The current state of pain management in the US

Dr. Heit, and many others, have recently talked about the use of “Civil Standards” of conviction in order to gain a conviction in cases where doctors are prosecuted for ‘overprescribing’ opioids [ OxyContin, morphine. Vicoden etc. ].

This is a problem for everyone in this country.

Doctors who practice legitimate pain medicine – and prescribe high doses of opioids – are being systematically forced to stop prescribing for one reason only.

The statutes, in all states – and federal law as well,do not specifically describe ANY DOSAGE beyond which a doctor can venture in order to be considered to be within the ‘meaning of the statute.’

This may come as a surprise to the readers – but it is absolutely true — there are NO boundaries defined by dosage limits.

Add to this the fact that VA guidelines for opioid prescribing allow and suggest very high dosages as ‘median’ amounts needed to treat pain. We are talking in the neighborhood of 400 – 500 milligrams daily of OxyContin and morphine. That would be the range of five or six 80mg. OxyContin tablets – daily. Thats about 56 pills every two weeks or 112 pills a month or about 1424 pills a year.

Chronic pain specialists may have as many as 200-250 patients; seen every two weeks. 200 times 56 = over 10,000 pills – every two weeks.

Those kinds of numbers really bother federal and state prosecutors.

The problem is that the laws, under which they try to destroy legitimate pain doctors,really don’t have any ‘teeth.’

Congress never intended for doctors to have to prove their innocence. When the drug prescribing laws were passed they were intended to do a couple of things-and only a couple of things:

1- Prohibit doctors from prescribing to KNOWN addicts.

2- Prohibit doctors from prescribing “Outside the Bounds” of legitimate medical practice.

THATS IT FOLKS – NOTHING MORE

There is no federal or state law-or DEA policy that prohibits doctors from prescribing to addicts who also have a legitimate chronic pain syndrome [ low back disc herniation etc. ]

Now – getting back to those VA guidelines, I mentioned above, they are based on government funded and sponsored research studies with controls and definitive outcomes.

Add to that the fact that The American Pain Society and most certified pain experts [ M.D.'s who specialize only in pain management ] have gone on record specifically stating that “High dose opioid therapy is legitimate medical practice.”

Lets also throw in the fact that everbody has a different need for opioid dosages which is genetically determined [ lots and lots of bona fide medical and genetics articles support this statement ]- and the propensity toward addiction is probably genetically determined in any given population. [ genetic receptor polymorphism ]

So the question to you is – If we are a ‘Nation of Laws’ then which law allows – within the definition of that law – a doctor to be convicted of ‘overprescribing’ if he has studied and practiced pain theory, examined each patient and believed, in his heart, that those patients needed the medicine to alleviate their pain and suffering?

The answer is – NO LAW, JACK !!!

Why is this YOUR PROBLEM? – Simple; the more the prosecutors fuck doctors around the less likely you will be able to get the drugs when you legitimately need them – because without basing their prosecution on facts – but rather – myth and prejudice

OH!!! THAT DOCTOR PRESCRIBED 8000 PILLS IN 7 MONTHS – AND OH!!! THAT PROFIT MOTIVATED GREEDY DOCTOR SAW 200 PEOPLE IN JUST 14 DAYS

then what doctor will continue to allow prosecutors to create stories – which, by the way, the stupid juries usually buy -’lock, stock, and barrel,’- that the doctor is unable to defend himself against.

These allegations [ civil standards based on the opinions of so-called government medical experts who will say "No, that doctor prescribed dosages higher than I or others would prescribe" therefore he violated the standards of medical practice ] are ‘Civil Standards’ that were never intended to convict doctors based on a difference of medical opinion.

Simply stated – this cannot be grounds for conviction of any doctor under any currently constructed state or federal statute.

The reasons why pain specialists are inundated with patients is because “Joe GP” won’t even give most patients a tylenol #3 for fear of getting people addicted or themselves getting arrested or because they aren’t comfortable prescribing medications they know little about- in many cases – not all. These faers are not based upon solid reasoning -period.

Here’s what the laws of ‘overprescribing mean-by intent of congress.

It means that the only real standard for convicting a doctor should be based upon the fact that the doctor knows that patient XYZ is coming to the office today to get a prescription that the doctor already knows that patient XYZ does not need.

That is the ‘Criminal Standard.’