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. Continue reading
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. Continue reading
Opioid Dose Tapering, Opioid Dependence, and Indications for Buprenorphine | Annals of Internal Medicine | American College of Physicians – September 2019
This article is significant only because its authors are all founding members of PROP, the group that initiated, escalated, inflamed, and essentially fabricated the whole issue with prescribed opioid medication:
- Roger Chou, MD;
- Jane Ballantyne, MD;
- Anna Lembke, MD.
I’m delighted to see even a tiny crack in the seemingly invincible force of opioid prohibition.
HHS Guide for Clinicians on the Appropriate Dosage Reduction or Discontinuation of Opioid Analgesics – Oct 2019
I’m furious that throughout this detailed 8-page document, the assumption is always that tapers must happen, one way or another. I couldn’t find a single sentence suggesting it may be best to leave patients on some dose of opioids for their pain because, for most of us, opioids are the ONLY effective means of pain control.
More judicious opioid analgesic prescribing can benefit individual patients as well as public health when opioid analgesic use is limited to situations where benefits of opioids are likely to outweigh risks.
Yet they never again mention this case of the benefit being greater than risks, even though that’s the case for so many of us. Continue reading
Opioid medication discontinuation and risk of adverse opioid-related health care events. – PubMed – J Subst Abuse Treat. 2019 Aug
Between 2012 and 2017, the United States dramatically reduced opioid prescribing rates.
While this may be appropriate given the opioid epidemic, there has been little research to guide the clinical practice of discontinuing patients from opioid medications and opioid death rates have continued to increase.
These forced tapers have been a horrible experiment on thousands of people, enacted without any knowledge of what the outcome might be. Continue reading
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.
Mortality After Discontinuation of Primary Care-Based Chronic Opioid Therapy for Pain: a Retrospective Cohort Study. – PubMed – NCBI – J Gen Intern Med. – Aug 2019
Despite known risks of using chronic opioid therapy (COT) for pain, the risks of discontinuation of COT are largely uncharacterized.
These “risks of discontinuation of COT” are not “largely uncharacterized” but rather completely unstudied.
Pain patients being tapered are being used as guinea pigs because those who are restricting opioids have no idea what the results might be. Continue reading
Pain patients left in anguish by doctors ‘terrified’ of opioid addiction, despite CDC change – Ken Alltucker and Jayne O’Donnell, USA TODAY – June 2019
I’m encouraged to see this article in such a mainstream publication where it will be seen by more than just patients and their doctors.
The Centers for Disease Control and Prevention issued guidelines in 2016 to cut back prescriptions after years of liberal opioid dispensing contributed to addiction and overdose deaths.
Those guidelines influenced more than doctors: State regulators, health insurers and even disability administrators have cited the federal guidelines to justify policies that limit pain pill prescriptions. Continue reading
Opioid Taper Is Associated with Subsequent Termination of Care: a Retrospective Cohort Study. – Pub Med – J Gen Intern Med. – Aug 2019
This study exposes the horrific aftermath of forced opioid tapers when patients are expelled from medical care because doctors have a reasonable fear of losing their livelihoods if treating pain with opioids.
Opioid tapering is increasingly utilized by providers to decrease risks of chronic opioid therapy, but it is unknown whether tapering is associated with termination of care.
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?
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