By Kelly Howard.
Editor’s Note—When Oregon’s Chronic Pain Task Force met in September, there wasn’t much opportunity for the public to speak. Kelly Howard was asked to submit it in writing, which she has. It is worth sharing.
“My name is Kelly Howard. I have been a chronic pain patient since the late 70s. My doctor first suggested I apply for disability in1989; I worked 22 more years because of responsibly used, prescribed pain medication. Many of those years I worked as a medical research specialist, so I’m here to discuss the bibliography of this task force.
Despite your repeated use of the word “evidence” you have less than no interest in it. You have no evidential basis for this extremist proposal. There is considerable medical evidence that these pain medications are efficacious in the treatment of complex chronic pain conditions –far more good evidence than the opposite.
I expected to see cherry-picked studies which confirmed your extremist proposal. I found no such thing: your own studies support the use and efficacy of opioids. I refer to the Scottish Guidelines for Chronic pain, the NICE guidelines for neuropathic pain, and the American Academy of Pain “minimum insurance benefits”. They all have 2 conclusions: 1. Opioids are safe & effective & have a role in the treatment of chronic pain. 2 “alternative treatments” may provide some benefits for some patients, so they might as well be covered. NONE of these say that ALL pain meds should be banned; all say opioids are safe & efficacious and are a legitimate part of pain management.
I was sure I’d see the remarkably poor Krebs study. If you read this study, as opposed to mainstream media’s absurd headlines, you’d know that it is so flawed that it’s an utter travesty. Some of the flaws: the study population does not reflect chronic pain patient reality on multiple ways; it looked at 2 conditions that are not normally treated with opioids and may improve over time. A major problem is that 11% the “non-opioid” group took Tramadol –a synthetic opioid– when OTC medicines proved insufficient. As for the opioid group, about 120 people were on those “heroin pills” for a year, with no abuse, addiction, dose escalation, overdose, or deaths. The only valid conclusion that can be drawn is that opioids can be used safely even when given in a flawed, biased study done by people out to prove that they can’t be used safely. Interestingly, the author of the study, Erin Krebs (clearly no fan of opioids), has come out against the CDC “guidelines” of tapering patients to 90 MEDD –so one can only conclude that she would not approve at all forced tapers to zero.
A review paper, Chou et al (AIM, 2015) lists several low-quality studies that attempt to correlate opioid use with numerous bad outcomes, including impotence and fractures. Leaving aside the fact that correlation does not equal causation (which is repeatedly ignored these days), the authors conclude that long-term opioid use results in higher usage of ED medication…yet it was not known whether ED med usage preceded the use of opioids –one may conclude with equal (in)validity that ED meds cause opioid usage! A study looking at fractures showed a very minor increase, but it was not statistically significant. Even though absolutely no conclusion whatsoever could be legitimately drawn from these two studies, the authors state unequivocally in the Discussion that the harms from opioid use are “clear” and include impotence and fractures! There were other problems with other studies in the review, but space limitations prevent further detail.
A review was done in direct response to this Chou travesty by Meske et al (J Pain Research, 2108). These authors arrived at the conclusion that “Opioids are efficacious in the treatment of chronic non-cancer pain for up to 3 months in randomized controlled trials.”
The paucity of studies looking at time periods longer than 3 months is due to the fact that study designers consider it too cruel to withhold pain medications from pain patients for longer than 3 months; this panel clearly has no compunction about the cruelty inherent in withholding pain medications from pain patients permanently.
The other studies in the list focus on alternative therapies. With varying degrees of quality of evidence (mostly low to very low), they indicate that these may help some people sometimes, for a little while. Many of us have already triedmany of them and have gone broke doing so.
But where the wheels completely fall off this bus is where you people insist that it’s one-way proposition: we may access alternate therapies, but all opioids must be banned. This is not backed by scientific or medical evidence, or even CDC guidelines. There is no moral, ethical, or legal validation for this insanity.
This state has already instituted an involuntary experiment upon its back-pain patients by forcing them off opioids. It has no idea of the impact of this forced treatment change. Now you want to expand this unethical, unsupported experiment onto thousands of other unfortunate citizens. There is no evidential basis for this extremist proposal. There is considerable medical evidence that these pain medications are efficacious in the treatment of complex chronic pain conditions –far more good evidence than the opposite. The recently released VA study shows that forcibly removing pain medications from patients greatly increases the suicide rate.
Despite repeated insistence –without convincing evidence– that Oregon is the only state in the entire Union where illegal drugs aren’t the problem, this state has no magical illegal drug-proof force field surrounding it. Ripping medication away from people who need them for functionality and quality of life is not going to cure any opioid problem in the state.”