“Do No Harm” Means Providing Proper Pain Treatment

“First Do No Harm” Means Providing Proper Pain Treatment – By Lynn Webster, M.D – July 2020

Many physicians say their ethical duty is to “First, do no harm.” This principle is often mentioned in the context of prescribing opioids.

Some people believe that prescribing opioids to treat people in pain violates the Hippocratic Oath, because, they say, a doctor’s first obligation is not to do anything that could make things worse for a patient.

However, that is a flawed oversimplification of the “First, do no harm” directive.   

Pain Patients Angry and Fearful about Govt. Interference

Charges against pain doctor reveal undercurrent of anger, angst among patients at federal government – cleveland.com – By John Caniglia, The Plain Dealer – Jul 2020

For more than 25 years, patients suffering in pain sought out Dr. William Bauer. They had crippling injuries from car crashes and work accidents, chronic headaches and debilitating spine issues. At 83, Bauer had a practice in Sandusky that cared for many of the same patients for 10 to 20 years.

Federal prosecutors have accused the neurologist of illegally prescribing thousands of opioid pills between 2015 and 2018. 

But realistically, “prescribing thousands of opioid pills” for pain patients is medically appropriate. These drug-warriors should do the math before they toss around meaningless phrases like this just to create drama.

AMA urges CDC to revise opioid prescribing guideline

AMA urges CDC to revise opioid prescribing guideline | American Medical Association – Jun 18, 2020

Finally! I’m still outraged that the AMA stood by silently for 5 long years as more and more pain patients were deprived of legitimate medical opioid treatment.

They remained silent as law enforcement second-guessed doctors’ decisions and essentially dictated our treatment. I didn’t hear a peep of protest when appropriate medical care was decided by the DEA and enforced by SWAT teams.

So pardon me if I’m not giving the AMA adulation or kudos or praise for doing what they should have done 5 years ago. Their inaction led directly to the suicides of so many pain patients who were deprived of pain relief on the basis of these appallingly arbitrary and misapplied CDC guidelines. 

Doctor Fights State Over Opioid Tapering Ethics

Doctor Declines State’s Offer In Battle Over Opioid Tapering Ethics – Redheaded Blackbelt

Here’s another courageous doctor fighting back for us, staring down the medical board, refusing to taper her patients faster than medically appropriate, no matter what the medical board or the DEA says.

In an update with Humboldt Last Week, Arcata doctor Connie Basch said she’s declined an offer from the Medical Board of California to receive probation in exchange for an admittance of guilt in her case involving the overprescription of opioids.

The complaint against Basch surrounds what she would call five “legacy” patients that came to her several years ago on high doses of opioids and anti-anxiety meds.  

Pain Specialists Denounce CDC Opioid Guidelines

Pain Specialists Pile on CDC Opioid Guidelines | MedPage Today – by Elizabeth Hlavinka, Staff Writer – Sept 2019

It’s infuriating that three solid years of professional medical criticism, even from some of the people involved in the original writing, hasn’t resulted in the withdrawal or “rewriting” of the CDC guideline.

In the 3 years since the guidelines were published, at least 33 states have enacted legislation that limits opioid prescribing, and although half of these states specify that the new limits are intended for patients with acute pain, many physicians have stopped prescribing opioids to chronic pain patients as well, according to Gary Jay, MD, of the University of North Carolina in Chapel Hill.

In April, the authors of the guidelines stated that the recommendations were not intended to force hard limits of opioid doses, abruptly taper or stop opioid use, or be applied to patients outside the guidelines’ scope, such as patients undergoing active cancer treatment or, in some cases, patients with chronic pain.  

Managing pain in the era of the opioid crisis

How do we manage pain in the era of the opioid crisis? – Rita Agarwal, MD | Meds | October 2, 2019

Here’s an example of another doctor who understands that the so-called “opioid overdose crisis” has nothing to do with prescription opioids or pain patients.

“6 in 10 Kids Got Opioids After Tonsil Surgery, Study Says.”
So screams the headline from The Daily Beast.

“In the midst of the opioid crisis, doctors sent many kids home with oxycodone and hydrocodone,” it goes on to say. Another example of scaremongering and sensational headlines, or is this something we should still be concerned about?  

Stanford Doc Says Opioids Necessary Sometimes

Here’s a very supportive Twitter posting from the leader of Stanford’s Pain Management efforts: Sean Mackey, MD, PhD.   (@DrSeanMackey) on Oct 22, 2019

This is a breath of fresh air! Coming from an influential leader in the pain management field at a high-status University, I have hope that it will get through to some of our tormentors.

1) I’d like to share this brief story about a patient who’s currently taking opioids.

2) We’ve been treating a patient at Stanford who has a lower extremity injury. He came to us on high-doses of opioids through fentanyl patches.  

His primary care doctor wanted him weaned off. He has tried every treatment imaginable.

And why did his primary doctor want him weaned off? The rest of this little story shows that there were no medical reasons to take the patient off opioids. 

Market barriers to appropriate pain management

AMA: Get rid of market barriers to appropriate pain management – by Andis Robeznieks – Senior News Writer – American Medical Association

This article makes a critical point and describes what should be the goal when treating pain: “appropriate analgesic prescribing and pain management.”  

Ending the nation’s opioid epidemic requires eliminating obstacles to treatment and appropriate analgesic prescribing and pain management.

New policies adopted at the 2019 AMA Annual Meeting took aim at barriers established by health plans and other players in the medical system. 

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.

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.