Tag Archives: prescription

HHS Guide for Clinicians on Opioid Dosage Reduction

HHS Guide for Clinicians on the Appropriate Dosage Reduction or Discontinuation of Long-Term Opioid Analgesics.pdfSeptember 2019

This is the federal document mentioned in the previous post.

This HHS Guide for Clinicians on the Appropriate Dosage Reduction or Discontinuation of Long-T erm Opioid Analgesics provides advice to clinicians who are contemplating or initiating a reduction in opioid dosage or discontinuation of long-term opioid therapy for chronic pain.

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.

This guide reiterates that benefit/risk calculation over and over as though it’s a special procedure for opioids when it’s what doctors have always been doing.  Continue reading

Contribution of Rx Versus Illicit Opioids to Overdoses

The Contribution of Prescribed and Illicit Opioids to Fatal Overdoses in Massachusetts, 2013-2015 – Oct 2019

Massachusetts is only an example of what we’d find in other states if they were more concerned with finding out what’s killing people who overdose. Instead, it’s often not tested adequately to find the real culprit because it’s already assumed that any sign of any opioid makes it a “prescription opioid overdose” to be added to those inflated numbers.

Objectives:
Opioid-related overdoses are commonly attributed to prescription opioids.

Whether true or not, our “public service” coroners just follow the path of least resistance and fall into the false confidence of their predetermined ideas.  Continue reading

People Without Pain Should Not Make Opioid Policies

People Who Have Never Experienced Back Pain Have No Business Making Opioid Policy – April 3, 2018 – By MICHAEL F. CANNON

I completely agree: pain is being ignored, even though opioids are THE medication for pain.

Economist Steven Horwitz writes in USA Today about President Trump’s proposal to reduce legal opioid prescriptions by one third.

This frightens me because it could lead to more shortages, not only for chronic pain patients, but hospitalized patients or those undergoing surgeries. Imagine being short of opioids when someone has third-degree burns over 80% of their body!

Such a drastic reduction would inevitably harm people like Horwitz, who relates his experience with excruciating back pain and how opioids were essential to relieving his agony and helping his body heal:   Continue reading

European position paper on appropriate opioid use

European Pain Federation position paper on appropriate opioid use in chronic pain management – O’Brien – 2017 – European Journal of Pain – Wiley Online Library

From Europe, where there is no “opioid crisis”, this is what a reasonable opioid policy looks like when it is not driven by anti-opioid hysteria:

Poorly controlled pain is a global public health issue.

Not in the U.S.A. – here pain is regarded as a nuisance symptom, to be sidelined and treated as a mental health issue more than a physical problem. (see “catastrophizing“) Continue reading

Cautious but Compassionate Approach to Opioids

This is a wonderful article and a pleasure to read. The author, Carlyn Zwarenstein, puts into words what it’s like to live with chronic pain and how opioids allow her to have a life that ankylosing spondylitis would steal from her.

I’ve only skimmed some excerpts from what is a thorough and clear-headed article:

Let’s Have a Cautious but Compassionate Approach to Opioid Prescribing A patient’s perspective on living with chronic pain in the midst of an opioids crisis – 4/4/18 – by Carlyn Zwarenstein   Continue reading

Opioid Refugees: Fentanyl crisis is leaving patients in pain

Opioid refugees: How the fentanyl crisis led to a backlash against doctors that’s leaving people in pain | Georgia Straight Vancouver’s News & Entertainment Weekly – by Travis Lupick on March 17th, 2018

David Reid’s body has taken a few blows over its 68 years. In 1992, he was in a bad car accident that left him with a severe concussion. This affected his balance and led to a couple falls down stairs

“And I do drywall for a living,” Reid said. “I still do it because there’s not enough in a pension to really allow you to survive,” he continued. “As long as I have the oxycodone, I can get by. It allows me to work.”   Continue reading

DEA Quotas Cause Opioid Shortage in Hospitals

Kalter: Boston hospitals in short supply of opioids | Boston Herald – Lindsay Kalter Monday, March 12, 2018

While authorities struggle to get opioids off the streets, there is a shortage of pain medications locally and nationwide in the places that need them the most: hospitals.

“We started seeing an impact on supply back in June, but it’s progressively gotten tighter,” said Christopher Fortier, chief pharmacy officer at Massachusetts General Hospital.

This is absurd. Why is the DEA setting quotas for essential medical supplies?   Continue reading

Prior Authorization’s Pain Continues for Providers

Prior Authorization’s Pain Continues for Providers | Medpage Today – by Joyce Frieden, News Editor – March 29, 2018

Prior authorization: it’s been around for years, but not much has been done to improve it, leaving it the bane of many physicians’ existence.

A recent survey by the American Medical Association (AMA) found that 92% of physicians agree that prior authorization — the need to have certain tests and procedures approved in advance by the patient’s health insurer in order to get them reimbursed — delays patient care.

And not just delays, but often denies outright or requires “step therapy”, other treatments that must be trialed before a patient is allowed to have the requested procedure.   Continue reading

Pill Limits Not a Smart Way to Fight the Opioid Crisis

Pill Limits Are Not a Smart Way to Fight the Opioid Crisis –  – March 30, 2018 – By Sally Satel and Stefan Kertesz

How much to prescribe, and to whom, is a complicated medical question.

Last week, President Trump traveled to Manchester, New Hampshire—a designated ground zero of the opioid epidemic—and announced a number of national initiatives to combat the crisis.

One proposal was a call to cut by one-third the number of opioid prescriptions over the next three years.  Continue reading

War on Opioids Will Only Punish Patients in Pain

 Trump’s False War on Opioids Will Only Punish Patients in Pain | Opinion – By Josh Bloom and Henry I. Miller On 4/6/18

The ongoing battle to control opioid addiction has not gone well, to say the least.

Many of the government’s efforts, mostly from the Centers for Disease Control and Prevention (CDC), have been unproductive.

Some have been counterproductive, medically and scientifically flawed, punitive, and perhaps most frightening, have usurped control of patient care from physicians.   Continue reading