#17: The Damage of Opioid Prescribing Guidelines

“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 not support 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

8/23/2019

#16: Drug Abuse is Equal Opportunity

“Did you know, did you know?” was literally screamed through my cell phone over and over by the hysterical wife of one of my male patients.  “I know you knew, just like the others”, she continued on in an angry and helpless sort of way.  This very real encounter occurred in the early 90’s when I was still in private practice and was my introduction into the world of drug abuse.  This woman, whom I will call Carol, had just found out her husband, whom I will call John, was addicted to crack cocaine.  Once Carol realized my ignorance of the situation was genuine, she gained enough self control to tell me her story.  She had accompanied John on several visits to different providers over the past several months in an attempt to discover why he had sores breaking out all over his body.  The drug was crystallizing under his skin and he was picking at the irritation.  HIPAA prevented those he “came clean” to from telling Carol the cause of this.  Thus her extreme reaction when she discovered the real reason their previously healthy bank account was almost completely depleted.  It turns out he had gone through about 500K on his habit.  Yes, you read that correctly.  His habit was so bad he was taking his three year old daughter to the crack house and leaving her in the car when he went in to get high.  

Typically cheaper and more available than powdered cocaine, crack is the most dangerous form of cocaine.  When smoked, crack, enters the bloodstream through the lungs and brings a quicker and more powerful sense of euphoria than snorting powdered cocaine.  Upon reaching the brain it increases the levels of dopamine, the neurotransmitter associated with pleasure and reward.  It is said that first time crack users experience a euphoria which is so intense, they spend the rest of their lives chasing that same feeling.  To date more than 9 million Americans have used crack that we are aware of.  It was such a common drug in the 80’s that Congress mandated a five-year minimum sentence for possession of five grams of crack when it passed the Anti-Drug Abuse Act of 1986.

John, now in recovery, was once a very wealthy businessman, who ended up losing his marriage and his business to a drug.  I am reminded daily as I see the positive drugs on the reports, that drug usage is not limited to opioids, age, status, income or really anything.  Drug abuse is an equal opportunity destroyer of lives.  Never take for granted, regardless of what role you have in your clinic, the importance of the job you do.  We, as a lab, also cannot take for granted the importance of the job we do.  We must be accurate in our testing and reporting, with a quick response to any clinical questions posed to us by our customers.  

In closing, I am reminded of an ancient Chinese proverb, “If you don’t change direction, you will likely end up where you are headed.”  Thank you for trusting us with your business.

Lance Benedict

President/CEO Industry Lab Diagnostic Partners 

8/09/2019