The Opioid Crisis and How to Safely Practice
Much has been written about the opioid crisis. It’s a difficult social and medical problem which conflates medical pain management with destructive addiction. Inevitably, the societal blame for this complex, multi-factorial problem falls on physicians who are also forced to solve the problem themselves. They are caught between a rock and hard place with greater fear of law enforcement, regulatory agencies, medical boards, hospital committees, and insurance companies.
The consequences for physicians and patients are often unfair. Regardless, it’s naive to expect anything different. Lawyers create, manage and profit from laws and regulations. However, it is up to us as physicians to deal with unfair practices while we advocate for change. In this short article, we will discuss the problem and how Pain Scored fits into your risk management toolkit.
“Lawyers create, manage and profit from laws and regulations… Pain Scored fits into your risk management toolkit“
In the last decade, the CDC became more active in opioid regulation leading to the release in March 2016 of “Guidelines for Prescribing Opioids for Chronic Pain.” The guidelines are not mandatory, and are generally for new instances of chronic pain. There are exceptions for patients already on chronic opioids or documented exceptions. These recommendations did not rise to the level of a standard; regardless, they have been interpreted in draconian ways by the DEA, health systems and insurance companies to deny pain medicine.
There was also a subsequent increase in DEA and regulatory body actions against physicians. A 2020 study by Daewhan et al. evaluated the numbers and found an increase in both rates of cases and prosecutions. The Medical Board in California had close to a 200% increase in disciplinary actions related to controlled drugs in several time periods. DEA prosecutions increased from 14 per year to 18 per year with the types of charges changing from drug dealing to allegations of improper medical practice described as “prescribing without medical purpose outside the usual course of medical practice.” Many investigations start, not with allegations of patient harm, but with secret analysis of clinical prescribing databases. There is no clinical context in these databases.