The CDC has issued new guidelines (JAMA, March 15, 2016) that strongly urge doctors to stop prescribing narcotics to patients with chronic pain. This public health organization believes its mandate will reduce deaths from opioid overdose. What the feds have not considered is the impact on people with long-standing severe pain, especially if they are disabled.
The Drug Enforcement Administration Changed the Rules:
In the last couple of years there has been a huge effort to make it harder for doctors to prescribe opioid pain relievers. In the fall of 2014 the DEA made it much harder for patients to obtain hydrocodone combination pain relievers (HCPs such as Lortab, Norco, Vicodin, etc). Previously, prescribers could call in or send in an electronic prescription to a pharmacy and could give a pain patient several refills. Now, patients can only get a 30-day supply and must visit the doctor’s office each time they need a new prescription.
Stories from Readers in Severe Pain:
The new DEA scheduling change has made it much more challenging for a patient who is disabled or in severe pain to access an opioid medication. Here are just a few stories from hundreds of readers who responded to our post on the DEA decision.
Stefany in Maryland shares:
“I have had 10 orthopedic surgeries–two on my back, plus a spinal fusion. I have also had four hip surgeries. These are only a few of the many surgeries I have had.
“I used to hate pain medication. I did all that I could to avoid taking opioids, relying on 800 mg of ibuprofen instead. Sometimes I try to avoid pain medication, but it is physically impossible. I hurt all over and become so miserable when I am off my meds. Since there is such a strict limit on them I usually run out. Trust me; I do not wish to be on them, but the alternative after 10 surgeries is basically impossible if I am to maintain two jobs and college classes.
“While I completely understand the DEA’s reasoning behind their new laws, all they are accomplishing is making people like us live in hell and for the drug seekers to turn more to heroin. You cannot control the people who are drug addicts. To punish people who do not abuse pain medicine and need them to live a more functional life than one of severe depression due to pain is really unjust.”
John in College Station, TX writes:
“I have been taking hydrocodone for over 25 years because of a severe accident. I have had a total knee replacement and neck fusion surgery. I have three bulging discs in my lower spine with nerve damage in my back.
“Last year the doctor said no more hydrocodone, per the new law, and changed it to Tylenol #4. It’s 80 percent less effective.
“Why did this new law punish me? I was barely surviving with the hydrocodone, and now this. I call it abuse to the elderly. I have a track record of 25 years of taking my hydrocodone and NEVER called in for extra or EVER abused it. Now I suffer in severe pain because others abuse it. The DEA, who got this law passed, did not think how it would effect the people who really need it to survive.
“I’m only 55 yrs old, and I’m scared to death what the rest of my life may become. I do not wish harm to anyone but if the people passing these laws ever experience the pain I have they would never have never passed such a law which amounts to ABUSE OF THE ELDERLY.”
Jake the Vet:
“I am a 28-year-old army veteran. I have a spinal cord tumor located in my nerves and am consistently in extreme pain–8 out of a possible 10 points on a 1 to 10 point scale.
“All I can get from my pain management doctor is a back brace, anti-inflammatories and acupuncture in my ears or gabapentin, which makes me feel awful. I have seen three neurosurgeons, none of whom will touch me. What am I suppose to do? Things need to change in this country. It’s an outrage!”
Carolyn in Nevada:
“I too have been taking hydrocodone for many years for chronic pain. Today I went to the pharmacy and was told I can no longer have it. My doctor prescribes it but the pharmacy says no. I’ll be spending my days in bed, I guess. May as well be dead.”
Charles in Ft. Worth:
“I was in a bad elevator collapse and have numerous spinal fractures as well as bulging, degenerated disks and bone spurs. I have lost two inches in height because of my back problems.
“I am living in pain I wouldn’t wish on my worst enemy. I need pain meds and I can no longer get any refills. My pain is making my life unlivable.
“The new laws have caused more damage than you can imagine. My mobility is very limited. I can no longer get out of bed or carry on my daily duties as I was able to before the laws changed last October. I feel my life is over. I can’t live with this pain. I don’t know what to do.”
The CDC’s New Guidelines:
In essence, the new federal opioid guidelines state that narcotics should not be prescribed for chronic pain patients. Instead, doctors should recommend acetaminophen (Tylenol) or NSAIDs like aspirin or ibuprofen. Other suggestions include cognitive behavioral therapy, exercise therapy or antidepressants. We suspect that there are many patients, like those above, for whom such suggestions will not be met with great enthusiasm.
For acute pain, such as after surgery or an accident, the CDC recommends that doctors prescribe opioids for no more than three days. Really? Some “acute” pain lasts substantially longer than three days!
The CDC acknowledges that cancer treatment may require opioid medication during the active phase of therapy. What the CDC has not taken into account is that cancer survivors may have to deal with chronic pain. The president of the American Cancer Society Cancer Action Network said it eloquently:
“Pain does not end when an individual completes treatment. Most often, cancer patients deal with lasting effects from their disease or treatment including pain for a significant period of time or indefinitely.”
The CDC guideline does not seem to take this into account.
Walking the Tightrope:
We recognize that there is tremendous abuse of narcotics in this country, but we are not sure the new guidelines will help reduce the problem. We have not seen convincing evidence that making it harder for chronic pain patients to access drugs like hydrocodone will make a huge difference in abuse or overdose deaths.
We also believe that it is virtually impossible to generalize about the most appropriate treatment for people with severe, chronic pain. Some people will do well with cognitive behavioral therapy; others can only function on opioid medications. These drugs allow them to work and function with dignity. They do not abuse the pain medicine, do not increase the dose and do not sell their medicine to drug abusers. They are about to become vulnerable to a huge federal mandate that will impact how physicians practice medicine.
It is our belief that the CDC should not tell physicians how to practice medicine, especially when it comes to something as complex as chronic pain. Each patient needs to be evaluated individually and treated with respect. The new guidelines will likely scare many doctors away from prescribing potent pain killers for longer than a few days or weeks. That could mean some patients will live in agony with no acceptable treatment through no fault of their own.
Share your own pain experience below and your thoughts about the DEA and CDC rules and guidelines. Please vote on this article at the top of the page. Here is a link to hundreds of reader comments about the DEA’s decision to make it harder for patients to get a prescription for hydrocodone-containing pain medicines.