The Opioid Crackdown Leaves Chronic Pain Patients in Limbo

The opioid crisis, which began in the 1990s, is worse than ever. According to the Centers for Disease Control and Prevention (CDC), for the 12 months ending in April 2021, there were over 100,000 overdose deaths, an increase of 28.5 percent over 2020 levels. 

Often lost in the understandable concern about these fatalities are millions of chronic pain patients who are unable to get adequate pain relief.

In 2012, American physicians wrote the staggering number of 255 million prescriptions for opioid pain relievers. To reduce deaths and other harms, the CDC and other federal and state policymakers focused on significantly decreasing opioid prescribing and usage. By 2020, there were only 142 million opioid prescriptions, although in some parts of the country there are still exceedingly high levels of opioids being prescribed. 

The reduction in opioid prescriptions, however, did not reduce overdose deaths. In fact, from 2012 to 2021, overdose deaths soared from 41,000 to 100,000, with most deaths now resulting from illegal synthetic opioids — fentanyl and its analogs. Fighting the “war on opioids” at every physician’s office was a terrible mistake, and an unintended consequence has been to increase the suffering of many patients with chronic diseases whose long-term pain management depends on access to opioids. How did we get to this point?  

Most of the millions of opioid pills taken by patients for pain each year are prescribed by physicians without specialized training in pain management. A study published in 2013, near the height of opioid prescribing, estimated that 20 percent of patients treated in doctors’ offices for pain received an opioid prescription. To address this dangerous overprescribing of opioids, in 2016 the CDC published its Guideline for Prescribing Opioids for Chronic Pain. It “provides recommendations for the prescribing of pain medication by primary care clinicians for chronic pain . . . in outpatient settings outside of active cancer treatment, palliative care, and end-of-life care.”  

Some recommendations in the guideline are especially troublesome. First is the recommendation that “Nonpharmacologic therapy and nonopioid therapy are preferred for chronic pain.” In following this recommendation, some doctors have prescribed ineffective over-the-counter pain medicines or talk therapy instead of opioids for patients who have serious injuries and illnesses confirmed by imaging and lab tests, and who have previously tried these measures without benefit. A recent review of the evidence found there is no scientific basis to conclude that non-drug treatments are an adequate substitute for opioids in controlling severe pain. 

The CDC guideline is also being applied beyond its intended outpatient, primary care settings. Many hospitals and other large health care 

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