THE COMING MEDICAL, LEGAL AND REGULATORY CHANGES IN OPIOID PRESCRIBING FOR CHRONIC PAIN
Hello! The Painkiller Law Blog went on hiatus for part of summer, and there really is nothing like a change of scenery to recharge the batteries and get perspective on things. So with Labor Day now behind us I’m back, and want to share with you what the summer break illuminated for me about the prescription opioid crisis and what it means for my healthcare provider-clients and their patients. In a nutshell, a steadily accumulating amount of new scientific and research data is debunking old assumptions about the safety and effectiveness of opioids for chronic pain. A rethink and reboot will soon be required for doctors to practice safe and legitimate medicine and to comply with the criminal laws of controlled substance prescribing.
Here are the things I’ll be talking about, starting today and in the coming weeks:
- We are in a major public health, public policy and law enforcement crisis. Medication designed to help patients is not supposed to be killing them in large numbers and creating what the Centers for Disease Control calls a national epidemic of unintended addiction, accidental overdose, and death.
- The assumptions that underlie today’s prescribing – that opioids are generally effective and non-addictive for chronic pain patients – are seriously in question, and some would say the assumptions have already been proven wrong. Some of course would say that the skyrocketing addiction, overdose and death rates are all the proof required.
- Medical Boards have to create guidelines that reflect current science. Only based on current science can doctors truly know when to prescribe, when not to, and when to stop.
- Lawyers advising and representing opioid prescribers have to identify where the medicine is going, and the implications of that, to know how to advise clients today and prepare for changes tomorrow.
In the coming weeks I will talk about each of these topics in detail. In the meantime, here are some current manifestations of the prescription drug crisis:
- Manufacturers of Narcan and other opioid-antidote (overdose reversal) drugs are making money hand over fist. Nothing wrong with making money, but the need for opioid overdose reversal drugs only arose from a nightmarish rise in accidental overdose from opioid prescriptions.
- Opioid addiction rehab programs are a growth area for substance abuse treatment centers nationwide. Again, there’s everything commendable in meeting this need, but it’s a tragic commentary.
- Communities around the country hold candlelight vigils for their numerous dead, victims of accidental prescription drug overdose, while organizations host International Overdose Awareness Day events around the world.
- Local and state governments plead for more federal money to address what governors, legislators, doctors and police call a “medical emergency” of addiction, overdose and death from prescription drugs.
- Heroin use across the country is by some estimates worse and more widespread than ever before, as everyone from soccer moms to senior citizens loses access to prescription opioids and turns to the street for pain relief and to avoid going into withdrawal. The active ingredient in heroin and prescription opioids is, after all, essentially the same.
- Mexican drug cartels have long since spotted the new heroin trafficking opportunity and are making a killing, on killing Americans.
- The State of Maine plans to do undertake two major efforts this Fall season: Preparing for the annual tourism bonanza as people come to see the leaves turn; and activating the National Guard to fight the dramatic rise in heroin trafficking within the state.
Is this what the pharmaceutical industry expected when it said new evidence proved opioids safe and effective for chronic pain?
Is this what the FDA expected when it approved the studies and allowed drugs like Oxycontin to be mass marketed and mass prescribed?
Is this what the Federation of State Medical Boards expected when it wrote guidelines for prescribing opioids to chronic pain patients?
Is this what your neighborhood internist or family practitioner expected when patients starting asking requesting opioid therapy for chronic pain?
Is this what patients or their spouses, siblings, parents, kids expected when someone in the family was prescribed an opioid for a sports injury, bad back, arthritis or other condition?
The answer to all of those questions is probably “no.” But that’s the situation we have. The time will soon be upon us for a rethink and reboot, medically, legally and regulatorily. Stay tuned for more posts on these topics.