Senior Fellow, Cato Institute
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. IN THE SPIRIT OF WALTER R. CLEMENT BS., MS, MBA. HARVEY JENKINS MD, PH.D., IN THE SPIRIT OF C.T. VIVIAN, JELANI ZIMBABWE CLEMENT, BS., MBA., IN THE SPIRIT OF THE HON. PATRICE LUMUMBA, IN THE SPIRIT OF ERLIN CLEMENT SR., EVELYN J. CLEMENT, WALTER F. WRENN III., MD., JULIE KILLINGSWORTH, RENEE BLARE, RPH, DR. TERENCE SASAKI, MD LESLY POMPY MD., CHRISTOPHER RUSSO, MD., 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, AISHA GARDNER, 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
Summary
Multiple sources detail the unintended consequences of government responses to the opioid crisis. The crackdown on opioid prescribing, driven by concerns over overdose deaths, has resulted in the under-treatment of chronic pain patients, leading to a rise in “pain refugees” who struggle to find adequate care.
This has, in turn, pushed some patients towards the black market or suicide. The sources also critique the methodology and application of government guidelines, highlighting flaws in the scientific basis for prescribing limits and the negative impact on doctors and patients.
Senior Fellow, Cato Institute
“For much of the 21st century, public health officials and policymakers have blamed doctors for overprescribing opioids and causing the overdose crisis.
“When you persecute doctors, you target their patients.”
In response, the Centers for Disease Control and Prevention issued pain management guidelines aimed at reducing opioid prescriptions. Most states have codified them into law.
“Pain Refugees: Collateral Damage of the War on Drugs”
Federal and local drug task forces have arrested doctors whom they accuse of overprescribing opioids. This has led to a situation where many physicians either undertreat pain or choose to abandon their long-term pain patients. As a result, opioid prescribing has dropped below 1992 levels, while overdose deaths among nonmedical users have skyrocketed.
Family and Pain Management Physician, Pain Patient Advocate, Helena, Montana
This crackdown has also created a population of “pain refugees”—chronic pain patients who have lost or were abandoned by their doctors and are left searching for a doctor willing to treat them. Many, out of desperation, turn to the black market for relief, while others resort to suicide.”
President and Chief Executive Officer, Chapman Law Group, Troy, Michigan
Unfortunately, State and local governments have taken legal actions against opioid manufacturers, accusing them of fueling the overdose crisis through aggressive marketing and by understating the overdose and addictive potential of prescription opioids.
Finally, the texts discuss legal actions against opioid manufacturers, indicating a multifaceted approach to addressing the crisis with unintended and negative consequences.
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REFERENCES:
- “Cops Practicing Medicine,” by Jeffrey A. Singer and Trevor Burrus
- “Today’s Nonmedical Opioid Users Are Not Yesterday’s Patients,” by Jeffrey A Singer, Jacob Z Sullum & Michael E Schatman
- “ ‘Entire Body Is Shaking’: Why Americans With Chronic Pain Are Dying,” by Maia Szalavitz
- “As Doctors Taper or End Opioid Prescriptions, Many Patients Driven to Despair, Suicide,” by Elizabeth Llorente
- “The Clampdown on Opioid Prescriptions Is Hurting Pain Patients, by Kate M. Nicholson
- “Inside an American “Pill Mill”,” by Ron Chapman II, ESQ
- “Doctor Bison’s Fables: The Crowded Exam Room,” by Mark S. Ibsen, MD
- “X Post, regarding opioid prescribing” by Stefan Kertesz, MD, MSc
- “An Indictment of US Public Health Policy on Pain Management,” by Lawhern Richard A. PhD
- “Opioid Prescribing and the Ethical Duty to Do No Harm” by Kate M. Nicholson and Deborah Hellman
Factors that contributed to the current opioid crisis and its impact on patients:
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The government’s response to the rise in opioid-related overdose deaths in the late 2000s, which was deemed a public health crisis, had a significant impact on the opioid crisis. The government implemented several interventions, including:
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Prescription Drug Monitoring Programs (PDMPs): These programs track opioid prescriptions and are used by law enforcement to identify providers suspected of overprescribing. The use of PDMPs led to raids and indictments of medical practitioners, creating a chilling effect on prescribing practices. Although PDMPs are associated with a drop in opioid prescription volume, they have not been shown to reduce overdose rates and may have even increased heroin overdoses.
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Abuse-deterrent formulations: The FDA encouraged the development of these formulations, but evidence suggests they have driven non-medical users to cheaper and more available heroin and fentanyl.
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DEA production quotas: The DEA sets quotas for opioid production, assuming it can accurately predict the needs of the entire US population. Since 2016, the agency has reduced these quotas.
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CDC guidelines: In 2016, the CDC issued guidelines for prescribing opioids for chronic pain. These guidelines were intended to be voluntary, but many states implemented statutory or regulatory limits based on them. Critics argue that the guidelines lacked a strong basis in evidence and relied on the flawed concept of morphine milligram equivalents (MMEs). The CDC revised the guidelines in 2022, removing MME-based dosage thresholds but still recommending an MME conversion table. Critics argue the revised guidelines are still flawed.
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Legal action: State and local governments have sued opioid manufacturers, alleging they fueled the crisis through aggressive marketing and downplaying the risks of addiction and overdose.
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The crackdown on opioid prescriptions had unintended consequences for patients with chronic pain. Many physicians undertreat pain or abandon their long-term pain patients to avoid legal scrutiny. This has created a population of “pain refugees”—patients who have lost their doctors and struggle to find new ones willing to treat them.
●
Out of desperation, many pain refugees turn to the black market for relief or resort to suicide. The sources also cite articles by journalists and academics that explore the impact of the opioid crisis on pain patients, including increased rates of despair and suicide.
The sources provide a detailed examination of the factors that contributed to the opioid crisis, focusing on the role of government policies and their impact on both prescribers and patients. They highlight the unintended consequences of well-intentioned interventions, such as the chilling effect on prescribing practices and the creation of a population of pain refugees.
