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Doctors Disagree on Best Way to Prevent Prescription Painkiller Abuse

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There is disagreement among doctors about the best way to prevent prescription painkiller abuse, sometimes even among physicians in the same hospital, according to The Plain Dealer. The Cleveland Clinic is among the institutions where colleagues disagree on the best approach to the problem.

Some doctors want stricter rules for prescribing opioids, arguing this could decrease addiction and drug abuse. Others are concerned tougher rules could penalize patients with long-term pain, particularly if the new rules call for opioid treatment only for those in severe pain, rather than moderate pain. This is a personal and subjective call, they say.

One Cleveland Clinic pain management specialist, Dr. Riad Laham, wrote a letter to the Food and Drug Administration (FDA) arguing that such a rule could lead patients to lie about their pain to meet higher thresholds, and could result in more illegal street sales of opioids.

Dr. Andrew Kolodny, who heads Physicians for Responsible Opioid Prescribing (PROP), says opioids are overprescribed. “We’re not trying to take these people’s opioids away from them, we’re trying to prevent new starts,” he told the newspaper. Dr. Edward Covington, Director of the Cleveland Clinic’s Neurological Center for Pain, supports a PROP petition to the FDA that states “an increasing body of medical literature suggests that long-term use of opioids may be neither safe nor effective for many patients, especially when prescribed in high doses.”

The group wants the FDA to change prescribing rules for opioids, so they are not indicated for moderate pain, to recommend a maximum daily dose, and to limit patients’ continuous use to a maximum of 90 days, the article notes.

The FDA, in a letter dated January 22, told PROP that it “has been unable to reach a decision on your petition because it raises significant issues requiring extensive review and analysis by agency officials.” The FDA did not say when it expects to make a decision.

7 Responses to this article

  1. Avatar of Jeffrey
    Jeffrey / March 8, 2013 at 1:35 pm

    Chronic pain is very subjective. Someone with RSD, Cancer, Back Issues, Neurologic problems or Nerve damage could be in severe pain while another person with the exact same diagnosis has little to no pain. I agree it is up to a coordinated effort between a patient and their doctor to find the balance of treatment that keeps them functioning and have a reasonable quality of life. I was in an car accident that left me with a myriad of symptoms. Everything from seizures to chronic pain. If it weren’t for opioids,and other medications, I would not have had any quality of life. I too, I am sad to say, have considered ending my life. Working closely with several doctors. Employing every possible option to stay comfortable (diet,stretching, electric shock, breathing,exercising my brain). I needed medication to keep life ending thoughts out of my brain. I happily submit my urine for testing and agree with prescription monitoring systems. I do what I have to do so I can sit with my children and my wife and enjoy life. I understand those who have to see and treat addicts, those who have lost loved ones to drug abuse and those who think opioids should not be available to anyone (for any length of time). You just never know until your in that position. Do I need something for pain or shall I let it rule my life? For me it was a difficult decision. One that weighs heavy. Especially when people look at me at the pharmacy and think “ooh here’s another addict”. Such generalities are a sad fact. But in the end. When it boils down to staying in bed all day with ice and heat and digging my nail into my arm to distract me from the pain. Or, relieving some of the pain, enough to get up for a while to be with my family. I have chosen to use opioids. Just enough to function in life.

  2. Avatar of S Goldberg
    S Goldberg / March 8, 2013 at 12:40 pm

    Over the last 2 years I have watched a friend spiral into opiate addiction, in my opinion, because her pain management during treatment for breast cancer was mismanaged. I think ALL patients should be offered detox and addiction recovery resources at the end of cancer treatment periods (or any period of severe pain treatment). It is simply irresponsible to expect 100% of the patients to be able to walk away from the drugs with no assistance.

  3. Avatar of Jan Beauregard, Ph.D.
    Jan Beauregard, Ph.D. / March 4, 2013 at 8:55 pm

    Having had several younger chronic pain patients has made me use a broader lens on this issue. There are times when these medications are the only thing that allows someone to function and enjoy any type of life. I am thinking of car accidents victims who injury soft tissue or have chronic back pain. It must be left up to the doctor to individualize treatment. Coordinating records is also important and right now this is a loop hole making it possible for abusers to see different doctors in different states. The problem is not simple. Jan Beauregard, Ph.D.

  4. Avatar of Dina
    Dina / March 4, 2013 at 5:58 pm

    The only certain way to accomplish this is to hold doctors accountable in a court of law for the deaths, suffering and addiction created by the prescribing of addictive drugs to anyone other than those who are facing soon and certain death caused by a terminal disease process. I have been working in the field of addiction for many years and have never once seen a valid reason for prescribing Opiates. Post-Op and Post-Trauma for a maximum of 3 days should be a reasonable time. Anything more than this, is solely due to the greed of doctors.

  5. Michael W Shore, M.D. / March 4, 2013 at 1:05 pm

    The debate over opiate prescribing misses the point. Doctors must be able to individualize treatment to the patient’s needs – some require higher doses and longer periods of prescribing. First, it should be mandatory that every physician prescribing opiates check their state’s Prescription Monitoring Program to ensure as best as possible that the patient is not receiving opiates from different physicians. Second, In office immunoassay drug testing should be strongly encouraged. Finially, and most important, we need to legislate TREATMENT ON DEMAND so that patients can quickly and readily access treatment for substance abuse and addiction problems. Dr. Shore

  6. Avatar of Denise
    Denise / March 7, 2013 at 2:07 pm

    Dina, I have been suffering from RSD a chronic neuromuscular pain condition. It’s not a terminal condition like cancer but te pain it causes rates higher than cancer pain on the Mc Gill pain chart. If I had been denied the opioids needed to manage my pain. It would have become a terminal conidition as I would have off myself! I have been able to manage my pain for the last 17yrs and raise my children, only because of opioids. I have tried many other types of treatments and medications to manage my pain. None were effective. It’s estimated that there are 200,000 to 6 Million suffers of RSDS aka CRPS in the U.S. alone. There are many other coniditions that bring about neuromuscular pain. My pain management doctor saved my life. I also worked in a drug and alcohol rehab years back before RSD. I watched how they would get off one addiction only to take up another. I myself weaned off of Morphine and was able to switch to Ultram. I’m one of the lucky ones. I would not have been able to do that years back as Ultram had given me no relief when previously prescribed. It took many years for my body to handle managing the pain I endure on a daily basis. Terminal Cancer pain is not on the top of the McGill pain chart! RSD is! You try living one week without opioids with the pain I endure and I guarantee you’ll be looking for something to end your life. My doctor employed a drug contract from the start, informed me of the risks both short term and long. He remains diligent to this day. If there was anything else that could manage my pain I would be taking it or doing it. I even went he experimental treatment route. Thank you Dr. Beauregard for your insightful view point

  7. Doug / March 21, 2013 at 11:22 am

    Yes, we had a notorious doctor who “individualized” precriptions for up to a thousand cash-only patients in our rural area. He is named in four wrongful death suits locally, and he fled Colorado to Texas and did the same thing there. He is back in Colroado, in jail, awaiting trial for his individualized care. He ran an opioid buffet more popular than the local chinese place. As long as people like him get rich the status quo is not wqorking.

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