Most Physicians Lean Toward Adopting CDC Opioid Guidelines
http://www.medscape.com/viewarticle/861831?src=wnl_tp10n_160505_mscpedit&uac=232297BR&imp
The question has to be asked… if a pt is harmed because a practitioner does not follow all CDC guidelines to the same extent as the opiate guidelines… could the practitioner be guilty of MALPRACTICE ? For example.. a practitioner doesn’t INSIST/DEMAND that all pts have flu shots, Zostavax (Shingles), Prevnar-13, Pneumovax 23 and/or any other recommended vaccine or booster vaccines. Should a practitioner have the latitude to strictly adhere to some CDC guidelines and ignore others without liability if pts suffer consequences ?
Roughly 3 in 4 physicians said in a Medscape Medical News poll that they lean toward adopting the stricter guidelines on prescribing opioids for chronic pain that the Centers for Disease Control and Prevention (CDC) issued in March to combat an epidemic of addiction and overdose deaths.
The guidelines, aimed at primary care prescribers, state that opioids should not be considered as first-line therapy for chronic pain and that clinicians should first consider nonopioid pain relievers or nondrug alternatives, such as exercise, meditation, and cognitive-behavioral therapy.
Although 76% of physicians said in the online poll that they were very (49%) or somewhat (27%) likely to incorporate the CDC’s recommendations into their practice, they also pointed to roadblocks in their way. These include pressure from patients to prescribe opioids and the lack of third-party reimbursement for nondrug treatment of chronic pain. ‘Nurses, including advanced practice nurses (APNs), were slightly less willing (62%) to embrace the government’s recommendations.
For many clinicians, treating chronic pain is a significant part of their work. Thirty-five percent of all physicians said they see 31 or more patients with chronic pain per month, or slightly more than one a day on average.
Of the 483 Medscape readers who completed the poll as of noon on April 6, 241 were physicians, and of that number, roughly 20% were from outside the United States. Ninety-four nurses, including APNs, also weighed in.
“Good to Know I Was Right All Along”
In comments posted on the poll, some readers affirmed the CDC guidelines for prescribing opioids. One family physician wrote that it was the government’s responsibility to respond to the “huge problem” of opioid abuse that is killing 40 people a day. “I am going to strive to work with the guidelines and refer when the tools of my disposal have been exhausted,” he wrote.
A number of physicians indicated that the new government guidance is old hat to them. “CDC’s guidelines align with decades of evidence based medicine,” wrote one pain management physician. An internist exclaimed, “Good to know that I was right all along — denying patients opiates when other docs handed them out like candy — ridiculous!”
Contrary to what the poll results might suggest, however, most readers commenting on the guidelines expressed dismay. Many of them warned that the CDC recommendations, if followed, would make it so hard for patients in pain to get relief that they would turn to illegal street drugs, such as heroin. “I wonder how long it will be [before] any ‘unintended consequences’…begin to appear?” asked one neurologist. “Will the number of ‘accidental deaths’ actually increase?”
Other readers predicted that stricter prescribing of opioids will drive some desperate pain patients to commit suicide. “Get ready for a big increase,” said one pain management physician.
Acceptance of the guidelines may be grudging. “I worry that most docs will want to follow them to feel protected against potential lawsuits,” wrote a healthcare administrator.
What About the Patients Already Taking Opioids?
Some of the criticism that Medscape readers leveled against the CDC opioid guidelines center on their real-world feasibility. The Medscape poll attempted to better understand that complaint by asking readers to identify the biggest barrier to implementation from a list of four that readers frequently mentioned in article comments.
Table 2. What Do Clinicians See as the Biggest Obstacle to Following These Guidelines?
| Responses | All Physicians (%) | Nurses, Including Advanced Practice Nurses (%) | All Respondents (%) |
| Not enough safe pharmalogic alternatives to treat pain effectively | 21 | 23 | 28 |
| Lack of insurance coverage for nonpharmalogic modalities | 19 | 20 | 17 |
| Concerns about patient complaints, low satisfaction scores when pain isn’t resolved with nonopioids | 20 | 14 | 19 |
| Patients already receiving opioids for chronic pain | 33 | 31 | 30 |
| Other | 6 | 9 | 6 |
The obstacle identified by the most physicians (33%) as number one is that many patients already take opioids for chronic pain. Physicians question whether they can switch these patients to nonopioid analgesics or nondrug therapy. “The CDC doesn’t seem to have any recommendations about what to do for them,” said one family physician. A clinical nurse specialist asked, “If a patient has been stable for years on a regimen [of opioids] and is not demanding more, where is the problem?”
A nearly identical proportion of physicians put lack of insurance coverage for nonpharmaceutical treatment of pain at the top of the obstacle list. “It would be nice if Medicare put their money where their mouth is in regard to paying for functional recovery programs to get long-term users off the opioids,” wrote one physician. “They agree it works, but won’t pay for it, at least in Michigan.”
Another one in five physicians pointed to the problem of patient complaints and low patient satisfaction scores when nonopioid pain relief doesn’t work. In their article comments, many physicians trace this phenomenon back to the movement in healthcare to make pain the fifth vital sign and never undertreat it. “As long as hospitals pay attention to patient satisfaction surveys, [patients] will be getting their happy pills,” said an emergency medicine physician.
Along those lines, many physicians contended that the opioid epidemic is not “doctor driven,” as CDC Director Thomas Frieden, MD, MPH, claimed recently but partly is the result of outside pressures to prescribe these drugs.
“It bothers me that Dr Frieden calls this a ‘doctor driven epidemic’,” said a pain management specialist. “Big Pharma’s push for profits by aggressively marketing opioids such as OxyContin is also a driving factor. The push that pain is the fifth vital sign and that we can achieve pain free life drives this as well. The policies of the government that drive a vision of healthcare where patients are customers to be satisfied and tying payments to satisfaction surveys drives this.
“Doctors bear our share of responsibility, but this national crisis has many authors,” the specialist said.
Filed under: General Problems
Exactly,,,all the numbers,the deaths,suicide,o,d, new false drugs ,,all the numbers have risen sharply,gone up since the government started playing Dr.Government with OUR lives,OUR medicines,,,NONE of the #’s have fallen,,except 1,,,how many chronic physical pain human being are left…..on this earth,,,sickening,,mary
These guidelines were intended for general practitioners who were overprescribing, not the pain management specialists. Caught up in preconceived legal terror, pain management doctors are now using these guidelines as the absolute law, making treatment for pain patients an expensive, time-consuming, frustrating fight for survival. I believe many patients are being under treated, shamed, and living far less productive lives. I predict higher suicide rates, higher overdose rates and immensely poor care for pain patients who, until the CDC guideleine hysteria took over, were able to manage their pain without abuse or addiction. Where are the lives that have been saved? Addiction and suicide rates are rising by the day. The abusers will continue abuse. The legislate rule following, pain patients are paying the big price, financially, emotionally, and physically.
My question is, haven’t we already seen an increase in denied patients seeking illegal and extremely more dangerous drugs such as heroin?
What about chronic pain suffer suicides, haven’t those numbers already begun to increase as well?
This shouldn’t include accidental overdose deaths after patients are denied opiates and no longer being under a doctors supervision with legally prescribed medications. True and honest chronic pain sufferers follow their doctors instructions when it comes to opiates, even if they are under prescribed or not receiving addiquit pain relief. The reason they do is because they would rather have some relief all the time rather then have good relief at first and zero relief after they run out of medication.
As far as legal action goes, doctors shouldn’t have to worry about being sued if they are treating a patients suffering. But they should have to worry about getting sued when they refuse to treat a patient.
I too suffer from heart disease and blood pressure problems. When I’m in severe pain, my blood pressure spikes and I have experienced systems of a heart attack. I have and still keep a record of my blood pressure and chest pains in regards to my chronic pain levels. It has consistently shown that my blood pressure spikes at the times I have more neck and back pain. I share this information with my pain management doctor, my family doctor and my cardiologist on every appointment and it has proven to be an effective tool in my pain management.
Excellent story,,I said this all along,,,these guidelines have nothing to do w/the welfare of patients and everything to do with/using these guidelines in a court of law,,,i say this because out of the 500 doctors the dea accuse of wrong doing,,98 % are winning their inncocents,,1 because they are ,,and 2,,the doctors lawyers quote previous guidelines,,which any Doctor can prescribe any medicine,,at proper dosage,,Since the dea is loosing 98 % of their cases,,”they” had to come up w/something to ,”get em”,,,that’s why dea,cdc,hhs,,,all hang out together in powwows,,,
Also off topic a little,,i think the rescheduling of the weakest opiates had MORE to do w/Tylenol damage control,,then actual opiates,,,as the stronger pure opiate meds thank god are,,well,,,still available,,,,, ,,jmo,,mary