There is a well-known maxim regarding the practice of medicine that implores those in the profession to “first, do no harm.” Most doctors probably agree with the sentiment behind those words. When you are treating someone with an illness you want to try your best to avoid doing anything that will make the patient worse off than they were before they came to see you.
Government officials, on the other hand, are not known for abiding by the principle of avoiding doing harm to the people they serve. Instead, they tend to take action in response to prevailing political winds, often without much regard for the consequences that may befall those who are harmed by their policies and regulations.
A good example of what I mean by that can be seen in the response that our government has given to the “opioid epidemic.” In recent years there has been a good deal of press devoted to the fact that the use of strong narcotic pain relief medications such as oxycodone and hydrocodone and the incidences of addition and overdoses of these medications has been on the rise. And when a problem like this gets a lot of attention in the media, government officials feel compelled to do something about it.
In 2016 they “did something,” as the Center for Disease Control and Prevention issued new, stricter guidelines for doctors who prescribe opioid drugs for relief of severe pain. In short, those guidelines recommended steep reductions in the prescribing of these drugs, and that included patients who have been using the drugs for chronic pain management over a long period of time.
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You can probably guess what happened next. State governments, insurance companies, and health care providers have responded to the CDC guidelines by passing laws and policies to sharply reduce the prescribing of opioid narcotics, sometimes cutting off people who have no other viable option to find relief from their chronic pain very suddenly.
And this often comes as a shock to patients who have been managing their pain with these drugs for years. They show up at their doctor’s office and are told they simply won’t be getting any more prescriptions for these drugs.
So they are forced to come off of them cold turkey, forcing them to face not only the return of their chronic pain but also the agony of withdrawal symptoms. In many cases no allowance is being made for the age or health status of the patients, either. This is happening to people all over the country, and it’s happening right here in Middle Georgia.
I’m not suggesting that opioid abuse and addiction is not a serious problem, or that doctors shouldn’t use discretion in prescribing them. But decisions about what drugs to prescribe need to be made by doctors on a case-by-case basis, with the status of each patient taken into consideration. It is not a decision that needs to be handed down in a one-size-fits-all government mandate.
Some healthcare providers have been pushing back on the CDC mandate. Earlier this month, over 300 of them (including three former U.S. drug czars) delivered a letter to the CDC admonishing the agency for a policy that is harming patients with long-term chronic pain who have no good alternatives to these medications for managing their symptoms.
In the letter, the doctors said that the strict opioid guidelines and the reaction to them by doctors and insurance providers has “led many health care providers to perceive a significant category of vulnerable patients as institutional and professional liabilities to be contained or eliminated, rather than as people needing care.”
The bottom line is that opioid drugs can be very harmful and addictive if misused, but they are also the only effective treatment for certain types of chronic pain. The decision on whether or not a person uses this medication should be between the patient and his doctor. The government needs to butt out and let physicians do their jobs.