By Jane Babin, Guest Columnist
The alphabet soup of federal agencies continues their full-frontal assault on pain patients and the opioid “epidemic.”
On Tuesday, the DEA raided the offices and home of Dr. Forest Tennant, an outspoken critic of federal efforts to regulate opioid prescribing.
Last week the DEA finalized plans for another 20 percent cut in the supply of opioid medication, apparently acting at the behest of 16 U.S. senators.
And this week FDA commissioner Scott Gottlieb declared a public health advisory over the increasing use of the herbal supplement kratom, telling people they should use FDA-approved medications instead.
Well, Dr. Gottlieb, people don’t have access to the FDA-approved pain medications they need and it’s getting worse each day. Fewer people might look for alternatives for their pain and/or addiction if they were treated adequately, with the dignity and respect they deserve, and without mistrust, denigration or a pound of flesh.
I’ve never bought into the narrative that the opioid “epidemic” was caused by prescription drugs or that the inevitable consequence of opioid pain treatment is addiction.
The problems are far too complex to assign blame to any one factor, person or group, and the simplistic solution of cutting opioid prescriptions flies in the face of not only my own experiences with opioids, but also that of millions of Americans with acute or chronic pain, and scores of respected pain specialists.
I was incredulous when the CDC proposed “voluntary” opioid prescribing guidelines in the dark, with a secret panel of wholly biased “experts,” most never having treated a patient for pain and perhaps never even being in the same room with one. I was even more outraged when it assembled a new CDC-friendly review committee and utilized a puppet scientific advisory committee to rubber stamp their approval.
After reports of fentanyl-related deaths appeared in the media, my reaction was two-fold:
- This explains the surprising surge in deaths of regular heroin users who are usually adept at managing their doses to avoid overdosing.
- This couldn’t solely be due to the diversion of prescription fentanyl, because it’s not easy to steal large quantities of transdermal patches and redistribute the fentanyl to heroin and pills.
Then, when carfentanil and other fentanyl analogues emerged, I thought the DEA, CDC and FDA would have to acknowledge that the “epidemic” wasn’t a prescription drug epidemic, because carfentanil isn’t prescribed to humans and is very tightly controlled. I was wrong.
What is even more concerning is their dogged refusal to consider the complexities of opioid addiction and alternative explanations for many opioid overdoses. If a person dies with a combination of alcohol, heroin, benzos, meth, and a trace of the Vicodin they took three days ago in their system, does that make it a prescription opioid death?
Yes, according to CDC analyses.
I wanted to know how the CDC's distinguishes between a prescription opioid death and those caused by incorrect coroner determinations, polypharmacy, counterfeit drugs, history of drug abuse, and even deaths from severe pain.
So I wrote to Deborah Dowell, MD, co-author of the CDC guideline and lead author of a recent article published in JAMA, which analyzed underlying factors in drug overdose deaths.
In that paper, Dowell acknowledges that “although increased heroin use and risk taking likely contribute, available data suggest contamination of the heroin supply with illicitly manufactured fentanyl as the overwhelming driver of the recent increases in opioid related overdose deaths.”
Which made me wonder what data was “available” and why they would need to qualify their conclusions.
“There are limited data about the effectiveness of interventions to prevent overdoses related to illicitly manufactured fentanyl,” Dowell explained. “However, interventions that reduce opioid use disorder and opioid overdoses are likely to reduce overdoses related to illicitly manufactured fentanyl. Unnecessary exposure to prescription opioids must be reduced to prevent development of opioid use disorder in the first place.”
Ah ha! So fentanyl is bad and they aren’t sure if they can save people from overdosing on fentanyl, so they want to target prescription opioids instead. Because, of course, all pain patients who take opioids inevitably develop opioid use disorder (at least they do after the American Psychiatric Association rewrote the definition of addiction.
I emailed Dowell and asked the following questions about her analysis of opioid deaths:
- How many different drugs did the decedents have in their bodies at death? What was the numerical range and average number? If other drugs were found, what were they?
- How many had a verifiable diagnosis or history of addiction? How many had a history of receiving opioid prescriptions for pain and for how long?
- Do prescription records validate a conclusion that the drug causing or contributing to death was a prescribed opioid?
- Were all causes of death considered, or was a death concurrent with detection of opioids presumed to be an overdose?
- In how many cases were police or coroner's findings considered and found consistent with the cause of death reported on the death certificate?
The response I received was astonishing. Less than 8 hours after emailing Dowell, I received a message from CDC’s Office of General Counsel. I had struck a nerve! They saw I was a lawyer and thought I was preparing for litigation.
After clearing my questions with CDC’s legal team, Dowell replied a week later. Her response should send a shiver down the spine of any pain patient who has been denied opioids, titrated down, or dismissed by his or her physician:
“The reality is that many of the answers to these highly specific and technical questions cannot be answered in a definitive manner based on available data.”
The bottom line is CDC does not have a grip on what’s really happening. CDC is targeting pain patients who are increasingly tortured by a medical profession scared silly by investigations and law enforcement. Yet they press on, with very little effect, continuing to blame prescription opioids and pain patients as the root cause of the opioid “epidemic” they aren’t responsible for.
The failure of the federal government’s efforts, particularly since the CDC guideline was issued, creates a justification to double down – no opioids for chronic pain and fewer opioids for acute pain -- all because pain never killed anyone and so there is no harm in forcing patients to suck it up.
The reality is that they can’t fix a problem they won’t acknowledge or attempt to understand, and they don’t have the data to understand it. They can’t manipulate data to support an agenda and then expect solutions based on faulty conclusions to ever reach a desired end.
Until they acknowledge what the real problems are, they will never solve them.
Jane Babin, PhD, is a molecular biologist and a biotechnology patent attorney in southern California. Jane has worked as a consultant for the American Kratom Association, a pro-kratom consumer group.
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.