Can we agree? Episode 5

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Would you vote yes or no?

Yes I support Portman's bill
2
25%
No I do NOT support Portman's bill
6
75%
 
Total votes : 8

Can we agree? Episode 5

Postby Zarniwoop » Wed May 30, 2018 7:16 pm

This one might find more dissenting opinions.

Rob Portman (R) has introduced a bill (https://www.congress.gov/bill/115th-con ... /2456/text) that would impose a 3 day limit on the initial prescription for opioids for acute pain. If the patient needs more medication they would have to revisit their doctor to get a prescription refill.

Portman says he is basing this bill on CDC guidelines, but according to the AMA he is misrepresenting the CDC position. Here is the specific CDC guideline Portman is referencing:

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.


the guideline goes on:

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.





If you were voting on this bill, would you vote Yes to support Portman's position or No to reject it?
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Re: Can we agree? Episode 5

Postby Rocker » Wed May 30, 2018 7:19 pm

I support the intent of the bill. I’ll read further into it tomorrow; but gut feeling is that I think it’s a step in the right direction.
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Re: Can we agree? Episode 5

Postby Mountaineer Buc » Wed May 30, 2018 9:03 pm

No.

For a couple of reasons.
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Re: Can we agree? Episode 5

Postby NYBF » Thu May 31, 2018 8:55 am

On the surface, my first objection is doctors now getting to co-pay you to death if your need for pain medicine is legitimate. However, if this could somehow be paired with nationwide legalization of medicinal marijuana to take the place of these pain pills, I'd be more likely to say yes.
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Re: Can we agree? Episode 5

Postby deltbucs » Thu May 31, 2018 9:11 am

At first I didn't really have strong feelings about it, because doctors can just write multiple scripts and date them forward like they do now. There's also the issue with the additional cost for the patient, as NY said. After a little more thinking I'm strongly in support of this bill. This could really help to prevent more addicts by not giving people more than they need. I think it's definitely a step in the right direction.
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Re: Can we agree? Episode 5

Postby Zarniwoop » Thu May 31, 2018 10:03 am

Here are my issues with a "Yes" vote

--Portman gives absolutely ZERO scientific evidence that this bill would make any meaningful change in the # of opioid addictions / deaths

--Both the CDC and AMA are vehemently opposed to this bill...instead of listening to doctors, bureaucrats think they know better

--Unlike not having real data on potential benefits - we know exactly what will happen on the cost side -- it will increase health care costs for patients -- they will have to see their doctors more often, meaning more co-pays, more time off work, more trips to the pharmacy, etc. All while that patient is clearly in considerable pain in the first place. It may lead to patients forgoing care.

--Why is the magic # with 3? Why not 5? Why not cap it at 7? Again, NO real medical evidence given

--One size fits all health care sucks ass



This completely reeks of the nanny state and the failed drug war. Many of the same reasons and justifications given for this bill have been given when trying to prevent medical marijuana and/or marijuana legalization: people on marijuana will become addicted to it, it's a gateway drug, people can't control themselves, Congress knows better than the doctors who support legalization, etc.
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Re: Can we agree? Episode 5

Postby uscbucsfan » Thu May 31, 2018 10:17 am

Zarniwoop wrote:Here are my issues with a "Yes" vote

--Portman gives absolutely ZERO scientific evidence that this bill would make any meaningful change in the # of opioid addictions / deaths

--Both the CDC and AMA are vehemently opposed to this bill...instead of listening to doctors, bureaucrats think they know better

--Unlike not having real data on potential benefits - we know exactly what will happen on the cost side -- it will increase health care costs for patients -- they will have to see their doctors more often, meaning more co-pays, more time off work, more trips to the pharmacy, etc. All while that patient is clearly in considerable pain in the first place. It may lead to patients forgoing care.

--Why is the magic # with 3? Why not 5? Why not cap it at 7? Again, NO real medical evidence given

--One size fits all health care sucks ass



This completely reeks of the nanny state and the failed drug war. Many of the same reasons and justifications given for this bill have been given when trying to prevent medical marijuana and/or marijuana legalization: people on marijuana will become addicted to it, it's a gateway drug, people can't control themselves, Congress knows better than the doctors who support legalization, etc.

Well said.
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Re: Can we agree? Episode 5

Postby Mountaineer Buc » Thu May 31, 2018 11:36 am

Zarniwoop wrote:Here are my issues with a "Yes" vote

--Portman gives absolutely ZERO scientific evidence that this bill would make any meaningful change in the # of opioid addictions / deaths

--Both the CDC and AMA are vehemently opposed to this bill...instead of listening to doctors, bureaucrats think they know better

--Unlike not having real data on potential benefits - we know exactly what will happen on the cost side -- it will increase health care costs for patients -- they will have to see their doctors more often, meaning more co-pays, more time off work, more trips to the pharmacy, etc. All while that patient is clearly in considerable pain in the first place. It may lead to patients forgoing care.

--Why is the magic # with 3? Why not 5? Why not cap it at 7? Again, NO real medical evidence given

--One size fits all health care sucks ass



This completely reeks of the nanny state and the failed drug war. Many of the same reasons and justifications given for this bill have been given when trying to prevent medical marijuana and/or marijuana legalization: people on marijuana will become addicted to it, it's a gateway drug, people can't control themselves, Congress knows better than the doctors who support legalization, etc.

Well said.

Doctor's are already clamping down on opiates due to the fact that some of their colleagues are getting hefty and well deserved prison sentences. They know their patients, they know what is or is not an appropriate prescription better than any congressman would, they know that opiates are a huge problem in the country right now and under a great deal of scrutiny, and they know what drug seeking behavior is better than anybody.
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Re: Can we agree? Episode 5

Postby Zarniwoop » Thu May 31, 2018 11:54 am

Mountaineer Buc wrote:Well said.

Doctor's are already clamping down on opiates due to the fact that some of their colleagues are getting hefty and well deserved prison sentences. They know their patients, they know what is or is not an appropriate prescription better than any congressman would, they know that opiates are a huge problem in the country right now and under a great deal of scrutiny, and they know what drug seeking behavior is better than anybody.



Good point, I should have added this. There is already tons of pressure on doctors to NOT overprescribe these drugs. Thanks for the add.



This legislation just completely screws over the Dr - Patient relationship. I remember when my dad had back surgery. They let him recuperate at home (both to save money, not take up important hospital space and be more comfortable with his therapy). It would have caused him great stress/pain to have to get into a car and drive 30 minutes to see his doctor to get a refill after 3 days. I think he got one week's worth of medication before he had to go back. That seems completely reasonable to me....at least until there is valid, medical and scientific evidence that something else is better.
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Re: Can we agree? Episode 5

Postby NYBF » Thu May 31, 2018 12:42 pm

Mountaineer Buc wrote:
Doctor's are already clamping down on opiates due to the fact that some of their colleagues are getting hefty and well deserved prison sentences. They know their patients, they know what is or is not an appropriate prescription better than any congressman would, they know that opiates are a huge problem in the country right now and under a great deal of scrutiny, and they know what drug seeking behavior is better than anybody.


Doctor's are already clamping down on opiates
I'll believe this when I see it.

they know what is or is not an appropriate prescription better than any congressman would
This is absolutely correct, yet we still have over-prescribing going on.
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Re: Can we agree? Episode 5

Postby Caradoc » Fri Jun 01, 2018 4:52 pm

Mountaineer Buc wrote:Well said.

Doctor's are already clamping down on opiates due to the fact that some of their colleagues are getting hefty and well deserved prison sentences. They know their patients, they know what is or is not an appropriate prescription better than any congressman would, they know that opiates are a huge problem in the country right now and under a great deal of scrutiny, and they know what drug seeking behavior is better than anybody.


And this is well said too. Anyone who has had any surgical procedures say, over 10 years ago, and a more recent one can attest to how much more tight-fisted doctors are with painkillers.
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