Pain Academy Opposes New Limits on Opioid Painkillers

Pain Academy Opposes New Limits on Opioid Painkillers

The board of directors of the American Academy of Pain Medicine (AAPM) says a petition to the FDA that calls for new limits on opioid painkillers is seriously flawed and could be harmful to patients if implemented.

The petition, submitted to the FDA last month, calls on the agency to limit the dose and duration of opioid prescriptions, and to limit the approved use of opioids to severe non-cancer pain. The petition was signed by dozens of doctors, researchers and public health officials, many of them associated with Physicians for Responsible Opioid Prescribing (PROP), which lobbies against opioid abuse and overprescribing.

“We have serious concerns about the petition and believe the rationale for the requested changes is seriously flawed, potentially harmful to patients with debilitating pain conditions for whom opioid therapy is indicated, and without substantive scientific foundation,” the AAPM wrote in a letter to the FDA.

The letter, signed by 12 members of the AAPM’s board, said there was no scientific evidence showing that the use of opioids to treat moderate pain was any more or less harmful than prescribing the painkillers for severe pain. It also questioned the petitioners’ request to limit prescriptions to 90 days for the treatment of non-cancer pain.

“Pointedly stated, this change effectively eliminates the use of opioids for chronic non-cancer pain. This is a radical position that would leave an untold number of pain sufferers with few treatment options given the on-label restrictions imposed by many insurers, including Medicare/Medicaid,” the AAPM’s letter states. “Theirs is truly a ‘throw the baby out with the bathwater’ approach.”

“We believe that the adoption of the recommendations in the PROP petition to lower doses or duration would provide a false sense of security for patients and practitioners,” said Lynn Webster, MD, president-elect of the AAPM. “In our view, a more effective means to address this problem would be enhanced prescriber education and adherence to principles of practice, including ongoing monitoring for aberrant behaviors and early signs of addiction.”

One area of agreement the AAPM has with the petition is the lack of scientific evidence supporting the long term use of opioids.

“Indeed, little research has focused on the question of long-term effectiveness of opioid therapy for chronic non-cancer pain. The majority of recommendations from a practice guideline endorsed by the American Pain Society and the American Academy of Pain Medicine are based on lower-quality evidence. At best, the literature has shown inconsistent effectiveness of opioids for chronic pain,” the AAPM letter states.

“In a way, their document helps make our case because they agree with us on the most central point — that evidence to support long-term use and high dose prescribing is lacking,” wrote Dr. Andrew Kolodny, one of the founders of PROP, in an email to American News Report.

“If AAPM wants to defend the right of drug companies to advertise high dose and extended use of opioids for moderate chronic pain as safe and effective, the burden of proof is on them,” said Kolodny. “We don’t have to prove this. The law requires drug companies to prove that products are safe and effective for use as advertised. It doesn’t require the public to prove that they’re not safe and effective.”

Kolodny stressed that doctors would still be able to prescribe opioids “off-label” for moderate pain, even if they were only approved for severe pain.

“At the end of the day, if FDA implements the label changes we’re requesting, doctors will still be able to prescribe long-term opioids to chronic pain patients who need them and AAPM knows this,” wrote Kolodny.

The AAPM is one of several pain organizations under investigation by the Senate Finance Committee for its financial ties to the pharmaceutical industry. The committee has asked for a detailed account of payments by three drug makers to the pain organizations and several prominent physicians.  Lynn Webster, along with Drs. Martin Grabois, Rollin Gallagher,  Perry Fine and Bill McCarberg are among those listed. All five signed the AAPM’s letter to the FDA.

Authored by: Pat Anson, Editor

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I second Erika’s comment. AAPM is correct. One size does not fit all, like PROP thinks. Ask the majority of chronic pain patients that have been on opioid therapy for many years if the medications work to keep the pain at bay? There is your proof and long term study. Until you find cures for incurable diseases 100%, then medications are suitable for pain. I have seen and heard of way too many botched surgeries and procedures that do nothing but drive up insurance costs. Plus we have many new painful diseases that were never around before, Lyme disease and Fibromyalgia for example. Lyrica, Cymbalta does not help or cure Fibro, I know I have tried them. Why does doctors think that anti-depressants are a cure all? These cause physical dependancy as well. They also have a high death rate associated with them as well, but those are okay? No.. They are not. They are dangerous drugs as well. They mess with your brain. Now your list is getting longer for diseases with no cure cure. I bet cutting dosages of pain medications will only drive people to combine other things trying to self medicate. Everyone is not going to live forever. People die everyday. Humans have a right to treat their pain the best way they see fit. I believe this is between the doctor and the patient, no else.

I looked up Kolodny. He is a psychiatrist who makes his money keeping addicts hooked on buprenorphine (a narcotic), and seeks to convert the majority of addicts who currently use methadone (a very inexpensive drug) to keep their craving at bay to his get-rich scheme (buprenorphine is VERY expensive). Apparently he revels in trying to discredit experts in pain medicine who advocate for legitimate treatments for people living with pain that ruins their lives or drives them to suicide (double the rate of those without chronic pain)—a credible psychiatrist ought to know that and take it very seriously. His political and personal financial gain agenda seem to take precedent over the interests of people living with bad pain that cannot be controlled by any other means but pain medicines. What is most disturbing as I dig into this, is that he disguises his true motives with a false interest in people and their health and well-being. Yes, there is a huge problem with chemical dependency and drug abuse in this country—but don’t take it out on legitimate patients and intimidate the doctors who take care of them by going to war against them. Chronic pain and addiction are horrible diseases that need solutions; Kolodny seems to me to be a big part of the problem, not the solution, by creating the distractions he does.

If Dr Webster and the AAPM were serious about education in pain care they would have supported bills like NYS Sb 2723 which requires doctors to have education in pain care- the AAPM refused to support such. The AAPM doesnt have the right stuff to move the ball forward in pain care, in my opinion. Wheres there inspiring vision or energetic plan to lower the prevalence of any painful condition? In my experience members of the AAPM focus on “treatments” for pain but not on curing disease. Hippocrates over 2000 years ago indicated the duty of medicine is to cure diseases. I think the AAPM-after recent events especially needs to take a good hard look at what they are all about-failing that -advocates for lowering the prevalence of painful conditions will steal their thunder.

Are we hearing this right?-that the AAPM is saying that any limitations on current opioid prescribing for the millions of patients with chronic noncancer pain would have “unintended consequences” and would cause more harm than the over 100,000 deaths from prescription opioids which have already occurred, and the 3/4 million people treated for prescription opioid addiction over the last decade, notwithstanding the millions more in need of treatment. Perhaps they need to seriously re-consider what the real consequences of unlimited, excessive opioid prescribing are.

I applaud the courage of the American Academy of Pain Medicine. Thank you for doing the right thing!