Opioid-related deaths continue to be an epidemic of crisis proportions. But federal and state agencies are focusing on the wrong target – legitimate prescribing of opioids – and have insinuated themselves into the doctor-patient relationship as never before.
The foundational facts remain undisputed. Opioid-related deaths continue to be an epidemic of crisis proportions. More than 72,000 opioid-related deaths occurred in the US during 2017. (Final results for 2018 are not in yet, but the death rate from opioid overdose is expected to remain relatively flat.)
Politicians work to legislate how doctors can or cannot prescribe pain meds
The opioid epidemic has gained widespread notoriety. And politicians sense an opportunity to gather some easy votes. But the solutions being considered in legislatures across the country impose draconian limitations on the discretionary judgment of prescribing physicians.
For example, the Oregon Health Authority recently proposed to taper the opioid use of all Medicaid patients suffering from chronic pain down to zero.
Dr. Beth Darnell of Stanford University was invited to address the commission considering that proposal. In her remarks, she noted that: “The debate has turned into an argument of opioid yes or opioid no. But it’s not a black-and-white issue. A forced taper to zero may destabilize an individual both medically and psychologically.”
What happens when government interferes between doctors and patients?
The media is now acknowledging some of the problems that will result from such governmental interference between patients and their doctors.
A Fox News opinion recently asked: “Since when does the government write prescriptions?”. The article goes on to assert that:
- “Federal and state agencies are focusing on the wrong target – legitimate prescribing of opioids – and have insinuated themselves into the doctor-patient relationship as never before. Our governments are taking prescription pads out of the hands of physicians and dictating which, and how much, prescription pain medication may be prescribed for patients. This is chilling and unprecedented.”
What’s the difference between opioid dependency and addiction?
New laws are being proposed by more strident politicians. But they overlook the fact there’s a big difference between dependency and addiction. Addiction is substance abuse. It’s compulsively using a drug despite significant negative results.
But dependency does not qualify as addiction. Patients can be dependent upon opioids and still lead normal, productive, and happy lives. There’s no reliable evidence that opioid dependence necessarily produces negative outcomes.
Policy analysis on the opioid epidemic from the Cato Institute argues that:
- “The opioid epidemic has resulted from too many restrictions on prescribing, not too few. The risk of overdose from the proper medical use of prescription opioids is low. Worse, restrictions on prescribing push users away from prescription opioids and toward diverted or illicit opioids, which increases the risk of overdose because consumers cannot easily assess drug potency or quality in underground markets.”
In any event, the federal government has been consistently unable to effectively regulate pharmaceuticals. The federal agency with jurisdiction over prescription drugs is the FDA. The mission of the FDA is to keep unsafe drugs off the market, not to regulate the sale and use of approved drugs.
The FDA doesn’t possess forceful tools for changing the behavior of either physicians or consumers
The only post-approval aspects of pharmaceutical drugs over which the FDA has direct control are labeling and marketing. And even making meaningful changes in those limited areas has been difficult for the FDA.
It took several years, from the late 70s to the early 80s, for the FDA to make relatively insignificant changes in how drug labels describe when a tranquilizer should be prescribed. And labels, of course, don’t really control how a drug is finally used.
Neither legislation nor regulation will provide the ultimate solution to the current opioid crisis
One-size-fits-all laws may sound good in a campaign speech. But in real-life applications those laws fail to recognize crucial distinctions. And until the FDA is given some effective means of controlling post-approval distribution of pharmaceuticals, its remedial powers will remain negligible.
It’s clear that no all-encompassing governmental control over how physicians prescribe for their unique and individual patients can ever provide a solution. The 2016 CDC opioid prescription guidelines confirm this principle. Those guidelines strongly encourage physicians to reconsider when and how they prescribe opioids.
But those same CDC guidelines also state that opioid therapy should be continued when opioids provide “clinically meaningful improvement in pain and function that outweighs the risks to patient safety”. In the final analysis, this basic calculus can only be resolved between a doctor and a patient, one patient at a time.
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Read the full article at: www.foxnews.com
Dr. Vahedifar's pain management strategies integrate cutting-edge medical technology with targeted interventions to minimize pain and treat pain’s underlying causes.
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