There is no dispute that doctors sometimes prescribe more pain medication than patients end up needing, and leftover pills from those prescriptions may be diverted to nonmedical use (or saved in case they are needed for another painful condition, which the government still considers "misuse," although someone who takes a pill originally prescribed after oral surgery when he throws out his back would probably disagree with that characterization). Bills like Gillibrand's force doctors to err in the opposite direction, which means some patients will suffer from pain that could have been relieved. And even if some of those patients manage to get additional prescriptions, the upshot could be that more pills are prescribed than otherwise would have been: two seven-day prescriptions, say, instead of the 10 days that would have sufficed.
"Most acute pain doesn't need more than seven days," says Lynn Webster, a former president of the American Academy of Pain Medicine. But while "there's clearly been more prescribed than has been necessary" in many cases, Webster says, seven days is "an arbitrary number" and "not sufficient for a large number of patients."
After some surgeries and traumatic injuries, Webster says, patients "end up having a need for far more than seven days," and "in many cases, these are people that can't easily get back into the doctor's office." He notes that "these are Schedule II drugs, so you can't call it in." If the initial prescription is legally limited to seven days, "you're going to have to stretch it out or otherwise you're going to be without analgesic."
Clinical pharmacist Jeffrey Fudin agrees that seven days will be too short for some patients with acute pain caused by major surgeries or by injuries such as compound fractures. "Imagine if you had your pancreas taken out," he says. "I mean, come on. It's going to be more than a week of pain for certain."
Gillibrand's bill makes an exception for patients with chronic pain (as well cancer patients and people in hospices or palliative care). But people who suffer from chronic pain worry that the distinction is not always clear, especially when you begin care or switch to a new doctor. "The distinction between chronic pain and acute pain isn't nearly as neat and tidy as the Gillibrand and Gardner press release indicates," Matthew Cortland, a chronic pain patient and disability rights lawyer, told The Huffington Post. "The patient community knows that for many living with pain, it can take months or years to get a correct diagnosis of chronic pain."
"Most acute pain doesn't need more than seven days," says Lynn Webster, a former president of the American Academy of Pain Medicine. But while "there's clearly been more prescribed than has been necessary" in many cases, Webster says, seven days is "an arbitrary number" and "not sufficient for a large number of patients."
After some surgeries and traumatic injuries, Webster says, patients "end up having a need for far more than seven days," and "in many cases, these are people that can't easily get back into the doctor's office." He notes that "these are Schedule II drugs, so you can't call it in." If the initial prescription is legally limited to seven days, "you're going to have to stretch it out or otherwise you're going to be without analgesic."
Clinical pharmacist Jeffrey Fudin agrees that seven days will be too short for some patients with acute pain caused by major surgeries or by injuries such as compound fractures. "Imagine if you had your pancreas taken out," he says. "I mean, come on. It's going to be more than a week of pain for certain."
Gillibrand's bill makes an exception for patients with chronic pain (as well cancer patients and people in hospices or palliative care). But people who suffer from chronic pain worry that the distinction is not always clear, especially when you begin care or switch to a new doctor. "The distinction between chronic pain and acute pain isn't nearly as neat and tidy as the Gillibrand and Gardner press release indicates," Matthew Cortland, a chronic pain patient and disability rights lawyer, told The Huffington Post. "The patient community knows that for many living with pain, it can take months or years to get a correct diagnosis of chronic pain."
Kirsten Gillibrand Says Her Limit on Opioid Prescriptions 'Is Not Intended to Interfere With These Decisions'
If the senator really believed "all health care should be between doctors and patients," she would not be proposing a one-size-fits-all rule for pain treatment.
reason.com