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Im fine with monitoring prescriptions more closely -- and what manufacturers/importers do with their products -- and I think that would help to control the improper use and make doctors more comfortable about prescribing.
But I'm not so sure about some regulatory requirement to exhaust other pain management avenues, since that basically requires patients to endure pain while doctors experiment with massage, herbs, hypnosis, acupuncture, or whatever. Not that these alternative systems don't have value, but I think a patient should be able to forego these and opt for immediate relief if that is what he wants. Again, I see it as an issue of personal freedom to use what is available and what I deem is best for me.
Exactly.
And...... I would like to point out, none of those treatments are covered by insurance.......WHY?........because they have never been proven effective.
If this is the route the medical community wants their patients to take, insurance should pay for it.
I think that is easy to say if you are not the one getting phone calls at all hrs. that MIL has yet again gone to the ER due to falling and as with my friend lives 5 hrs away. It is a huge family issue. This, as with many, it becomes a family issue, not just an issue for the individual.
That coin has another side.
People who are in so much pain they lose their appetite and spend their days lying in bed which will also damage their health.
Next thing you know they are so debilitated they end up in a nursing home.
Alternative pain treatments are their own deal. Do I think the government is to restrictive on MM and other alternate methods? Absolutely.
You can be for medical marijuana and against the pill pushing going on in places like here in Appalachia, Ohio, etc. Many communities have been severely negatively impacted by these drugs. If inconveniencing some pain patients cleans up these communities, then I'd rather have them inconvenienced than have all these pills of the street.
Appalachia also has a higher than normal alcohol abuse problem but I don't see anyone advocating severe restrictions on the sale of alcohol across the board.
Why is that?
Why not restrict alcohol like we do pseudophedrine? You have to show ID, sign for it and are only allowed to buy a small amount each month?
The new reality is NOT that the only source of pain meds is the street. There are specialists, pain clinics, which do write prescriptions. This is less convenient, of course. You have to sign a contract, undergo a urine test to check for current drug use, and must return to that office in person if a refill if needed after 30 days, at which time a new Rx is written following another urine test.
I think a lot has changed in the last 10 years. It was about 10 years ago that I had hernia surgery, they sent me home with a bottle of 30 pills (narcotics). I used only 8, leaving 22 which I could have sold on the street if I hadn't had a sense of integrity and had known where to go. It took me several years to use up the other 22 pills - an occasional headache, or a sprain, or whatever - one at a time. I wondered why they gave me so many - I suppose for the sake of convenience so I wouldn't have to be running back to them. And I also wonder how many I would get if I had the same surgery today.
Several years ago? This was a common practice among a couple of docs in a Shore town in NJ in the late '60's early '70's. I wasn't aware they were getting away with this kind of stuff since computers have been in widespread use for this kind of stuff. These guys were writing scrips for bottles of 500 Seconals Tuinols and Quaaluds.
^^^^ THIS! Why punish the people who legitimately need them. The FDA just took a one-approach solution to the problem that dragged all the legitimate pain sufferers into the net. First of all, any gray-haired person who is retired should immediately eliminate 75% of suspicion in Dr's minds because the vast majority of retirees are not addicts looking for a high. We've gotten past all that. All we want is to spend our few remaining years in comfort free from pain but the government has robbed us of even looking forward to that. I don't know how this will end. I know it will get much worse before it gets better, if it does get better. People wracked in pain cannot leave their homes to attend protests because they are bedridden and couch-ridden, therefore they have no voice in pressuring the Feds to exempt them from the rules obviously designed to stop young people from abusing opioids. But young people will always have the wherewithal to get them on the streets, whereas old people won't, That's the tragedy: the idea that an old person has to turn to a dealer to get something to make his/her life a little more bearable because of their government's heartlessness.
I am an R.N. working in a primary care clinic and a great deal of my job involves pain management. From my experience I would like to share with you a little history behind what has evolved over a number of years that in addition to the issues involved with addiction, there was another issue that equally contributed to the current state of heavily regulated narcotic prescribing. Some years ago pain was made the 5th vital sign and the normal parameter made for this new vital sign was zero pain. For clinicians to meet this clinical performance measure of their patients being 100% pain free it was virtually impossible to meet without the prescribing of narcotics. So thus began the promotion of the liberal use of narcotics for the treatment of chronic pain. Since at that time there was not a great deal of research on the use of long term narcotics in treating chronic pain since their previous use was mostly short term, and those that were treated longer with narcotics were mostly those with terminal illnesses and they did not live long enough to see the long term effects of narcotic use had on them, that still did not impede making pain the 5th vital sign and the use of long term narcotics to meet the zero pain measure. Time would prove the unfortunate fact that this would produce more harm than good.
The red flags began to fly when most patients who were started on narcotics to treat chronic pain were shown to eventually develop narcotic tolerance. In an attempt to now relieve their increasing pain that their current narcotic doses were no longer effectively managing their doses had to be continually increased. There comes a point when a narcotic dose becomes lethal and no safe further increases can be made. For a patient who has been on very high doses of narcotics for an extended period of time and are near the lethal dose level, attempting to reduce their dose is very difficult because their pain tolerance is so low. With just a slight bump down in dose often results in pain that is worse than what it was prior to taking narcotics. So what was aimed to more effectively treat chronic pain worsened it, and many patients suffered and continue to suffer dearly as a result. So now in an attempt to reverse the past damage long term narcotic prescribing has created and prevent future damage, narcotic prescribing is being heavily regulated and monitored, and the goal is for them to be replaced by less potential harmful treatments such as PT, chiropractic, acupuncture, massage, etc., as well as the use of non narcotic nerve agent meds such as Gabapentin, and for many patients medicinal MJ has proved to be an equally effective and thus far safer alternative to narcotics. Counseling and therapies such as biofeedback are also being utilized to help chronic pain patients better cope with living a life that will involve a certain level of pain because 100% freedom from chronic pain will likely not be possible.
I hope from what I shared you gained some understanding that safely treating chronic pain has proven to be no easy task. And the new prescribing regulations are being put in place for patient safety and not as a means of punishment.
... And the new prescribing regulations are being put in place for patient safety and not as a means of punishment.
Tell that to my husband, a severely injured Army veteran who has been on pain pills for years. With pain pills, he has a little bit of a life. Without them, he vegetates in a chair in severe pain. He has been the model patient taking the pills as prescribed and without incident. But now the VA is cutting back on prescribing pain pills for everyone. Hubby has just been cut back again, and I have to watch him disintegrating before my eyes. He went through all of the BS of TENS units, chiropractors, etc, but none of it helped long-term. Maybe those things would work for those with little pain, but they are useless for most with severe chronic pain.
Thanks to the druggies of this world as well as those who have never lived with chronic pain but think they know what's best for everybody else, many good people who really need these pills will no longer have any quality of life. Good medicine should not be "one size fits all." Pain pills are not a perfect solution, but for some they are the only reasonable solution. It's disgraceful what is happening to good people.
True statements on their face, but doctors do not practice medicine in a vacuum. By necessity, they have to think about more than their patients' interests, more than figuring things out. They have to think about the law, about their medical licenses, and about potential crimimal prosecution. You can't blame them for that - it's just the reality of the present-day situation.
So it's Big Brother government you should be mad at, not doctors. The law's priority is protecting the lowest of the low (addicts and abusers) not the legitimate patients (you and me). And even in defense of Big Brother government, if you read my earlier post in this thread, there have been horrendous abuses on the part of some doctors themselves whom I consider to be among the lowest of the low despite their medical degrees.
I most certainly can.
The AMA is backing these new draconian laws even though they know innocent, legitimate patients are going to suffer because of them.
Case in point.....the new laws popping up requiring patients to see their doctor every 5 or 7 days to refill pain meds.
Even though the doctor knows the patient has a legitimate need for a 10 or 14 day course of pain medication, that patient still has to show up in their office every 5 days.
Let's see.....instead of getting paid for ONE office call, they get paid for THREE......CHA-CHING for the doctor......too bad for the patient and what it costs THEM both financially and physically.
The AMA is a powerful organization and could easily advocate for patients and they have chosen NOT TO.
If someone is truly in unbearable, acute pain, narcotics are a great option. Still, they're way too prevalent. This isn't an issue contained to just retirees - one of our local radio programs did a special on local disabled veterans being denied access to narcotics.
I live in an area ravaged by opoids and other pain medications. I've lost at least half a dozen fairly close friends to opoid overdoses, and nearly 10% of my high school class (2004) is dead because of suspected or confirmed drug overdoses.
What ends up happening is most addicts usually did start out with some legitimate need for the narcotics, then it takes over their lives. A friend of mine had a rough pregnancy in her early 20s, got started on narcotics after the delivery to ease the pain, and after many years of addiction, ultimately died from an overdose. My mother fell back in 2007, breaking bones in both feet simultaneously, and had a very difficult time coming off the opoids after the injury. Being in an area with a higher than average rate of manufacturing and mining jobs (physical work), a lot of laborers get broken down at a relatively early age, getting on narcotics, SSI, and "the draw."
Most people on high, consistent narcotic doses are unemployed and unemployable. The narcotics become the focus of their lives, and many formerly decent people commit crimes to either find drugs or money with which to buy them. In some respects, the medical industry is partly to blame, but ultimately it come down to the end user to police their own usage.
No one is trying to "deny granny pain medication," but in some areas, the problem is so bad that being overly restrictive is probably the better policy. If there is a true need for narcotics, they need to be prescribed judiciously, usage monitored closely by the provider, pharmacies, and the patient, and ideally for a short duration.
There are two types of opioid pain users:
1. responsible
2. irresponsible
Your dead friends, I'm sorry to say, were likely in the latter class. Of the two examples you gave, both should have used them for the situation at hand and then immediately stopped. If they developed a dependency, which can easily happen, there are practical ways to wean off them if the person just asks for help. Your friend who got pregnant. She should have used when she needed them, then immediately gone to her OB/GYN, explained her problem and the doc would get her into a short-term program to get her off of them.
The reason seniors in chronic intractable pain through unpreventable conditions that come from old age are in this jam is because young people looking for a cheap thrill by getting high on their parents' meds or through a script they were given for an injury continued to use them way past their useful purpose. In short, they loved the high and said, "Wow, I want more of this." Consequently they OD'ed and died. This is not rocket science. It's plain common-sense stuff that anyone with half a brain could figure out. I'm not the brightest bulb in the room but even I can figure out that the government rules should start by dividing people into 3 groups: young, middle age, and old. And the types of pain into 1. acute and 2. chronic. With these two criteria alone combined with MRI's and doctor's reports the rules could keep older chronic pain sufferers with no history of abuse on the medications they need. At the first incident a person breaks the rules by 1. running out of meds before the refill date or 2. getting caught selling a script, they would be cut off from the meds forever and made to suffer the pain. Young people shouldn't be given the pain meds except for a single fill of 15 pills or less and no refills under any circumstances.
Simple common-sense approach that the government never even thought to consider. If the government wants to hire me as policy-maker for their drug policy they're welcome to hire me. But I don't come cheap: $250,000/a year. And all the Oxycodone I want for my sore muscle .
Last edited by thrillobyte; 05-05-2017 at 08:15 PM..
The Dr. had to rely on x-ray even though MRI would have been preferable. The problem was there were too many inpatients scheduled to have an MRI and the only way I could be fit into the schedule would have been to be admitted as an inpatient as well and stay overnight, something I wasn't willing to agree to. Otherwise I couldn't get an MRI until three days later on walk-in. So the doc decided to do an x-ray because it was the only thing available on a moment's notice.
So now in an attempt to reverse the past damage long term narcotic prescribing has created and prevent future damage, narcotic prescribing is being heavily regulated and monitored, and the goal is for them to be replaced by less potential harmful treatments such as PT, chiropractic, acupuncture, massage, etc., as well as the use of non narcotic nerve agent meds such as Gabapentin, and for many patients medicinal MJ has proved to be an equally effective and thus far safer alternative to narcotics. Counseling and therapies such as biofeedback are also being utilized to help chronic pain patients better cope with living a life that will involve a certain level of pain because 100% freedom from chronic pain will likely not be possible.
I hope from what I shared you gained some understanding that safely treating chronic pain has proven to be no easy task. And the new prescribing regulations are being put in place for patient safety and not as a means of punishment.
It'd great to make some alternative therapies available, i.e., accepted by insurers, since at least some people will be helped by them.
But people with genuine, serious pain -- for whom pain medication was invented in the first place -- shouldn't have to jump hurdles, but should always be able to ask for and receive adequate medication from their doctor as long as they are advised of the potential consequences. Fighting "the prescription painkiller problem" is a fine idea, but not on the backs of the people who need them the most.
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