Yes, Restrictions on Opioids Are a Threat to Human Rights – May 12, 2018 by Lynn Webster, M.D.
In a recent Washington Post story, “Are restrictions on opioids a threat to human rights?,” Charles Lane states that the wave of prescription opioid overdoses has crested thanks to public policy changes including the 2016 CDC Guideline for Prescribing Opioids for Chronic Pain.
Actually, opioid prescribing and overdoses essentially peaked four years before the CDC guidelines were introduced.
According to a recent report from the CDC, the rate of opioids prescribed is lower than at any time in the past 10 years. The peak occurred in 2010. Continue reading
Of lamp posts, keys, and fabled drunkards: A perspectival tale of 4 guidelines – Trisha Greenhalgh – April 2018
I owe my life to evidence‐based medicine (EBM), but that is not the story I want to tell in this article. Here, I want to tell a more critical story—of how the assiduous application of “good” evidence‐based guidelines can sometimes result in a “bad” patient experience
Evidence‐based medicine saves lives, but it is not perfect.
Valkenburg et al distinguish between limits to EBM that might someday be overcome by more research and more philosophical limits that are inherent to EBM’s recommended approach. Continue reading
“A sea of suffering” – The Lancet – Richard Horton – April 2018
How did it happen that palliative care lost the dignity debate? Palliative care is a discipline dedicated to improving quality of life by preventing and alleviating suffering. There can be few higher callings in medicine.
Yet those who advocate “dignity in dying” have successfully claimed that the idea of dignity lies not in palliative care but in assisted dying for the terminally ill. A large majority of the public seems to agree. Continue reading
Some doctors say it’s time to reconsider the CDC’s guidelines on opioid prescribing – Apr 2018 – by Allison Maass
The Center for Disease Control (CDC) published guidelines on opioid prescribing in 2016, but some doctors think it is time to re-examine the guidelines because they say they might have been influenced by inaccurate data.
“It was obvious from the get-go that they were inflating the numbers,” said Dr. Dan Laird, pain management physician and medical malpractice attorney in Las Vegas.
Even I was doubting that so much of the “opioid crisis” was with prescription drugs. There aren’t enough pills in granny’s medicine cabinet to have fueled the surge in “opioid use” when millions of pills flooded the black market. Continue reading
Controlling the Swing of the Opioid Pendulum | NEJM – Feb 2018
Mr. P. is a 34-year-old man who sees his primary care physician regularly for chronic spine pain. Several years ago, he had a motorcycle accident that left him with a ruptured spleen, a shattered pelvis, and multiple thoracic vertebral fractures.
His daily pain regimen consisted of 3600 mg of gabapentin, 60 mg of baclofen, 120 mg of oxycodone IR (a 180-mg morphine-equivalent dose), and nonsteroidal antiinflammatory drugs as needed.
Mr. P.’s condition had been stable on this regimen for 2 years. His prescription-drug monitoring reports and urine toxicology screens were pristine. Continue reading
Should Doctors Try to Alleviate Pain? | Cato @ Liberty – Nov, 2017 – By DAVID BOAZ
The rising level of deaths from opioid overdoses is getting a lot of attention, including from a Nobel laureate economist and the White House.
In the rush to find a solution to the problem of opioids, I hope we don’t forget the problem that opioids were intended to cure: chronic severe pain. Living with that kind of pain is awful, and it’s wonderful that science has found ways to help people in pain.
But that’s not the way President Trump’s surgeon general sees it. Continue reading
Opioid Crisis Continues to Pressure Physicians, But Patients Bear the Pain – Pain Medicine News – NOVEMBER 7, 2017 – by David C. Holzman
The efforts to crack down on opioids are coming to a head. As a result, patients are hurting—literally.
Payors and legislators are limiting physicians’ ability to prescribe, said Joseph Ranieri, DO, an addiction medicine and pain specialist who is medical director of Seabrook House, in Newell, N.J.
Moreover, even where rules are absent, the specter of monitoring has many physicians caught between protecting their practices and protecting their patient. Continue reading
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
Why Human Suffering Should Bother You – October 23, 2017 – By Margaret Aranda, MD, Columnist
A recent column in The Conversation by Dr. Andrew Kolodny bothers me because of two sentences:
“They (opioids) are also helpful when used for a couple of days after major surgery or a serious accident.
Unfortunately, the bulk of the opioid prescriptions in the U.S. are for common conditions, like back pain,” wrote Kolodny, who is a psychiatrist, not a pain management doctor.
Let’s look at the different ways that Dr. Kolodny is minimizing pain: Continue reading
America’s Current Guidelines For Fixing The Opioid Crisis Will Increase Suffering And Death, Not Relieve It – by Kat Suricata – Oct 2017
Yesterday afternoon, President Trump declared America’s opioid crisis a public health emergency, and for good reason: the American Society of Addiction Medicine estimates that there’s nearly 2.6 million Americans with an opioid addiction, and the communities affected include some of our poorest and most vulnerable
The only problem:
- current guidelines by the FDA and CDC are ineffective,
- based on a factually‐faulty premise unsupported by evidence, and
- will almost certainly increase suffering and death without significantly improving the numbers for opioid addiction. Continue reading