Rolling Stone: Are opioid guidelines causing patient suicide?

[drusso]

Could CDC Guidelines Be Driving Some Opioid Patients to Suicide? – Rolling Stone

"Ultimately, Satel is clear that the intention of the letter is not to prompt the CDC to revise its guidelines entirely: “these aren’t bad guidelines at all,” she says, nor should medical providers be totally reliant on prescribing opioids to manage chronic pain. She would, however, like individual health care providers to “use common sense, on a patient-by-patient basis” when prescribing opioids. She is also pushing for the CDC to issue a press conference clarifying its guidelines and to“make clear to doctors and patients there is no federal requirement to alter the dose of medication for someone who is maintained successfully on opioids for chronic pain. Just make that loud and clear: the DEA will not kick down your door if you’re being maintained on high doses.”

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[Aether2000]

No, but they will kick down the doctor's door and arrest him for prescribing high doses.

 

[deleted480308]

I’m not throwing away my license to give someone high dose opioids. Not happening

 

[paindoc007]

No, but they will kick down the doctor's door and arrest him for prescribing high doses.

Is there any evidence that they do that though?
Is there a case of a legitimate doctor doing legigimate work where that happens ? Every article I read is a total quack who gets in trouble.

 

[Ducttape]

apparently, Lynn Webster, Forrest Tennant and Perry Fine were doing legitimate work before they got investigated....

 

[lobelsteve]

apparently, Lynn Webster, Forrest Tennant and Perry Fine were doing legitimate work before they got investigated....

And Russell?

 

[Ducttape]

As far as I am aware, the feds have not investigated his practice.

The major “thought leaders” have all been sued multiple times outside of their practice...

https://www.google.com/amp/s/financ...rs-face-scores-opioid-lawsuits-160906369.html

 

[KHE]

As an optometrist, I'm obviously not particularly skilled in this area but my understanding is that opiates were not indicated for chronic pain and that there is mounting evidence showing that using opiates for chronic pain actually worsens the pain.

Am I out to lunch on that?

 

[SSdoc33]

As an optometrist, I'm obviously not particularly skilled in this area but my understanding is that opiates were not indicated for chronic pain and that there is mounting evidence showing that using opiates for chronic pain actually worsens the pain.

Am I out to lunch on that?

you post is a bit myopic

stop being so short-sighted.

you certainly have a eye for detail


seriously, your understanding is correct

 

[Aether2000]

Yes, there is significant evidence for high prescribers being investigated. Several state medical boards and the DEA over the past several years have publicly announced they are going after the highest prescribers of opioids. "Legitimate" is in the eye of the beholder, and certainly to a person receiving 1000mg morphine a day (or equivalent) for chronic non-malignant pain, their doctor is "legitimate". To the DEA, even a small fraction of that is illegitimate if being prescribed to large numbers of patients. Of course the DEA is also focused on the daily number of pills of controlled substances being prescribed.

 

[KHE]

you post is a bit myopic

stop being so short-sighted.

you certainly have a eye for detail


seriously, your understanding is correct

If that's the case, why do docs keep prescribing for chronic pain?

Is it just not wanting to deal with the hassles of taking someone off? Fear of "bad reviews?" Fear of psychotic patients? All of the above?

What's the solution?

 

[emd123]

If that's the case, why do docs keep prescribing for chronic pain?

Not everyone gets harmful addiction. Some people, particularly the elderly, otherwise disabled, benefit from a low to moderate dose opiate, which they report allows them to have less pain, improved quality of life and function better, without ever having harmful addiction and without selling or diverting pills. Not even the government or DEA is talking about a complete ban on low-moderate dose opiates for some chronic non-cancer pain patients.

You're the doctor now. How do you, personally, justify making those people who follow the rules, suffer, perhaps yourself someday, because other people we've never met are breaking the rules and causing problems? What do you tells those patients? What do you do to the ones who appear to be benefiting, who are following the rules and appear to have no addiction?

 

[emd123]

Yes, there is significant evidence for high prescribers being investigated. Several state medical boards and the DEA over the past several years have publicly announced they are going after the highest prescribers of opioids. "Legitimate" is in the eye of the beholder, and certainly to a person receiving 1000mg morphine a day (or equivalent) for chronic non-malignant pain, their doctor is "legitimate". To the DEA, even a small fraction of that is illegitimate if being prescribed to large numbers of patients. Of course the DEA is also focused on the daily number of pills of controlled substances being prescribed.

I would say, in 2019, prescribing 1000 mg morphine per day, to anyone, is just asking for DEA scrutiny. In fact, I'd say that after the CDC gifted us the 90 MED road map, any prescribing over 90 MED invites unnecessary scrutiny. I think 99.9% of this, particularly the people involved in criminal cases could be avoided by not being brazenly stupid. Most, if not all of these criminal cases against doctors that I've looked at, involve brazenly stupid breaches of standard of care, like: not keeping records, accepting cash pay from opiate patients, ordering no imaging/old records, not drug testing at all or ignoring illicits, prescribing way over 90 MED, dose escalating without end or justification, bribing patients into unnecessary injections, drinking/drugging on the job & having their own addiction, and trading pills or sex with patients.

 

[SSdoc33]

If that's the case, why do docs keep prescribing for chronic pain?

Is it just not wanting to deal with the hassles of taking someone off? Fear of "bad reviews?" Fear of psychotic patients? All of the above?

What's the solution?

solution is to put down the pen. i havent written for an opioid in 8 years. best thing i ever did. some on this board may say im not a real pain doctor. fine by me.....

 

[Ducttape]

most doctors justify prescribing on the - mistaken - belief that they are helping the chronic nonmalignant pain patient.

some do it for the money, either directly or indirectly.

some do it because they aren't sure what to do, and are subconsciously listening to Big Pharma...



I disagree that there are population groups of chronic pain patients that benefit per se. an individual will state that they do.

there are individuals who have limited options of learning how to manage their pain using non-opioid treatments, such as the elderly (physically and mentally unable to do so). so the default treatment is opioid medications. many elderly patients fall in to this category.

 

[Crybaby]

I am so tire of hearing this excuse to get more narcotics/benzos/soma. I heard it even before the %#$! guidelines.
It was really awesome when psych doubled the pain meds on a guy that I had recommended be weaned off while inpatient for depression and suicide ideations. Low and behold his pain score was still 10/10 and still later tried to off himself (with prescribed meds)
You are then the bad person for sticking to recommendations.

 

[emd123]

I am so tire of hearing this excuse to get more narcotics/benzos/soma. I heard it even before the %#$! guidelines.
It was really awesome when psych doubled the pain meds on a guy that I had recommended be weaned off while inpatient for depression and suicide ideations. Low and behold his pain score was still 10/10 and still later tried to off himself (with prescribed meds)
You are then the bad person for sticking to recommendations.

Threatening suicide is not a valid means of showing your doctor you're a responsible, stable patient, that is a good candidate for opiates. In fact, it's likely the opposite. A true threat of suicide in my office buys a patient a 911 call, transfer to the ED and involuntary commitment to a psychiatric hospital. It does not buy them an opiate prescription.

 

[Ducttape]

"but doc, I was only kidding. I wont off myself, just a few more oxy 30s is all..."

and on gravestone:
All he asked was a few more Oxy 30s