Comedian Chris Rock has a great bit about why we should all be vigilant for evidence of prejudice or bigotry. As he puts it, when illegal aliens are targeted, “I start listening, because I know blacks and Jews are next.” Then he looks at his watch and adds, “That train’s never late!” This lesson of vigilance is extra important today for all medical providers who prescribe opioids for chronic pain.
For months now, law enforcement has been leading the charge against so-called corrupt doctors and others who prescribe what are viewed as excessive amounts of opioids. In my view, as you know from previous PAINKILLER LAW blog posts, law enforcement’s leadership in this area amounts to putting the cart before the horse: Cops should not be telling doctors how to treat patients. But very recently there has been a slew of crucial developments that sends an unmistakable signal to prescribers, to the risk managers who help insure them, and to the malpractice defense attorneys who defend them. Attention must be paid, or prescribers will get in trouble, risk managers will write a lot more checks, and malpractice attorneys will not prevail using old arguments. And, of course, patients could be unsafe.
To have your ear to the train tracks on this issue is to know that now the scientific evidence is starting to match law enforcement thinking. This means a provider who does not keep up with scientific advances, and information provided by a source other than the pharmaceutical industry, risks getting run over by the oncoming locomotive of opioid reform.
Consider developments from just the past two weeks:
-The Centers for Disease Control’s director declares that too many doctors are prescribing too many opioids for too many people, with deadly impact and little patient improvement.
-The American Medical Association’s new recommendations on opioid prescribing acknowledge the CDC’s position and urge a significant shift in direction by opioid prescribers.
-A Harvard Medical School study finds it inconclusive that opioids are effective in the treatment of chronic pain.
These statements and studies have profound implications: If you as an opioid prescriber practiced in a way that even six months ago was roughly in compliance with the state of scientific knowledge, it would be harder to pin a crime on you if something went terribly wrong with a patient. But now, in the face of evidence from leading scientific and medical authorities which up-ends previous thinking about opioids for chronic pain, a practitioner who doesn’t adjust and adapt and possibly wholesale reform his or her methods of practice is putting themselves on a perilous path. It’s time for opioid prescribers nationwide to shift their practice methods to reflect and incorporate the CDC’s and AMA’s statement and recommendations. To ignore the advancing science is to invite law enforcement scrutiny, and deny yourself the chance to say, “As soon as the science changed, so did I.” Don’t get hit by an oncoming train.
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