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VOL. 131 | NO. 74 | Wednesday, April 13, 2016

Impact of CDC Opioid Guidelines Will Come With Time

By DEVIN GREANEY

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Former Memphian Jennifer Wansley McCarthy of Illinois says she is labeled as a drug abuser and faces ridicule and humiliation on any given day.

McCarthy suffers from surgical neuropathy due to cancer surgery and also has a connective tissue disease that causes pain.

When the Centers for Disease Control came out last month with new guidelines for physicians on prescribing opioids for pain, McCarthy said the CDC wasn’t listening to patients.

When getting her prescription filled, she feels “regular humiliation” by the pharmacy staff.

“If you’re a chronic pain patient, you are questioned,” McCarthy said. “You have to climb mountains. I have been accused by them of stealing these prescriptions on many occasions. (With the new guidelines) you are just adding an extra step.”

The new guidelines are aimed at stemming “an epidemic” of prescription opioid overdose, according to the CDC, which says 40 Americans per day are dying from prescription overdoses. Contributing to the epidemic is a quadrupling of opioid prescriptions and sales since 1999, according to the agency. The CDC guidelines prefer physicians not prescribe opioids outside of active cancer, palliative and end-of-life care, and that when used, that the lowest possible effective dosage be prescribed, with attention paid to the medication selected and its duration.

McCarthy goes to a pain clinic once a month and says her pain medication requirement is “a fraction of what it once was.” The clinic works with the causes of her pain, doing things like nerve blocks, injections and therapy, plus she is drug-tested to make sure she is not a substance abuser.

“I’m lucky I have the insurance. I have transportation. I have gas money,” she said. “I am able to go to these pain clinics that are inconvenient. I was able to get a referral. A lot don’t have these options.”

Dr. Rajendra Raghow, pharmacology professor at the University of Tennessee Health Science Center in Memphis, supports the move by the CDC in its culling the “hard” (controlled experiments and observations) and “soft” (not based on double-blind studies) sciences to come up with these guidelines. In an email to The Daily News, he emphasized they are guidelines to the primary care physicians.

“CDC’s guidelines will always be subservient to the physician’s pledge to ‘do no harm,’” Raghow wrote. “There are several common-sense provisions that offer alternatives, including in unique situations (e.g. major surgery) to use opioids judiciously. The unintended consequences cannot be predicted with certainty until these guidelines begin to be followed by most practitioners.”

Opioid addiction is not limited to heroin or drug addicts, but affects people of all ages, sexes, races and economic and education levels. Many have had injuries and are taking pain medicine to get through the day.

Opioids taken on a regular basis react with receptors in the brain that over time may become used to the dosage and, unlike McCarthy’s experience, require a stronger dose to become effective. It may even end up causing hyperalgesia, a condition of heightened sensitivity to pain when lesser stimuli causes more pain for the patient. Sometimes a non-steroidal anti-inflammatory like ibuprofen or the injectable acetaminophen Ofirmev may work better at palliating chronic pain than Vicodin, and it is not addictive.

“There is not much new. If you paid attention in pharmacology class in 1970 you got pretty much the same message,” says Dr. Daniel Sumrok, director of the new Center for Addiction Sciences at the University of Tennessee Health Science Center.

“Take a drug for about a week and the withdrawal is very physical and very unpleasant,” he said.

He hears stories of adults recovering from childhood sexual abuse, deaths of children, war … and they looked for something to ease that pain. But he also hears stories of patients as they get better.

Methadone has been the drug used for treating opioid dependency, but he predicts Suboxone, a newer medication he has been prescribing at his clinic in McKenzie, Tenn., will be the future.

“Unlike methadone, there is no buzz and no impairment.”

He makes it clear medication is used to fight disease, and that addiction is a brain disease caused by physical and mental pain.

“When you see it as a brain disease you shed a lot of guilt,” Sumrok said. “Mental trauma shows on the MRI.”

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