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Step up, pain doctors!

May 21, 2015

Fifteen months ago, the Federal Drug Enforcement Agency, or DEA for short, began an investigation in four states: Alabama, Arkansas, Louisiana, and Mississippi.  The DEA was looking for illegal drug trafficking, as they do.  But they were looking for prescription drug dealers, not Columbian drug cartels.  And they found them.  They are doctors.

Forty-eight people were arrested on Wednesday, seven of them doctors.  DEA agents went undercover and told doctors that their elbows hurt.  No exam, no X-ray, no history.  Just a prescription.  The agents secretly videotaped them urging their patients to overstate their pain.

In an era of diminishing trust in physicians, this is not OK.  Actually, in any era this is not OK.  This is not, never has been, never will be, OK.  I’m sure the American Academy of Pain Management will back me up on this.

“Getting them the care they need is a major challenge.  The D.E.A. tends to seize their medical records, so they have nothing to bring to the next doctor. And when they say who their previous doctor was, many providers don’t want to touch them for fear that they’re not legitimate.”

That, according to the New York Times, is Dr. Bob Twillman, the executive director of the American Academy of Pain Management, speaking about how patients with legitimate pain complaints could be caught up and harmed in this investigation.  Dr. Twillman is not a medical doctor, by the way.  He has a PhD in Clinical Psychology and Oh if that’s not blindingly ironic.  According to the AAPM, Dr. Twillman is responsible for federal and state pain policy developments.  He advocates for “those supporting an integrative approach to managing pain”.  He’s even Chair of the Prescription Monitoring Program Advisory Committee in Kansas.  A guy who can’t even write prescriptions.

Oh, but wait.  There’s another national Pain organization.  The American Academy of Pain Medicine.  Also, confusingly, AAPM.  Their website front page doesn’t say anything about Wednesday’s events.  It talks a lot about a 71-page National Pain Strategy, which is good…I guess?  Is the AAPM doing anything to mitigate this problem of physicians becoming drug dealers?  Well, they have Continuing Medical Education programs…

The program encourages multispecialty exchange of information concerning scientific advances in the field of Pain Medicine and its application to clinical practice. Providing quality pain care is a universal competency to providing quality medical care and as such, content areas must reflect the identified learning needs of physicians specializing in the treatment of pain, as well as providing quality pain continuing medical education to the physician community at large. AAPM CME program includes activities designed to improve knowledge in the major domains of Pain Medicine, improve competence in evidenced-based, pain treatment modalities (integrative and interventional), and provide applicable tools for mitigating risks, assessing, and managing the medico-legal aspects of Pain Medicine.

Not so helpful.  Well, who’s in charge of this AAPM?  A guy named Bill McCarberg, a real doctor this time.  A primary care doctor.  He wants the focus of his organization to be on, well, primary care.

Primary care is my background and my year as president of the AAPM will be structured to help define, organize and shape our relationship with the primary practitioner, the provider who is tasked with helping the vast majority of pain patients.

The major advocacy organizations for pain management shouldn’t be drafting Pain Strategies, teaching doctors about the medico-legal aspects of anything, or dealing with primary care.  They should be loudly and aggressively denouncing the kind of behavior the DEA found over the last year, and in prior years as well.  Dr. Twillman shouldn’t be weakly suggesting that maybe such DEA raids might possibly be hurting some real patients.  He should be shouting to the hilltops that this sort of behavior is unacceptable and will not be tolerated.  Dr. McCarberg should be jumping on this with both feet.

Since doctors seem unable to police themselves, the Federal Department of Health and Human Services is going to try to do it for us.  Here is, in part what HHS wants to do:

Teaching medical professionals how and when to prescribe opioids by working with lawmakers on bipartisan legislation requiring specific training for safe opioid prescribing and establishing new opioid prescribing guidelines for chronic pain.

Lawmakers teaching medical professionals how and when to prescribe opioids.

Step up, pain doctors.  Make it clear that this is not what you do, not who you are, and not what you believe in.  Because to the world, it kinda looks like you don’t care.


From → Healthcare

One Comment
  1. dave permalink

    Im sure doctors do care- about continuing to be free to treat people in pain anyway they chose-after all who is society to dictate to infallible medicine how to treat people in pain. Oops- doctors really dont treat people in pain- they just treat pain through their heroic simplifications-my dont they “see like a state”. But that comment is too generous to the purblind profession of medicine that cant even seem to remember Semmelweis and wash their hands between patients.
    But lets mention a few studies- a few years ago showed the average doctor failed basic tests on musculkoskeletal knowledge-and dont we know 80% of pain is musculoskeletal. Attitudinally we know that doctors dislike both people in pain and treating pain-and maybe thaty is why they continue to miss that hour lecture on pain in med school. Shall we mention their lack of concern over the ever rising prevalence of pain due to diabetes and arthritis. How bout those health professional in NIH- Patricia grady in 2008 indicated in a symposium on neuropathy tthatNIH was negligent in researching neuropathy. How bout fetuses- a large rise in nas due to doctors ignorantly throwin pain meds at everyone including pregnant moms- but they dont talk much about still births associated with pain meds. Lets talk about the $77 billion opioid diversion costs the Nation every year-and doctors still unwilling to have not just education on pain but on prescribing opioids- didnt the FDA report less thenm 20% adherence to opioid rems.
    Such self-serving rhetoric comes from doctors regarding poor pain care- that its the dea’s fault or the fault of people in pain.
    The health care industry has been too morally and mentally lazy regarding pain care- it is negligent entrustment to allow them to continue on their reckless orientation to people in pain. And yeah my dorsolateral prfrontal cortex is methylated enough to debate any medical”professional” on the issue- oh i forgot they dont like to be challenged and iengage in discursive imperialism or othering when confronted with someone who care about people in pain.

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