NEJM: Controlling the swing of the opioid pendulum

[drusso]

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http://www.nejm.org/doi/full/10.1056/NEJMp1713159?query=pfwNGTpc#.WpVXMbn5yso.twitter

"In our opinion, however, the most important contributor to a desire to stop prescribing opioids is the effect of opioid prescribing on clinicians’ emotional well-being. We worry about the potential unintended consequences of these medications even if they’re used appropriately. More immediately, it’s difficult to walk into an exam room knowing that we have to significantly reduce or stop a patient’s opioid treatment — and then deal with the lengthy, emotional, possibly confrontational encounter that typically ensues."

 

[244913]

http://www.nejm.org/doi/full/10.1056/NEJMp1713159?query=pfwNGTpc#.WpVXMbn5yso.twitter

"In our opinion, however, the most important contributor to a desire to stop prescribing opioids is the effect of opioid prescribing on clinicians’ emotional well-being. We worry about the potential unintended consequences of these medications even if they’re used appropriately. More immediately, it’s difficult to walk into an exam room knowing that we have to significantly reduce or stop a patient’s opioid treatment — and then deal with the lengthy, emotional, possibly confrontational encounter that typically ensues."

Yes- clinicians afraid of having difficult conversations so patients are maintained on high dose opioids ad infinitum. We all see this every day. Doctors being bullied by addicts diverting their medications which wind up on the street.

PP IPM predators injecting patients on high dose opioids instead of suggesting a taper. Or refusing to see these patients at all. Leaving them in the hands of overwhelmed PCP's

How exactly are we the victims here?

- ex 61N

 

[drusso]

Yes- clinicians afraid of having difficult conversations so patients are maintained on high dose opioids ad infinitum. We all see this every day. Doctors being bullied by addicts diverting their medications which wind up on the street.

PP IPM predators injecting patients on high dose opioids instead of suggesting a taper. Or refusing to see these patients at all. Leaving them in the hands of overwhelmed PCP's

How exactly are we the victims here?

- ex 61N

I consult with our county's drug court. Get a judge to order a medically-supervised detox and addiction treatment. MD is legally & professionally indemnified for a coercive taper, patient is legally compelled to comply, everybody is happy. That's the end-game.

 

[Disciple]

Yes- clinicians afraid of having difficult conversations so patients are maintained on high dose opioids ad infinitum. We all see this every day. Doctors being bullied by addicts diverting their medications which wind up on the street.

PP IPM predators injecting patients on high dose opioids instead of suggesting a taper. Or refusing to see these patients at all. Leaving them in the hands of overwhelmed PCP's

How exactly are we the victims here?

- ex 61N

I just don’t get the self-loathing stuff that goes on here.

Man, those poor PCPs. If not for all those dirty MF’ing IPM doctors.

C’mon.

 

[newbie04]

Our group has “taken on” high dose, legacy patients from PCPs.

PCPs state they can’t prescribe “due to the new laws.” It’s a PITA with most of these patients (“how will I LIVE, doc?).

However, we are weaning 99% of these patients.


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[244913]

I just don’t get the self-loathing stuff that goes on here.

Man, those poor PCPs. If not for all those dirty MF’ing IPM doctors.

C’mon.

Not self loathing. I'm simply observing and commenting on the trend in my region vis a vis IPM. There are good ones around too. I've never thought that this board and it's posters represent the norm out there in PP.

Most of the PCP's in my region are good folks. They end up inheriting the disasters who were ramped up by surgeons, IPM guys, palliative docs. Many of them taper themselves and do a pretty good job but when you are dealing with 5 other complaints in a 20 minute visit...my group tries to help them out.

- ex 61N

 

[101N]

Not self loathing. I'm simply observing and commenting on the trend in my region vis a vis IPM. There are good ones around too. I've never thought that this board and it's posters represent the norm out there in PP.

Most of the PCP's in my region are good folks. They end up inheriting the disasters who were ramped up by surgeons, IPM guys, palliative docs. Many of them taper themselves and do a pretty good job but when you are dealing with 5 other complaints in a 20 minute visit...my group tries to help them out.

- ex 61N

I think you will go a long way by supporting your PCPs. In fact, if you build a pain/SUD service they will refer to it en mass.