The US Congress never ceases to amaze me! Recently, the Senate HELP (Health, Education, Labor, and Pensions) Committee had a hearing entitled ‘Managing Pain during the Opioid Epidemic.’ In Chairman Lamar Alexander’s opening statement he conceded that in fact, there have been unintended consequences to their heavy-handed regulatory response. This evasive terminology is their way of saying “we screwed up.” In fact, five of the original authors of the 2016 CDC Guidelines for Opioid Prescribing have disavowed them, citing bias and irreparable harm. This thought was echoed by other witnesses at the HELP hearing with a directive to address or redress the contentious ‘mme daily limit,’ cherry-picked by Ballantyne, Franklin, and other CDC advisory committee members.
This response came in the way of a mountain of legislation called HR 6, which had been in the legislative pipeline since just before former President Obama left office. Also of note are CARA, CARA 2.0, VA Opioid Safety Initiative(s) which are well intentioned but simply went to far in prohibiting effective health care for the most ill, the disabled, the elderly, cancer patients and survivors, and our beloved Veterans who keep us safe in their oath to the Constitution of the USA and its people.
Congress failed to pass Palliative Health Care legislation despite wide bi-partisan support, according to the American Cancer Society in DC. The sad part is PCHETA legislation failed because much of Congress failed to differentiate between ‘Hospice Care’ and ‘Palliative Care.’ Perhaps legislators felt it would be political suicide to seek a middle ground after the stern response to the very problem they created and encouraged out of the gate. Prosecuting doctors and creating an environment of fear for physicians has done nothing to keep class 1 narcotics from flowing like the Niagra Falls (link story: Huge Fentanyl Bust). Expanding chronic pain through palliative care is a solution for many of the gaps that currently exist in the state of pain management, but must now be re-introduced which has yet to occur.
The epidemiology suggests regulatory and legislative actions have failed to stop mortality rates while persecuting physicians in Harry Anslinger 2.0 style. In the late 90’s we saw JHACO, Pharma, and the US Government push an aggressive and broad pain revolution that resulted in HUGE profits for all. With that increase, we saw a parallel increase in overdose deaths. When prescribing rates began to fall, something very interesting happened. Mortality increased despite a steady reduction in prescribing which indicates a failure of regulatory and administrative law policy. Physicians are being punished for adhering to ‘do no harm’ and are denied their judgement and training through PDMP ‘outlier’ targeting. This is a dangerous path to go down and ultimately harms us, or will harm us in the future. Congress knows it must act quickly with bi-cameral and bi-partisan veto proof legislation to rid us of street drugs that kill us and allow safe and effective FDA approved medicines that help us.