AMA Delegates Back Physician Freedom in Opioid Prescribing – by Joyce Frieden, News Editor, MedPage Today November 13, 2018
In the fall of 2015 the anti-opioid advocacy group, PROP, prodded the CDC to formulate the notorious Opioid Prescribing Guideline using PROP’s literature as a blueprint. Already provoking a great deal of alarmed protest, the guideline was officially released in the spring of 2016.
Since then, insurers, hospitals, pharmacies, and even doctors themselves have chosen to interpret the guideline as a “rule of law”, applicable to all patients taking opioids for any reason at any time. The result has been three excruciating years of pain patient suffering and suicide as pain relief is withheld.
Only now is the AMA finally speaking out against these crude and inappropriate restrictions. Continue reading
‘Every time it’s a battle’: In excruciating pain, sickle cell patients are shunted aside – By Sharon Begley @sxbegle – Sept 2017
The U.S. health care system is killing adults with sickle cell disease. Racism is a factor — most of the 100,000 U.S. patients with the genetic disorder are African-American — and so is inadequate training of doctors and nurses.
And the care is getting worse, sickle cell patients and their doctors said, because the opioid addiction crisis has made ER doctors extremely reluctant to prescribe pain pills.
STAT interviewed 12 sickle cell patients who described the care they received and didn’t receive. They were old and young, men and women, scattered from coast to coast, some with jobs or attending school and some too sick to do either. Continue reading
Evidence-Based Medicine: Common Misconceptions, Barriers, and Practical Solutions – JAY SIWEK, MD, Georgetown University Medical Center, Washington – Sep 2018
More than 25 years have passed since the term evidence-based medicine (EBM) was introduced into the medical literature. Its original definition has been expanded to include not only the quality of the evidence, but also the two key players applying the available evidence—namely the clinician and patient.
A current working definition is: the integration of the best available evidence with clinical expertise and the individual patient’s values, preferences, and unique circumstances.
EBM is not dogmatic, “cookbook ” medicine.
Oh really? But that’s exactly how it’s being used. Continue reading
Congress Needs an Opioid Intervention – Reason.com – J. Rich – November 2018
In an effort to “combat the opioid crisis” in America, Congress is calling for a slate of governmental interventions that have been tried, tested, and shown to cause more harm.
Too much of the new legislation is grounded in the “overprescription” hypothesis, which blames the current unprecedented rates of overdose on an expansion in the number of opioid prescriptions that began in the 1990s. Continue reading
Opioid Drugmakers Call for Specificity in Cases of Harm in Government Lawsuits Filed Against Them – Oct 19, 2018 By Alex Keown
As more and more lawsuits are filed by state and local governments over the opioid epidemic, drugmakers are fighting back in court by demanding the allegations include specifics on how the companies are to blame.
As the city of New Orleans and Missouri’s Franklin County become the latest local governments to file more than 1,500 lawsuits against opioid manufacturers, companies like Purdue Pharmaceuticals, the maker of OxyContin, are asking the plaintiffs for specifics in exactly how the companies are to blame for the overdose deaths, The Wall Street Journal reported Thursday.
This is an interesting avenue of defense that could expose how few legitimate patients overdose. We may find out how few specifics we have about this “opioid crisis” and how few specifics we about all the drug deaths that have been counted as “opioid overdoses” to arrive at the huge numbers we’re seeing. Continue reading
Professional Societies Should Abstain From Authorship of Guidelines and Disease Definition Statements – John P.A. Ioannidis – Oct 2018
Guidelines and other statements from professional societies have become increasingly influential. These documents shape how disease should be prevented and treated and what should come within the remit of medical care.
Changes in definition of illness can easily increase overnight by millions the number of people who deserve specialist care. This has been seen repeatedly in conditions as diverse as hypertension, diabetes mellitus, composite cardiovascular risk, depression, rheumatoid arthritis, or gastroesophageal reflux.
Similarly, changes in prevention or treatment options may escalate overnight the required cost of care by billions of dollars.
For example, if we accept PROP’s argument that we’re all addicted to our “heroin pills”, we’d all suddenly need “addiction-recovery programs/clinics/residential treatment centers/resorts” for our “substance abuse” instead of “chronic pain”. Continue reading
The Tyranny of Pain Management Contracts (repost from 7/17/16 related to a Opioid contracts harm the doctor-patient relationship)
– To receive opioids from a pain management clinic, you are required to sign away your personal rights and privacy in extremely restrictive and coerced contracts.
How would you feel if you entered a doctor’s office with distressing pain, only to be treated like a lying drug addict, presented with a completely one-sided legal contract, and be expected to sign away important personal rights just to get a medication you need?
Perhaps you just can’t understand just what it feels like to read such a contract when you are a person 100% dependent on opioids to live somewhat decently. It is demeaning, infuriating, and even scary to be treated like an addict without any provocation. Continue reading
Does evidence-based medicine adversely affect clinical judgment? | The BMJ
For practical and theoretical reasons, says Michel Accad, evidence based medicine is flawed and leads to standardised rather than excellent individualised care, but
Darrel Francis argues that it protects patients from seemingly rational actions that cause more harm than good.
This is an interesting conflict arising when EBM, which is population-based, runs into individualized medicine, which is mostly based on a doctor’s judgment. Continue reading
No wonder doctors don’t want to deal with prescribing opioids when they get these ridiculously time-consuming requests from insurance companies and pharmacy benefit managers, not to mention running the risk of losing their license and livelihood.
Government efforts to curb opioid prescriptions may have backfired – Aug. 24, 2018
In the case of the DEA’s 2014 action to move opioid painkillers [hydrocodone, Vicodin] to a more restricted class, this “may inadvertently motivate surgeons to prescribe greater amounts to ensure adequate pain treatment,” said Dr. Jennifer Waljee, lead author of one of the studies.
Her team believes that once prescription refills became tougher under the new DEA rules, surgeons who worried about a patient’s longer-term pain control simply ordered a larger number of pills so the patient had a “stockpile” of opioids to use at home.
This seems like a perfectly appropriate medical response to such arbitrary limits. Continue reading