In de­fense of Colorado’s opi­oid rules

The Denver Post - - OPINION - By Phillip E. Es­say Re: Phillip E. Es­say, M.D., is board cer­ti­fied in pain medicine and anes­the­si­ol­ogy. He lives in Lin­coln, Neb.

“Opi­oid rules hin­der treat­ment,” Dec. 10 ed­i­to­rial.

Colorado’s pol­icy for pre­scrib­ing and dis­pens­ing opi­oids — au­thored by the Colorado Den­tal Board, Med­i­cal Board, Board of Nurs­ing, and Board of Phar­macy, in collaboration with the Nurse-Physi­cian Ad­vi­sory Task Force for Colorado Health­care — is a re­spon­si­ble and ex­tremely well-writ­ten set of guide­lines for pre­scribers and dis­pensers of one of the most clin­i­cally and so­cially im­pact­ful classes of med­i­ca­tions in ex­is­tence.

These and sim­i­lar guide­lines from the Cen­ters for Dis­ease Con­trol and Pre­ven­tion do not man­date a stan­dard of care, nor do they en­cour­age the de­nial of these med­i­ca­tions when treat­ing physi­cians deem them ap­pro­pri­ate. The doc­u­ments are only a ra­tio­nal guide­line and are as­suredly not the cause for any chronic pain suf­ferer’s per­cep­tion of a doc­tor’s un­will­ing­ness to pre­scribe opi­oids to treat chronic pain.

Rather, med­i­cal pro­fes­sion­als are wisely be­gin­ning to ap­ply mea­sure­ment, ev­i­dence and science to the dis­ease of chronic pain much like what is done with di­a­betes, hy­per­ten­sion and can­cer. Physi­cians are re­al­iz­ing that it is in­ad­e­quate and at times ir­re­spon­si­ble to solely rely on pa­tients’ self-re­ports of re­lief. Opi­oids are no longer viewed as a good al­ter­na­tive to other pain man­age­ment treat­ment op­tions. Opi­oids are very ef­fec­tive in re­liev­ing pain, just not all types of pain. In fact, to date, there are no stud­ies that in­di­cate that opi­oids are ef­fec­tive at all for chronic, be­nign (non-can­cer or non­ter­mi­nal) pain.

Physi­cians and pol­icy mak­ers have the re­spon­si­bil­ity to strive to bal­ance ben­e­fit and risk not only for the in­di­vid­ual but also for so­ci­ety. One un­spo­ken risk is that opi­oids heighten pain more of­ten than was once be­lieved and can ren­der more mean­ing­ful, nono­pi­oid treat­ments for pain in­ef­fec­tive. Their use for treat­ing chronic pain is at­trac­tive be­cause they re­quire no ef­fort on the part of the pain suf­ferer. How­ever, a pas­sive treat­ment plan sti­fles the hu­man body’s own painre­liev­ing mech­a­nisms and can cre­ate un­re­al­is­tic pain man­age­ment ex­pec­ta­tions for pa­tients and their fam­i­lies.

The risks of in­ju­di­cious pre­scrib­ing of opi­oids to so­ci­ety are stag­ger­ing, much more stag­ger­ing than the mis­lead­ing 2015 statis­tic of 5.8 Colorado deaths due to opi­oids for ev­ery 100,000 res­i­dents. With 5.4 mil­lion peo­ple liv­ing in Colorado, the true death due to opi­oids rate in 2014 was 326 lives lost. The true death due to opi­oids rate in 2015 was 310. That is an im­prove­ment of 16 lives saved in Colorado due to more thought­ful pre­scrib­ing. That seems like a wor­thy, ad­mirable and, quite frankly, in­cred­i­ble im­prove­ment.

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