# Sweeping changes to US opoid policy.



## NomadicMedic (Feb 4, 2016)

http://www.nejm.org/doi/full/10.1056/NEJMsr1601307?query=featured_home&


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## Carlos Danger (Feb 4, 2016)




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## NUEMT (Mar 11, 2016)

House bill 4365 is attempting to address this.  

THe DEA basically said they had no verbiage for standing orders in their laws so they have been working with the NAEMSP on a specific set of EMS rules.

https://www.congress.gov/bill/114th-congress/house-bill/4365


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## Carlos Danger (Mar 11, 2016)

Opioid abuse has become a massive problem, but not every problem - no matter how large - is best addressed by the federal government. 

Any regulatory action that makes it more difficult for opioid abusers to obtain opioids will also make it more difficult for people who _need_ opioids to obtain them, as well. In fact, this is already a well-documented problem. Imagine having chronic, debilitating pain - or even acute pain - but living in an area where many physicians simply refuse to prescribe opioids because the legal risks are too great.  

Some of the strategies that can be used for minimizing opioid prescriptions were outlined in the linked article. But those are issues for the medical community to deal with, not federal regulatory agencies. Frankly, I see little role here for federal governmental involvement at all, aside from stepping out of the way in terms of the development of new pharmaceutical modalities of managing both pain and addiction.  

As with everything else (drugs, guns, prostitutes, etc.), people who want this stuff will still get it, or they'll substituted something entirely different but just as dangerous. That's actually exactly how we got here in the first place -  a really good argument can be made that our prescription opioid abuse problem is largely a result of our idiotic prohibition of other, less harmful drugs. 

More regulation of legally-produced opioids will harm legitimate patients, and will only provide the impetus for increased availability of illegally-produced opioids, which is already a growing part of this issue. Continuing to double down on failed approaches is just stupid. Prohibition has never worked, and it usually makes things worse.


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## johnrsemt (Mar 14, 2016)

Well said Jeep


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## SandpitMedic (Mar 14, 2016)

Yeah, _Jeep_. 
Spot on!


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## NUEMT (Mar 14, 2016)

Remi said:


> Opioid abuse has become a massive problem, but not every problem - no matter how large - is best addressed by the federal government.
> 
> Any regulatory action that makes it more difficult for opioid abusers to obtain opioids will also make it more difficult for people who _need_ opioids to obtain them, as well. In fact, this is already a well-documented problem. Imagine having chronic, debilitating pain - or even acute pain - but living in an area where many physicians simply refuse to prescribe opioids because the legal risks are too great.
> 
> ...




While I don't entirely disagree with you, I will on one point specifically.  I believe that there _is_ a role for the feds here.  The feds are more likely to be able to address the problem from an interstate commerce angle more quickly than the states could go about thinking up 50 different responses to regulatory compliance.  EMS would suffer further in this model.  MAny reasons have been discussed for the problem but at the base of nearly all sides of the argument is money.  As evidence, I would look to the companies who have profited the most from opioid medication production who have also profited from the manufacturing of Nalaxone.


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## Carlos Danger (Mar 14, 2016)

NUEMT said:


> While I don't entirely disagree with you, I will on one point specifically.  I believe that there _is_ a role for the feds here.  The feds are more likely to be able to address the problem from an interstate commerce angle more quickly than the states could go about thinking up 50 different responses to regulatory compliance.



The feds always trying to "address the problem" _is_ the problem. They need to back off. There is nothing the federal government can do that won't make the problem worse for somebody, if not everybody.


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## NUEMT (Mar 14, 2016)

Ok. Based on what?  The undertreatment of pain was the catalyst for clinicians and pain societies to successfully lobby for increased use of opioids for all pain types, including non-cancer pain. -Atkinson, TJ et al. The damage done by the war on opioids: the pendulum has swung too far. Journal of Pain Research; 2004, 7: 265-268.

The FDA approved the drugs because of the "medical community."  This coupled with "the war on drugs" has led to the increase in availability and distribution.  I would also point out that that the disproportionate enforcement of drug policy against minorities has opened the door for middle age whites to have an open road to undiagnosed dependency. (http://www.newsweek.com/2016/01/08/big-pharma-heroin-white-american-mortality-rates-408354.html)

If they back off, who will pay the bill when the "medical community" fails to curb appetite. Because the relationships between Pharma and Med have no legal restrictions as the arguably do in Gov?


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## Carlos Danger (Mar 14, 2016)

The only thing the feds can do is put in place legal restrictions that make it harder to prescribe opioids. That is the only tool that they have. That would probably help a little in reducing the exposure of opioid-naive people to long-acting opioids - you can't become addicted to something you never take, after all. However, it would also harm people who legitimately rely on those opioid prescriptions. And that is simply unacceptable.

What needs to happen is that physicians need to be allowed to use their judgement about who needs opioids and who doesn't. This problem didn't start to get really bad until the early 2000's, a handful of years after the whole "no one should ever feel pain" campaigns started pressuring doctors into handing oxy out like candy. Now the chickens are coming home to roost and everyone is pointing fingers and begging the government to save us from ourselves. It is pathetic.


*Government in the mid-90's:   *You need to be more aggressive in treating pain. Start giving out more opioids if you have to.
*
Doctors:          *But not everyone needs opioids. Giving these drugs out liberally will cause serious problems.
*
Government:   *Look, you just better fix this pain problem. The advocacy groups are all up my butt about it. If your patient satisfaction scores aren't high enough, you know what that means for your reimbursements. And if your nurses can't document a pain level of "3" or less every four hours for your inpatients, you are really in trouble.
*
Doctors:          *This is a bad idea, but I guess I have no choice.
*
----- 20 years later ----- 

Government:  *Dammit! Opioid addiction and related deaths have been skyrocketing! What are you doing with the opioids!?!?
*
Doctors:          *Treating pain more liberally, just like you wanted.
*
Government:  *Well clearly you just don't know what you are doing. We are going to have to more closely manage how you prescribe opioids. Bring me the charts of everyone you prescribe opioids to!


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## NUEMT (Mar 14, 2016)

"The only thing the feds can do is put in place legal restrictions that make it harder to prescribe opioids. That is the only tool that they have. That would probably help a little in reducing the exposure of opioid-naive people to long-acting opioids - you can't become addicted to something you never take, after all. However, it would also harm people who legitimately rely on those opioid prescriptions. And that is simply unacceptable."

This is just flat out not true.  The federal government not only puts in place the regulatory framework for the production of and dispensation/control/enforcement arm of these drugs but, also funds billions of dollars of research that the Pharm companies thrive on.(http://www.news-medical.net/news/20...-government-funding-in-pharmaceutical-RD.aspx)

This has a huge effect on the way the companies like to be seen and thought of by the feds.  The campaigns, as noted in my citations originated from medical groups made up of medical professionals.  What you really had was a difficulty in defining physiologic pain associated with a chronic pain condition, and withdrawal pain (also with physiologic symptoms) associated with opiate withdrawal secondary to increased enforcement; among other things. (http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2711509/)

Maybe I am totally wrong.  Maybe your timelined Government/Doctor conversation did occur.  Just prove it.

Otherwise, you are doing exactly what most lawmakers do.  Surmise a solution to a problem based on anecdote and opinion and dogma.  It's like EMS and MAST pants.


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## Carlos Danger (Mar 14, 2016)

Pharm companies are already being supported with billions of dollars of corporate welfare each year. I suppose we could increase that, though, and maybe in 10 years we'll have a pharmaceutical solution to this. Maybe potent non-addictive analgesics. Maybe a drug that cures or prevents opioid addiction? Maybe no advances in this area at all. Who knows.

Everything else is just more restrictions.

If you really think more of the same is going to provide a different result, well, I just don't know what to tell you, other than that you have far too much faith in the government.


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## NUEMT (Mar 14, 2016)

You're  towing a line that is old and ragged my friend.  I am challenging you to prove what you are saying.  Not just repeat what I can turn the TV on for.  My point is that despite what you believe being at least, partially true, _we _have the opportunity to be the practitioners collecting the data and participating in the research that makes the difference.  Throwing my hands up in the air and condemning government in this country will not solve anything at all.  I remind you that the "corporate welfare " that you reference, is how we got many of the medications that we use to save lives.  You have told me plenty.  You just haven't really provided evidence of your position.  And evidence, is how we speak to these opposing sides.  That is what they understand because they aren't on the street pushing narcan everyday.  

You are a well known member.  Lots of trophies. Tons of thumbs ups.   Do you have those because people believe you are a chill guy? Or because your posts reflect a level of expertise that can be referenced? 

What kind of medic do you want treating you in your 80's..... ?


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