Tag Archives: rules

Opioids allocated based on business decision

‘Business decision’: Former DEA official works for opioid lawyers but set standards for how many pills were madeBy John O’Brien | Sep 3, 2019

The DEA knew more about what quantities of opioids went where than anyone else, so I’m baffled why they didn’t stop the excessive orders that everyone is complaining about now.

Asked what would’ve happened if a pharmaceutical distributor wanted advice on whether a large order of opioids was suspicious, the man in charge of federal regulation of those pills for 10 years said he wouldn’t have helped.

Instead, Joe Rannazzisi, who set always-increasing opioid quotas for theindustry while he headed a Drug Enforcement Agency department from 2005-15, said the company would be left on its own to figure it out.    Continue reading

Doctor Punished for Cutting Opioid Dose

State Regulators Punish Doctor for Cutting a Pain Patient’s Opioid Dose and Dropping Him After He Became Suicidal – Reason.comJacob Sullum | July 2019

Here’s another encouraging article that I hope is only the beginning of a return to sanity about opioids in this country:

A New Hampshire doctor recently got into trouble with state regulators because of the way he treated a pain patient.

But in a refreshing twist that suggests state officials are beginning to recognize the harm caused by restricting access to pain medication, the New Hampshire Board of Medicine reprimanded and fined the doctor not for prescribing opioids but for refusing to do so.

The settlement stems from a June 2018 complaint in which a patient reported that Greenspan, “after treating him for years and prescribing the same dosages of pain medication, suddenly reduced his medications, which led to increased pain and anxiety, and suicidal ideations.”

Court challenge to Controlled Substances Act

Federal appeals court refuses to dismiss the federal cannabis lawsuit. – Mike Hiller, Esq. – May 30, 2019

I just came across this and I’m not sure if this applies to our situation with opioids, but I’m delighted to see this challenge to the misbegotten Controlled Substances Act, which was passed and signed into law in 1970, almost half a century ago.

In a groundbreaking decision, the United States Second Circuit Court of Appeals became the first Court to refuse to dismiss a lawsuit challenging the constitutionality of the Controlled Substances Act.

Hurray, a judge finally comes to a rational decision! 

Continue reading

HHS Report on Pain Management Finalized

Report on Pain Management Best Practices: Updates, Gaps, Inconsistencies, and Recommendations May 30, 2019

Below is a link to the final version of the draft report:

The Comprehensive Addiction and Recovery Act of 2016 (CARA) required the Pain Management Best Practices Inter-Agency Task Force to develop the

Report on Pain Management Best Practices:
Updates, Gaps, Inconsistencies, and Recommendations,

which identified gaps or inconsistencies, and proposed updates to best practices and recommendations for pain management, including chronic and acute pain.

Background

Opioid cessation and chronic pain

Opioid cessation and chronic pain perspectives of former opioid users – free full-text article – PAIN: May 2019

This mixed-method study included 49 former opioid users with chronic pain [this is a tiny sample! -zyp] and used quantitative survey data and qualitative focus group data to identify themes pertaining to former opioid user’s experience before, during, and after opioid cessation.

Participants described several reasons for wanting to stop opioids including

  • lack of efficacy,   [if so, why are they taking them? -zyp]
  • impact on quality of life, [impact is positive when pain relief is achieved -zyp] and 
  • concerns about addiction.

I don’t understand those who stated that opioids didn’t help their pain. What possible rationale could there then be for them to be taking opioids in the first place?     Continue reading

CDC Guideline Harms Pain Patients

CDC Guideline Harms Pain Patients, Panel Saysby Judy George, Contributing Writer, MedPage Today – March 11, 2019

The CDC’s 2016 opioid guideline is being implemented in ways that harm chronic pain patients, a panel of physicians said here.

I agree that the problem isn’t with the guidelines themselves.  They were just

1) suggestions,
2) for primary care providers and
3) first-time opioid prescriptions.

The problem is that they have been weaponized by anti-opioid crusaders to make laws and rules that force opioid tapers even when not medically indicated.  Continue reading

Were Consequences of CDC Guideline Unintended?

CDC Opioid Prescribing Guideline: Unintended Consequences? – July 2018 – an angry essay by yours truly, Angelika Byczkowski (Zyp Czyk)

I’m sick and tired of reading over and over how all the entirely predictable consequences of the CDC Opioid Prescribing Guideline were “unintended” and “unforeseeable”.

The broad misinterpretation of the guideline as establishing fixed limits on opioid prescribing has stranded hundreds of thousands of pain patients in agony without the effective relief they had achieved with opioids.

Yet we are expected to believe that these consequences were “unintended” and “unforeseeable” by the guideline authors. Most pain patients realized right away that the guideline’s suggestions would become codified rules, no matter how little evidence supported them.

And we were right – more than we ever imagined…  Continue reading

Medical guidelines may be biased, overly aggressive

Medical guidelines may be biased, overly aggressive in USCornell University – Apr 2019

Dr. Sunita Sah practiced general medicine for several years in the United Kingdom’s National Health Service. When she came to the United States, she noticed something strange.

The U.K. guidelines for tests such as mammograms and colon cancer screenings drastically differed from those in the U.S…

…even though they were based on the same medical evidence.   Continue reading

CDC Issues Key Clarification on Guideline

CDC Issues Key Clarification on Guideline for Prescribing Opioids for Chronic Pain | ASCO – April 9, 2019

I’m angry that the CDC issued this clarification for only three discreet conditions

  • cancer patients,
  • cancer survivors, and
  • individuals with sickle cell disease.   

Because it so carefully carves out these three very specific conditions for special notice, it seems to imply that any other conditions not listed are currently being understood and implemented as intended, and I’m afraid it could become even harder for chronic pain patients to get opioid relief. Continue reading

Inconsistent Definitions of Opioid Use Disorder

Agreement between definitions of pharmaceutical opioid use disorders and dependence in people taking opioids for chronic non-cancer pain (POINT): a cohort study – The Lancet Psychiatry – free full-text – Mar 2015

Background

Classification of patients with pharmaceutical opioid use disorder and dependence varies depending on which definition is used.

I find it outrageous that OUD can be diagnosed on a whim just by using the fitting definition in one of the several classification systems.

The DSM-5 is the worst, thanks to its “spectrum” of Opioid Use Disorder (OUD), which always places us pain patients, with our regularly prescribed opioids, into the low end of this spectrum.  Continue reading