As opioid prescription rates decrease, overdose deaths remain the same: Is this progress?
Vermont Governor Peter Shumlin also offered an opinion on the proposed laws in an interview with the Associated Press, citing a 2012 statistic that 250 million doses of opioids were prescribed in 2012:
“For nonchronic conditions, it should be no more than 10 [pills] … You can’t convince me that we’ve got 250 million Americans in chronic pain,” he said.
You can’t convince me that there is much medical intelligence/experience in the Governor’s Mansion in Vermont
JAMA Internal Medicine recently released a fascinating study1 looking at the prescribing rates of hydrocodone-acetaminophen combinations after the Drug Enforcement Administration (DEA) rescheduled hydrocodone-acetaminophen from a schedule III to a schedule II drug.
Unsurprisingly, the data show significantly decreased prescriptions being filled for hydrocodone-acetaminophen drugs, particularly related to refills. Schedule III drugs are more easily refilled, which can partially explain this decrease. The released data provide a snapshot that will undoubtedly be viewed as progress in the effort to decrease opioid abuse and misuse, but it may not be that simple.
Currently, 5 states prohibit physician assistants from prescribing schedule II medications – Georgia, Maine, Missouri, Oklahoma, and West Virginia – and 8 states prohibit nurse practitioner prescribing of schedule II medications. While the intent of the DEA was clearly intended to reduce abuse, what impact did this have on patient access to pain medication when appropriate?
As pain medication restrictions increase, unintended consequences abound. Nationwide, data show a marked decrease in opioid prescribing over the last several years, yet when looking at total opiate deaths (including heroin), there has not been a net decrease. This calls into question the heavy focus on prescription drug abuse without an accompanying focus on heroin use and deaths. It potentially sends a message to heroin users that their lives are not as valuable as non-heroin uses, something that many heroin users I have worked have long believed to be the prevailing thought in both the general and medical communities.
The recent meeting of the National Governors Association (NGA) in Washington, D.C. resulted in an increased effort to create laws limiting the number of pills that individual prescribers can prescribe to an individual. President Obama offered a cool response, citing his belief that such an effort is off the mark, and that it would more likely decrease patient access to legitimate pain treatment, particularly in rural areas.2
Vermont Governor Peter Shumlin also offered an opinion on the proposed laws in an interview with the Associated Press, citing a 2012 statistic that 250 million doses of opioids were prescribed in 2012:
“For nonchronic conditions, it should be no more than 10 [pills] … You can’t convince me that we’ve got 250 million Americans in chronic pain,” he said.
Most of us would agree that the last thing we need is politicians telling PAs how many pills they can prescribe. We all support reasonable, evidence-based efforts to decrease the harm to patients from opioid abuse, while still maintaining access to pain care for patients who need it. But the key words are “evidence-based,” and so far, there is a great shortage of such evidence to support these drastic efforts to limit pain medication prescribing. One excellent evidence-based resource is the recently updated Interagency Guideline on Prescribing Opioids for Pain,3 developed by the Washington State Agency Medical Directors’ Group (AMDG), which offers rich resources and guidance to pain medication prescribers. But even resources such as these will provide much more value when they are also accompanied by intensified efforts to increase addiction treatment. When pain medication deaths go down while heroin deaths go up, we’re not really making any progress.
Jim Anderson, MPAS, PA-C, ATC, DFAAPA, is a physician assistant in Seattle.
Filed under: General Problems
I’ll say this as a female who has birthed a child. When Shumlin grows a vagina and pushes something the size of a watermelon out of it, he can then comment on how many pain pills HE needs after doing so. Sorry, but this man (as well as so many other legislators, including females) is so out of touch with reality I just can’t stand it anymore. He can cram his “no more than 10 pills” statement where the sun doesn’t shine (and do so with no pain relief).
Secondly, my doctor is a nurse practitioner. He has prescribed me tramadol for 10 years (thankfully, it helps me, though I realize it’s very weak and does not always help others). Over the years, I have went to him when I injured myself or had ruptured ovarian cysts. He’d prescribe me hydrocodone to get me through it. (With ruptures, it can take up to 6 weeks for the blood to dissipate from the abdomen.)
Now that they’ve rescheduled it (and since I live in a state that does not allow NPs to prescribe IIs), I’m screwed if I have another ovarian cyst rupture or fracture my ankle. I refuse to use our ER because of numerous reasons, so what will I do? Go to another ER and make it appear I am “doctor shopping” and “drug seeking?” Nope, I’m not willing to risk getting treated like that. Maybe I’ll bleed to death, maybe I won’t. (This is the position these idiots have put me and so many others in.)
One more thing I can tell Shumlin – 10 pills for an ovarian cyst rupture or most post-op procedures, including the removal of wisdom teeth is laughable. The day he experiences an ovarian cyst rupture, bleeding internally, having that blood settle in his abdomen area, particularly around his diaphragm, which literally feels as if you’re being stabbed every time you take even the smallest breath, he can comment on how many pills HE needs. Until then, he needs to shut it up.
I try not to wish bad things on people, but I want to be there when Shumlin and the rest of his buddies have to undergo a hip replacement. I will watch with glee as they cram Lyrica, tylenol and ibuprofen down his throat as he begs and cries for pain relief. When he is released from hospital in pain, I will gladly remind him that 10 pills will be sufficient for those months of rehab and physical therapy he will be expected to participate in 3 to 4 times a week.
Our politicians and bureaucrats have become too big for their britches. They’re literally dictating pain relief. Withholding pain medication from the chronically ill and in pain (a group of people who are already vulnerable) is one of the easiest ways to gain control of a person. The one who is ill and in pain is literally at the mercy of the one dictating and withholding relief.
This is a very slippery slope that we, as Americans (in pain or not), do not want our country to go down. Our government has literally become Big Brother, who always knows best (sarcasm). America has turned into an Orwellian Society. We need to vote these arrogant, judgmental, uneducated, ignorant dictators out ASAP! We pay their salary. They work for us, not the other way around.
I couldn’t have said it better!
WHAT THE F%€£? Sounds to me like some politicians need to have the proverbial sticks removed surgically from their ASSES and without any post operative pain relief.