Editorial | Second thoughts

Editorial | Second thoughts

Chronic pain patients are being denied the opioid medication they desperately need.

The opioid crisis has been devastating. But there are two sides to the story.

One side has received the bulk of attention from public officials and media outlets. It's the story about the widespread and unnecessary prescriptions that lead to gross abuse by addicted patients, too many of whom have ended up dead.

The other side of the story is largely unknown, just starting to get the attention it deserves.

Medical experts have warned the Centers for Disease Control and Prevention that the agency's guidelines counseling physicians to limit opioid prescriptions are having a dramatically negative impact on chronic pain patients who use the medication in high doses but have not become addicted.

The experts warned the CDC that, as a consequence, patients who benefit from the drugs have been forced into painful physical withdrawals, suffered renewed and debilitating pain and endure a life so miserable that suicide has become a viable option.

CDC critics are urging the agency to issue modified guidelines urging physicians to loosen the current restrictions and leave treatment decisions to the individual judgment of physicians.

In response, the CDC contends that its guidelines urging limiting opioid prescriptions are reasonable.

Given the national attention and official concern devoted to this subject, it should be no surprise that the too-frequent dispensation of opioid prescriptions has swung the other way into the not-frequent-enough dispensation of opioid prescriptions.

After all, opioids have been cast in recent months as approaching public health threat No. 1, and they may be. But that should not obscure the fact that this medication also can serve a perfectly valid purpose.

The letter, written by 300 medical experts, was signed by three former White House drug czars. Other signatories include addiction specialists and pain specialists.

"The CDC really does need a rigorous evaluation of this because we don't know how big the problem is. Minimally, we need some level of clarification on the appropriate use of the guidelines," said Dr. Michael Botticelli, the Obama White House drug czar.

The New York Times reports that opioid prescriptions have "fallen dramatically" since the CDC issued new guidelines to primary care physicians three months ago. Further, the administration wants the numbers to drop by another one-third over the next two years.

But the doctors say just pushing the numbers down leaves out those who use them in a constructive way. Those patients are described as so physically dependent on them that they will suffer severe withdrawal if their doses are dramatically reduced. The key, however, is that the medication helps these individuals function in the face of the pain they endure.

Addiction medicine is complicated. So it's not at all clear that heavy reliance on opioids is proof of dangerous dependence. One addiction specialist defined addiction as a "behavioral maladaptation where the medication takes over their lives and they continue to use despite negative consequences."

That sounds much different from a patient with pain issues who uses opioids to live a normal life.

The CDC guidelines are purely advisory, but they do recommend physicians press their patients to taper their use down, prescribe opioids for only a short time and reduce dosage strength.

The CDC may not view that message as a flashing red light. But it's easy to see why physicians, acting out of a sense of caution, would.

In that context, it's time to rethink the current approach. No one wants to see real opioid abuse continue. At the same time, no one benefits when patients who need them to live relatively normal lives unnecessarily suffer.

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