OR: 90 MME per day Limits & the Opioid “Hyperalgesia” myth.
In America, the consequences of opiophobia since their 2016 CDC Opioid Prescribing Guidelines were introduced, has been the creation of arbitrary ceiling doses for opioid usage & the continued propagation of an opioid “hyperalgesia” myth. AND most alarmingly, leading to the routine persecution, prosecution & jailing of Doctors by their Federal Drug Enforcement Agency or DEA.
WHY are physicians being punished, i.e. for simply prescribing opioids & treating chronic pain humanely? Unfortunately, “unnecessary prescription of opioids” continues to be one of the most common causes of action taken against physicians who provide treatment for chronic pain unrelated to cancer.” [SEE REF. 1 BELOW]
POINT 1: What is “Hyperalgesia”?
“Hyperalgesia… is used in two different contexts in pain medicine. In one context, hyperalgesia refers to the excessive pain often induced by neuropathies or certain chemicals…Another context is the unfounded assertion that some patients who chronically take high-dose opioids develop increased pain with increased doses, or increased sensitivity to noxious stimuli.”
POINT 2: Do high dose opioids routinely cause “hyperalgesia”?
“High-dose opioids do not induce tolerance in intractable pain patients, nor do they induce hypothetical allodynia or other pain hypersensitivities to any significant extent. Opioids are effective in controlling pain and dramatically improving the quality of life in patients who experience chronic pain. Opioid overdoses are nearly always due to addictive misuse or unauthorized polypharmacy, frequently including alcohol, and are statistically insignificant among pain patients when the medication is used as prescribed.”
POINT 3: WHY is “hyperalgesia” used as an excuse to limit pain relief?
In America…“The assertion of opioid-induced hyperalgesia has found its greatest usefulness by physicians and regulators looking for justification to limit opioid prescribing, and by some cost-conscious insurance companies seeking a medical reason to deny payment for high doses of opioids.”
THEREFORE: WHY have Australian Medical Authorities implemented policies of drastically restricting opioid prescriptions & force-tapering chronic pain patients in very recent times? [We certainly don’t have an illicit fentanyl problem causing the vast majority of non-medical “opioid” overdose deaths, as now is statistically & unequivocally proven in America!]
Our issue in Australia with regard to “opioid” overdose deaths is due to Polypharmacy, not opioids ALONE. The 2022 Penington Institute Report clearly indicates there were 28 deaths from “pharmaceutical opioids ONLY” in 2020. [SEE REF. 2 BELOW]
SADLY, we have swallowed the unfounded hype & disinformation being spread in America by anti-opioid lobbyists, media & those who seek to discredit the benefits of pharmaceutical opioids, used responsibly & safely in the Chronic Pain Community for many years previously.
IN FACT, as I & other Advocates have said before, chronic pain patients DID NOT cause any opioid crisis in either country. Instead, taking away our mobility restoring pain killers, has ONLY resulted in an epidemic of untreated pain & an unfounded “Fear Of Opioids” in both countries.
https://www.hcplive.com/view/opiophobia_consequences
Author: Kevin R James
Chronic Pan Patient Advocate and Writer. Medically Retired RN [B.Nurs.]