reported by youarewithinthenorms.com
NORMAN J CLEMENT RPH., DDS, NORMAN L. CLEMENT PHARM-TECH, MALACHI F. MACKANDAL PHARMD, BELINDA BROWN-PARKER, IN THE SPIRIT OF JOSEPH SOLVO ESQ., INC.T. SPIRIT OF REV. C.T. VIVIAN, JELANI ZIMBABWE CLEMENT, BS., MBA., IN THE SPIRIT OF THE HON. PATRICE LUMUMBA, IN THE SPIRIT OF ERLIN CLEMENT SR., WALTER F. WRENN III., MD., JULIE KILLINGWORTH, LESLY POMPY MD., CHRISTOPHER RUSSO, MD., AISHA GARNER, NANCY SEEFELDT, WILLIE GUINYARD BS., JOSEPH WEBSTER MD., MBA, BEVERLY C. PRINCE MD., FACS., NEIL ARNAND, MD., RICHARD KAUL, MD., IN THE SPIRIT OF 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 NJOKU, BS., RPH., IN THE SPIRIT OF DEBRA LYNN SHEPHERD, BERES E. MUSCHETT, STRATEGIC ADVISORS
INTRODUCTION
The DSM-5 identifies a spectrum of symptoms to characterize the severity of substance abuse.
However, nowhere in that deeply flawed document is a clinical framework offered within which clinicians may choose a therapeutic course of action that is appropriate to the patient’s needs if they suffer from both chronic pain and substance abuse. Likewise, the consequence of patient exposure to prescription opioids is almost always an improvement in quality of life.
It is sincerely telling that the field research behind the DSM-5 was abysmal.
Two weeks before publication, the National Institute of Mental Health publicly repudiated the DSM-5 as a framework for organizing research on mental health disorders. That did not keep the U.S. CDC from using the term extensively in its revised and greatly expanded 2022 opioid prescribing guidelines.
DISCUSSION
We now know definitively that — despite repeated misdirection from the US CDC and DEA — there is no relationship between physician prescribing and either opioid addiction or overdose-related mortality.
Many so-called “diagnoses” of opioid use disorder by clinicians reflect a disorder called “pseudo-addiction,” suffered not by patients but by clinicians intimidated by the risk of possible criminal sanctions.
Such doctors may render a diagnosis of substance use disorder or enter case notes on “drug seeking” for any patient who complains of inadequate pain relief or who informs them of a record of successful previous treatment with prescription opioids. Such notes are a “kiss of death” for further effective treatment of pain employing safe and effective prescription opioids. Sometimes, that kiss of death directly results in suicide.
We also know that the best predictors of bad outcomes from treating patients with prescription opioids have very little to do with past prescribing as such.
ARGUMENT
As established by a highly accurate predictive model for one-year risk of opioid overdose or suicide events, risks are four to 20 times higher in patients who have a history of severe mental health disorders or past hospitalizations for overdose than they are in patients who have no such history. For populations at the highest risk, only one factor among eleven in patient history is related to prescribing: the use of multiple sedating medications.
The probability of overdose or near-term suicide events from all causes was on the order of 2% or less in a population of over a million Veterans Administration patients. Such incidence is within the range of diagnostic error, loss of the noise generated by high patient loads, and poor clinician education on pain management.
CONCLUSION
It is now time to purge the term “opioid use disorder” from medical practice and public health policy. It is also time to publicly repudiate and withdraw 2022 CDC guidelines on the prescription of opioids – without replacement.
By their unqualified use of this term and their scientifically unsupported emphasis on risks of substance abuse disorder, the CDC has revealed itself to be acting from sloppy research and either gross incompetence or bad faith.
Richard A. Lawhern, PhD is a patient advocate and data analyst who has written widely on the intersection of public health policy and US pain medicine.
FOR NOW, YOU ARE WITHIN
THE NORMS
Opioid Use Disorder is a disorder caused by the Shinks and doctors that titrates a patients opioids up to the point they come close to working and then they reduce the opiates to a point where the patient suffers immensely from the lack of pain medication. I believe shrinks came up with this DSM5 so they could apply many of the worthless medications that don’t relieve pain.
Ted