Article Test

The US regulatory climate pertaining to the prescribing of opioids in acute and chronic pain is presently highly fraught and polarized. The US Center for Disease Control has claimed that over-prescription of opioids by clinicians to their patients is an ongoing major cause of narcotics addiction and overdose mortality. Despite this premise having been conclusively disproved, many US clinicians face disciplinary proceedings and sanctions by State Medical Boards or the US Drug Enforcement Administration (DEA).Those who have not left pain medicine altogether are under pressure to force-taper legacy patients below arbitrary and scientifically unsupported dose thresholds. Patients are being deserted to agony and medical collapse. Clinicians are being imprisoned for no crime other than treating their patients with safe and effective opioid therapy.

This paper offers a compendium of 81 references for clinicians practicing in pain medicine and for their lawyers, who choose to contest undeserved persecution or legal sanctions by State Medical Boards or the US DEA. Also of interest are recent references that demonstrate beyond any reasonable contradiction that the incidence of iatrogenic addiction to prescription opioids is so low that it cannot be reliably measured. The DEA has known for at least three years that the US opioid “crisis” was not created and is not being driven by clinicians “over-prescribing” to patients.

Among references provided herein are papers demonstrating that the US DEA has been aware for years that over-prescribing of opioid pain relievers is not a dominant cause of either hospital admissions or mortalities involving clinically prescribed opioid analgesics. This awareness may offer grounds for appeal or vacation of court verdicts finding clinicians in violation of “usual and normal” practice of pain medicine.

METHODOLOGY

This paper comprises a critical review and analysis of medical literature pertinent to safety and effectiveness of prescription opioid analgesics employed by clinicians in the management of acute or chronic pain. Taken in combination, the references herein challenge prevailing memes and misdirection in regulation of prescription pain relievers and in otherwise unfounded prosecutions of clinicians by the US Drug Enforcement Administration, State drug enforcement authorities, and State Medical Boards.

The assembled references are selected by the author from over 15,000 accumulated papers and articles acquired during 26 years of reading clinical and popular literature as a data analyst, healthcare writer and patient advocate. Clearly, the author operates from a personal agenda of advocacy on behalf of clinicians and their patients. Evaluation of the scientific and conceptual validity of the references must ultimately rest with Medical Boards and courts in an essentially adversarial process.