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The Centers for Disease Control and Prevention (CDC) is updating its guidelines for prescribing opioids for chronic pain, citing new research on alternative treatments to treat pain rather than recommending strict dose limits on prescription practices that were in the initial guidelines, according to the agency’s website. The current guidelines date to 2016.
In the 1990s there was a call by some pharmaceutical companies, insurers and pain specialists for better control of pain for common medical problems like back pain and arthritis, which was intertwined with a simultaneous aggressive marketing push for prescription drugs like OxyContin, according to a recent Oregon Public Broadcasting (OPB) report.
Bottles of several opioid based medication at a pharmacy in Portsmouth, Ohio, June 21, 2017. (Bryan Woolston / REUTERS)
Journalist Beth Macy’s 2018 book "Dopesick: Dealers, Doctors, and the Drug Company That Addicted America" showed how the pharmaceutical company Purdue Pharma’s devious marketing of OxyContin directly contributed to patients getting addicted to the prescription pain meds, leading to the epidemic crisis in the U.S., according to Healthline.
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The report noted the streaming platform Hulu adapted the book into a partially fictionalized limited series titled "Dopesick" which concentrated on the epidemic crisis through the perspective of the doctors and addicts as well as the pharmaceutical company who downplayed the addiction potential while aggressively up-marketing them.
In response to the worst opioid epidemic in U.S. history, the CDC issued the 2016 opioid prescribing guidelines to " … ensure that clinicians and patients consider safer and more effective treatment, improve patient outcomes such as reduced pain and improved function, and reduce the number of persons who develop opioid use disorder, overdose, or experience other adverse events related to these drugs."
The CDC issued the 2016 opioid prescribing guidelines to " … ensure that clinicians and patients consider safer and more effective treatment, improve patient outcomes such as reduced pain and improved function, and reduce the number of persons who develop opioid use disorder, overdose, or experience other adverse events related to these drugs." (iStock)
These guidelines recommended opioids should not be as first-line treatment for chronic pain, instead suggesting nonpharmacological options, but when opioid prescriptions were prescribed for acute pain, the prescriptions only be for a maximum of three days, according to the OPB report.
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Although these were voluntary guidelines, the report noted the 2016 guidelines were adopted by many physicians, leading to a dramatic decline in opioid prescriptions, but some patients and drug manufactures criticized the guidelines for not allowing pain to be adequately treated.
"We began to hear how the guidelines were being misused and misapplied," said Christopher Jones, a co-author of the draft guidance and acting director of the CDC's National Center for Injury Prevention and Control.
File photo shows Purdue Pharma headquarters in Stamford, Conn.
The CDC responded by using a multifaceted approach to revise the guidelines, including a comprehensive review of the new research on the treatment of acute and chronic pain, public engagement of both patients and clinicians working in the field and establishing an independent Opioid Working Group to review and provide feedback on the draft.
"The previous [2016] guidance has harmed patients with chronic pain, cancer, sickle cell disease, and those in hospice. The restrictive policies also failed patients who are stable on long-term opioid therapy, and it has denied care to post-surgical patients and those with an opioid use disorder," said Dr. Bobby Mukkamala, chair of America Medical Association Substance Use and Pain Care Task Force.
The main message of the updated guidelines is for doctors to first recommend non-prescription-based therapies and nonopioid prescriptions, like prescribing physical therapy, massage and acupuncture or prescribing ibuprofen over opioids, according to the report.
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"The CDC’s new draft guideline – if followed by policymakers, health insurance companies and pharmacy chains – provides a path to remove arbitrary prescribing thresholds, restore balance and support comprehensive, compassionate care," Mukkamala noted.