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.
It is a sad and frightening state when the government paints all patients with the same brush of addiction. Not all patients have the disease of addiction. However many people with pain are paying the price of being treated like addicts. Legislators do not understand the complicated range of pain, patients and vulnerable populations. In an effort to obliterate deaths from all opioids (including illegal drugs laced with opioids) they enacted legislation on rapid tapering in many states. I urge you to contact your congressman, senators and any legislator that will listen to your story. Many professional organizations are fighting the rapid tapers as you experienced. Many HCP have been raided by the DEA and accused of inappropriate prescribing. Patients and HCP are in this storm together and we all must work towards solving it. Thank you so very much for sharing.
I have been a totally compliant chronic pain patient since 2000. Back surgery 2001, back fusion 2004, r hip replacement 1995, l hip replacement 2006, r hip revision 2015, 1987 car accident that should have killed me…broken back.. in hospital for 3 weeks. The initial right and left hip replacements are of the recalled variety that have left me with extremely elevated cobalt and chromium blood levels. The 2015 hip revision left me with multiple areas of oestiolysis that had to be debrided and repaired with cadaver bone.The wear particulate literally caused my bone to be eaten away. My entire spine has issues, stenosis, degenerative disk disease, permanent nerve damage, etc… Over 18 years I was slowly titrated up to 1100mme. Beginning in Oct 2018 I was tapered down to 60 mme in Feb 2019. Soma was abruptly stopped( only muscle relaxer that was effective for me, and yes I have tried every other I could get approved or afford. A medication called Phrenelin was abruptly stopped(a benzo) that was a miracle for neck pain and preventing my migraines. I lost my pain mgt Dr. of 14 years due to DEA raid. This Dr treated a collection of patients that were suffering from unintended consequences of failed surgeries, cancer patients, incurable diseases, and those needing palliative care. I do not blame my PCP for his actions under the current climate. He was just practicing ” cover his ass” medicine. He did not abandon me. He has sent out a plethora of referrals to pain mgt dr’s. I have had appointment with 6 pain mgt dr’s all of whom said there was nothing they could do for me and passed me back like a hot potato back to my PCP. I have tried every modality of pain management treatments that are available that I could get approved, or could afford. Pain medication has been a treatment that has relieved my pain, restored my function, allowed me to raise my two daughters that I have full custody of. I have a college degree, a concealed carry permit (FBI background check to get one), and am an American citizen in good standing. My rights have been violated and I believe that history will show that this is a dark time in medical care for those in pain.
This period time will be seen as the Dark Ages of pain management. I just hope that I can find a place to move to where patients are treated before the end of my life.