ASAM Weekly Editorial Comment
William Haning, MD, DFASAM, DFAPA
In a Businessweek column yesterday, January 10, Michael R. Bloomberg provides “A Seven Step Plan for Ending the Opioid Crisis.” https://www.bloomberg.com/view/articles/2018-01-10/a-seven-step-plan-for-ending-the-opioid-crisis
This article, which has achieved rapid dissemination in our field, has a number of strong points and merits. It also has a number of misapprehensions that seem to derive from confusing policy objectives with good clinical practice. One example is the proposed cap of several days’ quantity placed on an initial opioid prescription, limiting larger quantities to “…doctors who complete specialized education in pain management.” This is misguided, and for more reasons than to assure adequate pain relief. Particularly for those patients who have pain from trauma, access to medical care is limited; and to complicate their recovery further by obliging repeated travel to hospitals or physicians’ offices, ends up affecting most those who can least afford to deal with it. The infirm, the parents of children, and of course the impoverished. It further strains existing resources. This becomes one of several unintended consequences which I am pretty sure Mr. Bloomberg would not want to cause, but is again a risk of confusing therapeutic intervention with public policy. We would all agree with an attitude of harm reduction or even prevention when considering the level of need for opioid pain medications, but even the most committed addictionist will concede that there are pains not solvable with acetaminophen, or even in a matter of a few days. Is it good advice? Sure. Is it bad doctrine? Absolutely. …A longer-term intervention is one that was commenced by the previous Surgeon-General, VADM Murthy, in 2016: the acceleration of training in analgesia and addiction management at the levels of medical schooling and residency.
It is a valuable contribution when a person with such influence and such acknowledged executive skills addresses a problem that is taking lives. These recommendations deserve respectful consideration, and discussion, and the contributions of the many skilled physicians who have worked with the problem. Doctors of a certain age will recognize echoes of previous initiatives from across decades. But if there is one severe criticism that this plan most deserves, it is for its unilateral emphasis on opioids rather than on the greater problem of addiction, regardless of the substance.
Editor-in-Chief: William Haning, MD, DFAPA, DFASAM
The laws of unintended consequences. Bloomberg may have been a good mayor and his heart’s in the right place, but addiction needs to be managed by trained PHYSICIANS!
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