ATIP WhitePaper: Principles for a Revised Opioid Prescription Guideline

A CDC Guideline for prescribing opioids to adults in chronic non-cancer pain was published in March 2016.  It has since become clear that this Guideline is generating horrendously negative outcomes for chronic pain patients and their doctors.  Many doctors are choosing to leave pain management rather than face possible prosecution by State authorities or the US Drug Enforcement Agency, for “over-prescription” of pain relieving opioids.  Tens (if not hundreds) of thousands of patients are being summarily discharged without referral and sometimes without management of opioid withdrawal. There are increasing reports of patient suicides.

Many medical professionals have published sharply critical reviews of the problems of the CDC Guideline.  Also of deep concern are proposed 2019 rule changes by the US Centers for Medicare and Medicaid, which make the Guideline a mandatory standard for insurance reimbursement and place sharp limits on the duration of opioid treatment for acute pain.

Many knowledgeable professionals and informed patients believe that the CDC Guidelines were deeply influenced by anti-opioid bias on the part of writers on the CDC Working Group which authored it. Even more damaging have been revelations that medical evidence assembled in support of the work was manipulated to discredit opioid reliability and to over-magnify opioid risks.  As one group of medical professionals aptly phrased the issues, the CDC Guidelines are “neat, plausible, and generally wrong.”  Inarguably, so also is most of the dominant public narrative on opioids and chronic pain. As phrased in a widely viewed TED Talk on U-Tube, “Everything You Think You Know About Addiction is Wrong.”

Read and download the rest of the White Paper.

References and Further Reading

Dowell D, Haegerich TM, Chou R., “CDC Guideline for Prescribing Opioids for Chronic Pain-United States, 2016.” JAMA. 2016;65. doi:10.1001/ jama.2016.1464.
https://jamanetwork.com/journals/jama/fullarticle/2503508

Stefan J Kertesz and Adam J Gordon, “Strict limits on opiod prescribing risk the ‘inhumane treatment’ of pain patients.” Stat News, February 24, 2017 [see reader comments] https://www.statnews.com/2017/02/24/opioids-prescribing-limits-pain-patients/

Jacob Sullum, “America’s War on Pain Pills is Killing Addicts and Leaving Patients in Agony,” Reason Magazine, April 2018 edition.

Bob Tedeschi, “A ‘civil war’ over painkillers rips apart the medical community — and leaves patients in fearSTAT News, January 17, 2017.
https://www.statnews.com/2017/01/17/chronic-pain-management-opioids/

Geralyn Datz, “Chronic Pain – A Suicide Story”, National Pain Report, February 26, 2018, http://nationalpainreport.com/chronic-pain-a-suicide-story-8835614.html

Thomas Kline, MD, Ph.D. “Pain Related Suicides”, February 2018. Medium. https://medium.com/@ThomasKlineMD/suicides-associated-with-non-consented-opioid-pain-medication-reductions-356b4ef7e02a

Jeffrey A. Singer, MD. “Let’s Stop The Hysterical Rhetoric About the Opioid Crisis,” Cato Institute – Commentary, August 31, 2017,
https://www.cato.org/publications/commentary/lets-stop-hysterical-rhetoric-about-opioid-crisis

Carl L. Hart, Ph.D., “People Are Dying of Ignorance, Not Because of Opioids” Scientific American, November 1, 2017
https://www.scientificamerican.com/article/people-are-dying-because-of-ignorance-not-because-of-opioids/

US Health and Human Services Centers for Medicare and Medicaid, “Advance Notice of Methodological Changes for Calendar Year (CY) 2019 for Medicare Advantage (MA) Capitation Rates, Part C and Part D Payment Policies and 2019 draft Call Letter.”   https://www.regulations.gov/docket?D=CMS-2017-0163

Baraa O. Tayeb, Ana E. Barreiro, Ylsabyth S Bradshaw, Kenneth K H Chui, Daniel B Carr, “Durations of Opioid, Nonopioid Drug, and Behavioral Clinical Trials for Chronic Pain: Adequate or Inadequate?” Pain Medicine, Volume 17, Issue 11, 1 November 2016, Pages 2036–2046.
https://academic.oup.com/painmedicine/article/17/11/2036/2447887

Stephen A. Martin, MD, EdM;  Ruth A. Potee, MD, DABAM; and  Andrew Lazris, MD, “Neat, Plausible, and Generally Wrong: A Response to the CDC Recommendations for Chronic Opioid Use”, Medium Corporation, September 7, 2016
https://medium.com/@stmartin/neat-plausible-and-generally-wrong-a-response-to-the-cdc-recommendations-for-chronic-opioid-use-5c9d9d319f71

Johann Hari, “Everything You Think You Know About Addiction is Wrong”, TED Talks, June 2015, https://www.ted.com/talks/johann_hari_everything_you_think_you_know_about_addiction_is_wrong