The nationwide opioid abuse epidemic has directed a lot of attention from the state and federal levels on the primary care provider. The CDC guidelines for the prescribing of opioids for acute pain can do a lot to help a provider to steel himself or herself in the event that there is inquiry into their practice of pain medicine. It’s not hard to comply with a number of the recommendations set forth in the CDC guidelines. Where the evidence is not strong, or the recommendations are inconsistent with what we know to be real practice, it’s easy for an individual to justify deviating from the guideline, if there’s appropriate documentation based on the best practices in the field. On the downside, we’ve seen the intense scrutiny on prescribing – not just from regulators or of law enforcement, but also now from insurers and plaintiff’s attorneys—has had the result that many practitioners are reluctant to prescribe. Unfortunately, that means that many people who need medications are going to go without appropriate treatment. In the midst of an epidemic that’s also supported by an illicit supply of things like heroin and counterfeit fentanyl, it can exacerbate the problem. So where there is a lack of balance in the regulators’ approach, or when there is a lack of training and education, providers don’t feel equipped to meet their obligations in the safer prescribing of controlled medications. And if providers are not willing to prescribe, there is going to be an exacerbation of the epidemic itself, as people seek relief from other areas.
We’re going to have to deal with this in two primary ways. First, we need to make sure that our policies are moderate, they’re based on science and medical practice, and that they reflect what is a true and appropriate approach that respects the prescriber’s professional discretion, Then we also need to make sure that we are equipping practitioners with the tools to do their job and meet the needs of patients in pain, so that individuals are not forced to go to the streets for treatment. At the federal level, there is legislation to put together a task force to determine appropriate standards for pain management. Hopefully what will emerge are recommendations related to opioid prescribing when medically necessary, as well as recommendations covering non-controlled pharmacological tools, and non-pharmacological treatments. These will include input from a variety of stakeholders, so we should have a much more moderate, well balanced, and better supported document available to primary care providers for the treatment of pain.