THE U.S. OPIOID CRISIS CAUSED THE GOVERNMENT TO INITIATE UNLAWFUL VIOLATIONS OF THE U.S. CONSTITUTION AND INTERNATIONAL TREATIES.
U.S. CONSTITUTION ARTICLE 6, CLAUSE 2, RATIFIED TREATY
INTERNATIONAL COVENANT ON CIVIL AND POLITICAL RIGHTS
Adopted and opened for signature, ratification and accession by General Assembly resolution 2200A (XXI) of 16 December 1966entry into force 23 March 1976, in accordance with Article 49
1 . In time of public emergency which threatens the life of the nation and the existence of which is officially proclaimed, the States Parties to the present Covenant may take measures derogating from their obligations under the present Covenant to the extent strictly required by the exigencies of the situation, provided that such measures are not inconsistent with their other obligations under international law and do not involve discrimination solely on the ground of race, colour, sex, language, religion or social origin.
2. No derogation from articles 6, 7, 8 (paragraphs I and 2), 11, 15, 16 and 18 may be made under this provision.
The Constitution of the United States
(ratified December 15, 1791)
The right of the people to be secure in their persons, houses, papers, and effects, against unreasonable searches and seizures, shall not be violated, and no warrants shall issue, but upon probable cause, supported by oath or affirmation, and particularly describing the place to be searched, and the persons or things to be seized.
Amendment 8 - Cruel and Unusual Punishment.
Excessive bail shall not be required, nor excessive fines imposed, nor cruel and unusual
THE U.S.A. HAS PAIN MANAGEMENT DOCTOR PROBLEMS.
THE GOVERNMENT HAS BUNGLED TEACHING MEDICAL DOCTORS THE LAWFUL WAY TO PRACTICE MEDICINE.
CRIMINALLY ABUSIVE DOCTORS ABOUND, AND DISHONEST DOCTORS OUTNUMBER HONEST ONES 10 TO 1
CDC Advises Against Misapplication of the Guideline for Prescribing Opioids for Chronic Pain
Some policies, practices attributed to the Guideline are inconsistent with its recommendations
Media Statement Embargoed Until: Wednesday, April 24, 2019, 5 PM, EDT
Contact: Media Relations
- Misapplication of recommendations to populations outside of the Guideline’s scope.
- The Guideline is intended for primary care clinicians treating chronic pain for patients 18 and older.
- Examples of misapplication include applying the Guideline to patients in active cancer treatment, patients experiencing acute sickle cell crises, or patients experiencing post-surgical pain.
- Misapplication of the Guideline’s dosage recommendation that results in hard limits or “cutting off” opioids.
- The Guideline states, “When opioids are started, clinicians should prescribe the lowest effective dosage.
- Clinicians should… avoid increasing dosage to ≥90 MME/day or carefully justify a decision to titrate dosage to ≥90 MME/day.”
- The recommendation statement does not suggest discontinuation of opioids already prescribed at higher dosages.
- The Guideline does not support abrupt tapering or sudden discontinuation of opioids.
- These practices can result in severe opioid withdrawal symptoms including pain and psychological distress, and some patients might seek other sources of opioids.
- In addition, policies that mandate hard limits conflict with the Guideline’s emphasis on individualized assessment of the benefits and risks of opioids given the specific circumstances and unique needs of each patient.
~~~~~~~~~ DON'T DROP YOUR PATIENT ~~~~~~~~~~~~
State of California GAVIN NEWSOM Governor
Health and Human Services Agency
California Department of Public Health
August 27, 2019
Health care providers are essential partners in ending the opioid epidemic in
California. Working together, we want to ensure that providers have access to
resources and support to help improve patient pain management, while avoiding
opioid overdose and dependence.
One of the most challenging situations reported by prescribers is how to respond
to patients already on high doses of opioids (> 90 MMEs) or with possible
These patients are at higher risk and may need your
assistance more than ever. Recent concerns about over-prescribing of opioids
has led to some misinterpretation resulting in abruptly terminating the use of
opioids, which can cause health risks for patients.
I want to stress that some pain
management situations may involve the use of opioid medications if alternative
approaches are not available or effective. It is my hope that we can offer
resources to support you as you continue your clinical relationship with your
patients to ensure their overall well-being.
On behalf of the Statewide Opioid Safety (SOS) Workgroup and partners, I am
contacting you to offer resources to assist you in addressing these critical
treatment issues with your patients:
Consider all pain management options before starting patients on opioids.
Recognize when and understand how to taper patients at risk.
Offer medication assisted treatment (MAT) to your patients.
Provide patient referrals to MAT and addiction recovery programs.
Please visit the link or access the QR code to find resources on each of these
topics. Summary information on each topic is included below.
Consider All Pain Management Options before Starting Patients on Opioids
The Centers for Disease Control and Prevention (CDC) recommends exploring
multiple treatment options (including non-pharmaceutical alternatives) to address
chronic pain management before starting patients on opioids. Speak with your
patients’ health plans to find out what alternatives are available.
Recognize When and Understand How to Taper Patients on Opioids
Health care professionals should not abruptly discontinue opioids in a patient who is physically
dependent on opioids, nor should they implement rapid tapers in patients with long-term
Safe tapers may take months to years to accomplish. Ensure patients understand the
risks and benefits of dose maintenance versus dose tapering and develop an individualized plan in
collaboration with patients.
The CDC recently clarified that its 2016 guidelines only recommended dose limits for new patients.
The CDC does not recommend applying arbitrary dose limits to patients dependent on long-term
opioids, as there is insufficient data supporting this practice.
In a recent study in the Journal of
Substance Abuse Treatment, after an abrupt taper almost half (49%) of people had an opioid related hospitalization or emergency department visit.
Offer Medication Assisted Treatment (MAT)
For patients experiencing opioid use disorder, the use of some MAT, such as buprenorphine, has
been shown to be highly safe and effective in lowering overdose risk, decreasing HIV and hepatitis
C occurrences, and increasing retention in treatment. If you are not yet certified to prescribe
buprenorphine, consider obtaining X-waiver certification. There are several short online MAT
training programs available as well as additional MAT treatment resources for X-waivered health
care professionals on our resource list.
Additional support on MAT and other substance use disorder questions for clinicians is available
through the California Substance Use Line – Staffed 24/7 in collaboration between addiction
experts at the UCSF Clinicians Consultation Center and California Poison Control:
Provide Referrals to MAT and Addiction Recovery Programs (Locator Tool)
If you are unable to provide MAT, refer patients to a drug or recovery program within your
community. Use the treatment locator tools on the Opioid Prescribers Resource sheet to find local
MAT and addiction recovery services.
For patients who use opioids or other drugs non-medically, harm reduction programs provide a
range of supportive, nonjudgmental services to prevent disease transmission and overdose, offer
substance use counseling, and help people connect to and stay engaged with health care. A
directory of harm reduction programs in California is available on the Opioid Prescribers Resource
Thank you for providing quality medical care to your patients.
Charity Dean, M.D., M.P.H.
Acting State Public Health Officer
1 Tami L. Mark and William Parish, Journal of Substance Abuse Treatment, https://doi.org/10.1016/j.jsat.2019.05.001