Pot, Pills and Us


By Joan E. Collier

If it’s not pot, it’s pills.

On Wednesday, the same day that the Louisiana House of Representatives passed a bill expanding that state's medical marijuana program (and one day after the Ohio House passed its own nascent measure), CNN aired a Town Hall hosted by Anderson Cooper and Dr. Sanjay Gupta on the opioid epidemic.

If the Ohio bill passes the state Senate and is signed by the governor, we will pass the halfway mark of medical marijuana approval in the state count. Currently, 24 states and Washington D.C. have legalized cannabis for medical use; a number of other states have legislative initiatives pending. The acceptance of recreational marijuana seems to be gaining favor also, albeit more slowly.

Opioids have done what none of the “reefer madness” films ever accomplished—make marijuana seem relatively safe. The opioid problem is so widespread that we now have commercials for a drug to help the constipation that results from taking these prescription pills.

According to the American Society of Addiction Medicine (ASAM):

Two other facts from ASAM, which are not getting enough ink:

As the column inches and talking heads focusing on opioid abuse increase, so too does the hunt for someone to “blame.”

In a letter last month to Andy Slavitt, acting administrator of the Centers for Medicare & Medicaid Services (CMS), more than 60 medical experts, state health directors and advocacy groups found their target.

The authors asked federal officials to remove questions related to pain treatment from hospital patient surveys that are used to rate hospital quality, saying such questions “have had the unintended consequence of encouraging aggressive opioid use in hospitalized patients and upon discharge.”

The group wrote, “Specifically, we request that the following questions be removed
 from the HCAHPS survey:
1. During this hospital stay, did you need medicine for pain?
2. During this hospital stay, how often was your pain well controlled?
3. During this hospital stay, how often did the hospital staff do everything they could to help you with your pain"

The coalition sent a similar letter to the Joint Commission, which accredits U.S. hospitals, asking that it revise its pain management standards—specifically, guidelines directing doctors to ask patients to assess their pain, as they assess other “vital signs.”

“Mandating routine pain assessments for all patients in all settings is unwarranted and can lead to overtreatment and overuse of opioid analgesics,” they wrote.

The Joint Commission disputes the interpretation of its pain management guidelines.

Let me tell you my experience. I have been very lucky, health wise. Aside from childbirth, I have never spent a night in a hospital. I have, however, logged hours there with friends dealing with significant illnesses. They tell me that every time—every single time—a nurse or other medical person came into the room, they were were asked how their pain was on a scale of 1 to 10, and if they needed more pain medication.

My friends—unfortunately well versed in pain management—repeatedly declined more meds. Frankly, they said they became annoyed at what appeared to them to be the constant “drug pushing.” As their pain diminished, they went so far as to spontaneously request that their current meds by lowered or discontinued. This was always met with, “Let me check with the doctor,” a reasonable answer, I am sure; however, increasing pain meds seemed to be something that could be accomplished with ease.

As I said, I’ve been lucky. No health problems, no “opportunity” to accept or reject pain management medications. If I ever am confronted with those challenges, hopefully my friends’ experiences will help me make the right decisions. Based on the staggering number of people struggling with opioid reliance, there are a great many people not as lucky as I.

(Read more Work Comp Nation blogs here.)

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