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The opioid crisis in the United States continues to occupy a central place, with the National Institute for Combating Drug Abuse stating that more than 115 people die each day from an overdose of drugs. opioids.
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The doctors are abusing the 2016 guidelines regarding opioid pain medications, Wednesday federal authorities said, a clear answer to the increasing number of complaints from chronic pain patients who claim to be victims of opioid pain. an overreaction to the opioid crisis.

The Centers for Disease Control and Prevention, in new guidelines on opioid prescribing, said many doctors were guilty of "misapplication" of the 2016 guidelines that banned the use of opioids. use of opioids. The new guidelines, published in the New England Journal of Medicine, were the latest federal recognition that many doctors' reactions to the opioid crisis had gone too far.

Scott Gottlieb, a former doctor of the Food and Drug Administration, spoke last July about the impact of the opioid crisis response on patients with pain, when he called for develop more options.

Until then, previous recommendations should not affect people undergoing cancer treatment, suffering from "acute sickle cell crises" or suffering from postoperative pain, the CDC said. These patients do not fall within the scope of the guidelines, which were intended for primary care physicians treating patients with chronic pain, the CDC said.

Federal authorities say doctors are abusing the 2016 opioid pain medication guidelines of 2016. (Photo: Thinkstock)

Doctors who set strict limits or eliminate opioids also erroneously apply government guidelines, the CDC said.

Physicians should prescribe the minimum effective dose and avoid increasing it to 90 "equivalent-milligrams of morphine" per day or "carefully justify" any decision to increase the dose to that level.

If doctors are already prescribing opioids at higher doses – at or above the 90 MME limit – they should continue to do so if needed, the CDC said.

More: Doctors and pharmacists from 5 states have been accused of having sold 32 million tablets

The CDC also cautioned against a sudden reduction or interruption of periods of operation to reduce the risk of severe withdrawal symptoms, including "pain and psychological distress".

Policies that impose strict limits go against the focus of the guidelines on an individualized assessment of the benefits and risks of opioids, depending on the specific circumstances and unique needs of each patient, said CDC.

In addition to physicians who reduce their doses or refuse to continue prescribing opioids, many pain patients have lamented the fact that they have lost their doctor after convictions and can not find new loans to treat this. pain.

Excluded patients

Lauri Nickel, 62, of Tempe, Ariz., Said that too many of her other pain patients had been excluded from the relief needed because of the closure of doctors' practices or discipline.

Lauren Deluca, a disabled chronic pain patient, leads the group on chronic disease and advocacy outside her home in Wooster, Massachusetts. She has announced the new guidelines, which she has been calling for for more than two years, but fears that, not to mention palliative care, it will not help people like her.

She suffers from pancreatitis and arterial disease which requires her to use a feeding tube about 90% of the time. It will never go better and will still need pain medication to "manage the symptoms".

Nevertheless, she applauds the CDC's decision to allow high doses of opioids and warn patients against withdrawing their drugs from their will.

"It's a fair and balanced step to correct what's going on, but now you have to educate the public about the changes," Deluca said.

The CDC has announced its intention to promote the guidelines using easy-to-understand language and teaching materials.

The revised guidelines may not help pain specialists who face discipline in prescribing painkillers, says Roanoke, Virginia's former family physician, Linda Cheek. She was found guilty of improperly ordering and served more than two years in prison and four months of house arrest after being convicted.

"The elephant in the room is the fact that doctors are being prosecuted for doing their job," Cheek said.

She now runs a website called Doctors of Courage, which includes articles on "Injustice Against Health Professionals and Patients With Chronic Pain."

Alternatives are needed

In the United States, more than 50 million patients with chronic pain need more alternatives to opioids, said Christine Lemke, co-founder of the Evidation Virtual Health Research Society. Lemke, who is suffering from an autoimmune arthritis disorder that affects her entire body, said she was currently following a diet and exercising to relieve her pain. She stopped taking opioid pain medications years ago.

His company is studying 10,000 patients with chronic pain to try to quantify the pain, which will help other companies to develop treatments. She notes that there have been only five new pain medications approved in the last 10 years.

"I have never met anyone who wants to take an opioid," Lemke said. "There is a lack of innovation in the pain, but there are no measures to properly quantify the pain."

Insurers are also developing policies and discouraging inappropriate opioid prescriptions such as OxyContin and Percocet.

America's Health Insurance Plans, the advocacy group of commercial health insurance companies, unveiled a new strategy to help doctors and patients manage chronic low back pain without using opioids. Among the group's goals: To build consensus on how to measure the effectiveness of pain care with non-opioid treatments and to better coordinate care between pain specialists and primary care physicians.

AHIP has also announced its intention to expand access to drug treatments helping people to wean themselves off highly addictive painkillers.

In addition to cautioning doctors against being cautious, the CDC emphasized the need for several safeguards. He recommended to the doctors:

• If possible, avoid prescribing opioid analgesics and benzodiazepines – such as Xanax – together.

• Develop the use of non-opioid treatments.

• Examine the risks of continuing to take high-dose opioids – with empathy

• Work with patients who agree to gradually reduce their withdrawal time.

• Monitor patients taking high dose opioids to prevent overdose.

Nickel suffers from back pain and multiple chronic health problems and takes opioids as prescribed. She said her pain level had increased, but she refused to ask for more or stronger pain pills. For example, she was prescribed tylenol for pain relief after extensive oral surgery including two root canals, fillings and several crowns.

"I do not ask what I need because I do not want to draw attention to myself or my doctor," Nickel said. "You become almost conditioned to be treated as a second-class citizen."

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