#cdc guidelines

[lifewithchronicpain]

Do pain patients on long-term opioid therapy make irrational decisions? Is their mental capacity so diminished by opioids that they shouldn’t be involved in treatment decisions with their doctors? The answer to both questions is often yes, according to a controversial new op/ed published in JAMA Internal Medicine. At issue is a recent update to the CDC’s opioid prescribing guideline, which calls for shared decision-making (SDM) when a prescriber considers tapering a patient or abruptly discontinuing their opioid treatment. The guideline was revised last year after reports of “serious harm” to patients caused by forced tapering.

“In situations where benefits and risks of continuing opioids are considered to be close, shared decision-making with patients is particularly important,” the 2022 guideline states. But that advice about consulting with patients goes too far, according to the lead author of the JAMA op/ed, Mark Sullivan, MD, a professor of psychiatry at the University of Washington and a longtime board member of Physicians for Responsible Opioid Prescribing

“The value of SDM has been recognized for many years but also has its limitations, including where patients make irrational or short-sighted decisions,” Sullivan wrote. “Long-term opioid therapy induces a state of opioid dependence that compromises patients’ decisional capacity, specifically altering their perception of the value and necessity of the therapy; and although patients with chronic pain are not usually at imminent risk of death, they often can see no possibility of a satisfying life without a significant and immediate reduction in their pain.”

Sullivan and his two co-authors, Jeffrey Linder, MD, and Jason Doctor, PhD, have long been critical of opioid prescribing practices in the U.S. In their conflict of interest statements, Sullivan and Doctor disclose that they have worked for law firms involved in opioid litigation, a lucrative sideline for several PROP members...

...“In the case of opioid prescribing, and especially opioid tapering, working to persuade the patient is almost always the best clinical strategy. But there are circumstances (opioid use disorder, diversion, serious medical risks) where tapering should occur even if the patient objects,” Sullivan wrote. Opioid diversion by patients is actually rare. The DEA estimates that less than one percent of oxycodone (0.3%) and hydrocodone (0.42%) will be used by someone they were not intended for.

As for patients on opioids behaving “irrational,” Sullivan and his co-authors cite an op/ed published 33 years ago in The New England Journal of Medicine (NEJM). But that article doesn’t even discuss opioids or tapering, it’s about whether patients and doctors should collaborate in making decisions about end-of-life medical care. It also makes an important disclaimer that “even the irrational choices of a competent patient must be respected if the patient cannot be persuaded to change them." Sullivan rejects that approach to opioid treatment...

...In a rebuttal to Sullivan’s op/ed also published in JAMA Internal Medicine, Mitchell Katz, MD, and Deborah Grady, MD, disputed the notion that a patient’s choices shouldn’t be respected. “Primary care professionals generally highly value the inclusion of the patient’s perspective in decision-making, consistent with the principles of patient autonomy and self-determination, and are loathe to go against a patient’s wishes,” they wrote. “As primary care professionals, we have found it helpful to tell patients that it is not recommended to take more than a specific threshold of opioids and that we do not want to prescribe something that is not recommended. However, that does not mean sticking to rigid cut points for dose and duration of opioid use, abandoning patients, or having them undergo too rapid a taper.”

Others questioned JAMA’s decision to publish Sullivan’s op/ed. “While I recognize the editors’ legitimate intellectual interest in providing a forum for open discussion on the opioid policy space, I question their decision to publish an editorial that represents an ongoing call for broad, ill-defined reductions in opioid prescribing,” said Chad Kollas, MD, a palliative care specialist who rejects the idea that patients shouldn’t be involved in their healthcare choices. “Errantly embracing a lower evidentiary standard for medical decision-making capacity creates an unacceptable risk for harm to patients with pain by violating their rights of medical autonomy and self-determination.” (Full article at link)

So essentially a man with a bias against opioids and who makes money litigating against uses a 33 year old op ed to assert pain patients shouldn't have a say in their medical care because we irrational. Proof of that irrationality is that if we have to deal with severe chronic pain with no relief, we may contemplate suicide. So fucking irrational, right? 🤬

This man is fucking cruel and inhumane. He works for an organization (PROP) that has had direct influence on the 2016 CDC Opioid Guidelines which lead to many pain patients committing suicide or dying from complications due to forced tapering and withdrawals. And this man has been given a platform to assert that our desire to not exist in severe daily pain is irrational. Fuck him!

[tietensgo]

There is no misinformation in the above posts.

Just saw this, wanted to respond.

In case you haven't seen it, linking my in-depth analysis of the CDC decision here for context. This analysis was written before the reblog above (this is only noted to demonstrate that contrary to the above claim, research had been amply conducted prior to posting), and I have put together a response below.

But first, some context to the timing of the reply. In all honesty I considered not replying, because I just saw this and it's been a while since the reblog was posted, but I feel that the claim of misinformation made is quite important to address, if only for casual readers who might think it's true.

So in summary, a reply:

The CDC maintains that they came to a science-based decision of how best to approach the issue of quarantine. That's not what the post challenges, though some do debate it. The point of the post is that they chose to do so in the middle of an outbreak of a novel, though less severe, version of the covid virus (omicron) just after they were notified by a corporation that said the outbreak plus restrictions on working were responsible for a reduction in available staff.

This is TRUE - that happened.

There is no misinformation there, and the point of the post is that people might want to think strongly about why that occurred. Why the CDC, despite being a public health institution, was taking into account economic data at all, let alone staffing shortages. It says WAS taking, and not APPEARED to be taking, due to a direct quote from NBC (top) and Dr. Anthony Fauci (bottom):

NBC: "Dr. Anthony Fauci, President Joe Biden's chief medical adviser, told NBC Nightly News that the new guidance takes into account both public health data and worker shortages."

Dr. Fauci: "On balance, if you look at the safety of the public and the need to not have society be disrupted, this was a good choice."

That's the CDC. No misinformation, just their words.

To your point about 5 days of quarantine and 5 days of masking (which I addressed in great detail in my linked analysis post), I summarize my view as follows, first addressing directly the assertion regarding misinformation:

"This post has done more damage in spreading the misinformation that the only requirement for covid patients is 5-day isolation". The post never said this. What was said was that the CDC shortened the number of quarantine days [from 10] to 5.

This is TRUE.

The CDC has always been in support of masking when in indoor spaces where you could be in close contact to other people while Covid is around (with some asterisks about vaccinated families at Christmas dinner), sick or not, vaccinated or not. Masking is absolutely a requirement in the updated guidelines, but the major shift in the guidance was to shorten the quarantine - that is, the difference between the guidance before and after the update was that from days 6-10, now you can work.

To be clear: the guidance was not about testing negative for Covid (that is, being Covid-free). It was about the ability to work while having Covid, using "symptom-free" as a proxy for "not infectious" (even though they are not the same). It was about the ability to work while sick.

To quote Dr. Fauci again:

"[people should]... wear a mask for the rest of the time [sic, 5 days], so you can keep people safe from getting infected from you if you still are infected (emphasis mine), but at the same time, getting you back to what might be an essential function in society."

Call me crazy but I think people should be able to stay home the entire time they are sick with anything, and Covid in particular, not just the first half.

Further, and pardon the reliance on anecdotes here, if you've ever been sick, you know that just because you're not sniffling anymore or your fever has broken doesn't mean you feel well enough to work. Nevertheless, with the CDC guidance, employers now had the means to require workers to return to in-person operation before they felt safe to do so. In addition, no negative test was required to return - you could be covid positive, symptom free, AND (by their own admission) INFECTIOUS and back to work as long as you were masked, pushing the onus for public safety onto people's good will to mask up effectively (tight mask, nose and mouth covered, etc) - in a political climate where anti-mask sentiment was not only present but high.

You only have to go through the replies and tags on this post to see that the foreseeable, obvious result of the guidance - regardless of the intent, science, or wording - is what occurred: people were forced to go back to work sick. Period.

The posts are not about hypotheticals - they are discussing LIVED experiences of that time when the CDC gave corporations - intentionally or not - the ammunition to coerce their employees at a time when we needed the government to stand firm in doing the exact opposite.

The reason we need to think about this is not because anyone is trying to sow distrust in the CDC; rather it is to hold them accountable, to give scrutiny to their actions, or, in the absence of that, inform anyone who is interested about the CDC's (in this case economic) influences (biases?) so they can make fully informed decisions for themselves.

What would've happened if society took a second to learn lessons from Covid and how many people can be taken out by illness at once? What if we tried to facilitate remote work or improve distance learning or lighten the load on emergency systems in times of need? We don't know- because we've been shown that ostensibly, corporate interests can muddy the waters of decision making and force people to operate so that we never have to find out.

THAT's what the post was about. Hope it's clearer now.

TLDR; I didn't "skim at best", and a well-cited, succinct response is not a "rage-post". In fact, I read the CDC posting in its entirety plus external analysis from Dr. Jha and others knowledgeable about the CDC's decision making process, and did a two-part analysis on what I read (which I understand, you might not have known about before you posted). There is no misinformation in the above post, and at any point, I retain my right to post about these matters and voice researched, thoughtful dissent on decisions that affect my life, angry or not.

i think its gross and bad and inexcusable that the cdc says you can end quarantine after day 5 of covid. omicron infections last 8-10 days on average. day 4-5 is the peak. it’s just fully not okay for covid-positive people to be wandering around and working and infecting others. im not blaming the people who don’t have a choice but to follow it. i don’t want you to get fired. this one is on your employers and on the cdc for giving shitty ass guidance that is not based in science but rather based on the fact that last winter’s covid wave was so severe that they were worried that if we let people quarantine until they tested negative that we wouldn’t have enough of a workforce to run society. regardless of the validity of that we are not at that point right now.

otherwise reasonable people are following this guidance and it’s really upsetting to see. people close to me have gone to coffee with their friends or voluntarily back to work while actively covid-positive because they diligently looked up the cdc guidance and that’s what it said.

im just so fucking tired.

[rikaklassen]

CW: discussion of the ongoing SARS-COV-2 coronavirus (COVID-19) pandemic

Not happy about the CDC's decision to end any and all isolation guidelines. The recommendations are anti-science and anti-worker in the interests of the capitalist class. It's appalling business owners in the US (and Canada) rather chase profits of the next quarter rather than think about the long-term consequences of a labour force that is too disabled to work.

It's mind-blowing there haven't been a clean air revolution yet. Yes, we may not be able to do much about SARS-CoV-2 being endemic and constantly mutating; but there are some things we can do like better filtration, better air circulation, ceiling UV-C light disinfections, providing free or subsidized masks and respirators, paid sick leaves and so on. The working class deserves better and safer working conditions. And they should demand those.

While I may be Canadian and our recommendations are separate from American's, my best friend works in the service industry, more specifically, bars and restaurants, and many Americans cross the border for a myriad of reasons. And she is much closer to the border than I am.

I am really trying my best to make sure my friend is safe. She already has been reinfected a few times, and each time increases the risk of long COVID (eg. chronic fatigue, brain fog), cardiovascular disorders and other adverse health effects. I try to make sure she has the equipment she needs to mitigate reinfections, the safety net to take time off from work if necessary in the event of a reinfection. For her to attend and study at polytech acquiring a specialized skill so she could find a safer workplace.

Bestie deserves the world. It saddens me entitled customers, business owners, politicians, corporations and bureaucrats see her and many others as disposable. She deserves all the opportunities. Everything. The whole bakery.

I already send all of my paycheques and deposits to bestie. Every single penny I have. I shouldn't. She never asked; and she asked me to take care of myself first. But I gave her my words, and within my social circles, saying you will do something is taken very seriously and is seen as a promise. People will actually remind if you have said something and hold you to your words, even if you did not intend to make a promise in the first place.

I do give her everything I have anyway because my anxieties go away and I get peace of mind. Otherwise I just stay up all night ruminating.

People are tired of me constantly plugging PayPal, but here is her link: paypal.me/bglamours.

You're not obligated to donate. I will send anything I earned or received from families and the government to her regardless. But I have to try everything.

[aniseandspearmint]

About covid being over: are we just meant to put our entire social lives, our entire society on pause forever? My mental health plummeted during lockdown and will take years to recover. Now that there's vaccines and crowd immunity and less deadly strains we ARE meant to learn to deal with it as a given, the way we have with many deadly diseases in the past, and move on. So for the sake of life moving on at some point it's **normal** to treat it as a cold, and I'm saying this as someone who's lost people during the pandemic too. Please do not fear monger.

No, but you SHOULD care about other people enough to still mask.

I am NOT fearmongering.

Covid is still dangerous, especially to the many MANY people who are immunocompromised and people who cannot get the vaccines (for whatever reason).

I know several people who THIS YEAR caught permanently disabling covid, despite all being fully vaccinated.

I am not saying you have to quarantine yourself anymore. That was NOT a thing I said. There is a world of difference between wishing that other people cared enough to MASK, a thing that is NOT HARD AT ALL, and demanding that people still observe full quarantine protocols.

Plugging your ears and closing your eyes and refusing to listen when people are still justifiably worried, and not listening to experts that haven't been pressured by the government to say 'COVID IS NOT A THREAT ANYMORE YAAAY!!!' just makes you a fool.

I know that's harsh, but it's the truth.

Hospitals are no longer required to report covid cases and covid deaths as such. This is a GIANT RED FLAG that people are happily ignoring so they can feel safe.

[largishcat]

new CDC guidelines say it’s totally fine to go pet that wild animal that’s acting kinda weird

[vampyroteuthid]

"centers for disease control and prevention" acting an awful lot like centers for disease circulation and perpetuation these days

[number1villainstan]

"However, both monotherapy [using only one antibiotic] and combination therapy [using multiple antibiotics] were more effective than no therapy [for anthrax infection]." YEAH NO FUCKING SHIT

[lifewithchronicpain]

Dr. Charles LeBaron is a medical epidemiologist who worked for 28 years at the Centers for Disease Control and Prevention. LeBaron was not directly involved in the development of the CDC’s 2016 opioid prescribing guideline, but knew colleagues who were and largely supported their efforts.

Then LeBaron developed crippling pain from a meningitis infection and learned firsthand how the CDC guideline was harming patients. While hospitalized, he screamed into his pillow at night because a nurse -- following the CDC’s recommendations -- gave him inadequate doses of oxycodone. The pain relief only lasted a couple of hours, and then he had to wait in misery for the next dose.

“I hadn't experienced the pain so that many patients feel, so I hadn't had the level of sensitivity to the issue that would have benefited me. It took full personal experience to straighten me out,” said LeBaron. “You'd rather be dead than in pain. In that bubble of pain, it really is life changing.

“Once you experience that, you tend to view things very differently through a very different lens. At least that was my experience. There was nothing like being in acute pain.”

LeBaron eventually recovered from the infection and no longer needed oxycodone. But his experience made him wonder if the CDC -- his longtime employer – made mistakes in developing the opioid guideline. That’s when he saw the CDC’s push to limit opioid doses was based on weak evidence and the false presumption that many patients quickly become addicted.

Most of all, he was shocked at how quickly the CDC’s guideline was adopted throughout the healthcare system. He’d never seen anything like it, in all his years at the agency.

“Most of the recommendations we come out with, that people should eat right, exercise or whatever, no one ever bothers doing. We have a tough time getting people to do things. This recommendation? They just had remarkably fast implementation,” LeBaron told PNN…

…“The problem here was not the motivation, the notion that if you can kind of reduce prescription opioids, maybe you'll reduce subsequent addiction. The problem was not looking at the thing sufficiently quantitatively and then not checking the consequences, or at least responding to the consequences when they're brought to your attention.”

People working in public health are normally careful about tracking the outcomes of their policies. But before and after the CDC guideline, the agency turned a deaf ear to a chorus of complaints that it was forcing patients on long-term opioids into rapid tapers that resulted in uncontrolled pain, withdrawal and even suicide.

Worst of all, the number of fatal opioid overdoses doubled to over 80,000 annually after the guideline’s release, an outcome that demonstrated CDC had gone after the wrong target at the wrong time and with the wrong solution.

“The typical person who's having an overdose is a 30-year-old male taking illicit medication. The most typical person who's getting chronic opioids for pain would be a 60-year-old woman with a variety of rheumatological conditions. So you're aiming at a completely off-center target,” LeBaron explained.

“Then subsequently the data started coming in that, in effect, you are worsening the situation. If you take people who really need pain control off their meds, in a sense, it normalizes illegal acquisition. (Read full article at link)

I don’t generally wish chronic pain on other people. But I tell you what, if doctors having an experience with under treated chronic pain is what it takes to give them some fucking perspective and empathy on the opioid crisis, then so be it. I hope they all do.

[sheshallfromtimetotime]

Uggghhh

[angels-heap]

Good morning to everyone except the Centers for Disease "Control and Prevention," who have officially given up on control and prevention and told us all to go fuck ourselves.

[liminalweirdo]

literally so funny walking into a government office the other day that had no less than FOUR different "wear a mask and protect your community" signs and the only people masking in that whole office were... me. and my husband.

it's like that train commercial that's like "get there faster, safer," and the whole commercial doesn't feature a single masked person? like okay. safe for ... no one, then?

finally, looking for an eye doctor still requiring masks so i MIGHT be able to get my eyes checked for the first time since before 2020 and their website is like

"To ensure the safety of you and our community, we are diligently following the guidelines from the Ministry of Health and our professional Colleges. What this looks like in detail: Masks are now optional inside our store."

It's a joke.

masking is community care.

[vergess]

Fuuuuuuuck the CDC

[venndaai]

day 6 of covid and my symptoms are almost gone but today’s the first day i actually truly feel like garbage because it’s the first day i’ve been at work 

[chussy]

mfw the only reputable sources on how long you’re contagious with covid are paywalled

[lifewithchronicpain]

I agree with this so much but I want to push back on one little thing. I really hate straw man claims that when people disagree with you it’s because they want you dead, that’s a bit much.

I don’t doubt that some of the people that enact and support these horrible policies may want people like me dead or in prison, I know that attitude exists. However, I think the majority of people who believe these laws and restrictions do so because they don’t know any better and they don’t care to know. They simply think we’ll put up with it because it’s probably not as bad as we say. It may seem pedantic, but if I think anyone who supports opioid restrictions and genuinely want me dead is not a mind I can change. I think more minds are changeable on this issue if they would just get that facts that are not available on most mainstream media.

It sucks. But I say this because as a pain patient I once told a nurse the new guidelines are going to force people in pain to illicit sources and she straight up said “I never thought of it like that.” And that to me is the biggest problem, people don’t see the reality of these policies and can lie to themselves that it’s all working and everything is fine. I believe if more people see this issue from mine and other perspectives hurt by the restrictions, many would change their minds. But since this is affecting people who are sick and in crisis, no one sees.

So we continue to suffer in silence while mainstream media continues to peddle the doctor to patient addiction myth.

It is actually way better for 100 addicts to get their fix on pain pills than a single person in pain go without. I call this the "Torture is bad" principle. You should be able to get the good stuff forever after a single doctor's visit. If you're worried about addicts fund rehab centers and needle exchanges instead of torturing people.

[shallpass13]

CDC guide to petting a feral cat:

✔️ Find feral cat

✔️ Pet feral cat

✔️ DO NOT let feral cat bite! (not again)

✔️ Wash hands

✔️ Strip clothing like contaminated gloves