Inaccurate Information Provided To Lawmakers

Damaging State Legislation Regarding Opioids: The Need To Scrutinize Sources Of Inaccurate Information Provided To Lawmakers – free full-text /PMC6857667/Nov 2019

Lawmakers are making laws on the basis of inaccurate information provided by persons without expertise in chronic pain management.

The whole country is awash in PROPaganda spread by those who do not understand, much less experience themselves, the extreme physical limitations, subsequent mood disorders, negative social impact, and unnecessary suffering caused by constant unrelieved pain.

On January 22, 2019, a Massachusetts State Representative introduced House Bill 3656, “An Act requiring practitioners to be held responsible for patient opioid addiction”.   

Section 50 of this proposed legislation reads, “A practitioner, who issues a prescription for a controlled substance placed in Schedule II, which contains an opiate, shall be liable to the patient for whom the written prescription was written, for the payment of the first 90 days of in-patient hospitalization costs if the patient becomes addicted and is subsequently hospitalized”.

This craziness only affects opioids because if it were any other medication, the true absurdity of such “laws” would be obvious.

When asked of the source of medical information on which he based his bill, the Representative mentioned the name of a nationally known addiction psychiatrist.

Unfortunately, this psychiatrist, to the best of our knowledge, had no training or clinical experience in treating chronic pain, nor has he published research on the topic area.

…going back to the early twentieth century, legislation limiting opioid prescription resulted in “an immediate switch of the moral imperative from patient to physician, and in fact a chilling effect on the provision of opioids for pain”, and that the “stigmatization and criminalization of opioids produced by regulations continues to interfere with the rational use of opioids for pain to this day”

Some pain management professionals have blamed the current suffering and potential suffering of chronic pain patients and those who prescribe opioids to them on the 2016 Centers for Disease Control and Prevention (CDC) Guideline for Prescribing Opioids for Chronic Pain. One of the most common criticisms of the Guideline pertains to its chilling effect on prescribers and appropriate use of opioid analgesia.

The CDC has recently published its “mea culpa” regarding policies and practices supposedly derived from the Guideline that have been misapplied.

See A Mea Culpa on CDC Opioid Guideline.

The authors of this recent admission claimed that CDC made an effort to educate various stakeholders regarding appropriate implementation of its Guideline.

Although they acknowledged that the document was associated with a number of unintended deleterious consequences, the authors failed to mention the potentially most damaging consequence, i.e. draconian state laws written “in the spirit” of the Guideline without adequate evidence-base

Gilson and Rich have recently noted that state laws regarding opioid prescribing, unlike federal laws, generally fail to recognize the importance of opioid analgesia to public health.

For example, the state of Rhode Island instituted a law in 2017, limiting daily prescription of opioids for acute pain to 30 milligrams morphine equivalents (MME). Besides being arbitrary and without evidence-basis, this law fails to take into account that “a regulatory approach that takes into account prescriber intent and patient-specific factors that influence prescribing is likely more effective than a strict limitation on the amount or duration of opioid prescribing”

An even more disconcerting piece of legislation signed into effect is the Arizona Opioid Epidemic Act of 2018. The lengthy document begins by stating that 75% of heroin users in treatment “started with painkillers, according to a 2014 study by the Journal of the American Medical Association”.

The JAMA study to which the authors allude was actually published in JAMA Psychiatry, not JAMA. The data were collected “from third quarter 2010 to third quarter 2013”, and included only a sample of patients admitted for substance dependence/abuse treatment during that timeframe. Consequently, the generalizability of this sample to all heroin users is questionable

Failure to recognize the dramatic change in the opioid prescribing zeitgeist between the study period and the time at which the state’s law was written essentially invalidates the claim on which it was based.

The rationale used to justify the Arizona law is rife with even more outdated and accordingly invalid data, such as its assertion that opioid prescribing rates for adolescents doubled between 1994 and 2007.

In addition to the highly inaccurate premise behind the Arizona opioid law, implementation of the premise also leaves something to be desired.

For example, the law dictates a 5-day limit on initial fills of prescription opioids in cases in which the state is the payer, even though there is no empirical evidence suggesting that this approach results in greater individual or societal safety. Regarding the law’s 90 MME prescribing limit, officials in Arizona, not surprisingly, evoked the 2016 CDC Guideline.

Perhaps the most ludicrous of the recent opioid laws is that recently enacted by the state of Nevada. According to this law, any provider who prescribes a controlled substance must, “Conduct an investigation, including, without limitation, appropriate hematological and radiological studies, to determine an evidence-based diagnosis for the cause of the pain”

As pain patients know only too well, even with a specific diagnosis for the cause of pain, like EDS or sickle cell disease, the pain component of the illness is ignored because it cannot be impartially be measured.

we cannot lose sight of the reality that much of the chronic pain that we treat is maldynic in nature, i.e. “pain that persists in the absence of ongoing tissue damage or injury” and is refractory to standard treatments

Our concern with the Nevada legislation, of course, is that patients plagued with severe, intractable maldynia should not be denied access to opioid analgesia simply because radiographs and hematological evaluations are unable to pinpoint the exact cause of their pain and suffering.

The take-away message of this editorial is that legislators cannot afford to rely on self-proclaimed experts who have backgrounds in disciplines such as addiction psychiatry with no training, clinical experience, or even research experience in pain medicine, nor can their constituent patients.

Pain education organizations and advocacy groups are willing to respond to legislators’ (as well as the media’s) inquiries for direction from experts who are bona fide key opinion leaders in pain medicine.

Laws, regulations should be determined by those with expertise in the field they are regulating.

10 thoughts on “Inaccurate Information Provided To Lawmakers

  1. Kathy C

    It is particularly frightening in the age of alternative facts. They avoid fact based medical research, history and data. They deliberately avoided patients, people who the medical industry can’t cure, or victims of the medical industry. When we look at the articles on this topic, that the mass media amplifies, most rely on faulty research. There is virtually no medical or scientific based research, on the cases of chronic pain. The public is fed a diet of advertising, and public relations releases, there is little fact based medical information on pain. The NIH and the corporate funders , are protecting the medical industry. The fund only the science that will get them the results they want or that they can monetize.

    There is massive denial and fraud in the medical, insurance and pharma industries. Fact based information is not good advertising. If the average person knew the statistics, on developing a pain disorder, or their odds of long term intractable pain after a surgery, they might opt not to do it, or avoid a marketed drug or device. The mass media did not cover the factual story about the how the FDA hid millions of reports of adverse events due to devices and pharmaceuticals. A lot of people who were victimized, by the lack of data, and facts are dead now. The only recourse for any of this is a lawsuit after the fact. People effected by this do not have the resources or the wherewithal to sue.

    There is an underverse of psychologists and psychiatrists who seeks out funding, and use misreported and distorted science, to spread industry lies and propaganda. Their only function is to protect the industry, create doubt, and get more funding. Academic institutions churn this stuff out, and have a sophisticated, public relations relationship with media outlets. The findings from these “studies” can be distorted and misrepresented, for deceptive purposes and to get attention. The media promotions help secure future funding, and attract attention. The fact based science is not sexy, it is boring,and does not support industry profits.

    A glance at the industry information sources, it telling, https://www.beckersspine.com/spine/item/46623-the-most-dangerous-trend-in-spine-surgery.html Fact based information tells us that a third of the people who undergo these surgeries, will have long term chronic pain, yet that word is almost never mentioned. The only research they did on the topic, was mostly directed at patients “motivations.” A corporation like Walmart, always focused on the bottom line, is trying to find a way to avoid millions in losses, due to their employees left crippled with pain after these surgeries. https://www.beckersspine.com/orthopedic/item/47101-walmart-pilot-program-to-identify-quality-physicians-will-include-orthopedics.html The lies and misinformation, are costing companies like Walmart a lot of money, so they are doing their own quality assessments. Even in the Data Age, the average person, has nowhere to go for fact based information. ,

    Even the Center for Medicare Services, the largest insurer in the US, does not collect this kind of data. The industries do not want accountability, so they made sure that CMS, and other organizations that are supposed to collect data and provide information for healthcare “consumers” only collect limited data. Data that could lead to scrutiny or a loss of profits is simply not collected. The regulators that were supposed to be protecting us, are firmly in the pocket of the industry. If we look at the US healthcare system in it’s entirely, it is extremely dysfunctional. The most expensive least effective healthcare system in the world. Inaccurate information is necessary to preserve profitability. There are so many lies and deceptions in healthcare, because they are profitable. The FTC and CDC no longer regulate health marketing, and most of these policies are based on pseudo science, beliefs, and deceptive marketing.

    They turned a societal pubic health issue into a marketing campaign. Marketing depends on leaving out relevant facts, playing on emotions, and amplifying the positive. All they had to do was edit out the reason these drugs were necessary in the first place. It was no accident that they conflated the people with addictions problems, and people with chronic pain. This deliberate “misunderstanding” has cost a lot of lives, but it was profitable. Demonizing sick people was the goal, to avoid scrutiny and accountability.

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    1. Zyp Czyk Post author

      Yes, it’s ridiculous to do studies on prescription drugs without ever mentioning “the reason these drugs were necessary in the first place”. Sadly, you can find the reason for almost anything that happens if you just “follow the money”. Capitalism was great, until it wasn’t: now its even eating its young by forcing them into such miserable lives that they commit suicide, purposefully or “accidentally” through addiction and overdose. Again, no one is asking why all these people became addicted, what drove them to street drug use in the first place.

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  2. Kathy C

    In my state, they rely on industry funded “research” social media promotions, old wives tales, and advertising to create their “guidelines.”

    This person is one of the “experts” on the Opiate Board, https://www.youtube.com/watch?v=b3UPhBp-UbU https://www.abqjournal.com/1045059/kinesio-offers-unm-300k-for-new-center.html They promoted this scam kinesio tape as a remedy for the opioid epidemic. there was zero evidence that it did anything to relive pain, or remediate illegal drug use, or addiction.

    Of course there is no way to determine what they are actually selling at this “Pain Clinic.” There is zero information available on outcomes, or failed back surgeries, or devices implanted in people with intractable pain. Treating all patients with intractable pain like they are craven drug addicts has not decreased the number of new illegal drug addictions in New Mexico. It probably did increase the number of surgeries, and mysteriously UNM hospital lost their accreditation for neurosurgery. https://www.dailylobo.com/article/2019/10/loss-of-unmh-neurosurgery-residency-program

    The state legislature, even though we live in backwater state, is going to give UNM researchers money to study harm reduction. https://www.dailylobo.com/article/2020/02/talks-of-legal-injectables-make-way-to-roundhouse They fail to mention that this has been successful in other countries. This makes it really clear that demonizing and shaming pain patients has not had any beneficial effect on the number of addicts or overdose deaths. New Mexico has had a problem with heroin use since the 1990’s, and their refusal to acknowledge it or understand why, created a generational problem. Instead of tackling the issue in a fact based manner, they chose to downplay it, shame people, deny limited healthcare,and generally ignore the issues.

    The marijuana industry has been key in misinforming our state legislature too. Another UNM researcher, who also does fundraising for his marijuana research, gets local media amplification. It is key in marketing whether it is marijuana or alternative medicine to always demonize the pain patients, and conflate them with street level drug addicts, it makes the product more appealing. https://news.unm.edu/news/study-finds-legal-cannabis-may-reduce-use-of-dangerous-prescription-drugs

    “Using outcome variables including baseline levels and pre- and post-enrollment monthly trends in the numbers of drug prescriptions, distinct drug classes, dates prescription drugs were filled, and prescribing providers, the researchers found that 28 cannabis program enrollees (34 percent) and one comparison group patient (2 percent) ceased the use of all scheduled prescription medications by the last six months of the observation period.”

    The findings from a select group of 28 people, were amplified to include all pain patients. what these researchers don’t tell us is that these patients would have been shamed or dissuaded when getting prescriptions, and expectation bias would have been projected on these patients. Pain patients were subject to criminalization and blame for the opioid epidemic, even though most have nothing to do with the illegal drug trade. Even filling these prescriptions would have been a difficult trial.

    No good can come from a psychological researcher teaming up with an economist. What is really frightening is the overlap between journalism and marketing, as if they are one and the same. UNM also does research for the Mind Institute, http://hscnews.unm.edu/news/mind-institute-pioneers-real-time-brain-imaging The latest thing they are peddling is hypnotherapy,
    http://hscnews.unm.edu/news/mind-magic New Mexico has some of the worst health outcomes in the developed world, limited access to healthcare, high rates of suicide, alcohol abuse, and illegal drug use. Academic institutions are forced to grovel for industry money, misreport scientific findings to attract media attention, and get NIH funding.

    Frightening indeed!

    Here is one of the research projects that got lots of media attention, due to the misogyny, and ignorance in our society. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4028658/ This is how the media misreported it and made it salacious, https://www.wishtv.com/news/national/the-curse-of-curves-study-says-curvy-women-more-prone-to-pain/
    “In men, it found those with broader shoulders could tolerate more pain.” This should be an example for how not to do science. This misogynistic, deceptively designed “study” was picked up by media outlets around the world. It is clear that there are serious issues, with misogyny in healthcare setting,and in our society, and ridiculous studies like this get more attention than facts, like the number of women who die in healthcare setting due to these pervasive beliefs.

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  3. Kathy C

    Yes ZYP, rampant unregulated capitalism is killing people, driving them to deaths of despair, and forcing them into bankruptcy to afford basic healthcare.
    I have been reading about the white collar criminals and how our regulatory apparatus no longer functions, https://www.huffpost.com/highline/article/white-collar-crime/

    These Neo liberal ideologists and libertarians have infected healthcare too, https://www.theguardian.com/technology/2020/feb/07/big-swinging-brains-fashy-trolls-clickbait-death-spiral-internet-media They are everywhere any discussion of healthcare takes place online.

    The media has silenced physicians, only the ones with something to sell or that repeat industry supported talking points are allowed in mass media.

    This kind of thing rarely makes the local news, in my community they replaced the facts with marketing and PR.
    https://khn.org/news/medicare-punishment-hac-preeminent-hospitals-penalized-for-rates-of-patients-injuries-medicare-hospital-acquired-conditions-reduction-program-aca/

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  4. Michelle S

    WE NEED A DOCUMENTARY / TV SHOW!!

    Nothing is ever going to happen to help chronic pain patients until we get media to listen to the cases of pain patients who are contemplating sucide or stories of those who commited sucide because of the uncontrolled pain.

    If what got us here was death by alot of people who should not have had those meds
    Then to get attention back on why it has a place in this world needs to be shown
    …. in statics form ! Like 70% of chronic pain patients who were force tapered can no longer work, and show the stories of people who had to give up their kids or how going from doctor to doctor and no answers
    Also educate the world on the many pain conditions that have no cure , no visible signs , no concrete blood tests or imaging to prove to the nay sayers.

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  5. Kathy C

    Tracking the outcomes is not profitable,the facts are not conducive to profitability. The for profit model, only functions because the outcomes are not tracked and facts have been replaced with marketing. Their used to be laws and regulations about advertising healthcare, or health related products, the idea was that it protected Americans from financial exploitation, and negative health outcomes.

    Open any mass media newspaper or health related website, they are all supported by advertising. Local newspapers do not discuss the shortcoming of local healthcare providers, only PR releases, mostly in the opinion section or business section.

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