April 12, 2019
Area(s) of Interest: Public Health Drug Prescribing/Dispensing
The Comprehensive Addiction and Recovery Act of 2016 required the U.S. Department of Health and Human Services (HHS) to create a task force to identify gaps or inconsistencies, and propose updates to best practices and recommendations for pain management, including chronic and acute pain.
The 29 member “Pain Management Best Practices Inter-Agency Task Force” recently published its Draft Report on Pain Management Best Practices: Updates, Gaps, Inconsistencies, and Recommendations.
The California Medical Association (CMA) considers the draft report to be a balanced, patient-centric approach to pain management that simultaneously addresses two public health crises – how to improve pain care for the millions suffering, while reducing the risk of opioid misuse, addiction and overdose.
CMA has been supportive of efforts to address the complicated issues related to prescription opioid misuse and overdose and has advocated for a well-balanced approach to opioid prescribing and treatment that considers the unique needs of individual patients. CMA is, however, opposed to arbitrary restrictions upon a patient’s ability to receive effective, patient- specific, evidence-based, comprehensive pain care – and recognizes that pain is a uniquely individual and subjective experience that is altered by a variety of biological, psychological and social factors.
The task force’s draft report is consistent with CMA's position on these issues, underscores the significant complexities involved in treating pain and recognizes that the best health outcomes are ones in which individualized, patient-centered care is prioritized in the treatment process.
The draft report also acknowledges that while safe opioid stewardship is needed to address the risks associated with opioid-related harms, the intense focus on the adverse consequences of using opioid analgesics rather than the management of pain has resulted in policies that impede patient care and increase stigma. A better understanding of the symbiotic relationship between the two crises is needed to reduce these unintended consequences.
In fact, just this week, the U.S. Food and Drug Administration (FDA) issued a drug safety alert to health care providers and patients, indicating it has received reports of serious harm in patients who are physically dependent on opioid pain medicines suddenly having these medicines discontinued or the dose rapidly decreased. These include serious withdrawal symptoms, uncontrolled pain, psychological distress and suicide. The FDA advises health care professionals not to abruptly discontinue opioids in a patient who is physically dependent, and to consider a variety of factors, including the dose of the drug, the duration of treatment, the type of pain being treated, and the physical and psychological attributes of the patient. No standard opioid tapering schedule exists that is suitable for all patients, according to the FDA.
It is CMA’s hope that this document and the FDA advisory will serve as the impetus to move the needle towards a balanced approach that emphasizes patient empathy and clinician judgment as the basis in delivering effective pain care.
For more information, see CMA’s comments.
View the FDA’s Drug Safety Alert.