Guidelines should allow for individual decisions

National Academies outlines new guidelines for opioid prescribing – By Andrew Joseph @DrewQJoseph – Dec 2019

 A new report issued Thursday by the National Academies of Sciences, Engineering, and Medicine outlines a framework for prescribers and others to develop their own plans for acute pain, without offering any direct recommendations itself. 

Here is finally a sensible “guideline” that essentially says to ignore specific “rules” and work with individual patients to find what works best for them.

But I expect the simplistic anti-opioid rules fabricated by non-medical “experts” will continue to override any thoughtful guidance from respected scientific groups like the National Academies of Sciences, Engineering, and Medicine.

After all, what could scientists possibly know that PROPagandists don’t?  

In creating and pushing for the reckless implementation of the unscientific and “not to be taken as hard limit” CDC opioid guideline, the anti-opioid zealots have ignored medical expertise, scientific processes, and even real data about the current and evolving crisis of overdoses. 

This “guideline for guidelines” stresses that guideline writers should be aware of “broader potential implications” on pain and quality of life; this is exactly what doctors are supposed to do for us.

Sadly, the prescribing of medications tailored to individual cases is now often expressly forbidden as politicians and uninformed zealots formulate medical policy.

The report says any group drafting prescribing guidelines should consider a host of factors:

• the evidence, or lack thereof, for using opioids versus alternatives for a condition or procedure;
• the downstream effects of any prescription, such as refill requests and the possibility that some pills will go unused; and
• the broader potential implications of their plans, including pain relief and improved quality of life

It notes that the guidelines should not be seen as ironclad, and should allow for individual clinical decisions — a critical point at a time when many clinicians and others have argued that overly strict adherence to certain guidelines have harmed patients.

Without individual clinical decisions, we may as well be treated by robots or, better yet, by simple procedural algorithms designed to create “standard treatments” for all and any patients, no matter the cause of their pain or other symptoms.

The goal was to inject some consistency into a sometimes capricious approach.

Depending on

• where they live or
• which hospital they go to or
• what kind of specialist they are treated by,

patients can receive drastically different prescriptions for pain related to a condition or following a procedure.

Notice that none of those factors are related to the patients.

These days, other people from other disciplines (not pain management) are creating different sets of rules unrelated to the individual, the type of pain, and the kinds of medications that work best for them.

This is the flippant arbitrariness that is ruling our lives.

Some of the guidelines issued by states have also been difficult to interpret, Lo said, outlining the number of days an initial prescription can last without considering the specifics of a dose or a particular opioid medication.

The 15-member committee defined acute pain as sudden and lasting up to 90 days. Guidelines for acute pain are distinct from the debate about if and how to reduce opioid prescriptions5 for people with chronic pain, who may have been on the drugs for years.

Prescribing guidelines are meant to strike a balance so that doctors can properly treat their patients’ pain while reducing the chance that people take overly strong doses for too long

Note that they are completely unconcerned that a patient may be prescribed insufficient medication. This highlights the completely unbalanced policy being forced on both doctors and patients.

Author: Andrew Joseph