what would happen if …. ?

What would happen if one or more people approached a law firm to generate a “generic letter” that anyone could take to another law firm to get them to send it to a prescriber, group of prescribers and/or their corporate employer’s legal dept.

The letter would have the general purpose to be sent by those pts whose prescriber is cutting or eliminating their pain management meds. It is common knowledge the physical/mental consequences of under/untreated pain as per this table


Besides of what is on this table, we all know that suicides of these chronic pain pts are on the increase.

The letter should address the complications of the pt’s comorbidity health issues and adverse affects on the pt’s quality of life.  Suicide should not be listed in the letter maybe just subtly implied of what might happen.  No one wants such a letter to cause the pt to get a 72 hr involuntary admission to a mental health facility.

However, complication of the pt’s comorbidity issues because of decrease/eliminated pain management could lead to a premature death of the pt.

The pt’s physician should be fully aware of the potential adverse health issues that the pt may experience and those adverse outcomes could be considered a DIRECT RESULT of the prescriber’s action(s)… including the demise of the pt from withdrawal issues.

Once such a letter is generated, it would be available to all chronic pain pts at no charge.  In turn, these pts could take the digital letter/text to local attorney or legal aid group.  This process should keep the pt’s out of pocket expense to a minimum.

Have the attorney to send the letter – via certified mail – to the prescriber and the legal dept of the corporate employer.

If the pt dies prematurely, then the surviving members of the family has documentation to have the prescriber charged with a number of crimes that contributed to the pt’s death.

Right now, no one is looking for a link between the actions of the prescriber and the pt’s death… if a pt dies, without any of this forewarning of all parties involved… the pt’s death will be listed as “opiate related death” because the pt’s toxicology shows a opiate in their system and/or the cause of death well be “natural causes” from the complication(s) of their comorbidity issues.

The DEA is charging prescribers with the OD deaths of one or more pts that the prescriber may have seen as much as one year back and may have written a single prescription for a opiate.

Today, healthcare professionals ( prescribers, pharmacists, & others) have not experienced any consequences for their actions and/or denial of care.  Mainly because it is claimed that 90% of chronic pain families are struggling financially and cannot afford legal services.

If a prescriber has told the pt that they are going to be reduced until they are off opiates… what is a prescriber going to do if they receive this letter … reduce the pt’s pain meds ? They are going to do that anyway.

If the prescriber discharges the pt because of the letter, then the prescriber has set themselves up for complaints being filed with the state medical licensing board for pt abandonment, retaliation and probably several other legal issues and if the pt is on Medicare or Medicaid then complaints filed with 800-MEDICARE.

If the prescriber is doing this to all of his/her pts then there is possible issue that could generate a class action…. especially if the prescriber is an employee of a larger corporation.

4 Responses

  1. And what does that 90 mm mean how that they have changed pain meds

    • What MME “means” is Morphine Mgs Equivalent there are websites that will calculate what different opiate meds doses will be “equivalent” to a certain number of milligrams of Morphine in regards to pain relief… but all of these calculating formulas have a footnote (same/similar) to this: https://globalrph.com/medcalcs/opioid-pain-management-converter-advanced/

      Published equianalgesic ratios are considered crude estimates at best and therefore it is imperative that careful consideration is given to individualizing the dose of the selected opioid. Dosage titration of the new opioid should be completed slowly and with frequent monitoring.
      Factors that must be addressed during the conversion process include: Age of the patient or presence of coexisting conditions. Use additional caution with elderly patients (65 years and older), and in patients with liver, renal, or pulmonary disease.
      Conversion ratios in many equianalgesic dosing tables do not apply to repeated doses of opioids.
      The amount of residual drug in the patient’s system must be accounted for. Example: fentanyl will continue to be released from the skin 12 to 36 hours after removal of the patch. Residual effects from discontinued long-acting formulations should also be assessed before converting a patient to a new opioid.
      Review the concept of incomplete cross-tolerance:
      D. McAuley: “Incomplete cross-tolerance relates to tolerance to a currently administered opiate that does not extend completely to other opioids. This will tend to lower the required dose of the second opioid. This incomplete cross-tolerance exists between all of the opioids and the estimated difference between any two opiates could vary widely. This points out the inherent dangers of using an equianalgesic table and the importance of viewing the tabulated data as approximations. Many experts recommend – depending on age and prior side effects – reducing the dose of the new opiate by 33 to 50 percent to account for this incomplete cross-tolerance. (Example: a patient is receiving 200mg of oral morphine daily (chronic dosing), however, because of side effects a switch is made to oral hydromorphone 25 – 35mg daily – (this represents a 33 to 50 percent reduction in dose compared to the calculated 50mg conversion dose produced via the equianalgesic calculator). This new regimen can then be re-titrated to patient response. In all cases, repeated comprehensive assessments of pain are necessary in order to successfully control the pain while minimizing side-effects.”
      The use of high but ineffective doses of a previous opioid may result in overestimation of the converted opioid.
      Ideally, methadone conversions (especially patients who were previously receiving high doses of an opioid) should only be attempted in cooperation with a pain specialist or a specialist in palliative medicine.

      The authors make no claims of the accuracy of the information contained herein; and these suggested doses and/or guidelines are not a substitute for clinical judgment. Neither GlobalRPh Inc. nor any other party involved in the preparation of this document shall be liable for any special, consequential, or exemplary damages resulting in whole or part from any user’s use of or reliance upon this material. PLEASE READ THE DISCLAIMER CAREFULLY BEFORE ACCESSING OR USING THIS SITE. BY ACCESSING OR USING THIS SITE, YOU AGREE TO BE BOUND BY THE TERMS AND CONDITIONS SET FORTH IN THE DISCLAIMER.

      What this basically means is that these conversion formulas are – at best – EDUCATED GUESSES – and pretty much MEANINGLESS when trying to move a pt from using one opiate to a different opiate. BUT … the CDC and others have accepted these conversion formulas as BLACK/WHITE “accurate” conversions.

      Generally, a prescriber that would use a process, testing equipment or some other methodology – that is know to be defective or produce inaccurate results and used those results to diagnose and treat a pt’s health issues… would be guilty of malpractice and/or unprofessional conduct. But in the case of the MME calculations, the CDC/DEA and others have adopted these faulty conversion programs and have instructed the healthcare community that they are to be used – without questioning – the resulting conversion and/or ignore the complaints of pts that the MME equivalent doses are not producing equal pain management. Since the DEA has been given – or taken – the authority to make interpretations of laws.. and they have decided that these conversion tables are “factual” and they are capable of “enforcing” those interpretations on prescribers that question the conversion tables and their outcomes.

  2. Why can someone they did not committee a crime can not get pain meds. .. But a person in jail is going to get 5490000 because they will not give him pain meds. I have been going though hell with my pain.. My Dr took me of my pain meds after 13 years gave me one month and told me I have to fine another Dr. For on reason of mine .i passed all my drug test , never had a bad word with anyone in the office… They sit me up big time.. And I am having all kinds of things going on . Sept I had to go to ER my BP was 220/120 And in around 15 min. Paramedics got here. It was 220/40 yes 40 the ER Dr said they was going to keep me over night . So I told my husband to go home.. He stopped at the desk and ask them what time the next day he could pick me up ….. They said the did not no. .. But anyway at 3: 30 am they said we are Sending you
    home.. I told them I could not get a hold of my husband
    That did not matter to them.. They told me I could go I did not even no how to get out.. The nurse said to me go up there push the blue bottom and them doors will open ….. I was still dizzie, still sick, BP was still up some . .. They did not take me to the door. So I wished there was lawyer out some place would just be a lawyer and help some of us that have been TRARTED bad by the medical profession I had the contaminated epidural injection in 2012, I can still not get no help what is going on in this USA of America, if a lawyer reads this and would like to help me i sure would be appreciated …. It is pretty dam bad when someone committees a crime and can get better medical care than someone that has not broken the Law

  3. Great idea Steve. Seems to cover all the bases and provide logical framework for future prescribing issues such as tolerance, dependence and deterioration of conditions that may require dose escalation.
    Seems that if the prescriber takes time to consider the patients intent of the letter, the same prescriber would see the protections the letter could afford them, as a defence against legal threats by brought by regulators.
    The prescribers have a prudent right to protect their practice and the focus of legal action would be shifted to the patient via the letter. I doubt the DEA or others would move to pursue a disabled citizen individually, over pain medication legally prescribed. The doctor’s interest in “effective” pain management is legitimately served and protected via the intent of the letter.
    I may do this soon. I wonder if I really need a lawyers letterhead?

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