PAINKILLER LAW: D.E.A. WINS TODAY; PATIENTS WILL LOSE TOMORROW

The FDA today concluded its highly watched two-day meeting on prescription drug abuse, notably – and erroneously, in PAINKILLER LAW’s opinion – endorsing a hardline proposal from the D.E.A. If the D.E.A. gets its way, and hydrocodone is reclassified as a Schedule II drug, patients will lose, and access to needed medication will be callously impeded.

The D.E.A has been pushing for this change, and the FDA panel by a close vote of 19 to 10 may be mistakenly coming around to the the D.E.A.’s position. Advocating similar change is a prominent doctors’ group, Physicians for Responsible Opioid Prescribing (PROP). But the coincidental joining of these two forces – cops and docs – doesn’t make the idea any more credible. This proposal if implemented could rigidly and with unreasonable orthodoxy deny thousands of legitimate pain patients access to the medicine they need. PROP and the D.E.A. in this instance seem to trust no one but themselves to decide for everyone else what medicine should be taken and for how long.

A direct and intended consequence of the D.E.A. proposal is that only MD’s could prescribe even Vicodin from now on. That means if you had dental surgery coming up, and your dentist told you it was going to be a tough recovery, he or she wouldn’t be able to give you even a few days’ worth of Vicodin for head-splitting midnight pain. You’d have to get that from your MD, after the pain was already knocking you over, or you’d have to get to the E.R. in the middle of the night to seek some relief. Why must the D.E.A. presume that ordinary citizens can’t be trusted to not become addicted to opioids even though they’re only given a three-day dose for acute pain?

This also means that if you see a physician’s assistant for your medical care, that person would no longer be able to write for certain pain medications, at all, ever. Is that reasonable? Is the D.E.A. making a competency judgment about licensed professionals? Is the agency dismissing the state legislatures and medical boards that have determined the legitimacy and licensing standards for PA’s in every state in the Union? Does the D.E.A. not care that frequently, PA’s serve patients in medically underserved communities? Did the D.E.A. not get the memo: That legislative support for PA practice often stems from the precise policy goal of getting qualified healthcare providers to those communities who need them most but have them least?

The best course is for the FDA to reject the D.E.A’s proposal. Expect the D.E.A., possibly PROP, and others to in good faith continue to pursue ultimately unsound idea. And remember that no amount of good intentions makes a bad idea better.

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PAINKILLER LAW: The Provider’s Dilemma, Part Two

Healthcare providers writing legitimate prescriptions for pain medication today swim in shark-infested waters.  Every provider needs to protect herself or  himself from the crusading law enforcement agencies that presently are happy to shoot first and ask questions later in the new effort to “crack down on” or “do something about” prescription opioid abuse.  In previous posts I have coined the phrase, “The Provider’s Dilemma,” to describe the conflict faced by physicians, osteopaths and physician’s assistants in prescribing Schedule II through V medication for patients with severe, chronic or debilitating pain, on the one hand, and providers’ being subjected to unwarranted or impulsive administrative or criminal scrutiny for prescribing pain medication, on the other.  Today I elaborate on The Provider’s Dilemma, with special attention to two news releases which, ironically, came out within hours of one another.

The first release was from Virginia Commonwealth University’s Spine Center, which in a recent study found that long-term intrathecal opioid treatment can be beneficial for pain management and reduction.  The study cited concerns about tolerance, absence of relief, or development of dependency which can occur with patients taking oral opioids, but the study did nothing to undermine or debunk the notion that these drugs can bring much needed relief to patients suffering from real pain.  The science continues to be in line with patient-care policy in states like California, and with the instructional and philosophical approach taught in the nation’s medical schools for the past few decades:  That good medicine includes treating pain patients in need.

But then, in the second news release, the White House Office of National Drug Control Policy (“ONDCP”) boasted of the recent summit it had with a dozen or so other federal agencies, including the Justice Department, on the Office’s #1 priority:  Fighting what it once again called the “Prescription Drug Abuse Epidemic.”  Just the issuance of this release by the ONDCP should be enough to give pause even to the most scrupulous and conservative healthcare practitioner, mid-signature on the prescription pad.  This is because the awesome power of the White House, the D.E.A, and the rest of the federal government is today arrayed and ready for what the government considers the latest iteration of the War on Drugs.  Only this time, they’re pursuing healthcare providers instead of cartel kingpins, and the scourge they’re deploying against is for legitimate and lawful prescriptions, not street drugs.

What should you do?  On the one hand, the people who tell you it’s still OK to use your best medical judgment in writing painkiller prescriptions carry the wise words of Hippocrates.  But the people on the other side of the issue carry badges and guns, and the blessing of federal, state and local government to come after you if in the “considered” opinion of a prosecutor or cop with not one day’s medical training, you’ve crossed the line in prescribing opioids for pain.

What are your options?  You can stop writing prescriptions for any opioid painkiller and hope for the best, not only for yourself but for your patients whose medical needs you may end up neglecting.  Or, you can carefully and thoroughly incorporate best practices into how you assess, diagnose, treat and monitor anyone who needs pain relief, and be in compliance with federal and state criminal laws about writing for these medications.

That is where Painkiller Law: Criminal Law Compliance for Healthcare Providers comes in.  Painkiller Law is a comprehensive legal service offered by the Meister Law Offices.  We provide a top-to-bottom review of your practice to enable you to verify, achieve and maintain compliance with applicable laws, incorporate best practices into all you and your staff do, know where the red flags might be, and stand with you if you ever find yourself under investigation.  In the current enforcement environment, you cannot control whether the D.E.A. or F.D.A., or your state’s Medical Board, start looking at you.  You do not, however, need to be at their mercy.  Be in compliance, be ready, and thereby be best positioned to prevail.

Call Painkiller Law today for a free consultation, at 213.293.3737, or email info@painkillerlaw.com

 

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PAINKILLER LAW: THE NEW “BLAME GAME” IN Rx ABUSE

Did you as a medical doctor, osteopath, physician’s assistant or pharmacist know that YOU are to blame for Rx abuse nationwide?  The White House Office of National Drug Control Policy is placing new emphasis on treatment and prevention of Rx abuse and urging a new, more “compassionate” model be adopted when it comes to how patients abusing prescription painkillers should be approached.  But blame for Rx abuse has to be placed somewhere.  And so it has been placed on healthcare providers who write painkiller prescriptions, and the pharmacists who fill them.

Look no further than an article in Wednesday’s Wall Street Journal for proof.  The article, “Making the Pharmacy Crawl,” explains that patients in many states have to travel to several pharmacies to fill legitimate prescriptions, as a result of new laws’ making “doctors criminally liable and revok[ing] their licenses for writing prescriptions for painkillers that lead to overdoses.”  This, in combination with pharmacies’ being subject to stricter limits on how many opioids they can dispense in a given period, has led, says the article, to a reduction in the number of doctors writing prescriptions, and in pharmacies’ not being able to fill what even a legitimate patient with a legitimate scrip might need. Is this really helping people? Or is it placing doctors’ judgment under a microscope, allowing if not requiring scrutiny of medical judgment, by government agents with no medical training or experience?  Is it substituting pharmacists’ judgment, discretion and ethics for hard and fast marching orders from the DEA?  Is it going to do anything to crack down on what the government calls the prescription painkiller epidemic, or will it just make people’s lives harder, subject them to more unwanted bureaucracy, and punish ethical practitioners and legitimate patients along with a few corrupt practitioners and drug addicts?

Ham-fisted governmental action that creates unintended consequences for good and law-abiding people abound, especially in an environment like this where the government is basically feeling its way as it goes.  When government treats a public health problem as a law enforcement problem, there is going to be a lot of collateral damage behind every press release or high profile arrest.  Don’t be the collateral damage.  Protect yourself and your practice from governmental heavyhanded behavior, by being in compliance now with all applicable criminal laws about prescribing painkillers.  Compliance goes a long way; it makes for ethical and sound patient care; it gives you peace of mind that if you’re ever investigated you will be ready; it helps persuade law enforcement that you are practicing appropriately and properly; and it acts as a foundation for a defense if you ever need.

Call Painkiller Law, a service of the Meister Law Offices, today for a free consultation on how to verify, achieve and maintain criminal law compliance in writing prescriptions for pain medication.  It’s good preventative medicine.  213.293.3737, or write us at info@painkillerlaw.com.

 

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