Federal and state actions on opioids are turning away from simply targeting physicians, and there are even signs of a return to balance when it comes to prescribing.
In articles last summer, we chronicled the ways in which headlines about the opioid crisis led to blaming physicians, especially orthopedists, creating legal and regulatory pressures which led to extreme caution—too much caution, in the views of patient pain advocates—in prescribing opioids (“Orthopedists Due Major Blame for Opioid Crisis?” Part I, Part II).
Now, the legal and regulatory actions are massively targeting opioid manufacturers and distributors (see below). And a U.S. Senate hearing on February 12 offered a glimpse into changing federal attitudes toward prescribers:
It Takes a Patient
A woman named Cindy Steinberg made national TV news when she was brought in, lying on her back on a cot due to a permanently disabling, constantly painful 18-year-old injury, to testify about opioid prescribing and the crisis before the Senate Committee on Health, Education, Labor and Pensions.
Her plea: “Opioids are one treatment among many. They should not be a first-line treatment for chronic pain. Patients and providers should work together to carefully balance benefits and risks for each person. Nevertheless, for many pain sufferers, particularly those with severe pain, opioids can be a lifeline to lessening their pain,” she testified.
“In the near term, we can and must restore balance to opioid prescribing with de-politicized, rational and clear-eyed recognition of the risks and benefits of these medications,” she said. “In the long term, we must invest in the discovery of new, effective, and safer options for people living with pain.”
Ignoring the AMA!??
Two years ago, a year ago, even six months ago, the testimony receiving national news was all about opioid deaths and the epidemic. Voices urging balance, even that of the American Medical Association (AMA), weren’t being listened to.
The fact that she was called to testify in front of national television cameras, creating such a dramatic moment, is a sign of a shift in national political thinking about pain management policy and opioids, from targeting surgeons and other prescribers en masse to a more nuanced view of opioid prescribing and toward stepping up research on alternatives.
Along the same lines, in a little-noticed but telling action in January, when the National Institutes of Health’s Helping to End Addiction Long-Term (HEAL) research initiative announced the membership of a Multi-Disciplinary Working Group tasked to guide long-term federal research policy on new approaches to pain management, the group included pain researchers, a representative of a pain management advocacy group, and an AMA representative.
The composition of this advisory group is in sharp contrast to the way the Centers for Disease Control (CDC) went about choosing only opioid critics as advisors when it rushed into its now widely criticized, restrictive, one-size-fits-all 2016 guideline on prescribing opioids.
