Maybe the Opioid Crisis Wasn’t Our Fault? Duh.
I am old enough to remember the stupid pain scale and mandates to treat the 5th vital sign. That was around the year 2000. I ignored it because I knew the risk of opioids. We were supposed to ask every patient in every visit their pain number. How ridiculous was that? My partners and I ignored that too. And we were right. In 20 years, thanks to the Joint Commission who helped Purdue Pharma cash in on Oxycontin, we now have an opioid crisis.
So the cavalry was brought in.
The government, in their collective wisdom, had to make themselves look good so they went after EVERY doctor to make sure they were NOT overprescribing narcotics. We all knew it was the pain “pill mills” causing much of this. The government ignored our pleas for years but since I never changed my pattern in 2000 I never had to worry about this. It turns out, as we knew, it wasn’t the majority of doctors doing this.:
Physicians have prescribed 44 percent less opioids over the past decade, yet fatal and nonfatal drug overdoses have continued to climb, according to a new report from the American Medical Association (AMA).
So, there you have it. The drugs are getting into this country illegally or there are still pill mills left. One or the other. How about we fix this?
Nope.
Doctors are easy targets. They are weak and rarely fight back. Just like the pain scale and the massive Physician Monitoring Programs, we will have new mandates to watch over us and intrude into our practice.
And the overdoses will continue.
Also remember it well. Thought it was bogus crap then and that is what it turned out to be. I was afraid of narcotics and continued to prescribe judiciously and rarely. Doctors are supposed to use their heads and make their best judgements, which the JCAHO decided wasn’t right. The sad part of this is that when I was a young doctor cancer patients’ pain was consistently undertreated due to concerns about addiction (I know, WTF) and that was also one sure way to get the boards after you. Now, years later (never mind how many) I suspect postoperative and cancer pain are again consistently undertreated again because everybody is (rightly) scared of the regulators again. Sure hope this evens out at some point. JACHO needs to be right in line behind Purdue Pharma and the pharmacies on the liability list. And remember the ‘expert’ witnesses who testified against their colleagues in lawsuits alleging undertreatment of pain? Them too.
Yes I remembrr it well. As a PA who did ER, FAMILY PRACTICE,URGENT CARE AND CHRONIC PAIN MANAGEMENT the 5th Vital sign. Must document and Treat.. Did that,gave tylenol or Ibuprofen seldom wrote for a narcotic. Was asked by nmy supervising Physician how I could deny them pain meds,My response was
Do I want to be part of their problem or part of their solution. I choose appropriate prescribing, and referral for evaluation for chronic pain management,addiction services and treatment. A guy showed me his pain patch,it was saran wrap.. He thought I would not know. Poor choice on his part.
The US Government is Responsible for the pain pandemic and 5th vital sign. They Mandated it,made reimbursement to ER,URGENT CARE ,CLINIC, a requirement for reimbursement. So did our STATE BOARDS.
PHARMA Government, and a few bad actors at all levels are responsible…
Changing work, lack of jobs, lack of retraining programs, poor individual choices cause the cyrrent Crisis in Drug Abuse.. So is legal Marijuana, higher you get,more paranoid,,and todays maryjane is a lot stronger than the 60’s or 70’s varieties.. Seen the commercial for the Herbicide Paraquat causing Alzheimers/Dementia.
Guess what the US Government sprayed all over central America,Mexico and USA marijuana Fields Yes
Paraquat herbicide… Lets create more problems.,Like the roaring 20’s when they poisoned the Legal Alcohol..
Killed Thousands. Wonder how many will face the Horror of Dementia/Alzheimers…
CHOICES HAVE CONSEQUENCES.. MAKE CAREFUL WISE LIFE AFFIRMING CHOICES..
ALL THE TRAPS OF EARTH….
As a nurse for more than 45 years, this has been a sore spot for me. It’s not like we couldn’t all predict the train wreck, but had no control of the tracks or the train. Joint Commission needs to publicly admit their part in the opioid crisis. I wish they practiced accountability as well as they preach it.
It is the partial fault of anyone who prescribed this drug AFTER they knew just how highly addictive it is. Yes, the pain score trollers were part of a marketing frenzy fueled by the pharma industry. But everyone looked away, and now they are getting looked a second time at by the Federal government. The pharmacists who filled more prescriptions for more tabs than people who lived in the town. The middlemen who shipped thousands of pills to rural areas that could have never used them-again, more than the towns population would need even if they were all taking them daily. Did anyone question this? WHY NOT? THEY QUESTION EV EVERYTHING ELSE, WHY NOT THIS? Was it all about the money? And now when the patients can’t get them, they try a five dollar bag of heroin. A better high for much less money. Unless it’s laced with fentanyl. Then more deaths and more hurt.
Funny, like Doug, and myself, many people did not prescribe Oxy. Tylenol number three or 4 Advils worked fine. But many did. Europe never bought into it. They knew it would lead to nothing positive. Why did we? So many factors we and many others did not question.
Dave
Did you know that there is a plaintiff’s attorney named Tal Franklin, from Dallas, who is pursuing a liability allegation naming The Joint Commission (The new name for JCHAO) on behalf of Huntington WV, Chaleston WV, and 2 smaller WV cities, that was filed in the applicable US District Court in November of 2017?
Reach out to him at [email protected] if you wish to start a communication with him. I have phoned him from time to time in trying to persuade authorities here in the metro St Louis area to join in this effort. Mr Franklin is very personable and surely would at least answer your emails if you wish to learn more.
He is a late-career attorney but started a firm.
Here is a link to the website the firm keeps for him:
https://www.franklinscottconway.com/team/talcott-franklin/
Couldn’t happen to a more appropriate entity. JACHO was one of the main drivers and need to be held accountable.
I agree with you, Doug, and Bob. Before I retired a few years ago I was writing monthly opioids for a number of patients and dutifully doing drug screens. I fired a couple of patients for using marijuana and now marijuana is becoming mainstream, slowly, for management of pain and PTSD. Fast forward to the present…I rented my building to a board-certified anesthesiologist who needed to expand his pain-management practice. This summer he got nicked by the state board because they pulled all of FOUR charts and felt he wasn’t meeting “their” guidelines, i.e., referring for chiropractic, acupuncture, cognitive behavioral therapy, counseling, etc….in the middle of a pandemic! So, with 60,000 overdose deaths a year and rising, in my opinion, the state boards have blood on their hands. As doctors have dutifully reduced prescribing (and almost none of the alternative methods above work for most of our patients) patients are turning to street drugs and killing themselves, mostly accidentally. Personally, I can’t even blame Purdue Pharma…OxyContin works, but tolerance quickly develops…it’s the pharmacology, dude! Until scientists develop new drugs for neuropathic pain, it’s a problem we’re stuck with.
I wish I could say I ignored the pain guidelines around 2000 but I was working emergency medicine, and we were expected to get those pain levels down immediately. We were expected to follow the joint commission guidelines and the way to do that was opioids. I was told by the ER director “we aren’t the narcotic police, just give them the pain meds”. And it wasn’t just the joint commission – state medical societies jumped on board the narcotic train, only to do a 180 and start coming after doctors for following the same guidelines they has set just a few years earlier.
The reason the government came down on doctors was that we were about the only aspect of the opioid problem they could control. They aren’t able to treat addiction or control the sale of illegal opioids very well, so the docs were an easy target.