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Lelena has struggled with pain for most of her adult life. She was diagnosed with fibromyalgia, a disease affecting more than 12 million Americans, marked by chronic pain with no definitive cause, and she was dependent for several years on opioid-based drugs as painkillers. But in March 2019, her urine tested positive for heroin in her urine and Lelena was bluntly sent back to the clinic where she was receiving medication. After one month, the results of the hair tests would confirm that the heroin was positive, which is rare in patients like Lelena, who use both morphine and over-the-counter badgesics. But it was too late.
In the absence of final script, draft calendar or even a referral for substance abuse treatment services, she was forced to undergo acute atrocious withdrawal, which included intense flu-like symptoms as well as increased pain. Lelena – her name on social media platforms, which she requested use – is among thousands of pain patients who have had to deal with a gradual decrease in the dose or a total cessation of treatment since the beginning of the opioid war in America in 2016. Now, the US health regulations The authorities are correcting the situation, while more and more doctors felt that their previous recommendations against opioid use were a way to suddenly stop essential drugs to relieve pain, thereby hurting people that these policies were supposed to help.
On April 9, 2019, the Food and Drug Administration issued a communication on drug safety in which the regulator unequivocally declared that patients like Lelena who are opioid dependent should not see their medicine interrupted abruptly. It also states that patients requiring cessation of opioid therapy should receive personalized cones designed to minimize withdrawal symptoms.
Centers for Disease Control and Prevention quickly followed suit. In the 2016 guidelines, she had directed prescribers to try non-opioid pain interventions before resorting to prescription opioids and suggested dosage limits for new patients to prevent depression. potentially fatal respiratory Patients and pain advocates have long criticized these guidelines as responsible for the sudden cessation of opioid medications. In April, he said that "the sudden cessation of opioids or the removal of patients from a doctor's office" was in fact against his recommendations – and this has always been the case.
It was difficult in some ways to change the CDC.
Kate Nicholson, Civil Rights Lawyer
The American Medical Association and the American Journal of Clinical Oncology – representing many of the best doctors in the country – publicly supported the CDC change. Laura Mills, of Human Rights Watch, believes that the change was necessary, but he also argued against the sudden cessation of opioids for patients with pain.
"We always emphasize that the risk of harm [from suddenly stopping opioid medication] is huge, since about 13 million Americans still take opioids in the long run, "Mills said.
According to medical experts and badysts, there are no accurate numbers of the total number of opioid patients who have been stopped suddenly since 2016, because doctors and medical researchers simply have not followed. But studies have shown the extent of suffering endured by patients such as Lelena. In a national study of 3,000 patients with pain by researcher and pain specialist Terri Lewis in 2018, half reported an interruption or discontinuation of care. In a survey conducted by the Boston Globe in 2017, nearly 10% of physicians reported having completely stopped prescribing opioids. According to a study by Veterans Health Administration in 2017, nearly 12% of sample veterans who had opioid discontinuation for a long time subsequently exhibited suicidal tendencies.
It's not just pain patients who have suffered, experts say. Opioid agonist medications such as methadone and buprenorphine – designed to reduce cravings and weaning in opioid-addicted patients – have also been similarly stigmatized as opioid-addictive drugs.
Many Alcoholics Anonymous and Narcotics Anonymous research grants, for example, make fun of patients who take these drugs as always being addicted. Psychiatric patients hospitalized for multiple disorders sometimes reported that their addiction medications had been stopped or that the doses had decreased rapidly. The FDA label change is intended to address this situation by clearly stating that opioid-dependent patients may face serious medical problems if their medications are withdrawn abruptly.
This is an argument that has been raging in the drug community for some time. Legal proceedings have been launched across the country to require access to methadone and buprenorphine in prisons and other restrictive institutions. Sally Friedman, legal director of the Legal Action Center, a non-profit badociation based in New York that helps clients fight drug discrimination, says the injustices for patients taking treatment-based treatments Opioid agonists remain commonplace. "The most important system is the criminal justice system. It's systemic, "she says, before detailing a litany of places where this type of forced removal is also common. Employers, child services and even drug rehab houses are on his list. In 2018, she helped a client stay with his medication after a Clinton County judge ordered him to not take buprenorphine that he had been taking for 13 years. But not all patients have access to such legal aid.
The FDA's explicit announcement could eventually mean that people in prison will no longer need legal action to obtain the appropriate medications. Since the announcement, a federal court of appeal has ruled in favor of a woman who was continuing her buprenorphine treatment while incarcerated, and Whatcom County, in the state of Washington , has agreed to provide badisted medical treatment in its prisons under an agreement with American Civil Liberties. Washington Union.
The change of approach of US medical regulators has not been done overnight. Groups such as the American Medical Association and the Working Group on Chronic Pain and Opioids have been putting pressure on the CDC for a year. Prior to the announcement of the agency, Kate Nicholson, a civil rights lawyer in Colorado, and Stefan Kertesz, addiction medicine specialist and professor at the University of Alabama in Birmingham, met with CDC leaders to obtain a public statement. clarifying their position on the 2016 guidelines.
Certainly, some doctors worry that the new approach adopted by the CDC and the FDA will encourage them to deliver opioid prescriptions without sufficient restraint. And all doctors do not believe the CDC was at fault in its 2016 guidelines. Andrew Kolodny, co-director of the Opioid Policy Research Group at Brandeis University's Heller School for Social Policy and Management, explains that in many cases – such as Lelena's – opioids have been wrongly prescribed. "There is no debate: you do not give opioids for fibromyalgia," says Kolodny. "It's the fault of this campaign that encourages people to prescribe opioids, a drug that is highly addictive and easily addictive."
Proponents of this new movement argue that it is precisely by ensuring access to opioid-based medicines to those in need that America can sustainably solve its substance abuse problem. Many prosecutions against doctors who have facilitated or encouraged the opioid abuse – 31 accused by federal prosecutors in April – will also serve as a deterrent in the future, they said.
And even Dr. Kolodny agrees that once the painkiller anomaly is underlined, it is "extremely cruel to abruptly remove a patient from opioids." For advocates such as Nicholson and patients like Lelena, the pbadage of US medical regulators represents renewed hope. Yet, they say, the work to ensure that the approach advised by the FDA and the CDC is actually followed by the rest doctors. "It was difficult in some ways to change the CDC," says Nicholson. "And in some ways it was the easiest first step."
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