A new report by the American Medical Association reinforces what Dr. Bloom, among others, has said for a long time. Opioid overdose deaths are not the result of the prescribing behavior of physicians.
CDC Opioid Guidelines
It is indeed another day and time to complete my deeper look at the origin and uses of Morphine Milligram Equivalents (MME). It is time to consider the uncertainty introduced in how MMEs are calculated and how that makes the research on MME a minefield of unintended errors and variation.
They are the foundation of the CDC's 2016 opioid guidelines, resulting in legislation that limits opioid prescribing in 36 states. Morphine milligram equivalents, or MMEs, are used to set arbitrary prescribing limits for opioids by physicians, since many state legislators fail to understand – and translate into policy and law – the ‘16 guidelines. If we had all known the history of MMEs, perhaps we would not have been so eager to embrace them.
The term "opioid epidemic" is outdated to the point where the message conveyed is inaccurate. Also, every time the phrase is used most people will automatically think "pills." But pills are now a minor contributor to overdose deaths; it is illegal street drugs – especially illicit fentanyl – that’s (by far) driving the surge in overdoses. Substituting the term "fentanyl epidemic" would instead shift the blame to where it belongs, while going a long way toward halting the demonization of vitally important medicines. Words matter.
The FDA is conducting a workshop to discuss the science (lack thereof, really) of Morphine Milligram Equivalents as it applies to the atrocious CDC 2016 Opioid Prescribing Guidelines. Public comments have been solicited. Here are mine.
Despite irrefutable pharmacological evidence of the wide range in individuals' metabolism of opioid drugs, states continue to impose "one-size-fits-none" laws. For example, Massachusetts, apparently not entirely at peace with the abolition of the Salem witch trials, became the first state to establish a seven-day limit on first-time opioid prescriptions. Others followed. It's safe to say that no one is really paying attention to the science. So, here it is. Again.
It's no secret that the CDC's 2016 Advice on opioid prescribing, by any measure, has been an unmitigated disaster. Dr. Red Lawhern, ACSH advisor and pain patient advocate, spares no one in his discussion of the egregious mistakes that the CDC made -- and continues to make.