The Guardian February 15, 2022

The US could see loosened guidance around prescribing opioids, as the US Centers for Disease Control and Prevention (CDC) considers relaxing some of its guidelines in a move that could signal a new direction for managing chronic pain.

The CDC last Thursday released proposed changes to its guidance on prescribing opioids, rolling back limits on which doses can be prescribed and for how many days in cases of acute pain.

The agency created rules in 2016 to reduce prescriptions that were fueling the opioid overdose epidemic. But as rules like these were put in place, opioid overdose deaths rose instead of falling.

New laws in several states were drafted to codify the restrictions, and some insurers began basing their coverage of medications on the guidance.

The sweeping actions cut off medications for some patients battling chronic pain and substance disorders, sometimes without the option of tapering down the medications or undergoing substance dependence treatment.

As the sources of medications dried up, some patients turned to illicit substances like heroin and fentanyl.

“You’re inadvertently driving people to an illicit supply if they’re being cut off,” said Kate Nicholson, executive director of the National Pain Advocacy Center. “The street supply is so tainted that you’re really pushing people to a very dangerous thing.”

Fatal overdoses rose from 63,000 in 2016 to more than 100,000 last year, many of them driven by the powerful synthetic opioid fentanyl. Deaths from fentanyl have doubled in the US in the past two years – but teens in particular have been hit hard by fentanyl overdoses, with the death rate tripling in that time.

Yet harm reduction groups have struggled to access affordable naloxone, the drug that reverses opioid overdoses. And only one state, Arizona, had enough naloxone in 2017 to prevent a majority of overdose deaths, according to a study published in the Lancet recently.

For patients like Bev Schechtman, the 2016 CDC rules made what would have been a routine hospitalization traumatic.

Schechtman has Crohn’s disease, and frequently suffers from kidney stones – sometimes several times a month.

In 2017, a case of kidney stones grew too difficult to treat at home. She checked into the hospital because she was worried she was developing an infection and she was vomiting too much to keep food, water and prescribed painkillers down. FULL STORY HERE