In the early days of this blog, I wrote about my perceived overprescription of opioid painkillers, how chronic disease fits in there, and why doctors often don’t have much choice in the matter. It turns out the CDC thinks the same.
“More than 40 Americans die each day from prescription opioid overdoses, we must act now,” said CDC Director Tom Frieden, M.D., M.P.H. “Overprescribing opioids—largely for chronic pain—is a key driver of America’s drug-overdose epidemic. The guideline will give physicians and patients the information they need to make more informed decisions about treatment.” (nationalpainreport)
So the CDC released recommendations for primary care physicians on opioids. Considering the anticipation around the issue, the actual report is kind of sobering. Try to prescribe non-opioid painkillers first. Limit the time these painkillers are given. Follow-up on your patients. No shit, Sherlock! (The big exception to these rules is cancer and end-of-life care of course).
Pharmaceutical companies protested, other critics felt that in these recommendations the focus is more on the danger of addiction, and less on the patient, their needs and, oh, yeah, their opinions on the matter.
As one patient stated in a comment:
At this point in my life, I’m 54 and have had 4 lumbar surgeries, a fusion at L4/5 and 3 cervical surgeries with 2 fusiond @ C6/7. I try to workout every day to strengthen those muscles and keep as strong as I can, but without my medication, I’d be lying in a bed or be in a wheelchair because of the pain. Why should I have to suffer because of the addicts who don’t need these medications, but either get them from their parents medicine cabinets or even worse, directly from the doctor himself or herself. I lock my meds up at all times. I’m just saying that all of these restrictions are hurting people who have real, chronic pain.
So, the question does arise: are we denying people with chronic pain quality of life because of America’s ever increasing war on drugs? And will there just be a bigger illegal market for opioids? Most states don’t allow medical marijuana, and doctors are hesitant to prescribe it as long term treatment, because there is too little research. So the patient will be on their own again.
I also feel that doctors get the blame laid at their feet. Since there are few alternatives, what are they supposed to do? When I am in a bad flare, a tylenol or aleve just won’t cut it.
Right now, these guidelines are nothing more: guidelines, recommendations, that at first seem to be common sense. How this will play out, we shall see.