Pain Killer Politics: Effort to Curb Prescribing Under Fire

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drusso

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Has PROP set up a mechanism to raise funds against Pain Care Forum? Has anyone made any tax deductible contributions to them for the fight? Who's in charge of passing the hat? You can set up a montly donation here:

http://www.supportprop.org/join-us/

If PhRMA has retained a conservative law firm, WLF, (WLF is the nation’s premier public-interest law firm and policy center. Our mission is to preserve and defend America’s free-enterprise system by litigating, educating, and advocating for free-market principles, a limited and accountable government, individual and business civil liberties, and the rule of law) then who has PROP retained on the liberal side to push against them? I think that Wilmerhale would be a good investment for them. The allegation that CDC and its Core Expert Group violated the Federal Advisory Committee Act, as outlined by WLF in their brief, might be difficult to defend without keen legal representation...

http://www.wlf.org/upload/litigation/misc/CDCComments-Opioids.pdf

https://www.wilmerhale.com/about/overview/

Painkiller politics: Effort to curb prescribing under fire
13 COMMENTS

Matthew Perrone, ASSOCIATED PRESS
POSTED: Sunday, December 20, 2015, 1:08 AM

WASHINGTON - A bold federal effort to curb prescribing of painkillers may be faltering amid stiff resistance from drugmakers, industry-funded groups and, now, even other public health officials.
The Centers for Disease Control and Prevention was on track to finalize new prescribing guidelines for opioid painkillers in January. The guidelines - though not binding - would be the strongest government effort yet to reverse the rise in deadly overdoses tied to drugs like OxyContin, Vicodin, and Percocet.

But this highly unusual move - the CDC rarely advises physicians on medications, a job formally assigned to the Food and Drug Administration - thrust the agency into the middle of a long-standing fight over the use of opioids, a powerful but highly addictive class of pain medications that rang up over $9 billion in sales last year, according to IMS Health.

Critics complained the CDC guidelines went too far and had mostly been written behind closed doors. One group threatened to sue. Then earlier this month, officials from the FDA and other health agencies at a meeting of pain experts bashed the guidelines as "shortsighted," relying on "low-quality evidence." They said they planned to file a formal complaint.

The CDC a week later abandoned its January target date, instead opening the guidelines to public comment for 30 days and additional changes. Anti-addiction activists worry the delay could scuttle the guidelines entirely.

"This is a big win for the opioid lobby," said Andrew Kolodny, cofounder of Physicians for Responsible Opioid Prescribing, a group working to reduce painkiller prescribing.

CDC Director Tom Frieden said politics did not play a role and the guidelines remain a priority.

"We want to make sure we don't go so fast that there are questions about our process, but we certainly don't want to see any further delay," Frieden told the Associated Press.

Frieden said the FDA and other agencies support his effort, despite the negative comments from some officials. The Department of Health and Human Services, which oversees both the CDC and the FDA, said the guidelines are critical to "tackling the opioid epidemic."

Frieden acknowledged the limited evidence comparing various treatments. "But there is no way we can wait for better evidence while so many people are dying."

Under the proposed guidelines, doctors would prescribe these drugs only as a last choice for chronic pain, after non-opioid pain relievers, physical therapy and other options. The CDC also wants doctors to prescribe the smallest supply of the drugs possible, usually three days or less for acute pain. And doctors would only continue prescribing the drugs if patients show significant improvement.

The CDC's logic: Reshaping how primary care doctors use painkillers would result in fewer prescriptions and, therefore, fewer deaths. By its estimation, deaths tied to these drugs have surged fourfold since 1999.

But industry-funded groups like the U.S. Pain Foundation and the American Academy of Pain Management warn that the CDC guidelines could block patient access to medications if adopted by state health systems, insurers and hospitals. Such organizations often look to the federal government for health-care policies.

The CDC decision to delay its guidelines followed months of lobbying by physician and patient groups aligned with the pharmaceutical industry, who have almost always had a seat at the table in federal discussions on painkillers. As a result, they have had far more influence over federal policy than addiction activists, according to experts.

"They're very well-funded and they have a lot of pharma money behind them," said Lewis Nelson of New York University, an FDA adviser who is also advising the CDC on its guidelines. "And then you have the anti-addiction groups on the other side, which is clearly much less funded and organized."

Behind the CDC controversy is a decades-long debate over the use of opioids, which include medications like morphine and codeine and illegal narcotics like heroin.

For most of the 20th century, doctors reserved opioids for severe, short-term pain - such as after surgery - or chronic pain from deadly diseases like cancer.

But in 1990s that changed, as some specialists argued the drugs could be used safely to treat common ailments such as back pain and arthritis. The message was amplified by multimillion-dollar promotional campaigns for new, long-acting drugs like OxyContin, which was promoted as less addictive.

That drug's maker, Purdue Pharma, would later plead guilty and pay over $600 million in fines for misleading the public about OxyContin's risks. But prescriptions continued to rise - along with deaths.

Purdue declined to comment for this story.

Deaths linked to misuse and abuse of prescription opioids climbed to 19,000 last year, the highest figure on record, according to the CDC. Meanwhile, heroin overdoses have more than tripled to 10,500 since 2010. CDC's Frieden says more Americans are "primed" for heroin use because of their exposure to painkillers.

Pain care advocates say they were blindsided, though, when the CDC moved to create formal guidelines without first consulting them.

"It looks to us like they had a pretty good idea of what they wanted these things to say and they wanted to minimize feedback that was contrary to that," said Robert Twillman of the American Academy of Pain Management, a group which represents pain physicians and receives funding from painkiller manufacturers such as Purdue and Teva Pharmaceuticals.

Twillman's group has asked Congress to investigate the CDC's handling of the guidelines, including an expert panel of advisers, which it says is "studded with a number of individuals who are publicly on record as opposing the use of opioids."

The CDC had not publicly disclosed the panel's membership, but Twillman and other pain-relief advocates identified several members, including two who are leaders with Physicians for Responsible Opioid Prescribing, a group working to reduce painkiller prescribing. That group is backed by Phoenix House, a network of rehabilitation clinics.

The Washington Legal Foundation - a conservative group which frequently represents pharmaceutical interests in court - says CDC is in "blatant violation of federal law" for not disclosing its advisers. The foundation wants the CDC to scrap its guidelines and start over.

Many of the patient and physician groups opposing the CDC guidelines are part of a larger coalition called the Pain Care Forum, which meets monthly in Washington to strategize on pain issues.

Read more at http://www.philly.com/philly/news/n...escribing_under_fire.html#iMc4q0Zet2Aqoqog.99

Members don't see this ad.
 
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Well the cdc was wrong. Secret meetings, hidden membership, etc. The entire process needs to be scrapped- but not dropped. The cdc has long played very loose with their "guideline" establishment that is quite different than the standard method of guideline development. There seems to be a pervasive belief by the cdc that the opinion of their statisticians and secret committees trumps ebm. And it does not end or begin with opioids. Other guidelines they have developed are using the same erroneous protocol. it could be the CDC is not the appropriate organization to develop the guidelines given their very checkered history. However we need guidelines for not only family practice but also for pain management physicians prescribing these drugs. The implication that primary care should prescribe less than 100 milligram equivalent of morphine a day and have no limit on pain physicians is missing the major reason for drug overdoses.
 
Well the cdc was wrong. Secret meetings, hidden membership, etc. The entire process needs to be scrapped- but not dropped. The cdc has long played very loose with their "guideline" establishment that is quite different than the standard method of guideline development. There seems to be a pervasive belief by the cdc that the opinion of their statisticians and secret committees trumps ebm. And it does not end or begin with opioids. Other guidelines they have developed are using the same erroneous protocol. it could be the CDC is not the appropriate organization to develop the guidelines given their very checkered history. However we need guidelines for not only family practice but also for pain management physicians prescribing these drugs. The implication that primary care should prescribe less than 100 milligram equivalent of morphine a day and have no limit on pain physicians is missing the major reason for drug overdoses.

Why would any group promote such a narrow and closed process to the extent that it caused a Federal agency to violates its own rules and Federal law? Who is accountable for developing these strategies? I detect some problems with "messaging." While the FDA stepped back, the CDC took the bait. Now, it looks like the promoters of the process shot themselves in the foot and drained any good will that might have been used to reach a constructive, evidence-based consensus. PROP was calling for the removal of the FDA commissioner. Now, it looks like the heads of some top brass at CDC may be on the chopping block. And, the courts will decide the matter. Welcome to America...
 
Members don't see this ad :)
bottom line - decisions about health care on an individual level will be decided more and more by politicians on the East coast.
remember "you can keep your doctor". so what? it won't matter who your doc is.
 
From USA Today

America's deadliest drug problem: Our view

http://usat.ly/1Yxbo1R

Looks like USA TODAY is on CDC side.

Well, I don't understand why anyone thinks that a lack of transparency could produce ANY good public policy: It's just another version of GIGO...but in the dark. All good public policies survive in the sunshine. Let the light shine in!
 
http://www.regulations.gov/#!docket...ct=PS;D=CDC-2015-0112;refD=CDC-2015-0112-0001
" I have several rare diseases that have dumbfounded the majority of my doctors. I have chiari malformation, syringomyelia, and pretty sure I have Ehler's Danlos syndrome. I've had debilitating pain, and no therapy has worked for me. I've been poked prodded, sat for countless hours in MRI machines, but nothing helps to take away the pain accept my prescriptions I receive from pain management. I honestly don't know what I'll do if that option is taken away from me. I'm already treated as a criminal, because most doctors don't understand these diseases and their related symptoms.

I agree the system is abused and many people obtain medicine that wasn't intended for them. That doesn't make it right to pull the rug out from under chronic pain patients and leave them fending for themselves. I'm afraid you'll have more blood on your hands from desperate people who try to obtain relief legally and cannot receive help from the medical system??

Nobody seems to comprehend pain unless it happens to them personally."

EDS, IC, Endometriosis,FMS, FBSS, and that's just the first page.

  • Comment from Julie Inpain
    • Patients have a right not to be in excrutiating pain, period. Why do we have to keep going around and around on this matter. Of course, everything should be done to keep these...
    • Public Submission
    • Posted:

      12/18/2015

    • ID:
      CDC-2015-0112-0348
    • Submitter Name:
      Julie Inpain

    Comment Now!
    Comments Due
    Jan 13, 2016 11:59 PM ET

    Comment from Dave Ondrejik
    • People in chronic pain do not need another roadblock put in their way to receive treatment. I find it hard to believe that you can find many people who are in chronic pain that...
    • Public Submission
    • Posted:

      12/21/2015

    • ID:
      CDC-2015-0112-0426
    • Submitter Name:
      Dave Ondrejik

    Comment Now!
    Comments Due
    Jan 13, 2016 11:59 PM ET

    Comment from Alicia Snyder
    • I have adhesive arachnoiditis. A lot of Dr's don't even know what this is. Many Dr's have reported arachnoiditis as worse than stage 4 cancer. Taking narcotics away from those with...
    • Public Submission
    • Posted:

      12/16/2015

    • ID:
      CDC-2015-0112-0228
    • Submitter Name:
      Alicia Snyder

    Comment Now!
    Comments Due
    Jan 13, 2016 11:59 PM ET

    Comment from Allen Shultz
    • Its as simple as this. If it works, why do a bunch of desk jockey bureaucrats want to interfere with what is best for people they know nothing about.Opoids have been around a long...
    • Public Submission
    • Posted:

      12/18/2015

    • ID:
      CDC-2015-0112-0336
    • Submitter Name:
      Allen Shultz

    Comment Now!
    Comments Due
    Jan 13, 2016 11:59 PM ET

    Comment from Anonymous
    • My spine was fused many years ago because I was born with congenital spondylolisthesis, diagnosed at age 17. I was told that this, and other genetic factors would put me at high...
    • Public Submission
    • Posted:

      12/18/2015

    • ID:
      CDC-2015-0112-0354
    • Submitter Name:
      Anonymous Anonymous

    Comment Now!
    Comments Due
    Jan 13, 2016 11:59 PM ET

    Comment from Sharyn Rossi
    • The regulations for obtaining Norco is already in place. The Physicians and Pharmacies have already implemented the dispensing of controlled substance drugs. I am in content...
    • Public Submission
    • Posted:

      12/18/2015

    • ID:
      CDC-2015-0112-0344
    • Submitter Name:
      Sharyn Rossi

    Comment Now!
    Comments Due
    Jan 13, 2016 11:59 PM ET

    Comment from Tammy Baughman
    • CDC-2015-0112-0001 Chronic pain is caused by illness, diseases, accidents etc. Some of these reason's listed cannot be seen by the naked eye orr even with a machine. Chronic pain...
    • Public Submission
    • Posted:

      12/16/2015

    • ID:
      CDC-2015-0112-0169
    • Submitter Name:
      Tammy Baughman

    Comment Now!
    Comments Due
    Jan 13, 2016 11:59 PM ET

    Comment from Trudy Ujdur
    • I work as a provider in an OP clinic and do addiction, chronic pain management and psychiatry. most of the psychiatrists/PCP see patients for a very short time and give a pill for...
    • Public Submission
    • Posted:

      12/17/2015

    • ID:
      CDC-2015-0112-0303
    • Submitter Name:
      Trudy Ujdur

    Comment Now!
    Comments Due
    Jan 13, 2016 11:59 PM ET

    Comment from Constance Small
    • I have had severe, intractable neuropathic pain from my Interstitial Cystitis and my Fibromyelgia for 28 years now. I could not lead any type of a normal life without my pain...
    • Public Submission
    • Posted:

      12/21/2015

    • ID:
      CDC-2015-0112-0427
    • Submitter Name:
      Constance Small

    Comment Now!
    Comments Due
    Jan 13, 2016 11:59 PM ET

    Comment from DIANA GERDING
    • To Whom It May Concern, I have been on Vicodin for 20 years now. Starting with a back injury in 1994. Until 10 years ago I only had to take the medication PRN(as needed for pain...
    • Public Submission
    • Posted:

      12/16/2015

    • ID:
      CDC-2015-0112-0189
    • Submitter Name:
      DIANA GERDING

    Comment Now!
    Comments Due
    Jan 13, 2016 11:59 PM ET

    Comment from Anonymous
    • I have had severe Interstitial Cystitis for 6 years. It has completely changed my life. I hear many speak of a flare up, I live in a constant flare up. The pain is unlike anything...
    • Public Submission
    • Posted:

      12/18/2015

    • ID:
      CDC-2015-0112-0350
    • Submitter Name:
      Anonymous Anonymous

    Comment Now!
    Comments Due
    Jan 13, 2016 11:59 PM ET

    Comment from Diane Poor
    • I have suffered with chronic pain all of my life. I have arthritis, DDD, SI Joint dysfunction, Fibromyalgia, Reynauds, generalized anxiety disorder, and bipolar type ll. Because...
    • Public Submission
    • Posted:

      12/16/2015

    • ID:
      CDC-2015-0112-0216
    • Submitter Name:
      Diane Poor

    Comment Now!
    Comments Due
    Jan 13, 2016 11:59 PM ET

    Comment from Melissa Mulvihill
    • I am 47 years old and I live with chronic pain. I am diagnosed with Narcolepsy without cataplexy, I survived Stage IV Endometriosis, and I live with the ongoing debilitating tendon...
    • Public Submission
    • Posted:

      12/17/2015

    • ID:
      CDC-2015-0112-0270
    • Submitter Name:
      Melissa Mulvihill

    Comment Now!
    Comments Due
    Jan 13, 2016 11:59 PM ET

    Comment from Terry Bressler
    • Please do not restrict access to the medications that are the only thing that give me any quality of life. I have CRPS and without the medications I am on I would have already...
    • Public Submission
    • Posted:

      12/21/2015

    • ID:
      CDC-2015-0112-0366
    • Submitter Name:
      Terry Bressler

    Comment Now!
    Comments Due
    Jan 13, 2016 11:59 PM ET

    Comment from Harold Laski MD
    • The intent of the Guidelines is good, if not great. I applaud the CDC for it's efforts. There is definitely a necessity for a guideline for both physicians and patients. The...
    • Public Submission
    • Posted:

      12/17/2015

    • ID:
      CDC-2015-0112-0292
    • Submitter Name:
      Harold Laski MD

    Comment Now!
    Comments Due
    Jan 13, 2016 11:59 PM ET

    Comment from Judith Sobel
    • As a patient with Hypermobile Ehlers-DanlosSyndrome,I suffer severe pain. There is no treatment for HEDS itself, so I work with a pain clinic to enable me to function daily. I...
    • Public Submission
    • Posted:

      12/21/2015

    • ID:
      CDC-2015-0112-0428
    • Submitter Name:
      Judith Sobel

    Comment Now!
    Comments Due
    Jan 13, 2016 11:59 PM ET

    Comment from Stacey Rosbury
    • In response to the "Guideline for prescribing opiods", How are you to judge what a person requires unless you stand in their shoes? You can't! The pain levels of Fibromyalgia in...
    • Public Submission
    • Posted:

      12/16/2015

    • ID:
      CDC-2015-0112-0126
    • Submitter Name:
      Stacey Rosbury

    Comment Now!
    Comments Due
    Jan 13, 2016 11:59 PM ET

    Comment from Anonymous
    • I ask that you please take into consideration that there are many individuals who use pain medication as ordered by their pain management MD's/DO's. They benefit from the treatment...
    • Public Submission
    • Posted:

      12/16/2015

    • ID:
      CDC-2015-0112-0220
    • Submitter Name:
      Anonymous Anonymous

    Comment Now!
    Comments Due
    Jan 13, 2016 11:59 PM ET

    Comment from Anonymous
    • It is very frustrating to have my orthopedic Dr. be with a group that has passed a policy to not give out pain meds after a certain number of months post surgery, then sends me to...
    • Public Submission
    • Posted:

      12/16/2015

    • ID:
      CDC-2015-0112-0141
    • Submitter Name:
      A Anonymous

    Comment Now!
    Comments Due
    Jan 13, 2016 11:59 PM ET

    Comment from Keith Guest
    • Hi, I work as a Geriatrician in long term care. My practice almost exclusively cares for patients in the last few years of life. Most are too disabled to come to an outpatient...
    • Public Submission
    • Posted:

      12/16/2015

    • ID:
      CDC-2015-0112-0233
    • Organization:
      Senior Health Associates
    • Submitter Name:
      Keith Guest

    Comment Now!
    Comments Due
    Jan 13, 2016 11:59 PM ET

    Comment from Emily Valtreaux
    • Why are your "professional panels" made up of people that will greatly benefit by throwing us all in detox I wonder? Why do you cry "hyperalgesia" (apparently the new fear mongerer...
    • Public Submission
    • Posted:

      12/16/2015

    • ID:
      CDC-2015-0112-0237
    • Submitter Name:
      Emily Valtreaux

    Comment Now!
    Comments Due
    Jan 13, 2016 11:59 PM ET

    Comment from Jenniffer Hawkins
    • As a long term sufferer of Ehlers-Famous Syndrome, I deal with chronic pain that is debilitating and without opioids, I would be unable to move or be part of my children's lives. I...
    • Public Submission
    • Posted:

      12/16/2015

    • ID:
      CDC-2015-0112-0176
    • Submitter Name:
      Jenniffer Hawkins

    Comment Now!
    Comments Due
    Jan 13, 2016 11:59 PM ET

    Comment from Sheila Defazio
    • I have a very aggressive form of Rheumatoid Arthritis..so far none of the RA meds have worked to stop the destruction of my joints, ligaments, and tendons..I cannot use a cane to...
    • Public Submission
    • Posted:

      12/16/2015

    • ID:
      CDC-2015-0112-0234
    • Submitter Name:
      sheila defazio

    Comment Now!
    Comments Due
    Jan 13, 2016 11:59 PM ET

    Comment from Anonymous
    • I read your proposed guidelines and note, with disgust, the biased and simply invalid statistics accompanied by the braying of the usual self-aggrandizing politicians and media...
    • Public Submission
    • Posted:

      12/22/2015

    • ID:
      CDC-2015-0112-0449
    • Organization:
      The Chronic Pain Abusers of the Obamanation and the CDC
    • Submitter Name:
      Anonymous Anonymous

    Comment Now!
    Comments Due
    Jan 13, 2016 11:59 PM ET

    Comment from Debbie Anonymous
    • My Name is Debbie, I'm 58 years old and have Fibromyalgia. I was diagnosed 12 years ago. I had no idea what Fibromyalgia was until I was told I have it and did a lot research on...
    • Public Submission
    • Posted:

      12/17/2015

    • ID:
      CDC-2015-0112-0304
    • Submitter Name:
      Debbie Anonymous

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Last edited:
http://www.regulations.gov/#!docket...ct=PS;D=CDC-2015-0112;refD=CDC-2015-0112-0001
" I have several rare diseases that have dumbfounded the majority of my doctors. I have chiari malformation, syringomyelia, and pretty sure I have Ehler's Danlos syndrome. I've had debilitating pain, and no therapy has worked for me. I've been poked prodded, sat for countless hours in MRI machines, but nothing helps to take away the pain accept my prescriptions I receive from pain management. I honestly don't know what I'll do if that option is taken away from me. I'm already treated as a criminal, because most doctors don't understand these diseases and their related symptoms.

I agree the system is abused and many people obtain medicine that wasn't intended for them. That doesn't make it right to pull the rug out from under chronic pain patients and leave them fending for themselves. I'm afraid you'll have more blood on your hands from desperate people who try to obtain relief legally and cannot receive help from the medical system??

Nobody seems to comprehend pain unless it happens to them personally."

EDS, IC, Endometriosis,FMS, FBSS, and that's just the first page.

  • Comment from Julie Inpain
    • Patients have a right not to be in excrutiating pain, period. Why do we have to keep going around and around on this matter. Of course, everything should be done to keep these...
    • Public Submission
    • Posted:

      12/18/2015

    • ID:
      CDC-2015-0112-0348
    • Submitter Name:
      Julie Inpain

    Comment Now!
    Comments Due
    Jan 13, 2016 11:59 PM ET

    Comment from Dave Ondrejik
    • People in chronic pain do not need another roadblock put in their way to receive treatment. I find it hard to believe that you can find many people who are in chronic pain that...
    • Public Submission
    • Posted:

      12/21/2015

    • ID:
      CDC-2015-0112-0426
    • Submitter Name:
      Dave Ondrejik

    Comment Now!
    Comments Due
    Jan 13, 2016 11:59 PM ET

    Comment from Alicia Snyder
    • I have adhesive arachnoiditis. A lot of Dr's don't even know what this is. Many Dr's have reported arachnoiditis as worse than stage 4 cancer. Taking narcotics away from those with...
    • Public Submission
    • Posted:

      12/16/2015

    • ID:
      CDC-2015-0112-0228
    • Submitter Name:
      Alicia Snyder

    Comment Now!
    Comments Due
    Jan 13, 2016 11:59 PM ET

    Comment from Allen Shultz
    • Its as simple as this. If it works, why do a bunch of desk jockey bureaucrats want to interfere with what is best for people they know nothing about.Opoids have been around a long...
    • Public Submission
    • Posted:

      12/18/2015

    • ID:
      CDC-2015-0112-0336
    • Submitter Name:
      Allen Shultz

    Comment Now!
    Comments Due
    Jan 13, 2016 11:59 PM ET

    Comment from Anonymous
    • My spine was fused many years ago because I was born with congenital spondylolisthesis, diagnosed at age 17. I was told that this, and other genetic factors would put me at high...
    • Public Submission
    • Posted:

      12/18/2015

    • ID:
      CDC-2015-0112-0354
    • Submitter Name:
      Anonymous Anonymous

    Comment Now!
    Comments Due
    Jan 13, 2016 11:59 PM ET

    Comment from Sharyn Rossi
    • The regulations for obtaining Norco is already in place. The Physicians and Pharmacies have already implemented the dispensing of controlled substance drugs. I am in content...
    • Public Submission
    • Posted:

      12/18/2015

    • ID:
      CDC-2015-0112-0344
    • Submitter Name:
      Sharyn Rossi

    Comment Now!
    Comments Due
    Jan 13, 2016 11:59 PM ET

    Comment from Tammy Baughman
    • CDC-2015-0112-0001 Chronic pain is caused by illness, diseases, accidents etc. Some of these reason's listed cannot be seen by the naked eye orr even with a machine. Chronic pain...
    • Public Submission
    • Posted:

      12/16/2015

    • ID:
      CDC-2015-0112-0169
    • Submitter Name:
      Tammy Baughman

    Comment Now!
    Comments Due
    Jan 13, 2016 11:59 PM ET

    Comment from Trudy Ujdur
    • I work as a provider in an OP clinic and do addiction, chronic pain management and psychiatry. most of the psychiatrists/PCP see patients for a very short time and give a pill for...
    • Public Submission
    • Posted:

      12/17/2015

    • ID:
      CDC-2015-0112-0303
    • Submitter Name:
      Trudy Ujdur

    Comment Now!
    Comments Due
    Jan 13, 2016 11:59 PM ET

    Comment from Constance Small
    • I have had severe, intractable neuropathic pain from my Interstitial Cystitis and my Fibromyelgia for 28 years now. I could not lead any type of a normal life without my pain...
    • Public Submission
    • Posted:

      12/21/2015

    • ID:
      CDC-2015-0112-0427
    • Submitter Name:
      Constance Small

    Comment Now!
    Comments Due
    Jan 13, 2016 11:59 PM ET

    Comment from DIANA GERDING
    • To Whom It May Concern, I have been on Vicodin for 20 years now. Starting with a back injury in 1994. Until 10 years ago I only had to take the medication PRN(as needed for pain...
    • Public Submission
    • Posted:

      12/16/2015

    • ID:
      CDC-2015-0112-0189
    • Submitter Name:
      DIANA GERDING

    Comment Now!
    Comments Due
    Jan 13, 2016 11:59 PM ET

    Comment from Anonymous
    • I have had severe Interstitial Cystitis for 6 years. It has completely changed my life. I hear many speak of a flare up, I live in a constant flare up. The pain is unlike anything...
    • Public Submission
    • Posted:

      12/18/2015

    • ID:
      CDC-2015-0112-0350
    • Submitter Name:
      Anonymous Anonymous

    Comment Now!
    Comments Due
    Jan 13, 2016 11:59 PM ET

    Comment from Diane Poor
    • I have suffered with chronic pain all of my life. I have arthritis, DDD, SI Joint dysfunction, Fibromyalgia, Reynauds, generalized anxiety disorder, and bipolar type ll. Because...
    • Public Submission
    • Posted:

      12/16/2015

    • ID:
      CDC-2015-0112-0216
    • Submitter Name:
      Diane Poor

    Comment Now!
    Comments Due
    Jan 13, 2016 11:59 PM ET

    Comment from Melissa Mulvihill
    • I am 47 years old and I live with chronic pain. I am diagnosed with Narcolepsy without cataplexy, I survived Stage IV Endometriosis, and I live with the ongoing debilitating tendon...
    • Public Submission
    • Posted:

      12/17/2015

    • ID:
      CDC-2015-0112-0270
    • Submitter Name:
      Melissa Mulvihill

    Comment Now!
    Comments Due
    Jan 13, 2016 11:59 PM ET

    Comment from Terry Bressler
    • Please do not restrict access to the medications that are the only thing that give me any quality of life. I have CRPS and without the medications I am on I would have already...
    • Public Submission
    • Posted:

      12/21/2015

    • ID:
      CDC-2015-0112-0366
    • Submitter Name:
      Terry Bressler

    Comment Now!
    Comments Due
    Jan 13, 2016 11:59 PM ET

    Comment from Harold Laski MD
    • The intent of the Guidelines is good, if not great. I applaud the CDC for it's efforts. There is definitely a necessity for a guideline for both physicians and patients. The...
    • Public Submission
    • Posted:

      12/17/2015

    • ID:
      CDC-2015-0112-0292
    • Submitter Name:
      Harold Laski MD

    Comment Now!
    Comments Due
    Jan 13, 2016 11:59 PM ET

    Comment from Judith Sobel
    • As a patient with Hypermobile Ehlers-DanlosSyndrome,I suffer severe pain. There is no treatment for HEDS itself, so I work with a pain clinic to enable me to function daily. I...
    • Public Submission
    • Posted:

      12/21/2015

    • ID:
      CDC-2015-0112-0428
    • Submitter Name:
      Judith Sobel

    Comment Now!
    Comments Due
    Jan 13, 2016 11:59 PM ET

    Comment from Stacey Rosbury
    • In response to the "Guideline for prescribing opiods", How are you to judge what a person requires unless you stand in their shoes? You can't! The pain levels of Fibromyalgia in...
    • Public Submission
    • Posted:

      12/16/2015

    • ID:
      CDC-2015-0112-0126
    • Submitter Name:
      Stacey Rosbury

    Comment Now!
    Comments Due
    Jan 13, 2016 11:59 PM ET

    Comment from Anonymous
    • I ask that you please take into consideration that there are many individuals who use pain medication as ordered by their pain management MD's/DO's. They benefit from the treatment...
    • Public Submission
    • Posted:

      12/16/2015

    • ID:
      CDC-2015-0112-0220
    • Submitter Name:
      Anonymous Anonymous

    Comment Now!
    Comments Due
    Jan 13, 2016 11:59 PM ET

    Comment from Anonymous
    • It is very frustrating to have my orthopedic Dr. be with a group that has passed a policy to not give out pain meds after a certain number of months post surgery, then sends me to...
    • Public Submission
    • Posted:

      12/16/2015

    • ID:
      CDC-2015-0112-0141
    • Submitter Name:
      A Anonymous

    Comment Now!
    Comments Due
    Jan 13, 2016 11:59 PM ET

    Comment from Keith Guest
    • Hi, I work as a Geriatrician in long term care. My practice almost exclusively cares for patients in the last few years of life. Most are too disabled to come to an outpatient...
    • Public Submission
    • Posted:

      12/16/2015

    • ID:
      CDC-2015-0112-0233
    • Organization:
      Senior Health Associates
    • Submitter Name:
      Keith Guest

    Comment Now!
    Comments Due
    Jan 13, 2016 11:59 PM ET

    Comment from Emily Valtreaux
    • Why are your "professional panels" made up of people that will greatly benefit by throwing us all in detox I wonder? Why do you cry "hyperalgesia" (apparently the new fear mongerer...
    • Public Submission
    • Posted:

      12/16/2015

    • ID:
      CDC-2015-0112-0237
    • Submitter Name:
      Emily Valtreaux

    Comment Now!
    Comments Due
    Jan 13, 2016 11:59 PM ET

    Comment from Jenniffer Hawkins
    • As a long term sufferer of Ehlers-Famous Syndrome, I deal with chronic pain that is debilitating and without opioids, I would be unable to move or be part of my children's lives. I...
    • Public Submission
    • Posted:

      12/16/2015

    • ID:
      CDC-2015-0112-0176
    • Submitter Name:
      Jenniffer Hawkins

    Comment Now!
    Comments Due
    Jan 13, 2016 11:59 PM ET

    Comment from Sheila Defazio
    • I have a very aggressive form of Rheumatoid Arthritis..so far none of the RA meds have worked to stop the destruction of my joints, ligaments, and tendons..I cannot use a cane to...
    • Public Submission
    • Posted:

      12/16/2015

    • ID:
      CDC-2015-0112-0234
    • Submitter Name:
      sheila defazio

    Comment Now!
    Comments Due
    Jan 13, 2016 11:59 PM ET

    Comment from Anonymous
    • I read your proposed guidelines and note, with disgust, the biased and simply invalid statistics accompanied by the braying of the usual self-aggrandizing politicians and media...
    • Public Submission
    • Posted:

      12/22/2015

    • ID:
      CDC-2015-0112-0449
    • Organization:
      The Chronic Pain Abusers of the Obamanation and the CDC
    • Submitter Name:
      Anonymous Anonymous

    Comment Now!
    Comments Due
    Jan 13, 2016 11:59 PM ET

    Comment from Debbie Anonymous
    • My Name is Debbie, I'm 58 years old and have Fibromyalgia. I was diagnosed 12 years ago. I had no idea what Fibromyalgia was until I was told I have it and did a lot research on...
    • Public Submission
    • Posted:

      12/17/2015

    • ID:
      CDC-2015-0112-0304
    • Submitter Name:
      Debbie Anonymous

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I wonder how many of the commentators are voting for Trump? It seems many have lost faith in the capacity of Government to look after the best interests of The People. Better messaging and social marketing will be required. Has any group done any polling, focus groups, or surveys about what sort of harm reduction messages are most effective? Break it out by political party affiliation, gender, etc. Seems like a logical place to start.
 
http://www.regulations.gov/#!docket...ct=PS;D=CDC-2015-0112;refD=CDC-2015-0112-0001
" I have several rare diseases that have dumbfounded the majority of my doctors. I have chiari malformation, syringomyelia, and pretty sure I have Ehler's Danlos syndrome. I've had debilitating pain, and no therapy has worked for me. I've been poked prodded, sat for countless hours in MRI machines, but nothing helps to take away the pain accept my prescriptions I receive from pain management. I honestly don't know what I'll do if that option is taken away from me. I'm already treated as a criminal, because most doctors don't understand these diseases and their related symptoms.

I agree the system is abused and many people obtain medicine that wasn't intended for them. That doesn't make it right to pull the rug out from under chronic pain patients and leave them fending for themselves. I'm afraid you'll have more blood on your hands from desperate people who try to obtain relief legally and cannot receive help from the medical system??

Nobody seems to comprehend pain unless it happens to them personally."

EDS, IC, Endometriosis,FMS, FBSS, and that's just the first page.
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I'm just a dumb ER doc, but I notice, again, that the vast majority of commenters that give a name appear to be female. I know 5/6 of borderline PD pts are female, but I don't recall the % of FMS that are female (but that it is a majority). Has anyone worked on the aspect of why women are more prevalent in the FMS/IC/CFS/IBS crowd? I have my own opinion that it's the depression aspect, but I don't have evidence.
 
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I'm just a dumb ER doc, but I notice, again, that the vast majority of commenters that give a name appear to be female. I know 5/6 of borderline PD pts are female, but I don't recall the % of FMS that are female (but that it is a majority). Has anyone worked on the aspect of why women are more prevalent in the FMS/IC/CFS/IBS crowd? I have my own opinion that it's the depression aspect, but I don't have evidence.

Freud had some interesting ideas about Penis Envy...
 
I'm just a dumb ER doc,

No, you are'nt.

Overwhelming evidence reveals that what is often labeled as a single chronic regional pain syndrome is, upon closer evaluation, a chronic illness beginning much earlier in life, where the pain merely occurs at different points of the body
at different points in time and is given different labels by subspecialists focusing on “their region” of the body.”


CENTRAL SENSITIZATION:
1. Pain in many body regions.
2. Higher current and lifetime history of chronic pain in several
body regions.
3. Multiple somatic symptoms (e.g., fatigue, memory difficulties,
sleep problems, mood disturbance)
4. More sensitive to other sensory stimuli (e.g., bright light, loud noises, odors,
other sensations in internal organs)
5. 1.5 to 2x more common in women.
6. Strong family history of chronic pain.
7. High self-reported pain (VAS/NPS)
8. Pain triggered or exacerbated by stressors.
9. Essentially normal physical examination +/- diffuse tenderness.
 
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It doesn't look like Congress is buying Frieden's argument that the Core Expert Group was exempt from the Federal Advisory Committee Act. I wonder why the whole process got off on the wrong foot? It's will be interesting to see what the Freedom of Information Act digs up from the minutes of the off-record meetings between the CEG and Frieden. Does anyone know how Frieden is connected to other the players in the process? Is there a conflict or confluence of interest at stake?

http://static1.squarespace.com/stat...t-Connolly-to-Frieden-CDC-FACA-due-Jan.-5.pdf
 
It doesn't look like Congress is buying Frieden's argument that the Core Expert Group was exempt from the Federal Advisory Committee Act. I wonder why the whole process got off on the wrong foot? It's will be interesting to see what the Freedom of Information Act digs up from the minutes of the off-record meetings between the CEG and Frieden. Does anyone know how Frieden is connected to other the players in the process? Is there a conflict or confluence of interest at stake?

http://static1.squarespace.com/stat...t-Connolly-to-Frieden-CDC-FACA-due-Jan.-5.pdf

Dr. Frieden migjt be looking for a new job soon. I read the pdf as a smackdown of the process and a witch hunt is afoot.
 
Members don't see this ad :)
No, you are'nt.

Overwhelming evidence reveals that what is often labeled as a single chronic regional pain syndrome is, upon closer evaluation, a chronic illness beginning much earlier in life, where the pain merely occurs at different points of the body
at different points in time and is given different labels by subspecialists focusing on “their region” of the body.”


CENTRAL SENSITIZATION:
1. Pain in many body regions.
2. Higher current and lifetime history of chronic pain in several
body regions.
3. Multiple somatic symptoms (e.g., fatigue, memory difficulties,
sleep problems, mood disturbance)
4. More sensitive to other sensory stimuli (e.g., bright light, loud noises, odors,
other sensations in internal organs)
5. 1.5 to 2x more common in women.
6. Strong family history of chronic pain.
7. High self-reported pain (VAS/NPS)
8. Pain triggered or exacerbated by stressors.
9. Essentially normal physical examination +/- diffuse tenderness.

upload_2015-12-22_20-16-1.png

Your moment of Zen...
 
I'm just a dumb ER doc, but I notice, again, that the vast majority of commenters that give a name appear to be female. I know 5/6 of borderline PD pts are female, but I don't recall the % of FMS that are female (but that it is a majority). Has anyone worked on the aspect of why women are more prevalent in the FMS/IC/CFS/IBS crowd? I have my own opinion that it's the depression aspect, but I don't have evidence.

Women are crazy!......its a medical fact.......
 
I remember reading 90% of FMS is in women

I know this is my personal experience. I can count on one hand the number of males I have seen with FMS. I feel FMS is simply the manifestation of a combination of poor coping mechanisms, emotional stress, physical inactivity and social/medical reinforcement. Think about it. 40-50 yo woman with various social issues (divorced, poor socioeconomic status, poor social structure) who comes complaining of multiple vague complaints with no clear underlying cause and who then is "rewarded" by her physician, society and family by getting a medical label for her dysfunctional life. She then gets fancy meds, narcotics, attention from family and others, disability and she is allowed to become even more sedentary and dysfunctional.
 
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Is there anything sadder than a man with Fibromyalgia?
 
Well, I don't understand why anyone thinks that a lack of transparency could produce ANY good public policy: It's just another version of GIGO...but in the dark. All good public policies survive in the sunshine. Let the light shine in!

Not surprised really. It's the way political agendas are achieved in this country.

One side throws money at the issue, the other side uses secret committees.
 
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Letter from PROP this AM:

Dear Friends and Colleagues,

As you may have heard, the CDC intended to release a guideline for opioid prescribing in January. CDC’s plan was effectively blocked by intense pressure from the opioid lobby, which sees more cautious opioid use as a financial threat.

CDC was pressured into opening a federal docket on its draft guideline. This will tack months on to the process- it is also highly unusual- federal dockets are typically opened for public comment on proposed regulations- not for medical guidance issued by CDC.

Your help is urgently required. Please take a few minutes to post a comment on the docket supporting CDC’s effort to issue opioid prescribing guidance.

Here’s the link you can use to post your comment:

http://www.regulations.gov/#!submitComment;D=CDC-2015-0112-0001

If you are a health professional, please list MD, DO, RN, etc. after your last name and mention your clinical experience in your comment. If you’re not a health professional, please mention your personal experience with overprescribing of opioids.

The draft guideline isn’t perfect- PROP submitted suggestions to CDC for improvements- but even as is, we strongly support CDC’s effort.

Here are some important points to consider including in your comment:

  1. The medical community is urgently in need of guidance from CDC because aggressive opioid prescribing is harming pain patients and fueling an epidemic of addiction and overdose deaths.
  1. Guidance on duration of use is required. Excessive quantities are frequently prescribed for acute pain, even when less than 3 days of medicine would have been sufficient.
  1. Dosing guidance is required because high doses increase risk for overdose death and other adverse events.
  1. Opioids should be avoided for fibromyalgia, chronic headache and low back pain because for these conditions, the risks of use clearly outweigh potential benefit.

Thank you for responding to this request. And please share this message with others who may also be willing to post comments supporting the CDC’s effort.

Sincerely,

Andrew Kolodny, MD
Executive Director
Physicians for Responsible Opioid Prescribing
www.supportPROP.org

BECOME A CONTRIBUTING MEMBER
With your support, we can strengthen our impact against the powerful opioid manufacturers and distributors. We will continue correcting misinformation about opioid risks and benefits and encouraging policymakers to put public health first. Donations of $100 or more will receive a PROP t-shirt.
 
The guidelines should apply to all physicians. CDC is a government agency and as much as they like to think of themselves being immune from federal law, they must obey the laws that prevent the government from having secret meetings that in effect result in the creation of de facto laws that would be used against physicians in a court of law. They need to start over. PROP should play a role in this process along with other pain organizations.
 
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The guidelines should apply to all physicians. CDC is a government agency and as much as they like to think of themselves being immune from federal law, they must obey the laws that prevent the government from having secret meetings that in effect result in the creation of de facto laws that would be used against physicians in a court of law. They need to start over. PROP should play a role in this process along with other pain organizations.

Sunshine is a powerful disinfectant.
 
The guidelines should apply to all physicians. CDC is a government agency and as much as they like to think of themselves being immune from federal law, they must obey the laws that prevent the government from having secret meetings that in effect result in the creation of de facto laws that would be used against physicians in a court of law. They need to start over. PROP should play a role in this process along with other pain organizations.

The problem is that the whole process is based on mistrust. Two competing agendas, with those taking a moderate/reasonable approach caught in the middle.

Those drafting the guidelines do so in secret, because they fear the powerful lobbying and advocacy efforts of the opposition. They don't feel that they can achieve their objectives otherwise.
 
The problem is that the whole process is based on mistrust. Two competing agendas, with those taking a moderate/reasonable approach caught in the middle.

Those drafting the guidelines do so in secret, because they fear the powerful lobbying and advocacy efforts of the opposition. They don't feel that they can achieve their objectives otherwise.

Despite almost 40 sets of guidelines, the interested parties can't come to a consensus. I wonder which group is more strident and hardened in their position and which group is more committed to accepting the outcome of a process/mediation.
 
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i would guess the group with more $$$ ie Big Pharma.

money rules in our system of government. those with the biggest wallets almost always win.

and, as usual, it will be the common man that literally dies as they get their way.
 
The guidelines should apply to all physicians. CDC is a government agency and as much as they like to think of themselves being immune from federal law, they must obey the laws that prevent the government from having secret meetings that in effect result in the creation of de facto laws that would be used against physicians in a court of law. They need to start over. PROP should play a role in this process along with other pain organizations.
This is a scientific issue. It should be decided based on data, NOT based on the rhetoric generated by a political lobbying group like PROP. Afterall, no rational argument can be made to allow Pfizer or Purdue to have a seat at the table.
 
True, but the CDC is not a scientific organization. They operate on an epidemiological standpoint, viewing the world retrospectively, and incapable of creating guidelines based on prospective RCTs or systematic analysis. The secrecy demonstrates absolutely they haven't a clue how to develop guidelines, therefore issues regarding opioids should be made by consensus of parties examining the scientific data, without the CDC leading or having input into the process. If there is insufficient data to make a recommendation, then as with other guidelines, there should not be a recommendation made. If there is sufficient data to make a recommendation, it should be subjected to GRADE just as other systematic reviews are.
 
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How do you determine or establish an evidence or scientifically based consensus when 1/2 of the parties involved are solely interested in financial gain?

Did Big Tobacco ever agree to any consensus regarding dangers of smoking until they were sued?

The CDC might have been secretive, and unwise... Or they may have realized that no consensus will EVER be reached based on the diehard opposition, and thought that the greater public good was worth this attempt...
 
I don't think violating federal laws for the "greater public good" is ever a function of government. The individuals sitting at the table may be appointed by different organizations to represent them, but they continue to be individuals with one vote. Clearly the manufacturers have an agenda as does PROP. Yet I believe if the data were to be viewed as a systematic review, guidelines could be developed. Guidelines, when developed using GRADE lend specific recommendations for questions that are asked. If there is not enough data to give a good evidence or moderate evidence, then low or very low evidence is often used to make recommendations. It is very probable the CDC agenda was that they really did not want to develop guidelines using standard techniques but simply wanted talking heads to parrot their pre-conceived agenda that they want to push down the throats of the public as "guidelines" (read: rules that will be used against physicians in court and would have immediate impact on pain patients). Therefore the CDC has no business developing guidelines at all since they eschew scientific methods and do not report the level of support of each recommendation. On the other hand, if they did not call them guidelines but called them "best practices", it is likely they would garner more support since this term has a legal and practical difference from guidelines.
 
The CDC might have been secretive, and unwise... Or they may have realized that no consensus will EVER be reached based on the diehard opposition, and thought that the greater public good was worth this attempt...

No one has persuaded me that any secrecy was required for the CDC to do its process. Why would a group insist on those kind of tactics?
 
The CDC is an organization that is uniquely sensitive to political pressures. This is probably because of prior experience with the potential of funding being pulled from them in the past. Just look at the role - or, actually, the complete lack of a role - in one of America's greatest issues - morbidity and mortality due to firearms.

Past threats of completely defunding the CDC posed by the NRA and the Republican Right essentially castrated the organization in that issue.

I do agree that "best practices" would be a practical option, but your talking points would definitely be seized by Big Pharma for reasons why opioids should never be restricted - cannot completely pinpoint deaths due to opioids (so risk is overinflated), no study showing long term benefit (but that doesnt mean it isn't there), not everyone dies of an OD (so us doctors just dont know who to give it to), variable rates of addiction (so the medical profession cant even determine that right)...
 
The CDC is an organization that is uniquely sensitive to political pressures. This is probably because of prior experience with the potential of funding being pulled from them in the past. Just look at the role - or, actually, the complete lack of a role - in one of America's greatest issues - morbidity and mortality due to firearms.

Past threats of completely defunding the CDC posed by the NRA and the Republican Right essentially castrated the organization in that issue.

I do agree that "best practices" would be a practical option, but your talking points would definitely be seized by Big Pharma for reasons why opioids should never be restricted - cannot completely pinpoint deaths due to opioids (so risk is overinflated), no study showing long term benefit (but that doesnt mean it isn't there), not everyone dies of an OD (so us doctors just dont know who to give it to), variable rates of addiction (so the medical profession cant even determine that right)...

Yes, firearms are one of our biggest issues. Left wing nutjub.

Amendment II

A well regulated Militia, being necessary to the security of a free State, the right of the people to keep and bear Arms, shall not be infringed.

The CDC is the wrong body for this. It is the FDA's job to smackdown pharma and adopt part of the PROP guidelines. It would also be helpful if the DEA would issue an edict or guidelines on what constitutes legitimate medical care from drug dealing.
 
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The CDC is an organization that is uniquely sensitive to political pressures. This is probably because of prior experience with the potential of funding being pulled from them in the past. Just look at the role - or, actually, the complete lack of a role - in one of America's greatest issues - morbidity and mortality due to firearms.

Past threats of completely defunding the CDC posed by the NRA and the Republican Right essentially castrated the organization in that issue.

I do agree that "best practices" would be a practical option, but your talking points would definitely be seized by Big Pharma for reasons why opioids should never be restricted - cannot completely pinpoint deaths due to opioids (so risk is overinflated), no study showing long term benefit (but that doesnt mean it isn't there), not everyone dies of an OD (so us doctors just dont know who to give it to), variable rates of addiction (so the medical profession cant even determine that right)...

CDC is picking their battles based on data, as well as politics.
 

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Yes, firearms are one of our biggest issues. Left wing nutjub.

Amendment II

A well regulated Militia, being necessary to the security of a free State, the right of the people to keep and bear Arms, shall not be infringed..
i wont disagree with your first comment (apparently you meant it as an insult? :) ). However, limitations are present for everything in society. You will never be able to convince me that mentally unstable individuals or members of terror organizations/on the terror watch list should be able to legally buy weapons.

But that is for a different thread.
 
No one has persuaded me that any secrecy was required for the CDC to do its process. Why would a group insist on those kind of tactics?

I'm speculating here, but my guess is that the same parties that failed through the FDA tried a Plan B through the CDC. Get it done quickly before the alarms go off.

Strike 2.
 
The CDC was also responsible for the Tuskegee experiment continuing, requiring Congressional hearings to force them to treat the men with syphilis. The CDC blocked them from receiving treatment, and they were not told they were part of the experiment.
 
I don't think anyone is convinced that CDC has the credibility to make recommendations about pain treatment.
Who does? As a profession, we dont have credibility, because of all the paid shills. DEA?

Seems like only the individual state DOH have potential to act... But this is also very politically driven.

If noone does, then this is a war we have lost before it even starts...
 
Who does? As a profession, we dont have credibility, because of all the paid shills. DEA?

Seems like only the individual state DOH have potential to act... But this is also very politically driven.

If noone does, then this is a war we have lost before it even starts...

I don't like the term war. Im not at war. This is not a war. Opiates have some role in pain management and it is certainly less than in the past 2 decades. But we cannot remove opiates as a treatment. We need to figure out some fairly rigid prescription guidelines before it is done for us. A seat at the table is needed to mitigate PROP and Pharma. Our rules for pain need to dovetail with all stakeholders regarding decriminalization of addiction and payment for care for this real and pervasive problem facing 10% of the US population and a third of most pain practices.
 
I don't like the term war. Im not at war. This is not a war. Opiates have some role in pain management and it is certainly less than in the past 2 decades. But we cannot remove opiates as a treatment. We need to figure out some fairly rigid prescription guidelines before it is done for us. A seat at the table is needed to mitigate PROP and Pharma. Our rules for pain need to dovetail with all stakeholders regarding decriminalization of addiction and payment for care for this real and pervasive problem facing 10% of the US population and a third of most pain practices.

There is nothing new under the sun. This has been going on for a long time....it almost bankrupted the British Empire.

https://en.wikipedia.org/wiki/Opium_Wars
 
The Opium Wars were actually fabulously profitable for the British Empire and its opium traders who won trade concessions, treaty ports and the right to sell opium freely; they were ruinous for the Chinese state and people.
 
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