NORMAN J. CLEMENT RPH., DDS, NORMAN L.CLEMENT PHARM-TECH, MALACHI F. MACKANDAL PHARMD, BELINDA BROWN-PARKER, IN THE SPIRIT OF JOSEPH SOLVO ESQ., IN THE SPIRIT OF REV. C.T. VIVIAN, JELANI ZIMBABWE CLEMENT, BS., MBA., WILLIE GUINYARD BS., JOSEPH WEBSTER MD., MBA, BEVERLY C. PRINCE MD., FACS., LEROY BAYLOR, JAY K. JOSHI MD., MBA, ADRIENNE EDMUNDSON, ESTER HYATT PH.D., WALTER L. SMITH BS., IN THE SPIRIT OF BRAHM FISHER ESQ., MICHELE ALEXANDER MD., CUDJOE WILDING BS, MARTIN NDJOU, BS., RPH., IN THE SPIRIT OF DEBRA LYNN SHEPHERD, BERES E. MUSCHETT, STRATEGIC ADVISORS
CDC’S 90 MME (MORPHINE MILLIGRAM EQUIVALENT), “A MEASUREMENT FAILURE” OF JUNK SCIENCE EQUAL TO BITE-MARK EVIDENCE ONCE EXCEPTED AS EVIDENTIARY FORENSICS
POLITICALIZATION AND MIS-INFORMATION OF OPIATE PAIN MEDICATIONS
All behavior good or bad is learned. That learned behavior starts in the home and is controlled exclusively by the parents. I have seen many parents of individuals who died of a drug overdose. These individuals were young and the stories are heart- wrenching. The question never asked is “how did this happen”?
Did their child’s addiction start with a opiate pain medication prescribed to them by their health care provider?
Did it start by using a opiate pain medication given to them by a friend or family member ( this includes the parents).
Did it start as a result of their child being introduced to heroin?
These are hard questions that are never asked so society can blame someone other than themselves for the problem. Health care providers and pharmaceutical companies get blamed although they play a small part in the opiate epidemic.
Politically the blame game, being popular, finds its way into government policy and legislation. Truth is not important nor knowing the real causes. Politicians are only interested in ideas that will get them reelected. Who’s responsible? All of us.
CDC OPIOID POLICY CREATED DISORDER
The medical community continues to report data concerning addiction and successful treatment. It is obvious from data from Europe and Canada that our approach to the laws and treatment are not successful. The deaths from opiate overdoses are increasing in the US and decreasing in other countries.
What is the reason?
Drugs are illegal in the US. Treatment for Opioid Use Disorder (OUD) is only available at methadone clinics and in physician offices who are certified to prescribe Suboxone. Individuals and governments reject fentanyl test strips and clean needle sites.
In Europe and Canada drugs have been decriminalization. They have clean needle sites. They have fentanyl test strips.
They prescribe opiate pain medication for those addicted to opiate pain medication.
They supply heroin to those addicted to heroin.
They also make Medication Assisted Treatment readily available without restrictions.
If we are to make a difference in decreasing opiate overdose deaths we must adopt successful treatments. Addiction cannot be prevented regardless of CDC guidelines or individuals proclaiming that drugs don’t cause addiction.
They either don’t know or won’t admit that opiates activates opiate receptors and the physiological response triggers the process that leads to addiction in vulnerable individuals. Also there is no way anyone can prevent illegal drugs from entering the United States.
Walter F. Wrenn III M.D.
“…The American crisis of opioid addiction and overdose compels our strongest efforts toward successful prevention and treatment…”
Stephen A. Martin, MD, EdM
Ruth A. Potee, MD, DABAM
Andrew Lazris, MD
From: Neat, Plausible, and Generally Wrong:
A Response to the CDC Recommendations for Chronic Opioid Use
Stephen A. Martin, MD, EdM;
Ruth A. Potee, MD, DABAM; and
Andrew Lazris, MD
“…Ultimately, for the individual patient, the choice to use opioids is not made in a vacuum. The decision is made in comparison with the status quo of chronic, intractable pain despite other medical interventions. As a comparison, chemotherapy for cancer treatment also has severe side effects, even toxicity. People make the choice to use such treatments because they are choosing against the alternative.
… get readily addicted and die of overdose of either the opioids prescribed to them or from a switch to lethal heroin.
The CDC states that “prescription opioids are just as addictive as heroin.”  Others call them “heroin pills.”  But a full year after after major surgery, only “0.4% of older opioid-naive patients continued to receive ongoing opioid therapy.” For chronic opioid treatment, studies show rates of developing an opiate use disorder to be in the range of 2% to 10% (Figure 1a). Even then, as others  have noted, the complexities of chronic pain and addiction behaviors make the outright diagnosis of opiate use disorder a challenge.
US DEPUTY ATTORNEY GENERAL KENNETH POLITE , “ILLICIT PRESCRIPTION OPIOID”
Unfortunately, recent publications have included “pooled studies with widely differing definitions, outcome variables, and populations,” which detract from their conclusions.  Concerns about such misleading data and definitions come from a wide variety of sources. [36–38] The term “prescription opioids” itself is problematic as the adjective does not distinguish how the drug was actually obtained by the user.
Annual Total and Long-Term Prescriptions of Opioids, with Risks of Opiate Use Disorder and Overdose Death
Among those who take opioids long-term for chronic pain, the CDC highlights the potential for overdose (“overdose” is mentioned 144 times in the recommendations) and death.  This is certainly an outcome to be feared.
The study cited in the CDC’s own tele-briefing , however, found “opiate-related” death to occur in 59 of 32,449 (0.2%) patients taking opioids for more than three months.  The context of these deaths was unknown (e.g., whether medications were taken as prescribed or from intentional overdose) and there was no corresponding control cohort of patients in chronic pain without opioid use.”
GOLLUM, LORD OF THE RINGS
FOR NOW, YOU ARE WITHIN
32. Tavernese S. C.D.C. Painkiller Guidelines Aim to Reduce Addiction Risk. The New York Times. March 16, 2016:A1.
33. Doctor: Prescription Painkillers Kill More People Than Heroin | Here & Now. September 9, 2015. http://hereandnow.wbur.org/2015/09/09/heroin-epidemic-overprescribing.
34. McHugh RK, Nielsen S, Weiss RD. Prescription drug abuse: from epidemiology to public policy. J Subst Abuse Treat. 2015;48(1):1–7. doi:10.1016/j.jsat.2014.08.004.
35. Scholten W, Henningfield JE. A meta-analysis based on diffuse definitions and mixed quality literature is not a good fundament for decisions on treatment of chronic pain patients. Pain. 2015;156(8):1576–1577. doi:10.1097/j.pain.0000000000000213.
36. Voon P. Further defining and conceptualizing opioid misuse in chronic pain. Pain. 2015;156(10):2107. doi:10.1097/j.pain.0000000000000246.
37. Nelson LS, Paulozzi LJ. The toxicology Tower of Babel: why we need to agree on a lexicon in prescription opioid research. J Med Toxicol. 2012;8(4):331–332. doi:10.1007/s13181–012–0266–7.
38. Secora AM, Dormitzer CM, Staffa JA, Dal Pan GJ. Measures to quantify the abuse of prescription opioids: a review of data sources and metrics. Pharmacoepidemiol Drug Saf. 2014;23(12):1227–1237. doi:10.1002/pds.3711.
39. Kaplovitch E, Gomes T, Camacho X, Dhalla IA, Mamdani MM, Juurlink DN. Sex Differences in Dose Escalation and Overdose Death during Chronic Opioid Therapy: A Population-Based Cohort Study. Mintzes B, ed. PLoS One. 2015;10(8):e0134550. doi:10.1371/journal.pone.0134550.
40. Gomes T, Mamdani MM, Dhalla IA, Paterson JM, Juurlink DN. Opioid dose and drug-related mortality in patients with nonmalignant pain. Arch Intern Med. 2011;171(7):686–691. doi:10.1001/archinternmed.2011.117.
41. Sullivan MD. Limiting the potential harms of high-dose opioid therapy: comment on “Opioid dose and drug-related mortality in patients with nonmalignant pain”. Arch Intern Med. 2011;171(7):691–693. doi:10.1001/archinternmed.2011.101.
42. FDA CDER Response to Physicians for Responsible Opioid Prescribing Partial Petition Approval and Denial. September 10. 2013. https://www.regulations.gov/#!documentDetail;D=FDA-2012-P-0818-0793.