Utilizing the palliative care “loophole” in chronic pain management

DEA rings in 2018 with fear-mongering resolutions

The DOJ is successfully escalating angst among general practitioners, already reluctant to prescribe narcotics above guidelines established by the CDC out of fear of being targeted as outliers by the DEA. In turn many patients with intractable pain are forced to “make due” with what pain medication they are prescribed, and tension runs high between appointments as their doctors push for even further tapering.

MontgomerySessionsD2-01.JPGAttorney General Jeff Sessions announced in January that over the next 45 days, a “surge” of Drug Enforcement Administration agents and investigators will focus on pharmacies and prescribers who are dispensing unusual or disproportionate amounts of opioid drugs.

The U.S. Drug Enforcement Administration has arrested 28 people and revoked the registrations of over a hundred others in a nationwide crackdown that targeted prescribers and pharmacies that dispense “disproportionally large amounts” of opioid medication.

For 45 days in February and March, a special team of DEA investigators searched a database of 80 million prescriptions, looking for suspicious orders and possible drug thefts.

The so-called “surge” resulted in 28 arrests, 54 search warrants, and 283 administrative actions against doctors and pharmacists.  The DEA registrations of 147 people were also revoked – meaning they can no longer prescribe, dispense or distribute controlled substances such as opioids.

The DEA said 4 medical doctors and 4 medical assistants were arrested, along with 20 people described as “non-registrant co-conspirators.” The arrests were reported by the agency’s offices in San Diego, Denver, Atlanta, Miami and Philadelphia.

In an interview with AARP, Sessions defended the use of data mining to uncover health care fraud.“Some of the more blatant problems were highlighted in our Medicare fraud takedown recently where we had a sizable number of physicians that were overprescribing opioid pain pills which were not helping people get well, but instead were furthering an addiction being paid for by the federal taxpayers. This is a really bad thing,” Sessions said.“It’s a little bit like these shysters who use direct mail and other ways to defraud people. They will keep doing it until they’re stopped. In other words, if we don’t stop them, they will keep finding more victims and seducing them.”

As a growing trend of doctors across America voluntarily leave pain management, their patients are left without medical care. From there, the sick and disabled get bounced back to primary care. General practitioners, no longer in the business of treating pain, can only offer referrals but rarely communicate or follow up with their colleagues to facilitate a comparable continuity of care. These limitations have been further aggravated, through an effective surreptitious recruitment campaign organized by Dr. Andrew Kolodny, Co-Director of Opioid Policy Research at the Heller School for Social Policy and Management, christened PROP (Physicians for Responsible Opioid Prescribing). Armed with government propaganda, Prop docs function as the CDC mouthpiece and have infiltrated teaching universities, medical schools, CME courses,and large HMOs. There they double down and intentionally disseminate biased misinformation, present flimsy evidence as a matter of fact that, more often than not, aggregates chronic pain and addiction. Is there any way around this patient-doctor dilemma?

2005_00_america-in-pain-1200x800_facebookIntegrating palliative care with primary care and pain management

The answermight be as simple as a physician order for palliative care — a treatment option already covered by CMS and most private insurance. You can have it at any age and any stage of an illness, but early in your illness is recommended.

Palliative care (pronounced pal-lee-uh-tiv) is specialized medical care for people with serious illness. This type of care is focused on providing relief from the symptoms and stress of a serious illness. The goal is to improve quality of life for both the patient and the family. Palliative care is provided by a specially-trained team of doctors, nurses and other specialists who work together with a patient’s other doctors to provide an extra layer of support. It is appropriate at any age and at any stage in a serious illness, and it can be provided along with curative treatment¹.

Talking to Your Doctor

If you or a loved one is facing a serious illness, you may benefit from palliative care. You can have palliative care at any point in your illness. Take the quiz if you’re not sure. Then speak to your doctor, and ask for it. Bring the handout with you!

Educating Your Doctor

Recently I had an in-home visit lengthy visit with a nurse from my Consumer Directed Services provider about lack of pain control and palliative care. She (mis)informed me from the outset her doubt about qualifying for palliative care. Notwithstanding the fact I have multiple documented life-limiting conditions that are disabling, progressive, and without cures, the nurse advised as far as she knew, “it’s mostly a precursor to hospice.” Doctors can improve the quality of life for their seriously ill patients while also reducing the patients’ medical expenses if they make of palliative care which is simply a particular care model, so why aren’t they using it?

According to Dr. Jeanine Ellinwood, a palliative care team leader, the single biggest obstacle might well be the words used to describe this care model. “People hear them,” she said, and think immediately of hospice care.”

It’s not. It’s palliative care, she said, and yes, there is a difference.

Hospice care focuses on making people comfortable in their last six months of life. Palliative care, however, aims to relieve the symptoms and stress of serious illness with the goal of improving quality of life, and it functions as an extra layer of support for patients and their families².

Dr. Thomas Kline recently co-authored the following article on the topic of integrating palliative care with pain management, particularly as a means of working with the CDC guidelines:

WHEN DOES PAIN TREATMENT BECOME PALLIATIVE CARE TREATMENT? A plan for doctors by Thomas Kline, MD, PhD @medium #opioid #OpioidEpidemic #OpioidHysteria #opioidcrisis #palliativecarehttps://t.co/7dDBmpJCCw pic.twitter.com/vVqDH1cr25

The Alliance for the Treatment of Intractable Pain has a form for palliative care:

Palliative Care Certification https://atipusa.org/2018/03/27/palliative-care-certification/

Additional References

¹ https://getpalliativecare.org/whatis/

²  Anderson, Cathie. “This type of care can sharply reduce medical costs, so why aren’t doctors ordering it?” (2018, June 25), The Sacramento Bee. Retrieved from https://www.sacbee.com/latest-news/article213706719.html#storylink=cgy

Published by The Intractable Pain Collective

Aaron Sells 2018-Present: Founder, Intractable Pain Collective Writer and Political Activist. Freelance math and science tutor: K-12 and college ===== Pittsburg State University - General education requirements; Humanities and Mathematics Writing Intensive (WI) coursework, 1996-1998 University of Kansas - Molecular Biotechnology, B.S., 1999-2001 ===== More about me: After sustaining a catastrophic spinal cord injury requiring emergency surgical decompression on August 12, 2012, I have dedicated most of my time to researching (my) rare and severely painful spinal disease: Chronic Cauda Equina Syndrome (complete) with Neurogenic Bladder and Bowel. I've had three major spine surgeries to date; the last operation in November 2018 only exacerbated my preexisting failed back surgery syndrome (a condition also referred to as post-laminectomy syndrome). I'm an aggressive advocate for individualized, mandatory medical treatment for intractable pain caused by complex, disabling, incurable, and/or terminal diseases. Truth and empirical evidence-based science must inform public policy. The pendulum has swung too far in the other direction, so we need to link arms right now and do everything in our power to end the War on Pain. We must demand the CDC's Opioid Policy Research Advisory Committee testify before a Congressional Hearing. On the heels of thorough criticism from the AMA and, most importantly, in the draft final report of the HHS Pain Task Force Recommendations, a mea culpa in the NEJM is wholly inadequate. We deserve answers for their inhumane, adversarial position against access to effective patient-directed medical treatment focusing on optimizing the quality of life for critically ill and injured patients suffering from intractable pain. ===== Send Secure, Encrypted Messages to: asells@pm.me ===== #DemExit2020 #Medicare4ALL #RentStrike2020 #MortgageStrike2020 #Strike2020

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