CDC Guidelines for Prescribing Opioids for Chronic Pain May See Updates in 2021

CDC Guidelines for Prescribing Opioids for Chronic Pain May See Updates in 2021

People with pain can’t wait two years. That was one of the resounding sentiments shared by individuals living with chronic pain during a public meeting of the Board of Scientific Counselors, National Center for Injury Prevention and Control (BSC, NCIPC). December 4 marked day one of two where members of the BSC, one of the Centers for Disease Control and Prevention’s (CDC) federal advisory committees, presented updates and data relating to health issues, including overdose prevention and opioid prescribing.

The hot button agenda item, which most attendees commented on during the meeting’s public comment period, was the “Background for Updating the CDC Guideline for Prescribing Opioids,” presented by Dr. Debbie Dowel, Director of the Overdose Response Coordinating Unit. Dr. Dowel’s presentation gave an overview of the guidelines since its inception in 2016, noting that the guidelines met their goal in the area of opioid prescribing. When asked why updating the guidelines was now being proposed, Dr. Dowel stated that science is always changing and that there had been instances of misinterpretations of the CDC guidelines.

Another agenda item heavily commented on by the public was the “Charge and Request for Establishment of Opioid Workgroup,” presented by Dr. Robin Curtis, Medical Officer for the Division of Overdose Prevention. Dr. Curtis listed what types of healthcare and medical professionals would serve on the workgroup. Members would be responsible for making proposed revisions to the existing CDC guidelines. In the next two years, the workgroup would publicly release the revisions, accept public comments, and finalize changes based off of the Opioid Workgroup’s findings, recommendations, and input from the public by 2021.

Each person who weighed in during the public comment period was given two minutes. The theme of the comments was desperation. One participant pleaded that federal government agencies not wait to make changes that will help pain patients, saying that many with chronic pain won’t be able to wait. Several comments related to suicide. Forced tapering was also brought up. One woman provided her personal experience with being abruptly cut off from medications. A clinician, who retired early to care for his wife with chronic pain, discussed how she also was forced tapered. Another individual gave testimony while fighting through tears, admitting he was crying from the stories and pleas that had been shared by others.

Speaking on behalf of the U.S. Pain Foundation, I explained the significant impact the existing guidelines have had on individuals living with chronic pain. I also welcomed the opportunity for the U.S. Pain Foundation to serve on the Opioid Workgroup, as Dr. Curtis indicated nominees could be suggested at the meeting. Our statement at the meeting, written by Cindy Steinberg, National Director of Policy and Advocacy, and myself is below:

Shaina Smith

My name is Shaina Smith and I’m a director for the U.S. Pain Foundation who also lives with chronic pain.

We’ve received countless stories from individuals negatively impacted by the existing CDC guidelines. The guidelines should be updated for the over 50 million Americans living with chronic pain.

Since its release, the guidelines have crippled an already vulnerable and stigmatized population due to misinterpretation by policymakers and clinicians. The misapplication of the guidelines can be punitive, a disservice to patients, and has led to irreparable damage such as forced tapering, prescribing limits, negative health outcomes, the firing of patients and even suicide.

The U.S. Food and Drug Administration has received accounts of serious harm in patients whose medications have been discontinued or the dose rapidly decreased; its April 9 safety announcement warned prescribers that no standard opioid tapering schedule exists that’s suitable for all patients.

The Pain Management Best Practices Inter-Agency Task Force Report notes in section 2.2 titled Medication that there should not be specific dosage limits, such as 90 morphine milligram equivalents, or MMEs, per day, especially since therapeutic needs vary from individual to individual.

In a Fox News series titled Treating America’s Pain: Unintended Victims of the Opioid Crackdown, Part 1 - The Suicides reporters spoke with doctors who said they knew of patients who took their lives after losing access to opioid treatment. With the CDC aware that those with chronic pain have died by suicide, as confirmed by Dr. Debbie Dowel, a lead author of the CDC guidelines, it is evident that change needs to happen sooner rather than later.

The updating process of the guidelines should be transparent, allowing ample time for the public to digest and comment on proposed changes. Pain management doctors, chronic pain patients, and nonprofit pain patient advocacy organizations must serve on the Opioid Working Group, as well as the Guidelines revisions committee. Language that clarifies individuals with chronic pain who have been medically stable on long-term doses of their opioid medication must not be forced off them but be permitted to remain on them if the patient wishes must be included in the updated revision. Thank you for the opportunity to speak to the planned updating of the CDC guidelines for prescribing opioids for chronic pain.

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Authored by: Shaina Smith

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DebbieG

Excellent! You guys did an amazing job. Thank you, from all of us!

Please, everyone, continue with comments to the CDC and comments regarding the 2021 timeline…that’s simply way too long!

Having served on numerous committees, it doesn’t take that long to rework the existing G/L’s. One retreat could have it done quickly. The disputed areas could have correction, and be published via the same Public Relations company the used the first time. It’s really not that hard!

They also need to reduce the psychological community from having so much influence in an area where they are not practicing or have an immediate degree. There should be as many, if not more, Pain Management experts who are currently practicing and have credibility, as well as the same number of PM Advocates.

It’s just not that hard! Let’s keep up the pressure to have the correct people, schedule and public relations company complete this shortly. It’s truly a matter or death for most of us.

Vanessa

The question still remains, “what do we do until 2021, suffer in daily pain”.

Gail l

What kind of fresh he’ll is this? The government’s error in thinking has already killed off many people who did NOTHING wrong, and yet they are facing torture they didn’t cause!!! Doctors, patients pharmaceutical companies, etc are being destroyed at record rates, while the CARTELS, Pushers and Addicts go on their merry way!!! How come I’m the only one that can see this!!!

Vicki

I suffer from chronic pain, I’ve had 3 neck surgeries through the front, and a 4th surgery going through the back to put 2 titanium rods on each side of spine with 14 screws through my vertebrae! The surgeon botched my surgery! Making my pain excruciating! It looks horrible and feels even worse! I have several pictures to prove how botched it is! And now my dr has fired me! I’m so sick of being treated like this! I’ve been going through this for almost 20 years! I suffer extreme migraines that last for days! I have degenerative disc also bulging and ruptured discs in lower back! You cannot group every patient in the same category! I also suffer ptsd, severe anxiety disorder, depression, and every day is a struggle! Weed out the people whose intention is to get high and separate those of us who can’t function because of our pain!

Fed Up

And HOW many chronic patients will die in agony between now and 2021?

Theresa L. Negrete

Hmmm! Since I have already been force tapered, cut off and now use Medical Marijuana, I have NO hope that my life will have any amount of normalcy. Marijuana just isn’t as effective for pain, it’s not consistent. Every strain and grow works differently on pain. It’s hit or miss. There’s also side effects to it, like not being able to get up and get things done, found out this is called “couch lock”. I also fit into to many of the categories that say I’m at risk of ADDICTION, even though I jumped through their hoops and passed all their damn forced pee tests, pill counts and more! I’ve now had enough! Too much pain, too much pleasing everyone else and jumping through hoops to get compassion. One thing I’ve learned through all of this is that illegal Fentanyl, that will definitely do the job, isn’t hard to find and if I die taking it, bonus no more PAIN! Absolutely will NOT be going back to Medical Professionals, not willing to risk anymore humiliation! I understand there are WONDERFUL, competent, compassionate Medical Professionals out there and I applaud you! I’m just not willing to search through the crappy ones for these WONDERFUL Medical Professionals any longer!

Jess Agee

My heart absolutely breaks every time I hear of one or 1,000 of my fellow Chronic Pain patients abruptly taken off their meds, or ppl getting a surgery & not getting pain relief, cancer patients & out vets not getting their pain medications. Ppl who have been stable for years! It makes no sense to me! It’s upsetting, Especially those who have ended their life or are thinking of doing so , over not having pain relief is ridiculous to me! I cry for them bc I’ve been there where my pain is so so horrible that I start thinking why am I here, I can’t be the wife, mother, daughter, sister, cousin & friend that I once was , it sucks Pain changed me! I can’t keep living in my bed, sleeping my life away & not being a productive part of society. I’m still here bc of my loving & supporting husband & kids! I do get some pain medication, tho it hardly takes the edge off of my pain, I really need a breakthrough medication. I’ve been on some sort of pain medication for over 12 yrs now. It started in 07’ from a cervical spinal fusion of the neck , that didn’t fix me it only led to more pain like nerve damage, cervical arthritis, fibromyalgia/ chronic fatigue syndrome, DDD, osteoarthritis, digestives & sleep issues along with anxiety and depression. With the dose I’m on , I’m not sure I can wait 2 years, tho I’m seriously lucky to have any medication, plus a support system here at home. Depression/anxiety/pain is a bad combination for those horrible thoughts & I’ll admit some days my mind goes to that place unfortunate. So I can’t imagine being without completely & having to wait two years for some hope. I wish everyone the best & gentle hugs to all my fellow chronic pain warriors! Spoonie , Jessica Agee xoxo

James McCay

WHAT KIND OF MORONS WORK AT & OVERSEE THE CDC?

First they release 2016 Opioid Guidelines done mainly by an average Family Physician & a Psychologist (NEITHER OF WHICH ARE ANY FORM OF OPIOID EXPERTS). We all know how that worked out: ALL PARANOID DOCTORS and OVEREACTION to “Guidelines” as if they were NEW HARDCORE RULES, IMMEDIATE CUTTING OFF OF OPIOIDS (without weaning by many) CAUSING THE HIGHEST SUICIDE RATE caused by the medical field ever, and doctors became so unduely PARANOID they absolutely REFUSED TO SEE NEW PATIENTS regardless of the patient’s severity of pain???
In short the CDC BROKE the entire Pain Management field!

Then FINALLY a few months ago it’s annonced that they are going to START fighting the importation of illegal Chinese OXYCONTIN & FENTANYL that gets in the US by way of Mexico! THIS IS WHAT SHOULD HAVE BEEN THE VERY FIRST THING DONE SINCE THE.GREAT MAJORITY OF OVERDOSE DEATHS WERE BY KIDS (avg. age 25) illegally using Oxycontin & Fentanyl! How is it that nearly all of us have known this since BEFORE the 2016 Guidelines, but the CDC TOTALLY MISSED THIS FACT???

There’s a lot going on behind the scenes here that none of us will ever be aware of, I’m convinced of this because NOTHING ELSE EXPLAINS THE ABSOLUTE STUPIDITY THAT HAS OCCURED (and was ALLOWED to occur???) SINCE 2017, actually since 2011 in NY where I live & have no option to LEAVE!

2021??? Are you kidding me! The AMA & US ATTORNEY GENERAL FOR HEATHCARE NEEDS TO DO A FULL INVESTIGATION OF THE CDC & SHUT THEM DOWN, THEN START FROM SCRATCH BECAUSE THEY ARE OBVIOUSLY A BROKEN ENTITY! How could they not be when the FDA & US InspectorGeneral AGREESWITH US? But they seem to scared to ACT & nullify the CDC Guidelines! Then allow the FDA to do the Guidelines (who I’ve though should have done it since DAY ONE).

NY still hasn’t gone to court to address ANY Opioid issues, nor will they! NY Democrats are TOO BUSY impeaching their OWN GUILT!

Dick fort

It’s about time hopefully this comes sooner then 2021 but either way it’s a move in correcting what they screwed up, but will it be to late and have doctors already totally made there mind up on them and that there terrible for paitents I guess we will see

Barbara Snow

I am so tired of leaving comments, here there and everywhere with capital letters. It does not make any difference. I have to move to a new state soon. All I want is to buy a gun before I leave here. Make sure my life partner is settled in a place where he will be surrounded by good people. And help him with his finances. Away from my children and grandchildren. Just in case I can’t find any help. I’m not writing any more letters that will have no impact. The government does not care about us, any more than they care about the homeless, addicts, or old people. We are just $ signs in their eye’s. The sooner we are gone the better.

Dave

We’re screwed.

Patricia Bradley

There is enough information available now to act. Why are they waiting for two more years to halt the harmful practice of these guidelines?
It’s torture and many more deaths are going to occur.

Linda Olds

The CDC should immediately say that they were wrong to set any kind of limits on opiate use except that it should be prescribed by a knowledgeable physician.
The ‘opioid’ crisis has nothing to do with the vast majority of chronic pain patients who are on morphine, Oxycontin, etc.
The rush to sue companies that produce these meds is fueled by ignorance and greed. It will only hurt pain patients.
Even though the CDC has said that they didn’t mean for patients to be tapered off their pain meds, it is still happening. Something needs to be done immediately to reverse this problem. Even a few days, a few hours of unnecessary pain is inexcusable. They need to act now, not in 2021.

Cecil Marble

I living with chronic pain I have had 12surgery on my knee two bad implants was put in just had another one put in the DEA they don’t know how much pain people are in they need to stay out it because it’s your body and they can’t tell you how much pain u are in you they need to be cut on and don’t give them anything for pain

Good luck with this. IMO, it is chasing rabbits down the hole instead of taking care of the elephant in the room-the attacks on good doctors for money and jobs by a rogue DOJ.

People need to learn the REAL cause of drug abuse, found as a video on https://www.doctorsofcourage.org/videos/, and we can stop the attacks on opioids, period. As long as the propaganda that opioids cause addiction is allowed to proceed, you won’t find appropriate treatment in 30 years, much less 2. Just look at history. When marijuana was attacked by Nixon in the late 60’s-70’s, how long has it taken to be recognized as a medicine, not a hallucinogenic? 50 years. That is standard pattern for eliminating false propaganda. Learn from history and learn what will stop it NOW, not 2050.

Chris

How many times do we all have to write comments about our chronic pain, forced tapering, not being able to get our medication, suicides, etc. on different sites, before these policy makers do something? It’s not like the definition of chronic pain has changed over the years.
These policy makers need to quit playing with our lives, quit stalling and make some decisions to help us! We’ve waited long enough, for no reason.