Tag Archives: ethics

A Crisis of Opioids and the Limits of Prescription Control

A Crisis of Opioids and the Limits of Prescription Control – by Stefan G. Kertesz and Adam J. Gordon – 23 July 2018

Here, again, is this seminal article by two high-profile pain/addiction doctors about the follies of current anti-opioid policies:

A rise in addiction and overdose deaths involving opioids in the United States has spurred a series of initiatives focused on reducing opioid risks, including several related to prescription of opioids in care of pain. Policy analytic scholarship provides a conceptual framework to assist in understanding this response.

Prior to 2011, a “policy monopoly” of regulators and pharmaceutical manufacturers allowed and encouraged high levels of opioid prescribing.

The authors then point out that the debate has been cornered by an “advocacy coalition” of anti-opioid fanatics.   Continue reading

Professional Pushback Against Anti-Opioid Policies

On the Importance of Using the Right Metrics for Patient Outcomes and Payment: Pain, Pain Interference, and Physical FunctionBeth D Darnall, PhD and Mark D Sullivan, MD, PhD – September 2018

I can only access the first few sentences of this article, but it is significant because its authors are two of the people who have championed the drive to reduce opioid prescriptions.

Now they are finally pushing back against the insanity of policies that have arisen in reaction to their vocal opposition to “excessive” opioid prescribing. These policies are focused only on reducing the milligrams of opioids prescribed and nothing else, resulting in mandated opioid dosage reductions in stable patients.

One of the authors, Beth Darnall, recently circulated a petition among medical professionals to reject such crude “solutions” to the “opioid crisis”. Continue reading

Patient drug use data at your fingertips

Patient drug use data at your fingertips – By Rachel Z. Arndt  | October 9, 2017

Every time Dr. Gina Huhnke writes a prescription for opioids, she first consults a number in the patient’s electronic health record.

That number, a risk score that providers can use to gauge a patient’s risk for a substance-use disorder, tells her whether she should prescribe the drug or instead have a conversation about drug addiction.

Sometimes even the patients themselves are surprised,” said Huhnke, director of medical affairs and emergency medicine at Deaconess Health System, based in Evansville, Ind.    Continue reading

Under Scrutiny, What’s a Pain Practitioner to Do?

Under Scrutiny, What’s a Pain Practitioner to Do? – By Jodi Godfrey, MS, RD – PAIN Week, Sept 2017
With presentations by Michael Barnes, JD, Kevin L. Zacharoff, MD, Stephen J. Zeigler, PhD, JD, and commentary by Forest Tennant, MD, DrPH

Opioids have been demonstrated to help manage pain when other treatments have not offered sufficient pain relief, said Michael Barnes, JD, MIEP, managing partner at DCBA Law & Policy, LLP, and a former Bush staff member.

Now, there is a need to both expose and push back against the heavy-handedness of insurers who are imposing the Centers for Disease Control and Prevention guideline for prescribing opioids for chronic pain as gospel.   Continue reading

Pain Patients Must ‘Deserve’ Treatment

Why Must Pain Patients Be Found Deserving of Treatment? – Jan 2008 – Jay M. Baruch, MD

Easing pain strikes me as an elemental human endeavor. But… doing so can be complex and nuanced in ways that much of medical treatment is not.

Inadequate pain treatment, termed oligoanalgesia, was recognized by the Joint Commission on Accreditation of Healthcare Organizations (JCAHO) in 2001 as a public health problem.

Across health care settings, pain is undertreated; the ED is no exception [2-6]. Physicians and nurses consistently underestimate the pain experienced by ED patients, which means that some leave the ED with little if any relief.  Continue reading

Renewing Medicine’s basic concepts: on ambiguity

Renewing Medicine’s basic concepts: on ambiguity | Philosophy, Ethics, and Humanities in Medicine | Full Text – April 2018

Edmund Pellegrino lamented that the cultural climate of the industrialized West had called the fundamental means and ends of medicine into question, leading him to propose a renewed reflection on medicine’s basic concepts, including health, disease, and illness.

My aim in this paper is take up Pellegrino’s call. I argue that in order to usher in this renewal, the concept of ambiguity should take on a guiding role in medical practice, both scientific and clinical.

Ambiguity = reality. Especially in humans, there are endless variations of the intricate machinery that guides our internal bodily processes, but these are obscured when studies look only at cumulative averages. (an “average” human has one breast and one testicle)   Continue reading

The Limits of Prescription Control

A Crisis of Opioids and the Limits of Prescription Control – by Stefan G. Kertesz and Adam J. Gordon – 23 July 2018

A rise in addiction and overdose deaths involving opioids in the United States has spurred a series of initiatives focused on reducing opioid risks, including several related to prescription of opioids in care of pain. Policy analytic scholarship provides a conceptual framework to assist in understanding this response.

Prior to 2011, a “policy monopoly” of regulators and pharmaceutical manufacturers allowed and encouraged high levels of opioid prescribing.

The authors then point out that the debate has been cornered by an “advocacy coalition” of anti-opioid fanatics:  Continue reading

Forcing Patients Off Opioids is Insane & Unethical

Forcing Pain Patients Off Their Meds Won’t End the Opioid Crisis – by Maia Szalavitz – Aug 2018

A relentless focus on reducing the number and dosage of opioid prescriptions is wreaking hell on people in intractable pain—while failing to treat addiction or reduce overdose deaths.

And, as a new study questions whether prescription opioid availability overall is actually declining, chronic pain patients continue to be thrown into the maw of a policy juggernaut that shows no signs of changing in response to failure.

As they say in AA, doing the same thing over and over and expecting different results is insanity, yet that’s exactly what the anti-opioid campaign is doing.  The people forcing these increasing opioid restrictions are literally insane. Continue reading

Ethics Approach to Opioid Treatment of Chronic Pain

This article is a response by Mitchell J. Cohen, MD and William C. Jangro, DO
to
A Clinical Ethics Approach to Opioid Treatment of Chronic Noncancer Pain” by Ballantyne JC, Fleisher LA –  Pain. 2010

Given the current state of knowledge regarding long-term opioid treatment, we suggest that dilemmas associated with this treatment are best approached using patient-centered clinical ethics.

We believe principle-based, deontological, and classical Hippocratic ethical approaches have less relevance in sorting out current controversies surrounding opioid treatment.

Indeed, effective medical treatment should always be “patient-centered” and not predetermined by some rules invented by politicians seeking to take advantage of this collective cultural insanity to increase their power.  Continue reading

Policy of chasing numbers did not and will not work

A Crisis of Opioids and the Limits of Prescription Control – by Stefan G. Kertesz and Adam J. Gordon – 23 July 2018

Here is just the abstract of this interesting article:

A rise in addiction and overdose deaths involving opioids in the United States has spurred a series of initiatives focused on reducing opioid risks, including several related to prescription of opioids in care of pain. Policy analytic scholarship provides a conceptual framework to assist in understanding this response.

Prior to 2011, a “policy monopoly” of regulators and pharmaceutical manufacturers allowed and encouraged high levels of opioid prescribing.

The authors then point out that the debate has been cornered by an “advocacy coalition” of anti-opioid fanatics.   Continue reading