Pain Patients Get Relief From Regulation

Wall Street Journal, April 14, 2019

By Sally Satel

In a span of 24 hours, the prospects for chronic pain patients treated with opioid medication vastly improved. On April 9, the Food and Drug Administration made official what hundreds of doctors have been saying for years: Patients whose intractable pain is being treated with opioids should move off them slowly, if they are to be tapered at all.

The agency said it received reports of “uncontrolled pain, psychological distress, and suicide” among patients who have become dependent on opioids when that medication is suddenly “discontinued or the dose rapidly decreased.” With serious withdrawal symptoms or increased pain, the agency instructed, it may even be necessary to return the opioid painkiller to its prior dosage and, once the person’s mental and physical state stabilizes, resume reducing the patient’s opioid usage more gradually.

Patients’ dosages are being too quickly reduced, often against their will, because of a tragic misapplication of the 2016 Guideline for Prescribing Opioids for Chronic Pain from the Centers for Disease Control and Prevention.

Along with four of my colleagues from medical and pharmacy schools across the country, I sent an open letter to the CDC March 6. We urged the CDC to clarify that its otherwise reasonable guideline didn’t mandate that doctors suddenly cut off or reduce the supply of opioid pain relievers to patients who need them. Nonetheless, many physicians, health-care systems and regulators have insisted that the guideline indicated that prescribing opioids for chronic pain puts them at grave risk for loss of license or other harsh penalties.

More than 300 medical professionals and three former drug czars signed the letter.

On April 10 we heard from CDC Director Robert Redfield, who dispelled any confusion. “The guideline does not endorse mandated or abrupt dose reduction or discontinuation as these can result in patient harm,” he wrote. That practice “can damage the clinician-patient relationship, and can cause patients to obtain opioids from other sources.”

“The letter from Dr. Redfield is a game-changer,” says Andrea Anderson, a former executive director of the Alliance for the Treatment of Intractable Pain. “We are encouraging patients to share this letter with their physicians, pharmacists, state and federal regulators, and reinstate pain management for chronic, long-term pain.”

The American Medical Association also praised the agencies’ communications. “I see the recent CDC and FDA statements as a welcome move back to balance opioid policy,” said Dr. Chad Kollas, chairman of the AMA Pain and Palliative Medicine Specialty Council.

It will be welcomed, too, by the millions of Americans who suffer from chronic pain. No government agency will force their physicians to deprive them of the medications that make relief, and life itself, possible.

Dr. Satel is a resident scholar at the American Enterprise Institute and a lecturer in psychiatry at Yale.