MEISTER’S SHABBAT SURPRISE/PAINKILLER LAW POST-HOLIDAY POST!

Maybe it’s the nice weather in most parts of the country. Maybe it’s looking at the calendar. Maybe it’s that Punxsutawney Phil, the famous groundhog, survived another harrowing winter. (Or maybe there’s a new Phil, just like there’s sometimes a new Shamu at Sea World, until the orcas achieve final victory over their cheery, smiling captors.) Or, maybe it’s because I heard that Bryan Cranston is writing a book about “Breaking Bad.” Whatever the reason, April sure does seem like a time of renewal and rebirth. So, in this post-Passover, post-Easter – um, post – let’s talk about good news coming out of the War on Your Internist, otherwise known as the inappropriate criminalization of opioid prescribing.

All over the country today, there are state legislatures and regulatory bodies figuring out that maybe all that’s happened over the past decade isn’t doctors’ fault, and that maybe it’s time to revisit prescribing guidelines, so doctors are equipped with updated information. My belief has long been that if a prescriber changes with the changing science, he or she is doing all they can to keep patients safe and treat patients ethically. But law enforcement doesn’t always see it this way; task forces take this year’s knowledge and apply it to last year’s conduct. Theirs is a bad idea, and it takes a lot of work and persistence to break down a faulty law enforcement analysis, if it can be broken at all.

There are signs of hope, however, that legislatures and regulators are finally approaching this issue with cooler heads. Consider that today:

-Vermont is revising pain treatment and prescribing guidelines for the first time in 9 years;
-California is recommending new guidelines in the workers’ compensation setting;
-Oklahoma expects to release new guidelines within weeks; and,
-Pennsylvania will roll out its own set of new guidelines shortly.

These are just four examples of states doing the right thing and incorporating a new body of medical and practical knowledge into their laws and regulations. The onus is on doctors to learn the new guidelines and incorporate them into practice – but this is a far better situation than what we’ve seen these past few years, where doctors get hauled into court and prosecuted aggressively as though new knowledge was ancient.

It’s overly optimistic to say the danger to medical providers has passed. It’s fair, though, to say these are all positive signs that reason and sound judgment may yet have a say in how we deal with a major public health problem.

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