By R Carter
The American Medical Association estimated in 2008 there were 41,718 practicing anesthesiologist, by 2019 that number had dropped to 29,030 according to sources other than the AMA. Primary Care Physicians (PCPs) treated roughly 52% of the 30-50 million chronic pain patients prior to 2010, by some estimates as many as 60% of those PCP’s no longer treat chronic pain, requiring, at a conservative estimate,18 million patients to either look elsewhere or have no access to medical care at all.
To a great extent this decline is a result of cracking down on providers who prescribe opioids for chronic pain, that crack down coming from medical boards and law enforcement.
Another estimate I’ve read says that for every physician no longer treating chronic pain, as many as 300 patients no longer have access to medical care. While no firm estimates exist for these kinds of criteria, the number of patients without access to medical care for chronic pain is still easily in the millions.
This response is due to the false and misleading narritive that treating chronic pain is the leading cause for opioid addiction and overdoses. When overdoses continued to climb after 2013 and as prescribing dropped nationwide as lmuch as 35%, the narrative changed. Now it was an (IMF) problem or illegally manufactured fentanyl.
But there are facts which health officials and government failed to report. These entities didn’t begin testing for IMF on a large scale until 2014, meaning overdose deaths from IMF could have been going on for years and they’d never known it, all along pointing a finger at prescribing as the problem. As more doctors were indicted and jailed for over prescribing, under this false narrative, the news media became hyper-focused on these reports and the topic went viral. This is what you call going off halfcocked, or as I call it premature adjudication.
Prior to 2015 crime labs and toxicology testing by coroners for poisoning deaths did not routinely test for anything other than heroin, morphine, hydrocodone and oxycodone using a $2 reagent strip. Identification of IMF required the more expensive gas chromatography and mass spectroscopy and naturally state governments were not about to fund such tests at a crime lab or coroners office.
Without being able to definitively connect the dots between prescribing and overdose deaths, the rush to adjudicate has produced the results we see today. Law suits against pharmaceutical companies, physician associations which promoted active pain management as the 5th vital sign and yes physicians losing their license for doing what they had been doing for forty years. The only difference now was, more patients were dying even though prescribed amounts hadn’t really changed during the same time frame. So why did people start suddenly dying? No one ever stopped long enough to check for other sources, government just assumed illegal drug traffickers were too dumb to make something like IMF, so no one ever bothered to test for it.
Now millions of chronic pain patients are suffering and hundreds if not thousands of doctors have lost their license to prescribe, practice or they’ve gone to jail based on an assumption which at best, is less than half true.
States have had prescription drug monitoring programs (PDMP’s) for at least 10 years now, and that data could easily be used to confirm or deny the extent to which prescribed opioids contribute to overdose deaths, but states will not publish this data. What secret are they hiding?
This poll of sixty questions on state medical boards and physician practice with regards to chronic pain management and opioid use disorder was open to any visitors coming to CERGM. In all 812 individuals started the poll but only 466 completed it. Most left the poll when asked to confirm their identity with an email address to prevent multiple responses from the same individual.
The poll collected general demographic data such as gender, age group and home state but was primarily directed at two groups, patients and healthcare professionals. Most graphs will display results from these two groups so the reader can compare results.
With regards to treating chronic pain and views on medical boards and targeted elements of physician practice, both healthcare professionals and patients had similar views and opinions. On the subject of opioid use disorder those similarities disappeared, with responses spread out nearly even between all available answers. The conclusion seems to indicates that personal experience and beliefs continue to carry more weight than known facts regarding OUD. As such OUD continues to be as misunderstood among healthcare providers as it is among the general public.
Because of the number of questions, groups and topics, the results for this poll will be published in three parts. Poll results were checked for multiple entries from the same individual and when duplicates occurred, any unfinished survey was deleted and completed results were kept. Of the 466 completed results all but one of the fifty US states is represented, with the largest groups coming from Ohio at 42% and Florida at 36%.
Some charts have a lot of data, such as the one below showing the percentage of individuals from each state. Each chart can be downloaded or clicked on to open it in a separate window for easier viewing.
Women out numbered men by 3:1 and respondents age 50 and above were the largest by age group, which has consistently been the case on all polls done at this sight, see Figures 2 and 3.
Participants were asked are they currently or in the past, been a practicing healthcare professional. For non-professionals, we asked if the individual worked with pain patients in some capacity. Between these three groupings 130 out of 466 or 27.8% of respondents had professional experience in healthcare. Another 28.6% or 133 out of 466 non-professionals responded indicating at least a casual knowledge and some experience about healthcare issues surrounding chronic pain management. See Figures 4-6.
438 of 466 or 94% of respondents reported they were chronic pain patients currently receiving medical care. 53.5% or 249 of 466 receive that care from a clinic specializing in pain management. See Figures 7 and 8.
73% or 343 of 466 respondents report taking opioids for pain management; this may be on an occasional basis or as often as daily.
Of the 122 not taking opioids or 26.2%, we asked them to give a reason for why they were not used. 75.4% or 92 responded it was their providers choice not to prescribe, 12 or 9.8% responded they didn’t need opioids, 13 or 10.7% responded they didn’t want to take opioids and the remaining 5 or 4.1% had other reasons such as a surgical intervention, either instrumentation or another device such as spinal cord stimulator. See Figures 9 and 10.
Finally respondents were asked to identify the provider type who treated them. Since a high number reported not taking opioids because it was their provider’s choice, the provider types were cross referenced by which were prescribing and which were not, excluding providers who can’t prescribe such as chiropractors. As expected, the largest group not prescribing; representing 45.6% of providers, were primary care physicians, with about half prescribing and other half not. The largest prescribing group was anesthesiologist representing 34.6% of providers.
In Part 2 you’ll see the results from patrons on questions regarding medical board regulations on pain management, physician practice and patients.