Tag Archives: rules

Justification of MME Dosage Above 90mg

Justification of Morphine Equivalent Opioid Dosage Above 90 mg – Practical Pain Management – August 16, 2017

It is recognized that some patients with severe chronic pain require opioid dosages over 90 morphine milligram equivalents (MME) a day.

The Centers for Disease Control and Prevention (CDC) has stated in its opioid prescribing guidelines that physicians should evaluate and carefully justify the rationale for prescribing above this level.

In California, where we practice, also has written guidelines that require justification for a daily opioid dosage above 80 MME.   Continue reading


The Dangers of Guidelines & Recommendations

Guidelines are wonderful. Guidelines are dangerous – KevinMD.com – ROBERT CENTOR, MD | July 2017

Over the past decade, I have thought often about the benefits and the problems of clinical guidelines. The first concept that attracted my attention was reading about conflicting guidelines.  

Given the same data, different guideline committees would have significantly different recommendations.  At the least, this problem raises questions about guideline validity.

It makes clear that committee perspective could influence recommendations.  

This is exactly what happened when the CDC opioid prescribing guidelines were ghost written by addiction specialists from PROP.   Continue reading

When Managing Pain Becomes a Criminal Offense

When Managing Pain Becomes a Criminal Offense: Advice for Health Care Professionals – Pain Medicine News – JUNE 7, 2017 – Jack Sharman

When does your patient care turn into your criminal trial?

That’s the question many physicians, nurse practitioners (NPs), certified registered nurse anesthetists (CRNAs) and physician assistants (PAs) are asking in the wake of a tidal wave of prosecutions related to pain medicine.

This has been partly spurred on by the “opioid epidemic.”

There has been a sharp spike in convictions—either by guilty plea or by conviction after a trial—of health care professionals involved in pain medicine.   Continue reading

What your doctor thinks when you talk about pain

INSIDER INFORMATION: Opiate Prescriptions – from drugs-forum.com – Richard_smoker, Mar 21, 2006

Interested in what your psychiatrist &/or pain control doc is thinking when you tell him you’re in pain?

Perhaps you will be shocked when you read what’s going through his mind. If you know what’s best for yourself (pun intended), then you will read the ‘suggestions’ herein very carefully.

Here it is. 2 back-to-back articles copied starting on pg. 1282, JOURNAL OF PALLIATIVE MEDICINE. Volume 8, Number 6, 2005.

Is It Pain or Addiction? – DAVID E. WEISSMAN, M.D.  Continue reading

Tragedy of Unrelieved Pain and Suffering

Back to the Future—the Tragedy of Unrelieved Pain and Suffering – PAINS – Pain Action Alliance to Implement a National Strategy –  PAINS Project | Jun 15, 2017 |by Richard Payne, MD, Medical Director, PAINS Project

As a young doctor I attended a conference at MD Anderson Cancer Center titled “Treating Pain in a Drug Oriented Society.”

One of the conference keynote speakers, Dr. Kathleen Foley, called for the “decriminalization” of cancer pain, noting that (even back then) the American Medical Association,

  • the American Pain Society,
  • the American College of Physicians and
  • the World Health Organization

recognized that opioid pharmacotherapy was the mainstay of treatment for patients with cancer experiencing moderate to severe pain.  Continue reading

Call lawyers Morgan & Morgan and tell your story

» call MORGAN & MORGAN ..tell your story… refer to chronic pain patient class action PHARMACIST STEVE June 19, 2017 by Steve Ariens

 Chronic Pain Patients – Call Now
Morgan & Morgan Lawyers

Ask for the medical malpractice department.
Refer to chronic pain patient class action and tell your story. 
Continue reading

Legislative Interference in Medical Practice

Lawmakers and practicing medicine without a license – Law Stack Exchange

Again and again we see lawmakers pass laws (generally in the context of abortion) that

  • direct doctors to provide medically incorrect information or
  • engage in acts which are medically unsound, or
  • to not provide medical information beneficial to the patient.

How is this not engaging in the practice of medicine? Why are they not prosecuted for such behavior?

It turns out that lawmakers have special rights, known as legislative immunity (link to Wikipedia article with explanation), which allows them to enact laws.   Continue reading

Standards to Foster Research Integrity

Top Scientists Revamp Standards To Foster Integrity In Research: Shots – Health News : NPR -April 11, 2017 – Heard on Morning Edition

It’s been 25 years since the National Academy of Sciences set its standards for appropriate scientific conduct, and the world of science has changed dramatically in that time. So now the academies of science, engineering and medicine have updated their standards.

The report published Tuesday, “Fostering Integrity in Research,” shines a spotlight on how the research enterprise as a whole creates incentives that can be detrimental to good research.  Continue reading

Abuse-Deterrent Opioids A Double-Edged Sword

Are Abuse-Deterrent Opioid Products A Double-Edged Sword? – Practical Pain Management – May 16, 2017 – By Jasmine Shah, PharmD and Ryan W Rodriguez, PharmD, BCPS

Solving the opioid epidemic is complex because of the multifactorial underlying causes. Complicating this issue is the need to maintain access to opioids for patients with chronic pain conditions for which prescription opioid analgesics are the only effective treatment.

Any attempts to mitigate opioid abuse must not have the unintended consequence of eliminating a viable treatment option for patients using opioid medications appropriately and experiencing meaningful clinical improvement.  Continue reading