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Old 07-25-2012, 09:00 AM   #1
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Red face New attack on pain meds reported by WSJ

The Wall Street Journal reports today that a group of pain specialists have filed a petition with the FDA to limit the use of extended release opiods pain meds to 100mg a day for a maximum of 90 days of round the clock use. It goes further in asking that all opiods be marketed for only severe pain, not just moderate. It claims that "there is very little evidence that with most patients a high dosage of opioids improve function and one's quality of life." This was signed by 3 dozen "leading pain-addiction experts and prominent health officials." plus politicians.

 
Old 07-25-2012, 10:35 AM   #2
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Re: New attack on pain meds reported by WSJ

I completely recognize that the death rate by prescription drug overdose has increased fourfold over the last decade. The average now is about 60 people a DAY die from prescription drug abuse.

So, no doubt there is a terrible epidemic happening and measures need to be taken.

However....throwing the baby out with the bath water is NOT the solution and most professional Pain Management Drs. with years and years of training realize this.

I can see how things have changed and yes...there are unfortunately many Drs. out there that way too easily prescribe heavy narcotics for even less that moderate/severe pain. When I had some of my other surgeries back in the late 80's....Everyone got by with a few Percocet after even major surgeries. That was the standard. No one was prescribed powerful....long acting medication and yes...that was for only cancer patients.

So...I am not naive to think that things have gotten really out of control on one hand and the states and DEA have a tough job out there.

The regulations that I am all for are:

The Prescription Monitoring Program (in 41 states so far). This monitors all prescriptions attached to your name and tracks anywhere in the state someone tries/does fill their prescription. This is no problem to any of us who take our meds as prescribed. This only helps catch those who are "Dr. shopping" and have multiple prescriptions of the same opiate.

I also don't have any issue with a random urine test as I take my meds exactly as prescribed. This is also a good deterrent for those who are abusing their meds. I actually think they should ONLY use the most sophisticated testing that includes gas chromatography mass spectrometry. This test is 99.9% accurate.

It's the in-house "dip stick" type test or other inferior labs that produce so many wrong test results which not only allows those abusing to get by but negatively affects those of us doing the right thing.

I also am all for more training and certification of Drs. who prescribe opiates long term. They should be as up to date with all the medications and new ones on the horizon and know what is appropriate based on the patient's pain issues.

I am also for Drs. who approach pain management in a comprehensive way. I would run from any Dr. who only wanted to prescribe opiates and not do anything else. As well as those who run "pill mills" where you walk in, spend less than 10 minutes with someone and then send you away with a prescription. PM is a multi-faceted approach that includes dozens of modalities as well as non narcotic meds in addition.

In conclusion....this particular petition I hope (and probably know) will get nowhere as it is way too broad and general. There are too many people who are non cancer patients that need long term opiate care.

If they were only requesting this of "acute" pain patients than that is one thing..(although I still don't agree with the approach or rules they are laying out) ..But for chronic pain patients...that is actually anything that last over 90 days. So to have a bunch of addiction specialists dictating what other trained professional Pain Mgmt. Drs. can/can't do for their own patients is absurd. To not only limit the dosage but the amount of time.

*It is just ridiculous that a small group of people....especially those specializing in addiction and NOT chronic pain managment try to write the rules for PM Drs.

Again...I know that there is work to be done to try and get the numbers of death down from prescription drug abuse....but this is not the way!

Last edited by Ilovemycutedog; 07-25-2012 at 10:50 AM.

 
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Old 07-25-2012, 11:23 AM   #3
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Re: New attack on pain meds reported by WSJ

This issue drives me crazy. hasn't the government figured out that the "war on drugs" has already been lost. Personally i think all drugs should be legalized like they are in many other countries. I don't have the articles of the studies handy but I've read that the crime and overdose's have actually decreased because of the legalization.

 
Old 07-25-2012, 12:46 PM   #4
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Re: New attack on pain meds reported by WSJ

This infuriates me. I am pretty sure none of the specialists actually suffers from chronic pain. As the pp mentioned, we have lost the war on drugs. An addict will always figure out a way to get high.

 
Old 07-25-2012, 01:11 PM   #5
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Re: New attack on pain meds reported by WSJ

Ridiculous, but as Ilovemycutedog said most good pain specialists know this. It does surprise me that an addiction specialist would recommend this, they should know that it doesn't matter what drugs are available, an addict will get their fix one way or another. Did taking all Sudafeds to behind the counter make a huge difference in how much methamphetamine was out there? No. It will just take some time for all this hype to blow over. But it is infruiating when we live the way we do and then read crap like this!

 
Old 07-25-2012, 05:01 PM   #6
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Re: New attack on pain meds reported by WSJ

Quote:
Originally Posted by Boxerluver View Post
Ridiculous, but as Ilovemycutedog said most good pain specialists know this. It does surprise me that an addiction specialist would recommend this, they should know that it doesn't matter what drugs are available, an addict will get their fix one way or another. Did taking all Sudafeds to behind the counter make a huge difference in how much methamphetamine was out there? No. It will just take some time for all this hype to blow over. But it is infruiating when we live the way we do and then read crap like this!
You're dead on with your sudafed example - end result, no decrease in meth available to the addicts out there and the law abiding citizens have to show ID, sign two forms and for what? To get 20 tablets for a runny nose. Give me a break. This is actually the end result of most of the government drug abuse "fixes". No decrease in the flow they're trying to restrict and the law abiding, well meaning everyday citizens are continually put out! When will they "get it"?

 
Old 07-25-2012, 06:52 PM   #7
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Re: New attack on pain meds reported by WSJ

This is very disturbing to me. I agree that the "drug seekers" and "doctor shoppers" have ruined it for us legit pain patients and I agree there are way to many deaths from prescribtion drug abuse. Instead of making better guidelines and use tests to determine what kind of pain the patient is having such as acute or minor. To moderate and sever. We should not all get lumped into the same group.

Second there are tons of people who have been suffering for years with chronic pain and what they are suppose to be better after 90 days???? That is crazy to me. Instead of prescribing long term narcotic for every tom and harry who have a sprained finger they should start treating there actual pain patients better and taking care of them better so so many pills didnt have to get prescribed.

 
Old 07-25-2012, 08:30 PM   #8
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Re: New attack on pain meds reported by WSJ

- I think you can get stats to skew to one side or the other. I don't think it shows that long term use of pain meds is unhelpful or dangerous.
- I disagree with a dose limit, due to tolerance. Someone may get a lot of benefit out of 100mg/day or less of morphine, where it does nothing for someone else. I see no way limiting the dose would help anyone.
-I think they need to consider how many patients are now getting pain treatment which didn't have it before (and there may be a lot more still out there).
-I'm all for reasonable restrictions/cautions to identify abusers. Similarly, I don't think its appropriate for someone to have pain and get a recurring narcotic script without trying all other reasonable treatments, etc.
-I think there is evidence that these meds turn around a lot of folks lives and don't think its wrong to prescribe pain meds to someone who may be able to get by without them but has an improved quality of life with them (in addition to someone who is stuck in bed without them).
-If there was a three month limit for prescribing for noncancer pain, I don't think that the patient should even be started on a long acting med. What doctor would say I think you will be better in three months but lets start you on this med that will take you a month to taper up and a month to taper down?
-I think limiting opiates to "severe" pain wouldn't help much as doctors could still prescribe them off label. If anything, insurance could refuse to pay for them as they would be off label. I wonder if the insurance companies are in on this lol?
-At the same time I agree with some of the article. They say moderate pain is a level 4-6, and they don't want drug companies marketing to treat moderate pain. I'd hope that most people being prescribed long acting opiates would rate their pain above that.
-I'm all for more physician training if it is helpful. Not the pain meds are bad, never prescribe them stuff...but a flow chart sort of thing of after trying what treatments and at what pain levels they may be helpful.
-Anyone know if/what recurrent training on opiates doctors have to do?
-It said one of the main purposes of the petition is to slow down the marketing by manufacturers to doctors. Sounds similar to how they banned giving doctors free pens and other swag with advertising, which I think is a good thing to ban.
-I don't think this would greatly decrease abuse and would tend to think that the measures everyone is aware of just aren't being use widely enough yet. Curious what percent of folks getting these prescriptions have a contract, and on top of that, what percent of doctors are appropriately enforcing the contract (doing the UAs and pill counts and such, but not overly so). Seems like a lot of groups would have similar goals, but the question is how to catch abusers but not weed out true patients.
-Also curious to read the actual petition to see if this dose limit suggestion is being blown out of proportion or not. Seems like this leaves more questions if anything. Thanks for the post! I read this on a blog but didn't know the course/context.
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Old 07-27-2012, 05:57 PM   #9
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Re: New attack on pain meds reported by WSJ

I pay no attention to media's sensationalism of pain meds. They'll go out and find some "specialist" willing to sell their opinions, then, after editing the story so it has shock appeal, will print it and get the general public to believe it's the last word on the subject. I wouldn't worry too much about these stories. Opioids aren't about to be taken off the market - regardless of what the so-called specialists say. The reason, I believe, that they won't be banned is strictly due to money. Pain meds rake in billions anually for the manufacturers. Further, we all know how much clout the drug manufacturers have with the government. It seems like these anti-pain med stories always surface when it's a slow news day. Let them say what they wish.

 
Old 07-28-2012, 09:41 AM   #10
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Re: New attack on pain meds reported by WSJ

One article in the Journal isnt cause for alarm and doesn't mean anything is going to change anytime soon. just my opinion. Dave

 
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