Just a week or so ago, I was asked about the new education requirements for physicians who wanted to prescribe certain opioids. I checked and found that in most places, there still aren’t any.
That surprised me, because I’ve noticed increased caution among the practitioners I work with, not just for opioids but for benzos such as Valium and Xanax. But I guess that was due to media coverage, or concern over potential liability.
Meanwhile, the battle over painkillers rages on. Despite the collateral damage, Big Pharma seems determined to preserve the market for its products, through sophisticated lobbying. In today’s politics, that means large infusions of cash, old-fashioned political pressure, and employing surrogates– often advocacy nonprofits formed for that purpose. It’s these surrogates who carry the message to an increasingly skeptical public.
Here’s a fascinating article that appeared just recently, courtesy of the Associated Press.
I’ve rarely criticized big for-profit corporations for doing what they’re intended to do– which is make money for their investors, large and small. I get that, and I certainly wouldn’t expect them to abandon their mission in favor of what I happen to think is the public’s best interest. But it does seem as if there are steps we could be taking, that for some reason– we still haven’t.
I liked the plan laid out in this article. A brief summary:
- Avoid using opioids for acute pain unless indicated.
- Limit the number of pills
- Make a time-limited plan for use
- Reevaluate before refilling
- Revise outdated policies at the state level
- Track trends, including prescribing, ODs, and SUDs
- Talk with the patient at every refill visit.
- Use a gradual taper to discontinue medication.
- Consider taxing painkillers to raise funds for addiction treatment.
OK, that last one will raise some eyebrows, but do you see anything at all among the rest that seems terribly unreasonable?
Neither do I.
I see a problem with a few.
2. “Limit the number of pills” – Who decides on the number of pills that can be prescribed considering everyone is different, their pain is different and the number of pills they may need to combat their individual pain is different? What I require to regain a semblance of a life may be substantially different from someone else. This decision should be left up to the Dr and the patient to determine, not the government.
3. “Make a time limited plan for use” – this may work for acute (short term) pain but what about chronic (long term) pain? Chronic pain will just come roaring back if the patient is denied their needed pain medication, so a “limited plan for use” wouldn’t work for them. Again, this decision should be left up to the Dr and patient to determine what’s best for that individual patient.
4. “Reevaluate before refilling” – how would this be done? With a set Dr appointment each and every month? Most people suffering from chronic pain conditions so severe they need prescription pain medication are unemployed (because of the pain) or on SS Disability and don’t make a whole bunch of money. So do you want to drive them further into poverty by making them pay for a Dr visit every single month just to get needed medication for a legitimate medical condition? Would a health insurance company even approve that? If not, would the patient then be responsible for the cost of the WHOLE visit instead of just the co-pay? Again, these people aren’t rich. This would be essentially denying them medical care and medication needed for a legitimate medical condition.
5. “Revise outdated policies at the state level” – What policies? Ones that would put more restrictions on patients? Sorry, but the last thing we need is more governmental intervention in what’s supposed to be our personal and PRIVATE medical information. You want to let them into your private medical records, go right ahead. But don’t assume others would feel as comfortable doing the same.
6. “Track trends, including prescribing, ODs, and SUDs” – Don’t worry, legitimate patients with medically verified medical conditions taking prescription pain killers responsibly are already having our privacy and our HIPPA rights violated by the prescription drug monitoring programs (PDMP) in place. We’re already being treated like criminals for no other reason than we were unlucky enough to have chronic pain conditions. Just being on prescription pain medication gets us unjustly labeled as an addict. Maybe next they’ll take blood samples, fingerprint us and do weekly home searches. You may laugh, but some police departments have already used the PDMP to conduct unlawful searches of people’s homes and charge them with crimes with no other evidence than that they just TAKE prescription pain medication. People have lost their jobs because of it. I wonder next if we’ll be required to wear gold stars on our sleeves.
7. “Talk with the patient at every refill visit.” – this goes back to #4 – so a chronic pain patient who’s never taken their medication irresponsibly and has a legitimate medical condition requiring pain medication would be required to schedule an appointment with the Dr every month? That’s discriminatory unless every patient with every condition is required to do the same every month. We’re not criminals. Please stop treating us as if we are.
9. “Consider taxing painkillers to raise funds for addiction treatment.” – You’ve gotta be kidding me. So now all chronic pain patients who take their Dr prescribed medications responsibly and have never abused them are now going to be burdened with the forced financial responsibility of funding the treatment of all addicts? Forget the fact that a lot of chronic pain patients are out of work so they don’t have prescription insurance and this would create an enormous financial burden upon them, or that even for the ones who do receive meager Social Security Disability benefits, they are barely making ends meet – but how in any sense of the word is it fair to allow addicts to receive free care while saddling those who took their prescribed meds responsibly with the cost of the addicts rehab? That’s just asinine. It’s inanity. Should all mother’s who stay at home be forced to pay the childcare costs for those mother’s who have to go to work? Should all gyms force fit members to foot the bill for memberships for obese members? Of course not. That would be insane – as this suggestion is. The only one responsible for an addicts addiction is the addict. They chose to abuse drugs. We all make choices in life and must take responsibility for those choices. It’s called being an adult. Maybe the addicts need to have jobs during rehab to pay for the treatment. If rehab is that important to them, they shouldn’t have a problem working for it. Maybe a little hard work paying for rehab and building their self esteem would prevent some from choosing to relapse.
This is just another way chronic pain patients with legitimate medical conditions who take their medication responsibly are being made into criminals and vilified. We should not be lumped in with those who do not have legitimate pain conditions that abuse prescription pain meds; we should not be make responsible for those who buy them illegally and choose to abuse them; we should not be made responsible for those who become addicted; and we should not be treated like criminals. We have done nothing wrong. All of these suggestions, lumped in with the dehumanizing pain contracts, urine tests, and pill counts that they are forced to go through at every doctor’s appointment, are unfair and unjust. Chronic pain patients with legitimate medical conditions who take their medication responsibly are being treated like addicts and criminals, and it needs to stop now. #PatientsNotAddicts