Community Thoughts: New guidelines for prescribing opioids

When the Center for Disease Control (CDC) releases new guidelines for prescribing opioids, many patients who experience migraine and other chronic health conditions may find this to be alarming and unsettling. It also tends to leave a substantial amount of debate and unanswered questions. Recently, we shared an update, “CDC releases guidelines for prescribing opioids for chronic pain” and both our Facebook and Migraine.com community members had a tremendous amount so share. Many were furious feeling as though they are being lumped together into the group of abusing opioids while others felt that this change will likely not affect them.

Here is what else you, our community members had to say…

This will have little to no impact

  • Those of us that have an established relationship with our doctors and have worked on controlling migraine, probably won’t have a problem.
  • My Pain Management doctor has the same practices in place already for patients on opioids.
  • I’m hopeful these guidelines (and they are only that) won’t have a negative impact on patients like me.
  • They are for primary care doctors, and common sense sort of stuff. I get my opioid pain meds from a pain management specialist, who I see every four weeks.
  • These are guidelines, not regulations. I think many of us have already noticed a distinct effect in doctors’ offices in the past few years when it comes to opioid prescriptions.
  • What I think, the word voluntary. So, there are now guidelines. I doubt this will change anything.
  • I have migraines and chronic pain issues. I am followed by a pain specialist. I play by the rules.

This makes me livid

  • The CDC’s suggestion that doctors have been using opioids as a first line of treatment in chronic pain is a joke. I have never heard of a doctor doing this. What the CDC is doing is taking the protocol already adopted by most doctors and publishing it as theirs, and new, to placate and console those who have lost loved ones to an overdose. It’s just a political maneuver and it changes nothing.
  • These new guidelines make me furious. Now I am not only ill, but I am to be treated like a drug addict?
  • This deeply affects newly diagnosed pain patients and people who suffer chronically.
  • Is insurance going to pay for these alternative treatments? If not, then yes, the guidelines will definitely impact me directly – physically, physiologically, and financially!
  • I don’t like the idea of additional obstacles for those of us with chronic pain who are NOT abusing opioids. We are getting the medication we need in order to function.
  • I pray that it doesn’t affect me. I absolutely HATE taking them but sometimes it’s my last chance to get relief.
  • This is terrible for people with chronic migraines. I have used opioids responsibly for years because otherwise I could not function. This is punishing people who need them.
  • This is such crap. Most people have tried everything, including exercise, diet modification, etc., before they even go to the doctor for the first time. This is as ridiculous as medical MJ still being unavailable in many places. The CDC is effectively telling patients that they know better than the patient does whether or not they’re in pain.
  • This scares me, I take opioids daily for my chronic migraines. By taking them daily I am able to be a contributing member of society, I am able to work most days, I am able to pay my rent, bills, etc. without them I would have to go on disability and get public assistance.
  • My concern is that this doesn’t spiral out of control to where docs suddenly decide to stop prescribing for patients like myself who need the chronic pain relief and are doing well on the opioids.
  • There they go, creating problems & obstacles for those of us with documented, long running chronic pain. Here’s an idea: focus on the problem, which is drug abusers. They are fairly obvious.

Further questions to consider

  • Only continue prescribing these medications if patient shows improvement in pain? And what if there is no improvement, just temporary control?
  • Isn’t improvement subjective? My improvement may not be the same as someone else.
  • Really? Would any doctors prescribe opioids as a first consideration? They are and always have been a last resort for me.
  • Why are you punishing the sick for the addicts? The guidelines are ridiculous for chronic pain patients. Leave us be if we are doing everything by the book.

What about you? How do you think these new guidelines will affect patients?

Comments

View Comments (14)
  • Gto
    3 years ago

    I find these recommendations absolutely absurd. I suffer chronic migraine headaches as well as continual lower back/hip pain. Prescription opioids allow me to function each day…sleep at night. Also when reluctantly forced to head up to hospital ER due to full blown migraine attack only med that will abort headache is morphine with gravol due to violenT nausea as well. Most time treated with compassion and respect , however, lately treated as some kind drug seeker. Do not understand how supposed trained professionals cannot or refuse to see incredible pain I am trying to endure. Also have family physician’s instruction on file with ER as to treatment when arriving in ER in my condition. ER Doctor chosen to ignore this instruction. I cannot state how frustrating this situation is as am in no condition to debate dr. especially when they will not listen and apparently mind made up. Is so frustrating as am suffering incredibly and ready to put one of these guys thru a wall. Am at wit’s end as to how to deal with this. Have filed complaint with hospital ( response was dr. only following hospital’s migraine protocol), filed complaint with ministry of health ombudsman ( no authority over hospitals and ER staff). Wondering where to turn next as most migraine attacks aborted with injection of Toradol if act prudently, however, is only matter of time before another full blown attack occurs.

  • afadedpicture
    3 years ago

    I don’t think this is a bad idea. Everyone is at some risk of becoming addicted to opioids. They are very addictive drugs that can lead to worse drug use and I think that these guidelines are trying to help prevent that.

  • Erin
    3 years ago

    The only reason I can get out of bed is my oxycodone. My neurologist, and GP both agreed that I’d tried everything else. I do not get any “high” from my medication, nor am I addicted to it. Implying that eventually everyone who takes these meds will be addicted to them is offensive, and kind of ignorant. These medications help a lot of people. Me included.

  • amityville
    3 years ago

    HaleyNicole;
    I will have you know that I too take Opioids, and I take them daily, and no other time do I neeed them.I don’t see where you think everyone will sooner or later take Opioids because they become addicted to them. I am afraid you are gonna find a lot of people who will disagree with you, I be one of them. We take these medicines because they help us, not cause we enjoy doing it and have nothing else to do. Believe me If I had my other reasons I would not of started taking them. But I went through 12 different medications before I found out this works, and my Neurologist agreed with me. I DID NOT Go in and Beg for these this is what helps me and others like me. so Deal with it. W.A.B

  • Jackie
    3 years ago

    If I ask my husband to take me to the ER he knows it is bad because I only go there as I am out of options for pain. The ER doc knew me on sight and implied I was looking for morphine. One of my pain specialist gave the narcotic oxycodone I took it for 3 days and threw then away. I woke up drenched in perspiration. My husband is in the military. He called the base and a doctor called me to take my vicodin because I was going through withdrawal systems.

  • Melanie
    3 years ago

    First and foremost, these are guidelines. However, the day after they were released my pharmacy began to treat them as regulations. I am a chronic pain, chronic intractable migraine, fibromyalgia, and osteoarthritis patient (plus a whole host of things). Pain is my first, last, and middle name some days. I am extremely fortunate that I have an excellent relationship with my PCP, my Neuro, and my Rheumatologist. They work together, in concert, to come up with a good plan for me, where I’m getting relief, but am neither over, or under, medicated. They all know with me that I’m a poly-pharmacy patient and we always make sure everything balances properly.

    Also, another thing that doctors, and patients must realize, is that these are guidelines from the CDC, not the FDA. The CDC can set all the guidelines they’d like, but in the end, the FDA is the group that makes the final determination on all legal prescription drugs. My hope is that this is just a quick, gut check for everyone and then we get back on the road to normal.

  • 29cot8q
    3 years ago

    My life changed in late 2014 when hydrocodone was rescheduled. I was already on a pain contract and working closely with my GP. My neuro called me on the phone and yelled “Are you selling your drugs on the street?” When I had one clean urine specimen. I was excited thinking that it was good that my blood levels were low that time, but I didn’t understand the “system”. My neuro was fired. I visited the head of her Dept within the next month, reviewed my care plan, pain contract, everything, and he said, no problem. Keep doing what you’re doing with your GP. Then the DEA raided them. Four months later, he yanked all opioids for all migraine patients. And this is a HUGE Kaiser facility in Marin County. So yes, first of all, these government voluntary proclamations are greatly affecting my care and every other migraine patient in Kaiser. Secondly, all my docs say they would prescribe opioids for me (because they know I’m not a seeker or addict) if not for the gov’t regulations; i.e. they’re hands are tied by Kaiser, and thirdly, these CDC regulations were not necessary. Prescriptions have already dropped dramatically. Now they’ll be non-existent. If the DEA had done their job from 2000-2010, we wouldn’t be in this mess. There was a guy in my home-town giving opioids to everyone and himself for years. His license had been suspended a few times before and he had mtiple DUI’s. Can you say low-hanging fruit? We was just arrested last year. Great job! This is all too late. I never took my opioid prescription for granted. I ALWAYS took small amounts and even went without when my pain wasn’t absolutely killing me. They are punishing folks who played by all the rules. I’m on disability now. I’m going to lose my house. How has my life improved?????

  • Crystalrz4
    3 years ago

    Kaiser in what area? I’m in San Diego and there is only one Migraine Specialist there. Just Curious.
    Thanks

  • 29cot8q
    3 years ago

    Just to be clear – I fired my neuro, not Kaiser. She still works there of course.

  • valofoz66
    3 years ago

    I have already been labeled as seeker. I can not get any rescue meds and if it gets so bad I need help the ER won’t help me. I moved to another state the doctors thin I’m lying about my treatments even though I never have a dirty UA, and they haven’t even used the releases I have signed to show my LONG standing medicines and infusions. I have been treated like a criminal for the last year just because I decided to move. I have multiple different types of migraines and have done my due diligence. I keep journals, know my triggers,and know what does and doesn’t work. I have to wait over 3 months to get a new pain management doctor so until then just keep taking otcs and if you come to the ER we wont help you go to your PCP and if they wont prescribe medications for you… You just want drugs..

  • kmh
    3 years ago

    From my perspective, these new guidelines are not even based in the latest scientific research involving pain. Yes, it is true that opioids can lead to Medication Overuse Headache. Also, generally speaking, these drugs are not a good long-term plan for migraine pain. HOWEVER, there is a very small group of migraine patients who have not found relief with more typical treatments. In these cases, opioids may be appropriate. This is because science has taught us about central sensitization. In other words, untreated, unmanaged migraines lead to MORE untreated, unmanaged migraines. We must prevent sensitization from occurring at any cost – and sometimes, opioids can help with that process.

  • Erin
    3 years ago

    These new guidelines worry me a great deal. It was extremely difficult to find a doctor that listened and actually believed that I was as in as much pain as I am in. He was also the first to give me oxycodone, which has given me at least a small chance at maybe some sort of life. My neurologist is also involved with my pain medication plan. I have signed a pain medication contract. It allows me to follow a set treatment options. I never abuse this chance I was given, nor do the several people I know who also follow a pain contract. I’m so afraid that it is going to punish those of us that are not breaking our contracts, or the law. Because in my experience, it is always those of us who are doing it right, that are the ones who keep getting screwed over.

  • rcailor
    3 years ago

    I am a nurse practitioner in pain management with 30+ years of medical experience. Guidelines are created only when their is a problem. I currently work in Pain management in Elko,and have seen the pain management model come full circle. In the 1990’s there were many evidence based studies which showed that patient’s were under- medicated post-op and PCA’s were invented.

    In 2000, JCAHO (the accreditation body for hospitals) declared that pain is the “6th vital sign” and patients had to be assessed for pain levels every 2 hours which is now a hospital standard.

    Now, mostly due to “pill pushers” who only prescribe for the money, and the lack of General or Primary Care Physicians (last report was that we are 500,000 PCP’s short), the CDC decided that physicians needed better treatment plans, with guidelines.

    In addition, the media has jumped on this and every famous drug overdose, i.e. Keith Ledger, is magnified x 10 in importance.

    As a pain management NP I can assure you that physicians are cutting back on opioid prescriptions, and the Pain clinic that I and my physician work in, is very busy. We already use the random drug testing, a narcotic contract, and other methods, i.e. nerve blocks, epidurals, and NSAID’s first. Remember, there are still specialists out there who “feel and heal pain”.

  • jns192 moderator
    3 years ago

    Rcailor,
    Thank you so much for sharing your inside perspective on the guidelines for prescribing opioids. It is interesting to see how opioid prescription has evolved over the past few decades. I love that you mention there are still specialists out there who “feel and heal pain.” Though sometimes they are far and few between, I too believe that there are clinicians out there who truly want to understand what we go through and how to work together on the best treatment plan. After seeing several specialists, I finally found a neurologist who I absolutely adore and can openly discuss anything with. I will begin Physician Assistant school this summer and I admire providers like you and my neurologist who focus on the person, not the diagnosis.
    Thank you for being an active part of our community. We hope to hear from you soon.
    Warm regards,
    Jillian (Migraine.com Team)

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