Letter: New guidelines for opioids aren’t logical

Letter: New guidelines for opioids aren’t logical

http://www.bendbulletin.com/opinion/lettertotheeditor/4154157-151/letter-new-guidelines-for-opioids-arent-logical

By Dr. Ron Ruff /

As a retired pain management specialist I have closely followed the new Centers for Disease Control and Prevention guidelines on “recommending” new limits for prescribers regarding opioids.

It was especially relevant to me not just as a physician but because of the discomfort I suffered while negatively shaking my head upon reading your editorial, “Guidelines a good start on combating drug abuse.”

Several decades ago, physicians were commanded under new recommendations that patient pain should be treated as the fifth vital sign (in addition to blood pressure, heart rate, respiration and temperature). Patient pain should be queried and aggressively treated, and physician performance on this matter would be closely monitored — albeit it was to be seen as merely a recommendation to improve care. Presently there is a narcotic abuse epidemic in the U.S. and worldwide that is being linked to the overprescribing of opioid drugs.

This is substantiated in the editorial and widely taken for causation by correlating “that fully 75 percent of those who become addicted to heroin get their start with prescription opioid drugs.” Statistics are funny things. One could argue the corollary that there are far fewer patients who become addicts that have been prescribed opioids, therefore the prescription must be preventative of addiction.

The new guidelines recommend these prescriptions for only a three-day supply and concurrent urine testing. Again, ivory tower medicine — think of what a three-day prescription looks like in the real world.

Having trouble getting a hold of your doctor now for blood pressure, diabetes and other chronic diseases for which pain actually dwarfs in numbers for the American population? Imagine having to do that every three days — one might as well start calling the minute they get home from the initial visit. Evaluating urine testing is more complicated than may appear to the layman, and indeed most physicians are not familiar with the nuances.

Tracking systems are essential and should be conducted by physicians and pharmacists in conjunction every time a narcotic prescription is involved. This should have been instituted long ago. The guidelines point out that other pain management avenues should be followed especially before or in conjunction with narcotic prescribing, and this is quite useful. In reality, the amount of time, effort and lack of systems in place to address this will negate the actual conduct of this, which is why the specific specialty of pain management evolved to allow physicians to refer their more complicated pain cases. Now these guidelines are asking overworked primary care physicians to take on this enormous responsibility, not only for the complicated case but for any involving a narcotic prescription.

Let’s be clear: From the standpoint of the practicing physician, these recommendations are another sword over their neck. Physicians were feeling these coming recommendations for the last decade prior and chose the most intelligent path for their practice to avoid litigation and the power of their medical boards: They just stopped prescribing narcotics completely. Those of us in the pain management arena saw this firsthand, and patients suffered tremendously.

Mark my word, these new guidelines, the feel-good words on paper to address an epidemic that is marginally caused by reputable physician practicing, will result in more pain and suffering for patient and physician both. It may actually increase the incidence of illicit narcotic use, and we will wonder how we ever thought this was good policy.

— Dr. Ron Ruff lives in Bend.

4 Responses

  1. Add this to the attitude of many nurses(of which I am one for last thirty years)…interns and harried staff residents. Fellows and hospitalists of which have no intimate knowledge that the specialists have with their patients of many years…These few mtgs with these random new players can exacerbate an already stressed out pt…my daughter has”malignant Crohn’s”gi docs term for her resistant type of disease…she had had all members of her health care team thru the ten year odessey insinuate to outright statements ranging from….”Hmm you sure know a lot about dilaudid..”to..”look we can fix this with out narcs bc I can Cure you…”, to. “I think all you need is a good decongestant”….she was crying and her nose was running…to this day I remember this self driving ego driven clueless upright baboon with a DEA#…

  2. I, along with every other Chronic Pain Patient are officially an Endangered Species! I do not deny that we have a massive crisis with Addiction here in the US; however, there are over ONE-HUNDRED-MILLION CHRONIC PAIN PATIENTS across the nation who are now being subject to many similar persecutions which were unleashed during Hitler’s Reign of Terror. We have had our livelihood’s stolen away through sickness or injury. Many of us are imprisoned by pain and the people who are making decisions about our bodies and what care we receive or more importantly DO NOT RECEIVE do not even know us, our health situations and needs or the fact that most of us have experienced great success when prescribed opiates.
    The new “cdc recommendations” are hurting us, victimizing the vulnerable and PEOPLE ARE DYING! My own insurance company continues to try removing medications that my PCP has purposely prescribed, when they know nothing about my healthcare needs. And, the recommendations are causing A frenzy of Fear amongst doctors who are abandoning the Chronically Pained and leaving us to the vultures. This is the America that my father served in the US Navy, my husband and two brothers served in the USMC & Army? We are being mistreated by doctors, their staff, pharmacies and their staff….We have been humiliated, shamed, disgraced and treated like Addicts and Common Criminals! And where can we turn? Who will listen?
    Our State Board of Medical Examiners see Chronic Pain Patients as subhuman. We are not granted proper access to meetings and hearings and have been muted on Conference calls. We have been told that Public Comment is welcome only to be cut off and reprimanded when we try to Advocate for ourselves. Even the codes established by The ADA (Americans With Disabilities Act) are being grossly ignored with the full knowledge and support of the MMA.
    Many of us see suicide as the only answer. At least we get to decide for ourselves what is going to happen. Heaven forbid we get put in on lockdown in Psychiatric ward where they believe us to be mental instead of what we are: Genuine Chronic Pain Patients. And they withhold our proper pain medications. Innocent patients are dying from suddenly being withdrawn from our prescribed opiate meds! But, instead of being treated humanely, we are treated worse than many of our family pets. It is tragic. Who will speak on our behalf?
    I became disabled because of a HUSHED BREAKOUT OF DISEASE in a hospital where I underwent a gall bladder removal and female procedure. Subsequently, I caught MRSA, CEPTSIS AND ASPERGILLOSIS which should have taken my life but instead I am left disabled at 48yrs old then, 56 at present. I not only get to enjoy the benefits of loosing everything; BUT NOW THE MEDICATIONS WHICH HELP ME TO GET OUT OF BED ARE TO BE TAKEN AS WELL!
    What did we ever do to deserve such heinous treatment?

  3. Thank you so much Dr.Ron Ruff for speaking up , I noticed that you are retired now , are most dr.s so afraid of being labeled as pushers they feel they can’t speak out ? I hope I’m wrong but untill more doctors also stand up and speak out with you , I fear the emperor will still be walking around naked , and our only voice will be body bags .

  4. My daughter has what has been labeled..malignant Crohn’s by her GI specialist.. one hospital that is not her usual inpatient stay choice has decided that they will no longer stick dilaudid as it is a”dangerous drug”…this is the only drug that works for her…ms04 can be increased to respiratory depression dosage to no avail for her….so her past hosp once for steroids and pain relief during a flair up ended up so bad that she had to get transfered into Philly for her university hosp…bc of the local hosp refusal to dose her at 2mgQ2Iv. Her highest dose in a flair.they wanted 0.5mgQ6..and no steroids….smdh…..Her mom…a thirty year RN…

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