First, do no harm

Wesley J. Smith:

I’m all for fighting the opioid epidemic. But not at the price of preventing patients from receiving quality medical care.

And that may be happening. Nevada doctors are apparently up in arms at a new Nevada law that they say is so vague, it could chill their proper prescribing practices. From the Las Vegas Review Journal story:

It’s been only three days since Nevada’s new opioid prescription law took effect, and doctors already are venting about its impact on their practices.

About 40 physicians, lawyers and others attended a meeting of the state medical and dental boards Wednesday in Las Vegas to express concerns over draft disciplinary rules for doctors who issue illegal, fraudulent, unauthorized or “otherwise inappropriate” prescriptions for pain medications under the law.

Several doctors said the law makes unreasonable paperwork demands, while the proposed regulations don’t specify the types of conduct that could lead to penalties or even the loss of their medical licenses.


But doctors who attended the meeting complained that the proposed regulations don’t specify what constitutes a violation and expressed concerns that they could be penalized for relatively minor infractions, such as forgetting to pull up a patient’s prescription history, or that an employee could make a mistake.

Doctors also are worried that the threat of discipline will funnel patients from specialists to primary care physicians to pain management clinics, which say they already are inundated.

Dan Laird, a pain management specialist at Flamingo Pain Specialists and a Las Vegas attorney, said in an interview with the Review-Journal that he has a stack of referrals from primary care doctors received over the past two days sitting on his fax machine.

“It will provide further disincentives to take care of chronic-care patients,” Laird said.

I am weary of how we punish the law-abiding and productive sectors of our society in order to protect people who may have serious addictions or criminal intentions. I mean, that’s why we have to limit our Sudafed purchases to once a month and present our driver’s licenses to get a non-prescription medication.

That’s a small inconvenience. But if you are in real pain and have to jump through continual bureaucratic hoops just to obtain proper medicine–or if you are an MD afraid to properly treat your patients–protecting those who abuse these drugs from themselves comes at a very high cost.

(I would argue the pseudoephedrine laws are not a small inconvenience to someone who is ill with frequent sinus infections but doesn’t want to run to doctors for antibiotics.)

In my previous life in private college public relations I once did PR for a medical ethics conference in which the speaker, from the UW Medical School, suggested that getting a patient hooked on painkillers was not as bad as other possible outcomes, such as that patient’s dealing with uncontrollable pain. I don’t remember who the speaker was, but I wonder what the speaker would say about that today.

As one commenter put it:

Elderly people with chronic arthritis and people recovering from brutally painful surgeries (eg, knee replacement) are not getting high and killing themselves with opioids. Yet, absolutely, they are being required to jump through hoops supposedly to curtail addict overdoses. Ridiculously strict prescribing rules have been in effect in many states for years and have had exactly zero impact on illegal abusive conduct, overdoses or deaths.

It is true that prescription painkillers can become gateway drugs to the big two of illegal drugs, heroin and methamphetamine. It’s also true, however, that marijuana, which is somewhere between illegal and decriminalized depending on where you live, and alcohol, which is legal everywhere, can also become gateway drugs. We still don’t know enough about addiction to figure out why some people become addicted and others don’t — brain chemistry? Personality? — let alone how to deal with addiction.



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