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19lin
@19lin

Posts: 127
Joined: Mar 22, 2016

The CDC and FDA are trying to cut back opioids by 25% nation wide

Posted by @19lin, Nov 3, 2016

There are many pain groups that are taking issue with the decision of the government agencies to reduce the availablity of opiods. I suggest that any one who suffers from pain, whether they use pain medicine or not, needs to let their elected offical know how they feel about cutting pain medicine to chronic pain suffers. There are many groups out their although Mayo’s is one of the few with a discussion board. Some of the others are Peoplewithpainmatter.org; USpainfoundation.org; Pain News Network and others. Some of them are sponsoring a campaign to write to your represenative about pain issues. Even if you can manage your pain without medication there are others who need the extra help of medication. This constant attempt of politicians to interfere between a doctor and their patient is a dangerous trend in my opinion. Medical doctors have a lot to do and think about without worring about if they perscribe some pain medicine will they end up in court defending their license to practise. One thing we all need to do is be aware of the events that effect our lives, beyond the immediate need for treatment. Too often the law makers over react to events without considering the long term effects of their actions. There is a group who is pushing for ways to prevent abuse of pain medication and that is fine, but if they do things their way they will stop all pain medicine except for terminal cases and emergy needs. This is why we need to contact our law makers and let them know that any law they pass can have an adverse effect on long term sufffers. Many people use strong pain medicine so that they can continue to work and carry on with their life in as normal a matter as possible. If the medicine is stopped then they can’t work or take care of their families or even lead a near normal life. (Sorry the spell checker is not working) 19lin

REPLY

As I understand the 25 percent cut in opioid production, the initiative came from the Drug Enforcement Administration (DEA), not the Center for Disease Control (CDC) or the Food and Drug Administration (FDA).

The difference could be crucial. The DEA has authority under federal law to limit the amount of a scheduled drug that may be produced and marketed by a drug manufacturer. Neither the CDC nor the FDA has that power over the pharmaceutical industry. Moreover, the DEA is not required to take account of patient needs when it moves to limit the manufacture of a drug. In contrast, the CDC and the FDA are focused — by law as well as by basic principles — on sensible concerns for patient health and comfort.

The DEA’s final decision in the matter was published about a month ago in the Federal Register. You can read it at https://s3.amazonaws.com/public-inspection.federalregister.gov/2016-23988.pdf.

An analysis of the DEA ruling is available at http://www.huffingtonpost.com/entry/dea-cutting-prescription-opioids_us_57f50078e4b03254526297bd.

A good example of the FDA dealing with patient use of opioids was published two months ago. The FDA issue a strong warning that the use of prescription opioids and benzodiazapines pose major risks to users, especially if they are taken together or in combination with alcohol. In a notice published at http://www.fda.gov/Drugs/DrugSafety/ucm518473.htm, the FDA told health care professionals to stop prescribing opioid cough medicines for patients taking benzodiazapines — or other depressants of the Central Nervous System (CNS) including alcohol. They should prescribe opioids for pain only when other treatment options are inadequate.

Opioids are widely prescribed for pain and cough. Benzodiazepines are often used for anxiety, insomnia, seizures, and sleep problems. Combinations of these drugs can cause extreme sleepiness, slowed or difficult breathing, coma, and death, the FDA said. At the FDA web site, several pages explain the risks and list the dozens of opioids and benzodiazapines on the market to which the FDA warning applies.

@predictable

As I understand the 25 percent cut in opioid production, the initiative came from the Drug Enforcement Administration (DEA), not the Center for Disease Control (CDC) or the Food and Drug Administration (FDA).

The difference could be crucial. The DEA has authority under federal law to limit the amount of a scheduled drug that may be produced and marketed by a drug manufacturer. Neither the CDC nor the FDA has that power over the pharmaceutical industry. Moreover, the DEA is not required to take account of patient needs when it moves to limit the manufacture of a drug. In contrast, the CDC and the FDA are focused — by law as well as by basic principles — on sensible concerns for patient health and comfort.

The DEA’s final decision in the matter was published about a month ago in the Federal Register. You can read it at https://s3.amazonaws.com/public-inspection.federalregister.gov/2016-23988.pdf.

An analysis of the DEA ruling is available at http://www.huffingtonpost.com/entry/dea-cutting-prescription-opioids_us_57f50078e4b03254526297bd.

A good example of the FDA dealing with patient use of opioids was published two months ago. The FDA issue a strong warning that the use of prescription opioids and benzodiazapines pose major risks to users, especially if they are taken together or in combination with alcohol. In a notice published at http://www.fda.gov/Drugs/DrugSafety/ucm518473.htm, the FDA told health care professionals to stop prescribing opioid cough medicines for patients taking benzodiazapines — or other depressants of the Central Nervous System (CNS) including alcohol. They should prescribe opioids for pain only when other treatment options are inadequate.

Opioids are widely prescribed for pain and cough. Benzodiazepines are often used for anxiety, insomnia, seizures, and sleep problems. Combinations of these drugs can cause extreme sleepiness, slowed or difficult breathing, coma, and death, the FDA said. At the FDA web site, several pages explain the risks and list the dozens of opioids and benzodiazapines on the market to which the FDA warning applies.

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@predictable:
This is my second attempt to reply. Thank you for clarifing the source of the 25% reduction. I only saw articles giving the FDA and CDC as being involved. Also thanks for the Huffington Post article reference it helps explain things. Still I am disheartened to see that there is little being done to improve things.
The medical-industrial complex is out to make money at the expense of everyone no matter the cost in lives and sufffering. They have no problem in finding the few weak links in our government and influencing them to help with ill conceived regulations and laws that are likely to increase their profits.
The need for good research to develop alternative pain medication as well as research into what pain is and how it works in our body, how to objectivily measure it, and what works best to control it are all areas that need more work. When I read some of the postings on the chronic pain site it is evident that there is much that medical science does not know. My pain started when I lost my leg and I experience strong phantom pain that no one could explain to me. Some doctors said it was all in my head, others believed I had the pain but did not want to give me any evil drugs to treat it. At the time all I knew was that I could not sleep or rest or do anything without considering the pain I felt. It did not help that among the other amputees on my ward only a few of us had strong pain and a few luckly ones had no pain or sensation of any kind. In a private room down the hall was a nurse from world war II who was much worst off than all of us. She had no appearent injuries but was in constant pain all the time. When anyone came near her she would scream at the top of her lungs as she feared they were going to touch her in some manner thus causing her immeasurable pain. The floor nurses told us no one had any idea what caused her pain nor what to do about it. It was here, some 48 years ago, that I learned how little medical science knows about pain.
The current manipulations by our government agencies just confirms that they have not learned much except what has always been known, that money is king. (please excuse the errors my spell check is still not working) 19lin

The post relative to pressure on docs to curtail prescribing opiods is correct that the DEA is the source of the pressure. All of a sudden I get a phone call from my Humana Pharmacy mail order clinic that they will no longer dispense my Fentanyl patches that have saved my life for 13 years, and Oxycodone pills which I only use for breakthrough pain. My kind, wise pain management doc is furious. “So the DEA and the pharmacists know more about you than I do!?” (He’s mad at them, not me.) “I have examined you physically, read your medical history, treated you and prescribed for you, but THEY know better?!!”
He said the DEA has power over pharmacists but not doctors. He said it’s a result of deaths by Fentanyl, but curtailing this drug by preventing legitimate patients from getting it, will NOT prevent the addict from getting it.
I was able to convince a Walgreens local pharmacist that I need it. After many questions!
I know the drug is strong, but it has enabled me to play with my grandchildren and exercise…..BOTH critical to my well being!
Without it I would be in bed, curled up in a fetal position, crying! And I’ve been there.

@barbara94, my understanding of the DEA’s authority is that it focuses on drug manufacturers — setting ceilings on the amount of a medication that a manufacturer may produce AND sell. Its influence on pharmacists is indirect — through the pharmaceutical manufacturers, as I understand it. Does this make a difference?

I’m not sure, but it looks like we patients have the power to make demands of our medical treatment teams as well as our pharmacists, without encountering DEA authority or enforcement. I’d be inclined to argue with my pharmacist, just as I argue with the first medical specialist who gives me a quick and convenient (for him or her) diagnosis and treatment plan. This is another chance to stand up against misguided medical advice.

@barbara94

The post relative to pressure on docs to curtail prescribing opiods is correct that the DEA is the source of the pressure. All of a sudden I get a phone call from my Humana Pharmacy mail order clinic that they will no longer dispense my Fentanyl patches that have saved my life for 13 years, and Oxycodone pills which I only use for breakthrough pain. My kind, wise pain management doc is furious. “So the DEA and the pharmacists know more about you than I do!?” (He’s mad at them, not me.) “I have examined you physically, read your medical history, treated you and prescribed for you, but THEY know better?!!”
He said the DEA has power over pharmacists but not doctors. He said it’s a result of deaths by Fentanyl, but curtailing this drug by preventing legitimate patients from getting it, will NOT prevent the addict from getting it.
I was able to convince a Walgreens local pharmacist that I need it. After many questions!
I know the drug is strong, but it has enabled me to play with my grandchildren and exercise…..BOTH critical to my well being!
Without it I would be in bed, curled up in a fetal position, crying! And I’ve been there.

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@barbara94 I understand what you are saying, I have Tricare through Healthnet. They have no problem with my Rx’s for pain it’s my doctor! I was taken off Fentanyl patch 25 mcg and 5 mg Oxycodone for breakthrough pain. I came off them without any withdrawal side effects in just one month. Obviously I was not addicted.The pain management docs in my area won’t even prescribe opiates at all. My PCP has be on 2 Vicodin a day. Yes you read that correctly TWO a DAY. So I basically get to choose which couple of hours I want to have relief from Chronic neck pain caused by a host of issues. Common sense just doesn’t seem to have a place in our society any more.

I knew this was coming when every news cast mentioned the oxycontin and vicodin rx’s flooding the midwest. The Governments historical response to drug use/abuse is to punish the users..It’s a crime to Doctor Shop..Going to two or three different Doctors for the same pain medication. the second response for those who need them is to make the prescription pain meds very difficult to obtain for everyone user or abuser. They have created a central database to monitor doctors and how many pain prescriptions they are writing a month and to monitor patients and their prescription drug use. as an example is use the over the counter drug Bronkaid to help with my COPD. It is also a CNS stimulant which has the same effects as amphetamines on a much milder scale. Every time I buy a box of 60 tablets They scan my drivers license into the system. Bronkaid is Ephedrine Sulfate and if you are a drug dealer it is very easy to cook the Ephedrine Sulfate into a very powerful amphetamine (Methedrine I think) and then sell it at a great profit. The Government never thinks about helping people with a drug problem by opening detox centers and rehab clinics.To cut the supply of the drug and criminalize its use has led to a dramatic increase in Heroin addiction.It is cheap to obtain and of a very high quality….The first new cases of HIV are showing up in these mid west communities. Treatment and rehabilitation almost completly unavailable. Arrests and jail time at an all time high…..We deserve the kind of Goverment we voted…. for. Just wait for Trump to really get going….and we voted him in.

Thanks for your comments, @medpup. I was taken especially by the statement that “They have created a central database to monitor doctors and how many pain prescriptions they are writing a month and to monitor patients and their prescription drug use.”

Could you provide some further information? Who is “they?” Where might I find information about the central database and what it is being used for? I would be greatly troubled by monitoring doctors and patients. Thanks.

@predictable

Thanks for your comments, @medpup. I was taken especially by the statement that “They have created a central database to monitor doctors and how many pain prescriptions they are writing a month and to monitor patients and their prescription drug use.”

Could you provide some further information? Who is “they?” Where might I find information about the central database and what it is being used for? I would be greatly troubled by monitoring doctors and patients. Thanks.

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I would assume it’s the DEA, but I don’t know for sure. In late 2015 I visited a Pain management Dr. who was referred by my UCLA Primary Doc. During the course of my final visit he told me that starting on January 1,2016 there was a telephone # he could call that would provide him with my recent history of filing Schedule 2 Rx’s. I assume it would tell him the date and the doctor who prescribed it . It would tell him if I was visiting different doctors and asking for the same medication.( Dr. Shopping) I assume they could make assumptions based on that data If I was a Drug Addict ….Drug Seller or engaged in some other illegal activities regarding controlled drugs.
If the data was so compelling, I assume they would talk to the Dr’s and finally to me about what I was doing and Why.

@predictable

Thanks for your comments, @medpup. I was taken especially by the statement that “They have created a central database to monitor doctors and how many pain prescriptions they are writing a month and to monitor patients and their prescription drug use.”

Could you provide some further information? Who is “they?” Where might I find information about the central database and what it is being used for? I would be greatly troubled by monitoring doctors and patients. Thanks.

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Thanks, @medpup1. I wonder whether the federal government is focused on catching drug addicts — in particular patients with real chronic pain problems — when it collects information on patients’ prescriptions — how many, how often, what drugs, what doctor prescribed them, etc. That seems questionable to me, since federal health policy regards addiction as an illness not a behavioral deviancy or crime. On the other hand, it makes sense that this kind of information collection is aimed at identifying unincorporated drug sellers as well as medical professionals who may be selling prescriptions as a sideline to their regular practice. It may also provide a metric that can be used to identify drug manufactures that are producing more drugs than the government allows them to manufacture. Perhaps others on this discussion can add to the information you provided; we would benefit from a better understanding of how government health policy and government law enforcement policy is coordinated and who gets hurt in all of this.

@predictable

Thanks for your comments, @medpup. I was taken especially by the statement that “They have created a central database to monitor doctors and how many pain prescriptions they are writing a month and to monitor patients and their prescription drug use.”

Could you provide some further information? Who is “they?” Where might I find information about the central database and what it is being used for? I would be greatly troubled by monitoring doctors and patients. Thanks.

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I won’t rehash my prior postings on this, but I, for one, believe the government is not trying to hurt anyone in this. The opioid epidemic in America is devastating and they are trying to address what big pharma and doctors on the take from them have brought on our nation.

It is not some conspiracy to hurt chronic pain patients, but rather to avoid the tragedy of opioid abuse in our nation. Big cities, small towns, rural areas, everywhere.

Big pharma won’t police itself.

Just my two cents plain.

I agree that “the government is not trying to hurt anyone in this”. The opioid epidemic is devastating indeed …. but does CDC have the right culprit?

The Pain News Network published this:

Fentanyl & Heroin Changing U.S. Opioid Epidemic
November 19, 2016
By Pat Anson, Editor

A prominent Alabama physician says the U.S. opioid epidemic has changed so profoundly in the last 3 years that a serious reconsideration of government policy is needed. STEFAN KERTESZ, MD states that ““Heroin and fentanyl have come to dominate an escalating epidemic of lethal opioid overdose, while opioids commonly obtained by prescription play a minor role,” Kertesz wrote in a commentary published in the journal Substance Abuse.

Kertesz says the Centers for Disease Control and Prevention relied on faulty data and failed to address the changing nature of opioid abuse when it released its opioid prescribing guidelines in March. Since then, many pain patients have reported their opioid doses have been lowered or discontinued, while some have been discharged by their physicians and forced to seek treatment elsewhere.

He likened the situation to Pontius Pilate washing his hands.

@david56

I agree that “the government is not trying to hurt anyone in this”. The opioid epidemic is devastating indeed …. but does CDC have the right culprit?

The Pain News Network published this:

Fentanyl & Heroin Changing U.S. Opioid Epidemic
November 19, 2016
By Pat Anson, Editor

A prominent Alabama physician says the U.S. opioid epidemic has changed so profoundly in the last 3 years that a serious reconsideration of government policy is needed. STEFAN KERTESZ, MD states that ““Heroin and fentanyl have come to dominate an escalating epidemic of lethal opioid overdose, while opioids commonly obtained by prescription play a minor role,” Kertesz wrote in a commentary published in the journal Substance Abuse.

Kertesz says the Centers for Disease Control and Prevention relied on faulty data and failed to address the changing nature of opioid abuse when it released its opioid prescribing guidelines in March. Since then, many pain patients have reported their opioid doses have been lowered or discontinued, while some have been discharged by their physicians and forced to seek treatment elsewhere.

He likened the situation to Pontius Pilate washing his hands.

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Thanks @david56, especially for your question, “Does CDC have the right culprit?” Did Dr. Kertesz answer your question? He said “opioids commonly obtained by prescription play a minor role.” Isn’t Fentanyl a common prescription drug? Is culpability linked to prescriptions? Are medical professionals responsible for reducing or discontinuing dosages? For me, the question remains unanswered.

Yes, the reference was to “heroin and illicit fentanyl” … the fentanyl at issue is not from prescriptions but from cartels in China and Mexico. I am new to this site and not yet allowed to post links, sorry for the lack of sources. My point is that “prescribed” opioids–especially the carefully considered doses from the primary care physician–are not the “main” culprit.

@david56

Yes, the reference was to “heroin and illicit fentanyl” … the fentanyl at issue is not from prescriptions but from cartels in China and Mexico. I am new to this site and not yet allowed to post links, sorry for the lack of sources. My point is that “prescribed” opioids–especially the carefully considered doses from the primary care physician–are not the “main” culprit.

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That’s helpful @david56. In this discussion, it seems to me we have been talking about culprits for two different human problems: First, growing widespread use of opioids obtained from medical professionals as well as illicit drug channels and, second, the shrinking supply of even licit opioids needed by chronic pain victims whose doctors are reducing to eliminating their needed dosages.

Medical professionals (including PCPs) are involved in both of these problems to some extent. I wonder why they are allowing federal law enforcement and health officials to override their decisions about the care needed by their patients-in-pain.

@david56

Yes, the reference was to “heroin and illicit fentanyl” … the fentanyl at issue is not from prescriptions but from cartels in China and Mexico. I am new to this site and not yet allowed to post links, sorry for the lack of sources. My point is that “prescribed” opioids–especially the carefully considered doses from the primary care physician–are not the “main” culprit.

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Yes, I recently was a guest columnist for “Pain News Network” (again, no link posting allowed yet) speaking to “government overreach”.

In a valiant attempt to stop an “opioid epidemic”, the CDC statistically linked pain pills with HEROIN. Lumping those statistics together produced some frightening statistics, but left the New England Journal of Medicine (“Reducing the Risks of Relief”) and others questioning CDC’s underlying research. There is simply not enough evidence for a “one size fits all” solution. The CDC guidelines are officially “voluntary”, but have had that “chilling effect” on physicians who would not want to risk the time and trouble necessary to defend their decisions. Per the CDC, chronic pain does not qualify for opioid pain relief. The patient’s chronic pain is at once acknowledged and also not addressed as to a solution.

So, when you wonder “why they are allowing federal law enforcement and health officials to override their decisions”, it is a the “asymmetry of power” … the physicians have less, and no time to fight it individually.

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