Tag Archives: standards

A patient’s opposition to the anti-opioid movement

A patient’s opposition to the anti-opioid movement – KevinMD.com – Mar 2019

I wrote this essay for the doctors’ blog, KevinMD.com. My original title was “California’s Death of Sanity Project” as I criticize what’s called the “California Death Certificate Project”.

It’s bad enough that they are prosecuting doctors for prescription they are writing now, but this project goes up to three years into the past, looking for any opioid prescription to a person who overdoses, even years after they received the prescription, even if the overdose was from fentanyl or a combination of multiple illicit drugs.

As I end my essay:

Trying to stem illicit opioid overdose deaths by mandating restrictions on opioids for patients in pain is only a cruel experiment fueled by ignorance and fear.

— Read on www.kevinmd.com/blog/2019/03/a-patients-opposition-to-the-anti-opioid-movement.html

Our health info bundled into simplistic “risk scores”

How your health information is bundled into a “risk score” – Twitter thread by Stefan Kertesz – @StefanKertesz – comment on previous Politico story.

1/How your health information is sold and turned into ‘risk scores’ – from @politico …Let me share a couple insights from using a risk tool paid for by US taxpayers https://www.politico.com/story/2019/02/03/health-risk-scores-opioid-abuse-1139978

2/First, risk scores of high quality use all health information, as VA studies show risk for OD/suicide reflects

(a) medical + mental + prior substance use, &
(b) # of co-prescribed sedating mess that are crucial.

Actual #opioid dose, formulation are relevant, but less so

https://twitter.com/StefanKertesz/status/1092266758436802560/photo/1 Continue reading

Our health information sold and turned into ‘risk scores’

How your health information is sold and turned into ‘risk scores’ – politico.com – By MOHANA RAVINDRANATH – Feb 2019

Companies are starting to sell “risk scores” to doctors, insurers and hospitals to identify patients at risk of opioid addiction or overdose, without patient consent and with little regulation of the kinds of personal information used to create the scores.

Over the past year, powerful companies such as LexisNexis have begun hoovering up the data [what ever happened to HIPPA?] from

  • insurance claims,
  • digital health records,
  • housing records, and
  • even information about a patient’s friends, family and roommates,

without telling the patient they are accessing the information, and creating risk scores for health care providers and insurers.   Continue reading

Switching Opioids for Better Pain Relief

Could Switching Opioids in Cancer Patients Provide Relief? – Lori Smith, BSN, MSN, CRNP – Nov 12, 2018

I’m disappointed to see this limited only to cancer patients. Since we know that there’s NO DIFFERENCE between cancer and non-cancer pain, these findings would also apply to other kinds of chronic pain.

Side effects and inadequate pain relief with the use of opioids in cancer patients is a challenge for healthcare providers to manage and can cause considerable problems for these patients.

While the topic is still debated within the medical community, opioid switching in cancer patients may provide relief of pain and alleviation of opioid-related side effects, according to the results of a recent Italian study.   Continue reading

We Need Patient-Centric Opioid Prescribing Guidelines

The Importance Of Patient-Centric Opioid Prescribing Guidelines – forbes.com – by Joshua Cohen – Aug 2017

In light of an opioid crisis that has claimed tens of thousands of lives, health authorities and regulators have attempted to reduce the number of opioids prescribed to patients by forced tapering or the institution of quotas.

While the U.S. Centers for Disease Control and Prevention (CDC) advocates tapering and, in some cases, discontinuing opioids in patients who have used using them as long-term therapy for non-malignant chronic pain, it purposely designed its guideline as non-mandatory

Guidelines are, by definition, not mandatory; they are simply guidelines, however…

They can be used to make rules establishing their suggestions as absolutes. I’m sure the guideline authors (mostly PROP members) knew this is exactly what would happen with opioid prescribing.

Additionally, it absolves them of guilt for the atrocities inflicted on chronic pain patients in the name of their “non-mandatory” guidelines, which have predictably been weaponized as hard limits on dosages.

However, a number of legislators, pharmacies, and payers have perhaps misinterpreted the recommendations and turned them into compulsory limits and quotas.

In certain instances, mandatory opioid tapers may do more harm than good, medical experts warn in a letter published in the journal Pain Medicine.

The letter states that “rapid forced tapering can

  • destabilize patients,
  • lead to a worsening of pain,
  • precipitate severe opioid withdrawal symptoms and
  • cause a profound loss of function.”

Obviously, reducing misuse is an appropriate objective. But, the means to do so ought to reflect a balanced approach of risk management, rather than blunt instruments, such as a blanket policy of compulsory tapering or the institution of mandatory opioid quotas.

…according to Dr. Joanna Starrels, an opioids researcher and associate professor at the Albert Einstein College of Medicine “the decision to taper opioids should be based on whether the benefits for pain and function outweigh the harm for that patient.

A case-by-case approach is warranted, she says, as each decision “takes a lot of clinical judgment. It’s individualized and nuanced.

We can’t codify it with an arbitrary threshold.

But that’s exactly what has happened in this country, despite the CDC’s insistence to the contrary: Opioid Guidelines Not a Rule, Regulation or Law.

And it’s not even addressing the problem it is intended to rectify:

According to Dr. Marcia Angell, the “overwhelming majority of deaths are caused not by opioids such as OxyContin, but by combinations of fentanyl, heroin, and cocaine. … frequently taken along with benzodiazepines and alcohol.”

The letter published in Pain Medicine calls for a patient-centered approach of “compassionate systems for opioid tapering” in carefully selected patients, with close monitoring and realistic goal

Notably, in 2016, the CDC laid the groundwork for risk stratification in its guidelines on opioid prescribing. In that guidance, the CDC outlined a nuanced, patient-centric view on opioid prescribing.

Namely, patients who present at the physician’s office with chronic pain should be assessed individually for their actual need for opioids versus non-opioid or even non-pharmacologic treatment, as well as key factors gleaned from a patient’s risk profile.

In other words, rather than automatically matching pain levels to specific doses of an opioid or other analgesic, physicians are advised in the CDC guideline to tailor treatment following a thorough evaluation of each patient that includes a review of tolerance for pain, subjective preferences for treatment, and risk of misuse, abuse, and diversion.

So why isn’t anyone enforcing this part of the guideline?

Forced tapers across the board go directly against this stated guideline to “tailor treatment following a thorough evaluation of each patient”, but no one is pushing for such individualized treatment.

Nor are they pointing out that the guideline was intended ONLY for primary care physicians and ONLY for initiating new opioid therapy.

Nor is the CDC doing what they said they would: studying and evaluating the outcomes of this bomb they dropped.

Can a Nice Doctor Make Treatments More Effective? 

Can a Nice Doctor Make Treatments More Effective? – By Lauren C. Howe and Kari Leibowitz – Jan 2019

Here’s proof that a doctor’s demeanor and empathy for the patient has powerful effects on the results of their care.

Our research in the psychology department at Stanford University suggests that having a doctor who is warm and reassuring actually improves your health.

The simple things a doctor says and does to connect with patients can make a difference for health outcomes. Even a brief reassurance to a patient from a doctor might relieve the patient’s symptoms faster.

Yet the titans of the healthcare industry are doing their very best to make doctors just another generic and interchangeable piece of equipment in their money-making enterprises. Continue reading

HHS Report on Pain Mgmt Best Practices – part 3

Draft Report on Pain Management Best Practices | HHS.gov – Dec 2018

This document is so long and so detailed that I spent hours working it over to add my own voluminous commentary.

I posted the second, most significant part yesterday, HHS Report on Pain Mgmt Best Practices – part 2, and the first part the day before: HHS Report on Pain Mgmt Best Practices – part 1.  

This is the third and final part of my series, and covers the middle of the document, starting where I left off in the second part detailing interventional procedures. Continue reading

HHS Report on Pain Mgmt Best Practices – part 2

Draft Report on Pain Management Best Practices | HHS.gov – Dec 2018

This document is so long and so detailed that I spent hours working it over to add my own voluminous commentary. I posted the first part yesterday: HHS Report on Pain Mgmt Best Practices – part 1.

Below is the second part, covering more about opioid medication with all its “risk” and then the final, most significant section, covering the problems and errors of the CDC Opioid Prescribing Guidelines:

2.2.1 Risk Assessment  Continue reading

HHS Report on Pain Mgmt Best Practices – part 1

This seems like the first good news in a while: a government agency admitting that most opioid overdoses are from illicit fentanyl. The report also documents the downsides of non-opioid medications and highlights the predicament of pain patients.

Draft Report on Pain Management Best Practices | HHS.gov

This document is so long and detailed that I spent hours picking it over to find the critical pieces and add my own commentary. It’s far from perfect, but still a welcome change from the usual PROPaganda – and I choose to celebrate.

Here’s the first part:   Continue reading

Automating clinical decisions with predictive analytics

Automating clinical decisions with predictive analytics – Twitter discussion from Terri A Lewis, PhD @tal7291

This is Dr. Lewis’ take on how Appriss is using the electronic health record (EHR) of pain patients to automatically calculate an “opioid risk score” and guide the doctor to prescribe less and/or add a naloxone prescription. (see EHR tool to assess patient risks for opioid abuse)

This kind of automated standardization flies in the face of the supposed intention to individualize treatments. Unfortunately, such personalized care is expensive, while standardization is cheap.

Allow me to point out the obvious. Med records are far too inconsistent, messy, wrong, incomplete for this to be a valid, reliable tool upon which to make clinical decisions that involve predictive analytics. JUST SAY NO.   Continue reading