On Sunday night, CBS 60 Minutes aired a segment that has raised the ire of many chronic pain advocates.
It asked “Did the FDA Ignite the Opioid Epidemic” and asserted a label change in 2001 by the FDA expanded the use of opioids without what 60 Minutes said was “any evidence”.
Cindy Steinberg, Policy Advocate for the U.S. Pain Foundation, tweeted;
“Shame on @60minutes for its 1-sided coverage: https://cbsn.ws/2IvwL7B that somehow forgot about the 20 million Americans living with hi-impact #chronicpain”
The Director of Research for the Alliance for the Treatment of Intractable Pain wrote a scathing letter to 60 Minutes Producer Ira Rosen and Correspondent Bill Whitaker. Richard “Red” Lawhern blasted what he said was “sloppy journalism and thoughtless propaganda”. Lawhern wrote in part:
- CBS 60 Minutes has accepted and represented as fact, the assertions of Andrew Kolodny as a supposed “expert” on opioids and chronic pain. He is in fact neither. His only board certification is in psychiatry, and his name appears on only 15 research papers (sole author on only three) published by peer-reviewed journals and indexed on PubMed. It may not be going too far to characterize Dr. Kolodny as one of the most hated figures in American medicine. His unsupported assertions are directly responsible for the deaths of multiple pain patients (possibly hundreds) who have descended into disability, social isolation, depression and suicide as a direct consequence of being deserted and denied pain management by doctors now afraid of losing their licenses in a hostile regulatory environment. This is an environment created in large part because of Kolodny’s prominent misrepresentations.
- You have also asserted as fact the outright silly idea that opioids are ineffective for chronic pain — a notion which Kolodny and his cohorts in “Physicians for Responsible Opioid Prescribing” successfully slipped into the 2016 CDC guidelines for prescription of opioids to adults with chronic pain. The guidelines conflate (deliberately confuse) a relative scarcity of long-term double-blind trials of opioids, for a lack of opioid effectiveness. This scarcity is wholly attributable to the difficulty of retaining patients who are placed on placebos for trials. However a group of Oxford academics have published a fundamental critique of this conclusion, demonstrating that the CDC writers applied a substantively different standard of research adequacy to opioid therapies versus those used with non-opioid drugs and behavioral therapies. This un-acknowledged bias violated the research standards of the CDC itself.
- It is telling that no less an authority than the American Medical Association is now on public record repudiating almost the entirety of the CDC guidelines. AMA specifically advocates against any and all “one size fits all” limitations on dose levels or duration as determined by healthcare providers who prescribe opioids. Go look up “Resolution 235” of the most recent meeting of the AMA House of Delegates.
- Opioids have been used for literally centuries precisely because they DO work for both acute and chronic pain. This reality is witnessed by the fact that over 18 million people in the US are treated with opioids every year. HHS/CMS acknowledges that approximately 1.8 million of these people are treated with high-dose opioids, at levels exceeding the 90-morphine milligram equivalent dose level advocated by the CDC as a threshold for safety review between doctorand patient. This threshold has regrettably and entirely inappropriately been “weaponized” in State and Federal regulations and laws restricting the availability of opioid therapy to people in agony. Likewise, recent papers establish that HHS/CMS Opioid Overutilization Criteria for Classifying Opioid Use Disorder or Overdose have very limited predictive accuracy in identifying patients at risk for opioid abuse.
- It is also apparent in your program segment that you have accepted the equally silly notion that our US opioid crisis was “created” by doctors over-prescribing to pain patients. I say it is silly because this narrative fails unconditionally when CDC data on prescribing versus opioid mortality from all sources (legal, diverted, or illegal drugs) are compared State by State. There is no observable cause and effect relationship between prescribing rates versus overdose mortality. The contribution of medical opioids gets utterly lost in the noise of illegal fentanyl, heroin and other street dregs. And there never has been such a relationship.
- Likewise, CDC data establish that the demographics of chronic pain and opioid abuse are almost entirely separate. Seniors are prescribed opioids nearly three times as often as young people, but seniors have the lowest rates of opioid related mortality of any age group — stable for 17 years. Mortality in kids has soared over that period to reach six times the rate in seniors. The typical initiating substance abuser is a young male with no history of visiting a doctor for pain, while the most common chronic pain patient is a woman in her 40s or older. If her life is stable enough to be able to visit a doctor repeatedly, she will almost never be identified as a substance abuser. There are many other sources in medical literature which contradict the over-prescribing mythology.