Are Federal Guidelines for Prescribing Opioids Hurting Patients with Chronic Pain?

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As Oklahoma and Purdue Pharma reach a landmark settlement, we look at an underreported result of the opioid crisis: the underprescribing of opioids for patients who rely on them for pain management. This month, more than 300 doctors and medical researchers sent an open letter to the Centers for Disease Control and Prevention warning patients have been harmed by a lack of clarity in guidelines for prescribing opioids. The CDC revised the guidelines for primary care physicians in 2016 in order to improve safety and reduce risks associated with long-term opioid therapy for chronic pain. But many say the new guidelines caused confusion and led to the reduction or discontinuation of opioids for people who responsibly use the medication to manage pain related to cancer, multiple sclerosis, lupus and fibromyalgia. We speak with Terri Lewis, a social scientist, rehabilitation practitioner and clinical educator who is running a national survey of patients and physicians to calculate the impacts of changes in chronic pain treatment. We also speak with Barry Meier, the author of “Pain Killer: An Empire of Deceit and the Origin of America’s Opioid Epidemic.” He was the first journalist to shine a national spotlight on the abuse of OxyContin.

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AMY GOODMAN: This is Democracy Now!, as we turn now, end the show, by looking at the flipside of the opioid crisis: the underprescribing of opioids for patients who rely on them for pain management. This month more than 300 doctors and medical researchers sent an open letter to the Centers for Disease Control and Prevention, the CDC, that warns patients have been harmed by a lack of clarity in guidelines for prescribing opioids. The CDC revised the guidelines for primary care physicians in 2016 in order to improve safety and reduce risks associated with long-term opioid therapy for chronic pain. But many say the new guidelines caused confusion and led to the reduction or discontinuation of opioids for people who responsibly use the medication to manage pain related to cancer, multiple sclerosis, lupus, fibromyalgia. A survey by the Pain News Network found more than 85 percent of patients say the CDC’s guidelines have made their pain and quality of life worse. Almost half those surveyed said the poor management of their pain prompted them to consider suicide.

For more, we’re joined by Terri Lewis, social scientist, rehabilitation practitioner, clinical educator, who’s running a national survey of patients and physicians to calculate the impacts of changes in chronic pain treatment.

Welcome to Democracy Now!, Terri. Can you explain this flipside? People might be congratulating the CDC by saying that prescriptions must be much lower. But talk about what is happening for people who are not addicted but need serious pain management.

TERRI LEWIS: Well, the bottom line is that the CDC guidelines were written for primary care, for new cases of illness and injury, and they were designed to prevent addiction from developing by not creating new people who were going to have a problem. The problem that we’re seeing is that these guidelines have been adopted and Incorporated into federal and state regulations in a way that they were never intended to. And we have characteristics in our population that we haven’t accounted for in this design. We’ve got an aging population. We’ve got an existing, multiply chronic care population that is on the books. These are people who are stable or have been stable in care, and they are no longer getting the care that they need, because we have applied and adopted a one-size-fits-all policy, a square peg in a round hole. And we’re seeing that problem develops in creating structural barriers throughout the whole care system.

AMY GOODMAN: So people are losing the ability to have their drugs paid by insurance. What role do pharmacies play in this?

TERRI LEWIS: Pharmacies are enrolled in insurer networks. Their job is to be a party to the dispensing decision that is made for people who live both in urban environments and rural environments. As the DEA reduces the available supplies, the job of the pharmacist is now to parse and determine who is a legitimate patient at the dispensing end versus who is not, and, secondarily, to determine who’s a reliable, legitimate prescriber and who is not. And that is a new role for pharmacists.

AMY GOODMAN: I want to go to former Attorney General Jeff Sessions speaking in February of last year about the opioid crisis.

ATTORNEY GENERAL JEFF SESSIONS: We need to stop addiction. The plain fact is, I believe, and I am operating on the assumption, that this country prescribes too many opioids. I mean, people need to take some aspirin sometimes and tough it out a little. That’s what General Kelly—you know, he’s a marine. He had a surgery on his hand. It was a painful surgery. He said, “I’m not taking any drugs.” It did hurt, though. He did admit it hurt. But, I mean, a lot of people, you can get through these things.

AMY GOODMAN: So, that’s Jeff Sessions saying, “Just take some aspirin.” I want to bring Barry Meier back into the conversation, author of Pain Killer: An Empire of Deceit and the Origin of America’s Opioid Epidemic. What about this flipside, the people who desperately need chronic pain management, and now they’re not—they’re losing their insurance for these drugs?

BARRY MEIER: Well, you know, the management of pain is an extremely complicated issue. And I agree with what Ms. Lewis said about there being a need for those patients to receive appropriate treatment. Appropriate treatment, however, doesn’t necessarily mean opioids. That’s not—one doesn’t equal the other. I think what doctors, what medical institutions are trying to do are use other technologies, other means of managing pain, other than opioids. And the successful application of those strategies has great value for patients in pain, because while we focus a lot on addiction, there are other serious health consequences to the long-term use of high doses of opioids. They have a range of side effects that patients would be well to be without. So, I think what we need to see and encourage is an evolution in pain management. And I think pain patients are a critical part of that evolution.

AMY GOODMAN: Terri Lewis, can you respond to Barry Meier?

TERRI LEWIS: Yes, I’d like to. First of all, I’ve been surveying this population since 2012. The majority of people that we’re concerned about are people with six or more chronic comorbid conditions. These are people who have been folded up in car wrecks by freight trucks. They have multiple progressive diseases that are not going to get better. By denying care at this level without a replacement system, we are denying people treatment. We do not have replacement treatment to deal with the kinds of problems that these folks have. Nor do we have payment systems and physicians trained to provide the care that is needed, both in urban and rural America, to serve this population. So, it’s a little naive to suggest that grandma, who is 82, who is dealing with not only Alzheimer’s, but also lupus and rheumatoid arthritis, is going to benefit from yoga and exercise. We have a very diverse, complex problem. There are at least four populations of pain patients in this problem. And we need to get the data right.

AMY GOODMAN: Last comment, Barry Meier?

BARRY MEIER: Well, I think that we have experienced a huge public health problem. Part of it has to do with the overprescribing of opioids—the overprescribing of opioids for patients who could benefit from other treatments. There are certainly patients that require and deserve these drugs. But for back pain, dental pain, the panoply of problems for which Purdue and others promoted this drug, that laid the seeds for what is the biggest health crisis we are now facing.

AMY GOODMAN: Well, I want to thank you both for being with us, Barry Meier, author of Pain Killer: An Empire of Deceit and the Origin of America’s Opioid Epidemic, and Terri Lewis, social scientist, rehabilitation practitioner, who’s running a national survey of patients and physicians to calculate the impacts of changes in chronic pain treatment.

And that does it for our broadcast. I’ll be speaking in Boston at the South Church on April 11, along with Noam Chomsky. You can check our website at democracynow.org.

Happy birthday, Nermeen Shaikh!

Democracy Now! has an immediate job opening. Check our website. I’m Amy Goodman. Thanks for joining us.

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