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AMA Castigated for Rightly Opposing a National 3-Day Limit on Opioid Prescriptions

The doctors' lobby is right that the arbitrary rule is medically unsound and misconstrues the CDC's guidelines.

Casey Fleser / FlickrCasey Fleser / FlickrA bill sponsored by Sen. Rob Portman (R-Ohio) would impose a nationwide limit of three days on initial prescriptions of opioids for acute pain. "People are dying around the country every single day because patients are being prescribed too many opioid pills at one time," Portman's spokesman tells The Daily Beast's Jackie Kucinich. "A three-day limit is common sense, based on CDC guidelines, and Senator Portman is going to stand up and fight for what is right."

In reality, Portman is fighting for what is wrong, both factually and morally, because a three-day limit is not common sense, it is not based on CDC guidelines, and it is not sound medicine. As Jeffrey Singer notes on the Cato Institute's blog, the American Medical Association for once is taking the right position on federal meddling with health care by opposing Portman's bill. In a statement quoted by Kucinich, the doctors' organization says:

A strict three-day limit ignores the admonition from the CDC guideline that "Clinical decision making should be based on a relationship between the clinician and patient, and an understanding of the patient's clinical situation, functioning, and life context," misstates the actual recommendation of the CDC, and applies limits to clinical situations to which they were not intended to be applied. Limits and one-size-fits-all approaches will not end this epidemic.

Here is what the CDC's guidelines say about opioid prescriptions for acute pain:

When opioids are used for acute pain, 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.

Contrary to what Portman seems to think, that is not an endorsement of a mandatory three-day limit. In fact, saying that three or fewer days "will often be sufficient" implies that longer prescriptions usually are necessary.

Even if Portman correctly understood the CDC's advice, he would be mistaken to think it is supposed to be a hard-and-fast rule, let alone a rule enforced under the threat of taking away a physician's prescription privileges, as Portman's bill would do. As the AMA notes, the CDC emphasizes that care should be tailored to each patient:

Clinical decision making should be based on a relationship between the clinician and patient, and an understanding of the patient's clinical situation, functioning, and life context. The recommendations in the guideline are voluntary, rather than prescriptive standards. They are based on emerging evidence, including observational studies or randomized clinical trials with notable limitations. Clinicians should consider the circumstances and unique needs of each patient when providing care.

The CDC's guidelines nevertheless have been widely misinterpreted as calling for strict limits, especially on daily doses, which has led to serious problems for people suffering from severe chronic pain. "When health care providers read and interpret these guidelines, they understand them to be informational, nonbinding, and inconclusive," writes Singer, a Phoenix surgeon, Cato senior fellow, and Reason contributor. "But that's not how politicians 'do science.'"

Unfortunately, the evidence suggests that many health care providers have joined politicians in misinterpreting the CDC guidelines. Otherwise chronic pain patients who have been doing well on opioids for years would not suddenly find their doses arbitrarily slashed, leaving them bedridden and in some cases suicidal. The CDC itself bears a lot of responsibility for those outcomes because the dose numbers it settled on do not have a firm scientific basis but are implicitly presented as the outer limits of sound medicine.

When it comes to acute pain treatment, however, Portman is clearly misreading what the CDC said, and he is far from alone in doing so. Since the guidelines were published in March 2016, legislators in 18 states have limited the length of initial opioid prescriptions for acute pain, according to a tally by the National Conference of State Legislatures. Seven days is the most common limit. Only two states, Florida and Kentucky, have imposed a statutory three-day limit for adult patients. Kentucky makes exceptions for major surgery or trauma, while Florida allows seven-day prescriptions "if medically necessary based on provider professional judgment." Portman's bill has no such exceptions.

Even seven days will be too short for many postsurgical patients, which could lead to more refills and paradoxically increase the number of pills dispensed. A three-day limit with no exceptions is clearly extreme and medically unjustified. Yet The Daily Beast's Kucinich portrays the AMA's opposition as nothing but self-interested special pleading. She quotes one senator's complaint that his colleagues are "too scared to take on the AMA," notes the group's spending on lobbying, and says "the AMA opposition to proposals like limiting prescriptions...to three-day supplies" has "confused and infuriated advocates." The problem, I think, is that they were already confused.

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  • Leo Kovalensky II||

    Republicans: "Get government out of healthcare! Wait... what's that? Drugs are involved? We need regulations or else people will die!"

  • Libertymike||

    Another iteration of the fatal conceit.

  • Diane Reynolds (Paul.)||

    But these are common sense drug measures. It says it right there in the quote.

  • RPGuy16||

    Close cousin of common sense gun laws.

  • Chipper Morning Baculum||

    What about police officers injured in the line of duty and suffering from pain?

  • Leo Kovalensky II||

    I'm sure they're exempt. If not, there are plenty of opioids seized every day. Just take a walk through the evidence room there, Sarge.

  • Tony||

    Is putting them down an option?

  • MichaelL||

    Took care of a police officer with kidney stones. Told that I was wrong giving him pain medication.! I guess they don't care if their cohorts hurt, either!

  • SIV||

    Mr. Portman (for himself, Mr. Whitehouse, Mrs. Capito, Ms. Klobuchar, Mr. Sullivan, Ms. Hassan, Mr. Cassidy, and Ms. Cantwell) introduced the following bill; which was read twice and referred to the Committee on Health, Education, Labor, and Pensions

    Half of them are Democrats.

  • Leo Kovalensky II||

    Yes but the Dems aren't ashamed of their love of govt healthcare. The Repubs only say they are apparently.

  • JesseAz||

    The government isn't paying for the pills. It is regulations, not healthcare. And plenty in the GOP are as bad as Democrats in that regard.

  • Tony||

    Nobody wants government making healthcare decisions more than Republicans. They just don't want poor people to be able to afford it.

  • BYODB||

    I can think of at least one political party that definitely wanted it more than Republicans...

  • Leo Kovalensky II||

    Nobody that is, except for Democrats.

  • JesseAz||

    God.youre dumb. This isn't about access at all dimwit.

  • Leo Kovalensky II||

    "This isn't about access at all dimwit."

    Funny, it's exactly about access to pain medication.

  • Devastator||

    Conservatives are as bad as liberals. They just fuck things up in a different way. They actually want more control over peoples lives than the liberals do and push their "Christian Values" on everyone.

  • JesseAz||

    What was the last Christian based law that was attempted to control others?

  • Diane Reynolds (Paul.)||

    So, the AMA won't stand up for Portman's opioid anthem, eh?

  • Chipper Morning Baculum||

    I am so sick of Natalie Portman's shit.

  • Sigivald||

    But someone might get hiiiigh!

  • Eidde||

    Isn't this what happens when you reward Oprahesque behavior in politicians?

    He was cosseted and petted by the media for basing his public-policy decisions on having a gay son (or was it daughter?).

    So now he probably heard some horror stories about opiod addicts and based public policy on *that.*

  • Zeb||

    Yes. I think that is probably a fair assumption to make.

  • Eidde||

    Portman for Gay Marriage After Son Comes Out

    https://politi.co/2Laf4XP

  • Chipper Morning Baculum||

    Let's hope his son comes out as an opoid consumer, then?

  • ||

    "I love my dead, gay son!"

  • Diane Reynolds (Paul.)||

    Comes out of what?

  • Chipper Morning Baculum||

    So now he probably heard some horror stories about opiod addicts and based public policy on *that.*

    He also wants to outlaw having teenagers stay in a cabin in the woods.

  • Finrod||

    Any volunteers to kidnap Portman and inflict crippling pain on him to the point that he needs opioids to live?

  • Eidde||

    Keep it classy, all I wish for for Portman is a peaceful retirement where he can write his memoirs and have nothing but good health.

  • Citizen X||

    And the sooner that retirement comes, the better for all of us. Like, yesterday would have been good.

  • MichaelL||

    Every minute I suffer poorly treated pain is one minute people like this should suffer horrendous pain! As a past pain doctor, I have received enough of their wrath! When will they learn how inhuman their hearts seem!

  • Rhywun||

    I get this but... my understanding is that the bill isn't about chronic pain.

  • JesseAz||

    How dare you bring facts into this drug den of rage.

  • ThomasD||

    You can tell who might have a problem when you talk about reducing or limiting their drugs and gauging their response.

    Anger is a bad sign.

    And people with pain can still have another problem.

  • ThomasD||

    But, at least in the past, nobody ever warned them it could happen, and now it's often to late to make them think otherwise.

  • DajjaI||

    This is terrorism and at the risk of being banned again by Reason - I CONDEMN IT. Having said that, if you really want to fight this, just infiltrate your local AA meeting. They are in every city and town across the country. Meet the manipulative losers and let them regale you with the stories of their sins for which you are suffering.

  • Chipper Morning Baculum||

    We do not condone any sort of violence here, Finrod. Shame on you.

  • perlchpr||

    Right. However, it would be somewhat apt if Mr. Portman developed stomach cancer, and found his pain inadequately treated.

  • ThomasD||

    It's a stupid idea. But not quite as stupid as yours.

    You'd have to inflict acute 'crippling pain' on him otherwise his own rule would nor apply.

  • $park¥ leftist poser||

    "People are dying around the country every single day because patients are being prescribed too many opioid pills at one time,"

    Trust him, he's a senator and he's got eight 200-page studies to prove it.

  • BYODB||

    See, weird thing to me is that the prescription and the number of pills didn't do anything: It was the patient misusing them that did something.

    Say I put ten pills in front of you, and tell you that one a day is enough. If you take two or more a day, does that mean my instructions are what did you in?

  • MichaelL||

    Of that were true...the overdose rates should have decreased by now! Opioid prescriptions have been curbed, markedly, by the ignorant do-good-ers!

  • Whorton||

    Krist, there is NOTHING worse than a bill which purports that "CONGRESS FINDS. . ."

    Well, except, "I'm from the government and I am here to help you!"

  • DajjaI||

    Ohio is a hotbed of addiction theology. 12 Steps started in Akron. Also Portman is terrible on pretty much everything. If he supports it you can assume it's horrible. E.g. sesta/fosta.

  • $park¥ leftist poser||

    "Clinical decision making should be based on a relationship between the clinician and patient, and an understanding of the patient's clinical situation, functioning, and life context,"

    Says the doctors. Nothing but a bunch of lackeys and yes men all toeing the company line.

  • Homple||

    What do they have against Death Panels?

  • Cynical Asshole||

    Something something... in league with the EVUL FARMASUITIKAL KKKOMPANIEZ11!1111!11!!!!!!11!!

  • gaoxiaen||

    The heroin dealer down on the corner runs a no-limit dispensary.

  • MichaelL||

    BS!!!!

  • Rhywun||

    Any chance that the 99.44% of doctors who aren't "overprescribing" pills are going to resent being presumed criminal dope dealers?

  • SIV||

    They did back in the '20s until the government threw a bunch of them in Federal prison. They mostly piped down after that.

  • Diane Reynolds (Paul.)||

    Well, every physician in America gets a DEA number so they can track what xe does with xer prescription pad.

  • Cyto||

    Hell, I resent the "criminal dope dealer" appellation.

    Our puritanical obsession with keeping people from getting high (except from alcohol!) is obscene. If we were not so worried about people getting high, there wouldn't be an opiod epidemic. They'd have legal means of using drugs to get high that are entirely unrelated to pain relief.

    And on the pain relief front... screw every one of you prohibitionist scaremongers in the neck. Now the rest of us have to sit around in pain every time we have surgery or a simple injury. I had a gall bladder surgery and because of the DEA targeting doctors in Florida they wouldn't give me enough morphine, so I spent a night without sleep in a lot of pain. Sure, no big deal in the grand scheme of things, but the anesthesiologist said that before the "pill mill" crackdown hw would have given me twice as much. But now they'll pull his license if he does that.

    Usually you only need a couple of days of pain relief... the CDC is right about that. But how about letting me and my doctor figure out how much that is, OK?

    And heaven help you if you have something with real pain, like cancer. I have a buddy who is suffering terrible pain from the neuropathy caused by the chemo from colon cancer. Hands and feet on fire.. no relief.

  • Cyto||

    So thanks guys! Because you are so worried that we are going to "misuse" the pills to get high, we are under medicated.

    At the same time, your obsession is helping kill people. My wife's cousin was an alcoholic. She also liked to take Vicodin for intractable pain she had in her hip from an old car wreck. Oops... bad combination. Why? Because the Feds put acetaminophen in the pills to prevent misuse... and acetaminophen is bad for your liver. And if you aren't that bright or well educated about medicine, you'll take Tylenol and Codeine and have a few drinks if you are an alcoholic. And kill your liver. And die a horrific and painful death at 42.

    To be sure, she killer herself by taking the wrong things. But if the Feds didn't put acetaminophen in her codeine she wouldn't have taken so much acetaminophen, and her liver would have held out a lot better.

    How about quitting with the good intentions, OK? You kinda suck at it.

  • Whahappan?||

    Apologies for the late reply, but what makes you think they have good intentions?

  • Cyto||

    It is a callback to the article.

  • Kaatje||

    I have incurable and intractable neuropathic pain, from an old spinal cord injury turned into inflammation (adhesive arachnoiditis) and a vascular benign spinal cord tumor at T4 (central neuropathic pain syndrome).

    The only medication that helps are IV infusions of ketamine, which I get in an academic hospital. It's like an internal icepack that finally calms down the relentless burning pain from chest level to my toes. Hope your buddy can try this.

  • Cyto||

    This place is filled with the coolest bunch of weirdos. Thanks for the tip!

    And since it is ketamine, he can go to an animal hospital instead of an academic hospital and get it for half price!

    (There's a double joke in there, if you knew my buddy. He's a beast.... about 320 before he got sick. Cut the entire pad off of his thumb with a power tool at work and "repaired" it with duct tape and went on working. He said "that stings a bit". So when this guy says it hurts.... it must really, really, really hurt. )

  • MichaelL||

    one script is too many to them!

  • My Dog Bites Better Than Yours||

    "if medically necessary based on provider professional judgment."

    Isn't that the point of a prescription for anything?

  • Fist of Etiquette||

    Look, do you want a one-size-fits-all and a pulled-directly-out-of-a-lawmaker's-own-ass piece of legislation or don't you? Because if you don't, you've gone to the wrong place.

  • A Thinking Mind||

    If only we could find an earth government not run by earthlings.

  • Fist of Etiquette||

    Oh, my. That The Daily Beast article.

  • Citizen X||

    The author is Dennis Kucinich's daughter, and she seems to have inherited his inability to have good ideas.

  • You are very stupid||

    Someone has never had serious dental work done.

  • Diane Reynolds (Paul.)||

    But enough about the English.

  • I am the 0.000000013%||

    Winning!

  • gaoxiaen||

    Or needed a hip replacement.

  • HeteroPatriarch||

    That's fine. Let's limit prescriptions to 3 days, and if you need opiates longer than that you have to buy them over the counter. Doctors won't have to deal with the moral hazard, patients get what they need, and Portman can find a less destructive issue to grandstand on. Maybe strengthen the warnings on violent video games? That's always good for calming down the vapors.

  • Dillinger||

    More people die around the country every day wholly unrelated to over-prescribed drugs.

  • Tony||

    Meh. This logical conclusion of this argument is that we can never talk about any social problem until heart disease is cured.

  • Dillinger||

    Alternatively, conclusion is pick a scarier monster. Portman's hyperbole-maker went haywire with that quote.

  • A Thinking Mind||

    10 people die every year due to elephants. It's time to have a conversation about common-sense elephant control. Sure, maybe it's not the BIGGEST problem, but if it saves even ONE CHILD'S LIFE

  • Echospinner||

    Rob Portman went to medical school where? Can't seem to find it anywhere.

    Enough already. The medical community got the memos, all of them. You wanna help Robbie? Here, put on some scrubs, grab a wheelchair and get this patient over to radiology. Either that or get out of the way.

    Addiction is a medical health care issue. Locking people up in prison is not helping anyone. Decriminalize it and adopt a treatment model as they did in Portugal.

  • loveconstitution1789||

    Anything to keep the War on Drugs going.

    Those poor narcs would have to find new jobs.

  • Cynical Asshole||

    Those poor narcs would have to find new jobs.

    Nah, there's plenty more wars to replace the WoD. War on "sex traficking," war on "assault weapons," war on "common sense..."

  • John||

    http://www.latimes.com/nation/.....story.html

    Progressive church in California vows never to call the cops again. Okay, they certainly have a point when they say that calling the cops almost never does any good and usually results in harm. The problem is that I doubt any member of a Progressive Church in Oakland owns a gun. So, white Progs refuse to own guns and now refuse to call the cops. If you won't own a gun and won't call the cops, you are no longer an activist. You are a Darwin Award. These people are retarded.

  • Tony||

    If the presence of guns increased safety then the US would be one of the safest countries in the world right alongside Mexico.

  • John||

    Guns are illegal in Mexico you half-wit. And yes, the safest places in America are places where gun ownership is the highest and the most unsafe places where gun ownership effectively illegal. Take away Chicago, Baltimore, and New Orleans, and the US outside of those places is one of the safest countries in the world. Those places have two things in common, they are run by Democrats and they make it impossible for people to legally own a gun.

  • Tony||

    So are you saying there aren't a lot of guns in Chicago? Is the regulation on guns somehow make the guns that are there more likely to cause harm? Do you even know what the fuck you're talking about or are you just randomly stringing together half-thoughts you picked up while drooling around the internet?

  • John||

    So are you saying there aren't a lot of guns in Chicago?

    No there are plenty. And that shows how stupid and pointless it is to ban guns.

    Is the regulation on guns somehow make the guns that are there more likely to cause harm?

    Yes Tony. The regulations just disarm the law abiding public and make them easy pray for criminals and make violence carry little risk. That is why gun control always causes more crime.

    I know you are really dumb Tony. But these things are not difficult. I find it hard to believe even you are so stupid you can't understand them. If nothing else, don't you ever get tired of losing arguments?

  • Tony||

    So guns do make people safer except when they are illicit? How does the gun know?

  • John||

    Tony that response is so stupid and so lacking in any sense or rationality, it is difficult to know how to respond to it. The gun doesn't know anything you fucking moron. But people do. And when it is illegal to own a gun, law abiding people don't own them and are defenseless against criminals who don't care about the law and do have guns.

    You actually think what you said was a sensible argument. How in the world did you become this stupid? Did your parents ever have you tested or take you to a specialist or maybe some kind of special school? Did they just not do anything? Or did they and there was just no way to help you?

  • You are very stupid||

    No, criminals will buy guns to use on the law abiding public, who in following the law, have disarmed themselves.

    Are you actually this stupid?

  • Sevo||

    "Are you actually this stupid?"

    I had the same question the first year or so in reading Tony's comments, and I've come to the conclusion that, yes, he is. And in fact, he's even DUMBER than that!
    Just wait a...

  • Tony||

    You have got to start supplementing your random bloviating with a few facts now and then. I found this in 5 seconds:

    State gun violence rates ranked

    Does your state vote for Republicans? It's probably got a higher-than-average gun violence rate. Illinois is 34th ranked from least safe to safest, so you're full of absolute mounds of shit.

  • You are very stupid||

    "CDC, in Surveys It Never Bothered Making Public, Provides More Evidence That Plenty of Americans Innocently Defend Themselves with Guns"

    Brian Doherty|Apr. 20, 2018 6:30 pm

    I don't give a shit where anything ranks on anything. This isn't a utilitarian argument.

  • Tony||

    Of course it is. John thinks more legal guns means less violence. I showed plain as day how that's false.

    If you want to make a deontological jerk-off claim about who gives a shit how many people die because you want your toy, then fuck off, because that's retarded.

  • You are very stupid||

    "I showed plain as day how that's false."

    Not really. You just found a study that very broadly defines violence and hoped no one would notice.

  • You are very stupid||

    "If you want to make a deontological"

    My rights aren't subject to your concerns.

  • Tony||

    Even you probably agree that your right ends when someone else's exploded head begins.

  • You are very stupid||

    Not if they are justifiably endangering me.

    Save the stupid fucking rhetoric.

  • VinniUSMC||

    My rights end when I explode someone else's head, not when you explode someone else's head.

  • VinniUSMC||

    My rights end when I explode someone else's head, not when you explode someone else's head.

  • loveconstitution1789||

    Tony|5.30.18 @ 4:27PM|#
    Of course it is. John thinks more legal guns means less violence. I showed plain as day how that's false.
    If you want to make a deontological jerk-off claim about who gives a shit how many people die because you want your toy, then fuck off, because that's retarded.

    Oh Tony, Chicago does not have a lot of guns. Furthermore guns are still treated as illicit items, so law-abiding citizens don't have all the gun freedoms that other pro-gun area have.

    In Georgia, I have zero problems in Atlanta. I have never had to use my pistol there to defend myself. Atlanta is fairly comparable to Chicago. Chicago is a haven for murderers evidently and not enough citizens there carry guns to defend themselves.

  • John||

    Tony that is using suicides to count as gun deaths. Our fun violence problem is the result of a few cities and sadly a few mostly minority violent young men.

    Lost in the debate is that even in high-crime cities, the risk of gun violence is mostly concentrated among a small number of men. In Oakland, for instance, crime experts working with the police department a few years ago found that about 1,000 active members of a few dozen street groups drove most homicides. That's .3 percent of Oakland's population. And even within this subgroup, risk fluctuated according to feuds and other beefs. In practical terms, the experts found that over a given stretch of several months only about 50 to 100 men are at the highest risk of shooting someone or getting shot.

    Now, going back to the WISQARS tool and filtering for black male victims between the ages of 15 and 35, a total of 4,675 homicide victims were recorded, with a rate (for that age group) of 65.5/100,000. That group makes up only 2.2% of the total population, but represents 29.6% of the victims of homicide. If we could reduce the homicide rate in that one group to the national rate of 4.96/100,000, it would save 4,321 lives.

    http://www.quora.com/Is-it-tru.....jor-cities

    It is not the guns you moron.

  • Tony||

    So Republican states have high rates of suicide but that isn't instructive about anything, I suppose. Maybe it's just a coincidence.

    Yes lots of gun violence is suicide. I never qualified that out, so I don't know why you think you get to. Blowing your own head off is, indeed, a form of gun violence. The presence of guns increases gun violence. Totally indisputable. Just look at the world if you don't want to look at the states.

    A ranking based only on gun homicides leaves less of a clear pattern on the red-blue spectrum (man it must just fucking suck living in a red state). But you're not wrong that much of it is attributable to gang violence.

    But I'm not talking about the problem of gang violence, I'm talking about the problem of gun violence.

  • John||

    So Republican states have high rates of suicide but that isn't instructive about anything

    No dumb ass. They have a higher rate of gun suicides. There are other ways to commit suicide. So, no it says nothing.

  • Tony||

    And guns make suicide easier, the precise thesis I'm offering. More guns means more death.

  • You are very stupid||

    And this is a Libertarian website ass, suicide isn't really a problem here.

    Did you forget your stupid ass was AT a Libertarian website?

  • Tony||

    Libertarians don't think suicide is a social problem? Okay, can I get an article on that to make it official?

  • loveconstitution1789||

    Tony, Libertarians are for maximum individual rights which would include the government not getting involved with people wanting to commit suicide.

    Its a big fuck you to the government to go out of this world on your terms.

  • You are very stupid||

    "Libertarians don't think suicide is a social problem? "

    I own myself or I don't.

    "Okay, can I get an article on that to make it official?"

    I think your unsupported original assertion that it IS a social problem goes first.

  • Tony||

    I don't see why it's not as much a social problem as any other cause of mass death, but whatever.

  • You are very stupid||

    So, you don't have anything to support your assertion. Just another Wednesday for Tiny.

  • Sevo||

    "Libertarians don't think suicide is a social problem? Okay, can I get an article on that to make it official?"

    See, You are very stupid, I TOLD you he was dumber than that!

  • BYODB||

    Are you stupid? There are way easier ways of committing suicide, and even if there weren't if you're going to commit suicide lack of access to a gun isn't going to stop you. The fact you even think this is a rational argument speaks volumes to your lack of anything approaching reason.

    Try just swimming to the bottom of a pool and inhaling or step off an overpass. Shit, just swallow a bottle of Tylenol.

  • BestUsedCarSales||

    Hanging is the most popular worldwide.

  • BestUsedCarSales||

    Your statement does not support that. It just says people are doing them with guns. It does not imply that the availability of guns leads to the suicides.

    Beyond that, comparing a person willfully taking their own life to someone willfully taking another's is disingenuous. We as people do and should have control over if and when we die.

  • You are very stupid||

    "So Republican states have high rates of suicide

    Is that true? I don't see that demonstrated anywhere, they may have a higher rate of gun suicides, but you can't assume that means their overall suicide rate is higher.

    Are you even capable of discussing this without saying something stupid or wrong?

  • Tony||

    Originally I said Republican states have higher rates of gun deaths. John ruled out suicides as gun deaths for some reason. Probably because it's devastating to his argument to leave them in.

  • loveconstitution1789||

    You don't have to protect yourself from suicides. You need guns to protect yourself from murderers. Chicago has a lot of murderers.

  • Tony||

    You protect yourself from suicide by not having a gun. Sans gun, suicides tend to fail, and people tend to be grateful about that after the attempt.

    You're unlikely to be either victim or vigilante in Chicago, but I'm all ears about your plan for reducing gang activity and associated social pathologies.

  • BestUsedCarSales||

    You protect yourself from suicide by not having a gun. Sans gun, suicides tend to fail, and people tend to be grateful about that after the attempt

    That they may regret it later is not a valid reason to prevent people from doing things. Besides, the next most common form of suicide, hanging, is also quite effective. Along with the many, many nations who have higher suicide rates with very strict gun control.

    Your argument is asinine on every front, and you are forcing a false relation between violence and suicide. They are two very different things. And that they sometimes share a tool is to ignore other more core questions.

  • ignorance=bliss||

    Like my mother committing suicide by taking the time to go by garden hose, drive up to the foothills, put hose in muffler then into cabin of car, i would say on a very personal level that apparently my mother wanted to die and was going to do so regardless of your having disdain for inanimate objects. BAN GARDEN HOSES, SAVE A LIFE!!!!!

  • You are very stupid||

    You didn't even remotely attempt to answer my question.

  • Tony||

    Fine, here's the CDC on all suicides by state:

    Link.

  • You are very stupid||

    Why are you still acting like we should care about your value judgement?

  • Tony||

    Why should I care about yours?

  • BYODB||

    Tony, your goal post moving must make you really tired yet somehow you never stop doing it. You're a sophist, through and through.

  • You are very stupid||

    because YOU'RE ON A LIBERTARIAN WEBSITE.

  • BestUsedCarSales||

    Well... he's on Reason.

  • You are very stupid||

    Touche.

  • MichaelL||

    That is because the rest of the state is safer than most areas in the coountry! Last time I checked, Democrats are control in the state, where I grew up, and moved away from! Chicago, alone would likely rank number one or two, if ranked by population!

  • Diane Reynolds (Paul.)||

    If the lack of presence of guns increased safety, the cops would stop carrying them.

  • Tony||

    Does the presence of cops increase safety?

  • You are very stupid||

    Who do you call when violence is being perpetreated on you or someone else?

  • You are very stupid||

    *perpetrated

  • Tony||

    The fire department.

  • You are very stupid||

    Stop fucking lying ass, I caught you and you know it.

  • Tony||

    I don't call cops. I don't like cops. Cops make all situations worse for somebody. You'd have to be wailing pretty hard on some granny for me to want to send you into the arms of those bastards.

  • You are very stupid||

    And yet, you admit you have to call them.

    Just admit I caught you.

  • Tony||

    Sorry, who the fuck are you again?

    Never called the cops in my life. My alarm tripped once and they invaded my home once where, if not for the fact that their entry was illegal, I might have been in some serious shit. So much for the added safety of cops.

  • You are very stupid||

    "Sorry, who the fuck are you again?"

    The guy who caught you.

    Stop trying to change the subject.

  • Tony||

    I permit myself a few outright biases. One of them is against cops. Of course I'd call them if that were the only option to stop something terrible from happening. Usually the fat fuckers only show up after the fact, of course, and get on with their duty of ruining as many people as they can find in the vicinity.

  • John||

    Thanks for proving my point. You won't own a gun Tony but you won't call the cops. And you are too stupid to see the problem with that. To the rest of us that is funny. But you are so sad and so stupid you couldn' t let us enjoy it and had to shit all over the thread.

    Fuck off you fucking sorry retard.

  • Tony||

    If there were a gun in my house there is a small likelihood that there would be one of two dead people in my house and not because anyone burgled me. Trust me, my household is safer without one.

    As are all households, just as the data says.

  • You are very stupid||

    Tony- "Both guns and cops are dangerous. I am privileged enough to live in a safe enclave, and don't care about those that may not. Their options for protection from violence are..
    be wealthy enough to live away from violence"

    Stop being a racist, classist asshole Tony.

  • Tony||

    Stop pretending like we live in the Old West and you're a movie hero. Of course that was a time when you couldn't even enter town with a gun unless you were permitted.

  • You are very stupid||

    Again, stop trying to change the subject.

    I gave you the CDC article title. It is here if you'd bother to read it.

    Which also changes nothing about me catching you.

  • loveconstitution1789||

    Tony. Citation. Every town?

    Before the 14th Amendment was ratified, states could do almost whatever they pleased with police powers.

    Yea, more lefty nonsense that gun control in the USA was rampant.

  • Diane Reynolds (Paul.)||

    Who do you call when violence is being perpetreated on you or someone else?

    The .45 in my sock drawer.

  • You are very stupid||

    Amen.

  • BestUsedCarSales||

    Who do you call when violence is being perpetreated on you or someone else?

    Have I been a bad boy?

  • Jerryskids||

    The problem seems to be the CDC's "Dear Colleague" letter in which they merely suggest guidelines which you're certainly free to disregard. But not if you know what's good for you, capisce? Nice medical practice you got there, Doc, be a shame if something was to happen to it. But don't go blaming the CDC for this shit, they never ordered nobody to do nothing, they was just offering helpful advice, see? All nice and helpful-like.

  • Tony||

    This is why bureaucrats get a bad rap. Would you prefer elected politicians sticking their noses and legislation into what should be doctor-patient medical decisions? Or is it not better, for when regulations and advice are necessary, to have medical professionals hired to make these calls?

    Of course it helps if the lawmakers could understand what advice they were being given.

  • John||

    Tony on juries

    This is why Juries are a bad idea. When it comes time to decide complex issues of guilt or innocence and punishment, would you rather have a bunch of yahoos off the street deciding or a professional?

    It doesn't matter who is making the decision Tony. They have no right to make it. I have a medical professional making these decisions. He or she is known as my doctor.

  • Tony||

    That is my exact opinion on juries. Congratulations John, you stumbled randomly into a correct characterization of something.

    I agree that these things should be strictly left to doctors and patients, but CDC guidelines are good to create a baseline of standards. What if your doctor was one of the two doctors Trump has had recently?

  • John||

    That is my exact opinion on juries.

    I am sure it is. That is because you are an idiot who thinks everyone else is as stupid and irrational as you are.

  • Tony||

    No it's just that everyone I've served on a jury with was stupid and irrational, if not outright psychotic.

    Failed experiment. We can do better than the jury system.

  • You are very stupid||

    As if your judgement on anything is to be trusted.

  • John||

    The thought of Tony on a jury is terrifying. But, even the worst voir dire would surely weed him out.

  • Tony||

    I was foreman because all the other jurors were less sane or intelligent than I.

    Now how do you feel about juries?

  • loveconstitution1789||

    Who cares who is foreperson. The other jury members assuredly realized quickly that you are a moron and made you the sacrificial lamb to sign your name on the verdict forms. In my state, the other jury member's names are not even on the form.

    It takes a unanimous verdict in many states. The other states still require a majority for civil trials.

  • BYODB||

    The fact is that even a group of 12 retards are more capable of judgments than politicians or elected and/or appointed judges. To think otherwise would indicate that the very democratic system that puts the judges in place would be even worse, as surely 10 million retards making a decision is worse than just 12 of them.

    Those 12 retards are your peers and just as affected by the decisions as the accused, whereas the state is not.

  • Leo Kovalensky II||

    "Would you prefer elected politicians sticking their noses and legislation into what should be doctor-patient medical decisions?"

    No

    "Or is it not better, for when regulations and advice are necessary, to have medical professionals hired to make these calls?"

    No

    I'd prefer a doctor-patient medical decision.

  • John||

    Tony wants medical professionals making these decisions. Don't you understand that Leo? Real professionals not some "doctor" who has a "practice" and treats patients. Professionals who never see patients and work for the government. You know, professional professionals.

  • Tony||

    There are two separate aspects: the conversation between doctor and patient, and the creation of medical standards. The stuff doctors are taught.

  • John||

    Are you really so stupid that you think "creating of standards" is any different than "making the decision"? Sometimes I almost forget how dumb you actually are. Fortunately, you are quick to remind me that yes, you really are this stupid.

  • Tony||

    So do you not believe there should be recommendations and guidelines for the practice of medicine? Should we even bother sending doctors to school?

  • John||

    Recommendations are not rules dipshit. And they are not making the decision. This is a rule, not a recommendation. Try learning the meanings of the words you use before using them.

  • Tony||

    What are you talking about again? I thought I was pretty clearly against Portman's law.

  • Diane Reynolds (Paul.)||

    Would you prefer elected politicians sticking their noses and legislation into what should be doctor-patient medical decisions?

    I'm trying to think of other areas where politicians stuck their noses into what should have been a doctor-patient medical decision. If it comes to mind, I'll let y'all know.

  • Tony||

    Ask John and maybe 3/4ths of the other people here. They know of one particular procedure for which they absolutely demand the cold fist of government be tooling around in people's bodies.

  • You are very stupid||

    Suicide? Is it suicide?

  • BestUsedCarSales||

    Ass implants

  • Cynical Asshole||

    A bill sponsored by Sen. Rob Portman (R-Ohio) would impose a nationwide limit of three days on initial prescriptions of opioids for acute pain.

    Christ, what an asshole.

  • GILMORE™||

    Trump signs "Right to try" bill

    http://thehill.com/policy/heal.....l-patients

  • Diane Reynolds (Paul.)||

    Hitler. Literally.

  • GILMORE™||

    Was this covered here?

    Its an issue the magazine has drawn attention to many times. and i follow most reason writers on twitter. i've seen zilch comment on it.

  • John||

    They covered it when it passed Congress.

  • GILMORE™||

    ""Whether passage of this bill is a good news for patients depends on whom you ask.... the only thing we can do now is wait for the market to react and hope for the best.""

    http://reason.com/blog/2018/05.....-to-trumps

    crazy how free market advocates suddenly become tepid skeptics when its actually given some leeway.

  • John||

    Wow. Did you see Chapman's article on Trump's puzzling softness towards Russia? No shit. Chapman wrote an article criticizing Trump for not being warlike enough. You can't make this shit up.

  • Tony||

    Did you see where nonlibertarian conservative Republican asshole John suddenly thinks it's cool to sell the US to Russia because an orange retard with an (R) after his name is doing it?

  • GILMORE™||

    ""it's cool to sell the US to Russia""

    What the hell are you talking about

  • Juice||

    A three-day limit is common sense

    It's not even.

  • My Dog Bites Better Than Yours||

    If you define "Common Sense" as what feels is right, but for which no rational justification exists. In this sense, he may be right.

  • Dillinger||

    struggling to find what a three-day limit might be common sense for

  • Vandalia||

    There is one absolute, exceptionless, norm for the "opioid crisis": everything that the politicians do only makes things worse.

  • ThomasD||

    I'd argue that, in some sense, government involvement is what gave us such a huge problem to begin with. All the prior regulation creating a false sense of security in both patients and prescribers leading to a lot of risky behavior.

    When you see enough "Danger Thin Ice" signs you begin to think a lack of signs means it's safe to go out further,

  • ThomasD||

    So, no. More regulation is not going to solve the problem. Probably just make the mess look a little different.

  • chipper me timbers||

    Absolutely infuriating.

    I hope every single one of these sons of bitches who votes for this disgtusting bill comes down with a chronic debilitating pain that makes them contemplate suicide without relief.

  • Echospinner||

    I do not read Reason for up to date information about science. The author cites a CDC article. There is a link. Worth opening if anyone wants to see more about the issue.

    The CDC article is about chronic pain, not acute pain. These are distinct in neuroscience, pharmacology, and medical treatment. There is one quote from the proposed guideline recommendations (table 1:6) which mentions acute pain but that is not at all what the CDC article is about.

    So citing this particular article from the CDC is not useful. It is not a review of treatment for acute pain at all. The review is intended as the authors state, for primary care practice audience with a patient with chronic pain and is useful information if you know what you are reading.

    There is a lot of confusion about this issue. Last thing we need is politics about a very difficult and real problem.

  • ThomasD||

    Oh man, too late for that. Sullum routinely stretches available information to support his preferred policy outcomes. Like the recent article about drug deaths and prescription rates. Or the 'Nevada' article where he tries to represent that it's not prescription drugs that are killing people. "But it's clear that the risk for any given patient is very low" is a statement that he simply cannot support based upon the available data. Any?

    And not that I disagree with where he wants to be. I just think that he should stick to solid principles rather than resorting to parlor tricks or (worse) utilitarian arguments.

    The government should not be involved in this because it's none of their damned business what we do.

  • pro-kratom||

    please..for all pain patients denied opioids or forced to take too little of them look into red vein kratom.. it works wonders for pain and I do mean wonders

  • Radioactive||

    sorry, not my fucking problem!

  • LEAPGuyAZ||

    Pain patients are going to die over stupid knee jerk laws like this. The MAJORITY of pain patients don't abuse their medications. As suicide rates rise who is going to be held responsible?

    Physicians just ignore the guidelines like in Arizona where patients continue to suffer at the hands of physicians like Dr Sutera in Bullhead City who can't read or understand the guidelines. He has told patients they can only receive 15 days of medications, and return every 15 days. That was wrong... He operates or rumors and fake news rather than facts.

    Now he refuses to follow the Arizona Governors guidelines by limiting long term patients to 3 pills a day causing withdrawal symptoms...
    WHY can't physicians understand the guidelines?

  • ThomasD||

    If people die from this it will be mainly due to increased traffic accidents from all the extra driving back and forth to the pharmacy.

    Because nobody whose primary problem is pain is going to start doing the reckless things (like taking street drugs) that would get them killed. Pain does not make you stupid or reckless.

  • ThomasD||

    Not that this is in any way an endorsement of the legislation - it's stupid and useless.

  • I am the 0.000000013%||

    Fuck common sense, fuck CDC guidelines, and fuck sound medicine.

    I'm not a child - if I want to kill myself or live a miserable life, let me.

    I can go to Walmart and find hundreds of ways to die, some of them probably pretty fun, especially if the Walmart has a liquor section.

    Control freaks, please, just go the fuck away.

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