Politicians Cannot Stop Punishing Pain Patients

Politicians Cannot Stop Punishing Patients for the Unintended Consequences of Drug Prohibition | Cato @ Liberty – Feb 28, 2018 – By Jeffrey A. Singer

This article is an uncanny expression of exactly what I think – and feel, starting with the very first sentence:

It seems no amount of evidence can make political leaders disabuse themselves of the misguided notion that the nation’s opioid overdose crisis is caused by doctors getting patients hooked on prescription opioids.

A group of eight senators unveiled the CARA(Comprehensive Addiction and Recovery Act) 2.0 Act on February 27, targeting the opioid crisis. It would impose a 3-day limit on all opioid prescribing for patients in acute and outpatient postoperative pain.

But the movement to restrict prescriptions is not evidence-based, as prominent experts have pointed out.  

The politicians base their proposal on the 2016 opioid guidelines put out by the Centers for Disease Control and Prevention.

The guidelines pointed out that the above recommendations were based on “Type 4” evidence:

  • “Type 4 evidence indicates that one has very little confidence in the effect estimate, and
  • the true effect is likely to be substantially different from the estimate of the effect.”

In other words, this kind of evidence is insufficient for individual healthcare decisions, let alone to the basis for rigid laws applied to all healthcare in the whole country.

It further described Type 4 evidence as being based upon

  • “clinical experience and observations,
  • observational studies with important limitations, or
  • randomized clinical trials with several major limitations.”

In their introductory comments, the guidelines stated:

Clinical decision making should be based on a relationship between the clinician and patient, and an understanding of the patient’s clinical situation, functioning, and life context.

The recommendations in the guideline are voluntary, rather than prescriptive standards.

Clinicians should consider the circumstances and unique needs of each patient when providing care.

This is the part that legislators miss entirely. They want black and white simple answers (perhaps because that’s all they can understand).

When health care providers read and interpret these guidelines, they understand them to be informational, nonbinding, and inconclusive.

But that’s not how politicians “do science.”

Nowadays, that’s no longer how researchers do science either:

It doesn’t seem to matter that studies have shown the addiction potential of opioids prescribed for acute pain to be extremely low, including a January 2018 study published in BMJ of more than 568,000 postoperative patients receiving opioids between 2008 and 2016 who were found to have a “misuse” rate (using all “misuse” diagnostic codes) of 0.6%.

It doesn’t matter that Cochrane systematic studies in 2010 and 2012 demonstrated a roughly 1% addiction rate in chronic non-cancer pain patients.

There has been a 41% drop in high-dose opioid prescriptions since 2010, yet overdose rates continue a steady climb, with more than 60% due to heroin and fentanyl.

In fact, the CDC notes

  • the fentanyl overdose rate has been increasing at a clip of 88% per year since 2013;
  • the heroin overdose rate has gone up 33% per from 2010–2014, and 19% per year since 2014.
  • Meanwhile the prescription overdose rate has been increasing at a stable rate of 3% per year since 2009.

All the evidence points to the overdose crisis being primarily the result of nonmedical users accessing drugs in the black market.

New York City recently reported that

  • 75% of the overdoses in 2016 were due to heroin and fentanyl, and
  • 97% of overdoses involved multiple drugs
  • 46% of the time it involved cocaine.

This is not an opioid crisis—it’s a fentanyl and heroin crisis. And the deaths are due to drug prohibition: the result of nonmedical users accessing drugs in a black market.

If CARA 2.0 passes as written, look for more patients to suffer in agony.

As a surgeon who prescribes postoperative opioids to my patients for pain control, I will no longer be able to individualize my prescriptions to my patients.

This will probably mean I will have to see many of my patients for their postoperative visit 3 days after surgery, rather than the 10–14 days that is usually the case, so that I can prescribe a refill of their pain prescription. And because I am being surveilled by my state’s Prescription Drug Monitoring Program, the pressure will be on me to limit those refills.

Meanwhile, not one intravenous heroin user will be moved to pull the needle out of their arm as a result of this policy.

The damage and death resulting from drug abuse will continue unabated as long as drug prohibition continues unabated.

Meanwhile, policymakers should drop their focus on doctors treating patients in pain and place their efforts squarely on reducing harm.

Medication-assisted treatment, syringe services programs, and naloxone distribution are good places to start. The current restrictive approach will only further drive up the death rate.

Author: Jeffrey A. Singer is a general surgeon in private practice in metropolitan Phoenix, AZ. He is principal and founder of Valley Surgical Clinics, Ltd., the largest and oldest group private surgical practice in Arizona. He was integrally involved in the creation and passage of the Arizona Health Care Freedom Act, and serves as treasurer of the US Health Freedom Coalition, which promotes state constitutional protections of freedom of choice in health care decisions.

Original article: Politicians Cannot Stop Punishing Patients for the Unintended Consequences of Drug Prohibition

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4 thoughts on “Politicians Cannot Stop Punishing Pain Patients

  1. scott m

    Maybe if doctors had balls, they would step up, UNITE and be the arrogant God like people theyve always been. Those were always the best doctors. The ones that k we more then anybody else about the human body and mind. THEY have all become sheep. FOLLOWING INSTEAD OF INNOVATING. THEY ALL KNOW OPIOIDS WORK FOR PAIN AND WORK WELL. THEY NOW LIVE IN FEAR AND BEACUSE OF TJAT FEAR PEOPLE WILL DIE. THEY CAN NOT BE RESPONSIBLE FOR DRUG ADDICTS. NO MORE THEN THAY CANT BE RESPONSIBLE IF A PERSON DECLINES A LIFE SAVING SURGERY. THATS WHAT IS NOW HAPPENING. PEOPLE ARE AVOIDING ALL SURGERIES BECAUSE OF THE AFTERMATH OF PAIN THEY WILL HAVE. THOSE ALREADY IN CHRONIC PAIN ARE IN NO WAY OPEN TO THIER ADVICE ANYMORE. IF TJEY ARE WILLING TO DROP A PATIENT BECAUSE THIER IN PAIN AND NEED OPIOUDS THAT PATIENT WOULD NEVER ALLOW A HIP, KNEE BACK OR HEART SURGERY. THEY KNOW SEVERE PAIN ON A DAILY BASIS AND IF THEY MUST BE IN EVEN.MORE PAIN THEN DEATH IS THE BETTER OUT COME IN TJE PATIENTS EYES.

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    1. Kathy C

      Doctors that work for the huge Healthcare Companies are not allowed to speak up, they have signed Gag Orders. The only Physicians that get published by mass media are the ones who have the most aggressive anti opiate comments. Physicians that are making money pushing the anti opiate agenda, using the fear to market their alternatives. Some of them peddle their books, denouncing opiates while peddling dangerous, expensive and ineffective treatments. Industry funded Foundations, support the academic research that either casts doubt on scientific facts or helps the market their alternatives. Physician attend conferences where they are “Educated” by slick manipulative Insurance Industry insiders about “Liability” and learn nonsense talking points. A lot of Physicians are leaving the business, they no longer have any control over their practices. Event he time allotted per patient is controlled by industry bean counters. Physicians are committing suicide too.

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  2. Kathy C

    The Politicians are using the “Alternative Facts.” The mass media has been running terrifying stories, deceptive research and advertising. Advertorials about cures, treatments and alternatives, mislead our science ignorant politicians and the general public about the effectiveness of treatments for pain. There are even comedians that make fun of people with back pain, they are scammers, and a target for ridicule according to Denis Miller.

    Our Federal Agencies that used to be trusted are now researching pseudo science and publishing dubious Industry funded Science. That article about Opiates being no better than NSADS, that ran in local papers across the country was carefully placed to mislead the general public and misinform Policy Makers. It was no accident that our President called for executing drug dealers at the same time that article ran.

    It was no accident that they conflated people with pain with drug addicts, they had to dehumanize sick people in order to deny basic care. At the same time they had to derail any kind of basic human empathy, by re framing the topic. Here is the NIH Magazine from 2011,
    https://medlineplus.gov/magazine/issues/spring11/toc.html The mostly evidence based information as been replaced by the current misinformation campaign.

    Data from Facebook, and other Social Media allowed them to tailor their message. The data they collected for marketing was weaponized and used to peddle alternative remedies, along with hate. The numbers and the cost of pain in our country made it a target for Industry groups, so they changed the narrative. They re framed the topic so that they could go after pain patients and deny the real problems behind the “Opiate Epidemic.”

    Journalists across the country run articles about “addicted babies,” drug crimes, and misleading articles on opiates. Some of these “Journalists attend conferences paid for by PhRMA, and other Industry groups. They spend millions to influence public opinion and ensure the profitability of the industry they represent. We are seeing a divergence from facts, and science to propaganda and marketing.

    When Machines Learn by Experimenting on Us
    https://www.propublica.org/article/breaking-the-black-box-when-machines-learn-by-experimenting-on-us

    Conflicts of interest in health care journalism. Who’s watching the watchdogs? We are. Part 1 of 3
    https://www.healthnewsreview.org/2017/06/conflicts-of-interest-in-health-care-journalism-1-of-3/

    The association between exaggeration in health related science news and academic press releases: retrospective observational study
    http://www.bmj.com/content/349/bmj.g7015

    Why reporting on health and science is a good way to lose friends and alienate people
    https://www.vox.com/2016/2/23/11098968/health-journalism-ethics

    Thanks Zyp for keeping us informed.

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