“What am I supposed to do? I’m over the limit.”
Recently I was visited by a patient “warrior”. I hadn’t known her before, but she had read one of my articles online and wanted to meet me. I was touched. There in the foyer of our surgical center, she motored up in her electric scooter and smiled the genuine smile of a person seeing a long lost friend.
Are there limits to friendship? No.
Are there limits to prescribing opioids for pain? Maybe.
At the vortex of misinformation swirling around pain regulations is the fact that no state has limited what physicians are allowed to prescribe, although some states make it unwieldy to treat legitimate pain patients compared to other states; some set unsubstantiated quantity limits while others require consultation to a pain specialist if a predetermined (yet not scientifically proven) “morphine equivalent dose is prescribed”. Nevertheless, no states unilaterally prohibit a prescription at any dose if the regulations are followed. However, requiring a pain specialist in some cases may become a logistical nightmare because in most instances there are not enough pain specialists to go around.
To be sure they have created thresholds above which physicians are required to do certain obligatory actions like: drug screens, re-evaluations, treatment agreements, and database queries. But these requirements do not represent ceilings to what can be prescribed – as long as it is medically necessary.
Are these regulatory obligations rational, reasonable, fair, or effective? That is a subject for another article. What is true now, however, is that prescribers are drowning.
“OPIOID” is the acronym used in an upcoming seminar that aims to rescue prescribers from the regulatory maelstrom.
“OPIOID” means Optimal Prescribing Is Our Inherent Duty. It is a seminar conceived by physicians, approved by Kentucky’s Medical Board, and produced by the Greater Louisville Medical Society in association with the University of Louisville – February 7 – 9, 2014. The goal of “OPIOID” is to empower prescribers to optimally care for suffering patients and adhere to the governing regulations. Clinicians and support staff can register by email: firstname.lastname@example.org or call: 502-736-6354 or visit online at https://www.glms.org/Home.aspx (and click on the “OPIOID” tab).
My new friend, whose pain had confined her to her motorized chair, wasn’t quite convinced when I assured her that her state’s (Indiana) regulations did not limit what her doctor could prescribe. But in her friendly eyes I saw hope. And her hope gave me strength.
Am I strong enough to climb over the barriers created by these regulations? Are you?
As long as there are patients willing to fight the good fight, then so will I. And courses like “OPIOID” provide us the tools we need to win. Together, the possibilities are limitless.
James Patrick Murphy, MD, MMM
January 26, 2014
Note: This article was originally posted January 27, 2014 on Dr. Jeffrey Fudin’s blog http://paindr.com/opioid-possibilities-are-limitless-2