Since the war on the “opioid crisis” started, it has been tough for those suffering from pain and those who minister to them. Public policies, or mis-interpretation of them, has led to a swing of the opium pendulum to an excess of abstinence. Many have been harmed in the process. Some have fought back.
There may be hope, though. For all those in pain or who will be in pain, especially those referred to as opioid refugees, one would have to look at the events of past few weeks as a sign of hope.
- The FDA sent a letter to all doctors in the US informing them of the dangers of abrupt discontinuation of opioids and advised physicians against that practice.
- The authors of the CDC guidelines, in response to pressure from various entities, published a clarification of the 2016 guidelines stating that: “policies invoking the opioid-prescribing guideline that do not actually reflect its content and nuances can be used to justify actions contrary to the guideline’s intent
- The “Pain Management Best Practices Inter-Agency Task Force Report” was released calling for increased access to various therapies for pain
In the midst of all of this, something really big happened. A physician was held accountable by the New Hampshire Medical Board for harming a patient by abrupt opioid dose reduction to fit within a mythical dose restriction, and then, when the patient de-compensated, was discharged from the doctor’s care. His punishment was not big, but it was a punishment. Many of my friends all over the country have said:
“It’s about time!”
And it all happened in my home state. That does not really surprise me. We have a good medical board and one of the more patient and provider friendly set of opioid prescribing rules in the country.
So, I should be excited, correct? Up to a point, yes, but I can’t help but be overwhelmed by the hypocrisy of all of this. It is always dangerous to comment when one does not know all the facts. I know the facts in this case as reported, but there is usually more to the story and there are two sides to every story. With that said, it really stinks being a pain doc these days. No matter what you do, someone will say you are wrong and will pressure you to do what they want you to do. In such a circumstance, it takes a really courageous individual to do what he or she believes is right.
When the war on the opioid crisis started, those in power felt a need to do something. When one identifies a problem, the first step is to find someone to blame. And so, they blamed prescribers, pain patients, and pharmaceutical companies. In some states, individual physicians were held accountable in a very public way by policy makers, regulatory agencies, and the media. I find it ironic that several years ago, the same newspaper that published this news release, released the names of the biggest opioid prescribers in our state, an action that sent chills down the spines not only of those named, but also of those who could have been named.
For every action, there is a reaction, and in this case, the reaction was that many doctors in our state started arbitrarily lowering doses of opioids to fit guidelines, discharging patients for sometimes flimsy or fictitious violations of agreements, or just discharging patients, period, and getting out of the pain game. You can call it “covering your backside” if you wish, but the reality is those docs were very much afraid because the threat was not just medical censure, but also potential criminal charges.
So policy makers, convinced that the opioid crisis was simply the fault of those three groups, got their way. Prescribing plummeted. Predictably, those in pain suffered. Some died. It has not mattered what type of pain, acute, chronic, or end of life, all have been affected. What bothers me most in my dealings with insurers, regulators, and policy makers, they don’t seem to either notice or care. And they, at base, are the ones at fault.
To change behavior, nothing is more effective than putting someone’s head on a spike to scare those you wish to affect. That is how the war on the opioid crisis started. So now a new head has been put on a spike in an attempt to move the opioid pendulum. Should this doctor have been so publicly punished? Maybe not publicly. At base, I do not believe that he was the only one to blame, or even the primary one. Still, this action draws our attention to those who have been harmed by such a myopic, un-balanced public policy, and that is important.
Every cause needs a sacrificial lamb to gain traction. For reasons both wrong and right, maybe we have our lamb. Let us share this example with those in power, so they too can see how their actions have harmed too many of our friends. Hopefully, they will choose a more balanced policy that reflects the needs of all. That is what we have been arguing about for more than twenty-five years. God speed.
David Nagel M.D. is a New Hampshire pain physician and an author. His book, Needless Suffering How Society Fails Those With Chronic Pain is an excellent read and can be ordered here on Amazon.