On October 10, the Trump administration issued a warning to doctors about opioid prescriptions and the dangerous effects of taking patients off of painkillers too quickly. This advisory statement reiterates concerns expressed by prominent doctors, including those who authored the 2016 Center for Disease Control (CDC) guidelines for opioid prescription. The Food and Drug Administration (FDA) backed the Trump administration’s warning, citing recent complaints from patients who were suffering serious withdrawal symptoms and even thoughts of suicide. These recent concerns highlight potentially disastrous effects of the misinterpretation of the CDC guidelines in efforts to combat the opioid crisis.
America’s Opioid Epidemic
The opioid crisis is the deadliest drug overdose crisis in American history.
The current crisis can trace its roots to the prescription of opioids in the 1980s, when a letter published in the New England Journal of Medicine assured readers that opioid addiction is rare and unlikely. It claimed that out of almost 12,000 patients who were prescribed opioids, only four developed an opioid addiction with no previous history. This was cited by many major pharmaceutical companies, including Purdue Pharmaceuticals, as evidence that opioids were safe for pain management, and the medical community overprescribed the drugs under the impression it was safe as a result.
Opioids have a high risk of addiction because of the pleasure and pain relief they can provide. Some commonly prescribed opioids include oxycodone, fentanyl, morphine, and codeine. Over long term use, the body will no longer produce the normal amount of endorphins, leading to the craving for a higher dosage to restore the pleasurable feeling. Even if opioids are taken safely after being prescribed, any long term usage maintains a high risk of addiction. Additionally, it is also dangerous to abruptly quit opioids, as the withdrawal effects can cause more pain than before the prescription started. In the United States alone, as of 2015, there were 240 million opioid prescriptions distributed, accounting for almost one to every adult in the general population.
The epidemic has continued to grow every year since the late 1990s and currently claims the lives of an estimated 170 people each day. It has ravaged many rural and underprivileged communities, and although progress has been made to reduce the overall number of opioid painkiller prescriptions, it remains a serious problem for America. Included in those affected by the opioid epidemic are a large proportion of the approximately 25 million people in the United States suffering from chronic pain, who utilize opioid painkillers as a way to cope. The CDC guidelines released in 2016 are the latest challenge for chronic pain patients.
The Problem with the CDC Guidelines
The CDC first introduced guidelines for opioid prescription under the Obama administration, and the suggestions have since been largely embraced by the medical community and health policymakers. The guidelines state that opioid painkillers should be used as a last resort for pain management, excluding certain circumstances like cancer and palliative care. It also describes the best practices for tapering users off opioids and urges doctors to use caution in recommending new opioid prescriptions to patients. However, recent concerns from doctors and the FDA have exposed some problems in how the guidelines are being applied to patients.
The primary problem with the 2016 CDC guidelines is that doctors have treated them as hard and fast rules, as opposed to general guidelines. After the CDC guidelines were released, many doctors began to refuse patients with chronic pain or other conditions that would require an opioid prescription. Furthermore, the Trump administration has introduced stricter penalties for both drug traffickers who bring opioids into the country and doctors who fraudulently prescribe opioids. These penalties bore some unintended consequences. As a result of these new policies, doctors are extremely reticent to prescribe opioids, fearing that misuse of the prescriptions on behalf of their patients could jeopardize their license to practice. As a result, after years of using opioids, chronic pain patients are finding it harder and harder to refill their prescriptions.
On the campaign trail in 2016, President Donald Trump vowed to cut the number of opioid prescriptions down by one-third over three years. Accordingly, the White House is pursuing an array of approaches to cracking down on opioid overdoses, including increasing penalties for drug traffickers. These include mandatory minimum prison sentences and, in some extreme cases, the death penalty. In 2017, Trump declared the opioid crisis a public emergency under the Public Health Service Act, which would allow the federal government to divert resources dedicated to research toward more direct means of dealing with the crisis. This declaration also enables the administration to access the Public Health Emergency Fund and negotiate prices for naloxone, a drug that reverses the symptoms of a drug overdose. The warning advised by the Trump administration in October is the latest in nationwide efforts to solve the opioid crisis.
However, the administration’s attempts to limit opioid painkillers could have the unintended consequences of harming the patients they were intended to help. Although the CDC guidelines have decreased the prevalence of opioid prescriptions, some patients with chronic pain are struggling to find doctors who will prescribe opioid painkillers. By closing off legal means of acquiring opioids, the CDC guidelines may have inadvertently caused desperate patients to seek relief through illicit means. A March letter from the group “Health Professionals for Patients in Pain” describes the devastating effects of the CDC guidelines on the chronic pain population.
Although it can be easy to look at the recent decrease in opioid prescriptions and consider it a sign of progress, unintended consequences of complex policies can harm the population of patients who are dependent on opioids to treat their chronic pain. The warning issued by the Trump administration is a reminder of the pervasiveness of the opioid epidemic and the length of the path toward the resolution of this crisis.
Gabrielle Smith is a Contributing Writer for the Gate. The image for this article is licensed under the Creative Commons Attribution 2.0 Generic. The photographer was Cindy Shebley. The original image can be found here.