…in updated opioid treatment guidelines from the Centers for Disease Control and Prevention (CDC). Action Alert!
The CDC recently proposed an updated set of recommendations for how and when to prescribe opioid medications. Doctors are, and should be, free to prescribe what they feel is necessary to help their patients—but should the federal government be recommending any opioid use in the midst of one of the worst addiction and overdose crises in history—particularly when agencies like the FDA played such a key role in the development of this crisis? Still worse, hardly any natural alternatives were discussed or evaluated in the CDC’s guidelines.
The overall message of the sprawling, 211-page document is that doctors should use non-opioid treatments first for both chronic and acute pain. These include over-the-counter drugs like ibuprofen, massage, exercise, and even acupuncture. Doctors should prescribe opioids for chronic pain patients only if expected benefits (like the ability to do everyday tasks) outweigh the calamitous risks, including addiction, overdose, heart problems, and more.
Whether doctors, in their clinical judgment, choose to prescribe opioids is one thing; for the federal government to be recommending the use of opioids, even in a limited fashion, reeks of cronyism, given the sordid history of the FDA aiding and abetting Big Pharma in creating this crisis. This history has been expounded upon in detail, particularly following the avalanche of lawsuits in recent years. Here are some of the highlights (or, rather, lowlights):
- When extended-release OxyContin was approved in 1995, safety studies showed that the drug was effective and safe mostly for short term use in severe, end-of-life pain. Yet the FDA approved the drug for a much broader treatment of chronic pain, including everything from fibromyalgia to back pain.
- There were no clinical trials to show OxyContin was less addictive than other opioids, but the FDA allowed Purdue, the manufacturer, to claim that the drug was “believed to reduce the abuse liability” and that addiction was “rare.” These claims allowed Purdue to launch a multi-million dollar advertising campaign, pushing their drug as safer than any competitor. In the words of a former FDA Commissioner, the FDA’s approved OxyContin label was a “blank check” that resulted in billions in additional sales.
- As the evidence mounted that opioid prescribing was outpacing clinical need and overdoses were skyrocketing, the FDA convened an advisory panel of ten experts tasked with recommending whether the agency should forbid dispensing opioids for chronic pain. Left unmentioned by the FDA was that five of the panelists had connections to Purdue as consultants or paid speakers; three others had similar connections to the opioid industry. The panel recommended no change in the FDA’s opioid labeling. It took another six years for the FDA to remove OxyContin’s label claim that addiction was rare.
- In the following years, the FDA continued to approve new, more powerful opioids. Even when advisory panels overwhelmingly voted against approval, top FDA officials, including then-FDA Commissioner Janet Woodcock, pushed them through. The leader of an opioid advisory committee told reporters that the “lack of insight…exhibited by the agency is in many ways a willful blindness that borders on the criminal.”
Drug overdoses are now the leading cause of death for Americans under the age of 50. Purdue Pharma, maker of OxyContin, made $10 billion from the sale of opioids—and that’s just one among several drug makers who made astronomical sums from the sale of these drugs.
There is a missed opportunity, or opportunities, in these recommendations for doctors to use proven natural therapies to manage pain. Natural treatments cannot always replace opioids, but they can be a first option for many patients because they are safe and non-addictive. The CDC did evaluate acupuncture, exercise, massage, yoga, and cognitive behavior therapy as options, but these just scratch the surface of what is available in the natural medicine toolkit.
First, CBD, one of the compounds found in the hemp plant, has shown great promise in pain management. A recent study found that a significant number of people with fibromyalgia are finding an effective replacement in CBD-containing products. In that study, more than 70% of people with fibromyalgia who used CBD for their illness had substituted CBD for opioids or other pain medications. Of those participants, many reported that they either decreased use or stopped taking opioids and other pain medications as a result. This is supported by other research showing CBD’s pain-relieving properties.
Other natural options ignored by the CDC:
- Homeopathy offers numerous customized approaches to the management or elimination of pain. For example, a study published in Rheumatology found statistically significant results from homeopathic treatment of people with fibromyalgia.
- Medical foods provide specific nutritional requirements for the management of a disease or condition that cannot be met by diet alone. Medical foods often manage the underlying metabolic cause of a disease or condition, not just the resulting symptoms. Used under medical supervision, medical foods should be considered part of effective management best practices for diseases and conditions that can lead to chronic pain. For example, Limbrel is a medical food for the treatment of osteoarthritis that contains safe ingredients like Chinese skullcap and catechin.
- Ozone therapy is the injection of oxygen gas (ozone) into affected areas. Ozone is known to deactivate bacteria, simulate oxygen metabolism, activate the immune system, and to help with chronic pain and inflammation.
- Hyperbaric oxygen therapy, or HBOT, (pressurized oxygen) may help with pain by flooding wounded tissue with the oxygen it needs to repair itself.
- A variety of dietary supplements have evidence to recommend them for pain, including: curcumin, Indian frankincense, black sesame seeds, omega-3 fatty acids, Palmitoylethanolamide (PEA), Gamma linolenic acid (GLA) Methylsulfonylmethane (MSM), capsaicin, vitamins C, D, and E, and B vitamins, to name a few.
We’re doing patients with pain a great disservice by ignoring these options. Eight percent of adults—16 million Americans in total—have chronic back pain; 24 percent of Americans, or 58.5 million people, have arthritis; and 4 million people, or 2 percent of the population, have fibromyalgia. We must offer these patients the full bevy of options to manage their pain, including safe and non-addictive natural therapies such as those listed above. Until we embrace a more holistic approach, we cannot expect to get a handle on the addiction crisis that is killing us in record numbers.
Action Alert! Write to the CDC and urge them to include natural options in their alternatives to opioid medications. Please send your message immediately.