Cassidy seeks guidance from DEA on responsible use of opioids for chronic pain

As federal lawmakers debate policies to quash the nation’s ongoing opioid crisis, U.S. Sen. Bill Cassidy (R-LA) urged the U.S. Drug Enforcement Administration (DEA) to ensure pain-management medication remains available to patients with chronic pain.

“I am concerned about the unintended consequences of clinically appropriate patients no longer receiving or having access to the appropriate treatment due to ongoing misunderstandings between the physician and regulatory agencies such as the DEA,” Sen. Cassidy wrote in an Aug. 28 letter sent to Uttam Dhillon, the DEA’s acting administrator.

Sen. Cassidy, a registered medical doctor, wrote that the Centers for Disease Control and Prevention (CDC) on April 24 emphasized in a commentary published in the New England Journal of Medicine that the 2016 Guidelines for Prescribing Opioids for Chronic Pain “have been misinterpreted or misapplied, presenting a challenge to patients with chronic pain and those who treat them.”

“There are anecdotes of patients on stable doses of opioids for years, being cut off from prescriptions (forced tapered or abandoned) due to physician misinterpretation of the CDC guidelines,” the senator wrote. “Unfortunately, these reports share that some of these patients have thereby turned to illegal opioids.”

Sen. Cassidy added that on May 9, the U.S. Department of Health and Human Services (HHS), in cooperation with several other federal agencies, released its Comprehensive Addiction and Recovery Act of 2016 legislated final report, entitled Pain Management Best Practices Inter-Agency Task Force Report: Updates, Gaps, Inconsistencies, and Recommendations.

The report emphasizes a key distinction between patients: those with chronic pain, on stable doses of opioids, in which the dose does not escalate while the patient remains under a physician’s care, and those with opioid use disorder who exhibit drug-seeking behavior, including “escalating doses, doctor shopping, purchasing illegal drugs, and resorting to criminal activity to support their lifestyle,” the senator wrote.

Sen. Cassidy requested that Dhillon answer several questions, including what instructions the DEA gives to pharmacists and physicians as they treat chronic pain patients, and if the instructions differentiate between the two types of patients, for example.

“Empowering the registrant community with instruction in best practices will serve those in need of medication who are combating pain in the acute and chronic period,” he wrote.