Pain and Suicide: The Other Side of the Opioid Story | Pain Medicine | Oxford Academic – March 2014 – Lynn R. Webster, MD
Here is a very sad story about a pain patient’s suicide that will resonate with many of us. It illustrates how arbitrary opioid restrictions put doctors in an impossible situation and leave patients without hope.
A former patient whom I’ll call Jack came to me for help after three back operations. He was on disability because of his pain. I treated him for about four years, struggling all the while to get his insurance to cover his therapies. I tried to get him to see a psychologist, but his insurance would not pay for the service. He was on what most physicians today would term a high dose of opioids and other medications.
He was mostly inactive and reported little improvement in pain or function while on his medication. Continue reading
Regain your quality of life … SUE THEIR ASS! PHARMACIST STEVE – January 17, 2017 by Pharmaciststeve
I have talked to… exchanged emails with… read chronic pain pts statements that they have contacted law firms to sue some healthcare provider for cutting their opiates, discharging them for no – or trumped up – reasons.
And without exception, the law firms have replied NOT INTERESTED !!!!
The truth of the matter is that in our legal system… the “value” of the life of a handicapped/disabled, elderly, unemployable person is NEAR ZERO… because these people are considered “takers” as opposed to “makers” within our society. Continue reading
An Opioid Quality Metric Based on Dose Alone? 80 Professionals Respond to NCQA by Dr. Stefan Kertesz
Efforts to reduce prescribing while optimizing care for patients with pain, and expanding access to addiction treatment, are of cardinal importance.
How we advance these objectives depends partly on changing our shared understandings of what it means to deliver good care. It also depends on policies, resources and formal methods to assess if we are doing a good job.
Dr. Kertesz points out that all these new restrictions aren’t based on any studies at all. Nor are any studies planned to investigate the effect of these new policies. Continue reading
Docs warn that Medicare crackdown will hurt pain patients – POLITICO – By Arthur Allen – March 2017
A group of prominent pain and addiction specialists are pushing back against the federal opioid crackdown by asking CMS to withdraw a notice that would make it extremely difficult for Medicare patients to get painkiller prescriptions above a certain strength.
More than 80 physicians, including four who helped create the 2016 CDC guidelines on opioid prescribing, wrote to acting Medicare director Cynthia Tudor about the notice, which would require pharmacists to refuse prescriptions over 90 milligrams of morphine or its equivalent unless the patient first went through a complex, time-consuming review.
While the CDC guidelines caution that high doses create an overdose risk, they also state that physicians should have ultimate discretion on prescribing, and warn that it is not advisable for patients to be tapered off high doses of opioids involuntarily. Continue reading
Though not particularly long, this comment took me several days to compose and edit (and edit again). I have only one chance to influence all these various agencies trying to restrict our opioid use, so I want to make my comment compelling enough to make someone think twice.
I intend to point out various issues the reader may have overlooked, the unfairness of the restrictions, the personal harm I will suffer, and end it with a strong question or statement that might resonate with the reader.
==== COMMENT ====
I’m writing to urge you to not let the government set standard medication dosages for individual patients, which will happen if this agency adopts policies based on the scientifically flawed CDC Opioid Prescribing Guidelines. Continue reading
Little Known Committee Setting New Rules for Opioids – March 07, 2017/ Pat Anson
Like the CDC, FDA, DEA and CMS, the National Committee for Quality Assurance (NCQA) is targeting high doses of opioid pain medication, as well as patients who see multiple prescribers and use multiple pharmacies.
NCQA is a little known non-profit organization that plays a big role in determining the standard of care expected of healthcare providers. It manages accreditation programs for physicians, medical groups and health insurance plans by measuring and ranking their performance against a set of standards known as the Healthcare Effectiveness Data and Information Set (HEDIS).
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The Feds Are About to Stick It to Pain Patients in a Big Way – VICE by Maia Szalawitz
“We need to cut the supply of pain, not the supply of drugs”
Before she turned 18, Anne*, a nurse, had endured at least five major surgeries, all without the use of post-op medication stronger than ibuprofen. As a child in Birmingham, Alabama, she had been diagnosed with cerebral palsy, but eventually learned that she actually has primary generalized dystonia, a genetic disorder that causes frequent painful muscle spasms and rigidity. By 19, she says, she had tried pretty much every treatment available, including a spinal implant that made matters worse.
Then she was given a prescription opioid. Continue reading
What’s in that Opioid Plan from CMS? by @StefanKertesz 2/28/17
Several physicians have asked me to justify concerns regarding a plan announced by the Centers for Medicare and Medicaid Services (CMS), a plan that Dr. Adam Gordon and I have described as enforcing opioid prescribing recommendations laid out by the 2016 CDC Guideline for Prescribing Opioids for Chronic Pain in a non-patient-centered way.
“When four CDC Guideline experts express a degree of concern at what CMS proposes to do, it suggests that CMS is not adhering to the intent of the CDC Guideline, but violating it.”
They don’t doubt our clinical concern. However, they want details on why we think the CMS Plan will have the impact that we project it will have, given what’s in it. Continue reading
Noninvasive Treatments for Acute, Subacute, and Chronic Low Back Pain | Annals of Internal Medicine | American College of Physicians
Given that most patients with acute or subacute low back pain improve over time regardless of treatment, clinicians and patients should select nonpharmacologic treatmentwith
- superficial heat (moderate-quality evidence),
- acupuncture, or
- spinal manipulation (low-quality evidence). Continue reading
The doctor who wrote this article is bravely “speaking truth to power” by pointing out the current practice of allowing businesses with conflicting financial interests to determine patients’ medical treatment.
I have long wondered why
- insurance companies,
- government agencies,
- various legislators,
- self-proclaimed addiction “experts”, and
- corporate employees in some remote office building
are allowed to decide what my medical treatment should be.
Dr. Dorio is also questioning this practice which interduces an obvious conflict of interest in determining a patient’s treatment. Continue reading