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Opioid Guidelines are Pseudoscience
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They do not pretend to treat pain
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CDC Opioid Guidelines limit opioids to
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90 mg morphine equivalent daily dose, MEDD
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Whose calculations will the DEA use against your doctor?
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Chronic pain is life altering. Opioid guidelines are life altering. The introduction of pseudoscience on a nationwide scale is life altering. Actually being the physician to reduce opioid doses to comply with arbitrary guidelines is life altering.
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The guidelines are intended to stop death and misuse from opioid overdose, not intended to relieve pain. About the same as taking drivers off the highway to stop highway deaths. We are just about back in the era of pain management before 1990.
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A nationwide mandate that affects the practice of thousands of doctors and the health and well being of 50 million people whom the authors have never examined, is life altering.
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We are all in shock. Guidelines don’t care about pain. CDC does not care. It’s all about death from overdose – tens of thousands of overdoses every year. Even when we calculate some magic pseudo-equivalent dose, just how are we to get from point A to point Z? It is not discussed. This anonymous treatment limit is an insult to our patients, and fails the standard of practice of medicine in this country that requires a good faith history and examination of the whole person, just to begin. Then to design a treatment plan.
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For example, how do we calculate the morphine equivalent daily dose (MEDD) of oxycodone? That can be tricky. Opioids vary from person to person, drug to drug and the tables used to calculate and convert from one to another all differ. How simple is that? Wouldn’t we rather be talking about opioid splice variants, anything, but this calculated number is based on pseudoscience, as explained in this publication:
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The MEDD myth: the impact of pseudoscience on pain research and prescribing-guideline development
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This critical paper is published by the Journal of Pain Research, which is open access peer reviewed. Why is this important?
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Let’s look at a few points:
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In 2014, Shaw and Fudin conducted a survey comparing various online opioid dose-conversion tools and found a −55% to +242% variation across eight opioid-conversion calculators.16 The standard deviations in these two studies alone exceeded many of the MEDD maximums that several states have employed to trigger consultation from a certified pain expert.8,17–19 These studies alone unequivocally disqualify the validity of embracing MEDD to assess risk in any meaningful statistical way. Outside of MEDD calculations, there are several factors that also require consideration, but that remain largely ignored. These include patient-specific attributes, such as pharmacogenetics, organ dysfunction, overall pain control, drug tolerance, drug–drug interactions, drug–food interactions, patient age, and body surface area.15 The bottom line is that as the scientific concepts upon which prescribing guideline authors depend are flawed and invalid, so are the guidelines themselves. As a result, we posit that these guidelines are disingenuous and highly unethical.
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Opiate overdoses unfortunately can occur at any dose, and patients are at risk on even low-dose opioids.
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Death can occur at any dose. There is no “distinct risk threshold.”
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The guidelines are intended to stop tens of thousands of deaths from opioid overdose, they are not intended to improve pain. Just as chronic pain seizes the brain, the opioid guidelines stop rational thinking and all your reflexes.
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The morphine equivalent daily dose (MEDD) of 90 mg is the maximum dose on the guidelines and affect everyone no matter how different your pain, your age, or your dose needs to be from another person, and regardless of how opioids differ from one another. Pseudoscience creates a huge problem. This is not only not evidence-based. There is no evidence at all.
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I have recently referenced criticism of the opioid guidelines which I recommend for additional details.
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It’s not only opioid guidelines. Medicine is an art, not a science. Real people and medicines have real differences. The New York Times reviews a book about medicine by Abraham Nussbaum, MD, that says it well:
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“He notes that partisans of today’s much promoted evidence-based medicine must determinedly finesse the fact that medicine is riddled with flawed, incomplete evidence. The leaders of genomic revolution trumpet a future that keeps being postponed. Quality-control gurus abound, but their work often fails to yield actual quality.”
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Will the opioid guidelines bring a prohibition like the alcohol prohibition of 1928?
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Pain Management Specialist in San Diego & La Jolla 
04/08/2016 at 12:48 am
Dr Sajben’s numbers are too optimistic because she neglects the most important element of the pseudoscience involved: The supposed thousands of accidental opioid overdoses are not happening.
CDC fabricated the “opioid epidemic” out of thin air, by ignoring the fact that there are thousands of suicides taking place, among patients who are not allowed sufficient amounts of opioids to control their pain. These patients are committing suicide with mixtures of opioids with alcohol, mixtures that are vastly more dangerous than their individual ingredients. Many of the dead are wounded war veterans who came home with combat-induced psychosis and chronic pain in combination. The VA won’t admit that it’s mental health care is deficient in quality…admit that war drives people insane and one might as well admit that war is a bad thing which reasonable people would avoid.
That said, a better analogy than 1920’s America is Germany in 1937.
CDC’s policy of calling suicides accidental, follows the same hideous reasoning as the German authorities followed, in telling the public that Jews carried a mysterious disease and had to be separated from German society to prevent it’s contagion.