Tighter Restrictions and New Recommendations for Opioid Use
Currently, the FDA is working on a program to ensure proper prescription of opioids, which will include safety training for physicians. In 2009, it will be gathering input not only from manufacturers, but patient advocacy groups, healthcare providers, addiction treatment communities, consumer advocates and the general public. But first they will talk with drug execs. A meeting will take place March 3 in Silver Spring, MD, to discuss tighter restrictions planned for this class of pain medication.
The American Pain Society and the American Academy of Pain Medicine recently released a new set of clinical guidelines for using opioid medication for chronic (non-cancer) pain. They arrived at the guidelines by first reviewing all the medical literature on the topic and then bringing in a panel of experts for interpretation and formulation of the recommendations.
The new guidelines cover:
- identifying the types of patients who will likely be successful on opioids
- informed consent
- medication management
- determining the dose (amount) of drug to be taken
- use of methadone
- how to tell if or when opioids should be discontinued
- how to manage high dose opioid use
- how to manage a situation in which more than one opioid drug is prescribed
- preventing and managing side effects
- working and driving safely when under the influence opioids
- identifying a medical home and when to obtain consultation
- managing breakthrough pain
- taking opioids when you are pregnant
- governmental polices related to opioids


This is a good thing – if it would only impact the substance abusers. However; what will happen is, the docs. will choose the “better safe than sorry” approach, and those who need pain relief AND choose to play by the rules will suffer, big time, as a result.
Re: “the docs. will choose the “better safe than sorry” approach, and those who need pain relief AND choose to play by the rules will suffer, big time, as a result”
Unfortunately, that is already the case. Some doctors have been thrown in jail for prescribing the dosage needed to really get rid of the pain in some spine patients.
This is incredible…I am a chronic pain sufferer now for 15 years, and jump through any hoops I must in order to get minimal pain relief and have somewhat of a quality of life,and now this really stinks as far as I can see, Yes, so awful about addicts, but we should do what some European contries do, GIVE them the stuff and monitor them closely!!…Last year or maybe 2 years ago now, Cogress passed a law called HR something or other to help pain sufferers (cancer and non cancer pain patients) and now I am sure the progress made (including pain being the 5th vital sign, and the #20 on the patient’s bill of rights which states”… have the right to effective pain treatment”)will slide backwards yet again!
Marie,
The way I understand it, the FDA is trying to get more input from patients and consumer advocacy groups so in an effort to deliver more relief without jeopardizing safety in the process. Time will tell if I am write. I will posts updates to this blog as they are released from the FDA.
Best,
Anne
I have been on the Fentanyl patch for 3 years.
I’m 49 with 5-7 herniated disc’s.
I stopped counting at 5.
I have the burning down the leg ect.
The patch has made my quality of life so much better.Like the Indians say u must walk a mile in someone Else’s moccasins.
Like could be worse!
In 1996 at age 33 my wife was struck down in the prime of her life with a brain stem stroke.
Count u r Blessings.
Cheers Jeff
I agree with the first few posts. I am a chronic pain sufferer for over 16 years. I have NO quality of life without the opids as I have tried countless other medications and every procedure under the sun. I could tell you horror stories NOW about the hoops I’ve had to jump thru even going to the same Dr. office and pharmacy for over 30 years. I wish I had a majic wand to wave so “they “could switch places with “us”for one week. I know they would change their tune. This is another example of someone else making a decsion about my medical needs with it having NO affect on them. The percentage of absusers is meniscle compared to those of us that take them when needed and are properly monitered. I am so angry about this as it is so difficult NOW to even get minimal pain control because “they”are so afraid. I had to even educate my own Dr. on opids thru months of research I did before he was comfortable enough to persribe them. I just can’t imagin what is coming next.
Tammy
I have been on opoids since 1990 when I broke my back – had multiple failed back surgeries and left with unbearable pain. I try to bend over backwards to make sure my doctor knows I take only what he prescribes and am very careful with the meds. Have made a point of bringing in any left over at the monthly appointment. I could not survive without this – and would never do anything to put myself in jeopardy. But still, the pharmacist acts like I’m some junkie and once when my home was broken into and pills taken – the cops all but accused me of selling them. It is just the attitude out there. No one can understand unless they experience the pain and I would not wish it on anyone. Am afraid this will only make a bad situation worse. I hope not.
I cannot believe in this day and age, we have to sometimes, literally fight for our health and the quality of it! There was a time I needed pain meds for a shoulder problem. My own mother called me a “junkie”! My nurse, who I did not see eye to eye to, told my mother (behind my back!) I was on enough medicine to “kill a horse”!! I had the same struggle as many of you, and at the time I really thought I was alone. Seeing this site has made me more aware that people are still out there, in legitimate pain, with doctors with no coommon sense! That’s what it comes down to – sheer common sense!! I went from Dr. to Dr. trying many more treatments, and endless NSAIDS, to no avail. Dr.s thought I were lying and/or was a junkie. These doctors never “heard” me!! Not once! One day it was discovered that my arm had become “frozen”, and that then I needed to move my shouler/arm so it could properly heal. I remember crying so hard fighting the pysical, and now the emotional pain. My story had a happy ending, but I still went through the seemingly endless pain, people callng me “junkie”, doctors simply not caring, as well as the depression that followed. I was doing better, and stopped seeing all the doctors, and no longer had to beg for meds, as I no longer needed them. But what stayed were the inner scars that had broken my spirit, and left my soul cold. These “people” who had said all the awful things to me, about me, were now acting like nothing had ever happed, and that they were “so happy” for me. I pondered where that emotion was back when I needed the someone to care. I stopped taking the meds cold turkey and on my own. I wasn’t addicted, as I knew that addiction was possible. I still even have a few pills left over. I won’t throw them away, because I think to myself, what if that happend again? Just because some people abuse the system, is not a reason to become intolerant to the needs of others. Those “others” would be any sane person, who is in pain and needs a little empathy, not wrath. I know my story has ended in a way, but in other ways, not. I thought I was crazy!! Leaving a lot of pain , now inside, that I continue to deal with.every day. This whole thing “thing” that leaves us and our dr.s wondering what to do, has left an imprint in my mind that I don’t think I’ll ever forget. I’m still leary about any doctor I go to see. and btw, I left old ones! I just wanted to share my story because I read all of your comments and I wanted you all to know that I understand. And I wish I could heal all of us with a magic wand as well as do some damage to those doctors – and we all know them, right?!! I not only understand, I empathize with each and every one out there suffering, for no one deserves that. It seems so wrong that our health can be at the mercy of someone else, and not with us. And so it goes…
It took me years to finally find a doctor who wasn’t afraid to prescribe pain meds. On top of excruciating, constant pain and sometimes total inability to even walk…I also, just have a body chemistry that has always been highly tolerent of most medications. Back in the late 50s when I was an extremely colicky infant, my pediatrician told my Mother to put phenobarbital in my bottle. She said that the doctor was floored. Most babies conked out for a few hours or more. My Mom said that I just stopped crying for ..maybe 5 minutes and then started screaming again. Most people worry about dying on the operating table. I’m afraid of waking up while they have me sliced open. It’s almost happened several times. I usually am awake before I get to recovery. This always gets everyone working in recovery dragging people over to see me because while everyone else is sleeping, groggy and drooling, I’m wide awake and ready to go home.It must be genetic because lot’s of people in my family are the same way. I had just gotten into recovery after a c-section and my belly was on fire and hurt like h—. I told the nurse and she tried to dismiss me. She said you just had morphine 20 minutes ago and you’ve had a Spinal, so you should be completely numb from the waist down and incapable of moving your legs for the rest of the day. I asked her to pull up the coves. She did and I did a little Irish jig for her on the bed….laying down of course. She shot out of there so fast that my husband, Mom, and Dad were laughing there heads off. She brought my doctor back. This was my 2nd c-section and he knew me very well. He told her, “This girl has learned how to live with incredible pain. She went through 14 hours of overlapping contractions after three days of labor and that was without one drug. (We all wanted to have natural childbirth in te 80s)I’ve learned, if she says she hurts…she hurts. Another time I had this great nurse after I had had some knee surgery and she used to come in and tell me not to be brave. That it just made the pain worse and last longer. A neighbor who has her doctorate in nutrtion and is a registered dietian thinks it’s fascinating and someone ought to do research on different people and genders and their reaction to pain and pain meds. She thinks it might be a metabolic thing…that some people metabolize certain things faster. The one size fits all mentality of many people in the health profession drives her mad. So, now they’re going to make the doctors even more afraid to prescribe what a patient needs. All that’s gonna do is send more people to mexico, or really getting into trouble buying illegally or when those roads get cut off….just checking out. Why not spend some money doing more research on this chemical, I was reading about that they’ve found that keeps your body from building up a greater tolerence, so you never need to increase the dosage of your meds and they still work at the same dosage that worked at the beginning. Then you’d know right away who is really an addict and who just wants to enjoy a normal life again because they would never need to go drug seeking or searching for a doctor who wasn’t afraid to prescribe the right medication for each unique patient..
I shattered 3/4″ of my upper arm and had surgery to repair. I had never experienced pain that was so prevasive that I wanted to crawl in a cave. It didn’t diminish for 3 monthsand then only some.
My doctor was not afraid to give me all the pain killers I needed. Even he said I suffered more than most of his patients due to the slow healing process. Eventually I began to cut back on the pills and was off in about 5-6 months. Thank goodness for an empathetic doctor.
As stated above the prescribers and restricters of meds should walk in the patient’s body before being critical.
Tammy (#6) is exactly right. I have suffered with chronic pain for years and feel the same as Tammy. Unfortunately, most physicans are untrained in treating chronic pain patients. Also, most physicians, unless they are sufferers themseelves, have little knowledge or care about our continual PAIN!
Most are just worrying about “covering” themselves, suspecting every patient in pain is a drug addict, and wanting to prescribe the minimum amount of medication to keep them from being sued. We need to EDUCATE the Doctors in this country of how to treat legitimate chronic pain patents and help them understand what we endure everyday.
Tammy (#6) is exactly right. I have suffered with chronic pain for years and feel the same as Tammy. Unfortunately, most physicians are untrained in treating chronic pain patients. Also, most physicians, unless they are sufferers themselves, have little knowledge or care about our continual PAIN!
Most are just worrying about “covering” themselves, suspecting every patient in pain is a drug addict, and wanting to prescribe the minimum amount of medication to keep them from being sued. We need to EDUCATE the Doctors in this country of how to treat legitimate chronic pain patents and help them understand what we endure everyday.
i have the same problem i live in my bed go to pain managment and yhey say because of my age bla bla bla, yet i have hade three surgurrys on my back and they have no problem saying i should get another surgury. now how does that make sence i actully had two go to emergency room two weeks ago after attempting to kill mtself because i can’t live with the pain no more they said it was a miricle i mad it yet im not so happy about it. im stuck in a bed with tears running down my face half the time.
Sorry to hear that Mike. I wish your first surgery was successful for you. This is what I am seeing all the time. Too many opting for surgery when there are other safe treatments to try first…but the doctors are not informing patients of all their choices most of the time..
Many still dont know about spinal decompression therapy.
I have had severe pain management problems for years, at least 15 years. I have had spinal fusions, a failed spinal fusion,blah,blah, blah…I have had countless injections,physical therapies, and so on…chronic pain is debilitating at best…having doctor’s make you jump thru hoops every single time you need pain control is terrible, humiliating at best. I have suffered many other issues from steroid injections,PT and so on… i have become chroniclly depressed from the pain..at times… there has to be an answer out there somwhere for chronic pain suffers…I have all the mri’s, ct scans etc. that show severe spinal issues, yet doctors just want you to “live” with the pain and go on with life.
The insurance co’s make it even worse…(wont pay for specialists and so on). I believe in my heart there is an answer for chronic pain magmt. Only $$$$ stops us from having the answer to lead a productive life with chronic pain.
It is a lot of talking about M. Jacksondead, it’s a very sad for me becsuse I love hisx music, I still didn’t beloeve in his dead. Hi was a definitely knig of ‘Pop’.
i agree totally with all the comments. im 25 and on methadone 10 a day, oxycodone30mg 4 a day,xanax2mg 3 a day,cymbalta restoril baclofen phenagen . it sounds like a lot but my pain overpowers the medicine so i end up taking 30 methadone at once as soon as i fill them and doing that for a few days just to get relief and feel ok for a few days then i end up having to take way less for the next 26 days before i get my prescription again. it is a viscious cycle i constantly feel like im in withdrawls except for the few days like i said earlier. i cant work and i keep getting denied for disability medicaid ssi any help . my grandparents adopted me they are losing everything they have trying to support me and my doctor visits and all my medicine that is so exspensive . my tolerance is so out of sight i was on oxycontin morphine pills fentnyl patches and i went back to methadone it is way cheaper and my only relief my dr says im to tolerant if i did take my methadone 10 a day i still dont feel better so i take so many for relief and suffer with taking 6 or 7 a day because im never gonna get a increase i have already been told that . and when i go to the pharmacy they look at me like im some scumbag because im prescribed 10 methdone a day if they only could live in my shoes for 1 month my dr included id be able to get an increase and probbaly a trophy for living in hell like this . i hate my life i broke my neck in 2005 and i have been in this situation since then . i feel like me 4 days a month it is sad and i wouldn’t wish this on my worse enemy. i hate to leave home im never happy there is always some health issue i cant afford to fix like 2 months of female bleeding after taking a antibiotic for a urinary track infection now that same antibiotic is on tv with a lawyer saying all the things it has caused people my problem wasn’t one of them i went to the er and they said id have to go to a obgyn with no money and no insurance i had to suffer and since then ive yet to have a month where i didnt have bleeding at least a little before it was that time of the month and i take birth control pills and i still had so much blood it was unreal it scared me to death this month i had light blood 1 week before my period maybe my body is getting back on track ive been praying my heart out. i cant work and have no money and cant find a lawyer to take my case im in a living hell and GOD is the only one who can help me and i feel like he will just when i dont know im just gonna keep praying and maybe i can get disability and go to a rehab and get off all this medication so my tolerance will go down and then try again with pain meds i see its a lifetime sentence once you hurt yourself and have chronic constant pain nobody knows unless they have been there and felt what you feel and live the life you live . i wish they would come up with a drug that keeps your tolerance the same forever i would be able to live like im 25 and not 90!!!!!!!!!!!
had recently herpes virus found in my blood. what I haveto do??? I’m in panic…