APS Conference on Opioid Dosing Guidelines

*APS Symposium: Opiate Dosing Guidelines – Outrage or Imperative?*; Alex DeLuca; War on Doctors/Pain Crisis blog of the Pain Relief Network; 2008-07-10. Broken link to Opioid Therapy for Chronic Pain fixed: 2008-08-08. **(Discuss on PRN’s Chronic Pain Forums)**

Permalink: http://doctordeluca.com/wordpress/archive/aps-guideline-confaps-guideline-conf/

See also:
Opiate Dosing Guidelines: Outrage or Imperative¹
PRN State Tort Claim vs WA State
PRN Complaint for Declaratory/Injunctive Relief, Damages

On May 8-10 of this year, about 2 months before PRN filed its historic class action lawsuits on behalf of disabled, chronic pain patients against the WA State Dosing Guidelines, the American Pain Society (APS) held it’s 27th Annual Scientific Meeting. A Symposium entitled, Opiate Dosing Guidelines: Outrage or Imperative has been made available online, and includes links to PDFs of the handouts and audio of the talks and discussion. [See also: Dr. Quinn's report on the APS meeting for the Pallimed blog]

The speakers include Dr. Gary Franklin, probably the primary individual behind the WA Interagency Guideline on Opioid Dosing for Non-Cancer Pain, published in 2007, which is the main object of PRN’s lawsuits (links above), Dr. Jane Ballantyne, author of the widely misunderstood 2003 review, Opioid Therapy for Chronic Pain, and Dr. Scott Fishman who does an excellent job defending the standard of care for pain management, criticizing the research basis for the WA Guidelines, and generally reminding everyone of the realities of the pain crisis, the war on docs, the (mostly failed) history of regulatory efforts, and of the chilling effect he feels certain has been worsened by promulgation of the WA Guidelines.

So I highly recommend listening to Dr. Fishman’s talk. But even more interesting is the discussion after the talks were given. For example, a doc in Atlanta tells how he is getting letters from insurance companies informing him that it has been determined that doses over 120 mg are no longer considered safe; and a lawyer informs the audience that the 120 mg number is showing up in criminal indictments of physicians, and physician “experts” are using the WA Guidelines as evidence for the prosecution in both criminal and licensure cases; and other testimony regarding the harm already done by the WA Guidelines. The audio for this Discussion part of the symposium can be found (confusingly) after the “Introduction” by Gregory Terman – in the second part of the Terman Introduction Recording. So the Discussion is also very worth listening to, and the other talks are professionally done and informative.²

As usual, the academics ignore the elephant in the living room. Regarding review articles that wring their hands about the lack of long term evidence of the safety and efficacy of opioid analgesic therapy, they never discuss the impossibility of measuring the efficacy and safety of a therapy that almost no physician is comfortable doing properly. For an excellent analysis of what we might call the “new academic opiophobia,” see the Pain Relief Network’s 2008 WA State Tort Claim (PDF), pages 34 – 37.

I think this APS symposium, Dosing Guidelines: Outrage or Imperative, occurring as it did on the eve of PRN’s lawsuit against that misguided effort, may end up being a historical marker of the end of the era in which “The Central Principle of Balance” reigned uncontested.

The pursuit of what I believe is an impossible balance – the apples of pain relief against the lemons of the drug war – has pretty much consumed the efforts of the public health, academic medical, medical ethics communities for decades, culminating in the Amazing, Vanishing DEA FAQ³. I have long believed that “law enforcement does not deserve a place at the table where scientists and clinicians and politicians of good faith should meet to honestly assess the harm that has been done to criminalized drug users, pain patients and physicians and earnestly seek ways to undue the public health crisis stemming from our disastrous drug war juggernaut.”⁴

So, hurray for the beginning of the end for the principle of balance as the only way to frame our issue! June 2008 marks a new era, in which the patients themselves enter the fray as primary actors re-framing the debate to one in which we see an opiobhopic culture, backed by governmental force, denying a vulnerable segment of the citizenry their civil liberties and access to the FDA approved medications they need to survive.

The new framework focuses on the rule of law, a matter for the courts – discriminated-against citizens vs the Govt, not ad-hoc working groups of cops and docs. This framework puts academic research and researchers back in their proper roles, as we no longer need them so much as lead-negotiators, researchers can do their research, the standard of care for pain evolves, and the patients and their lawyers will refer to it.

Very nice historical markers! This APS Symposium on the one hand, and the WA Complaint and WA State Tort lawsuits on the other. Enjoy the links!

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