Senator Portman Presumes To Know How Many Days Of Pain Relief All 328 Million Americans Need

Senator Portman Presumes To Know How Many Days Of Pain Relief All 328 Million Americans Need

With clear evidence that restricting the number of prescriptions increased the death rate by driving non-medical users to heroin and fentanyl, the last thing one wants to hear about is a politician planning to double down on this deadly policy by calling for further prescription limits for patients in pain.

Yet Senator Robert Portman (R-OH) is proposing legislation that would impose a national 3-day limit on opioid prescriptions following surgeries. He will be kind enough to allow exceptions for people dealing with cancer, chronic pain, and “other serious matters”—whatever that means.

Government data show there is no correlation between the number of opioids prescribed and their non-medical use or the development of opioid use disorder. Overdose rates skyrocketed during the last 10 years while high-dose opioid prescriptions dropped more than 58 percent and total volume of dispensed opioids dropped more than 29 percent. Seventy-five percent of opioid-related deaths in 2017 involved fentanyl and heroin, and fewer than 10 percent involved prescription pain pills without also involving heroin, fentanyl, cocaine, tranquilizers, or alcohol. 

The senator has determined that, “After the second or third [postoperative] day, other pain medications work just as effective (sic).” In my more than 35 years as a practicing general surgeon, I usually find that my patients recovering from major surgery require prescription opioids to control their pain for more than 2 or 3 days. It is bad enough that many states have imposed 5 or 7 day limits on opioid prescriptions, forcing many patients in severe pain to make multiple trips to the doctors office for refills. Imposing a national 3-day limit lacks an understanding of the science. It would be an unfounded and callous government intrusion into the practice of medicine.

Senator Portman, like so many other politicians untrained in medicine or pharmacology, is guilty of misinterpreting and misapplying the guidelines on opioid prescribing published in 2016 by the Centers for Disease Control and Prevention. He must still believe that today’s non-medical users are yesterday’s pain patients, even though, as mentioned above, there is no evidence of any correlation between the two

He also seems to think there is a high risk of addiction in patients prescribed opioids for acute post-surgical pain. Yet a well-publicized study in the medical journal BMJ by researchers at Harvard and Johns Hopkins looked at 568,000 opioid “naïve” patients in the Aetna health insurance data base given prescription opioids for acute postoperative pain over the period of 2008-2016. The researchers found the “total misuse rate,” i.e., rate of all opioid misuse diagnoses among the 568,000 patients prescribed the opioids, was 0.6 percent.

Senator Portman told Ohio reporters, “After day four, five or six, the chances of becoming addicted are higher.” Maybe he is reacting to the statement by the researchers in the BMJ report that each refill and additional week of opioid use was “associated with an adjusted increase in the rate of misuse of 44%.” But a deeper look at their data shows the incidence of opioid misuse rose from 145 cases per 100,000 person years, or 0.15 percent per year, in patients who had no refills, to 293 cases per 100,000 person years, or 0.29 percent per year, for persons who had one refill. Indeed, that is nearly double. But if you nearly double a very low number, you still get a low number.

The fact is the overdose rate from the non-medical use of licit and illicit drugs has been on a steady exponential increase since the 1970s and shows no signs of slowing down. The only thing that has changed over the years is the particular drug in popular use at any given time. The reasons behind this are complex and multifactorial, and likely sociocultural and psychosocial. In the early part of this century the popular drugs for non-medical users were diverted prescription opioids. Next it became heroin. For the past several years it has been heroin and fentanyl. Methamphetamine related deaths are now surging to all-time high levels, and preliminary estimates from the CDC place the number of meth-related deaths at nearly 13,000 in 2018—eclipsing the number for prescription opioid-involved deaths.

Senator Portman is two or three drugs behind in his prosecution of the drug war. 

To bring the death rate down, Senator Portman should learn a lesson from his home state of Ohio, where a recent embrace of harm reduction measures—expanding needle exchange programs, distributing the overdose antidote naloxone, and increasing access to Medication Assisted Treatment—has led to a 23.3 percent drop in overdose deaths in 2018 according preliminary CDC data. Harm reduction is a proven strategy for saving lives.

If Senator Portman wishes to craft legislation that can truly save lives, he should propose a repeal of the federal “Crack House Statute.” This law stands in the way of many of the country’s largest cities that wish to establish Safe Injection Facilities, which are preventing overdoses and saving lives in more than 120 cities throughout Europe, Canada, and Australia.

8 Responses

  1. “If Senator Portman wishes to craft legislation that can truly save lives…”
    I used to sneer at conspiracy theories, but several years of being a target of an active, designed campaign to kill off a group of people has me wondering if they really are out to get us…i.e. kill us off. I really do not believe they give a flying *^@$ about “saving lives,” at least not of us “unproductives” or of anyone stupid or weak enough to need surgery (unless they’re already rich/powerful, in which case I’d bet anything I have they get whatever they need).

    I never, ever dreamed that at nearing 60, after a lifetime of being very hardworking in the sciences & truly patriotic, I’d truly believe my country was trying to run a repeat of Nazi plans, but it’s real hard not to believe it at this point. I wish to God I had the resources to leave this stupid, hysterical, propaganda-swallowing, anti-fact, anti-science country.

  2. Don’t you guys understand they DO get it, They DO realize what is happening by continuing to restrict LIFESAVING PAIN MEDICATION to anyone in pain will cause agony, torture eventually death to millions!! Pain pts are self medicating, wtf are we supposed to do?! When a person cant find help the legal way, help they had for DECADES and these scumbag politicians come in with their holier than thou self righteous attitudes dictating to we the people who gets a pill! #ENOUGHISENOUGH! Id love to see every one of them suffer unbearable pain but even if they did they would get what they needed. They don’t go by the laws they put in place. Smdfh

  3. govt should NOT have the ‘authority’ to interject themselves into the Dr/ Pt relationship!!!
    Congress & all the various 3 letter govt branches (CDC, FDA, DEA, NIH, etc) NEED to stick to politics & stay out of medical Tx issues 2° to their obvious LACK of knowledge, compassion & human decency.

  4. Thank you for your considerable knowledge and experience. Keep fighting. My husband underwent a fem/pop surgery and acquired a horrible infection. 5 strains, a golf ball sized hole and 18 days in the cardiac icu. No way could he have been taken off the pain meds in 3 days. No way.

  5. Okay, it’s high time someone call’s for this idiots resignation. These guys can’t seem to get it through their block heads that they are causing a great deal of harm out here. It’s obvious to the author and most people with any sense that this jerk is not reading the data that is being posted by even the CDC! I’m firing a letter off to this so called representative of the people of Ohio. Senator Portman, how many more bodies do we have to stack before you and those like you are heading in a dangerously wrong direction! The reduction you have forced on sick people have only resulted in suicides and had zero impact on overdoses. Jack Ass

  6. Idiot! Stay out the of the doctor patient relationship and stick to politics. Board certified medical professionals know more about treating pain than the Congress

  7. I don’t get why these clowns are allowed to write law on subjects they no nothing about. How I mean it doesn’t even make sense. There’s a “bartender’ from N.Y. that is as dumb as the day is long and she can write law on anything she likes?

  8. No no, …I get it. Their is a contest to see who can be the world’s biggest stupid asshole, no I get it now.

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