Opioid Use Disorder vs Complex Persistent Opioid Dependency

[drusso]

Distinct entity or a distinction without a difference?

MSN

"... the guidelines seem to enlarge an addiction category to include many non-addicted legacy patients by the guideline’s criteria for complex persistent opioid dependence (CPOD). The difference between OUD and CPOD are startling. To be diagnosed with CPOD one only has to have the desire to take opioids for pain, without opioid cravings, no compulsive use, and no harmful use, the patient takes opioids “exactly” as prescribed, and has no social disruption other than from experiencing pain. This is an incredible description and includes all model chronic pain patients."

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[Ducttape]

interestingly, part of the article is about the Oregon Pain Action Group.

a group so secretive that you cannot see their webpage. a group that is secretive that their Facebook page is a private group.

that being said, calling legacy patients CPOD is not unreasonable. however, in the article, the Oregon Pain Action Group implies that this distinction is sufficient to justify long term and high dose opioid therapy in patients with risk factors for conditions that do include fibromyalgia...

Amid pressure from advocates and patients, Oregon’s Taper Task Force added a clarifying statement to its updated materials, stating not all patients need to be tapered. But then the rest of the guideline goes on to recommend providers consider a taper for those who meet certain criteria, easily met by the majority of legacy patients. These criteria include:

The patient is on a daily opioid dose of 50–90 MED or higher. The patient has medical risk factors that can increase risk of adverse outcomes, including overdose (e.g., lung disease, sleep apnea, liver disease, renal disease, fall risk, medical frailty). The patient is taking other medications that increase the risk of drug-drug interactions or the risk of overdose, such as benzodiazepines or other sedating medications (e.g., Benadryl, gabapentin). The patient’s history indicates an increased risk for substance use disorder (SUD) (e.g., past diagnosis of SUD, SUD-related behaviors, family history of SUD).
To put this in other words, the majority of legacy patients are on 50 MED or higher of opioids, so that one criterion alone encompasses a huge percentage of patients. In addition, the rest of the criteria includes advanced age (medical fragility — the term they use to describe older people), people who have allergies (take Benadryl) people who have anxiety disorders or need awake oral surgery or any other twilight surgery (benzodiazepine), those who have nerve pain (gabapentin), and those who don’t have SUD, but who have a family member who has it (have an uncle who has SUD, even though you don’t). After including all these, there will be few chronic pain patients who won’t fall within the recommendation to consider tapering.

 

[drusso]

interestingly, part of the article is about the Oregon Pain Action Group.

a group so secretive that you cannot see their webpage. a group that is secretive that their Facebook page is a private group.

that being said, calling legacy patients CPOD is not unreasonable. however, in the article, the Oregon Pain Action Group implies that this distinction is sufficient to justify long term and high dose opioid therapy in patients with risk factors for conditions that do include fibromyalgia...

My impression is that OPAG is very anti-libertarian.

 

[Orin]

Many addicts are undertreated pain patients. Either way, wean OUD or CPOD with MAT/off-label buprenorphine.

Patients with CPOD are still at physiologic risk from being on these medications, even if they are safer than someone who meets OUD criteria. You may wean them slower to be kind, but the risk to life/well being is elevated, especially with diffuse pain states.

At least in Oregon, CPODers can now do all the other drugs they can get their hands on, and earn the OUD designation.

Oregon becomes 1st state in the US to decriminalize drug possession

Advocates say Oregon has taken "a sledgehammer to the cornerstone of the war on drugs." Oregon is the first state to do away with criminal charges and jail time for personal drug possession.

www.opb.org

 

[lobelsteve]

People making up diagnoses out of thin air. CPOD? Same as with antihypertensives, BZD, Sz meds. None of these are medical diagnoses.