This is a section of the CDC opiate dosing guidelines… Those prescribers and corporations that create policies and procedures based on portion of this guidelines and not the guideline in its entirety may be walking into a legal minefield.
This is just ONE PARAGRAPH from the CDC guidelines… but contains a lot of very important information that if a prescriber or prescriber group ignores or chooses to omit from the policies and procedures … could put them at legal/financial risk of malpractice, failing to meet a standard of care and best practices, pt abuse for starters..
First of all the guidelines are based on “limited information” and are VOLUNTARY and primarily directed towards primary care clinicians. Pts in need of palliative care – most/all chronic pain pts – has cancer and/or terminal are AUTOMATICALLY EXEMPT from dosing limits.
Primary focus of the guidelines The guideline is intended to ensure that clinicians and patients consider safer and more effective treatment, improve patient outcomes such as reduced pain and improved function.
The very act of arbitrarily reducing a pt’s dose/medication(s) causing the pt to endure increased pain levels, become house/chair/bed confined because of increased pain – that were previously being well/better managed.. would seem to be in direct conflict with the intent of the guidelines.
Finally, it is clearly stated in these guidelines that Clinicians should consider the circumstances and unique needs of each patient when providing care. So once again, a prescriber that arbitrarily limits a pt’s medication therapy would seem to be in conflict with these guidelines.
Likewise, a prescriber practice and/or an employer entity – like a hospital – mandates these guidelines and dosing limits be followed… would appear to be “practicing medicine” … for which they don’t have the legal authority to do.
I am not an attorney, but large medical practices or corporate entities (hospitals) that implement only portions of these guidelines … while ignoring other portions of these guidelines… could be setting themselves up for some law firm that specializes in class action lawsuits… since the harm to pts could and should be consider INTENTIONAL by their actions… and intentionally harming another human being via a specific action(s) or lack of action(s) could have legal/financial consequences.
https://www.cdc.gov/mmwr/volumes/65/rr/rr6501e1.htm
This guideline provides recommendations for the prescribing of opioid pain medication by primary care clinicians for chronic pain (i.e., pain conditions that typically last >3 months or past the time of normal tissue healing) in outpatient settings outside of active cancer treatment, palliative care, and end-of-life care. Although the guideline does not focus broadly on pain management, appropriate use of long-term opioid therapy must be considered within the context of all pain management strategies (including nonopioid pain medications and nonpharmacologic treatments). CDC’s recommendations are made on the basis of a systematic review of the best available evidence, along with input from experts, and further review and deliberation by a federally chartered advisory committee. The guideline is intended to ensure that clinicians and patients consider safer and more effective treatment, improve patient outcomes such as reduced pain and improved function, and reduce the number of persons who develop opioid use disorder, overdose, or experience other adverse events related to these drugs. Clinical decision making should be based on a relationship between the clinician and patient, and an understanding of the patient’s clinical situation, functioning, and life context. The recommendations in the guideline are voluntary, rather than prescriptive standards. They are based on emerging evidence, including observational studies or randomized clinical trials with notable limitations. Clinicians should consider the circumstances and unique needs of each patient when providing care.
Filed under: General Problems
Most pain clinics are fake. Just a few are helpful. Be careful check references on them.
Where is the part that patient requiring higher level of opiates should be referred to pain management??maryw
You have my email you know my condition if you know of a lawyer please contact me.
Palliative is basically now hospice
Danny it may just be the state you live in. Don’t give up trying to get help ..never give up.
It’s very difficult to even find palliative care these days. Cancer patients are NOT excluded in this failed opiate War. Finding legal counsel even with stage 4 cancer is impossible. This is just way out of control
Standing O, sir. Standing O. ~wheels
It’s all fine to point out the illegalities which we all know are rampant but finding an attorney to take anyone to court seems to be an impossibility. We know that we need many voices both from the patients as well as the families and the community. The government has an agenda and the chance of changing that agenda is slim but we must try! It seems to be a situation like many others in this day of only caring about what affects the individual. Even among those who suffer with chronic pain have the idea that what works for them personally is what works for everyone
I can’t tell you how many times I have read statements such as “fentanyl doesn’t work for fibromyalgia” when I am an example of one for whom it’s successful! Maybe someday we’ll all be on the same page and will THEN have success fighting this stupidity!
Amen Connie,,finally a voice of reason,,,the big picture for all of us is,,,It is literally FACTUALLY impossible to physically feel the physical pain of another,,thus NO-ONE,, has the rite to force u to suffer in physical pain,,,WHICH IS EXACTLY WHAT IS HAPPENING,,,iT IS AND THERE IS A UNIVERSAL LAW,,THERE IS A NAME TO IT LEGALLY,, can’t remember it just yet,,but TORTURE is illegal everywhere by law,,,and by forcing us to suffer in physical pain,,is TORTURE BY LEGAL LAW DEFINITION,,, as a humane,civilized society,,,,we can only lessen the physical pain of others with MEDICINE that effectively lessen’s that physical pain,,maryw
Keith Wailoo, speaking at the Center for Practical Bioethics, makes the point that these issues typically end up being settled judicially, not legislatively or bureaucratically. “Pain: A Political History”
I’ve previously seen a letter from the chairperson of the group within CDC that issued the so-called “guildelines”, claiming that they are voluntary. However, Congress made adherence to authoritative prescription guidelines mandatory for the Department of Veterans Affairs, even before issuance of the Guidelines themselves. DEA has mounted several cases for “over-prescription” based on this so-called voluntary standard, and individual States are enshrining it in restrictive laws.
This is particularly ironic in that the CDC has gotten caught with its figurative pants around its ankles by a group which analyzed the evidence supporting effectiveness of Opioids, non-opioid meds, and talking therapies. That group found that the CDC consultants group which wrote the guidelines applied a criterion for inclusion or rejection of studies from literature, which was different for opioids than for other treatment measures. The criterion rejected any study of opioids that was closed in less than a year, but failed to apply the same criterion to non-opioid and non-drug therapies. But the literature itself shows that the other categories of treatment have very much the same periods of study as opioid studies. Then this group of educated fools had the gall to claim that the effectiveness of opioids for long term treatment was unknown or limited, despite the fact that non-opioids had been studied for no longer.
See “Durations of Opioid, Nonopioid Drug, and Behavioral Clinical Trials for Chronic Pain: Adequate or Inadequate?” Abstract on PubMed — https://www.ncbi.nlm.nih.gov/pubmed/27880651. The report itself is regrettably buried behind a pay wall.
Guidelines are CLEAR …. The guideline is intended to ensure that clinicians and patients consider safer and more effective treatment, improve patient outcomes such as reduced pain and improved function
So when these mgs/day limits are imposed on established/stable pts and their pain increases and their function(s) decrease… then the guidelines are being VIOLATED.
It is also clear in the guidelines that those pts in need of palliative care… which the WHO’s definition strongly suggests most/all chronic pain pts would qualify for… exempts those pts from the mgs/day limits.
IMO… it could be argued – in a court of law – that the guidelines need to be followed in totality and not part/pieces be carved out to be followed as best practices and standard of care
Likewise, when administration of a hospital complex create policies and procedures that limits their employed prescribers… then they are attempting to impose their P&P in place of the prescriber’s clinical opinion… as provided by the state’s medical practice act.
I don’t disagree. I suspect that the only way this mess is going to get sorted out is for the families of suicide victims to sue hospitals and doctors for denial of care and malpractice under the Guidelines themselves – however fraudulent the guidelines are in reality. There is little prospect of suing a State government for restrictive opioid policies, however ill-founded they are, because of sovereign immunity laws.
Fraudulent guidelines not withstanding… it is when prescribers, large practices or institutions state that they are adopting the CDC guidelines and then choose to slice/dice the guidelines and adopt those parts of the guidelines that they wish and ignore – fail to follow other parts of the guidelines where – IMO – they are walking into a minefield… especially on well established chronic pain pts. The number of large practices or institutions that are claiming to be adopting the CDC guidelines is growing and most are only adopting certain portions others are just cutting off any pt on opiates… IMO.. the 800 lb Gorilla in the room is the damages to the spouses/children of lost of consortium and companionship.. states have limits of $300,000 – $400,000 on such cases and a class action toward large practices or institutions for cutting back on opiate dosing and/or tossing pts out.. could run into some major dollars… these entities are doing what they are doing for fear of financial consequences imposed by the DEA and other bureaucracies. A large class action settlement could change theirs and others focus of fear of financial consequences.
Keith Wailoo, speaking at the Center for Practical Bioethics, makes the point that these issues typically end up being settled judicially, not legislatively or bureaucratically. “Pain: A Political History”
So the State Medical Boards, and Public Health Departments that are harassing doctors and calling them a public health menace for “over-prescribing” based on the “State Medical Boards Opioid Limits” (which are often times even lower than the CDC Guidelines)…now seem to be the main problem!! The great CDC hand-off. Palliative Care is restricted to a handful of medical conditions and is usually hospital practice based… even though in “theory” it is supposed to be exempt at the doctors office….a very few chronic pain patients fall into that category of covered conditions, CDC knew that.
So are the State Medical Boards and legislators now to be held accountable for patient harms because of faulty implementation and interpretation of the CDC Guidelines, or for having any guidelines????…every patient is different so cookie cutter medicine doesn’t work.
Pharmacies and insurance companies are also calling the State Medical Boards to report doctors when they deem them to be over-prescribers because of State guidelines and MED limits, along with CDC guidelines.
Doesn’t matter if genetic test have been done, they want these patients to be invisible.
Orwellian-yes!
According to the World Health Organization.. the definition of which pts can be entitled to palliative care is quite broad.
Someone needs to call all of these bureaucrats OUT … when they are denying the WHO’s definition of palliative care
http://www.who.int/cancer/palliative/definition/en/
WHO Definition of Palliative Care
Palliative care is an approach that improves the quality of life of patients and their families facing the problem associated with life-threatening illness, through the prevention and relief of suffering by means of early identification and impeccable assessment and treatment of pain and other problems, physical, psychosocial and spiritual. Palliative care:
provides relief from pain and other distressing symptoms;
affirms life and regards dying as a normal process;
intends neither to hasten or postpone death;
integrates the psychological and spiritual aspects of patient care;
offers a support system to help patients live as actively as possible until death;
offers a support system to help the family cope during the patients illness and in their own bereavement;
uses a team approach to address the needs of patients and their families, including bereavement counselling, if indicated;
will enhance quality of life, and may also positively influence the course of illness;
is applicable early in the course of illness, in conjunction with other therapies that are intended to prolong life, such as chemotherapy or radiation therapy, and includes those investigations needed to better understand and manage distressing clinical complications.
WHO Definition of Palliative Care for Children
Palliative care for children represents a special, albeit closely related field to adult palliative care. WHO’s definition of palliative care appropriate for children and their families is as follows; the principles apply to other paediatric chronic disorders (WHO; 1998a):
Palliative care for children is the active total care of the child’s body, mind and spirit, and also involves giving support to the family.
It begins when illness is diagnosed, and continues regardless of whether or not a child receives treatment directed at the disease.
Health providers must evaluate and alleviate a child’s physical, psychological, and social distress.
Effective palliative care requires a broad multidisciplinary approach that includes the family and makes use of available community resources; it can be successfully implemented even if resources are limited.
It can be provided in tertiary care facilities, in community health centres and even in children’s homes.