Is Government Opioid Data Telling the Wrong Story?

Is Government Opioid Data Telling the Wrong Story?

By Ed Coghlan

Another report has been issued that concludes that the CDC strategy of targeting legal prescriptions to reduce opioid overdose deaths is not working.

In fact, Dr. John Lilly of Springfield, Missouri argues it may increase them by driving more users to illegal sources.

Dr. Lilly’s study–published online by the Association of American Physicians and Surgeons– reviewed existing government data. After looking at the Centers for Disease Control and Prevention (CDC) Wonder data base, Dr. Lilly sorts out the deaths associated with illicit fentanyl.  Until 2013, deaths attributed to synthetic opioids were fairly stable, but a sharp upward trend began then, with an increase of 635% from 2014 to 2016.

Notably, the spike in deaths has occurred while opioid prescribing is being heavily discouraged and placed under increasingly severe constraints. Dr. Lilly concludes that these policies are apparently driving opioid misusers from legally prescribed drugs to illicit drugs, which are far deadlier because of high potency and unreliable dosing.

Dr. Lilly’s study is the latest in a number of analyses that indicate the CDC action has been misdirected.

One of the critics is Dr. Terri Lewis; a public health advocate shared her feelings with the National Pain Report.

“Since the CDC Guidelines were a cloud on the horizon, persons with chronic and intractable pain have questioned the assumptions that CDCs guidelines are predicated upon.  The ultimate error is to base wholesale changes to public policy without accounting for all of the data – including the missing data.

“If fewer than 2% of persons who rely on opiates get into trouble, what’s to be said about the 98% of users for whom opiates have made a profound difference in the quality of their days?  Checking that assumption is something that our government has been profoundly uninterested in, choosing to respond to the loudest voices in the room.

“The obvious conflation of pain care with the needs of other user groups has predictably led to catastrophic care failure for persons with crises of pain and substance abuse even as user groups have been pitted against each in the competition for public funds.

“When we ask the wrong questions we get the wrong answers. The recent analyses by Michael Schatman and Stephen Ziegler, Stefan Kertesz, Josh Bloom, and now John Lilly make it abundantly clear that not only is CDC’s recent mea culpa insufficient, but it is still wrong from a design of data perspective.  It demands that the systemic error installed throughout the entire system must be addressed to right the wrong course of public policy so that we can get back to the business of caring for patients instead of servicing errors.”

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Authored by: Ed Coghlan

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Steve Lanier

And the CDC’s LIES significantly inflating the number of PRESCRIPTION Opioid deaths in their own research would seem to be the biggest argument against the CDC Guidelines that some states are considering codifying into law!
It is FAR PAST TIME for the CDC to in a loud public way admit their mistakes confess the lies and work to stop CMS from creating a “One Size Fits All” system of pain care for patients who access care via Medicare!

https://www.cato.org/blog/cdc-researchers-state-overdose-death-rates-prescription-opioids-are-inaccurately-high
https://www.painnewsnetwork.org/stories/2018/3/21/cdc-admits-rx-opioid-deaths-significantly-inflated
https://www.acsh.org/news/2018/03/19/cdc-quietly-admits-it-screwed-dishonestly-counting-pills-12717

the cdc report based on lie’s,medical personal are being told if a patient’s say’s tooo much about pain just say to patient your going thru with draws,world health organization looks at patient in great pain who’ve had they opioid medication lowed or stopped say’s it’s murder,torturing patient jeff session’s say’s let them die to lie and kill your own people is murdering,torturing them,world health say’s patient’s in great pain jeff session’s have already tryed what you said,and now they are calling for your help and you tell them to just die,their a place of your own in hell for you and hitler,pain nazi.

Jul

I’ve downloaded the WHO (world health organization) pain ‘ guidelines. Interesting statements re: chronic non-cancer related pain and SUGGESTED treatment. I don’t know how to link this but my search was: WHO, chronic pain guidelines.
This torture must be stopped.

Mary

In reply to comments posted by Donna and Joe Lane: there were chronic pain patients who were properly titrated to a working dose by their specialist physician(s) [note: not general practitioner but a physician specializing in pain management]. These patients suffering from intractable pain were compliant in Rx treatment and were STABLE with their respective dosage; their use of opioid therapy was successful for their condition or diagnosed injury. There is research which substantiates that some patients require a higher dosage; it is a matter of genetics and DNA markers. We are all different with pain tolerance.

Perhaps in the next century our scientific community will determine a pain threshold “marker” just like the medical researchers discovered blood types (i.e. “A”, “AB”, “O”, “B” and whether the blood type is positive or negative). DNA and genetic profile is complex, and our researchers continue to discover new things about our bodies. Perhaps a pain profile test awaits.

But from a legal viewpoint, I am shocked CDC combined legitimate Rx opiate data analysis with illicit (illegal) drugs such as Heroin and offshore non-Rx Fentanyl to determine overdose death. Why did CDC fail to isolate Heroin and other illicit substances in their data classification? Why did CDC fail to create those street drugs as a subset cause of human fatality? Why force legitimate chronic pain patients and their specialist physicians into a living hell by reducing dosage of legitimate pharmaceutical opiate meds? It seems that illicit drug death data should be separated.

This mistake by CDC harms diagnosed RESPONSIBLE patients suffering pain because of degenerative disk disease, RSD, complex regional pain syndrome, spine injury – just to name a few causes of pain. It is also a HUGE insult to patients’ specialists who are skilled in diagnosing and treating the complexity of chronic pain.

Physicians, pharmacists and medical professionals raised the issue to CDC and CMS/HHS Medicare about the legal risk in “forcing” an arbitrary number of 90MED per day. Legal risk as in law suits, and the question becomes “What if a lawsuit is filed by an individual party’s undertreated/untreated pain”? Case law court past decisions were decided in favor of pain patient’s right to opiate treatment.
Let us not forget Skip Baker’s untreated pain in Virginia, the torture inflicted on him and his legal victory. http://druglibrary.org/schaffer/asap/virginia1.htm

Donna

How do we stop this CDC screw up IMMEDIATELY! How do we create a Chronic Pain Sufferers Bill of Rights so that this never happens again! I was forced off my meds just a couple of days ago (because of CDC) and for the first time I seriously thought I am going to go home and take all the pills I have left and kill myself. Life without relief from pain is no relief. I just felt so alone and like nobody cared and how cold the Dr. who did this and the world of people who condone this are. I really wanted to die and as I face withdrawal (as if I am some kind of addict) I can’t really say I’m in the clear about those dark thoughts.

Joe Lane

I have suffered with severe chronic pain since 2002. I have seen a big upswing of health professionals that have bought into the CDC’s opiate propaganda machine, due mostly to the sensationalism by “journalist”. My guess is this study will get little to no press because it has no blood and guts associated with it.

Barbara W

I don’t know how many readers the Human Rights Watch will reach but this is so out of Control the CDC is pure corruption & Collusion influenced & ALLOW I NG FRAUDS like Debra Houry (EMORY university their in Atlanta GA next to CDC)whom received a $5 million Grant from the CDC to join the Anti Opiod groups to make up all the Lies about Opiods don’t work & lead to Addiction .(EMORY University also GRANTED the CDC MONEY co mingling!)They ran Bogus tests The CDC has aquired monies I’m sure from other Universities that play Ball with special agendas players like Andrew Kolodny whom asked for Grant money all the time for Rehab industry & treatment which he owns & works in. $50 billion in 2015 $30 billion in 2018 & every year $20 billion alloted for rehab in the budget of $75 billion alloted to “War on Drugs” Law Enforcment & DEA!!! Dirty Grant money!! This is a National Crisis of Denial ,genocide & Torture this needs to be handled too by the UN ! Inhuman dept! KOLODNY is going to other countries & spouting all his Anti Opiod Propaganda! This is dangerous to all people. The DEA poison is in 67 other countries as well.! at least certain countries have cured their problem by lifting Prohibition, but this whole government & special interests are in bed with the Drug money & Rehab drug cure money etc etc!!

Kathy

I am 54 years old, that makes me old enough and wise enough to make decisions on what medications I need and don’t need and I can follow my doctors instructions. The CDC and any other government agency that thinks they should have a say is wrong. As long as our doctors prescribe what we are taking and the pharmacies answer any questions we have, I think we as pain patients know what we need. The problem is you are mixing the patients or people who take non prescribed drugs or mix both. Most overdoses is due to illegal drugs being mixed with prescriptions medications or just illegal drugs period. The actual pain patients that depend on medication to live a somewhat normal life are not the problem and would give up the medications in a heartbeat if doctors could stop the pain. We the pain patients are the ones that suffer because your regulations are not being made on the correct data. I as a pain patient have been to hell and back trying to help to get rid of my pain. Instead of coming down on doctors and patients why don’t you look at insurance companies who deny us seeing proper specialist so we can resolve issues instead of just being written a script and sent home. I would much rather consider medication temporary and the correct physician care no matter how many it takes to find or correct the problem. It is easy for all of you agencies to fight against each other making it impossible for the doctors and their patients to have the major say and the insurance and pharmaceuticals to have answer to the doctors. No, you have tied the hands of doctors by giving insurance companies and pharmaceuticals telling doctor what they can do, I am sorry, but the power needs to go back the the physicians, insurance and pharmaceutical companies need to comply with the doctors. Until that happens I don’t see any area of major medical to change for the good.

Jenifer Markoe

Actually cutting prescription meds from chronic pain patients is not send people to abuse heroin and most heroin user now are starting off with alcohol and other drugs them move to heroin or just start using it if a friend introduces ot to them. In fact 80% of heroin users never got a prescriptions from a doctor and 90% of overdose are from people who have never a medical condition to be on them to be on a opiate. I image some maybe chronic pain patient who medical care has been dumped and are desperate maybe trying to find someway to survive there pain and have gone to the street. Meanwhile little or no money is being spent on teaching teens other ways to dealing with stress of having social media in there faces all day. Basically cutting and taking medication from chronic pain patients is not working because they are not dealing with the mental health issues that get people to abuse them in the first place.

Mist,
Trump’s statue is absolutely hideous. It will only serve as a painful reminder to the families who have tragically lost someone who has committed suicide in most of these overdoses they are referring to. Until something is done about their “little crisis”, it will only serve as a painful reminder to those who remain in chronic pain without the help they once had and so desperately continue to need. At least he finally placed blame on the drug dealers instead of publicly going after our doctor’s, pharmacist, the pharmaceutical companies not to mention, We The Chronic Pain Warriors. We The Chronic Pain Warriors need to be heard about from a different point of view. Hopefully after the rally in Washington on April 7th, light will be shed on “our” situation that has been tragically intermingled with “their” situation.

Dear Terry with the Y and Mark, Your stories break my heart. I know what it’s like to sit and stare or think about what desperately needs to be done. Finally getting up to do it, sitting back down for a while so the next job can be accomplished. I also know what it’s like to look at my little one and tell her give me a few minutes honey and then we’ll play, etc. Other than to ask you to pray and pray for you with faith, I’m sorry I can’t recommend any other advice right now. I know none myself right now other than writing my congressman which was totally useless. I will say very special prayers for you though and keep you in them. Hope it helps to know someone cares very much about your lives and took time to read your stories.
Sincerely, Terri James

Also stories like Patricia’s make you wonder don’t they. If you weren’t hurting then why was there a chance you would take the whole bottle? For unless one is hurting one is not supposed to take them at all. That’s the whole point. Yes it’s “nuts” they would give someone pain medicine that’s not in pain and those of us that are Chronic Pain Warriors are having it taken away. I agree with you 110%!!!

Janie Anderson

my biggest beef with all of this is the following nothing is happening to correct this problem, doctors folded their tent and have allowed the likes of dr. kolodny and his evil minions to destroy the rights of pain patients in this country, no single person or groups have done anything except bitch but have solved nothing, this has happened while chronic pain people have been forced off the meds that allowed them some peace and relief, the result of this “war on drugs” is nothing, they have solved nothing and have done great harm, does anyone in power care, i don’t think so, why have all the powers that be folded their tents and run for the hills,i also don’t buy the “if only more people new something would happen,” i call BS,in the mean time i am one of the pain patients who life is falling apart after 35 yrs use of pain meds, i was cut cold turkey, after a yr of jerking me around i am at my witts end i can no longer go on and on with no care, pain is insideous, constant and unrelenting enemy and i am close to saying “I GIVE”

Mist

https://abcnews.go.com/Politics/trump-praises-opioid-overdose-memorial-slated-open-white/story?id=54051841
Trump praises opioid overdose memorial slated to open outside White House in April
This should outrage the Chronic pain Community

patricia schiewe

I had a laser surgery to flatten my eyeball because the wrong lense was put in my eye and there was practically no pain afterwards – not even eough that I needed to take an aspirin but I got a perscription for an opioid and there were enough pills that I could maybe have gotten addicted and it might have ruined my life. That is nuts.

MichaelL

Katie Olmstead,
Apparently you did not read any information about the “Fentanyl” being abused. It is not legally obtained medication. It is coming from Mexico and China where it is being illegally manufactured, in in the same way “heroin”, better known as diamorphine. it is being clandestinely manufactured. If you understand that, then you might understand that it is not coming from pain specialists. It is coming from the drug cartels!

cynthia

Katie Olmsted….the Fentanyl on the streets,w which is flowing across our southern border, should be named something else. it bears little resemblance to prescription Fentanyl. It is 100 times stronger and highly toxic. It is a bootleg drug made mostly in Afghanistan and China, as I understand it. it goes by plane and boat to south of Mexico and then up into the US. Correct me if wrong. the Fentanyl used by pain patients is a whole different drug. it’s too bad the authorities don’t call the street fentanyl something else.

cynthia

i also forwarded to Bret BAier the Human Rights Watch article….both so important.

Geraldine Leblanc

Im so speechless. That some professional are speaking up. This a sad situation that the honest people that have cronic pain agreeing.to to drug testing are suffering beyond belief.
I am a severe chronic pain suffer. And cannot see a pain management. Dr. In Louisiana. Ive never have abused legal. Nor illegal drugs.
Thank you

Marty

This is great!!! I just hope someone with authority to change the CDC guidelines will read it and take action! There is a glimmer of hope now that the human rights folks are getting involved. At least, it appears someone is listening. We need to be vigilant in our letters, phone calls, etc..

Katie Olmstead

All of us are sure going to agree with this article. One question I have, and I fear the answer. The fentanyl that is hitting the streets and causing anarchy, why in the world has this much fentanyl even been produced? I gather it is used in hospital settings primarily; could be wrong about that. But clearly, there is no reason that it is even in existence to this extent. I assume this is fueled by greed. Someone is making money.

Joanne Thompson

Thank you for helping people with chronic pain. We need a voice because the truth is not being heard.

Mark Sisemore

When I starting having trigeminal neuralgia attacks it was unbearable pain. Without the opioids and other pain medications I wouldn’t be here on this earth. Twenty years later the pain is constant but controlled with medications. If you take away my pain meds I won’t last long. Please take a more in depth look before sentencing me to death.

Robert

While our debt has just exceeded $21 trillion, it’s the future debt of baby boomers which is truly staggering. Social Security, Medicare, Prescription Drug, etc., is an unbelievable $123.3 trillion. I cannot help but believe this draconian approach to seniors has something to do with our future inability to pay for the elderly.

The amount of this debt means every single person owes $375,901.11. Can anyone tell me how we can possibly deal with this, or has the government already started to work on a solution.

Praise God! Prayers are being heard and answered!

Laura

Yes! Please give our suffering Chronic Pain family members their pain medicine back? This is INSANE ABUSE!

Leslie Meadows

I’ve been saying this all along their numbers are wrong their questions are wrong the people they’re asking the questions are wrong it fits their narrative and that’s how they want it to look!

Terry

I hate to be a wet blanket, even though your information is very encouraging, but we need a fix for this problem months ago. How do we get legislation passed that will allow chronic pain patients to get their lives back? I go for my monthly appointment with my pain management doctor tomorrow and he will be lowering my medication doses yet again. I’m already at a point where I literally only have about 25% function of what I used to have when my meds were properly dosed. The most important question is, “what can I do or say to my doctor to stop him from lowering my meds again?” I know that I have rights as a patient, is there anything legally that I can do? I know he keeps on telling me that the DEA is forcing him to lower my meds and he CAN’T do anything about it. When I try and take a stand and recite all of the misinformation that my research has shown, he tells me that I’m wrong and the DEA is FORCING him to do it, he is totally paranoid about losing his license and his practice. So now, today I ask, is there anything I can threaten him with? Some patients rights law? Can I sue him? Is there any way to make a case for myself tomorrow when I see him? I’m terrified at the thought of lowering my meds yet again. There are a lot of people who depend on me for a lot of different things on a daily basis. I’ve already given up volunteering for meals on wheels, I have to find someone to cut my grass, my 11 year old grandson depends on me for everything, my wife has a really difficult job, very stressful and hard, she depends on me to cook and clean and other household chores, I have elderly neighbors on either side of me and I help them out, there’s much more but you get the idea, I’m an artist and I find it difficult to find the energy and motivation to create, not to mention my creativity is gone, I’m so distracted by pain and being tired, I sit on my couch awhile, then I do dishes, then I sit on the couch again, I clean a room, sit down, clean another room, sit down, you get the idea. Before my meds were cut down I was a very high functioning member of society, happy in my life, my life had meaning and purpose, now I’m depressed, lonely, tired, I am only just surviving, nothing that I would call living. May 30 I will be having my 19th surgery on one of my legs to remove my popliteus tendon and muscle, another major event. What do I do for pain? If there are any lawyers with suggestions, we’re all ears. We need a fix right now. Until next time, God bless.

Kim

Thank God someone sees & understands what happened. It’s common sense that some people who r in pain & getting cut back or taken off their opioids will get them illgeally. Then the other group of us that r homebound/ or choose not 2 buy illegally will suffer & detearate more. While the drug dealers make more $$. I hope the government starts 2 understand.

MonacoMan

“WE THE 98%”
Who do not abuse opioid pain med. We have here in our hands now the basis for every argument in our fight moving forward in this battle.
May I recommend you look at the link from the post & you Will find the paper submitted by the Doctor to the AAPS. The last two paragraphs are the info we need to arm ourselves with.
Fight On!
Thank you NPReport
Thank you Dr. Lilly
http://www.jpands.org/vol23no1/lilly.pdf

Alice Carroll

After reading this paper from the Washington Legal Foundation titled Preemption and Opioid Lawsuits & Monitoring Corporate Monitors- A Prescription for Conflict: Opioid State Tort Claims Raise Serious Federal Preemption Questions By Erika L. Maley and Jacquelyn E. Fradette │ Sidley Austin LLP It is clear that for the hundreds of lawsuits against corporate drug manufacturers that the various state governments, cities and other entities will have to have data that prove that the FDA is erroneous in its findings that opioid medications are able to provide relief for long-term chronic pain. This is because the FDA supersedes any judgement against the manufacturers. The FDA has asked for new studies on long-term opioid use which for their purposes is over 12 weeks.

Again, no one ever asks us, the chronic pain patients who greatly benefit from opioid therapy and have for years, even decades! No one wants to do studies on those of us whom opioids are able to give a much better quality of life because we don’t fit their agenda. We are on the front lines of this Drug War. Our pain is being used against us. It would be a crime to have these medications stripped from us forcing some into the black market for relief. Is that what the government wants? More overdoses, more death.

Jmwr

Thank you for giving this a voice!

Nancy

This article in my opinion is right on target. The CDC guidelines were done so quickly without looking at all of the data. It appears to me that they just “put something out” to get it done. I have not seen any follow up as was promised. Obviously, they did NOT consider the number of people who truly have chronic pain, monitored their medications, and medically need the medication to function. The Medical community has now become so intimidated and as a result, it is difficult to find a physician who will prescribe needed medication. Clearly it has caused us to go backwards not forward.

M.Billeaudeaux

Finally, a concrete study was written by a professional who understands and knows this problem and how changes need to be made in addressing it. The overdoses from legal pain medication is very low, 2%. That means that 98% of all patients who take opiates do so legally, safely, and most importantly, effectively. The patient’s quality of life is improved so that they actually have a life again. The manner in which the government and the CDC are going about trying to solve this problem is all backward. Target the addict. Improve the substance abuse clinics, increase the clinic and make them affordable for everyone. Evidently, improvements need to be made in treating addicts. Don’t stop the medication that helps millions of people every day, the medication that allows them to work, live, be productive again and not dependent on others or the government for assistance. Stopping the medication will lead to more serious problems, more illegal drug use, more overdoses, more deaths from suicide. This is all just common sense.

Terri Lewis

The data, which still needs work, indicates strongly that we are chasing the wrong target with a very blunt instrument. All of the targeting of prescriptions in the world will not address the problem of fentanyl on our streets. Attacking physicians, Medicare recipients, chronic pain patients, and so on simply amounts to fiddling while Rome burns – to the ground. Further, it does indicate that we need to get back to the business of treating patients AND assuring access to care of persons who are vulnerable to street drugs – whether they arise from diversion, they are counterfeit, or they are any combination of heroin and fentanyl. Until we get this data right and start targeting the appropriate solutions, we have nothing. One thing is sure – this ongoing argument that pits persons with substance abuse disorders against persons in pain (in a pitiful attempt to parse public resources), is the wrong argument to be having, and it distracts us from the reality of what the available information is telling us. There are multiple vulnerable populations that need our attention. We could get this right if we wanted to.

The most-dangerous flaw in the CDC Opioid Prescribing Guidelines is so serious, that if the CDC were a drug manufacturer they would lose their FDA license over it and be sued by the FTC for endangerment of the public.

That flaw is the Milligrams Morphine Equivalent (MMEQ) calculation they purport to make.

Supposedly every opioid drug can be assigned an MMEQ number, comparing it to morphine, and all of the drugs are then set against the alleged standard of 90 MMEQ.

Here’s the problem.

Morphine is removed from the body in a different way than all the other opioids are.
To flush excess morphine from the body, the liver uses two enzymes, called UGT2B7 and UGT1A1, to react the morphine with glucose and then with urea, creating morphine glucouronide. The morphine glucourinide is then excreted into bile or urine and flushed from the body.

But other opioids aren’t eliminated the same way. They flush out faster or slower, depending on which of dozens of enzymes carry out their degradation.

This means that at any given time after administration, the amount of active pain medicine in a person is different, from the amount of morphine. that would be in the person at that same time, if the person had been given morphine. The number is not an MMEQ constant, that can be looked up with a cellphone app. The number is variable, depending on how much glucose and urea is available to make the glucouronide and how active the individual patient’s enzymes actually are.

Pharmacologists and chemical engineers refer to this field as Pharmacokinetics. It’s quite a complex science that requires laboratory tests of real chemicals on live tissue, done repeatedly over a period of time. Pharmacokinetic models have to be validated for each patient, by performing blood chemistry studies, to account for variations in glucose availability, urea availability, enzyme activity, and opiate concentration, A doctor cannot simply type some numbers into a cellphone app and get an accurate guess about these numbers, from out of a computer model.

A good short article by Thorn, Klein, and Altman explaining this further, is at http://www.pharmgkb.org/pathway/PA146123006

Lori T.

Amen! Music to my ears, finally. But are the right people listening?

Paulc35

Finally the truth is said. I’very been saying this since 2010, which was the warning to doctors about prescribing opioids to everyone and overnight real chronic pain patients were sent to pain management doctors. This is when the overdoses went through the roof because those that are addicts turned to heroin that’s frequently laced with fentanyl. Canada anounced today that it would give the addicts either clean heroin, or fentanyl. The cure to the problem is the mandatory Treatment when they overdose and wind up in the ER. First they would be arrested and taken to a treatment facility for 6 months . Then upon their release they can be given a shot that renders opioid useless if taken. It blocks the affects of opioids making it pointless to use. If the addict doesn’t show up every 30 days to get this shot they would be arrested and put into mandatory rehab for 1yr and if they don’t show up every thirty days then possibly a third strike 5yr prison sentence. I imagine the problem will get under control in 2yrs. Myself and many others that needed prescription meds to function are now having them taken away due to the pressure put on the pain doctors , which in turn creates unnecessary suffering and I’m sure the suicide rate is climbing. The chronic pain patient is put through the ringer just to get meds every two months. The plan above to treat the addicts will be very costly as many facilities will need to be built.

Doug

Thank Ed -Your article / analysis is like a ray of sunshine upon a gloomy horizon !

Yay! The second bit of good news in a week or so. The other being Human Rights Watch getting involved. This has GOT to turn around. Patients r being sent home from surgery without pain meds, told to take Tylenol or NSAIDs. Omg.