After investigation by federal authorities, six doctors at a Detroit-area pain clinic now face a grand jury indictment for alleged health care fraud and illegal prescriptions. It is alleged that between 2013-2018, the doctors engaged in, among other things, issuing more than 13.2 million dosage units of opioids including Oxycontin, Percocet, Vicodin, Norco, and Dilaudid.
In the wake of the opioid epidemic, primary care providers are facing increasing scrutiny by State and Federal authorities for over-prescribing, beyond CDC guidelines, for the treatment of chronic pain.
When prescription recommendations are inconsistent with established guidelines, deviations based on best practices must be properly documented. The American Society of Interventional Pain Physicians has published guidelines, but no comprehensive federal document yet exists which outlines treatment of chronic pain, with opioids, which is consistent with best medical practices and FDA labeling.
There remain no definitive guidelines based on actual scientific studies which demonstrate the correct opiate dosing for chronic pain. The most recent CDC recommendations remain nothing more than that: “Recommendations.” Little to no outcome-based scientific data is available on the subject and the statistics regarding death rates are based on the assumption that the deaths were caused by the prescribing of narcotics.
In many states which have shown a reduction in prescribed narcotics, death rates have continued to climb. The powerful synthetic opioid fentanyl has been involved in the greatest number of overdoses, which have increased dramatically over the last decade and may be under reported. The actual cause of the increasing death rate is likely due to a combination of factors, of which over-prescribing is one. Over-supply is the other.