By Anne Fuqua, Guest Columnist
Since its birth in 1946 following World War II, the Centers for Disease Control and Prevention (CDC) has been a world leader in combatting disease and human suffering. The young agency earned worldwide acclaim through substantial contributions to our understanding of bacteria and the virtual elimination of malaria and typhus in the United States. The CDC provided a service to humanity with efforts attacking communicable diseases such polio, tuberculosis, and influenza.
In the latter part of the 20th century, the CDC expanded its role from fighting diseases to emerging health problems such as gun violence and workplace safety. Eventually the CDC’s National Center for Injury Prevention and Control was established – which is now tackling the prescription drug abuse problem by drafting new guidelines for physicians on the prescribing of opioid pain medications.
The CDC is recommending “non-pharmacological therapy” and other types of pain relievers as preferred treatments for chronic non-cancer pain. Smaller doses and quantities of opioids are also recommended. A complete list of the guidelines can be found here.
The guidelines may seem reasonable at first sight. But sadly, an agency that eliminated so much human suffering is now threatening to inflict more suffering on some of society's most vulnerable -- acute and chronic pain patients.
The population-based epidemiological approach that revolutionized efforts to control disease is simply not appropriate for the prescription drug abuse problem. With communicable diseases, the focus is on preventing them from spreading to a larger population. But if the prescription drug abuse problem is attacked in this way, millions of people that need opioids could be deprived of them.
Public health programs tend to prioritize the health of society as a whole as opposed to the individual. This was why tuberculosis sanatoriums were developed. They were seen as the most effective way to isolate and control the spread of that that deadly disease.
But tuberculosis is different from prescription drug abuse in several ways. First, it is a communicable disease. And secondly, unlike opioids, tuberculosis has no known benefit and its presence only contributes to human suffering.
When properly used, opioids are one of our greatest weapons against human suffering.
For reducing their use to be reasonable, we would have to accept that overprescribing is endemic and that more people are being hurt than harmed by opioids. That is simply not true, as opioid prescribing and overdoses have been declining in recent years. Many chronic pain patients during that period lost access to opioids as a result, because their doctors no longer prescribed them or pharmacists refused to fill their prescriptions. Some patients suffered so greatly they took their own lives.
Statistics show that opioid addiction occurs infrequently in chronic pain patients. Current estimates suggest 8% to 12% of patients develop actual addiction. Opioid misuse is more common (21% to 29% of patients), but misuse entails a wide range of often benign behavior such as taking a medication early, taking an extra dose, or ceasing to take medication. Yes, when a patient stops taking opioids because they are no longer in pain, it is often counted as “misuse.”
Another way to look at those statistics is that 90% of patients on opioids are not addicted and about 75% are strictly following their doctor’s orders. That's a pretty good compliance rate, is it not?
Putting efforts to fight drug abuse ahead of the compliant patient's need for pain medication is not good medicine and is simply unethical. Pain control promotes physical activity, social functioning and workplace productivity. It makes people healthier; physically, mentally and financially. Take that away and you are promoting physical inactivity, isolation, depression, disability, and a host of other health and social problems.
Removing compliant patients from a successful opioid regimen and allowing uncontrolled pain and its consequences violates the Hippocratic Oath that demands physicians “first do no harm.”
How did we come to this? Why is the CDC even getting involved in prescribing?
When addiction specialist Andrew Kolodny, MD, and others from the advocacy group Physicians for Responsible Opioid Prescribing (PROP) failed to convince the Food and Drug Administration to adopt tougher warning labels for opioids, they regrouped and focused their lobbying on the CDC. They knew the agency was historically more accepting of measures limiting individual freedoms for the welfare of society as a whole.
It appears PROP offered their "expertise" to assist the CDC with efforts to combat addiction and overdoses. PROP even managed to get several of its board members on CDC advisory panels. PROP's focus on reducing opioid overprescribing, combined with the CDC's public health approach to disease eradication, created the perfect storm that became the CDC's Opioid Prescribing Guidelines.
Sadly, the CDC’s legacy of reducing disease and human suffering is now being threatened by these guidelines – which will increase the suffering of patients who dutifully follow their doctor’s instructions. The welfare of these patients cannot and should not be compromised to protect vulnerable individuals from addiction.
(Editor's note: A spokesman for PROP denies the organization approached the CDC with the goal of getting the agency to draft opioid prescribing guidelines. "We did not ask CDC to do this. I am pleased that they're doing it, but I was actually pleasantly surprised. This was not something PROP asked CDC to do," he said.)
Anne Fuqua has primary generalized dystonia. She enjoys volunteering with animal rescue and youth programs in her community.
The information in this column should not be considered as professional medical advice, diagnosis or treatment. It is for informational purposes only and represents the author’s opinions alone. It does not inherently express or reflect the views, opinions and/or positions of Pain News Network.