NEW $1.4M IN PUBLIC FUNDS FOR OPIOID SAFE-PRESCRIBING DATABASE THAT DOCTORS DON’T USE
PDMP databases available for years, designed to stop high-risk opioid prescribing aren’t used by America’s medical providers – even when mandated
by Clark Miller
Published April 23, 2023
I don’t know about you, but something powerful and triumphant is conjured up for me just reading the words “Combat” and “tackle“. Something American!
And what could be more American than lots of money thrown at a lethal public health crisis? How can that not be a way to tackle it?
It’s exciting and of course reassuring to get reminders of just how effective these efforts and use of public funds are. And, of course have been, over decades and billions, and billions.
And there’s more on the way!
From the news piece –
December 06, 2022 – The Harold Rogers Prescription Drug Monitoring Program (PDMP) is expanding its effort to address the opioid crisis with $1.4 million in grant funding to support PDMP EHR integration throughout New Jersey.
Health experts say PDMPs enable better prescribing practices, target treatment to at-risk patients, monitor the use of opioid painkillers, and mitigate the risk of potential abuse or fraud by patients who obtain prescriptions from multiple providers.
. . . “The NJPMP is a highly effective tool in our fight against the opioid crisis. It helps ensure that prescribers and pharmacists have access to key signs of abuse and addiction,” Cari Fais, acting director of the Division of Consumer Affairs, said in a press release. “These enhancements to the NJPMP will prevent opioids from falling into the wrong hands and will make the NJPMP an even stronger and more user-friendly tool for clinicians.”
Perfect! What could go wrong?
I mean . . . okay, so there is this –
Okay, that’s not good.
But maybe medical prescribers just don’t like being told how to competently practice medicine. Like they would need to be told!
They likely would practice to protect patient safety if they weren’t overly constrained by rules and regulations, instead voluntarily, like in Oregon –
No. Okay, must be some explanation. It must be that the system is so cumbersome that the time involved just doesn’t justify the effort to protect patient safety.
Just needs to be easier, less demanding of time. For example, like an email alert from a pharmacy directly to a prescriber for a particular patient that could allow prescribers to avoid high-risk prescribing of a benzo with an opioid.
Simple. Have your MA flag any such email, the prescriber takes 3 minutes to read it, then avoids the potentially lethal prescribing, potentially save a life. What ethically practicing medical professional would not do that?
Email alerts to practitioners from pharmacists did not reduce concurrent prescribing of opioids and benzodiazepines, a randomized trial showed.
They’re just not feeling it.
As, I guess, they just have not been feeling the obligation to meet arguably one of the most basic of ethical principles guiding practice to ensure the safety of patients – provision of informed consent. Informed consent an absolute ethical mandate whenever an offered or recommended course of treatment involves risk, like say risk of dependence, even death with use of addictive opioids –
The Patient Opioid Notification Act requires that medical practitioners discuss the addictive potential of opioid-based painkillers with their patients – and parents of minor patients – as well as discuss, when appropriate, safer non-opioid pain relief alternatives.
. . .
Prior to enactment, only 18% of the participants warned patients about the risk of opioid addiction when prescribing opioids. After enactment, 95% routinely warned patients about the risk of addiction.
. . .
Dr. Andrew Kolodny said, “These findings show that very few opioid prescribers were warning patients about the risk of addiction before New Jersey required them to do so.”
That’s less than half the story.
All medical practitioners were already required – by the most fundamental of their ethical duties and standards of practice – to provide explanations of risks, benefits, and alternatives for any recommended or provided medical procedure or prescription. They just weren’t doing that over the decades that their opioid prescribing was leading to dependence and death for more and more Americans. It would take enactment of new state law and risk of violation to get them to follow their medical training and existing ethical standards protecting patients’ health and rights.
Consent without being fully informed of real risks of a medical intervention – including risk of illness and death – is not consent, it’s reckless neglect, or deception.
America’s medical practitioners appear to have been little more compelled to provide informed consent for prescribed opioids – required for patients to make choices protecting their own safety – than to protect public safety by use of PDMPs.
Or to apply in practice knowledge of consistent indicators against use of opioids for chronic pain generally, from research and information that had been available for decades.
Or, described in this post, to comply with the ethical and practice obligation to confidently monitor safe use of the medications they prescribe.
And they – America’s prescribing medical professionals – have definitely not been feeling the ethical compulsion over past decades to avoid overprescribing and misprescrbing addictive opioids even when knowing it was not in the best interests of their patients, was placing their patients at risk of harm.
Sam Quinones, Chris McGreal in American Overdose, and some others have outlined the sordid confluence of forces –
deception, fabrication, submission to pressure from patients and medical organizations, and failed responsibility to vulnerable, trusting Americans – driving generation of the lethal opioid epidemic: a remarkable abdication of competence, integrity and ethical behavior by players including big pharma, America’s top medical, oversight, and research institutions, and the medical profession, with mass media along for the ride.
As McGreal describes in American Overdose, the clinical environment in medical practice settings became coercive and toxic – a collusion of patients trained by decades of programming to seek a pill for every distress including opioids, supported by the medical/hospital/insurance industrial complex to report doctors who would resist providing opioids inappropriately and threaten them with complaints and action by professional and licensing boards.
McGreal talked to Dr. Charles Lucas, a surgeon in Detroit who resisted growing pressure to overprescribe opioids, ended up being subject to a complaint and summoned before a hospital ethics committee for failure to provide adequate pain treatment.
(from American Overdose pp 88 – 89)
The case was dropped, but it was not an isolated incident. Luca has worked closely with another surgeon, Anna Ledgerwood, since 1972. She too was hauled before the ethics committee on more than one occasion on the same charge. One of the investigations, for alleged inadequate pain management after a hernia operation, went all the way up to the state medical board. It cleared Ledgerwood, but Lucas said more junior surgeons buckled to the pressure to administer opioids just to stay out of trouble. “If they will give me a hard time, then they will surely give a young resident a harder time,” he said. “I tend to be a fighter. That’s my nature. But somebody who just wants to take care of patients, they want to be a professional physician, they don’t want to put up with all this crap; they’re intimidated. They’re also frustrated by it. The medical community knows that too many pain medicines are being written. Doctors talk about it among themselves. They’re not in a position to challenge the system. But they know.”
Lucas regarded the new pain orthodoxy as a growing tyranny, and he thought it was killing patients.
Of course they knew. Or should have, or should not be practicing medicine.
But the forces driving runaway, medically inappropriate dispensing of opioids were not knowledge, competence, integrity or professional courage. There were other forces at play.
It is much less discomforting – especially for America’s journalism institutions instrumental in helping to fabricate out of nothing a bogus scientific rationale for runaway use of opioids against all evidence – to focus on Big Pharma (another example of the unfortunate excesses of corporate greed) as the reason for the lethal crisis, than to accurately indict America’s most trusted institutions including the impotent and enabling watchdog press that helped to create the needed fabrications. The more attention diverted to Big Pharma, the less on the necessary roles of media, the medical profession, research and oversight institutions. Corporate greed is a given; incompetence and betrayal by the core democratic and public health institutions trusted to protect American well-being and lives must be disguised, distracted away from.
And just as blanket Medical-Media messaging has constructed pill manufacturers, somehow, as responsible for the runaway dispensing – against all longstanding lines of evidence – of addictive opioids for the non-medical condition of chronic pain, generating the increasingly lethal opioid crisis – the same collaborating forces successfully fabricate a STORY of street fentanyl as explaining continuously mounting opioid-related deaths, those deaths correlated with increasing provision of the Medical-Media “treatment”.
Quinones spilled the truth, more directly, as part of a cover story in the LA Times, when he noted, simply, that
Doctors told me they misprescribed the addictive opioids – Schedule II Controlled Substances – knowing it was medically not indicated.
Right, they disclosed the obvious which must be covered, hidden – the purpose of the cowardly LA Times Op-Ed.
Again, from Chris McGreal’s “American Overdose” –
“The medical community knows that too many pain medicines are being written. Doctors talk about it among themselves. They’re not in a position to challenge the system. But they know.”
Lucas regarded the new pain orthodoxy as a growing tyranny, and he thought it was killing patients.
American doctors, by their own accounts, conveyed by McGreal and Quinones, knew it was indicated against, wrong, placing patients at risk.
But they were inhibited from practicing ethically, competently.
Okay, yes, it’s placing patients at risk, some at risk of serious harm, but . . . I’d have to go up against the hospital board, the system, maybe get in trouble . . . this is my medical career.
Looks like that PDMP, its funding and the media hype around it are a dog and pony show, a distraction, the real action hidden, distraction and waste of public funds in lieu of real changes to failed, sham treatment systems and practices that predict harm.
It hasn’t stopped.