Painkiller Critics Target Hospital Pain Surveys

     (CN) – Groups concerned with the overprescribing of addictive painkillers have formally requested that U.S. health officials phase out hospital questionnaires and procedures that are used to manage pain and evaluate patients’ experiences.
     Advocates argue that the current system inadvertently creates incentives for doctors to prescribe addictive drugs such as Vicodin and Oxycontin have contributed to an epidemic of addiction and overdoses within the United States.
     Nearly 19,000 deaths in 2014 were associated with the misuse and abuse of prescription opioids — the highest figure on record, according to the Centers for Disease Control and Prevention.
     More than five dozen nonprofit groups and medical experts cosigned a letter sent to the Joint Commission, a nonprofit agency that handles the accreditation of American hospitals, requesting that it review its standards for pain management.
     Hospitals must be accredited in order to receive Medicare and Medicaid payments from the government, which make the agency’s standards very significant.
     “Aggressive management of pain should not be equated with quality health care as it can result in unhelpful and unsafe treatment, the end point of which is often the inappropriate provision of opioids,” the letter states.
     Health commissioners from Alaska, Rhode Island, Pennsylvania and Vermont cosigned the letter.
     By the 1990s, doctors were encouraged to measure pain as a vital sign — like body temperature, blood pressure and heart rate. Under the present guidelines, doctors are instructed to routinely assess the pain their patients experience.
     “We believe that that practice results in over-treatment of pain,” said Dr. Andrew Kolodny, executive director of Physicians for Responsible Opioid Prescribing, which spearheaded Wednesday’s letter. “We’re actually harming more patients than we’re helping by requiring aggressive screenings for pain.”
     The group supports alternative medical treatments, including physical therapy, psychotherapy and non-opioid pain relievers.
     Its letter outlined three questions from a survey by the Hospital Consumer Assessment of Healthcare Providers and Systems that the coalition feels contribute to doctors over-prescribing opioids. One of the questions is: “During this hospital stay, how often did the hospital staff do everything they could to help you with your pain?”
     If patients report that they experience pain that was not sufficiently treated, it may affect funding — incentivizing hospitals to get good scores on pain-related questions.
     “We think that that’s having the unintended consequence of leading hospitals to encourage their staffs to prescribe aggressively in order to get good scores,” Kolodny said.
     The group’s letter comes a month after the CDC released guidelines for the use of opioids, recommending that they only be used for three to seven days and encouraging doctors to use non-opioid painkillers in situations that call for extend pain relief. While these guidelines are nonbinding, Kolodny applauds the CDC’s efforts.
     “Up until now, most of the communication from the federal government on the opioid crisis has focused on trying to prevent abuse,” Kolodny said. “It’s the first time the federal government is communicating clearly that the widespread, routine use of highly addictive drugs for common conditions is inappropriate.”
     The group also submitted a petition to the agency that administers Medicare and Medicaid, both government health programs that help the poor, elderly and disabled.
     “By treating common problems with long-term opioid prescriptions, we’re addicting patients and fueling a public health crisis,” Kolodny said.
     The coalition has called on the federal government to release a proposal for updating the current questionnaire within 90 days.

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