Pain treatment

Kirsten Gillibrand Says Her Limit on Opioid Prescriptions 'Is Not Intended to Interfere With These Decisions'

If the senator really believed "all health care should be between doctors and patients," she would not be proposing a one-size-fits-all rule for pain treatment.

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Larry Burton / Zuma Press / Newscom

In response to a backlash against her bill imposing a nationwide seven-day limit on initial prescriptions of opioids for acute pain, Sen. Kirsten Gillibrand (D-N.Y.) suggests she is open to changes that would address the concerns raised by critics. Gillibrand's acknowledgment of the criticism is encouraging, but her response seems confused, wrongheaded, and disingenuous.

"I want to get this right," the presidential contender writes on Medium, "and I believe that we can have legislation to help combat the opioid epidemic and the over-prescription of these powerful drugs without affecting treatment for those who need this medication. I fundamentally believe that all health care should be between doctors and patients, and this bill is not intended to interfere with these decisions but to ensure doctors prescribe opioids with a higher level of scrutiny, given their highly addictive and dangerous effects."

If "legislation to help combat the opioid epidemic" includes an arbitrary limit on the length of these prescriptions, there is no way that it won't affect "treatment for those who need this medication." It is impossible to reconcile such a one-size-fits-all rule, which doctors would have to follow if they want to legally prescribe controlled substances, with Gillibrand's avowed commitment to not "interfere" in the doctor-patient relationship. Her bill, which is co-sponsored by Sen. Cory Gardner (R-Colo.), is designed to interfere in that relationship and to override physicians' medical judgment. If it did not do that, there would be no point to it.

To be fair to Gillibrand, she did not invent the seven-day rule, which at least a dozen states have imposed in the last few years, according to a tally by National Conference of State Legislatures. Several others have imposed shorter limits. Legislators in Arizona, New Jersey, and North Carolina have decreed that five days is plenty; Minnesota settled on four; and Florida and Kentucky say three, which is the national rule that Sen. Rob Portman (R-Ohio) proposed last year, prompting criticism from the American Medical Association. Medicare began enforcing a seven-day limit at the beginning of this year.

These legislators and bureaucrats all seem to be taking their cue from the opioid prescribing guidelines that the U.S. Centers for Disease Control and Prevention (CDC) published in March 2016. "When opioids are used for acute pain," the CDC says, "clinicians should prescribe the lowest effective dose of immediate-release opioids and should prescribe no greater quantity than needed for the expected duration of pain severe enough to require opioids. Three days or less will often be sufficient; more than seven days will rarely be needed." Legislation like Gillibrand's takes this advice and makes it mandatory, while ignoring the qualifications. Saying that three days is "often sufficient" obviously does not mean it is always sufficient, and even if more than seven days is "rarely" needed, it sometimes is.

A study reported last year in JAMA Surgery found that the prescription length associated with the lowest probability of a refill was nine days for general surgery, 13 days for women's health procedures, and 15 days for musculoskeletal procedures. "In practice," the researchers concluded, "the optimal length of opioid prescriptions lies between the observed median prescription length and the early nadir," i.e., the point where a refill was least likely.

That rule of thumb would put the optimal prescription length between four and nine days for general surgery, between four and 13 days for women's health procedures, and between six and 15 days for musculoskeletal procedures. "Although 7 days appears to be more than adequate for many patients undergoing common general surgery and gynecologic procedures," the researchers wrote, "prescription lengths likely should be extended to 10 days, particularly after common neurosurgical and musculoskeletal procedures, recognizing that as many as 40% of patients may still require 1 refill at a 7-day limit."

There is no dispute that doctors sometimes prescribe more pain medication than patients end up needing, and leftover pills from those prescriptions may be diverted to nonmedical use (or saved in case they are needed for another painful condition, which the government still considers "misuse," although someone who takes a pill originally prescribed after oral surgery when he throws out his back would probably disagree with that characterization). Bills like Gillibrand's force doctors to err in the opposite direction, which means some patients will suffer from pain that could have been relieved. And even if some of those patients manage to get additional prescriptions, the upshot could be that more pills are prescribed than otherwise would have been: two seven-day prescriptions, say, instead of the 10 days that would have sufficed.

"Most acute pain doesn't need more than seven days," says Lynn Webster, a former president of the American Academy of Pain Medicine. But while "there's clearly been more prescribed than has been necessary" in many cases, Webster says, seven days is "an arbitrary number" and "not sufficient for a large number of patients."

After some surgeries and traumatic injuries, Webster says, patients "end up having a need for far more than seven days," and "in many cases, these are people that can't easily get back into the doctor's office." He notes that "these are Schedule II drugs, so you can't call it in." If the initial prescription is legally limited to seven days, "you're going to have to stretch it out or otherwise you're going to be without analgesic."

Clinical pharmacist Jeffrey Fudin agrees that seven days will be too short for some patients with acute pain caused by major surgeries or by injuries such as compound fractures. "Imagine if you had your pancreas taken out," he says. "I mean, come on. It's going to be more than a week of pain for certain."

Gillibrand's bill makes an exception for patients with chronic pain (as well cancer patients and people in hospices or palliative care). But people who suffer from chronic pain worry that the distinction is not always clear, especially when you begin care or switch to a new doctor. "The distinction between chronic pain and acute pain isn't nearly as neat and tidy as the Gillibrand and Gardner press release indicates," Matthew Cortland, a chronic pain patient and disability rights lawyer, told The Huffington Post. "The patient community knows that for many living with pain, it can take months or years to get a correct diagnosis of chronic pain."

Gillibrand evidently thinks these burdens are justified by the goal of preventing addiction to pain pills that turn out to be medically unnecessary. "If we want to end the opioid epidemic, we must work to address the root causes of abuse," she wrote on Twitter last week. "One of the root causes of opioid abuse is the over-prescription of these powerful and addictive drugs," she says in the press release she issued along with Gardner.

The idea that leftover pain pills are a "root cause" of substance abuse is fundamentally mistaken. If these pills were as "highly addictive" as Gillibrand says, they would not be left over to begin with. The fact that partial prescriptions from old surgeries and injuries can be found in medicine cabinets throughout the country tells us that exposure to these drugs usually does not result in addiction. According to the National Survey on Drug Use and Health, about 2 percent of the nearly 100 million Americans who used prescription opioids in 2015, including nonmedical users as well as patients, qualified for a diagnosis of substance use disorder that year. By comparison, NSDUH data indicate that 9 percent of past-year drinkers had an alcohol use disorder in 2015.

People do not become addicted to opioids simply because they are there; they become addicted because of pre-existing personal, social, and economic circumstances that make these drugs appealing. The "root causes" of drug addiction are misery, anxiety, and despair, not half-finished bottles of hydrocodone. "Oftentimes," Gillibrand says, "the first over-prescription spurs the devastating path of addiction." But studies of patients find that people rarely become addicted in the course of bona fide medical treatment. Nonmedical users typically do not obtain pain pills from prescriptions written for them, and opioid-related deaths generally involve polydrug consumers with histories of substance abuse and psychological problems.

"Each day," Gillibrand's press release says, "41 people die from an overdose related to these prescription painkillers." She is referring to the 14,500 deaths involving "natural and semi-synthetic opioids" that the CDC counted in 2017. Yet according to the records collected by the CDC, more than 90 percent of those deaths involved combinations of drugs, and the true number may be even higher. In New York City, which has one of the country's most thorough systems for reporting drug-related deaths, 97 percent of them involve mixtures. And although Gillibrand portrays her bill as a response to the "opioid crisis," 75 percent of the opioid-related deaths reported by the CDC involved illegally produced drugs such as heroin and fentanyl.

Even if it were morally acceptable to sacrifice the interests of patients for the sake of preventing opioid-related deaths, there is little reason to think Gillibrand's bill would achieve that goal. Not only is she focusing on drugs that account for a small share of opioid-related fatalities, but her bill could increase the death toll by driving more nonmedical users into the black market, where the drugs are much more dangerous because their potency is highly variable and unpredictable. That kind of substitution helps explain why reductions in opioid prescriptions have been accompanied by a surge in opioid-related deaths.

In any case, it is not morally acceptable to sacrifice the interests of patients in the name of preventing opioid abuse. That kind of collectivist calculus has no place in a free society that treats people as individuals, a society in which "all health care should be between doctors and patients," as Gillibrand puts it. If she really meant what she says, she would not be trying to replace their judgment with hers.

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73 responses to “Kirsten Gillibrand Says Her Limit on Opioid Prescriptions 'Is Not Intended to Interfere With These Decisions'

  1. The problem is that every single one of her proposed solutions to solve the “crisis” will actually make it worse, while also continuing to trample on the liberty of Americans. Which maybe be what she actually wants.

    1. No, I strongly doubt she wants that. She’s tapping into a political vein I explain below by which she seems to address a problem without imposing any costs.

      1. Yup there is no reason for congress to get involved at all. Major medical organizations, state medical boards, the CDC and DEA already are all over this.

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    2. She has no idea what the actual crisis is.

      Dr. Lonny Shavelson found that 70% of female heroin addicts were sexually abused in childhood. http://powerandcontrol.blogspo…..eroin.html

      Addiction is a symptom of PTSD. Look it up.

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    4. This cunt is ok with leaving the murder of a fully viable infant up to the mother and er doctor, it I can’t get a reasonable supply of pain medication when needed?

      And peple here often whine when I advocate forcing all the progtards out.

  2. this bill is intended to interfere with these decisions but to ensure doctors prescribe opioids with a higher level of scrutiny, given their highly addictive and dangerous effects.”

    This bill is intended to interfere with these decisions.by forcing doctors to agree with government bureaucrats on what your course of treatment should be, need be damned.

    FTFY

    1. This bill is intended to create a safe harbor from liability lawsuits going forward. Everyone who deals with this stuff on a routine basis knows that the suits are coming. And when lawsuits have corpses then payouts, while perhaps not proper, are inevitable.

      That’s why outfits like the National Association of Chain Drug Stores is strongly behind it.

      And plenty of prescribers are all for these sorts of restrictions, because it makes the hard stuff easier.

      Because this law does not limit what a course of treatment might be, it just makes it more tedious and time consuming if that course of treatment exceeds seven days. You have to write another prescription.

      So if your doctor says he can’t give you more after the seven days then he’s either an idiot speaking out of ignorance, or he’s using that as a convenient excuse to wash his hands of you.

  3. ” I fundamentally believe that all health care should be between doctors and patients, and this bill is not intended to interfere with these decisions . . ”

    Bullshit.

    1. I believe that we can have legislation to help combat the opioid epidemic and the over-prescription of these powerful drugs without affecting treatment for those who need this medication.

      BELIEF. Brought to you by the Party of Science.

      Belief = Science

      BS

  4. “Kirsten Gillibrand Says Her Limit on Opioid Prescriptions ‘Is Not Intended to Interfere With These Decisions'”

    She also says she’s still looking for bids on Ebay for this great bridge she’s selling.

    1. No, she built that bridge… she should sell it on Etsy.

  5. This, like all of Gillibrand’s bills, sounds like a recipe for more prison rape.

  6. Much like Tony, she lies easily and without remorse.

  7. She speaks with a forked tongue.

  8. Sen. Kirsten Gillibrand (D-N.Y.) suggests she is open to changes that would address the concerns raised by critics.

    My suggestion – link your legislation to cat videos

    1. So yesterday you said the 2% NATO countries agreed to spend was on force projection outsude of Europe, nkt on defense. I linked to the document and an NPR article which analyzed it and clearly stated it was for defense.

      Thoughts? It appears you were incorrect. You were very vociferous too, but I didn’t see a response to my linked document and article.

      1. That’s JFree. Expect lies and obfuscation when s/he’s call on his/her bullshit.

        1. Figured I’d give it a chance to explain and see if there was some misunderstanding.

          It didn’t.

          1. Ask him/her for a cite showing how a certain company forces him/her to buy their product. I got several days worth of insults by asking, and no answer.
            JFree has a well-deserved rep as a lying lefty shill.

      2. I already linked to the page at NATO that says how they are funded.

        1. Then you can easily do so again for those of us who didn’t see it.

          1. He may very well have done that. It doesn’t have anything to do with his claim that the 2% they agreed to was to be used on projecting force outside of Europe instead of on defense though, so I really don’t care.

            1. From NPR

              NATO members did make a commitment four years ago to spend at least 2 percent of their GDP on defense by 2024. Just nine of the military alliance’s 29 members are expected to reach or surpass that target this year.

              I posted that, a link to it and a link to the actual agreement itself. He didn’t refute it in any way and still hasn’t.

              1. you linked to a PRESS RELEASE from NATO. Who gives a shit what words are used in a press release. those never have much to do with reality. I linked to a page at NATO that describes how NATO is actually funded and structured under the terms of the NATO treaty – not under the ‘terms’ of some fucking photo op where they issue a press release.

          2. I don’t do busywork linking to other threads here

            1. JFree|3.22.19 @ 6:09PM|#
              “I don’t do busywork linking to other threads here”

              See?
              Bullshitter.

              1. You find the thread then jackass.

        2. That wasn’t the question or the discussion.

          Again you said the 2% NATO countries agreed to spend was on force projection outsude of Europe, not on defense. I linked to the document and an NPR article which analyzed it and clearly stated it was for defense.

          I linked to a document from NATO that showed you werw wrong.

          “I linked to a document outlining funding” isn’t a response to my rebuttal of your claim.

          1. No I believe I said that that 2% WOULD only be used to project force outside Europe. Because if that increased spending was on troops and equipment just sitting in Europe (and there are no wars currently in Europe – so they would just be sitting there), it would violate the terms of various treaties (mostly negotiated between the US and Soviets – with zero European input) limiting conventional forces in Europe.

            This is all a bunch of Kabuki theater. Because we (and by that I do mostly mean the US) have no intention of actually restructuring what NATO means in a world where its reason for existence (the Soviet Union) no longer exists and where the only real role for the US in European defense would be with a nuclear umbrella not anything conventional at all. Diverting attention to ‘spend 2%’ is an attempt to AVOID the serious discussion.

            1. JFree|3.22.19 @ 6:21PM|#
              “No I believe I said that that 2% WOULD only be used to project force outside Europe. Because if that increased spending was on troops and equipment just sitting in Europe (and there are no wars currently in Europe – so they would just be sitting there), it would violate the terms of various treaties (mostly negotiated between the US and Soviets – with zero European input) limiting conventional forces in Europe.”

              M0re bullshit.

  9. Kirsten Gillibrand Says Her Limit on Opioid Prescriptions ‘Is Not Intended to Interfere With These Decisions’

    Here’s the problem Gillibrand, this right here;

    . . . but to ensure doctors prescribe opioids with a higher level of scrutiny, given their highly addictive and dangerous effects

    That’s you flat-out saying you intend to interfere with these decisions. You might be right to do so, these decisions may not have sufficient scrutiny behind them – all that’s irrelevant. You saying you ‘didn’t intend’ when you plainly intended is just you lying.

    Also – ‘didn’t intend’.

    “Heya, I didn’t intend to shoot you, even though I deliberately fired in your direction, knowing you were there” isn’t a defense either.

    1. “Here’s the problem Gillibrand, this right here;

      . . . but…”

    2. the drones stop listening before the “but”

    3. The trouble is that, as with many people & many things, many health care pros want to have someone else to blame for a diminution of care.

  10. why does anyone listen to this (possibly personally lovely) lady about anything?

    1. Because she might be running for prez, & might get elected. Odds are strongly against the latter, but you never know.

  11. She strongly supports freedom of speech, but…

  12. She’s an idiot, and/or she thinks everybody else is an idiot.

  13. “I want to get this right,”

    Then shut up and fuck off.

    1. Yep. She’s the genius we’ve been missing to ‘get it right’.

      “…shut up and fuck off.”
      +1

  14. That kind of collectivist calculus has no place in a free society that treats people as individuals,

    “but fortunately the modern US is not such a society.”

  15. Wanna help?

    Stay out of it.

  16. How could you possibly better showcase the political mindset?

    * I want to send doctors to jail if the prescribe more than a week of painkillers.

    * But I don’t want to interfere between doctors and patients.

    * But legislation can guide doctors.

    They simply have no clue about anything, whether real world or political world.

  17. Can we send the DOJ after her for practicing medicine without a license?

  18. As a libertarian, IMAO all drugs should be over-the-counter for adults to use when they’re on their own property.

    That being said, however, I know an opioid user (a nephew living with my Dad), who will eventually die of an overdose as he lacks the will to undergo long-term rehab and stop doing heroin again, thereafter. He started off using heroin as a teenager for the euphoric effect. He got off it for years but eventually started again. He has agonizing withdrawal episodes that include pain and nausea and only end with excursions to the hospital for days.

    He went on Fentanyl for a while and is now on methodone, but these will only prevent his withdrawal systems – not satisfy his craving for the euphoria. When he has cash available, he Ubers himself to places where crime and drugs proliferate. His (silly) mother has given him a credit card for Uber and food.

    Not all people are like this, of course. I also have a cousin in England who became addicted to opioids after a serious motorycle accident. He applies Fentanyl patches every three days but has never taken opioids for euphoria (although he likes cannabis). When he has a chance he will go into rehab but is now engaged with other more important things.

    But, before opioids and other recreational drugs are made legal, we need to be honest and admit that many are going to suffer tragic consequences as a result. Truth matters.

    1. Death from heroin is rare. Heroin users that die usually succumb when they use heroin and alcohol together. Fentanyl is synthetic and deadly on its own. Withdrawal from from heroin is like having the flu and quitting drugs takes willpower and for the family to stop catering to the user/abuser. The tragedy is that users had no life before they started drugs and drugs become their life. His “silly” mother gives him enough to make her feel better and avoid guilt. He needs a job to support his own habit but sounds like he is a lazy-ass but he will end up in prison and his ass will be buying his high-priced drugs in the joint.

      BTW, all drug laws are based in racism…

  19. She’s feeding the myth that narckies are just doing what’s natural due to circs beyond their control. It’s an appealing idea that works politically: nobody’s to blame, it’s just a medical mistake which we can hereby rectify, taking the burden off doctors for an international problem.

  20. If only we had some idea about the cause of addiction.

    Dr. Lonny Shavelson found that 70% of female heroin addicts were sexually abused in childhood. http://powerandcontrol.blogspo…..eroin.html

    Addiction is a symptom of PTSD. Look it up.

  21. Central committee knows what’s best for you.

  22. The sadistic bitch wasn’t expecting a backlash, and now she’s trying to lie her way out.

    -jcr

    1. Gillibrand was 100% in favor of your gun rights when she was an upstate legislator. She had NRA endorsements. When her state sent her to DC, she discovered that she couldn’t hang out with the cool kids unless she dissed her old pals, and now she’s all about outlawing guns. Her entire career has been consumed by her enthusiasm to gild turds “the right way,” and this is just another one.

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  24. Next up

    Kirsten Gillibrand Proposes New Legislation for Treatment of Thyroid Disorders

    “Too long have thousands of Americans suffered from this disease” she said. ” It is the responsibility of congress to address this problem and I will be proposing a new bill to effectively diagnose and offer treatment from those suffering from TGT Thyroid Glandular Dysfunction.”

    The American College of Endocrinology was not available for comment at this time.

  25. Ten years ago, lawmakers, law enforcers, prosecutors, and practically every newspaper and magazine in the country were raging against meth, calling it “evil.” Now those same people are promoting laws that, by intent and and in effect, make life more difficult for the sick, the handicapped, and the elderly. Well, I know evil when I see it, and it doesn’t come in a plastic baggie.

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  27. If one felt compelled to use the state, grant or research funding for equally effective, less addictive pain medications would be a considerably better option than making it far more challenging to get opiates which just results in further proliferation of heroin or fentanyl.

  28. The proposed legislation wouldn’t limit the number of pills, only the initial length. There’s nothing preventing a patient’s doctor from providing a refill.

    1. Well then there isn’t much point to the bill, is there? So instead she should fuck off and concern herself with TDS conspiracy theories.

  29. All of these rules already exist in every state. This is just political grandstanding.

    https://tinyurl.com/Opiate-Rx

    Not that in this context “guidlines” are not mere suggestions. If a doc does not follow them they will lose a license and will never get another one. Every opiate prescription is now tracked and monitored by the state.

  30. Gang, this is very simple. Get rid of prescriptions and make all drugs legal and “over the counter.” There no reason, in a free society, why one person has to get another one to write her a note so that she can go to the store and buy something. REALLY?? And we’re reading “Reason” magazine???

  31. She lies poorly.

  32. ” I believe that we can have legislation to help combat the opioid epidemic and the over-prescription of these powerful drugs without affecting treatment for those who need this medication. I fundamentally believe that all health care should be between doctors and patients, and this bill is not intended to interfere with these decisions but to ensure doctors prescribe opioids with a higher level of scrutiny, given their highly addictive and dangerous effects.”

    The DoubleThink is Strong with this one.

  33. How the ****, after I just got hit by a car while riding my bicycle for enjoyment even get a script of Roxicodone.

    Hew is just another reason, there will never be a woman or a black man or a black woman as president.

    Why President Trump set the bar so high, no one will dare run. No matter how big their ego is. Then the next day, when you don’t have a quarter in your pocket.

    Another prime contender for Devo’s de-evolution theories.

    Man has reached his peak, like silicone. There is no Mars mission. If you ever played a video game when you reached the boundary of the game, that is how astronauts are able to keep the secret.

    We are forbidden to go past low earth orbit, The millennials are buying up every forgotten artifact to prove that.

    There was never a moon landing. The ISS will be coming down sooner than expected. The electric car is dead, Elon’s words, not mine.

    There is no such thing as a quantum computer. There is no such thing as absolute zero anywhere in the created and only universe.

    Absolute zero is impossible. At the molecular level, atoms start flipping out and make absolute zero impossible to reach. Ask why Microsoft changed their view to almost absolute zero, no such thing.

    This is lady of end de-evolution now before we are all monkeys. I’m not nor are my ancestors a lake of soup.

    People get ready.

    1. A prime example of a case where an opioid prescription of 30 days is indicated, if not more.

  34. up to I saw the bank draft of $7781, I did not believe that my best friend was like they say actually taking home money in there spare time from there new laptop.. there uncle started doing this 4 only 22 months and at present cleared the loans on there mini mansion and purchased Dodge. this is where I went,

  35. I was in a car accident last year. I had a broken and dislocated wrist, 7 broken ribs, a cracked sternum, bruised spleen, and numerous contusions (I am still struggling with the entire left side of my left thigh – everything was deadened for months, and is slowly waking up). I was hospitalized for the first 4 days, and the pain was excruciating. Within a week or so, I could sit relatively comfortably WITH pain meds, unless I did something to flex the ribs or sternum. I ran out of pain meds after 2 weeks, and was at the point where I could just deal with the pain. About that time I had surgery to repair my mangled wrist (great surgeon – it is darn close to back to full function), and went back on pain meds to deal with the aftermath of having a delicate joint opened up, worked on, and closed. That was another 2 weeks. In each case, the doc gave me enough to deal with the pain until I could deal with the pain without the meds. In neither case was it 7 days.

    3 years ago, I tore a quadriceps tendon – the repair is not arthroscopic – most people think I’ve had a knee replacement from the scar. Probably mostly because the repair requires complete immobilization for 6 weeks or more, 7 days of pain meds were enough to cover it. I’m not even sure I finished them.

    Let the doc figure it out – let the empty suit from NY keep her nose out of it.

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