Proposed 2016 Guideline for Prescribing Opioids for Chronic Pain

Regulations_gov

 

 

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Proposed 2016 Guideline for Prescribing Opioids for Chronic Pain

*** Deadline for Public input — ends Wednesday, January 13th ***

Page down to see “4 WAYS you can add your voice” and to view the full list of Proposed Guidelines.

Please note that EDS Awareness is not advocating FOR or AGAINST these guidelines. We are providing information as a service to those who want to express an opinion on this proposal.

You may be aware that the Centers for Disease Control and Prevention (CDC) has proposed a “Guideline for Prescribing Opioids for Chronic Pain”. The proposed guideline were written by a small group of people with questionable expertise and bias, that didn’t take into account any specific chronic conditions (except to exclude cancer pain). The result is that some of the guidelines could make it more difficult for people with disabling chronic pain conditions like Ehlers-Danlos (EDS).

 

Please refer to the 12 point outline of the proposed Rx guidelines & link that appears later in this email below or http://www.regulations.gov/#!docketDetail;D=CDC-2015-0112

 

WHAT can I do if I disagree with this proposal?

The government is currently gathering public input on these recommendations, but the comment period ends this Wednesday, January 13th, at 11:59pm ET. There are currently very few comments (for something of this scope– tens of millions of Americans with chronic pain), and many of them are from people who don’t seem to understand disabling chronic pain at all. I hope some people in the EDS community will share their own thoughts and experiences.

 

4 WAYS you can help our EDS patient voices to be heard:

 

1) Petition for people to sign (to send to the President, Eliz. Warren et al)

Important petition concerning the DEA and its retraction of opioids for pain treatment.

http://www.petition2congress.com/5202/first-do-no-harm-dea-targets-physicians-who-treat-their-patients

 

2) Subject: Re: A powerful tool to stop abuse at hospitals- call the insurance companies!!!!!

http://empoweredpatientcoalition.org/report-a-medical-event/report-a-hospital-or-facility/

 

3) Subject: Link for Comments on CDC Opioid Restrictions

 

Here is the link for anyone who has still not commented on the restrictive CDC opioid guidelines that will harm many in our community.

http://www.regulations.gov/#!submitComment;D=CDC-2015-0112-0001

 

 

4) Templates for writing a LETTER:

 

Sample DEA Letter:

 

Dear Decision Maker:

In the current political climate, more and more physicians are afraid to treat patients who suffer from debilitating chronic pain. This is due to the misguided campaign by the DEA, which has had a chilling effect on how doctors treat their patients and what they prescribe. This failure is deeply harmful to patients suffering from chronic pain, and can cause lifelong damage, both physically and mentally. It often causes the sufferer to withdraw from society and discourages them from seeking appropriate medical treatment.

 

By discriminating against pain patients in this way, which makes them feel labeled, humiliated, and abandoned, the medical system is unwittingly causing an increase in both depression and suicide among this population of patients.

Doctors must instead treat the whole patient, addressing complex medical conditions and the underlying causes of chronic pain when possible. However, there are many instances, from failed surgeries to repeated injury and connective tissue diseases, when doctors are not yet able to clearly identify the cause of pain. It exists nonetheless. Concerns about possible addiction must be balanced with a concern for the patient’s quality of their life and their right to live their life to live without debilitating pain.

 

I have a genetic connective tissue disease, Ehlers Danlos Syndrome, which is associated with high levels of joint pain. For several years, I have been able to avoid taking anything for the pain, but I am concerned that this option will not be available to me, should I need it as my disease progresses.

 

Chronic pain patients are not the cause of the current opioid abuse epidemic. To understand that, we should be looking at the dangerous marketing practices of pharmaceutical companies, the absurdly high case loads that many doctors are forced to carry, and the failure of our health care system to value meaningful relationships between doctors and their patients.

Sincerely,

your name

Sample Comment to the CDC:

The Proposed 2016 Guideline for Prescribing Opioids for Chronic Pain will result in more and more physicians refusing to treat patients who suffer from debilitating chronic pain. The misguided campaign by the DEA has already had a chilling effect on how doctors treat their patients and what they prescribe. This failure is deeply harmful to patients suffering from chronic pain, and can cause lifelong damage, both physically and mentally. It often causes the sufferer to withdraw from society and discourages them from seeking appropriate medical treatment. By discriminating against pain patients in this way, which makes them feel labeled, humiliated, and abandoned, the medical system is unwittingly causing an increase in both depression and suicide among this population of patients. Doctors must instead treat the whole patient, addressing complex medical conditions and the underlying causes of chronic pain when possible. However, there are many instances, from failed surgeries to repeated injury and connective tissue diseases, when doctors are not yet able to clearly identify the cause of pain. It exists nonetheless. Concerns about possible addiction must be balanced with a concern for the patient’s quality of their life and their right to live their life to live without debilitating pain.

 

I have a genetic connective tissue disease, Ehlers Danlos Syndrome, which is associated with high levels of joint pain. I am concerned that appropriate care will not be available to me as my disease progresses. Chronic pain patients are not the cause of the current opioid abuse epidemic. To understand that, we should be looking at the dangerous marketing practices of pharmaceutical companies, the absurdly high case loads that many doctors are forced to carry, and the failure of our health care system to value meaningful relationships between doctors and their patients.

 

Sincerely,

your name

 

These are the 12 proposed recommendations:

“Guideline for Prescribing Opioids for Chronic Pain” (complete details on each may be read in the PDF, link at the bottom):

 

“1. Nonpharmacologic therapy and nonopioid pharmacologic therapy are preferred for chronic pain. Providers should only consider adding opioid therapy if expected benefits for both pain and function are anticipated to outweigh risks to the patient.

 

  1. Before starting opioid therapy for chronic pain, providers should establish treatment goals with all patients, including realistic goals for pain and function. Providers should not initiate opioid therapy without consideration of how therapy will be discontinued if unsuccessful. Providers should continue opioid therapy only if there is clinically meaningful improvement in pain and function that outweighs risks to patient safety.

 

  1. Before starting and periodically during opioid therapy, providers should discuss with patients known risks and realistic benefits of opioid therapy and patient and provider responsibilities for managing therapy.

 

  1. When starting opioid therapy for chronic pain, providers should prescribe immediate-release opioids instead of extended-release/long-acting (ER/LA) opioids.

 

  1. When opioids are started, providers should prescribe the lowest effective dosage. Providers should use caution when prescribing opioids at any dosage, should implement additional precautions when increasing dosage to ≥50 morphine milligram equivalents (MME)/day, and should generally avoid increasing dosage to ≥90 MME/ day

 

  1. Long-term opioid use often begins with treatment of acute pain. When opioids are used for acute pain, providers should prescribe the lowest effective dose of immediate-release opioids and should prescribe no greater quantity than needed for the expected duration of pain severe enough to require opioids. Three or fewer days usually will be sufficient for most nontraumatic pain not related to major surgery.

 

  1. Providers should evaluate benefits and harms with patients within 1 to 4 weeks of starting opioid therapy for chronic pain or of dose escalation. Providers should evaluate benefits and harms of continued therapy with patients every 3 months or more frequently. If benefits do not outweigh harms of continued opioid therapy, providers should work with patients to reduce opioid dosage and to discontinue opioids.

 

  1. Before starting and periodically during continuation of opioid therapy, providers should evaluate risk factors for opioid-related harms. Providers should incorporate into the management plan strategies to mitigate risk, including considering offering naloxone when factors that increase risk for opioid overdose, such as history of overdose, history of substance use disorder, or higher opioid dosages (≥50 MME), are present.

 

  1. Providers should review the patient’s history of controlled substance prescriptions using state prescription drug monitoring program (PDMP) data to determine whether the patient is receiving high opioid dosages or dangerous combinations that put him or her at high risk for overdose. Providers should review PDMP data when starting opioid therapy for chronic pain and periodically during opioid therapy for chronic pain, ranging from every prescription to every 3 months.

 

  1. When prescribing opioids for chronic pain, providers should use urine drug testing before starting opioid therapy and consider urine drug testing at least annually to assess for prescribed medications as well as other controlled prescription drugs and illicit drugs.

 

  1. Providers should avoid prescribing opioid pain medication for patients receiving benzodiazepines whenever possible.

 

  1. Providers should offer or arrange evidence-based treatment (usually medication-assisted treatment with buprenorphine or methadone in combination with behavioral therapies) for patients with opioid use disorder.”

 

You can view the full PDF (the first link under “Supporting Documents”) and submit comments on this government website:

http://www.regulations.gov/#!docketDetail;D=CDC-2015-0112

 

Thanks to those who contributed to this posting,

EDS Awareness staff

 

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