Taking opioid education seriously, doctoral students at the Albany College of Pharmacy & Health Sciences (ACPHS) currently enrolled in the Pain Management elective class were assigned the task of uploading a rebuttal to the FDA website with their opinion on opioid relabeling.
Each student received a grade on their ability to make a valid argument for or against the opioid label changes. Students were not graded on their opinion or which position they took; they were however graded on their ability to substantiate their recommendations with supportive evidence or lack thereof. In a previous assignment, this very class posted a blog that essentially verified that it’s not possible to determine an exact “morphine equivalent” dose because of a huge disparity in conversion literature and online calculators.
PY3 Student Julie Yu took this new assignment to another level when she prepared a newsletter of sorts. Because of her dedication to the topic, she was invited to write a guest blog which follows below. Ms. Yu’s classmates will have an opportunity to add their FDA submissions in the commentary area beneath her blog either anonymously or by name.
Julie Yu writes…
Implications of Opioid Relabeling on Chronic Non-Cancer patients
Last week, the FDA finished collecting comments regarding the impact of opioid relabeling in treating chronic pain. A quick search on the internet brings up an overwhelming number of statistics completed by experts in the field. In an already busy conversation, my approach was to avoid robotically echoing studies that have been mentioned before. I thought it would be the best use of the FDA’s time to give my perspective as a pharmacy student. In the following commentary, I have briefly highlighted the main points that I have made to the FDA.
The United States has experienced a steady increase in opioid sales and related deaths every year. At first glance, this may lead some to think that opioid prescribing has become relaxed, or that opioid abuse is getting out of control. I was hesitant about taking these numbers at face value. After all, medications used to treat hypertension have also been increasing over the years. The cause of chronic pain often times cannot be predicted or prevented. Therefore, the number of opioid sales and deaths is expected to increase as the population increases. However, the diversion of opioids from one family member or friend to another can be prevented. Pharmacists have a critical responsibility as opioid educators to prevent many of these tragedies.
Out of all the proposed changes to labeling, establishing a maximum length of treatment is the one that makes the least sense to me. To illustrate my point, mood disorders and chronic pain share certain similarities. They are both conditions where treatment is heavily influenced by the patient’s perspective over laboratory values. The patient’s quality of life is significantly affected if they are inadequately treated with medication. Despite arising from different causes, many mood disorders are also treated with the same class of drugs. Patients with mood disorders are treated as individuals, and there is no rigidly defined maximum length of therapy. Why can’t we afford the same type of patient-centered approach to those with chronic pain? Chronic pain should be handled in a customized manner, as it is with every other medical condition.
Complementary and Alternative Medicine (CAM) can often be overlooked in the treatment of chronic pain, but it is a powerful adjunct to opioid therapy. Most patients in 2007 have used CAM to help alleviate pain in the neck, back, and joint areas. However, I think it is also important to be cognizant of the patient’s needs. Recommending yoga for a patient working 50 hours a week with 3 children is not practical or helpful. It is a combination of pharmacotherapy and CAM that provides the best control for chronic pain.
While reading several stories directly from patients, I cannot help but feel a kind of sadness. Unlike many other medical conditions, chronic pain patients are often met with hostility in an effort to live with diminished pain. Opioids have powerful analgesic properties, but they are also potentially addicting and life-threatening. As health care professionals, one of the best ways to get involved is to be active educators. Having an open conversation with all patients can simultaneously help prevent tragedies and appropriately help those who need it.
As always, comments are encouraged and welcomed!