As a retired pain management specialist I have closely followed the new Centers for Disease Control and Prevention guidelines on “recommending” new limits for prescribers regarding opioids.
It was especially relevant to me not just as a physician but because of the discomfort I suffered while negatively shaking my head upon reading your editorial, “Guidelines a good start on combating drug abuse.”
Several decades ago, physicians were commanded under new recommendations that patient pain should be treated as the fifth vital sign (in addition to blood pressure, heart rate, respiration and temperature). Patient pain should be queried and aggressively treated, and physician performance on this matter would be closely monitored — albeit it was to be seen as merely a recommendation to improve care. Presently there is a narcotic abuse epidemic in the U.S. and worldwide that is being linked to the overprescribing of opioid drugs.
This is substantiated in the editorial and widely taken for causation by correlating “that fully 75 percent of those who become addicted to heroin get their start with prescription opioid drugs.” Statistics are funny things. One could argue the corollary that there are far fewer patients who become addicts that have been prescribed opioids, therefore the prescription must be preventative of addiction.
The new guidelines recommend these prescriptions for only a three-day supply and concurrent urine testing. Again, ivory tower medicine — think of what a three-day prescription looks like in the real world.
Having trouble getting a hold of your doctor now for blood pressure, diabetes and other chronic diseases for which pain actually dwarfs in numbers for the American population? Imagine having to do that every three days — one might as well start calling the minute they get home from the initial visit. Evaluating urine testing is more complicated than may appear to the layman, and indeed most physicians are not familiar with the nuances.
Tracking systems are essential and should be conducted by physicians and pharmacists in conjunction every time a narcotic prescription is involved. This should have been instituted long ago. The guidelines point out that other pain management avenues should be followed especially before or in conjunction with narcotic prescribing, and this is quite useful. In reality, the amount of time, effort and lack of systems in place to address this will negate the actual conduct of this, which is why the specific specialty of pain management evolved to allow physicians to refer their more complicated pain cases. Now these guidelines are asking overworked primary care physicians to take on this enormous responsibility, not only for the complicated case but for any involving a narcotic prescription.
Let’s be clear: From the standpoint of the practicing physician, these recommendations are another sword over their neck. Physicians were feeling these coming recommendations for the last decade prior and chose the most intelligent path for their practice to avoid litigation and the power of their medical boards: They just stopped prescribing narcotics completely. Those of us in the pain management arena saw this firsthand, and patients suffered tremendously.
Mark my word, these new guidelines, the feel-good words on paper to address an epidemic that is marginally caused by reputable physician practicing, will result in more pain and suffering for patient and physician both. It may actually increase the incidence of illicit narcotic use, and we will wonder how we ever thought this was good policy.
— Dr. Ron Ruff lives in Bend.