By Steve Ariens, P.D. Pharmacist
We have all seen/heard where many politicians/bureaucrats have passed rules/regulations/guidelines that place a limit on amount of opiates that a prescriber can provide any individual patient. Usually expressed in Morphine Equivalents.
This “cookie cutter medicine” concept totally ignores the patient’s individual source, intensity of pain and if the patient is a fast or ultra fast metabolizer of opiates.
Because these limits are being put in place by some/many that have little/no medical background or education. IMO, they have included loopholes for chronic non-cancer pain that may enable them to get better pain management. Our society, as a whole, has empathy for those who are suffering from terminal cancer, because they can spend their final days in excruciating pain.
Most/all of these politicians/bureaucrats have placed in these legal requirements, exemption for those who are terminal, cancer and in need of palliative care. All of these politicians/bureaucrats who are “short on medical knowledge” seems to believe that palliative care is exclusive to terminal cancer patients.
The World Health Organization (WHO) has issued guidelines for palliative care and demonstrates that palliative care can be a free standing method of patient care.
Palliative care is an approach that improves the quality of life of patients and their families facing the problem associated with life-threatening illness, through the prevention and relief of suffering by means of early identification and impeccable assessment and treatment of pain and other problems, physical, psychosocial and spiritual. Palliative care:
- provides relief from pain and other distressing symptoms;
- affirms life and regards dying as a normal process;
- intends neither to hasten nor postpone death;
- integrates the psychological and spiritual aspects of patient care;
- offers a support system to help patients live as actively as possible until death;
- offers a support system to help the family cope during the patients’ illness and in their own bereavement;
- uses a team approach to address the needs of patients and their families, including bereavement counseling, if indicated;
- will enhance quality of life, and may also positively influence the course of illness;
- is applicable early in the course of illness, in conjunction with other therapies that are intended to prolong life, such as chemotherapy or radiation therapy, and includes those investigations needed to better understand and manage distressing clinical
To the best of my knowledge, there is no special education, licensure or certification for a prescriber to provide or diagnose a patient in need of palliative care.
Because most prescribers are fearful of the DEA coming in and raiding their practice, many are attempting to follow the letter of these laws.
Most/all laws have loopholes that can be utilized. In this case, this loophole could provide a prescriber a path to be able to provide better treatment to chronic pain patients by exceeding the imposed Morphine Equivalent limits and still conform to the letter of the law.
My suggestion to chronic pain patients, whose prescribers are reducing their pain medication and using these various rules/laws/guidelines as justification. Take a copy of the WHO palliative care guidelines along with a copy of whatever rules/law/guidelines the prescriber claims to be following and pointing out where those patient in need of palliative care are exempt from those limits, and ask the prescriber why they cannot be diagnosed as being in need of palliative care per the WHO guidelines.
I would suspect that all too many prescribers have only read the Morphine Equivalent limits and not bothered to read the entire text, and have established their own policy based on the general rule and not tried to find a reason within the text to allow them to provide better pain management for their patients.
Steve Ariens is a pharmacy advocate, blogger, and National Public Relations Director for The Pharmacy Alliance.