I am taking the time to share with you how stressful my chronic pain practice has become since insurance companies, community and state opioid task forces, local pharmacists, anti-opioid stakeholders, etc., began adopting the 2016 CDC Guidelines for prescribing Opioids for Chronic Pain as model legislation versus using it as a guideline for safely prescribing opiates and managing pain therapy.
I am a Nurse Practitioner of 23 years, specialized in Addiction Medicine, Hospice & Palliative Medicine, Terminal pain, Chronic pain and formerly Birth pain. Pain is very complex in nature and there is not a single solution for treatment and healing. I whole heartedly believe pain is to be treated as a multimodal, individualized, integrative, biosychosocial condition. To meet all of these qualifiers and receive adequate treatment, many chronic and palliative pain patients would by definition include regular use of opioids for optimal pain relief and consequently improve quality of life and ability to function. Legitimate pain patients (who have failed all other non-opioid remedies) are burdened by their daily dependance on opioids (who really looks forward to the daily ups and downs of significant pain levels and chasing pain with serial medication dosing!). From my clinical experience, patient’s with chronic pain take opioids because they actually want to LIVE with less pain and have functional lives. Unanimously, chronic / palliative pain patients report opioids allow them to achieve their desire to perform their activities of daily living, drive to and function at work, play with their children, travel, exchange intimacy, etc. It is also my experience that chronic pain patients have tried and failed numerous non-opioid therapies without finding adequate sustained relief and only elect opioids when other treatments have failed to allow them to achieve measured functional pain relief for improved life quality.
Since the mass adoption of the 2016 CDC Guidelines, I have received pain patients who were suddenly dismissed by their providers who had been prescribing them high opioid doses (300 to 700+ daily MME’s). I have had pharmacists tell me I am not allowed to prescribe above 90MME (mind you, individualized pain management for all of my established patients, including terminal and palliative, ranges 5 - 300 MME daily and 100% have Narcan and 100% are safety screened and educated at each visit and 100% are not addicts). I attended our 2018 state Opioid Task Force Consortium whereby the content was 100% anti-opioid and totally focused on addiction mangement. Patients who rely on a treatment method that reduces chronic pain do not meet the criteria of being “addicted”. These patients may well have developed dependance and or episodic tolerance, yet this is significantly different from “addiction," which has its own set of criteria defined by DSMV as Opioid Use Disorder. To describe everyone who uses opioids for pain as an “addict” is potentially harmful patient mislabeling and misdiagnosing. The 2016 CDC Guideline implementation has caused patient dumping, forced opioid tapering (often more rapidly than is helpful and safe for the patient), increased patient debilitation, increased patient use of alcohol and other drugs, increased depression, anxiety and suicide in patients who have their pain management altered or discontinued, increased provider cessation of pain management and increased DEA provider arrests and licensure revocation.
I have become insecure as a Pain Provider because I feel non-medical entities are guiding the course of pain management and government entities are prosecuting pain providers and miseducating the public - chronic pain patients are legitimately opioid dependent; NOT opioid addicts! Chronic pain patients who are opioid dependent rarely have overdoses and only a select few develop addiction. This is because Chronic Pain patients want tolive and function, NOT because they want to take excess opioids, overdose and possibly die. Most Americans do not know the difference between opioid dependance for pain relief versus opioid dependance for opioid addiction. The White House, the media and other uneducated sources have widely disseminated mis-information about this very serious issue! My comments are respectfully submitted to this Task Force from this provider who has devoted her life to gold standard evidence based patient care.
Source: "Nurse Practitioner letter to HHS pain task force"