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How We Got Where We Are in Michigan
Because of widespread concern about the adequacy of pain management in the early 1990’s, the Michigan legislature in 1994 enacted a law establishing an interdisci- plinary committee to review and make recommendations on how to deal with this issue. The Health Care Integra- tion Subcommittee of that group, in 1995, made the following recommendation, based on the assumption that opioids were safe to take and under prescribed:
Any physician treating a patient suffering from intractable pain in Michigan should feel free to prescribe Schedule 2 controlled substances where such treatment is medically necessary to control the patient’s pain. No physician licensed in this state need fear administrative action for rendering medically necessary pain control treatment through use of Schedule 2 controlled substances as long as such necessity is properly diagnosed and documented.
An integral part of pain management is ensuring that patients with intractable pain are able to obtain the prescription drugs necessary to manage and control their pain.
This led to the establishment in 1999 of the Pain and Symptom Management Advisory Committee within the State of Michigan’s Department of Consumer and Industry Services, Bureau of Health Services.
This committee adopted as the definition of pain the one defined by the International Association for the Study of Pain as “an unpleasant sensory and emotional experi- ence,” and classified it as acute or chronic without a clear distinction between the two except to say that one could become the other.
In November 2002, the Pain and Symptom Management Advisory Committee Report offered the following recommendations:
The state legislature, MDCIS and MDCH should work to minimize the state regulatory impediments to access to effective pain medications under Schedule II to assure appropriate care in pain management. These include:
a. Lengthening the time limit for filling prescriptions from five (5) days to 90 days
b. Lengthening the period from 72 hours to 14 days for completely filling a prescription that is only partially filled.
Other agencies weighed in with the goal of ensuring that patients with pain received adequate pain management. The Joint Commission on Accreditation of Healthcare Organizations promulgated a “bill of rights for people with pain” stipulating that patients “have the right to have (their) pain controlled, no matter what its cause or how severe” and mandating that all patients be interrogated about their level of pain at every opportunity.
At the same time, the Agency for Healthcare Research and Quality produced a guideline for management of post-operative pain (of which I was one of the authors), which recommended the more liberal use of non-steroidal anti-inflammatory medications and alternative, non- pharmaceutical methods of pain relief instead of opioids unless pain was greater than 5 out of 10.
All of the sets of recommendations regarding better pain management called for better education of physi- cians in opioid prescribing, the development of and distribution of educational materials, and mandated continuing medical education on pain management. However, given the highly subjective nature of pain perception, the general ineffectiveness of passive educa- tional materials and mandated CME, these guidelines and booklets did not have the desired effect on practice. They were no match for the much greater publicity and exten- sive marketing of opioids by Purdue and other pharma- ceutical companies.
Fast Forward 20 Years: The Michigan Prescription and Opioid Abuse Task Force
Fast forward 20 years and we begin to see some of the effects of the misinterpretation of policies, the manipula- tion of caregivers, the susceptibility of a small segment of the populace to addiction and the power of the market- place to facilitate inappropriate prescribing and create pill mills, a downturn in the economy that created widespread depression and feelings of hopelessness. Mix in cheap, synthetic fentanyl and you have a full-fledged opioid crisis.
In response to the “opioid crisis”, in June, 2015 Governor Snyder appointed a task force of 21 members, led by Lt. Gov. Brian Calley and co-chaired by Attorney General Bill Schuette. The Pain and Symptom Management Advisory Committee was still around, but had no input, and has now been dissolved. The make-up of the task force heavily reflected law enforcement over medical expertise.
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Washtenaw County Medical Society BULLETIN APRIL / MAY / JUNE 2018
THE EDITOR AT LARGE
THE OPIOID “CRISIS:”
A Michigan History
By Richard Burney, MD
“We have met the enemy and he is us.” In the comic strip, Pogo, by Walt Kelly, 1970












































































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