGANIZATION.

What do I think? I think this is alarming in light of what’s happened recently, in light of the “opiod epidemic” terminology being used, in light of the fact that we’re talking about the CDC… the CDC who made the guidelines that are causing us all such difficulties!!!!!

I’m not going to say it’s promising. I don’t care what words were written in the letter… but I did read them. I absolutely did.

You know what else is missing? Two things:

1. Where is mention of HEROIN? Or FENTANYL-laced HEROIN? Because that’s what is contributing to all the stories we usually see on the news. Because the omission means that it’s lumped in with “opiods.” There needs to be a distinction and that’s got to be made firmly and urgently!

2. Where is there any talk about research? They (again) are going to focus on action without understanding the problem. I hear lots and lots of statistics which lump us together with street-drug users. The quantitative data has been used and abused. Where’s the addiction experts who can speak on why addiction occurs? Where’s the research on why the addiction is occurring? What data are they going to base their conclusions on?

It has to be more than just “What are we going to do?” but yes, there is an urgency to address the street-drug problem. Rushing in to take pain medications away from people who need them without doing research is a different issue and should be handled with the care that has most certainly been lacking.

The language in this letter you shared is meant to placate pain patients, while it’s the action that will come out of it that will greatly harm us.

Lives are at stake. When pain medications are taken away from people whose quality of life is improved by them, the suicide rate is going to climb.

My message to the CDC is DO NO HARM to legitimate patients.

William Dorn

All pain advocate groups should demand to be heard.All unions should be heard.All police and firefighter organizations should be heard. All these groups have many members that suffer chronic pain.If they would speak up the CDC and FDA could not claim everyone on opiutes is a drug addict.Come on guys HELP.

Don kraus

Chronic pain patients must rise up over their feelings of doom and helplessness against the machine known as our federal government.we are the ppl that pay for their huge bugets that they need to operate,and now they use our funding to make our lives miserable.Do not be fooled, these ppl are smart and know Damn well what these guidelines will do to chronic pain patients, that is exactly why there is no mention of us, but we are the ppl that make this country great, although it seems to of lost it’s luster, only WE THE PPL can make it great again, remember they WORK FOR US,THE PPL.Don’t sit back and hope other ppl make the change for you. You must write,support chronic pain patient advocates,talk to friends, family, etc to make the issue of chronic pain patients being unrightly denied their medicine as big a issue as they have with the opioid epidemic. Do not be afraid to discuss this issue with ppl,i myself have always kept it to myself that I take pain meds, but now I must speak out or soon there will be nothing to speak about, it won’t be long before these guidelines are set in stone. PPL RISE UP BEFORE ITS TO LATE, and we all will be looking for a street dealer to ease our suffering, instead of our doctors.RISE UP AND BE HEARD!!!

Bob Schubring

The FDA has been asleep at the switch on cannabis policy since 1974 and their refusal to do their duty has caused today’s set of addiction problems. The Cannabis plant contains several Investigational New Drugs. One or more of those chemical substances, acting alone or in combination, prevents cancer. This fact became known to the Government in 1974. Rather than take charge of the investigation, FDA allowed a new agency, the DEA, to maintain the legal fiction that nothing inside a Cannabis plant was medically useful, and that Cannabis consumption and Cannabis research should be prohibited by law. Spanish and Israeli scientists repeated the suppressed American experiments, confirmed that the anti-cancer activity of Cannabis was real, and the Israeli government acted. In no small measure this was due to the Orthodox Rabbinate, who note from the Torah, that God commanded Moses to make a Holy Anointing Oil by cooking cannabis and several other herbs in olive oil, and to use the oil as a medicine. (English-speaking Americans who read the King James translation of the Bible, sadly, are treated to a translator’s goof. Instead of translating the Hebrew Bible name “kanah bosem” as “Cannabis”, the doofus translated it as “Calamus”. It was this falsification of the Bible that enabled certain Christian denominations to be duped about the Cannabis plant in the 1930’s. Thanks, King James! It’s why Jewish kids learn Hebrew and read the original texts in Hebrew for their bar mitzvah…you can’t mis-translate the original!) The Israeli research has identified several chemical compounds with useful activities against quite a number of diseases and theit patent attorneys have been busy applying for patents here in the US. You can’t patent the marijuana cigarette…it’s already been invented. But you CAN patent a slow-release capsule that you swallow with your breakfast, that supplies the exact cannabis-derived molecules that someone needs to fight off a disease they have. Billions of dollars will be made on that, and they will be made offshore, if we continue to be bloody stupid about using the Cannabis plant. The key finding that ought to motivate the new guy at FDA, is that Cannabis is highly effective against anxiety, which left unchecked, increases the perception of pain. That is to say, a pain that 20 milligrams of morphine would control, if one is relaxed and free of fear, becomes intolerable if one is frightened, shaking, and having muscle spasms that pull on the injury and create additional pain. So taking a cannabis drug for the anxiety can make a huge difference in how much opioid medicine one needs for pain control. (Some people actually get so much of their pain from anxiety, that they need no opioids at all for pain control, once the anxiety is held in check with a cannabis drug.). Colorado research now bears this out starkly. The state re-legalized all Cannabis use, and discovered that doctors wrote fewer prescriptions for opioids because patients had access to cannabis for symptom control. (Lutheran Christians quickly supported… Read more »


I’m appalled at what is happening to pain patients. I recently was forced to seek another pain clinic bc the one I was going to was shut down. Not bc they did anything wrong but bc of the hoops they had to go through and fear of losing their licenses.

My experience at the new cattle call pain clinic was horrible and demoralizing. Counting my pills. Immediate UA. Couldn’t leave to urinate prior even though I needed to urinate badly. Forced to stay until they were ready. Then next trip told he couldn’t give me OPANA if I continued another sleep medication bc of black box warning even though I’ve taken that medication for four years. Tried convincing me to get a pain pump!!!!

I have a rare spinal disease!!

To read that now, the ONLY medication that’s helped me be functional after my surgeries, OPANA, is going to be taken off the market by FDA bc they feel it’s part of overdoses and epidemic, concerns me greatly!! It took 1.5 years of trial and error for me.

It is not our fault for this epidemic. I say let those stupid addicts die. They are stupid to take their healthy bodies for granted. It’s their choice to use. It’s not our choice to use. We use to have an assemblance of a life. We have enough to deal with just getting out of bed and doctor visits. Now I have to jump through more hoops.

I’ve lost 8 friends to suicide bc they couldn’t get the medications they needed. They have the same disease as myself.

I cried yesterday hearing the FDA is pushing OPANA to go off market.

They don’t want to hear about the few patients that really need these medications. More people are dying from their own stupidity. We may die because of the addicts. What’s the ratio going to be?

I’m disgusted and anguished!!

I am so upset with all the messages I get from older folks in chronic pain….This is what I told my fbf just now…. *** there is also a plant called Kratom which has been made illegal in 3 states so you know it must relieve pain, right?…. I also started a Group for that… I refuse to live in chronic pain as I age… so many older people are depressed as hell mainly do to chronic pain they are in every single day with no relief and yes Medical Marijuana helps greatly and so many people have gotten completely off prescription drugs by ingesting it… Why should an old person have to pee in a dam cup to get drugs to relieve their chronic pain? People are going to develop chronic pain simply by the body breaking down due to the ageing process. I am so serious… why should we have to pee in a cup to get these drug to relieve pain… most of the older folks I know could give a shit about getting high, we want to get relief and the hell with all the politics….


Call it what it is… It’s HERION OVERDOSES not pain patients abusing their pain medication!

Michelle mcdonald

I really wish the CDC would stay out of our lives as chronic pain paintents. You hear this you hear that. They are torturing us. LIVING with Rsd and ms is no joke. If they cut our pain meds you will see alot of unessery suicide..

Candi Simonis

I am, along with the 100 millions of other Americans, are on the other end of opioids. I am one of these 100 million Americans who have chronic incurable pain disease. As the CDC, DEA and Medicaid and medicare, and numerous other government associates, are blaming Dr’s for the over prescribing of medication, NOBODY, is looking at or reading the statistics from chronic pain disease patients. How about not addressing these drugs as dangerous and addictive. Let’s look at them as lifesaving and medically necessary for the million of Americans with a chronic disease? Chronic pain is a disease. It is now becoming an epidemic.
No other disease medication is scrutinized. We as patients are being denied, dismissed and overlooked by our drs due to all the scrutiny associated with treating chronic pain disease. Our Dr’s are afraid to treat us adequately. We have a disease that medication is readily accessible to us and we are being denied. We pain patients are truly being discriminated against, due to people who have used heroin, illegal fentanyl, and placed a blame on anyone but themselves. This is a witch hunt for Dr’s who prescribe life saving medication for pain disease patients who benefit from this medication.
We have a chronic disease. We want to be able to take care of our homes, our children, our selves, as much as possible, but without access to these life saving medications, we are unable to do so. We want to live not just exist in pain 24/7.
We need the government agencies to look at the real statistics, not the hand picked.
We need help. With all the headlines, topics and stories on how opioids are bad, let’s look at what good they do for our disease of chronic pain and the million of Americans they help.

Sue Tedford

This is terrifying. The narrow focus on pain prescriptions as the cause of this “epidemic” is ignorant and bodes ill for chronic pain patients. What about all the ODs from opioid analogs produced by dealers in makeshift labs and imported from China? Where are his “facts” coming from? I just feel like we are all going to end up committing suicide as they methodically remove our medications without offering any comparable relief.


The commish is just another dishonest risk averse careerist who will do what is best for himself regardless of how it will increase public suffering. Weve heard it all before commish and youre cut from the same cloth as other careless and clueless federal officials that have only added to heroin misuse and the suffering of people in pain. Go home and write your memoirs about how great you are and leave People in pain alone.

The true “addicted” individuals are many times not patients that see a pain specialist. Of course, there are going to be exceptions to that statement. I have had chronic pain for 22 years due to: Interstitial cystitis, arthritis & fibromyalgia. Tomorrow I’m have a biopsy to determine if I have another auto immune “syndrome” or disease.
I do not get “high” when I take tramadol (useless for severe pain” or hydrocodone. I never have It takes the edge of and that’s about it. You have to learn to live with a certain amount of pain. Chronic changes your whole life from loss of employment which not only effects your livelihood but your self esteem when you can’t advance in a career that you loved. It ruins relationships because your partner can’t understand your pain and you are not able to do things you used to do. Not only is cleaning a small house an impossible task but forget a social life. So there comes the divorce which brings you to a new level of heartache, financial losses and friends of the formal couple. And then we have the loss of personal friendships because the “friend” is tired of you backing out of social events and is tired of a constantly sick friend. To put it succinctly it’s hell on earth. All the while the addicts are “drug seeking” and buying prescription meds off the street. Most dr’s think oneself is drug seeking. I know as a disabled RN have very judgmental medical professional can be. Now, they are wanting to make it more difficult to get the help one needs. The druggies are going to find what they want illegally anyway. It’s all so frustrating and difficult for thousands of us that need help & don’t abuse. I wish every lawmaker and healthcare individual had to live with just 2 weeks of what I’ve gone through in 22 years. Most of them would be singing a different tune.
I don’t know what the future holds but the American lawmakers are taking away more of our rights every day and yes I voted for Trump (no alternative) and I’m from the South- Texas at that so I must be total idiot!
I’m considering moving out of the country in a few years. Much cheaper, great inexpensive health care in certain countries and a healthier, less stress free lifestyle. I love America with all my heart (and the Lone Star State) but we are in the biggest mess since the Civil War. It’s going to be interesting to see what unfolds.

Candace Way

I probably can’t add too much to this issue, as David Nagel, MD’s post seems to cover most of the bases. Reading the article by Scott Gottleib, MD, makes me feel like the cart is still being put fully and completely before the horse. There is nothing in Gottleib’s article that shows any understanding that there can be, and are in fact, both knowledgeable, careful doctors and properly prescribed patients out there who cannot manage their pain well on other medications. Because opioid ‘guidelines’ have suddenly become unnecessarily overinclusive ‘rules’, they just too widely encompass both doctors and patients who have no reason to be called to the bar for being abusive of the meds they are prescribing or receiving . It makes no sense to harm these people who are absolutely doing the right thing

Somehow, someway this must be stopped!!! People can not live in horrible chronic pain 24/7 day after day…if they don’t end up blowing their brains out, they will surley in up insane!! I know I can’t live without my medication, so now we have the CDC, DEA, FDA, all in each others pockets. All I can say is I will either become a “street drug addict” or blow my brains out, because i just can’t do it!!!!!

jillianne willett

I do not see any reference or consideration to the chronic pain population in this statement. am I missing something? What happens to those who have been taking for say 15-20 years , with no problems what so ever- perfect urines every single time? what is the risk of those people overdosing now after all this time say vs being taken off of them now and being unable to live with the pain? Are they being considered at all?

Ibin Aiken

WHERE better is information noted and recorded other than opioid pain medication prescribers to their patients, accurately, monitored by the DEA? WHY, how much dosage, what strength, and the informed physicians “due diligence” from prescribing medication after education, training, experience, and the ever watchful eye of the DEA be found OTHER than the physicians records.I know they are required to keep accurate records and weigh the benefits of each, individual, chronic pain patient of HOW opioid medication is actually BENEFITING the individual patients AND is this data even being considered overall policy for the patient by the FDA or CDC? Not no but……..no. By ALL means consider collective information BUT on an individual basis to help any amended or new policy in opioid prescribing medication to be rectified BEFORE ANY further unnecessary suffering and negative outlook on life from the chronic pain patient. The current guideline is the least “helpful”, most detrimental policy to millions ( for a positive end??)causing needless suffering for those of that have worked “up” from the least effective treatment for chronic pain to arrive at the most and least invasive effective treatment for chronic pain patients! Harmful, unjust, and needless lowering ( to worthless) of opioid medication IS actually detrimental to our physical and mental health. Leave the physicians that practice common sense, REQUIRED “due diligence” and the patients overall health and welfare, in all forms to our prescribers and stop harming the patients to the point and brink of suicide!! LISTEN to our doctors BEFORE some inadequate study with extreme negative results making drug abuse…..worsen. THINK, educate yourselves ( policy makers) and then and only then….act! Stop looking at desired results before regarding negative, unnecessary, costly, detrimental, undesired final impact and then stating…..Ah Oh. Make informed decisions by actually LISTENING to the Opioid prescribers and their patients of America!!!! By ALL means include at least a 50% input from the patients ourselves. We have documentation if a patient that has been using opioid therapy for even a small amount of time that has benefited from the medication and no harm done, to the INDIVIDUAL patients! It Is NOT difficult for the physician to place us through available acceptable, proven, actual testing and if not, the heath condition is self evident to the qualified physician! Testing with their qualified opinion along with our doctors due diligent prescribing more that ANY other agency can compile studies to enforce the beneficial prescribing of opioid medication FAR better than the “one dosage all” chronic pain patient prescribing agenda!! There are too many other forms of manufactured chemicals that are called “pain” relievers being illicitly manufactured and marketed outside of the pharmaceutical companies and the physicians care that is taking the forefront OUTSIDE of media reporting that are NOT include in the CDC “opioid epidemic”!!!THE CHRONIC PAIN PATIENT IS BEING MADE TO SUFFER….NEEDLESSLY DUE TO THE MEDIAS NON REPORTING. making ALL opioid prescribed chronic pain patient look like the backbone of drug related fatality! The REPORTED “Opioid crisis” which… Read more »

You fail to mention the fact that your 75% rate on beginner addicts were using either fake or diverted prescription meds. Not once do you mention chronic pain patients who are suffering in agonising pain because of all this stats rhat are inflated or have NO SUPPORTING LEGITIMATE DATA! Less than 1% of chronic pain patients become addicted. 1000 ods a day? Thats a stretch! 365,000,00 a year? Seriously? You need to take lessons in lying from either content://media/external/file/37043 CDC or the DEA.


It’s amazing to me that pain is mentioned nowhere in this document. Dependence and addition are mentioned together as if they were interchangeable. It states that a 30 day opioid prescription results in a 35% chance of taking them a year later. I guess this guy has never heard of major accidents or illnesses.
I was hit by a truck that was driving on the wrong side of the road while bicycling, causing catastrophic injuries. I took opioids in differing amounts for almost four years to treat increasing and decreasing pain including after the eight surgeries that it took to put me back together, more or less. This allowed me to return to work a year after my accident. I weaned myself completely off 160 mg of OxyContin+ oxycodone in less than six months. Because my final surgery solved my terrible pain, the tapering process was easy because my surgeon allowed me to set the pace of the taper.

Opioids made my life bearable, the side effects were negligible, and were easy to taper off when I didn’t need them anymore. Other non-opioid pain medications like Lyrica turned me into a brain dead zombie and tapering off of them was sheer hell. And yet, because of the current anti-opioid craze, doctors push medications like anti-depressants and anti-convulsants that can be very problematic medications for many people and that often barely touch pain.


You know, to me this smacks of probition era talk and that marijuana witch hunts of past decades. Both of these items are highly profitable and condoned by society today. A big difference in these issues is that opioids are medically proscenium to provide pain relief to a degree that other medications haven’t been able to. Part of the human condition is to feel physical pain; and to not allow our fellow human beings to some relief is really criminal. If you can’t understand that all people who use Asprin, foe example, aren’t addicted to Asprin..why are you in these policy making panels?

When did it become within CDC scope to prescribe medical treatment? This is absurd and everyone will follow along because it doesn’t impact them at the moment…and they better pray that they never need the compassion in their lifetimes–or anyone tuna they love. Chronic pain is a killer of life and spirt. So what else is left? I’m frustrated and if someone knows how us humans can make a difference please let me know. Writing to a politician who has taken his into their scope of influence just seems ludricous.

Debra McDonald

Oh dear Lord, this crap just gets worse with every new post! Again, I understand there is an epidemic of opioid abuse. That is NOT because of me or the other thousands of chronic pain sufferers who follow this group. Apparently the powers legislating these changes have never lived with chronic pain or known anyone who lives as we do. I have been on meds off and on for the last 25 years with the past 8 years being reliant on morphine and oxycodone just to do average household tasks that most people take for granted. I dont even remember a time when I was prescribed a 2 or 3 day rx for pain relief! Why do they never ask us?

Virginia Holmes

I am a dying cancer patient with other serious painful conditions. It has now spread to my brain. So at the age of 38.I have no life. I can’t function. I am suffering along with friends that are too. I also have had friends just like me that were on pain medications to help control pain so that we do NOT SUFFER. These friends have committed suicide. Poor white trash is thrown away like garbage and treated like garbage. My doctors PROMISED they would not let me SUFFER to DEATH. I am now homebound suffering in agony to the point I have shut everyone out of my life. I do not want them to see me dying suffering like this. Also, my doctors who I thought “cared”. Are now Assholes and treat me like shit a burden on society. There is no hope. And now “YOU” the Government, Insurance Companies, and doctors are making this Opiate Crisis so much worse. I just want to thank all you ASSHOLES, for letting me and so many others suffer to DEATH!!!!!!!!


Another boatload of nonsense from the government fools who do not understand. There is not one mention here of chronic pain being a disease or condition that plagues millions of people, from many causes, or from no known cause. Not one mention. I guess in their minds, it doesn’t exist. It’s just outrageous, and exceedingly dangerous for patients to have this stupidity coming from people with power over our lives. Paragraph 2 is so indicative of their lack of understanding.. Let us know what to do…I’ve been writing to politicians for years now. That doesn’t seem to help.


What the D.E.A. and the F.D.A. refuse to acknowledge is that most opioid additions are primarily because of social disobedience. Legalization or minimal regulation would only make the problem go away.

David Kilby

So more regulatory nonsense. That will solve the problem. I live in Oregon, and heroin is cheaper than a gallon of milk. Here’s a novel idea, deal with the illegal drugs and leave the legitimate chronic pain patients alone.


FDA Education Blueprint for Health Care Providers
Involved in the Management or Support of Patients with Pain (May 2017)-


Please please go after the junkies the people that do heroin people that do it just to get high,,,NOT people like ME IN CHRONIC PAIN, I am 51 years old and I have fibromyalgia I have arthritis in my L3 L4 bulging disc in my L4 L5 and I also have fibromyalgia,i work I’m single I have a good job I have good insurance I see a responsible doctor I go for injections I go every 3 months and get piss tested, and get my medication to mangae my pain, I have to work I cannot retire that is the only way I can get through my day with some sort of relief from my pain to keep my job it’s physical and it is so hard on me my job,and I need this medication to help me have something to take the edge of my pain to keep working, if not I would not be able to work I would be homeless,there is no way I could have a normal life if that’s what you want to call it. my medication helps take my pain away for a while, so then come home after work and keep my apartment clean,I’ve also had disc decompression surgery I’ve had my nerves burned!!! I mean it’s just crazy don’t hurt the people that needed the most the doctors the responsible doctors they know what they’re doing and I have a great one and when I retire maybe I won’t need so much medication please, SO PLEASE DON’T TAKE AWAY from people who need it to live just to not hurt so bad for four hours a day, and I also have arthritis in my knees and my shoulders that are tore up from my job ,which is screwed up! My job is physical hard on me and I need this medication to help me keep my job if not I would not be able to work,, I would be homeless… I’ve had this decompression surgery I’ve had my nerves burned I mean its just crazy don’t hurt the people that need it the most… doctors the responsible doctors they know what they’re doing and I have a great one and when I retire maybe I won’t need so much medication, please please don’t take away from people who need it to live, and I would give anything if I did not have all these problems, I don’t get lead a normal life because my work days are hard and I have to come home and rest, and once again I have a responsible doctor and I’m a responsible Pace patient so please keep letting the doctors let us have a normal life… it makes me mad because in Most states you give junkies free needles and you want to take pain medication away from people who are not abusing it but yet you cater to the Junkies…


The FDA plans to include Pain Management Doctors as well as other prescribers. They also plan on including Extended Release and Immediate Release Opiates. They may make this training mandatory. They are taking Public Comments until July 10, 2017.

Draft Revisions to the Food and Drug Administration Blueprint for Prescriber Education for Extended-Release and Long-Acting Opioids; Availability-

Michael G Langley, MD

I have a very hard time listening to people, who use inaccurate information to push the agenda, to hurt people in chronic pain. Most opiate related deaths are due to clandestinely produced morphine (diamorphine called heroin) and Fentanyl (Mexico? China?) The numbers presented here seem to be way out of line, with the facts. (What I would expect addictionologists to say, defending the existence of their specialty) With that, it becomes hard to determine what else presented is propaganda, and not fact. A very small percentage of chronic pain patients suffer from addiction. What this type of ignorance results in is refusing to treat chronic pain patients who have not done one thing wrong! Essentially, their treatment of us chronic pain patients is akin to throwing the baby out with the bathwater!


No. This sounds like the revamp of the 2016 CDC guidelines already. Already in a state where the are attacking an opiate used for both chronic pain and addiction. This needs to be left to the practitioners and patients. I bet PROP (“aganda”) will be involved, just as their board members were in the drafting of the 2016 CDC guidelines. Dr’s will simply retire or leave the profession altogether. Chronic pain patients are left to suffer, while what we are really experiencing, is a massive epidemic of explosively powerful illegal heroin & fentanyl. I really don’t think the FDA should be involved in this. We’ve already seen what a great job the CDC has done, a full train-wreck of a year. If we continue down this road, we will only see a mammoth rise in illegal fentanyl, fake pill making, and pain patients will basically be caught up in a cruel form of genocide. That’s my rant.

Candice Hawkins

Well….that’s about the most idiotic excuse for rationalization in throwing opioids down the toilet that I’ve ever heard. It’s quite apparent that this poor excuse for an intelligent person has no idea that chronic pain is defined as pain that lasts longer than 90 days. Most spinal issues, any neuropathy and or CRPS do not go away with a wave of a hand. Anti-inflammatory meds don’t work or due to esophageal and gastric issues can’t be used. My son has such terrible foot pain from having his feet repaired at 1 yr of age to make an instep arch by pinning his foot bones will always have chronic pain at a level of a 6-8 with no end in near. He is allowed 2) 7.5mg per day and still is barely able to walk and is disabled. Of course the latest from Capitol Hill is disabled people are to buck up and go back to work.
I really have to wonder what is wrong with this country when pain patients are in the same group as those who buy the drugs off the street.
Why is it that the officials ask for help from citizens and those citizens are never chronic pain patients but ‘know it alls’ who have framed ideas in their mind about pain patients being just whiners.