Tag Archives: doctor-advocates

Outcomes After Opioid Tapers: Time to Start Counting

Outcomes After Opioid Dose Reductions and Stoppage: It’s Time to Start Counting – Stefan G. Kertesz, MD, MSc – Aug 2019

As clinicians reconsidered the value of a muchoversold drug class [opioids], the institutions that govern, regulate, pay, and police health care pushed for reductions. 

The unanswered question[s] would be

  • how such reductions would be carried out,
  • who might measure the outcomes, and
  • whether those outcomes included benefits, harms, or both.

And into that chasm of deliberate blindness are falling the suicides of pain patients who cannot live with their pain untreated.
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Authors of the CDC guideline protest misapplication

The authors of the CDC’s opioid guidelines say they’ve been misapplied – By ANDREW JOSEPH @DrewQJoseph and ED SILVERMAN @Pharmalot – Apr 2019

The authors of influential federal guidelines for opioid prescriptions for chronic pain said Wednesday that doctors and others in the health care system had wrongly implemented their recommendations and cut off patients who should have received pain medication.

They said some health care players had used the guidelines to justify an “inflexible application of recommended dosage and duration thresholds and policies that encourage hard limits and abrupt tapering of drug dosages,” when the guidelines did not actually endorse those policies.

The new paper comes three years [of unrelieved agony and suicides] after the Centers for Disease Control and Prevention published the prescribing guideline.   Continue reading

Preventing Opioid Abuse Ignores Patients’ Pain

Preventing Opioid Abuse Shouldn’t Mean Ignoring Patients’ Pain by Subhash Jain – Aug 2019

I’m surprised and delighted that this article was published in the respected “Harvard Business Review” so that it reaches the people making the rules from their seats in the executive suites of medical corporations.

From lawsuits by several states against the manufacturers of opioids to criminal prosecutions against pharmaceutical executives, much has been made about pain medications and their misuse. Unfortunately, if you just pay attention to these headlines, you’re likely to miss an important fact:

Pain medications are an important and medically necessary part of many patients’ treatment.

Hurrah, another doctor pushing back against the widespread policies of reducing long term opioid use to almost zero.  Continue reading

Rx Opioids: Culprits or Scapegoats?

Are Rx Opioids the Culprits or Scapegoats for Opioid Crisis? — Pain News Network – By Dr. Lynn Webster, PNN Columnist – Aug 2019

The Washington Post recently published a series of stories about the volume of opioid medication distributed over the past several years in the United States. Over 76 billion pills were distributed from 2002 through 2012.

That sounds like a huge amount, but it is difficult to know what the number means. What is clear is that the stories are meant to suggest the number of pills is excessive and responsible for the rise in opioid overdose deaths.

It sickens me to see how the media sensationalizes the huge numbers of individual pills without putting them into context.  Continue reading

Opioid Moderation

Opioid moderatism and the imperative of rapprochement in pain medicine – free full-text /PMC6388760/ – byMichael E Schatman, Alexis Vasciannie, and Ronald J Kulich –  J Pain Res. Feb 2019

A brief history of the “prescription opioid crisis”

Although many have attempted to blame this crisis on a single cause, more thoughtful analysis has yielded numerous contributors to the onset and maintenance of the abuse crisis.

health insurance carriers’ decision to discontinue coverage of interdisciplinary pain management programs left physicians without the most effective means of treating chronic pain, resulting in the consequence of turning to increased opioid prescribing.

There are many in the pain community who will not acknowledge this dubious conjecture. I don’t really believe it either but will concede the point if it allows us to initiate a dialog with the “opposition”.   Continue reading

OPIOID FACTS: Are we getting the whole picture?

OPIOID FACTS: Are we getting the whole picture? “A Physician’s Perspective” – by medium.com/@ThomasKlineMD/ Jun 2019

This is an article in quasi-interview format by Dr. Kline, who is also tracking the damage done by the “unintended consequences” of the CDC guideline with a list of SUICIDES associated with forced tapering of opiate pain treatments

Q: Is there an epidemic of opioid overdose deaths?

Not really.

The actual increase from 2014 to 2015 was in line with years past, a 0.001% increase. These are street overdose deaths in addiction communities, not in the general public. No particular year was statistically higher than another.   Continue reading

Aligning Practice and Policy with Actual CDC Guideline

National Imperative to Align Practice and Policy with the Actual CDC Opioid Guideline – by Beth Darnall, PhD – July 23, 2019

Here’s another article by Dr. Darnall arguing against the rigid anti-opioid sentiment she previously seemed to support when she claimed that much of chronic pain was due to “catastrophizing”.

This year (2019) she has completely reversed course to push back against the fallout from her previous stance. I admire her courage in so publicly attacking the anti-opioid sentiment that was encouraged by her previous stance.

Although the national focus on opioid reduction preceded the CDC guideline [2016 CDC Guideline for Prescribing Opioids for Chronic Pain], its issuance emboldened opioid reduction practices and policies in ways that its authors never intended.   Continue reading

Opioid taper as an institutional mandate

Opioid discontinuation as an institutional mandate: Questions and answers on why we wrote to the Centers for Disease Control and Prevention: Substance Abuse: Vol 40, No 1 – Stefan Kertesz, MD – May 2019

This article explains what the HP3 group wanted to accomplish with their letter “protesting” the CDC guideline. It looks like it worked!

On March 6, 2019, a self-designated committee (Health Professionals for Patients in Pain, HP3, a group that is not incorporated and accepts no contributions) sent a public letter to the Centers for Disease Control and Prevention (CDC), urging the agency to address the widespread misapplication of its 2016 guideline on prescribing opioids.

318 health care professionals and three former directors of the White House Office of National Drug Control Policy (“Drug Czars”) signed the letter, as did the parent organization for Substance Abuse, the Association for Multidisciplinary Education and Research on Substance use and Addiction.   Continue reading

A doctor crusades for caution in cutting back

Amid a reckoning on opioids, a doctor crusades for caution in cutting backBy Andrew Joseph @DrewQJoseph – May 2019

About four years ago, Dr. Stefan Kertesz started hearing that patients who had been taking opioid painkillers for years were being taken off their medications. Sometimes it was an aggressive reduction they weren’t on board with, sometimes it was all at once.

Clinicians told patients they no longer felt comfortable treating them.

Pardon me for not being terribly concerned about physicians “discomfort” in prescribing me opioids for my much greater “discomfort” (and which I don’t have a choice about) with chronic pain.  Continue reading

No Shortcuts to Safer Opioid Prescribing

No Shortcuts to Safer Opioid Prescribing – Deborah Dowell, M.D., M.P.H., Tamara Haegerich, Ph.D., and Roger Chou, M.D.

Since the Centers for Disease Control and Prevention (CDC) released its Guideline for Prescribing Opioids for Chronic Pain in 2016,1 the medical and health policy communities have largely embraced its recommendations.

Although outpatient opioid prescribing had been declining since 2012, accelerated decreases — including in high-risk prescribing — followed the guideline’s release

Indeed, guideline uptake has been rapid…

…as the survivors of loved ones who fell victim to pain induced suicides after their effective pain relievers were taken away can attest.    Continue reading