AMA Delegates Back Physician Freedom in Opioid Prescribing – by Joyce Frieden, News Editor, MedPage Today November 13, 2018
In the fall of 2015 the anti-opioid advocacy group, PROP, prodded the CDC to formulate the notorious Opioid Prescribing Guideline using PROP’s literature as a blueprint. Already provoking a great deal of alarmed protest, the guideline was officially released in the spring of 2016.
Since then, insurers, hospitals, pharmacies, and even doctors themselves have chosen to interpret the guideline as a “rule of law”, applicable to all patients taking opioids for any reason at any time. The result has been three excruciating years of pain patient suffering and suicide as pain relief is withheld.
Only now is the AMA finally speaking out against these crude and inappropriate restrictions.
I cannot understand why the AMA stood by silently for so long as their hallowed “practice of medicine” was invaded by the ignorant and clueless: politicians, administrators, self-appointed experts, and various other anti-opioid zealots.
The CDC’s guidelines on the use of opioids for pain management are well-intentioned [?], but some insurers and pharmacists have used them to restrict providing and need to be discouraged from doing so, members of the American Medical Association (AMA) House of Delegates said Tuesday.
“This is a recognition that there are many patients we deal with daily who are outside the norms proffered by the CDC guidelines,” said Bob Wailes, MD, of Rancho Santa Fe, California, a delegate for the American Academy of Pain Medicine.
“Some acute or chronic pain patients can benefit from taking opioid pain medications at doses greater than generally recommended in the CDC Guideline, and that such care may be medically necessary and appropriate.”
“The gist of this proposal is that the CDC guidelines have gone way too far and have been used as strict legislative and pharmacy benefit limitations….
We need to recognize by policy that there are patients who fall outside the guidelines.“
And why speak up now after 3 years, as though these events had just happened recently?
For a little history from 2015:
- Opioid War Intrigue: A Crime Drama
- Secretive guidelines for opioid prescribing from CDC
- New CDC Opioid Guidelines Incite Backlash from Patient Groups)
Delegates approved a resolution that both applauded the CDC for “its efforts to prevent incidence of new cases of opioid misuse, addiction, and overdose deaths” but also urged the AMA to talk to pharmacy chains, pharmacy benefit managers, state insurance commissioners, and state medical boards and argue against putting blanket limits on the amount and dosage of opioids that physicians can prescribe.
“…against misapplication of the CDC guidelines for prescribing opioids by pharmacists, health insurers, pharmacy benefit managers, legislators, and governmental and private regulatory bodies in ways that prevent or limit patients’ medical access to opioid analgesia.”
“We’re getting feedback from physicians around the state … with physicians being punished, prescriptions not being filled, and patients left without medications.
It’s extremely harmful — these medicines do work and care [needs to be] individualized.”
Another provision from the group called for the AMA to advocate that
“no entity should use MME (morphine milligram equivalents) thresholds as anything more than guidance, and physicians should not be subject to professional discipline, loss of board certification, loss of clinical privileges, clinical prosecution, civil liability, or other penalties or practice limitations solely for prescribing opioids at a quantitative level above the MME threshold found in the CDC guideline for prescribing opioids.”
As you’d expect from such a self-serving organization, they itemize in great detail the various punishments doctors should not be subjected to. No mention is made of treating pain.
It seems that we pain patients are a mere afterthought in this fight over opioids.
Scott Pasichow, MD, of Warwick, Rhode Island, a resident delegate for the Massachusetts Medical Society who was speaking for himself, asked that the MME provision be referred to the board of trustees for further consideration. “MMEs are part of Rhode Island state law right now, so there are places where a practice like this is enacted; I would just want more information on the effects of that being positive or negative on our patients as well as us as providers, before we come to the decision that we oppose this as anything more than guidance,” he said.
This is just a bunch of mumbo-jumbo to justify inaction – a smokescreen over an absence of ethics.
This doctor seems to fear that his organization (AMA) might dare “come to the decision that we oppose this as anything more than guidance”.
But, how can it possibly be “more than guidance” when it was specifically created as a “guideline”? Still, he’s basically saying that he might *not* oppose this clear misinterpretation of the guideline as some sort of law.
And he needs “more information on the effects of that being positive or negative“, as though it were ever appropriate to set universal dose restrictions on a pain relieving medication.
How many more suicides of pain patients denied opioids does he need to decide whether “the effects of that” are “positive or negative“. I find it amazing that such an uninformed, narrow-minded, slow-witted, and indifferently cruel person is or ever was a doctor.
Arlene Seid, MD, an alternate delegate for the American Association of Public Health Physicians, who was speaking for herself, agreed with Pasichow. “I work for a regulatory agency and the issue is, sometimes guidances are used to take in drug dealers, especially those of us who do not adhere to good practice,” she said.
This is a horrifying statement coming from a doctor. She’s hinting that she supports the criminalization of prescribing over the guideline-suggested levels because it legally empowers her agency to “take in drug dealers“…
And then she goes on to imply that these “drug dealers” are “those of us who do not adhere to good practice.” I wonder who is the “us” that she’s speaking for?
This is how a doctor can become corrupted by the power and culture of a regulatory role. Dr. Seid’s focus as a doctor was (or should have been) on her patients, but now she’s out gunning for other doctors who dare break the sacrosanct legacy of the drug war.
“I ultimately would be supportive of this [provision] properly crafted, but [for now] I would be in favor of referral.”
However, the delegates ultimately voted against referral. “This is extremely timely and needs to be addressed,” Wailes said. “Please vote against referral.”
“Draft comments will be coming out in a couple of weeks and will very specifically address the misinterpretation of the CDC guidelines,” he noted. “
This is really timely because the comments from the AMA will be extremely important in weighing in [on the issue].”