Regulation of opioid formulations has increased and decreased over time for as long as opioid substances have been used by humans. Regulations are driven by many things, including prevalence of use to manage pain in a healthcare setting, connection to overdose, illegal drug trafficking, public opinion, religious views, politics, and science. The regulations have, at times, been more restrictive, and less so at other times.

The Pain Community has enlisted several people that represent different stakeholder groups in the Pain Management arena to share their perspectives on how the current state of opioid regulations impact them. We will hear from healthcare providers, patients, caregivers and public policy folks.

Negative consequences from the publication of the CDC Guideline for Prescribing Opioids for Chronic Pain are abundantly evident. Many of us in the pain community warned of this potential impact. Our words went unheeded.

There are increasing reports from people living with pain and their healthcare providers. Healthcare providers report that they feel forced to taper or discontinue opioid medications for their patients. Pressures from insurance providers, policy makers, medical societies and media play a key role. In many cases, patients who were once stable and thriving on a multi-modal, integrative pain treatment plan, including opioids as one of the treatment options, now suffer without the aid of opioids. People living with pain who have taken opioids responsibly (including jumping through all the hoops placed on them) report adverse effects of opioid withdrawal, deterioration in their quality of life and experiences of despair. Once engaged in living a productive, full life, now their poorly managed pain often renders them unable to work or to participate in social activities and family life. These negative effects also impact their families, friends, colleagues and medical team. Undue suffering caused from withdrawal effects and depression as their life experience becomes more unbearable has thrown many into a dark hole where end of life is considered a way out—thoughts or acts of suicide are becoming more common. This is happening to far too many, including staunch pain advocates.

This reality is unacceptable.

A recent Perspective in the New England Journal of Medicine written by three authors of the CDC Guideline acknowledges that “some policies and practices purportedly derived from the Guideline have in fact been inconsistent with, and often go beyond, its recommendations…resulting in sudden opioid discontinuation or dismissal of patients from a physician’s practice…Such actions are likely to result in harm to patients.” The authors recommend that “Policies should allow clinicians to account for each patient’s unique circumstances in making clinical decisions.”

We at TPC call on you to act by sharing your experiences.

  • If opioids are or were a part of your integrative pain management plan and tapering and/or rapid discontinuation of opioid therapy was recommended, we want to hear about it.
  • If you are a healthcare provider who struggles with the pressures placed on you to taper or discontinue opioid therapy while watching your patient’s quality of life slip away, we want to hear about it.

The first in the series comes from our Board Chair, Karen Kiefer, MSN, APN, NP-C, RN-BC, and illustrates the healthcare providers’ dilemma.

Please read each article in the series and explore the provided references as they are presented in the coming weeks. We encourage you to comment on the articles and invite you to submit a blog with your own perspective.

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