Human Rights Watch Report: Chronic Pain Patients Denied Medicine

[drusso]

“Not Allowed to Be Compassionate” | Chronic Pain, the Overdose Crisis, and Unintended Harms in the US

"There’s a lot of talk in the pain medicine world that if you do not get people down to 90 morphine equivalents, you set yourself up for a liability, especially if something were to happen to that patient. It doesn’t matter if you did everything appropriately [to prevent abuse] — and we do everything, urine drug testing, prescription monitoring, screening for mental health issues, pill counts. It doesn’t feel like enough. We still feel like we’re vulnerable to being held liable for patients if they’re over that guideline limit, even when you know they’re not addicted and they’re benefitting [from opioids]."

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[lobelsteve]

True.

 

[Ducttape]

so in other words, people who we iatrogenically got dependent and/or addicted to opioids need to be prescribed pain meds ad infinitum.

good luck with that. all the more reason to not start the vast majority of chronic pain patients.

 

[drusso]

so in other words, people who we iatrogenically got dependent and/or addicted to opioids need to be prescribed pain meds ad infinitum.

good luck with that. all the more reason to not start the vast majority of chronic pain patients.

How do you tell the difference between an iatrogenic addict versus a stable opioid dependent chronic patient?

 

[lobelsteve]

How do you tell the difference between an iatrogenic addict versus a stable opioid dependent chronic patient?

@drusso if he sees us he is a functional member of society and working. Dependent. If he sees duct he is an addict.

 

[No Pain All gain]

Guidelines are not based on evidence. Do no harm is guiding principle. I never start patients on opioids but I accept them and manage responsibly. I am helping to control the problem and did not start it. So I don’t think even lobelsteve can review my charts and say I am liable. I’m part of solution not problem.


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[SommeRiver]

I hate opiates but there are individuals who use them successfully and to deny those individuals their low dose hydrocodone is cruel. There are worse things than dependance, and that is clearly different than addiction.

 

[Aether2000]

There is an ethical and scientific duty to attempt to gradually wean patients down or off opioids given the studies suggesting improvement in pain and function once withdrawn or significantly lowered in dosage. It is impossible without a gradual trial of opioid reduction and period of stabilization, to determine whether a working patient is functioning because of the opioids vs. functioning in spite of opioids. It is less difficult to determine whether the obese sedentery welfare patient or those on disability are functional- they are not. In those cases opioids being continually prescribed have no objective meaningful justification. Governments and prosecutors know this and particularly in cases where there are non functional opioid dependent patients at the hands of physicians, heads will roll if there is an OD, even if it was because if binge drinking or sedating drugs prescribed by another physician. The fall guy is the opioid prescribing physician who, according to the government "should have suspected or known" about the potential for OD and did nothing about it. Good intentions or "compassionate medicine" will not avoid destruction of a career nor jail time when thing go south. Given multiple ODs dating back a decade, the physician is toast. It is Russian roulette.

 

[DOctorJay]

Opioids offer little chronic pain benefit and wane over time, study says - CNN

 

[callmeanesthesia]

Opioids offer little chronic pain benefit and wane over time, study says - CNN

While I approve of the conclusion as it fits my worldview, the first two authors are a DC/PhD and an PhD

 

[SSdoc33]

Guidelines are not based on evidence. Do no harm is guiding principle. I never start patients on opioids but I accept them and manage responsibly. I am helping to control the problem and did not start it. So I don’t think even lobelsteve can review my charts and say I am liable. I’m part of solution not problem.


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prescribing opioids indefinitely just because someone else started the patient on them is A. non-fulfilling B. high burnout C. low reimbursing D. arguably bad medicine. i mean, you could have a clinic full of legacy patients and justify it i guess. but do you really want to?

 

[Ducttape]

fwiw,

@drusso if he sees us he is a functional member of society and working. Dependent. If he sees duct he is an addict.

Probably true. Because if he sees you, unless one of your Medicare patients, he using private insurance and has to take time off of work to see you. As opposed to.....

Btw If do no harm is the guiding principle, one must balance the benefits of not being on opioids with the risk of taper. While WD is painful, regardless of what is said in this article, it is not lethal. Most of the cases printed are from patients unwilling to give up on opioids and will state that they are bad off and need more at every point of their prolonged history of use.