Guidelines advising doctors on how and when to prescribe opioid pain pills have proved useful in limiting their use. But who should be issuing that advice, and what it should say, has turned into an acrimonious debate, with a Kansas City patient advocate playing a leading role.
The U.S. Centers for Disease Control and Prevention, which views the widespread use of opioids as a public health threat, recently proposed guidelines of its own. What the CDC called for stirred an uproar among pain treatment advocates and medical organizations.
They complained that the CDC rushed its proposals through, relying heavily on opioid critics, such as members of Physicians for Responsible Opioid Prescribing, while ignoring pain patients and doctors with other viewpoints.
The proposals were so restrictive, they said, that many chronic-pain patients would no longer be able to get the dosages they need.
Instead of releasing finalized guidelines in January, as planned, the CDC has sought further comment.
The delay frustrates Andrew Kolodny, executive director of Physicians for Responsible Opioid Prescribing. One person he singled out for her role in blocking the guidelines is Myra Christopher, a founder of the Kansas City-based Center for Practical Bioethics.
Although not a physician, Christopher is a recognized authority on pain treatment and an outspoken advocate of people in chronic pain.
But as The Star reported in 2012, her bioethics center received more than $1.5 million from Purdue Pharma that was used to endow a chair in pain and palliative care that she now holds. Purdue makes the opioid OxyContin.
The bioethics center is among seven nonprofit organizations investigated by the U.S. Senate Finance Committee for their ties to opioid manufacturers.
Kolodny called Christopher “one of the most prominent spokesmen of the opioid lobby.”
Christopher is unapologetic about her advocacy.
“I’ve been labeled everything in the universe, but it doesn’t matter to me,” she said. “I’m not financially motivated. … What I care about is that we make decisions based on good data and that we don’t harm populations that have nothing to do with this problem.”
Kolodny, she said, “is a true believer. I have a lot of respect for Andrew Kolodny. He’s just wrong.
“I know of many, many chronic-pain patients who are dependent on opioids but who aren’t addicted.”
Taking on the CDC is important because doctors, hospitals and insurance companies probably will adopt whatever it recommends, Christopher said.
She said guidelines should be coming from professional organizations such as the American Medical Association, rather than from a government agency.
Many health care organizations and medical societies have been offering such guidance, often recommending that non-addicting drugs and other pain therapies be tried before opioids.
Before Temple University Hospital in Philadelphia established guidelines for prescribing to emergency room patients with certain minor pain complaints, 52.7 percent were receiving opioids. After the guidelines went into effect: 29.8 percent.
Christopher took no issue with opioid critics who say the drugs have been overused and misused.
“We have done a really lousy job of using these medications,” she said. Opioids are effective for only about half the patients who receive them; pain management should include other kinds of care, such as counseling, chiropractic, acupuncture, she said.
“I don’t want to sound like I’m pushing opioids. I’m not,” she said. “But to deny (opioids to) people in pain because there’s an addiction problem is cruel and wrongheaded.”