Last week, the U.S. Centers for Disease Control and Prevention (CDC) released a new set of guidelines for doctors intended to reduce the “addiction risk” of prescription painkillers such as Vicodin, Percocet, and other opioids. Coming on the heels of a years-long freakout in the U.S.—or, as addiction journalist Maia Salavitz calls it, “America’s prescription painkiller panic”—regarding abuse of prescription painkillers and addiction to those same drugs, the CDC’s new recommendations are not particularly surprising. But to people with chronic pain who use opioids responsibly, these recommendations are particularly fraught for many reasons.
1) The timeline is off
The CDC’s document acknowledges that the development of these recommendations did not take studies on opioid treatment that lasted for more than a year, and intended to treat chronic pain, into consideration. The plural of anecdote is not “data,” of course, but leaving out the experiences of people in chronic pain who have had success with long-term opiate therapy in reducing pain—and, crucially, improving their quality of life—seems like a misstep. Hard data on opioid use lasting longer than a year for chronic pain may also be difficult to come by, since very few studies have been completed on that issue. But apparently for the CDC, the absence of much evidence in favor of opiate therapy for chronic pain is just fine, especially when it lines up with their recommendations.
2) The recommendations seem like yet another exercise in throwing pain patients under the metaphorical bus, while collapsing addiction issues into pain management issues even though they are completely different.
As Salavitz has written, “There’s little evidence that such policing prevents addiction or does anything else beyond inconveniencing and stigmatizing pain patients […] The stigma of addiction is what’s behind the curtain here […] When the situation is considered rationally, our outsized fear of addiction has little to do with the reality of chronic pain. Instead, it’s about the way we see addicts: gun-toting robbers of Oxy from pharmacies and other scummy, lying, sociopathic criminals—people we don’t want to be around or become.”
A 2008 study cited by Salavitz showed that only 3.26% of chronic pain patients with no previous drug/alcohol problems became addicted to opiate medication when opiates were used as part of treatment for chronic pain; over 96% of patients whose medication use was tracked in that study did not become addicted.
Certainly, those struggling with opiate addiction should have access to comprehensive drug treatment and rehabilitation options, but collapsing the issue of opiate addiction with the issues that people with chronic pain face serves no one. It can also mean, in practice, that people with chronic pain who rely on opiates to control their pain are treated like potential addicts—subject to unending suspicion from medical professionals, random drug tests, and pill counts, in addition to the pressure to act “compliant” at all times.
It is a real possibility that were the CDC recommendations to be adopted by doctors’ offices and pain clinics around the U.S., such measures of control would only increase for pain patients. Just take a look at recommendation number six, for example:
When opioids are used for acute pain, clinicians should prescribe the lowest effective dose of immediate-release opioids and should prescribe no greater quantity than needed for the expected duration of pain severe enough to require opioids. Three days or less will often be sufficient; more than seven days will rarely be needed.
A lot of people with chronic pain—and I include myself in this category—don’t know exactly how long acute pain “flares” are going to last, particularly when they’re in the middle of one. Extrapolating from this CDC guideline, a person who has three days’ worth of medication but whose flare lasts longer than three days would have to a) go to their doctor’s office when they are in extreme pain or b) “tough [the flare] out” after they’ve run out of medication. Neither option is great, but since chronic pain has been linked to changes in the brain over time, forcing a patient to “tough it out” if three days’ supply is not enough seems not only unhealthy (especially if the patient experiences withdrawal symptoms), but needlessly cruel for their long-term well being.
3) Chronic pain is an energy suck, and the guidelines could make it more so for some patients
Is there any acknowledgement in the CDC guidelines that being in chronic pain is a full-time state for people with it? Unsurprisingly, no—and this is the crucial piece that the CDC authors seem to be missing (or disregarding) with these new recommendations. Having to go to the doctor’s office and then the pharmacy once per week—or perhaps more, if one only gets three days’ supply of a medication at a time—is a more-time and energy-consuming activity for people with chronic pain than for people without it.
Disability activist and Disability Visibility Project founder Alice Wong (@sfdirewolf on Twitter) compiled a Storify of tweets by people with chronic pain regarding the new CDC opiate guidelines, and some of the participants in the conversation following the release of the CDC guidelines speak to this point. (In the interest of full disclosure, a few of my tweets are included in Wong’s Storify.) A person who uses up most of her available energy one day per month to obtain a controlled substance medication—and who can’t get out of bed in the morning without that medication—will not be served well by new regulations that require her to get a new prescription for that substance and then get refills once a week or more.
Of course, the reasons enumerated here as to why the CDC’s “suggested” guidelines will do more harm than good for pain patients are not the only reasons to be skeptical of the recommendations; even more tightly controlled opiate prescription will not stop the diversion of opiate pain medications to drug dealers, nor to addicts. A “no narcotics for chronic pain” policy, if widely adopted by medical professionals around the United States, could very well result in more people with chronic pain turning to street drugs, thereby feeding the very epidemic that the failed War on Drugs—and the CDC’s recommendations—have claimed to be fighting for the good of the public.
With this latest crackdown on the so-called “overprescription” of opiate medications, people with chronic pain who use these medications for legitimate reasons could be forced to further bear the brunt of an epidemic that they had no hand in creating, as will the medical professionals who are only trying to help by prescribing pain medications responsibly. The World Health Organization has called access to pain relief a “human right”; unfortunately, with the release of these recommendations, the CDC has shown just how far the United States has left to go in advancing that right for people disabled by chronic pain conditions.
Photo: schnaars/Creative Commons