Saturday, December 16, 2017

Joint Commission sued over allegations about the opioid crisis

So who’s to blame for the opioid epidemic? How did we get where we are today? There's been a lot of finger pointing at the pharmaceutical industry and while it deserves a share of the blame there have been other factors. The Joint Commission had some pretty aggressive pain management standards starting back in the late 90s. Unless you’re in mid or late career (and didn’t have your head in the sand about 18 years ago) you wouldn’t remember this but I do. Oh, how well I remember it.

I remember our joint commission surveys with all the preparation we went through and how pain management was the hot topic of conversation. There were lots of documents from those days (old Joint Commission manuals and hospital committee records) that I'm sure folks would like to suppress and I can say the same thing for certain CME materials promulgated by our own professional societies who tried to shove this pseudoscience down our throats.

Fingers have been pointed at Joint Commission for a while now concerning this, so recently they issued a disclaimer. That vigorous attempt to deflect blame was recently called out by Skeptical Scalpel and I linked to the post here. From that post it would appear that Joint Commission cooperated with industry in pushing for expanded indications for narcotics while minimizing risks.

So the latest news is that four cities in West Virginia have sued the Joint Commission, claiming economic losses not only for the health care of victims but for the cost of efforts to stem the epidemic. This came out just last month (H/T EP monthly). Whether or not they prevail, this will shine light on the history of the problem by bringing old documents into public view that up to now would have been difficult to access. Joint Commission, in their denial that they contributed to the problem, correctly points out that they did not coin the phrase “fifth vital sign.” But, as the documentation shows, they did a great deal to propagate the idea.

Here are the introductory paragraphs from the court document:

1. In 2001, Defendant JCAHO, as part of its certification program for health care organizations, teamed with Purdue Pharma L.P. and its affiliates (“Purdue”), as well as other opioid manufacturers, to issue Pain Management Standards (or “Standards”) and other related documents that grossly misrepresented the addictive qualities of opioids and fostered dangerous pain control practices, the result of which was often the inappropriate provision of opioids with disastrous adverse consequences for individuals, families, and communities. These dangerous Standards, with minor modifications, exist to this day.

2. JCAHO zealously enforces these dangerous Standards through its certification program and has persisted in this course of action even after Purdue was found by the Food and Drug Administration to have misrepresented the quality of its opioid OxyContin in 2003, after Purdue pleaded guilty to felony criminal charges for making misrepresentations respecting OxyContin in 2007, and after warnings from health care professionals concerning the horrible impact wrought by the Standards.


It then goes on to quote from past JC standards:

36. For the 2001 Standard RI.1.2.8, The Official Handbook provides “[e]xamples of Implementation of Standard RI.1.2.8,” the first of which is: “Pain is considered the ‘fifth’ vital sign in the hospital’s care of patients...”

46. The 2001 JCAHO Monograph stated: “Some clinicians have inaccurate and exaggerated concerns about addiction, tolerance and risk of death...”

62. The 2003 JCAHO Monograph stated:

a. “Clinicians’ misconceptions about pain treatments could include an exaggerated fear of addiction resulting from use of opioids; confusion about the differences between addiction, physical dependence, and tolerance; or unwarranted concerns about the potential for the side effect of respiratory depression.”…

c. “Many practices are faulty and outdated (e.g., promoting the idea that there is a high risk of addiction when opioids are taken for pain relief).”…

The pharmaceutical industry, our professional organizations and published articles promoted pseudoscientific dogma on pain management. Joint Commission made it a mandate.

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