#17: The Damage of Opioid Prescribing Guidelines

August 23, 2019 Archived Blog Posts

“Stuck between a rock and a hard place is where I am,” complains a local health care provider.  The one size fits all provisions, regarding prescribing pain medications, which have found their way into law in at least 32 states, along with two recently announced federal bills, have paralyzed many providers.  The issuance of the 2016 CDC opioid guidelines caused many providers to practice medicine from a position of fear. 

Due to the uncertainty of what they could or could not do, and not wanting to be the next headline in the local paper as the doctor whose patient died from an overdose, many providers abruptly stopped prescribing opioids altogether.  This immediately left hundreds of thousands of patients, who had been taking opioids for appropriate medical reasons, without medication the body and the brain had become dependent upon.  The pendulum swung so far and so fast adverse to opioids, it was only a matter of time before “gravity” forced it to swing back!

On April 9th of this year the FDA made public a warning that the abrupt cessation of opioids or reducing doses too rapidly could cause uncontrolled pain, psychological distress and even suicide in patients.  (Really?  You mean suddenly stopping a medication as powerful as opioid pain medication will cause a reaction in the brain and/or the body?) Too much, right?  Not to be outdone, the director of the CDC responded with alacrity and on April 10th issued a letter clearly stating that the opioid prescribing guidelines do notsupport abrupt or mandated tapering not taken in a carefully negotiated, patient-centered way.  In other words, the guidelines were meant to be suggestive, NOT prescriptive!!  Wow, is this not a classic shut the gate after the cows have already gotten out?  Did the powers that be not realize how their “guidelines” would be taken, especially with the increase with drug overdoses?    

The damage has been done. The stigma associated with the prescribing of opioids as well as the taking of opioids has become ineffable.  Excellent providers who have practiced with confidence in their knowledge and training for years suddenly become parsimonious in the writing of scripts for pain.  Patients who have relied on their pain meds for years to be able to work or carry on activities of daily living are no longer able to do so.  Good people who never entertained the idea of using illegal drugs find themselves in back alleys searching for some form of pain relief.

Watching the prescribing and drug testing trends of the clinics we service it is obvious I may be preaching to the choir.  Working with competent providers who aren’t easily intimidated and continue to do the right thing for their patients, regardless of the endless rhetoric by non-medical individuals (can you say politicians), is rewarding.   

As always, we appreciate and thank you for your business.

Lance Benedict
President/CEO Industry Lab Diagnostic Partners