Setting Arbitrary Opioid Dosage Limits

Setting Opioid Dosage Limits in Clinical Practice | Clinical Pain Advisor | November 12, 2015

It can be enlightening to read articles from a physician-oriented site, like this one from Clinical Pain Advisor, and find out what doctors are thinking about opioid pain management.

I’m saddened to see that they are advocating for same arbitrary opiod limitsthat are being pushed by PROP.

Like the media, medical professionals are parroting unproven opinions, not scientifically proven facts and, because they are medical professionals, we all tend to believe what they say… until proven otherwise.  

Patients tend to believe doctors.

It should not be the responsibility of patients to do their own research and understand the science about opioids and pain management. That is the job of medical professionals.

Medical professionals have been derelict in their duty of providing factual, scientific knowledge. Instead, they merely parrot the latest propaganda they hear from PROP, a group of virulently anti-opioid “interventional” pain specialists.

Doctors also tend to believe doctors.

And what alternatives do they propose?

  1. Risky, unproven, and highly profitable interventional surgeries and injections,
  2. virtual abstinence and a stay at an expensive “rehab facility”  (hopefully insurance-reimbursed) to recover from our supposed addiction.

The members of PROP can provide both: they own both surgical centers and “recovery” facilities. Conflict of interest?

And now, the article:

With the ever-increasing concern regarding overdose in patients prescribed opioid medication, there is a growing interest in possibly establishing clinic-determined daily dose limitations when opioid medications are prescribed.

“Growing interest” by whom? Medical professionals? Or administrators, bureaucrats, legislators, and law enforcement?

Although this safeguard alone may not prevent overdose deaths, it might provide an additional measure of safety in which higher doses of opioid medication can inadvertently lead to more unwanted opioid-induced events. 

There is only correlation between higher doses and unwanted opioid-induced events, and even the criteria upon which the study is based are being widely challenged:

Patients are informed at their initial visit that limitations have been established;

  1. no more than 90 mg/d of any morphine equivalent will be issued using immediate-release opioid medication and
  2. no more than 200 mg/d of a morphine equivalent dosagewill be prescribed per any given day using a combination of a short-acting and longer-acting opioid.

if a current dosage is no longer effective, they are informed that opioid rotations will take place vs escalations in dosages that exceed the limitations of the clinic.

Even when patients have initially presented with higher doses than those allowed in this particular clinic, after discussing the prescribing limitations of the clinic, most have agreed to opioid tapers and have been adequately treated with lower doses of opioid medication within the prescribing limitations of the clinic.

Who decides when a patient has been adequately treated for pain? Certainly not the patient!

It’s made abundantly clear that the doctor is in complete control of the patient’s pain relief and responsible for the decision about what’s adequate.

The article requests comments, but certainly not from patients in this “moderated forum”.

Have you experienced a similar occurrence with your patients? Share your  experience in the Comments section below. Mr Pacheco will be available to provide insight and feedback to your comments in this moderated forum.

4 thoughts on “Setting Arbitrary Opioid Dosage Limits

  1. Kurt W.G. Matthies

    One-size fits all medicine is bad for people, good for business.

    Many parties have an interest:

    Medical Industrial Complex – Limits risk of losses
    CDC – limits risk of loss of authority, budget
    Anti-Analgesia Cartel – increases opportunity of profits
    Malpractice attorneys – win/win situation
    Big Pharma — buy low, sell high medication (huge profit margin)
    Osteopathic/interventional medical associations – growth industry in injections, surgery
    Pain doctors – limit but don’t ban preserves income stream
    Average American – safe from the dangers of drug addiction
    American Media – another controversy to keep people tuned in.
    DEA/Police state – budget guarantees
    Politicians – Saving a nation from the ravages of drugs.

    Opioid anagesic controls – what’s not to like for so many groups.

    Except those who experience daily, unmanaged pain.


    Read Power in Numbers — people in chronic pain need to stand up and be counted. Minimizing our numbers minimizes the problem and allows them to ignore us.

    Liked by 2 people

    1. Zyp Czyk Post author

      Well, I think you’ve exposed all the “interested parties”, those who make money from our pain, and those deluded by all the propaganda being spread by the media.

      Patients with chronic pain are nowhere in the picture- we’re just the “Golden Goose” for pain management doctors.

      We are a source of endless and increasing income for pain management doctors, due to two unfortunate inevitabilities:

      1. chronic pain almost never goes away and
      2. the aging of America guarantees a constant stream of new customers.

      Liked by 1 person

  2. kimmeekmiller

    Why bother to gather a medical professional, a patient and their medical record all together in a room, when the ultimate decisions are made already? Just have the patients call once a month, deposit $240.00 in the phone for an office visit, spin a wheel that appears on their phone, their RX is automatically generated by their one and only pharmacy. Nobody has to fool with that pesky sphigmomonometer or, oh, wait, I forgot…You can’t pee in the phone!

    Never mind.

    Liked by 2 people

    1. Zyp Czyk Post author

      You’re right: they are trying to standardize treatment so they can turn doctors into generic “medical providers” that can be managed like fast food workers. They’ll all be interchangeable and eventually replaced with machines.

      Liked by 2 people


Other thoughts?

Fill in your details below or click an icon to log in: Logo

You are commenting using your account. Log Out /  Change )

Google photo

You are commenting using your Google account. Log Out /  Change )

Twitter picture

You are commenting using your Twitter account. Log Out /  Change )

Facebook photo

You are commenting using your Facebook account. Log Out /  Change )

Connecting to %s

This site uses Akismet to reduce spam. Learn how your comment data is processed.