Doctors are cutting opioids, even if it harms patients

Doctors are cutting opioids, even if it harms patients By Felice J. Freyer, Boston Globe – January 3rd, 2017

I’m finding more and more articles pointing out the absurdity of restricting opioid prescriptions to prevent heroin/fentanyl overdoses. I see stories about how pain patients are being abused to prevent other people from overdosing on illicit fentanyl and heroin.

I find the increasing numbers of such stories in mainstream media to be very encouraging.

More than half of doctors across America are curtailing opioid prescriptions, and nearly 1 in 10 have stopped prescribing the drugs, according to a new nationwide online survey.

But even as physicians retreat from opioids, some seem to have misgivings: More than one-third of the respondents said the reduction in prescribing has hurt patients with chronic pain.  

I really wonder how the other two-thirds who believe it has not hurt patients with chronic pain. I would like to know how they justify this belief.

Those responding to the survey gave two main reasons for cutting back:

• the risks and hassles involved in prescribing opioids, and
• a better understanding of the drugs’ hazards.

If they got their  “better understanding” of the drugs from the CDC, they have been taught lies. It is becoming more and more widely known that the CDC committed fraud when it published the opioid guidelines.

See CDC Scientists Expose Agency Corruption

The results also suggest a substantial minority of physicians may believe the pendulum has swung too far, depriving pain patients of needed relief.

As policy makers sought to tackle the abuse problem, “the physicians were an easy group to target,” said Dr. Joseph Audette, chief of pain management at Atrius Health, a large Massachusetts medical group.

But the regulations won’t solve the addiction problem, he said. Instead, they make doctors reluctant to prescribe opioids.

“A lot of primary care doctors feel like they can’t comply. They’re overwhelmed,” Audette said.

Just over half of all respondents had cut back on opioid prescribing within the past two years or so, while more than two-thirds of family medicine and internal medicine doctors had done so.

The percentage who believed patients had been hurt by reductions in prescribing differed little among specialties:

• 36 percent of all specialties,
• 38 percent of family doctors, and
• 34 percent of internists.

Cindy Steinberg, a national advocate for pain patients, speculates that doctors probably don’t follow up after referring patients to other care, and may not know that many can’t afford it.

Dr. Stefan G. Kertesz, a professor at the University of Alabama Birmingham School of Medicine, has witnessed the downside of that trend: chronic pain patients who have essentially been abandoned by their doctors in the stampede away from opioids.

Kertesz recently published an article in the journal Substance Abuse showing that physician prescribing no longer plays a major role in sustaining the opioid epidemic, which is now driven by heroin and illicit fentanyl.

See The Changing Opioid Epidemic: Not from Rx

“But public discourse has been contaminated by aggressive and inflammatory language that frightens doctors,” he said in an interview.

The decline in opioid prescribing is steady and nationwide, according to data from athenahealth, a Watertown company that provides electronic medical records.

But despite low prescribing rates in Massachusetts, the state has one of the highest rates of overdose deaths. Those deaths continue to increase — the vast majority resulting from illicit drugs.

Dr. Stephen A. Martin, a family physician in Barre and University of Massachusetts Medical School professor publicly calling for a recalibration of attitudes toward the drugs.

most specialists agree that past prescribing practices were too lax. But opioids work for some patients who can safely take a steady dose, and rely on the drugs for daily functioning.

She implores doctors who curtail opioids to “partner with your patients and stay with them to help find other options.” “It’s frightening,” Steinberg said, “to be living in that kind of pain and not have help.”