DEA Recommending hydrocodone CLASS TODAY

[Mtn. States Resident]

Originally Posted by Rubi3

A man I went to high school with many years ago, had spinal problems when he became older and had a morphine drip attachment for easing the pain. Eventually, the morphine ceased to help. Rather than spend the rest of his life in agonizing pain, he put a gun into his mouth and blew his brains out. Whether or not his pain could have been eased by more morphine, I don't know. If a person in great pain becomes an addict, so what?

Rubi3,

So sorry about your friend. With his spinal problems it sounds like the Morphine gave him relief for a while. It didn't change what was wrong so I doubt this person was on the street trying to buy other pain relevers.

To me, your friend may have become Morphine dependent, but that did not mean he was an addict. Many get the terms confused.

This is where I disagree with what MarkG. posted much earlier. I do think there is a place in certain patients for Oxycontin and other longer acting drugs.

I don't know how many years ago this was with your friend. Other medications and therapies can be tried if a medication doesn't seem to be working any longer. However, I think two things about patients such as your friend.

1. He deserved new imaging to make sure something else hadn't been injured. 2. I think patients like your friend should be treated for his pain by a specialized pain doctor not a FP or IM (no offense to those specialties). Other treatments and medicines combined may have given him more relief.

I agree, I think patients in severe pain due to various diseases or traumas deserve pain relief. Again, they may become dependent on certain medications, but it isn't addiction.

Thank you for sharing your friend's story.

MSR

[Mtn. States Resident]

Originally Posted by markg91359

Interesting indeed.

I have been prescribed Lortab on a number of occasions in the past when I developed kidney stones or tore a tendon in my leg. For me, its a very useful drug that would "tide me over" until the stone passed naturally. Doctors tend to prescribe more Lortab than they really need too. I have typically gotten prescriptions for 10 pills, 20 pills, or even 30 pills. I seldom take more than 4. I realize these pills are addictive for some people. I don't find them very addictive. My desire is to stop taking them as soon as I can.

They should be viewed by people as "tools" rather than pain killers. They serve a specific function which is to get people through short periods of acute pain. Kidney stones, the time after a bone has fractured, and post surgical pain are the best and appropriate uses for these medications. They should never be used for chronic pain. My son broke his arm years ago and I learned that Lortab was simply invaluable in allowing an orthopedic surgeon to manipulate and set the fracture. I suppose some people who suffer from diseases like cancer can make a legitimate claim to using them for the pain that results from that condition. Although, my own father who died of cancer chose to stop taking them, or any pain killer, in the last stages of his disease.

You have to give people with acute pain something and so I'm not crazy about more regulation. However, people do overdose on this medication and do die because of it.

My real beef is with Oxycontin. Its caused so many problems that I think we'd be better off simply banning it. Make those who use it get something else like Lortab or Percocet. Oxycontin can't possibly be worth all the problems its caused in our society.

What I really like about your post, Markg, is how you label pain medications as tools. Most likely your son got an antibiotic if surgery or incisions were involved. Antibiotics or antifungals etc. are tools too. Occupational and physical therapies are tools as well.

For those with chronic or lifelong severe pain can also view analgesics as a tool.

I hope you read the posts about disabling, chronic severe pain. I respectfully disagree about Oxycontin. However, as I wrote earlier, I think only certain types of physicians should be allowed to prescribe Oxycontin and other long acting pain medications.

Plus, Oxycontin is actually safer for some patients, depending on what co-morbid conditions exist.

As I wrote earlier, the A.G. of West Virginia would argue the Oxycontin point with you. He says hydrocodone is the the agent responsible for the most suicides in W.V.

Thanks for your post

MSR

[jimj]

After reading through some of the posts above about how doctors prescribe higher and higher doses and/or switch to more powerful drugs and restricting pain meds to a pain clinic I'd like to add a couple of thoughts.

First off, the final say in your health care is YOU. I say this because you need to educate yourself on what you're being given and if you have reservations state them to your doctor. Many people just take whatever the doctors say as gospel and take whatever they're handed without question. Don't be afraid to suggest alternative drugs,treatments or strength.
As I've stated before, I've been on Hydrocodone for 15 years now and realized early on that I had to be careful not to become immune to it too quickly as I've got lots of years left to live (hopefully) and don't want to run out of pain options before either I die or better options become available.
I've had doctors want to ramp me up to Oxycontin/Methadone after the first couple of years,then Fentanyl patches and doubling my dose (pain clinic).
I declined all of those solutions (fired the pain clinic) and stayed at a low mg dose of Hydrocodone for well over 7 years before I asked to move up to 75/325 where I've been for years now. I will not move up to 10/325's until I absolutely have no choice. This has caused some raised eyebrows from my doc's but they seem to respect my decision (surprised I'm not bugging them for more and more).
This is NOT my doctors choice but mine.

I spoke with my Pharmacist friend again yesterday about this new regulation and he just sighed and said "another useless change that will change nothing except to make it harder/more expensive on patients".

I'm sorry but all I see coming out of this is hardship for those that actually need the drug while not changing the abusers who get it with exception to what they pay for it on the street.

Lastly, it's been my experience with various pain clinics that they only remain in business if their patients are returning for more and more meds and new patients enter the doors regularly. Wonder if they had any hand in promoting this new regulation trying to become the only source?

[Mtn. States Resident]

Originally Posted by jimj

After reading through some of the posts above about how doctors prescribe higher and higher doses and/or switch to more powerful drugs and restricting pain meds to a pain clinic I'd like to add a couple of thoughts.

First off, the final say in your health care is YOU. I say this because you need to educate yourself on what you're being given and if you have reservations state them to your doctor. Many people just take whatever the doctors say as gospel and take whatever they're handed without question. Don't be afraid to suggest alternative drugs,treatments or strength.
As I've stated before, I've been on Hydrocodone for 15 years now and realized early on that I had to be careful not to become immune to it too quickly as I've got lots of years left to live (hopefully) and don't want to run out of pain options before either I die or better options become available.
I've had doctors want to ramp me up to Oxycontin/Methadone after the first couple of years,then Fentanyl patches and doubling my dose (pain clinic).
I declined all of those solutions (fired the pain clinic) and stayed at a low mg dose of Hydrocodone for well over 7 years before I asked to move up to 75/325 where I've been for years now. I will not move up to 10/325's until I absolutely have no choice. This has caused some raised eyebrows from my doc's but they seem to respect my decision (surprised I'm not bugging them for more and more).
This is NOT my doctors choice but mine.

I spoke with my Pharmacist friend again yesterday about this new regulation and he just sighed and said "another useless change that will change nothing except to make it harder/more expensive on patients".

I'm sorry but all I see coming out of this is hardship for those that actually need the drug while not changing the abusers who get it with exception to what they pay for it on the street.

Lastly, it's been my experience with various pain clinics that they only remain in business if their patients are returning for more and more meds and new patients enter the doors regularly. Wonder if they had any hand in promoting this new regulation trying to become the only source?

Another great post jimj. Sorry I can't rep you again yet.

An adult, parent/guardian, spouse or other competent adult has the responsibilty, IMO, to. Advocate for the patient. You may know of other treatments or therapies. Absolutely, I believe you should ask and if you don't know ASK.

I want to be clear that there are pain clinics AKA pain mills where basically every patient has the same treatment -- usually oral medications. Ask how many providers are in the clinic, do the doctors order diagnostic tests, what hospital (s) do they have privileges at and what modalities of treatment do they use besides oral medications. Also, ask the average number of patients seen daily. Usually legitimate clinics can answer as fast as you can ask. And always keep your PCP in the loop. If a solo practitioner sees 50 or more patients/day, that is probably not the best clinic to use.

Conversely, the newer name of Pain Management Clinics usually have one or morr fellowship trained pain mgt. Anesthesiologist. That matters as only they and sometimes fellowship trained Interventional Radiologists can do certain procedures like RF, lysis procedures, and blocks/ treatments specific to symptoms.

They also use other specialists and can order diagnostic tests. These clinics are different from the first pain clinics where every patient got essentially the same blocks.

Always keep your PCP doc in the loop. You are the master of your health. You get and deserve a vote in how you want to proceed. Good luck and better pain relief to all.

MSR

[Mtn. States Resident]

Originally Posted by tinytrump

some people need relief from pain etc -some just dopeheads. period- can't hang with life and have no coping skills,,,I have no idea which has the higher count. We got big problems with being high or drunk? So DEA and others have to keep some from falling off the cliff altogether.

And I get confused of why the DEA vs. Providers are making those decisions

Thanks for the post.

MSR

[Mtn. States Resident]

Originally Posted by Larry Caldwell

The whole addiction thing is really overblown. In most parts of the world, you can buy codeine over the counter. I came down with the flu while traveling in Paris once. I walked into the neighborhood pharmacy, mimed my symptoms, and they sold me a bottle of cough syrup that was full of codeine. I don't know if things have changed, but 20 years ago you could buy aspirin with codeine in a grocery store in Canada.

I understand that a small but significant percentage of the population can't metabolize codeine. I don't know if that is true for hydrocodone, but suspect it is the case. That may be why hydrocodone doesn't work on your husband. I'm at low risk for addiction simply because I don't find narcotics to be a pleasant experience. The pain relief is great, but I don't experience a pleasurable "high." Years ago I had major surgery and was given IV morphine for pain relief. Immediately post-surgery I was very grateful for the pain relief, but within 2 days I asked them to stop, because the feeling of being drugged was not pleasant for me. I think I'm at low risk for alcoholism for the same reason; the feeling of being drunk is not pleasant for me.

You or I could have unrestricted access to any narcotic and it would never become a problem. We find our recreation in other ways. Like you, I see no attraction in abusing an analgesic, though I will use one if it really hurts. I don't see this as a moral virtue, but as a biological issue. Some people metabolize narcotics or alcohol differently, and have an entirely different drug experience. I have my doubts that restrictive drug laws have a positive effect on reducing addiction rates. Drug seekers will always be able to find drugs.

All the points you make are true, Larry. It makes me wonder why the DEA had to take this on. Those who seek a chemical high will continue to find more dangerous chemicals and other meds to try. I would have preferred to see the $ used for substance abuse research and/or treatment.

Thanks for another viewpoint.

MSR

[brightdoglover]

Originally Posted by Mtn. States Resident

I hope that was a sincere comment, brightdoglover. For what I've seen and been taught, hydrocodone doesn't create people cooking their own meth out of whatever they can access. Yet, several stimulants are Schedule II as hydrocodone will be.
MSR

Yes, sincere, not snarky. I am considering all the stimulents, like the Dexadrines and such. I only referenced meth since the post I was referring to did so. I think this is an important discussion and wouldn't want to lower the level of conversation.

[Mtn. States Resident]

Originally Posted by john3232

Let me see if I've got this correct:
As of right now, doctors can prescribe a six-month supply of pain killers with up to five refills under Schedule III.


In other words a 3-year supply of pain killers?

I think it depends on the person, the severity of pain and underlying etiology. For some people that could be a three year supply. For others, it may be a few months.

I'm not sure if your hypothetical example is correct, John. Even if a prescription has refills, I don't think pharmacies can refill without a new, written prescription after 10/15.

MSR

[Mtn. States Resident]

Originally Posted by christina0001

I think the government is overstepping. I have a few points:

1. as mentioned several times, there's a shortage of physicians, and the ones we have are BUSY. Why are we making more work for them? I feel this is putting people with legitimate pain issues at risk for increased suffering. I know of a few primary care doctors locally who just flat-out refuse to prescribe any pain meds, period, which is just silly. But they don't want to deal with the risk of the government breathing down their neck and questioning their professional judgment.

2. I've had seven surgeries in the past 3.5 years. Your doctor has no way of knowing how much pain you'll have for no reason.afterwards. I've had surgeons give me a generous amount of pain medication, and I might have only needed one or two pills before switching to Tylenol. On the other hand, I've had surgeons assume I wouldn't have much pain, and I went home with something minor for pain that did not work at all. My last surgeries occurred 2.5 hours from home (I had a very specialized procedure not done in many places). My surgeon was not able to prescribe what she would have liked to prescribe, because it would have required a paper script and I had no way of getting one from so far away. If I ever have major surgery again I'm going to always ask for something strong - I'd rather have it and not need to use it, than suffer

3. I work in geriatrics and it's ridiculous that our elderly who have chronic, severe pain need a new paper script every month. It's a total waste of the doctor's time and the pharmacy's time. It's not like at the age of 90 their joint issues, etc. are just going to magically improve or go away.

Addicts are addicts... you can restrict this and that, they're just going to find something else to get addicted to. They need help getting the addiction under control. Making us responsible people suffer isn't going to help any.

Well stated, chrstina!

MSR

[Emeraldmaiden]

Originally Posted by Mtn. States Resident

Another great post jimj. Sorry I can't rep you again yet.

An adult, parent/guardian, spouse or other competent adult has the responsibilty, IMO, to. Advocate for the patient. You may know of other treatments or therapies. Absolutely, I believe you should ask and if you don't know ASK.

I want to be clear that there are pain clinics AKA pain mills where basically every patient has the same treatment -- usually oral medications. Ask how many providers are in the clinic, do the doctors order diagnostic tests, what hospital (s) do they have privileges at and what modalities of treatment do they use besides oral medications. Also, ask the average number of patients seen daily. Usually legitimate clinics can answer as fast as you can ask. And always keep your PCP in the loop. If a solo practitioner sees 50 or more patients/day, that is probably not the best clinic to use.

Conversely, the newer name of Pain Management Clinics usually have one or morr fellowship trained pain mgt. Anesthesiologist. That matters as only they and sometimes fellowship trained Interventional Radiologists can do certain procedures like RF, lysis procedures, and blocks/ treatments specific to symptoms.

They also use other specialists and can order diagnostic tests. These clinics are different from the first pain clinics where every patient got essentially the same blocks.

Always keep your PCP doc in the loop. You are the master of your health. You get and deserve a vote in how you want to proceed. Good luck and better pain relief to all.

MSR

I actually go to a pain clinic for management of my hip and sciatic pain. When I got the new patient packet in the mail, I saw some paperwork that I was very uncomfortable with - a narcotic contract, a treatment agreement that held the patient to far more than the doctor. Some of the things that bothered me were:

Not allowed to let anyone else pick up prescriptions
May be declined for any narcotics if anyone else in the household uses them
Urine drug screens at every visit
The doctor being allowed to report any concerns to any agency s/he deemed proper, despite HIPAA
No narcotics in the ER, without them calling the doctor first

There were others, but these all bothered me. After all, I was going in for a hip injection, not going to rehab! So I refused to sign those, and the pain specialist does not prescribe for me. He does interventional pain control only. I did let them do the initial urine test, but they've not required one since then. My husband picks up prescriptions most of the time as he is out and about (and it doesn't hurt him to walk), and my in laws, who share this house with us, are on vicodin for daily pain control. I've never been to the ER for pain, or any particularly painful condition.

But I'm controlling pain from severe arthritis with an NSAID and tramadol, so I may be out of the norm.