We all know there’s an opiod epidemic that’s causing a lot of addiction and deaths. But we also know there are a lot of people living with chronic pain. As imperfect as the system is, I don’t know that politicians replacing doctors’ judgment with their own is a bright idea. This line from the article chilled me:
What? Do you not appreciate that the government already does regulate how a variety of controlled substances are prescribed? Why do you think they are called “controlled substances?”
Some doctors are doing a poor job within the current controls. This is regional (worse in the South and in more rural districts) and associated with patient mix (White patients are more likely to be inappropriately prescribed opioids).
I would be cautious with the fixes. Good intentions can sometimes cause significant harms. But the issue is not whether or not government should be involved, they are, but a reasoned debate over exactly how they should be involved in a more useful way than they currently are.
Of course not. Everyone knows that’s what insurance companies are for. 
I had thought that as a general principle, the decisions on how to get treated were between a patient and her doctor and the government should stay out of it. The government already has reasonable restrictions on access to pain meds: you need a prescription. Doctor says you need pain pills, you get pain pills. Not sure what’s wrong with that system or how politicians are supposed to make it better.
I’ve got an idea. Let’s have Congress get together and decide how to alter how doctors help patients manage unwanted pregnancies.
I am not expert on the regulations for opioids but I know for simulants the amount and frequency I can prescribe an individual are controlled.
I also know that in my state, Illinois, there is a new state run Prescription Monitoring Program that allows prescribers and dispensers to check how many other scripts an individual is filling from other providers/dispensers.
I’m not sure what point you’re going for, but this seems like another example of the same problem.
Health care decisions should be based on the following:
- The patient’s needs and wants.
- What doctors think is reasonable within the scope of medical science.
Politics doesn’t have a place on this list. Legislators shouldn’t be getting involved in decisions about pain killers or pregnancies. A law deciding who can have a narcotics prescription or who can have an abortion makes as much sense as a law deciding who can have an appendectomy.
Then you get the point exactly. Sure, the government should establish best practices guidelines, but those guidelines are already more than sufficient. The government is trying to achieve a result and how they get there seems to concern them less than just getting there. The steps already taken have made it harder for legitimate patients to get access to drugs.
I think the focus should be on using the leverage of licensing rather that setting barriers between the doctor and patient.
If a doctor is prescribing medications unnessesary there should be medical review, and the doctor should lose prescription privileges/and or thier license if found negligent.
Just in case some actual facts might inform this discussion, here is the actual proposed law.
Note: as far as doctors’ judgement goes, what it proposes is to gather together a task force of various expert groups and involved parties to develop recommended evidence based best practices. Of note
Their task would be to provide the framework for the expert groups to develop an agreed upon best practice guideline and to advise on how to educate the prescribing population about them.
Any problems with the rest of the bill?
Also FDC regulations rather than direct legislation by ham-fisted politicians who have axes to grind. The FDC is in a much better position to evaluate recommended dosages, etc.
A directed Federal law is a little like the nationwide 55 MPH law: it’s using a sledgehammer where a scalpel (local speed zone laws) would be better.
Title VI- incentivizes the states to create more barriers to access than already exist.
Yeah, I didn’t think that actual facts would be of any interest.
Carry on with the ill-informed rants about that which does not exist.
I say make the opioids available OTC. There are always going to be addicts, but we don’t need to make the problem worse. Keeping the drugs illegal leads to robberies and murder. The drugs being illegal also makes it harder for addicts to get help.
it’s the principle, not the facts around one law.
No, other than regulating licensing of doctors, the government should not ever interfere between a patient and a doctor. If a doctor is incompetent, we have ways of dealing with that already.
They used to be available OTC. As far as I know, there wasn’t a higher rate of addicts back then. Prohibition has never worked.
So the law of the op has nothing to do with getting in the way between you and you doctor, but theoretically, should the state have anything to do with regulating professional conduct including imposing any restrictions on how medicines are prescribed?
Yes. Yes it should.
It should not abuse that oversight capacity for political purposes (as has been done in various states to restrict abortions by imposing actions that have nothing to do with or even contradict medical standards and has been done in Florida restricting physicians from asking about safe gun storage in households) but there clearly is professional oversight required and mandated.
Those capacities are spelled out in this pdf.
Bolding mine.
As has been pointed out, the system is already adequate. The rise in opioid deaths comes from two main sources, neither of which will be helped by more regulations on doctors:
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Drug abuse by people who do not need opiates. They are not getting these drugs from doctors.
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Accidental overdoses by people who do need opiates. Assuming doctors are doing their jobs right(and who are politicians to decide that?), the only way to reduce opiate deaths among people who actually need them is to simply deny access to painkillers. WHich is what states have been doing, primarily by restricting supply to pharmacies. So I can get a prescription for painkillers, and then I get to go to 10 drug stores who all tell me they don’t have it in stock and don’t know when it will be in stock. It’s brilliant! Brilliant in its stupidity.
As has been pointed out the proposed law does not suggest more regulations on doctors. I’ve given the link; have you looked at it?
People who do not need opioids ARE being prescribed them by doctors, and those who do need are being prescribed excessive amounts. In my end of the practice world, Western suburbs of Chicago pediatrics, teens are getting on opioids from sports injuries and then transitioning to heroin because of easier availability. In rural South Whites are prescribed opioids with excessive casualness and given too many for too long with regularity. Blacks in the South not as much and less so Whites in urban areas.
Inappropriate physician behavior is a significant part of the problem.
Who are politicians to decide that? The elected representatives of the people who as part of their job description have the responsibility of doing so.
There clearly is room for improved and well distributed evidence based best practice guidelines to be developed by and agreed upon by the various expert groups and communicated clearly to physicians who prescribe these meds.
If I’d seen some evidence that that was already going on I’d be more sanguine. We’re talking about politicians here. If they get the death rate down, then they go on TV and claim victory. Doesn’t matter if they do that while improving care or making it worse. You have to admit, limiting supply to pharmacies to below legitimate demand is nonsensical unless you’re just trying to get the numbers down and don’t care how you do it.