Tag Archives: policy

Clinical Challenge: Opioid Tapering

Clinical Challenge: Opioid Tapering | MedPage Todayby Judy George, Senior Staff Writer, MedPage Today March 1, 2020

Too much focus on the pill and not enough on the whole person: that’s a key piece missing in the movement to reduce opioids among chronic pain patients, said Beth Darnall, PhD, of Stanford University in Palo Alto, California.

Some agencies and companies used the 2016 guideline to push hard dose limits and abrupt tapering, which the CDC later said was inconsistent with its recommendations

I notice that this hasn’t changed any of the “wrong” laws, which may be enforced long after the truth is known.   Continue reading

Pain Needs Patient-Centered and Individualized Care

The HHS Pain Management Best Practice Inter-Agency Task Force Report Calls for Patient-Centered and Individualized Care – Jianguo Cheng, MD, PhD, FIPP, Molly Rutherford, MD, MPH, FASAM, Vanila M Singh, MD, MACM – January 2020

At least these folks see the reality: for pain, both acute and chronic, standard treatment with standard doses of standard medications is simply not medically appropriate. Pain treatment is not suitable for standardization.

Some healthcare services must be personalized to be effective, even when they become much more complicated and difficult (meaning, expensive).

The same people insisting on standard dose limits for opioids wouldn’t think of suggesting standard dose limits for blood thinners or insulin or cancer treatments.

The Pain Management Best Practices Inter-Agency Task Force (Task Force) was convened by the US Department of Health and Human Services (HHS), in conjunction with the Department of Defense, the Department of Veterans Affairs, and the Office of National Drug Control Policy. Continue reading

Addicts and Pain Patients are NOT the Same

Defining Addicts and Pain Patients as One and the Same, A Moral and Ethical Failure in Policy • CERGMBy R Carter – Mar 2019

Morals and ethics are often used interchangeably, but there are small differences.

  • Ethics refers to rules provided by an external source, e.g., codes of conduct in workplaces or principles in religions.
  • Morals refer to an individual’s own principles regarding right and wrong

There are two great arbitrators of morality devised by mankind, the State and Religion. Each has a power they use to enforce ethical standards.    Continue reading

FDA’s 2019 policy and regulatory agenda

Statement from FDA Commissioner Scott Gottlieb, M.D. on the agency’s 2019 policy and regulatory agenda for continued action to forcefully address the tragic epidemic of opioid abuse – from FDA.gov – Feb 2019

I believe this is Mr. Gottlieb’s goodbye to go along with his resignation.

The opioid crisis is one of the largest and most complex public health tragedies that our nation has ever faced. It remains the biggest public health crisis facing the FDA.

The toll of addiction, in lost lives and broken families, touches every community in America. Sadly, the scope of the epidemic reflects many past mistakes and many parties who missed opportunities to stem the crisis, including the FDA.

I’m surprised that he admits right off the bat that this crisis could have been mitigated if they had acted sooner, though not in the manner he imagines. 
Continue reading

Evidence? We don’t need no stinkin’ evidence.

The Opioid Crisis Requires Evidence-Based Solutions, Part I: How the President’s Commission on Combating Drug Addiction Misinterpreted Scientific Studies | Bill of Health | law.harvard.eduBy Mason Marks – Dec 2017

Despite the Opioid Commission’s justifiable recommendations, it drew many conclusions that lack empirical support or are contradicted by scientific evidence.

the Opioid Commission was convinced that pain-related questions are driving inappropriate prescriptions.

PROP has really outsmarted all of us patients and doctors who rely on opioids to ease pain. Early on, they framed the discussion as a simplistic opioid addiction issue and ever since, we’ve been stuck trying to defend ourselves against this ignorant tide of drug-war-based policies.  Continue reading

HHS Guidance for Dosage Reduction

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

Health Officials Urge Caution in Reducing Opioids

Health Officials Urge Caution in Reducing Opioids for Pain Patients – The New York TimesBy Abby Goodnough – Oct 2019

In a newly published guide, federal health officials say doctors “should never abandon” pain patients and warn of acute withdrawal and other risks.

The Trump administration on Thursday instructed doctors to use more caution when taking chronic pain patients off opioid medications, a response to reports that many have been cutting off prescriptions too quickly, in some cases even dismissing patients from their practice.

Question: Why did we have to wait 3 1/2 years for this?
Answer: because no one wanted to know the results.  Continue reading

Misconceptions About Opioid Use Disorders

Prevalent Misconceptions About Opioid Use Disorders in the United States Produce Failed Policy and Public Health Responses | Clinical Infectious Diseases | Oxford AcademicAugust 2019 – free full-text

The current opioid crisis in the United States has emerged from higher demand for and prescribing of opioids as chronic pain medication, leading to massive diversion into illicit markets.

This massive diversion is how so many millions of pills ended up on the streets, not from individuals stealing a handful of pills from grandma’s medicine cabinet.

This is an aspect of the “opioid crisis” that seems deliberately ignored. I suspect it’s because supposedly “legitimate” opioid dealers have been able to deflect investigations of their opioid supply chain dealings by pointing to the drama of “innocent kids” overdosing on prescription opioids (not prescribed to them).  Continue reading

No evidence Rx opioids caused “Opioid Crisis”

The Link Between Misconceptions About Opioid Use Disorders and Current Policies – Clinical Pain Advisor – Aug 2019

Though the subject here is opioid addiction, I’m amazed and delighted to find this publication for medical professionals repudiating the assumed link between opioid prescribing and addiction.

The current opioid crisis is the third one observed in the United States. This latest trend is, however, the result of unusual factors and has had some unique effects.

Knee-jerk reactions to restrictions on opioid prescriptions have resulted in an increase in the narco-trafficking of heroin and fentanyl, and as the consumption of opioids shifted from oral intake to injections, hepatitis B and C and HIV infections have increased.   Continue reading

Patient safety is sacrificed for greater access

Scope of practice expansion: Patient safety is sacrificed for greater accessSuzanne M. Everhart, DO | POLICY | Jul 24, 2019

The job of a physician is to provide the highest quality care to patients, while fostering a relationship based on trust.

There are serious consequences for the health of our patients if that standard is eroded and compromised by well-intentioned, but misguided, interest groups and politicians.

“Misguided” is a nice word for “wrong”  and I have my doubts about anything being “sell-intentioned” when it comes from interest groups and politicians”.  Continue reading