My name is Ed, and I am addicted to the A&E television series Intervention. For those of you unfamiliar with the show, it cynically exploits people at their lowest point – drunk, addicted to meth, often homeless or sponging off family, etc. – under the guise of a "documentary" about addiction and recovery. Since each episode devotes about 2 minutes to recovery and treatment, it's pretty clear that the show exists to let us all gawk at train wreck addicts at their lowest point.
Like everyone who watches it, I watch Intervention to feel better about myself.
To discuss every messed up aspect of this show (not to mention its popularity or mere existence) would take too long, but one thing really blows my mind regularly. Many of the addicted people have bathrooms full of prescription pill bottles the size of pop cans filled with opiates, stimulants, and other varieties of addictive narcotics. Yes, obviously some of the pills a drug addict consumes are going to be obtained illegally. But that doesn't account for all of it. Some of the show's subjects reveal how they get legitimate prescriptions for insane quantities of Oxycontin, Xanax, and so on. And my question is, who are these doctors writing out 30-day scrips for 150 maximum strength Oxycontin?
I've talked before about how American medicine is basically a big vending machine of prescription drugs. It goes without saying that the idea of actual patient care and accurate, thorough diagnosis is foreign to the American for-profit model of medicine. Doctors have every incentive to get patients out of the office as quickly as possible and with as few (expensive!) diagnostic tests as possible, and the easiest way to send the average patient on his or her way happily is with a prescription or five. I did assume, though, that if for no reason other than self interest, doctors wouldn't prescribe narcotics quite so casually. One would imagine, for example, that oversight by the DEA and state licensing authorities would make a doctor think twice and act conservatively when controlled substances are involved.
Is that hopelessly naive? I can't say I've ever tried it, but…is it really as easy as semi-reality TV makes it seem to walk into a doctor's office reeking of the symptoms of drug abuse and walk out with a Keith Richards sized allotment of mind altering drugs? My confusion on this point goes beyond reality TV. For instance, I regularly hear students telling tales of getting large prescriptions for Adderall and other stimulants at the slightest mention to a doctor of having "a hard time concentrating."
As a kid I remember our family pediatrician offering candy to patients who completed a visit without crying. This encouraged me to be brave, but in reality the good doctor was pretty liberal with the candy policy. In fact, no matter how I comported myself in her office I don't recall ever leaving without having been given candy. This seems like a good policy in hindsight; the kids would probably cry even more if they were denied candy in addition to being poked and prodded. This worked because the doctor figured that there is no real harm in one piece of candy, especially if it meant getting a child out of the office calmly and expediently. This same policy seems dubious when applied to addictive drugs, however. Is our system of assembly line, bottom line focused medicine really so broken that we're willing to hand out prescriptions for whatever the patient wants just to keep things moving along?
I think I already know the answer to that question, unfortunately.
Will says:
The DEA enforcement is underfunded. Every few years, an individual state will decide to crack down on opiate friendly doctors, and for a year or two, it gets better. Unfortunately, no state consistently has the cash to police things appropriately. Anytime you can relate something to infrastructure (like DEA numbers/Rx enforcement), odds are the problems are related to under funding.
jgalt says:
Pot is illegal because Big Pharma can't make a profit from it; it's too easy to grow
your own if it's legal.
baldheadeddork says:
My wife's first husband is a prescription drug addict. Here's how it works and why it's such a tough problem to tackle.
On the acquisition side, addicts become very good at presenting the symptoms that are most likely to get the script they want. Most doctors will see the red flags of a new patient coming in for a narcotic script, but unless the person is being obvious there isn't an easy way to handle it. If they refuse to treat a legitimate patient they can get sued and have a complaint filed with the licensing board. It's not worth the hassle. The doctor usually writes one script and tells his office staff to not take any more appointments for that patient.
The doctor will also probably hope none of his script pads just walked out the door with the pillhead. We had to go to my wife's ex's apartment after he'd been arrested on a DUI and found script pads from multiple doctors. That's the mother lode. Get one script pad and if you live in a large city, you can (literally) write your own ticket for months. Just keep going to different pharmacies and keep the volume and dosage below what might raise suspicion. That was his MO for years and it worked.
The most likely way to get in trouble is to get caught driving while blasted out of your skull. This happened to my wife's ex more times than she can remember. He totaled four cars in less than two years and had countless smaller accidents. There were several times when my wife called the cops to their home, laying out everything and begging them to arrest him. So how many times was he charged? Three, and all for DUI. He's never had a single drug charge laid on him because he's just smart enough to never carry a large number of pills on him and he hid his stash from everyone. Without that evidence it's damn near impossible for the police to put a case together. When he got pulled over they knew he was high, but there wasn't any evidence of illegal drug use. The cop had the ugly choice of trying to make a DUI case without any toxicology evidence. It was really easy for his lawyer to claim he had a bad reaction to a prescription drug (he usually had one or two that were legitimate) and he had no criminal record.
The crashes and arrests finally piled up to the point where prosecutors could make a case worth taking to court and get a conviction. In that way his free ride is over now. He has convictions on his record so when he gets stopped the cops are more confident in making an arrest. But for years he got away with an amazing volume of shit. If he had tracks on his arm or booze on his breath he would have been arrested and convicted dozens of times, and he'd be doing time in a state prison. But because it's pills he has a record no worse than your typical Republican state representative.
This problem exists partly because of industrial medicine, but the much larger cause is just that the drugs are available. These drugs for chronic pain and mental illnesses didn't exist thirty years ago, and the lives of millions of people are better today because we have them.
What's the solution to stop people from abusing them? How much are you willing to prove your innocence? Is this worth giving up the right to refuse a blood or urine test? Without that, there's no way to prove someone has enough pills in their system to anesthetize a whale and didn't have a bad reaction to a prescribed dose. Do you want a central database tracking all of your prescriptions so the $10 an hour clerk at Walgreens can tell if you've already bought 500 Xanax this month?
wetcasements says:
There are people who need appropriate pain meds, and they've basically been fucked over by the drug war.
mk says:
Given the ease and would-be legality with which one can get opiate meds, I wonder if they've been studied as a sort of test case for the general legalization of narcotics. Gangs don't control their distribution and tax money goes to the state, but they are really widespread, highly addictive and very problematic. I'd be really curious to read about the various trade-offs to the distribution of drugs this way vs the underground heroin trade.
Mrs. Chili says:
I wonder about this, mostly because I can't IMAGINE walking into my doctor's office and walking out with a prescription for opiates without having a genuine, demonstrable need for them. Is it just that my doctor is ethical? Is it that I am unskilled in the art of lying? I don't understand how SO many people can be addicted to prescription drugs because I like to think that at least MOST of the doctors are doing their jobs. Perhaps, though, that's just me being naive.
anotherbozo says:
Your post coincides with doctors and other medical professionals joining the protest downtown at Occupy Wall Street. Making some of the same points, that medical care is skewed to make insurance companies, drug companies and medical equipment companies richer. I like that of these professionals showed up in lab whites and uniforms: visuals are important to TV. Now if we can only GET some TV coverage when it counts, on the evening news.
Pope Guilty says:
In reality, doctors loathe the bureaucrats.
squirrelhugger says:
I disagree with one minor point— my doctor is an average insurance company technician type, and is very quick to assign tests. Insurance pays, so it's just not an issue. Even better, the medical group that owns her practice owns the local hospital where all the tests get done.
Probably a good thing in the end, since a recent hearing loss complaint led to a hospital test where the patient was sent away because of a giant clot of ear wax the doctor hadn't noticed before ordering the test. As an ex-biomedical engineering student, I'd guess the fees from 2 or 3 hospital lab tests would pay for a completely automated hearing test device for a doctor's office, that an electrical engineering grad student could easily build for a master's project. I'd bet they already make them in India.
It's hard to keep track of how many ways we're fucked.
San Narciso State University says:
I'm with Mrs Chili in wondering where all these prescriptions come from. But it must be pretty lousy for the doctors who have to deal with med-seeking patients.
I had a persistent cough recently – a nasty one that was pulling muscles in my back and generally making my ribcage sore. I couldn't see my usual doctor, so I saw another guy in the same practice. He figured out the source of the cough, and then we talked about my back and ribs; he seemed flabbergasted when I said that I should be able to manage with ice and ibuprofen. He asked a few times whether there was 'anything else', not in a helpful way but in a testy, 'there's something you haven't said yet' sort of way.
It was only after I left that I realized he was probably worrying that I was going to ask for opiates or something similarly strong. Not my usual doctor, nebulous pain from a generic ailment, etc. – it must have seemed fishy. (I'd like to think he was prepared to kick me out rather than fulfill that hypothetical request.) If I were a doctor, I'd dread having to deal with that sort of situation.
DocAmazing says:
I have patients who have chronic pain–and I'm a pediatrician. It's far worse for adult docs. For most chronic pain-causing conditions, there is no lab test and no specific diagnostic finding–just a suffering patient. As has been pointed out above, I can be sued, lose my license or even get jailed for refusing to treat pain.
If you want opioid meds and you have any acting talent, you can get them, because it is unethical to leave a person suffering and because there is no way to prove that a person is not in pain. From my point of view, I'd rather supply a dozen pill-heads than let one of my patients remain in pain.
Ike says:
Several times I've been to the dentist for pain and complications related to a root canal. It always amazes me how willing they are to just whip out the 'ol pad and give me 30 days of opiates for a 3 day problem (usually along with an antibiotic to knock down the tooth infection).
@Baldheadeddork… Now I think those prescription pads are pretty highly regulated, individually serialized with anti-counterfeit features and a whole regulatory shit-storm for a doctor who misplaces them. Dunno how well it's enforced though.
Jon says:
You might be interested in The Last Psychiatrist's post on The Terrible, Awful Truth about Supplemental Security Income.
Here's the relevant quote:
"Same with benzos (Xanax, Klonopin, Valium, etc) and narcotics (percocet, MS Contin etc.) Once in a while some doc gets publicly arrested for handing out Vicodins in Valu-Packs, but the amount of benzos being routinely prescribed in an inner city is unbelievable. Go to your suburban doc and try and beg for a few Xanax. Come to the inner city and you can get #90 Xannies on first visit. Why? Because the government isn't going to mess with the eleven or so sandbags they have placed in each neighborhood to hold back a flood of proletariat rage. Patients want them (to use, to sell, whatever) and docs give them because if they didn't, they wouldn't come back. If they don't come back, what are they going to do instead? Go work for Walmart? No, they're going to burn it."
Use your google fu to find the original post.
K. says:
I'm addicted to Intervention, too. Unfortunately it makes me feel ashamed of myself.
I've never encountered a doctor who prescribed drugs freely. Of course, I've never been to any sketchy back-alley doctors, so that might explain why. But I have to say that I prefer my doctors to treat me instead of being insanely suspicious and jittery about giving me medication for pain. When I was given a 30-day pain prescription for an injury to a back muscle, it was my responsibility to take it appropriately, and I was beyond grateful to my doctor for prescribing it instead of being too nervous and telling me to take (totally ineffectual) aspirin, as many doctors I've encountered and heard about do. You can't even get antibiotics for a sinus infection half of the time because good doctors have such a fear of "overprescribing."
Of course, I've never had a chronic pain problem, never been to a "bad" doctor, but in my personal experience, doctors do not prescribe with gay abandon. So I'm also left wondering, Where these folks get their drugs?
Darby Withers says:
I went to the doctor for some flu or sinus infection one time. I knew I just needed antibiotics. I had no cough and no pain and told the doctor as much. When the nurse came in with the script for the antibiotics she also handed me one for loritab. I told her that I was not in pain, but she insisted.
In another incident, I had all four of my wisdom teeth removed at the same time. I was put under because they had to cut into my jaw bone. I left with a 30-day Demerol prescription, which is a fairly strong narcotic, and the first day I needed one. After that though the pain was manageable with some chronic weed and a popsicle, so I took the almost full bottle of pills back to the pharmacy. I've never seen someone more confused as the pharmacist when I told her I didn't want the narcotics. Apparently no one had ever brought pills back before.
jeneria says:
I worked for a doctor who would see 5 patients an hour, regardless of their complaint. Needless to say, he was very liberal with the prescriptions.
When my husband had knee surgery, they gave him vicodin. He can't take vicodin (or really any synthetic pain killer they make him violently ill), the only thing that would work for his pain was codeine but his doctor wouldn't give him that because "it's addictive, so here's percodan and vicodin see if that works." So Tylenol 3 was a no go, but the big dogs were free flowing.
Jonathan says:
Ed, usually I'm with you on most things you say, but you really want a bunch of armed bureaucrats stewed in the Vogon/Ferengi/American/Judeo-Christian/Pharisee sadism/fascism culture and their own agency's "prosecutorial culture" to decide whether people should get pills or not? That's a very American solution from someone I'd hoped was less American than that.
As it is, doctors are scared to prescribe opioids for legitimate cases without even more hard-nosed "oversight" by a bunch of martinets whose legal charge (per the "designer drug" acts of the 1980s) is essentially to eliminate any chemically induced altered states of consciousness. I do not believe that this state of affairs is a less bad problem than a few proles with addictive personalities finding an outlet for them that's safer than the full black market.
Edward says:
The drug industry has no doubt developed many strategies to manipulate doctors into overprescribing drugs. Government regulation is probably a thing of the past unless the rules help big business such as copyright laws.
Da Moose says:
If over medicating the population means an acceleration of the demise of your average obese redneck then so be it. Hell, in fact, provide free cable TV, subsidize McDonald’s, and hand out free prescription meds. By 2020, we will have rid ourselves of T-baggers.
ladiesbane says:
A few notes:
There are doctors who want to be loved by their patients, or who want their patients to feel cared for at all costs. Doctors can be emotionally needy and / or enabling, just like us regular civilians.
There are patients who do not feel "treated" if they have not been prescribed something, given a test, or had surgery recommended. A doctor who uses sheer experience and observation to diagnose your problem as something that will be resolved without treatment in a few days is not a good doctor, in their eyes.
Mental health issues can heighten physical pain. There is no reliable cure for mental health problems, and not everyone wants or can afford long-term hit-or-miss psychiatric care. Psycho-somatic pain is as real as somatic pain; both are felt in the head, regardless of where the physical injury is, or when the psych trauma occurred. To disagree, respectfully, with Mrs. Chili, there is no genuine, demonstratable need for opiates. They cure nothing. The need for pain relief is very real, but it is all in the head. Unless you have a way to measure pain to an objective standard — and no one does — the subjective suffering of the patient must largely be taken on trust.
Hysteria over the "right amount" of drugs keeps a lot of people in chronic pain jumping through hoops, suffering out-of-meds days, and going up and down a rollercoaster of toleration. Serious pain is blunted by pain meds; there is no feeling of being high. Start low, by all means; titrate always; clear out your system regularly when possible. But don't make terminal patients suffer, and don't torture chronic pain patients, by prescribing according to standards for people with tennis elbow.
But watching people suffer, with curiosity rather than interest, is unhealthy, in my opinion. Like sexual objectification, it prevents a contextual understanding of the complete person. (It's disrespectful as hell, too, not that most people give a damn.) A little voyeurism is normal, but remember: that person you're gawking at could be you, or someone you love, with a story that can't be meaningfully reduced to a single episode with voiceover narrative and limited commercial interruption.
Slocum says:
"And my question is, who are these doctors writing out 30-day scrips for 150 maximum strength Oxycontin?"
And what are their office addresses and hours?
JohnR says:
"Like everyone who watches it, I watch Intervention to feel better about myself. "
Huh – that's exactly why I read various and certain blogs. What a co-inkeydink!
You serve a vital public interest, Ed, and you serve it well. Keep it up!
Arslan says:
I don't get American TV so I just learned about this show. It sounds pretty terrible, but I highly doubt it could ever match the comedy value of To Catch a Predator. That show mixed voyeuerism with hilarious comedy and antics.
First it was funny because it's really a lot of fear-mongering over a problem that isn't really that dangerous when you look at the facts. For one thing, the most likely candidate to molest or abduct a child is someone in the child's home. Second, the stats they used regarding how many children are actually solicited online were deceptive; the question was about whether anyone had ever spoken to them about sex online in a way that made them uncomfortable- which in this case included other teens talking about sex. Lastly, it is VERY easy to teach kids how NOT to use the internet. As long as they know the basics of protecting their privacy, it is highly unlikely that your 13-year-old daughter wants to lose her virginity to some 300 lbs neckbeard who takes photos of his micro-dick with his webcam.
Now on the other hand, these guys are sick fucks, and contrary to common belief, they are not "entrapped" as they go under their own volition and they must bring up sex and meeting in person. The thing is that unless you have this set-up, it is highly unlikely that your kid is going to get molested by someone online.
That's what makes To Catch a Predator so hilarious. These pedos get humiliated AND it's all because NBC decided to make a show about it.
Personally I'd like to see some new episodes as soon as possible. Chris Hanson kicks ass!
Dick Nixon says:
A woman in my immediate family (lets call her "Pat" ) suffers from a denegerate bone disease that is excruciatingly painful. Fenatanyl and Oxicontin have been prescribed for several years to ameliorate this condition.
The problem is not with her doctors, who have reams of test results backing their prescription of these controlled drugs– it's the damn pharmacists who take it upon themselves to conduct in-store interrogations, call her doctors at home to verify the scrip, and at times deny the medication outright on a "judgement call". We always straighten it out, but the humiliation and struggle take their toll on this nice lady. After all, she is the sick one.
wetcasements—"There are people who need appropriate pain meds, and they've basically been fucked over by the drug war."
There sure are.
sluggo says:
@Dick Nixon
Amen!
The reason people take pain meds is simple: they are in pain! Why the hell would someone jump through all these FN hoops?? If someone was just looking for good time, then alcohol and firearms are perfectly legal.
DJ says:
Once place people get these drugs? Other "patients". I know more than one person who regularly goes to the doctor with complaints about some painful ailment that may or may not exist, and walks out with a prescrip for a healthy stash of pills. Then they turn around and sell the pills to other people. In some cases, the buyers turn around and *re-sell* the pills at a higher price.
I'm truly amazed at all of the pill-popping that goes on around me, especially being a guy who's leery about taking anything more potent than Ibuprofen…
doug says:
I had a fairly invasive surgery at major southern university hospital. Upon leaving they handed me a script for 120 oxy somethings. I went to pharmacist and asked for only 30. I had 10 left for a long time, and I am a pain wimp. The 120 number was crazy large, and I still don't know why it was so high. Makes no sense.
KellyD says:
I agree with you generally. But I agree with "Dick Nixon" and "wetcasements" and think it is worth pointing out that the flip side of harsh oversight of doctors' prescribing pain meds is that there is a population of patients who are under-medicated for pain because doctors are afraid to get in trouble for more liberally prescribing pain meds. Or, as one commenter pointed out, legitimate patients are getting harassed for their legitimate prescriptions. That is not to say a careful policy and enforcement plan could not address both sides. The status quo clearly isn't working.
PhoenixRising says:
No, our system isn't giving out candy to anyone who asks.
I've had 2 major pain episodes in the past 5 years, following one in my early 20s. For none of these problems (impacted wisdom teeth, 7 broken bones plus collapsed lung, surgery to remove malignancy) have I been offered any form of pain control that works on me.
Made me itch, develop what appeared to be Tourette's, prevent ever taking a crap again, cause immediate onset apparently terminal vomiting, and ice pick insertion level headache? Had all those side effects, no appreciable pain control.
So as far as I can tell, we haz no candy.
As to why anyone would prefer the effects described above to being knocked out with alcohol, morphine or a brick to the frontal lobe…I dunno. Do any of those people want to buy back my prescriptions, which of course the pharmacy won't let me return?
Andrew says:
I've had at least two dentists who will give me four or eight Vicodin in an unmarked brown envelope after a procedure that is unlikely to require Vicodin except in the most pain-averse patient. I usually take one right after the procedure just in case, and by the time it wears off, I'm fine and don't need another, but I keep them around just in case. So my anecdotal evidence is that modest quantities of strong pain medicine are pretty easy to get.
marydem says:
As a recovering alcoholic, I watch Intervention to empathize with the addict's struggle. It reinforces my sobriety. I don't think I'm superior nor that these people are hopeless. It takes what it takes to hit your bottom. And I'm always gratified when they choose recovery. If they don't, it just reminds me of what my life could be like if I chose to drink again.
So, I say Intervention serves a purpose.
Southern Beale says:
A related story is the preponderance of "pain clinics" popping up everywhere, which are basically legalicalized drug pushers. I saw a documentary somewhere recently (Current TV? Can't remember) about the lax laws in Florida which have led to pain clinics cropping up everywhere and people drive to the state from as far away as Michigan to get their Oxy scrip.
Chris says:
It's pretty terrifying how lax some doctors can be.
I remember going to one of the few psychiatrists my insurance covered, to get anti-depressants, and ADD medication.
She didn't even bother asking or diagnosing me for the ADD (a previous shrink had done that, but still), she just gave me however much I wanted, whatever type I asked. She even said "careful, you can sell these for a lot of money!"
I was absolutely terrified. Also, later on, apparently she got in trouble for forward dating prescriptions for people.
Ike says:
I suppose a lesson is that physicians and medical people, just like cops, school teachers, and clergy, are not necessarily in their chosen profession because they want to help people. We tend to make blanket judgments about a person's character based on her profession.
Mackeyser says:
Here in Florida, Oxycontin has been a scourge. The new Pill Mill law will help as they are now putting a database in place to help curb "doctor shopping".
Still, they found that only THREE doctors in Miami-Dade county alone were prescribing something like 50% of ALL of the oxycontin in the entire US.
And the top 20-50 were prescribing something in excess of 90+%. I'll have to rewatch Current's EXCELLENT documentary on this subject, Oxycontin Express to get their numbers exactly right, but they were shocking. Someone correct me as it's late and I know I'm close, but I have a feeling that my recollection is missing something.
As for Doctors pushing pain medication, I can attest to that.
I'm a service-connected disabled vet. I know I addict easily. My family has a history of addiction. I'm addicted to gambling. The only reason I don't go to Gambling Anonymous meetings is that I recognized those symptoms of addiction and promised my wife before we got married that I wouldn't gamble… and other than $20 in Vegas…once… and a few dollars on the Lottery, I've kept that promise. But the doctors have tried for nearly two decades to addict me to opiates, even threatening to rescind my VA benefits if I didn't take opiates since not taking opiates to relieve my pain was the same as "refusing treatment". That was WITH the knowledge that I had a family history of addiction and all the personality indicators that I, too, would become addicted.
Thankfully, since moving to FL, my primary care Dr. at the VA not only supports my decision to remain opiate-free, but she is amazed I've survived in the system this long without being on them.
It's not JUST that they're easy to get, Ed. In some instances, Doctors are FORCING them on patients to their direct detriment.
I'm sorry for this long post, but I want to relay this to your readers. It was in fall of '92 at the VA Hosp in Wilkes-Barre, PA. I went up there in great pain. I have Crohn's, an Ideopathic Seizure Disorder, GERD and daily Migraines/cluster headaches. The Crohn's was NOT controlled, the Migraines/cluster headaches were out of control so I was basically bedridden, I did NOT know at the time that the med combos I was being given for my Seizure disorder was making my Crohn's worse and vice versa. The cocktail was about the worst cocktail imaginable one could give someone like me. I went there to demand someone do…something. I passed old vets, some who had to have been in WWII or Korea hooked up to IVs on gurneys or in wheelchairs just lined up jammed packed against the walls staring into space. They were in in-patient pajamas so they were headed somewhere, but THIS WAS THEIR DAY… sitting under florescent lights and staring at…nothing.
I finally saw a Dr after some time and he looked and my chart and actually raised his eyebrows. Then he set his jaw and told me words, I'll never forget. "Look. You're obviously sick and in pain. I can admit you right now, put you on a morphine drip and by the looks of it get you into hospice (I was 23 about to turn 24 at the time with a young baby and a wife) and that will be it." He let that sink it. "..that will be it…" "Or.. you can go home and deal with it."
I turned around and left right then. I didn't even check out of the clinic. I wasn't about to end like that. But THAT'S the end that gets pushed on far too many. Granted, I was demanding a solution, but I got lucky. I was very young and I got a doctor who shot me straight. If I was my current age and just got a tired doctor who just didn't want to deal with it… it would have been… over.
I think it's more than just pushing pain meds, tho. I think it's pushing symptom management over diagnostic efforts or curative efforts. The show, "House" is science fiction. Drs never spend that much time on a single patient who isn't a gazillionaire because they don't diagnose anymore. And I just don't see Drs spending ANY efforts on being proponents for cures then they're being paid so handsomely to shill for Big Pharma… Not all, mind you, but enough that the industry has reached critical mass. So whether it's Oxycontin or Adderall or whatever, if it allows the Dr to play "whack a symptom" with his/her Rx pad, then you can bet that's how it will go rather than that Dr spending dozens or hundreds of hours testing and researching a difficult case.
Phoinix says:
I call bullshit. Do you have any actual facts? Or just some random stories and a *feeling* that this is happening? Pretty much like how everyone "knows" how out of control the court system is with bad lawsuits. A lot of what everyone "knows" is wrong.
From the bottom link: "An article in the April 5, 2000 issue of JAMA reports on the use of opioid-based analgesics (strong painkillers, like morphine) to treat severe pain and its relationship to drug abuse (overuse or improper use of a substance or drug for a purpose other than its original medical purpose, for instance, to get high rather than to relieve pain). The researchers found that even though the use of these painkillers for medical purposes has increased, the rate of abuse of the prescription drugs
remains relatively low."
1. Pain medication given to people who are in pain isn't addictive. Yes, you become tolerant to it, requiring an increase in dosage – but that's physiological and pretty common to other drugs. Addiction is different from tolerance. Don't use them interchangeably. If you are in pain, the medication will prob ease it slightly while also making you nauseous.
2. Pain medication, with few exceptions, is pretty hard to get even when you have a need for it. There is an immediate presumption of guilt, that a patient is a "drug seeker". That assumption is entirely up to the patient to attempt to disprove. Show up in an ER for something unrelated w/pain meds on your file & you will be questioned even if you're there for antibiotics. These drugs are already controlled.
3. Chronic pain, aside from being rather unpleasant causes damage to your health in itself – it's a legit medical condition. It's also hard to prove. But here's the thing, a good doc can easily spot addicts once they're being treated. When these are written there are rules a patient agrees to follow and signs a contract on. They are rules that experience has shown, addicts cannot adhere to. This isn't hard.
4. Refusing pain medication you need doesn't make you a hero any more than refusing insulin would. It makes you a fool. Getting a second opinion or getting medication adjusted b/c of side effects is one thing, but pulling this Puritanical-Warrior-Battling-Evil crap is just dumb.
5. Addiction is a disease, not a result of a particular substance. Lets say we restrict pain medication even more than we do, and let's say we "win," have we prevented any actual *addiction*? Unlikely. What you do, is to make it functionally impossible for people who need the medication to actually get it.
6. You can't say "let's make these drugs available to only people who need them" AND at the same time try to heavily restrict a doctor's use of them. You have a choice: Do you want doctors who err on the side of treating serious pain? Or would you rather pile on restrictions until it's nearly impossible for any addicts to get them? You can't functionally do both.
Here are some actual facts for you:
http://www.orthorehab.wisc.edu/rehab/paincenter/What_Everyone_Should_Know.pdf
http://www.orthorehab.wisc.edu/rehab/paincenter/managing_pain_JAMA.pdf
Halloween Jack says:
who are these doctors writing out 30-day scrips for 150 maximum strength Oxycontin?
Primary-care providers–the most overworked and worst paid of the different medical specialties, with the possible exception of psychiatrists–who are in such great need of recurring and relatively undemanding patients and under so much pressure from HMOs and insurers to avoid expensive treatments and tests that they're willing to keep passing out the scripts for a "condition" that has no real objective diagnostic test and depends heavily on the patient's self-reported condition for diagnosis. God Bless America.
Mackeyser says:
@Phoinix. I respectfully disagree with your points.
Point 1 is demonstrably false. Oxycontin, for example, is pharmaceutical grade heroin and is HIGHLY addictive. Every opiate, due to the biochemical chain of actions and reactions is addictive. Period. You are just wrong on this point. See point 5.
Point 2. Pain meds are quite EASY to get depending on your diagnosis. I've had private insurance VA care and seen LOTS of doctors over the last 20 years. At any time, I've had access to opiates the minute I wanted to give up this fight. The very second I want to stop being opiate free, I can have opiates for life. Hell, I won't even have to show up for appointments, but for once ever 6 months. So…yeah. EASY. As MANY other vets can attest with more severe injuries than me, it is all TOO easy to get these meds. Only recently has the VA put more emphasis on pain management that didn't revolve around opiates.
Point 3. I've been treated for chronic pain for over 20 years. I don't know what your experience is, but it seems to be purely academic. Let me tell you that you can quote the rules all you want. That's NOT how it actually works. At least not for me and not for the hundreds of other chronic pain sufferers I've talked with over the years. Been there. Living it. You might as well have had Rodney King read the LAPD his Constitutional Rights. How it's supposed to go and how it actually goes is often significantly different.
Point 4. Seeing as you don't know that substances are inherently addictive (otherwise, there would never be crack babies, or babies born addicted to crack because their mothers were addicted.), of course you wouldn't understand why someone would refuse pain medication. Worse reducing anyone's treatment plan to "Puritanical-Warrior-Battling-Evil crap" is just your poorly disguised dismissive dogma.
Point 5. I have SERIOUS issues with the 2 statements from the UW pdf. What it doesn't cover is how powerful those emotional or psychological needs are and how they SYNERGIZE with the physiological tolerance. Moreover, we're dealing with people, not robots who easily can parse their physiological from their psychological or emotional needs when it comes to severe pain. If it were as neat and clean and easily parsed as that pdf puts it, addiction wouldn't be near the issue it is in this country. There is a MASSIVE difference between what is technically true and what is practically true. While the document may be technically true, any addiction counselor will tell you that it's just NEVER that neat. Otherwise, alchoholics could just compartmentalize their addictive behaviors and moderate their alcohol consumption. And yet, we know it doesn't work that way. We know that there simply is no way to practically extricate the psychological, emotional and physiological. We can become aware of the various facets, but we have to deal with them all as interconnected. Which is why I say in point 1 that Oxycontin is highly addictive. People have said they were addicted to crack from the first hit. Expressly because the emotional and psychological can directly affect the physical (depression alone can cause chronic pain), one simply CANNOT parse addiction based on emotional/psychological and "physical dependence" based on tolerance due to long term exposure. It's a purely academic and abstract parse that doesn't exist in reality. Trying to use that parse as "the truth" is simply disingenuous.
Point 6. As the Current documentary "Oxycontin Express" pointed out, MOST of the Oxycontin in the US actually comes from 20-30 clinics in South Florida and is then sold illicitly through the country. So the issue isn't most doctors in Denver or Portland or Detroit or Boston not following the rules. That doesn't mean that doctors across the board aren't still a bit too free with opiates. They are and I say that because they refuse to engage in either a) serious diagnostic work because they lack the patient time under the current insurance model and b) many doctors don't want to lose patients. They can prescribe drugs, but unless they open an associated non-drug oriented pain/stress management clinic, they essentially lose that patient. And doctors DO have a vested interest in writing scrips. Ask any drug rep. They have less incentive to see patients manage their pain without needing expensive meds or billable doctor visits.
FYI, one document from one source does not provide one with "THE TRUTH". I'll tell you that my opinion has been informed by my personal experience of being treated for chronic pain for over 20 years, reading peer reviewed journals, talking in depth with dozens of specialists and at least several hundred chronic pain sufferers of many varieties over these two decades. I'm by no means THE authority. Not by any stretch. I will say that my opinion is informed both by experience and fact, both theoretical and practical.
The issue Ed brought up was a serious one. And it is whether you agree or not.