Chilling Effect

Doctors are well aware they are under scrutiny. The Drug Enforcement Administration and other law enforcement agencies monitor prescription drug databases (PDMPs) to track opioid prescriptions. While PDMPs were initially promoted as a way to protect physicians from “doctor shopping” patients, they are now routinely used by the DEA to identify, threaten and raid the offices of doctors who prescribe high doses – even when there is no evidence of a patient being harmed by the drugs.

“PDMPs are tracking prescribing based upon CDC guidelines. That has an adverse effect upon prescribers who end up being profiled and in jeopardy of arrest and prosecution,” a doctor wrote.

“They have weaponized the political and legal manifestations of appropriately treating chronic pain,“ said a pain management doctor.

“They have shamed high dose long term opioid patients and treat the prescriber like a bad guy. They are clueless to the fact that majority of deaths have always been street addicts and not legit pain patients. The guidelines embolden medical regulators to come after doctors, resulting in chilling effect on prescribers,” said an addiction treatment doctor.

The crackdown has also had a chilling effect on pharmacies and insurers, who are just as eager to stay out of trouble. Nearly three out of four providers (73%) say they’ve had a pharmacy refuse to fill an opioid prescription and 70 percent say an insurer has refused to pay for a pain treatment.

“Why does CVS, a drug store that sells NSAIDs without restriction, have control of how I treat my patient?” asked one provider.

“The insurance companies are acting beyond the CDC guidelines with their hard limits on dosing, even sending threatening letters to doctors,” said a physician.

“Pharmacies and insurances are dictating how we treat our patients without the medical ability or authority to make diagnosis or treatment plans. Each patient is different,” wrote one provider.

“The guideline is extremely narrow-minded and reactionary. Yes, opioid addiction has become a huge problem, and yes, some physicians are partially to blame because of inappropriate prescribing, but plenty more physicians prescribe opioids appropriately. Now many of those doctors are scared to do their job, leaving patients in unnecessary pain,” said a doctor.

Biased CDC Advisors

Many providers believe the guideline advisors assembled by the CDC were biased and unqualified to make recommendations for pain management. Their initial meetings were closed to the public and the agency refused to disclose who the advisors were. Later it was revealed that five board members of Physicians for Responsible Opioid Prescribing (PROP), an anti-opioid activist group, were involved in developing the guideline, including two that belonged to a key committee that helped draft it.

“They are an abomination that has been foisted on the world by PROP via the CDC and have no real clinical or evidence based background, yet are carried forward by political and bureaucratic purveyors of untruth,” said a pain management doctor.