Cato: CDC Opioid Guidelines Re-duex...

[drusso]

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New FDA Initiative Implies CDC Opioid Guidelines Are Not Evidence-Based

"Recognizing the work of the Centers for Disease Control and Prevention for having “taken an initial step in developing federal guidelines,” Commissioner Gottlieb diplomatically stated the FDA initiative intends to “build on that work by generating evidence-based guidelines where needed” that would differ from the CDC’s endeavor because it would be “indication-specific” and based on “prospectively gathered evidence drawn from evaluations of clinical practice and the treatment of pain.”

Statement by FDA Commissioner Scott Gottlieb, M.D., on new steps to advance the development of evidence-based, indication-specific guidelines to help guide appropriate prescribing of opioid analgesics

"To that end, we’re announcing today that the FDA has awarded a contract to the National Academies of Sciences, Engineering, and Medicine (NASEM) to help advance the development of evidence-based guidelines for appropriate opioid analgesic prescribing for acute pain resulting from specific conditions or procedures. The primary scope of this work is to understand what evidence is needed to ensure that all current and future clinical practice guidelines for opioid analgesic prescribing are sufficient, and what research is needed to generate that evidence in a practical and feasible manner."

 

[emd123]

New FDA Initiative Implies CDC Opioid Guidelines Are Not Evidence-Based

"Recognizing the work of the Centers for Disease Control and Prevention for having “taken an initial step in developing federal guidelines,” Commissioner Gottlieb diplomatically stated the FDA initiative intends to “build on that work by generating evidence-based guidelines where needed” that would differ from the CDC’s endeavor because it would be “indication-specific” and based on “prospectively gathered evidence drawn from evaluations of clinical practice and the treatment of pain.”

Statement by FDA Commissioner Scott Gottlieb, M.D., on new steps to advance the development of evidence-based, indication-specific guidelines to help guide appropriate prescribing of opioid analgesics

"To that end, we’re announcing today that the FDA has awarded a contract to the National Academies of Sciences, Engineering, and Medicine (NASEM) to help advance the development of evidence-based guidelines for appropriate opioid analgesic prescribing for acute pain resulting from specific conditions or procedures. The primary scope of this work is to understand what evidence is needed to ensure that all current and future clinical practice guidelines for opioid analgesic prescribing are sufficient, and what research is needed to generate that evidence in a practical and feasible manner."

Notice its says to develop guidelines for "acute" pain. We need evidence based guidelines for prescribing in chronic pain, not acute.

 

[Ducttape]

As we all work to confront the staggering human and economic toll created by the opioid crisis, we recognize the critical role that health care providers play in addressing this public health priority – both in reducing the rate of new addiction by decreasing unnecessary and/or inappropriate exposure to opioids and ensuring rational prescribing practices, while still providing appropriate treatment to patients who have medical need for these medicines. With millions of Americans misusing and abusing opioids and more than 40 people dying every day from overdoses involving prescription opioids, it’s clear that we need to do everything we can, including working with stakeholders, to get ahead of this crisis.

Many people who become addicted to opioids will first be exposed to these drugs through a lawfully prescribed medication. Unfortunately, the fact remains that there are still too many prescriptions being written for opioids. And too many prescriptions are written for longer durations of use than are appropriate for the medical need being addressed.

Our analyses suggest that the first prescription for many common, acute indications could typically be for many fewer pills – maybe just a day or two of medication rather than a 30-day supply, which is typically prescribed. In some cases, the excess pills that aren’t used by patients may end up being diverted to illicit markets or misused or abused by friends or family members. In other cases, patients who are prescribed more medication than necessary may find themselves at increased risks for misuse, abuse and addiction.

This is what guys like 101N (and myself) have been saying all along...

 

[NOSfan]

Many people who become addicted to opioids will first be exposed to these drugs through a lawfully prescribed medication. Unfortunately, the fact remains that there are still too many prescriptions being written for opioids. And too many prescriptions are written for longer durations of use than are appropriate for the medical need being addressed.

Our analyses suggest that the first prescription for many common, acute indications could typically be for many fewer pills – maybe just a day or two of medication rather than a 30-day supply, which is typically prescribed. In some cases, the excess pills that aren’t used by patients may end up being diverted to illicit markets or misused or abused by friends or family members. In other cases, patients who are prescribed more medication than necessary may find themselves at increased risks for misuse, abuse and addiction.

Our institution has begun a strong push for such measures - Opioid Rx for post-surgical pain in the opiate naive patient.

Attached is Dr. Brummett's webinar on the matter.

Also, some eye opening data:

 

[drusso]

This is what guys like 101N (and myself) have been saying all along...

We’re failing in the opioid crisis. A new study shows a more serious approach would save lives.

"To this end, the researchers’ model found that over a 10-year window, reductions in chronic pain prescribing, rescheduling painkillers to increase restrictions on them, and prescription drug monitoring programs actually increase opioid-related deaths by as much as the tens of thousands — because they increase heroin deaths more than they cut painkiller deaths.

But some other interventions on the prescribing front fare better: reductions in acute pain prescribing, reductions in prescribing for transitioning pain, drug reformulation to make opioids less prone to misuse, and more excess opioid disposal. All of these policies seem to prevent more deaths than they cause in a 10-year window (although not always in a five-year window), based on the model."

 

[Ducttape]

my points exactly. with one exception.

the only major problem I have with their research is that they are automatically deciding that the increase of illicit narcotic deaths is due solely to more people using. unfortunately, this model is completely screwed up because of the introduction of carfentanyl and new designer fentanyl products that are much more fatal.

of course, there is an increase in heroin deaths when prescription opioids are stopped, but not to the extreme we are seeing..... without new fentanyl derivatives, illicit death rates would be markedly lower and invalidate their numbers of actually increasing drug deaths.

in 2017, out of the 72,000 OD deaths, 30,000 - 42% - were due to fentanyl.