Dallas Observer: Pain Doctors are POW's in War on Opioids

[drusso]

Caught in the Mill: Pain Doctors Say They're POWs in the War on Opioids

“Our country is in the midst of a drug abuse crisis, enabled and worsened by rampant drug trafficking and prescription drug diversion,” he [Attorney General Jeff Sessions] said. “This surge of resources ... will help us make more arrests, secure more convictions and reduce the number of diverted or unnecessary prescription drugs causing addiction and overdose.”

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[hyperalgesia]

"Patients, sometimes hundreds at a time, lined up daily to see him. He wrote more than 54,000 prescriptions in 2002 and wrote more scripts for Valium than any other doctor in Texas..."

"Officials claimed he was responsible for 11 patient-related overdose deaths..."

He lost his license and narrowly avoided prison but had to shut down his practice. Seems like the correct outcome to me. I don't need him in jail but he needed to stop doing what he was doing.

 

[244913]

Caught in the Mill: Pain Doctors Say They're POWs in the War on Opioids

“Our country is in the midst of a drug abuse crisis, enabled and worsened by rampant drug trafficking and prescription drug diversion,” he [Attorney General Jeff Sessions] said. “This surge of resources ... will help us make more arrests, secure more convictions and reduce the number of diverted or unnecessary prescription drugs causing addiction and overdose.”

You get to choose whether you are a victim. Are you a wolf or a sheep? Start having the difficult conversations

- ex 61N

 

[emd123]

You get to choose whether you are a victim. Are you a wolf or a sheep? Start having the difficult conversations

- ex 61N

I doubt many of the "sheep" that were slaughtered, were following CDC guidelines.

-Don't start opiates if patients aren't on them.
-Confirm pathology on imaging and exam.
-Check old records for signs of discharge, aberrancy.
-If continuing opiates in legacy patients started by someone else, that appear to be doing well and are behaving, don't dose escalate (only rotate to equivalent or lower MME/day)
-Stay at or below 90 MME; the lower the better.
-Don't accept new patients over 90 MME/day (unless they're so close, they can tolerate the drop in dose).
-Make opiate patients taper off benzos/soma, if not, then taper opiates.
-Discontinue opiates if illicit + UDS, and don't restart them ever; no exceptions, not even MJ, because the Feds consider it illegal in all 50 states, under Federal law.
-When in doubt, stop or lower: Actively look for reasons to stop, taper or lower opiate doses, where appropriate. New paradigm, opposite of old "Prescribe first, ask questions later."

There are more than enough people breaking all these rules, and flagrantly, to provide low hanging fruit for the Feds and medical boards to stay busy, without having to harass doctors who are practicing conservatively.


The six "Don'ts" of opiate prescribing for weathering the Opiate Crisis:

Don't forget exam, imaging, diagnosis
Don't start
Don't escalate
Don't exceed 90
Don't allow benzos
Don't allow illicits

 

[emd123]

PS: And if you forget all of those, and follow only one of the six "Don'ts" (you can't do that, you must follow them all) the most important one is the,

"Don't exceed 90 MME/day" CDC recommendation.

It's by far the most important, because it's concrete, its unambiguous, it's numerical and BY FAR the easiest for a non-medical law enforcement person or regulator to explain a deviation, to another non-Pain MD (medical board) or non-medical person (juror). It's also the easiest, most concrete and unambiguous to follow and therefore provided the most concrete and unambiguous protection. Does that mean no one can ever get over 90 MME/day? No. It's just means you aren't going to be the one doing it.

 

[hyperalgesia]

I doubt many of the "sheep" that were slaughtered, were following CDC guidelines.

-Don't start opiates if patients aren't on them.
-Confirm pathology on imaging and exam.
-Check old records for signs of discharge, aberrancy.
-If continuing opiates in legacy patients started by someone else, that appear to be doing well and are behaving, don't dose escalate (only rotate to equivalent or lower MME/day)
-Stay at or below 90 MME; the lower the better.
-Don't accept new patients over 90 MME/day (unless they're so close, they can tolerate the drop in dose).
-Make opiate patients taper off benzos/soma, if not, then taper opiates.
-Discontinue opiates if illicit + UDS, and don't restart them ever; no exceptions, not even MJ, because the Feds consider it illegal in all 50 states, under Federal law.
-When in doubt, stop or lower: Actively look for reasons to stop, taper or lower opiate doses, where appropriate. New paradigm, opposite of old "Prescribe first, ask questions later."

There are more than enough people breaking all these rules, and flagrantly, to provide low hanging fruit for the Feds and medical boards to stay busy, without having to harass doctors who are practicing conservatively.


The six "Don'ts" of opiate prescribing for weathering the Opiate Crisis:

Don't forget exam, imaging, diagnosis
Don't start
Don't escalate
Don't exceed 90
Don't allow benzos
Don't allow illicits

I totally agree with this. But it is not compatible with the financial model of majority of pain practices.

 

[emd123]

I totally agree with this. But it is not compatible with the financial model of majority of pain practices.

You may be correct, but it's compatible with the financial model of my practice.

I eat.
I have a 401K.
My kids will go to college.
I have one car and 1 house.
I take vacations.

I do just fine.
But I don't have multiple fancy cars (just one I bought used, on Carmax).
I don't have vacation houses, boats or club memberships.

I don't earn in the top 25% of incomes for Pain MDs. I don't make in the bottom 25% either. But I do just fine.

 

[emd123]

You may be correct, but it's compatible with the financial model of my practice.

I eat.
I have a 401K.
My kids will go to college.
I have one car (that I bought used on Carmax) and 1 house.
I take vacations.

I do very well.
But I don't have multiple fancy cars.
I don't have vacation houses, boats or club memberships.

It just so happens that today, several local Pain and a couple Primary Care MDs woke up today to find out they were on the news. The local news station pulled Medicare's data on the top 1,000 opiate prescribers in the country. Turns out several are in my immediate practice area. These are people I've met, who's records and prescribing practices I've seen. One of them is top 100 in the country. There have been no board actions, no arrests, no charges, just a media "expose" on the "opiate crisis." They just wanted to 'let everyone know.'

So I took it upon myself to go to the Propublica site and pull the data myself, add the numbers up, and compare my total yearly opiate Rx's to theirs.

Doc #1- Prescribed 543% more total opiate Rx's than me in the most recent year (Medicare data). And no, that's not a misprint. It's not 5% more, not 54% more, it's 543% more.

Doc #2- Prescribed 561% more opiate Rx's than me, in the most recent year's data.

Doc #3 - Prescribed 994% more, yes, that's NINE HUNDRED NINETY FOUR PERCENT MORE total opiate prescriptions than me during the year. This guy and his prescribing practices are no secret, certainly well known to the authorities for the last 15 years he's been practicing in the area. His license is fully intact.

I can only imagine, if you added these numbers up in MMEs/day, they would likely be even higher, since I know for a fact these people do not stay at or below 90 MME/day or any other dose ceiling, that I know of.

 

[SeniorWrangler]

I'm not happy about this development but not surprised, either.

 

[Ducttape]

So, end, your search suggests that hyperalgesia is correct....

 

[clubdeac]

You aren’t in the Jacksonville area are you?

It just so happens that today, several local Pain and a couple Primary Care MDs woke up today to find out they were on the news. The local news station pulled Medicare's data on the top 1,000 opiate prescribers in the country. Turns out several are in my immediate practice area. These are people I've met, who's records and prescribing practices I've seen. One of them is top 100 in the country. There have been no board actions, no arrests, no charges, just a media "expose" on the "opiate crisis." They just wanted to 'let everyone know.'

So I took it upon myself to go to the Propublica site and pull the data myself, add the numbers up, and compare my total yearly opiate Rx's to theirs.

Doc #1- Prescribed 543% more total opiate Rx's than me in the most recent year (Medicare data). And no, that's not a misprint. It's not 5% more, not 54% more, it's 543% more.

Doc #2- Prescribed 561% more opiate Rx's than me, in the most recent year's data.

Doc #3 - Prescribed 994% more, yes, that's NINE HUNDRED NINETY FOUR PERCENT MORE total opiate prescriptions than me during the year. This guy and his prescribing practices are no secret, certainly well known to the authorities for the last 15 years he's been practicing in the area. His license is fully intact.

I can only imagine, if you added these numbers up in MMEs/day, they would likely be even higher, since I know for a fact these people do not stay at or below 90 MME/day or any other dose ceiling, that I know of.[/QU

 

[emd123]

You aren’t in the Jacksonville area are you?

No