Note: The NIH link supports the CDC link that states that overdoses due to prescribed opioids dropped in 2012. The CDC notes that during this time frame, and up to the present time, prescriptions were also less. One item that would help to us to understand the CDC’s report is giving statistical information on how much this drop in prescriptions was/is starting in 2012. Was it also 5% as stated by the NIH? Personally, I am wondering if it coincides with the timing of the introduction of Cymbalta and Lyrica. It seems to me that these medications exploded in the prescribed med arena about then, a few years after it was approved by the FDA for use in both depression and chronic pain. The same, or many similar, pathways in the brains of both depressive disorders and chronic pain react to both medications. However, they address different issues. Both of these medications come with a very long list of concerns the user should pay attention to, including “suicidal thoughts or actions”. I will leave you with this thought and continue on with my considerations in what is happening in the medical arena and my thoughts on how these new guidelines may affect us.
As promised a few days ago, I am going to do my best to address the new guidelines from the CDC concerning how to, or if opioid prescriptions should be written by doctors for any chronic pain other than cancer. These are my thoughts on the subject (I have not performed any empirical research, only added trusted links to sites that do use empirical research). Please remember that I have posted previously that there are alternative methods that work for Peers, along with lifestyle changes. This post is strictly addressing the new CDC guidelines.
In reviewing these two links above, I discovered data within them that makes sense to me. I discussed a part of what may have occurred in the note section after the second link; the emergence and ever-widening prescribing of medications intended for depression, but now often used for chronic pain management. The link to NIH’s article discusses the need for practitioner education about opioid prescriptions and the importance of monitoring their patients for the possibility of addiction that leads to overuse, and, overdose. To be fair, there may be further links in the CDC articles that also discuss this.
Interestingly, this post is very similar in content to my post yesterday concerning monitoring co-morbid mood disorders when prescribing opioids. There will always be those who have co-existing conditions that may lead to emotional addiction and not just physical dependence, but abuse. These guidelines help push us towards the creation of the need to check the patients past history for a known history of mental health conditions and implementing a full intake history to discover any potential genetic, behavioral or environmental factors to follow-up with in discussion at each visit. That takes this subject back to the need for educational classes for Fibromyalgia diagnosis, posted a while back. The emphasis of the outcomes of these two studies show how important it is for the pain patient to be honest with their doctor if they do have a co-morbid condition that could lead to abuse. The importance of scheduling a visit every month with your doctor, bring your medications, and sign a pain contract. While you are there always briefly discuss with your doctor how your month was; social activities or lack of, exercise, and any event that increased or decreased your pain.
I have always done this my doctors. I wrote down notes about my month, my pain levels and what caused the increase or decrease, along with a count of how much was left of each separate medication and then divided it into days left to refill, beginning with the request of my first doctor. He then added my letter into my chart. I have never obtained refills on opioid medications, except for a few months when I traveled. It is part of my monthly chores to visit my doctor every three and half weeks to obtain my next refill. I began this monthly ritual 14 years ago. The CDC guidelines may create requirements like this for all pain patients. It should be a heads up that we should all begin doing this on our own (if you’re not already), and even suggest a pain contract before the doctor does. This is being proactive, taking control of our own bodies and could help to decrease fears about abuses for all of us.
The NIH article is suggesting that this relationship with our doctor, along with increased doctor education and visits should be mandatory in chronic pain patients. The CDC article is simply following their history of trying to prevent death from overdoses, be it from prescribed medication or illegally gained medications and street drugs that can cause overdose. It is also not new that prescription medications are being attacked for overdoses. It is easier to address something you can track like prescription medications; try tracking the amount of illegal street drugs and overdoses, it is not nearly as simple as pulling records from doctors, pharmacies and hospitals. It will not stop being discussed and their guidelines will continue to be handed out on this subject. I applaud it. If you have ever experienced the pain of loss due to a friend or a family members overdose, it is horrible.
I found in the literature that numbers have gone down for the last three years; in overdose and prescriptions. What I don’t find, but believe is very important in this discussion, is how people are obtaining medications they don’t need and how many people in chronic pain who are denied assistance turn to street purchases of pain medication which could play a part in the overdose count by the CDC. This is much more alarming to me then the idea that all doctors should be better educated when assisting chronic pain patients. Especially monitoring their paitients who may begin to show signs of addiction. I am fairly sure, but could be wrong, that there are more overdoses from street drugs by addicts than there would be from prescribed medications if these methods were used.
The CDC sounds this type of alarm every decade. Their current alarm is focusing on pain medications. They have focused on this before and will again, with good reasons. There is not enough practitioner education about chronic pain, pain contracts and how to monitor patients in case they fall into that 3-5% of persons who might become abusers. Pharmacies have the ability to track every prescription from every pharmacy in at least 48 states, but, do they? Why don’t pharmacies and doctors interact closely in tracking the filling of prescriptions by patients? If any abnormalities showed up in the pharmacy tracking system, alerting doctors would help enormously to avoid abuse and possible overdose. Both would also be able to flag the patients who are obtaining opioids under false pretenses. I believe strongly that the prescribed chronic pain patient overdoses would fall by a large percent if this was incorporated.
I am not overly concerned at this point in time about the CDC creating these guidelines. If I become alarmed or, if you are already concerned, take action. Advocate for yourself and your Peers. Find a petition or create one online and send it not only to the CDC but to your doctors group, insurance company and pharmacies, suggesting these or other reasonable items to include in chronic pain management.
If I responded well to the newly created and prescribed anti-depression drugs, I would take them! But, I don’t. I take opioids and have created a Well lifestyle, integrating alternative therapies, understanding my triggers, using exercise, and I spent years journaling my every daily activity and corresponding pain levels in order to reach the functional ability I currently experience. It’s not perfect, but it’s much better than the first several years. I hope that all the Peers find their answers, using the treatments that works best for them.
Pro-guidelines and education for needed chronic pain treatment,
Lucinda Tart, Fibromyalgia Peer Advocate/Life Skills Advisor