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Opioid script drop
- Thread starter bedrock
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As opioid deaths continue to rise....
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Ruh-roh...
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epidemiologically, the purpose of reducing inappropriate opioid use now is to decrease overall opioid use in future generations. a concept that seems lost to some...
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Yes, reducing diversion, harm to community. Regrettable that OD deaths rising but it's not coming from my rx pad
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We are significantly reducing opioid use in anesthesia and post op- we can't get any. Out of hydromorphone IV, morphine IV, sufenta IV, and buprenorphine IV, 2ml fentanyl, and fentanyl 5ml is in short supply. Massive shortages throughout the country.
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I hope I don't need surgery any time soon. Wait, I always hope I don't need surgery....
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So treat the public health, at the expense of the patient in front of you. Breach of duty? Just saying, a case could be made. Look at thread where folks with broken limbs or post-op getting nothing for pain.
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"All animals are equal but some animals are more equal than others"
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So you are implying that you believe that opioid therapy is mandatory in certain cases....
What happened to pain being a subjective experience? Are we mandated per your opinion to give opioids if patients demand it?
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As I've said many times, dropping the number of scripts written by MDs, does nothing to stem the tide of counterfeit fentanyl from overseas from coming into the US and leading to fatal ODs, while bypassing all legitimate pathways altogether. Reducing the total number of opiate scripts written in the U.S. needs to happen, and I agree with it, but it is another issue entirely from illicit sourcing which are increasing rapidly. There is absolutely no reason to assume that reducing legal opiate prescriptions, will reduce overdose deaths from illicit sources which is a very large and unlimited source that the Feds thus far have shown virtually no ability to control.
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Right, addicts are still going to OD, it will just be off of street drugs rather than my prescription, or (more likely) someone's else's rx which got sold on the corner. The current legal climate, with aggressive Attorneys general and plaintiff lawyers doesn't make me eager to stick my neck out one inch.
I wean a lot of people down and off. Many from 150 MED, some from 200+ Their pain levels don't change. Their function actually seems to improve. They wake up. I've had a couple actually go back to work part-full time.
Stuff like this makes me question whether Opioids work at all long term for chronic pain. Maybe all I am doing with the low dose crowd is preventing withdrawal
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Agree on all counts. If the Feds say next year go down to 60 MME/day, and then on down from there after that, I'm okay with it.
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Next time up your way we should shoot hoops. You accidentally jump over me and I accidentally stand up while you are in air. You suffer tib/fib fx. I will give you a tylenol.and a rope to bite.
yea that's the same as COT
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pretty reasonable numbers for postop pain.
fwiw for all my ACL tear and subsequent knee surgeries and wrist fractures, i took a grand total of 2 vicodin. and regretted each of them.
so ill take the tylenol (and maybe a few ibuprofen), tyvm.
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For dental, pre-op pre-emptive analgesics work incredibly well. Start patient on Celebrex 200 q 12 two days pre-procedure and then continue for up to 5 days post-op if needed. I had an extraction with literally 0 pain using this technique.
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Lap chole- zero opioids, took advil twice. Refused the surgeon written script for 40 tablets of percocet three separate times.....
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Dummy. That's $400. Not quite the deductible.
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Yeah. I'm the CDC. I'm the DEA. I make the rules. I jail doctors.
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Yup, see the guidelines. Docs can still rx opiates when needed.
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I never said that the CDC guidelines ban opiates. In fact, by their wording, they don't even apply to Pain specialists at all, or create a hard dose limit for the primary care MD's they are written for. That doesn't mean we shouldn't ignore them, or that we shouldn't read the tea leaves.
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This is one of the major problems with physicians today. There are pain specialists all around the country saying "the CDC says I can't prescribe opiates at ALL". It's because they are "reading the tea leaves" and thinking the guidelines are saying something they're not. If you all would just follow the guidelines exactly as they are written then there wouldn't be any issues........
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The guidelines don't even apply to Pain physicians, at all. I have all 49 pages of it right in front of me on my desk. Here are the first words, "This guideline provides recommendations for primary care clinicians who are prescribing opioids for chronic pain outside of cancer treatment..."
Note 3 very important words in the first sentence:
1) It's a guideline, not law, or absolute.
2) It applies to Primary Care, only, not Pain specialists.
3) It recommends how to prescribe opiates, not that one can't prescribe opiates.
But, it doesn't matter!
Because the end result is, that the drug enforcement authorities are getting more punitive, harsh, strict and less forgiving on everyone, not just PCPs. As Pain Specialists, we'd be stupid to ignore everything else that is happening outside of the 49 pages of the CDC guidelines, and to ignore where things are going. We'd be utter *****s to ignore these 'guidelines.' Even more important than the wording of the guidelines, is what they mean and what they indicate to our future survival. I'm not sure what kind of work you do Mr. Doeson, but would you go to jail or give up your ability to every work again, for some principle that a customer thinks you should have, that pisses off the people with the ability to take away your livelihood and jail you?
While you think about your answer, here's some pleasure reading for you:
"DEA Raids Dr. Forest Tennant's Pain Clinic"
Clinic Raided And Shut Down, Prominent Pain Doctor Lynn Webster Faces Hundreds Of Lawsuits
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