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The Opioid Pendulum Swings

The CDC guidelines are out, and that’s a very, very good thing.

Yes, there’s an apparently-reasonable argument that the guidelines’ basis is not sufficiently evidence-based to stand up to the most rigorous standards.  There are two reasons that argument fails.

First, opioid advocates, manufacturers, and most prescribers did not worry about “evidence” when pills by the bucketful were prescribed and dispensed to anyone who presented with a sore back.  For advocates to caterwaul about science, evidence, and a lack of randomized controlled trials lasting more than 12 months is unfair at best.

Second, opioids kill more than 24,000 people a year – likely a lot more.  Mothers, daughters, sons, brothers, fathers are dying every day, causing destitution, devastated families, and disaster for communities. The time for half-measures is long past.

I understand this may lead to a few folks who ostensibly “need” opioids not getting their pills quickly or in the volume they desire.

Ask yourself this – how does this “need” stack up against the deaths, ruined communities, and parent-less children caused by rampant overuse of opioids?

I’d imagine the parents, siblings, and friends of those killed by opioids would be only too happy to wait a while or take another drug or try exercise or…


10 thoughts on “The Opioid Pendulum Swings”

  1. While understanding that there is a clear clinical indication for the SHORT TERM use of opioids, it is not in chronic musculoskeletal/soft tissue com0laints without any noted improvement in overall clinical presentation. At what point does Mr. Einstein’s law come into play?

  2. The best response I heard to the argument about lack of evidence was on NPR. There are no random control trials telling us that hand washing is a good idea.

  3. Better late than never. These guidelines were needed 10 years ago, when Florida was awash in pill mills and appeared to be supplying the entire east coast. In 2009 the Florida Legislature enacted a law authorizing a prescription-drug database for physicians and pharmacists to check before writing and filling scripts for controlled drugs.It was only after the database was established and local and state law enforcement started working on it together that this state shut down the pill mills. The fly-by-night clinics moved to other states.

  4. American exceptionalism at work again. The US uses opiates at a multiple of other developed countries. We ignore the evidence.

    When I was trained in the 80’s in medicine, I was told that opiates have a place in acute and terminal pain, not in chronic. Then Purdue deceived the medical community with the concept that pain is a vital sign and deserves treatment with their drugs (Oxycontin) and others, and that they weren’t addictive. Incredible I know. The human condition has not changed to justify opiates as currently used, for chronic pain, including musculoskeletal. Those using opiates are convinced that my view and that of other traditionalists is wrong, and they can be persuasive and manipulative. But speak to someone who is candid and managed to get off of such drugs, about how they viewed their past behavior.

    For more background see the book “Dreamland” by Sam Quinones:

    The human and social waste is tragic.

  5. I have just filled in a form for an injured worker who is on the maximum level of opiate based medication that is allowed under Australian law- the form was for this injured worker to gain access to home care-everything from cleaning the floors to changing the bed linen and you guessed it helping the person to shower after not “making it to the bathroom”

    This person no longer has any idea as to where the pain of the injury stops and where the opiate addicition starts- nor does this person have any idea as to the impact on the renal health of the opiates that have been prescribed for her over the last 7yrs.

  6. Time to take action, Big question is what our we going to do about the pain. when we take away the drugs.

    1. We’re not going to do anything about the pain when we take away the drugs except advise Tylenol and NSAIDs (and exercise- super, for example, for patients suffering from painful progressive and degenerative neurological diseases) and then wait for people to present to the ER with liver damage from using it in quantities to try to get it to work. And for those of you comforted by the carve outs for palliative, cancer and hospice patients, don’t be. I have lived first hand, in wealthy urban areas, the inability to get opiates for these patients because even if you have a scrip, pharmacists can and do refuse to fill it. Why? Thanks to the countrywide hysteria, people trying to legitimately get these drugs are deemed drug seekers. Good luck everybody. May you never have anything so bad a cough drop can’t fix it.

      1. Ms Morris
        Thanks for the note. I’d suggest that the reaction is anything but hysteria. If 24,000 people were dying every year from airplane crashes or lead poisoning or whatever there would be even more outrage.
        In addition I’d suggest your assertion that there will be a wholesale termination of opioid prescriptions for individuals with chronic neuro pain is just not valid. The guidelines are specific to primary care providers. However, there is no question exercise, cbt, and other approaches hold much promise for a better life for chronic pain patients.
        Finally, comparing adverse events due to NSAIDs to those of opioids is a false equivalency.

  7. There does seem to be an underutilization (by payers, PBM’s, etc…) of programs such as Medication Monitoring/drug testing, Personal Metabolic Evaluations (to confirm the drugs prescribed are actually effective for the individual taking them) and opioid tapering programs. UR is a powerful tool and is frequently used appropriately but I would wager there are significant gains to be made in patient safety, reduced pharmacy/medical spend, reduced lost time and ultimately reduced indemnity costs using UR in combination with the aforementioned programs.

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Joe Paduda is the principal of Health Strategy Associates



A national consulting firm specializing in managed care for workers’ compensation, group health and auto, and health care cost containment. We serve insurers, employers and health care providers.



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