New opioids’ guidelines stifling pain management| BY PATTY MILLER | THE EDMOND SUN | Sep 21, 2018
Although no laws have been passed that negatively impact chronically ill patients in Oklahoma, guidelines are being created and treated as laws by the healthcare profession because of the doctors’ fear of running afoul of law enforcement.
“Guidelines are set by the CDC (Center for Disease Control and Prevention),” said local pain management doctor and Edmond resident, James Lynch, M.D., and if a pharmacist believes a doctor is prescribing too much medication then the pharmacist reports the doctor to the DEA (Drug Enforcement Administration).
How can a pharmacist decide how much medication is appropriate, when they do not have access to the patient’s healthcare history or diagnosis?
“Innocent doctors have been turned in in the past,” Lynch said. “What can happen is 10 officials show up at the doctor’s office, they isolate the workers, and then they question procedures being used in the office. They are looking for inconsistencies in the answers given.”
Because of the strongly enforced guidelines, Lynch said doctors are being forced to reduce the amount of pain medication that can be given to patients.
How is it possible to enforce a guideline, when it is not a law or a rule?
“Insurance companies are also forcing the doctors to limit the amount of pain medications they are able to give to their patients,” Lynch said. “They do this by only allowing a certain amount of dosage or a specific number of pills that they will pay for.”
Why are insurance companies being allowed to dictate healthcare, even the very specifics of what medications and in what quantities a patient needs?
GUIDELINES ATTACK PATIENT STABILITY
“People who have been stable on chronic pain medication for 10 years, we are now having to bring them down to below what the guidelines have stated,”
Lynch said. “I have literally hundreds of patients who were once working, living a normal life, and now many of them can barely walk or function.”
Lynch said most of them will have to go on disability because they are no longer able to hold down a job.
“It is not like I can keep them at a higher dose because insurance companies have followed these guidelines and won’t pay above the 90 mg. morphine that is mandated,” Lynch said
“Sixty mg. of Oxycodone is the maximum any patient can have each day, which is fine for most, but just too low for others,” Lynch said.
How can a medicine whose dose is based on symptom severity be limited to standard dosages?
“Sam’s, Walmart, Walgreen’s and CVS have made up their own questionnaire and guidelines to try to help this problem. Walmart and Sam’s are refusing to fill patient’s prescriptions if they are over a 50 mg. equivalent of morphine,” Lynch said
This is even worse than CVS, which will fill up to 90MME.
He added, “No matter what I decide my patient needs, it can be turned down by the insurance company and then the pharmacist.”
This means that pharmacists and insurance companies are practicing medicine without a license.
“I haven’t had a patient die of an overdose in 10 years, but I had my first patient commit suicide in February when our clinic began strongly enforcing these guidelines,” Lynch said.
“Fortunately there has been only one, but we expect more. These patients are so discouraged. The pain rents a large space in your head along with depression.”
What a sad commentary on the CDC Guideline: a pain doctor expecting more suicides due to enforcement of the guideline as a rule.
People who have not lived with debilitating pain can not realize what people living with it deal with.
This is clearly a doctor who understands the great burden of chronic pain, the consequent depression and discouragement when pain relief is withheld.
OPIOIDS BLAMED FOR DEATHS
Looking at the overall picture with deaths blamed on opioids, there are discrepancies in healthcare reporting.
Lynch said deaths from opioid-related causes have almost quadrupled in the past four years, but doctor’s care makes the difference.
“I cannot emphasize enough that these deaths are not from patients under a pain management doctor’s care,” Lynch said. “These deaths are all from Mexican heroin laced many times with Chinese fentanyl.”
So much of the statistics used by the CDC are distorted, Lynch said.
“The 90 mg. per day limit was for patients who have opioid naivety, who have never taken pain meds,” Lynch said. “The healthcare system has embraced that as the normal. A 300-pound guy with five back surgeries is clumped with the woman with chronic elbow pain.”
This is another absurdity of our healthcare “guidelines” in general: they are created for the “average patient” and then applied to any and all patients, no matter how physically different from average the individual patient is.
“One of the more important things is the DEA is decreasing the amount of pain pills being produced by the pharmaceutical companies,” Lynch said. “The DEA has placed restrictions — 25 percent in 2017 and another 20 percent in 2018. Hospitals across the country have run out on a daily basis.”
And the proper and necessary medical use of the items has no impact on opioid deaths these days.
Lynch said the reduction of prescribed pain medications is not going to reduce the deaths from Mexican heroin.
Lynch said if there is a nanogram of opioid in a body during an autopsy, the death is labeled an opioid death no matter what other drugs are found in the body.
“For people with chronic pain, who are routinely taking opioid pain meds, the death rate is 3 percent a year from all causes,” Lynch said. “This includes heart attacks, kidney failure, and etc. Since 2006 it hasn’t changed.”
It would seem as if this would cause some doubts about the narrative that pain patients with their opioid prescriptions are driving, or even related to, the opioid crisis.
BASE RULES ON REAL RESULTS
“I just returned from The National Conference on Pain Management and most of the discussion included the fact that we love to see decisions made on the actual true results. The decisions by the CDC are being made on skewed results,” Lynch said.
“We need to contact whomever we can to pressure the officials at the CDC who started these mandates, who by the way none of them were pain management doctors,” Lynch said.
“All were pain addiction doctors and all are anti-opioid use in dealing with pain. I believe there is a lot of bias in their decisions.”
TREATMENT FOR END OF LIFE NOT EXEMPT
Medications for end-of-life care for cancer patients is not exempt.
“At this time, because of the restrictions being placed on opioids being prescribed by licensed physicians, we have 25 to 75 percent of our patient’s dying in the last week’s of life in moderate or severe pain,” Lynch said.
All insurance companies are taking a great advantage of the fact that they technically no longer have to pay for pain meds above the 90 MME’s, Lynch added.
Why are they technically not forced to pay for above 90 mg?
“I am terribly sorry the DEA is losing the war with the Mexican Heroin that is extremely powerful, but good people trying to have some quality of life with chronic pain should not have to suffer,” Lynch said.
PAIN DOCTORS CAUGHT IN MIDDLE
The truth is the pill mills are less than 1/2 percent of all pain doctors, but even Donald Trump’s anti-drug task force said pain management doctors are drug dealers and will be prosecuted like a drug dealer, Lynch said.
“Yes, the death rate from Mexican heroin has quadrupled, but let me say one more time, there is no relationship between heroin users and patients who are prescribed medication for chronic pain.”