Tag Archives: standards

Doctors Protesting Medicare Opioid Limits

Doctors Are Protesting Medicare Change That Would Let Insurers Deny Opioid Prescriptions – by Ed Cara – Mar 6, 2018

The most exceptional aspect of this article is where it appeared: in a publication devoted to high tech, Gizmodo. This means it will be seen by a completely different audience than most such pieces.

In response to the opioid epidemic that is killing tens of thousands of Americans a year, the U.S. government is poised to further restrict the amount of opioids Medicare patients can have access to at any one time, via a policy that would tell insurers to deny coverage for certain prescriptions on the spot.

But a group of doctors and researchers is pleading with officials to reconsider, saying the move would harm cancer patients and others who desperately need pain relief. Continue reading


Doctoring destroyed by legislators and admins

Our noble profession is being destroyed by legislators and administrators – KevinMD – CATHLEEN LONDON, MD | Aug 2017

A doctor describes the frustration of her hard-won knowledge and expertise being overruled by an insurance company minion with barely a high school degree.

I had a great day in the office today. Not that I came up with any brilliant diagnosis nor cured anyone.

I was able to just be a physician. No time wasted on the phone with insurance companies. No prior authorizations to do.

It was a reminder of how much I love my job.   Continue reading

DSM-5: Withdrawal = Substance Use Disorder

American Psychiatric Association Proposes 5 Changes to DSM-5 – Gary Rothbard, MD, MS – Feb 2018

I’m outraged that In the DSM-V, any drug withdrawal was coded with Substance Use Disorder (SUD), even when any reasonably intelligent person understands that withdrawal from any drug, whether opioids, caffeine, or antidepressants, is unrelated to a SUD. 

These ignorant people who insisted that withdrawal indicates a SUD were so sure of themselves they published it in *the* psychiatric manual used by every doctor and insurance company?

How many people read this nonsense and approved it? With so many psychiatric experts vetting this important manual, how did this complete distortion of fact get by?  Continue reading

Limitations of the DSM-5

Limitations of the Diagnostic and Statistical Manual of Mental Disorders — also known as the DSM – Medium Feb 2017 – by Jeffrey Guterman

The Diagnostic and Statistical Manual of Mental Disorders (DSM-5; American Psychiatric Association, 2013) may be among the most controversial and polarizing books in the world.

Informed by the medical model, the DSM-5 is the official diagnostic manual of mental disorders authorized by the American Psychiatric Association (APA, 2013).

It has engendered debate in the public arena as well as professional circles. At the same time, it has been a best-seller on The New York Times, Amazon, and other book lists.   Continue reading

Crash Course for Submitting Comments to CMS

#HPM Crash Course in Submitting Comments to CMS | Matthew Cortland on Patreon – Feb 2018 – by Matthew Cortland

Mr. Cortland gives excellent advice for the best way to write your comments on opioid policy. Though his words are aimed at Hospice & Palliative Medicine (HPM) clinicians, I believe many of us chronic pain patients have just as much knowledge and experience with this subject.

CMS has published their proposed changes to Medicare for 2019.

Here are the changes that, in my view, may be the most concerning to Hospice & Palliative Medicine (HPM) clinicians:  

  1. Starting to crack down on opioid ‘potentiator’ drugs – like gabapentin and pregabalin.
  2. Limiting opioids to 90 MME per day.
  3. Making it more difficult for patients to fill two or more long-acting opioids.    Continue reading

Managing concerning behaviors in opioid therapy

Managing concerning behaviors when opioids are taken for chronic pain | EurekAlert! Science News – 11-Dec-2017

Patients receiving long-term opioid therapy for chronic pain sometimes demonstrate challenging and concerning behaviors, such as using more opioid medication than prescribed or concomitant alcohol or drug use.

A new study, published in the Journal of General Internal Medicine, establishes expert consensus about treatment approaches that should be implemented when these behaviors arise.   Continue reading

Clinical non-biased opioid guideline from doctors

I found this extremely sensible opioid guideline from 2009. It was developed by doctors and other professionals in pain management, not addiction specialists.

Clinical Guidelines for the Use of Chronic Opioid Therapy in Chronic Noncancer Pain – ScienceDirect – February 2009,

Although evidence is limited in many areas related to use of opioids for chronic noncancer pain, this guideline provides recommendations developed by a multidisciplinary expert panel after a systematic review of the evidence.   Continue reading

The Opioid Crackdown: Have We Gone Too Far? (Part III)

The Opioid Crackdown: Have We Gone Too Far? Part III – November 21, 2017 – by Anne Fletcher 

Part three of this series examines what happens when government guidelines and recommendations such those in as the CDC Guideline for Prescribing Opioids for Chronic Pain are used to make rules and regulations about medications that leave little or no room for physicians’ discretion and individual patient needs.

How does this impact people who depend on these medications to avoid suffering and have a decent quality of life?   Continue reading

A Modern-Day Physician’s Pledge

The Revised Declaration of Geneva: A Modern-Day Physician’s Pledge Oct 2017

A newly revised version of the Declaration of Geneva was adopted by the World Medical Association (WMA) General Assembly on October 14, 2017, in Chicago.

As the contemporary successor to the 2500-year-old Hippocratic Oath, the Declaration of Geneva, which was adopted by the World Medical Association (WMA) at its second General Assembly in 1948, outlines in concise terms the professional duties of physicians and affirms the ethical principles of the global medical profession.   Continue reading

UN Says Untreated Pain Is “Inhumane and Cruel”

Editor’s Memo October 2017: United Nations Says Untreated Pain Is “Inhumane and Cruel” – Oct 2017 – Forrest Tenant

The national debate on the proper use of opioids continues to build as the high prevalence of addiction and overdoses fuel the continuing attention to this “public health crisis.”

Much of the anti-opioid rhetoric regarding the “opioid epidemic” implies that pain is a nuisance that really doesn’t require treatment.

Instead of making the focus one of achieving good pain relief, far too much attention has been directed solely at the risks of opioid prescribing and how we must provide naloxone on every street corner where an opioid might be sold.   Continue reading