Opioids

Arizona's Misguided War on Opioids

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Reacting to concerns about rising opioid use and abuse, Arizona's governor, Republican Doug Ducey, issued an executive order earlier this month requiring the director of the state's Medicaid program, as well as the director of the state's employee health plans, to limit the coverage of opioid prescription to a seven-day supply. There are a few exceptions allowed, such as prescriptions for children with cancer.

Physicians across the state are incensed at the order. They rightly view this as an infringement upon their autonomy, integrity, and judgment as medical professionals, and as interference by an outside party with the doctor-patient relationship. As a surgeon in private practice in Phoenix, I share in that reaction.

In fact, I recently performed an outpatient surgical procedure on a Medicaid patient. When I handed her an opioid prescription in the recovery room for her postoperative pain, I was tempted to tell her to contact the Governor's office if she is still in pain when she uses it up and needs a refill.

But this new policy is wrong on many other levels beyond the obvious one just mentioned.

Policy makers constantly implore doctors to practice "evidence-based" medicine. But this executive order is not evidence-based. Despite the fact that the Governor cited 401 deaths in Arizona due to opioid addiction last year, the National Survey on Drug Use and Health (NSDUH) reports that non-medical use of opioids peaked in 2012 and has since dropped to 2002 levels. And even taking into account the Center for Disease Control and Prevention (CDC) report that heroin use has gone up as opioid prescribing has gone down, total opioid use was still lower in 2014 than 2012.

Furthermore, the actual evidence suggests that restricting opioid prescriptions, especially to those who have developed a physical dependence, has contributed to the increase in the use of heroin, marijuana, and other illegal drugs, as patients seek to self-medicate.

And upon what evidence does the Governor arrive at the seven-day limit? Why not five-days? Why not ten?

Meanwhile, as Medicaid patients across the country face longer and longer wait times to see the diminishing number of participating medical specialists, it appears that Governor Ducey will make many of them suffer needlessly in pain while waiting.

The governor was certainly within his rights, as the ultimate CEO of the state's employees and the Medicaid program, to issue this order. But this brings to light another point: "He who pays the piper calls the tune."

The third party payer gets to decide what services, drugs, and devices it will pay for, and under what circumstances. Private third party payers enter into voluntary contracts with consumers and providers, and if a system is completely voluntary and non-coercive, then the parties to the contract have no right to complain.

But when that third party payer is inserted into the equation coercively it's completely different. The Affordable Care Act forces the public to contract with third party payers who are indirectly managed by the government. And in many cases, it places people into government-run programs like Medicaid.

Now many are calling for replacing the ACA with a single-payer government-run system—sort of "Medicaid for all." When the politicians have complete control of health care, look for more and more instances of politically driven encroachments on the practice of medicine and the patient-doctor relationship.

With "Doctor" Ducey's latest prescription for a large cohort of Arizona patients we might just seeing be the tip of the iceberg.

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  1. Its not like some of you are suffering by not getting your prescriptions of pain killers. Oh wait…

    1. I’d search for Penn & Teller’s “suffering kink” line about Mother Theresa, but I’m still at the office.

  2. While Ducey is wrong on this, the article isn’t quite accurate.

    “The order signed by the Republican governor limits the initial prescription of opioid drugs for adults to a 7-day supply”

    http://www.azcentral.com/story…../92688280/

    1. Pants shitters must be placated at all cost. If that means lots of people have to suffer unnecessarily, then so be it. Don’t worry though, the important people like Congressmen won’t suffer because of it. So it’s all good.

    2. Percocet is cheap. Use blinkhealth and pay cash and the cost for 90 pills is less than 30 bucks.

      I am having a hard time getting worked up that a Medicaid patient may incur out of pocket costs for a small part of their healthcare.

  3. You don’t understand how addiction works. If you prescribe it for too long then it is more likely that some will be left over, and this is what can start an addiction. Here’s how it happens: a kid feels compelled to steal or ‘borrow’ your pills, and this leads to a disease (or disorder or learning disability) where the kid feels compelled to steal or borrow more of your pills. Do you get it now? No? Well then, you might have a disease or disability or learning disorder. Don’t worry, it’s covered under Hillarycare. Now, please come with us.

  4. Physicians are outraged? Who the hell do they think they are? They should only be allowed to prescribe something if a politician decides they can, and in a way a politician decides they can. What? You want anarchy!?

  5. We need a strongman like Duterte in the Philippines, who shoots drug users in the streets. It’s a big problem and we gotta do something. Our leaders are stupid and corrupt. Too bad we didn’t have any candidates in this election cycle who could fix it for us.

    1. Everyone will forget all about Duterte and his silly little whims when Hillary is setting the entire planet on fire.

    2. It’s a big problem and we gotta do something.

      The primary drug of abuse where I live is called “alcohol” … maybe we should ban that, that would fix everything!

      1. If we go by the left method, you just keep trying something over and over and over again, no matter how many times it goes horribly wrong, because we’ll have the right people this time. It would have worked if Obama would have been King. Hillary can totally make it work. For the children.

  6. I have personally been affected by this mentality in Florida. I had a surgery and was in quite a bit of pain all night. The nurses couldn’t do anything about it. In the morning I let the surgeon, resident and anesthesiologist have it for leaving me like that.

    The anesthesiologist came right out and said that prior to the war on opioids and “pill mills” in Florida, he would have put me on a morphine pump. But because of new guidelines, he had me on tylenol III. He said he was not only afraid of losing his license, but in the atmosphere at the time he was worried about getting arrested.

    So thanks for that, Drug warriors. It was only a day that I had to suffer through. I don’t know how cancer patients do it, having to suffer for months at a time without adequate pain management.

    1. This is so f**king ridiculous. My wife had gallbladder attack, and had level 10 pain in the emergency room for 7 hours, and all they offered her was a regular Tylenol. Next time, I’m driving a few blocks and buying some heroin.

  7. It’s always a good idea to have connections in case you need them. Fuck the government.

  8. Notice the change in this page from the page jumped from: Rather than being about prescriptions being fillable only 7 days, it’s Medicaid reimbursement only 7 days.

  9. Coverage. COVERAGE. That word means something.

    1. Right. Its the nominal coverage thats important, not what that coverage will get you. Luckily coverage is a lot easier to quantify.

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  12. Some people like opioids so much they make their own lives more difficult. For fairness’ sake we should preemptively make everyone’s life more difficult. Its really the only moral thing to do.

  13. I broke my leg very badly in a motorcycle accident and was on morphine and oxycodone for 3 months. I cannot imagine going through that period without the painkillers.

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