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How Should a Physician Respond to a Patient’s Pain When New Opioid Prescribing Laws Limit Shared Decision Making?

This commentary responds to a case and examines pragmatic concerns about operating a busy outpatient practice in compliance with new laws that regulate opioid prescribing. Specifically, the article considers how regulating opioid prescribing can influence the therapeutic alliance in patient-physician relationships and how innovations in decision science can facilitate shared decision making given time constraints.

Multisociety Pain Group Comments on Proposed Radiation Regulations in Colorado

AAPM participates in the Multisociety Pain Workgroup (MPW), a coalition of medical specialty societies, comprising physicians dedicated to pain management. This group convened to review and comment on the Colorado Board of Health’s Department of Public Health and Environment proposed regulations that would expand opportunities for advanced practice providers to perform procedures under fluoroscopic guidance. The MPW responded with a Position Statement on Prerequisite Training for the Performance of Spine Interventions as well as the American Medical Association’s Pain Management Practice Parameter (H-410.950) Invasive Pain Management Procedures for the Treatment of Chronic Pain, Including Procedures Using Fluoroscopy.  

DEA Warns of Alarming Increase of Scam Calls

  The Drug Enforcement Administration urges its DEA-registered practitioners and members of the public to be cautious of telephone calls (from a Salt Lake City area code) from criminals posing as DEA or other law enforcement personnel threatening arrest and prosecution for supposed violations of federal drug laws or involvement in drug-trafficking activities.

HHS Announces Guide for Appropriate Tapering or Discontinuation of Long-Term Opioid Use

  The U.S. Department of Health and Human Services (HHS) published a new Guide for Clinicians on the Appropriate Dosage Reduction or Discontinuation of Long-Term Opioid Analgesics. Individual patients, as well as the health of the public, benefit when opioids are prescribed only when the benefit of using opioids outweighs the risks. But once a patient is on opioids for a prolonged duration, any abrupt change in the patient’s regimen may put the patient at risk of harm and should include a thorough, deliberative case review and discussion with the patient. The HHS Guide provides advice to clinicians who are contemplating or initiating a change in opioid dosage.

HHS Announces Guide for Appropriate Tapering or Discontinuation of Long-Term Opioid Use

Today, the U.S. Department of Health and Human Services published a new Guide for Clinicians on the Appropriate Dosage Reduction or Discontinuation of Long-Term Opioid Analgesics – PDF. Individual patients, as well as the health of the public, benefit when opioids are prescribed only when the benefit of using opioids outweighs the risks. But once a patient is on opioids for a prolonged duration, any abrupt change in the patient’s regimen may put the patient at risk of harm and should include a thorough, deliberative case review and discussion with the patient. The HHS Guide provides advice to clinicians who are contemplating or initiating a change in opioid dosage.  

AMA Responds to Walmart’s “Refusal to Fill” Policy

The American Medical Association (AMA) continues to express its concerns over Walmart’s corporate prescription opioid restriction policy in its recent letter to Walmart’s Chief Medical and Analytics Officer. The new policy limit opioid prescriptions to seven days or 50 morphine milligram equivalents (MME) has caused harm to patients with acute, palliative, cancer-related, chronic pain and other medical conditions requiring amounts or doses greater than the corporate policy. According to the AMA, “this policy has disrupted legitimate medical practices that receive form letters telling them their prescribing rights under state law will be superseded by a Walmart-created algorithm that deems a physician unfit to prescribe.”

AAPM has echoed AMA advocacy efforts on this subject. In 2018, AAPM Past President, Steven P. Stanos, DO, traveled to Walmart headquarters with an AMA-led contingency to discuss these issues including ensuring access to comprehensive pain care; opioid prescribing guidelines; pain care and stigma; and reducing opioid misuse and diversion. Later in the year, AAPM’s AMA Delegates joined other pain and palliative medicine societies to rally the AMA House of Delegates to adopt a policy opposing the misuse of the 2016 CDC Guideline.

Further, AAPM’s advocacy efforts around the misapplication of the CDC Guideline for Prescribing Opioids for Chronic Pain has been ongoing, and included the AAPM Foundation consensus panel report that addressed the challenges of implementing the CDC Guideline. In April, the CDC issued an advisory cautioning against the misapplication of its guideline, following the publication of an editorial in The New England Journal of Medicine. The editorial referenced the AAPM Foundation consensus panel report and recognized that some policies and practices derived from the CDC Guideline are inconsistent and go beyond its recommendations, causing undo difficulty for patients and their providers. Furthermore, the editorial acknowledges the need for improved patient access and provider reimbursement for multidisciplinary pain care.

AAPM continues to advocate for the pain medicine and its members, continuing to serve as the voice for pain clinicians in national efforts to address the opioid crisis and promote the importance and adoption of patient-centered multidisciplinary care.

Opportunity for Input to CMS Action Plan on Pain Management and SUD ends October 11

CMS has issued a Request for Information (RFI) required by the Substance Use-Disorder Prevention that Promotes Opioid Recovery and Treatment for Patients and Communities Act (SUPPORT Act) asking for public comment on ways to address the treatment of acute and chronic pain, and the treatment of substance use disorders including opioid use disorder (OUD). Comments must be received by October 11. 

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American Academy of Pain Medicine