1-#ChronicPain patients knew that the opioid 'guideline' re: prescribing practices was not law.
But as intended, PROP's 'guideline' shaped the Standard of Care re: #opioid prescribing practices so it might as well have been law.
Why?
Tort law.
Let's try and break it down.
2-Once PROP's ‘opioid guideline’ was published through CDC, prescribing practices started to formally change nationally and altered how doctors were to treat pain; altering the Standard of Care. This was crafted around an ‘opioids are dangerous drugs' narrative. #ChronicPain
3-The recommendations to instate a maximum morphine milligram equivalent altered things further in the practice of treating pain. It changed pain treatment recommendations for acute pain, post surgical pain control, and most of all, the way #ChronicPain was treated.
4-As stated above, the opioid prescribing guideline was NOT law per se; but after the Standard of Care changed, MDs/medical facilities knew that if they deviated from standards crafted around the 'guideline' they could be held legally liable in negligence/malpractice litigation.
5-All of this, PROP's CDC ' opioid guideline' & changes in the treatment of pain were based on the assertion that drug deaths were being driven by prescribed opioid medicines and blanket 'over prescribing' practices, as well as an evil Big Pharma agenda. #ChronicPain
6-But the data was flawed & deaths being attributed to RX medication were being conflated when it was primarily illegal street drugs and polypharmacy causing increased drug deaths.
Street Fentanyl was involved as early as 2013 & CDC knew it. #ChronicPainlink.springer.com/article/10.100…
7-But I digress.
Bottom line-MDs are living in fear of prescribing opioids now and not without good cause.
Between possible civil litigation if they deviate from the standard of care re: opioids and DEA intrusion if they DARE practice pateint centered care, they instead opt out.
8-The nightmare that #ChronicPain patients in particular are facing has been based on theories, false premises, and conflated data-
People are suffering & dying due to fallout from CDC's guideline.
9-CDC's 'opioid guideline' should be renounced & rescinded immediately.
Sanity returned re: treating pain w/opioids.
MDs must regain prescribing autonomy while law enforcement's taken out of the exam room altogether and drug policies changed.
IF saving lives is the goal.🧐
10-This thread is very condensed explanation of what was a convoluted process, touching on what should be an involved & nuanced discussion nationally.
But it does highlight some of the more important aspects of how we got here and touches on why things must change. #ChronicPain
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1-Thread about the barriers to care for people in pain and what needs to change.
I. Addressing Chilling Effect
End Morphine Milligram Equivalent (MME)
Prescribing must reflect individualized patient need, considering benefits/risks for each patient.
#PainCareCrisis
2-Regulation of Prescription Drug Monitoring Programs (PDMPs):
Define clear & limited circumstances under which law enforcement can access PDMP data.
Protect healthcare providers from unjust prosecution based on PDMP data and require warrants for any LE investigation.
3-Rescind CDC Opioid Guidelines: Transfer oversight and guideline development to a specialized body of pain management and chronic pain experts, separate from the CDC and focus solely on medical health issues and pain management.
Thread: Denying opiate medications to individuals who genuinely need them for pain management can lead to many serious health issues and so much more...
#PainCareCrisis #TheOutlawAdvocate
2-Increased Pain and Suffering:
The most immediate effect is an increase in pain, which can severely degrade the quality of life, making daily activities unbearable or impossible.
3-Mental Health Deterioration:
Chronic pain can significantly contribute to or exacerbate conditions like depression, anxiety, and suicidal ideation. The psychological toll of unrelieved pain can be profound.
Kolodny laid out a detailed plan in how to reduce opioid Rxing in a meeting in NY, before guideline was even published.
@jmkillingnyc has so much information on how insidious this anti-opioid agenda was from inception in early/mid 2000s and even earlier I believe.
#PainCareCrisis
2-In order to fight back against draconian prescribing protocols, we need to understand how we got here & what's preventing change.
Changes in Standard of Care requires MDs to stay withing the bounds of restrictions.
Law enforcement in medicine has created a chilling effect.
3-With changes re: opioid Standard of Care, if MDs stray, Medical Boards can target them, DEA can charge them, jailing at worse, destroying their reputation and financial standing at the very least. Pts claiming harm by opioids have increased ability to sue for malpractice.
Thread...1-Prescribing practices should never have gotten to the point where some of the most vulnerable people in our society-the sick/injured/elderly-are left in agony, driven to the point of desperation with little to no hope in sight of things changing.
#PainCareCrisis
2-People with serious illnesses and injuries have been being told every year for over a decade to 'hold on', that change is coming. I know from having boots on the ground in the chronic illness community that for most, things have only gotten worse.
#PainCareCrisis
3-Right after CDC/PROP's unrolling of the 'opioid guideline', I and others watched medical professionals convene boards to change the Standard of Care in managing pain in EVERY aspect of medical care, with an anti-opioid, 'dangerous drug', directive driving those changes.
1-What I've noticed over 14 years of advocating for people in pain is when you make it clear you're not anti-opioid, MDs, legislators, media, and GOV officials become rude then dismiss you. If you still don't go away, they'll then attack your character/ignore you.
#PainCareCrisis
2-Even when presenting facts-like the extremely low incidence of 'addiction by prescription'.
Or if we explain the safety/efficacy of opiate medicines when taken as prescribed, or the real dangers of leaving someone without effective pain control, including death- we are ignored.
3-More often than not, a pain patient advocating for themselves is automatically judged as ignorant and having no credibility. We are usually labeled as people 'just wanting THOSE drugs', called junkies or pharma shills, or bots.
Thread-There's probably more to unpack here than X or my current flare will allow me to elaborate on.
From deflection to gaslighting and than on to dismissal of anything we #chronicpatients or even professionals say.
#ChronicPain #PainCareCrisis @DEAHQ federalregister.gov/documents/2024…
2-Section 306 of the Controlled Substances Act (CSA) (21 U.S.C. 826) requires the Attorney General to establish aggregate production quotas for each basic class of controlled substance in schedule I and II...
Maybe next letter writing campaign to the U.S. A.G?
#PainCareCrisis
3-DEA received 4,699 comments from people with chronic pain, patients (ADHD), pain advocacy associations, U.S. professional associations, U.S. nurses, and far more.