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https://www.ama-assn.org/press-center/press-releases/ama-urges-cdc-revise-opioid-prescribing-guideline

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In 2016 as part of the urgent response to the epidemic of opioid overdose deaths, the CDC issued new recommendations for prescribing opioid medications for chronic pain, excluding cancer, palliative, and end-of-life care. While not law or regulations which carry the weight of law, the CDC guidelines have been widely adopted by state medical boards and implemented by regulation with the force of law. The word guideline(s) is used 173 times throughout the publication. the word recommend or recommendation is used 237 times, the word should 227 times, and the word taper or tapering 58 times.

Despite these cautionary words, practitioners, hospitals, and clinics abruptly terminated patient medications resulting in a rash of suicides across the U.S. with the last reported count being in excess 1,500 deaths in 2018, and they experimented in performing surgeries without the use of opioids for post-op pain management. Due to these rash actions, the CDC had to issue an erratum revision of the guidelines stressing that the guidelines were for general practitioners treating chronic pain not acute pain. The erratum provided guidelines for a staged reduction with frequent reassessments of the patient's condition. As of 2020 it's estimated that more than 1,000,000 individuals are no longer employed, forced into lower-paying jobs, onto welfare rolls, or into early retirement on reduced Social Security Benefits do to these actions. With the number of prescriptions written now down by more than 33% the overdose death rate continues to climb.

The CDC routinely archives publications, for this reason, the entire publication has been copied here.

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Dr. Stefan Kertesz, in this Tedx Talks, "We need to measure the opioid crisis differently."https://youtu.be/gMXHAPutGJA

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Mbabazi Kariisa, PhD1; Lawrence Scholl, PhD1; Nana Wilson, PhD1; Puja Seth, PhD1; Brooke Hoots, PhD1 (View author affiliations)

Summary

What is already known about this topic?

Overdose deaths involving cocaine and psychostimulants continue to increase. During 2015–2016, age-adjusted cocaine-involved and psychostimulant-involved death rates increased by 52.4% and 33.3%, respectively.

What is added by this report?

From 2016 to 2017, death rates involving cocaine and psychostimulants increased across age groups, racial/ethnic groups, county urbanization levels, and multiple states. Death rates involving cocaine and psychostimulants, with and without opioids, have increased. Synthetic opioids appear to be the primary driver of cocaine-involved death rate increases, and recent data point to increasing synthetic opioid involvement in psychostimulant-involved deaths.

What are the implications for public health practice?

Continued increases in stimulant-involved deaths require expanded surveillance and comprehensive, evidence-based public health and public safety interventions.

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On January 7, 2019, three patients arrived at the Community Regional Medical Center emergency department in Fresno, California, after snorting (i.e., nasally insufflating) white powder they thought was cocaine. One (patient A) was in cardiac arrest, and two (patients B and C) had opioid toxidrome (miosis, respiratory depression, and depressed mental status) (Table). After spontaneous circulation was reestablished in patient A, he was admitted to the intensive care unit, where he was pronounced brain-dead 3 days later. Patients B and C responded to naloxone, but repeated dosing was required to maintain respiratory status. Routine urine drug screens, which do not include testing for synthetic opioids such as fentanyl, were negative for opioids for all three patients. This finding, in combination with opioid toxidrome requiring repeated doses of naloxone, caused the medical toxicology team to be suspicious of an unintentional synthetic opioid exposure, and they notified the Fresno County Department of Public Health (FCDPH). After discussion with law enforcement the following day, a fourth patient (patient D) was identified in neighboring Madera County. Patient D was in cardiac arrest when emergency medical services arrived, and she was pronounced dead at the scene. Blood and urine specimens for patients A, B, and C were analyzed using liquid chromatography quadrupole time-of-flight mass spectrometry* for 13 fentanyl analogs and metabolites, one novel synthetic opioid (U-47700), and 157 other drugs and metabolites. Results confirmed fentanyl without fentanyl analogs or other novel synthetic opioids.

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We, the undersigned, stand as a unified community of stakeholders and key opinion leaders deeply concerned about forced opioid tapering in patients receiving long-term prescription opioid therapy for chronic pain. This is a large-scale humanitarian issue.

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Rhode Island pain patient legislation returns in 2020.

Follow WJAR News 10 Rhode Island's coverage of Bill 738 with Claudia Merandi on this link.

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This post is meant to be a guide or resource for individuals searching for information on laws and regulations in their state which govern the practice of pain management and prescribing of controlled substances. This is a work in progress and with 50 States, there are several hundred documents which must be tracked down. If you have a pressing matter which needs immediate assistance for a specific state, contact Randall Carter or Caludia Merandi on the DPPR website or via email at CERGM. Links provided in this post were current as of Janruary 2020, some document links in the table below, may have broken links, primarily because states change document locations frequently, which result in a dead links. If you find information not included in this post and wish to share it, follow the links above to forward that information.

Don't Punish Pain Founder, Claudia Merandi/Rep. Amore sponsor legislation that addresses the need for protection of chronic intractable pain patients, click here to read more.

Study reveals War on Drugs is to blame for opioid crisis, not prescription pain medication.

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Blaming pain medication for overdosing crisis is fake news.. 

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Summary

What is already known about this topic?

Chronic pain has been linked to numerous physical and mental conditions and contributes to high health care costs and lost productivity. A limited number of studies estimate that the prevalence of chronic pain ranges from 11% to 40%.

What is added by this report?

In 2016, an estimated 20.4% of U.S. adults had chronic pain and 8.0% of U.S. adults had high-impact chronic pain. Both were more prevalent among adults living in poverty, adults with less than a high school education, and adults with public health insurance.

What are the implications for public health practice?

This report helps fulfill a National Pain Strategy objective of producing more precise estimates of chronic pain and high-impact chronic pain.


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Summary

What is already known about this topic?

Provisional opioid-involved overdose deaths suggest slight declines from 2017 to 2018, contrasting with sharp increases during 2014–2017 driven by fentanyl overdose deaths.

What is added by this report?

From July–December 2017 to January–June 2018 in 25 states, opioid deaths decreased 5% overall and decreased for prescription opioids and illicit synthetic opioids excluding illicitly manufactured fentanyl (IMF). However, IMF deaths increased 11%. Benzodiazepines, cocaine, or methamphetamine were present in 63% of opioid deaths.

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Summary

What is already known about this topic?

In 2016, opioids were involved in 42,249 U.S. overdose deaths.

What is added by this report?

Among 11 reporting states, most (58.7%) opioid overdose deaths involved illicit opioids only, followed by those where both illicit and prescription opioids were detected (18.5%); 17.4% of deaths involved prescription opioids only. Bystanders to the overdose, who could potentially intervene, were documented in 44% of deaths; however, laypersons rarely administered naloxone.

What are the implications for public health practice?

Development of overdose prevention programs should consider the types of opioids contributing to deaths, link persons to treatment during and upon release from an institution or after a nonfatal overdose, and expand naloxone distribution to laypersons.

Related Materials
The founder of the Don't Punish Pain Rally branches out to launch The Doctor Patient Forum. Follow this link 

Founder of the Don't Punish Pain Rallies discusses the importance of people with pain receiving adequate pain management

Visit this link to watch

The Doctor Patient Forum

Claudia A. Merandi 5 Chedell Avenue / East Providence, RI 02914 / USA 1.401.523.0426