does this make any sense to you?

[exnavynuke]

Gotta love how our "war on drugs" has become more of a problem for law abiding people than criminals...

I'm thankful I get my gabapentin through the VA and the feds haven't reclassified it (yet). Many vets are getting abruptly taken off all pain medication without warning, despite having chronic pain conditions, all due to bureaucracy trumping a doctor's ability to care for their patients.

 

[MRG]

Great discussion. I really appreciate it.

My last PCP'S office had a "all controlled substances are treated alike policy". Didn't matter if it was grandma's cough syrup or Oxy. You came in and picked up a 30 day prescription, but there was no visit or charge. I asked my doc about it, nothing he could do, the risk management folks decided the policy.

Recently DW was given gabapentin(off label) and it's been a miracle. In her case she came off of 2 medications that are way more addictive. We did many 4:00 AM walks as she came off of these, she refused to be treated in patient. The other day she came out wearing makeup for the first time in 10+ years. I asked what the deal was, oh it's the first time I've felt well enough to. I don't care if she does or doesn't wear makeup, it's about the underlying reason.

 

[Bryan Barnfellow]

My wife is one of those patients taking morphine sulfate and Norco permanently. That means we cannot travel extensively in our RV or go to Europe for more than 4 weeks. Medicare is picking up the office visit @ $450 a month.

What the hell

-BB

 

[ChiliPepr]

When you go back every moth they will probably make you pee in a cup...

Be careful you don't end up in a situation like this woman.

After Elizabeth Moreno had back surgery in late 2015, her surgeon prescribed an opioid painkiller and a follow-up drug test that seemed routine — until the lab slapped her with a bill for $17,850.

 

[Meadbh]

True not everything is a money grab, but I'll bet the doctor office will charge for it anyway, so it becomes a money grab.

Are you expecting doctors to see patients for free?

 

[HadEnuff]

When you go back every moth they will probably make you pee in a cup...

Be careful you don't end up in a situation like this woman.

So....let's review.... Back surgery patient has legitimate organic need for opioids, and as a requisite of her care she has to agree to random urine tests. (I agreed to the same thing when my doc gave me an Rx for hydrocodone), and then when submits to the test, she gets nailed with a 17K bill by the lab which just happens to be owned by the same company that owns the surgery clinic...

and why should we not be suspicious of money grabs?

 

[Walt34]

So....let's review.... Back surgery patient has legitimate organic need for opioids, and as a requisite of her care she has to agree to random urine tests.

One nurse told me that the reason they do that is not to check for opiods, but to check for the lack of them to make sure the patient is taking them and not selling them.

But I'm pretty sure they don't charge $17k for the test.

 

[copyright1997reloaded]

Are you expecting doctors to see patients for free?

When they are having patients come for unnecessary reasons, yes. If the doctors weren't reimbursed, I think pretty quickly this stuff would come to an end.

Our medical system is rife with situations like this...and yet we can't understand why medical costs are so high.

 

[Meadbh]

When they are having patients come for unnecessary reasons, yes. If the doctors weren't reimbursed, I think pretty quickly this stuff would come to an end.

Our medical system is rife with situations like this...and yet we can't understand why medical costs are so high.

Unnecessary according to whom?

 

[6miths]

Just to be clear, it isn't the doctor who is making the patient come for the visit. It is either the medical practice management company (in which case it is either a money grab or a risk management strategy) or a regulatory body, either professional or governmental (in which case the MD must comply or lose their ability to practice medicine and make a living). I don't think it is unreasonable for the MD to charge for the visits as they do incur costs.

 

[harley]

I think they should have a day set aside once a month for refill meetups. Stop in, pick up your script, pay the vig, and go home. That way the doctor can spend the rest of the month seeing real patients with real reasons to come in. Then once a quarter or 6 months, the patient can really see the doctor and see if the condition has changed or the medication needs to be adjusted. This would be for the chronic patients only, of course. The ones who are short term prescriptions would continue to be seen as the doctor prefers.

 

[CaptTom]

This is the dark side of the fight against abuse of opioids and other painkillers.

DW was on a low, stable does of an opiod for years, due to chronic pain. It actually worked. She never became addicted, never needed a higher dose. She kept the pills safe and they never fell into the hands of abusers.

The state kept making it harder and harder on the prescribing Dr.

It was absurd. They wanted her to see the Dr every month, and get drug testing done (both not covered by insurance) regularly. The drug test alone would be something like $450. They wouldn't give her a 90-day supply, so the insurance wouldn't pay most of the cost of the pills, either. They wouldn't even give her a 30-day supply. Although the Dr prescribed it, the office just kept knocking the number of pills down. Never did figure out why they did that, but it left her without meds the last few days before the next Rx could be filled.

They finally made it so difficult that she had to give it up cold turkey. She never had any withdrawal symptoms. Just got the pain back.

My heart goes out to those suffering from addiction. But why take it out on DW?

 

[harley]

it's for the good of all mankind! Better 10,000 people suffer than one person get addicted.

 

[copyright1997reloaded]

Unnecessary according to whom?

The patient. We have plenty of medications which require a prescription that shouldn't. The state would rather impact the freedoms of many to prevent the abuse of the few. Doctors are participants in this system (whether willingly or unwillingly).

The requirement for prescriptions is a 20th century phenomenon, and first occurred as a result of the 1914 Harrison Narcotics act and the Federal Pure Food and Drug act of 1904. The fundamental reason for the 1914 anti-drug act was as a revenue raising mechanism that provided for the regulation and taxation of on the manufacturing and distribution of drugs such as opium. The 1937 Marijuana act imposed a tax of $100 per ounce on the sale of Marijuana, and ever since the federal government has increasingly controlled pharmaceuticals.

Don't get me wrong - I don't use any illegal drugs (well, except for my home brew which hasn't been illegal since 1978), and don't even like taking Aspirin or Tylenol...

 

[copyright1997reloaded]

it's for the good of all mankind! Better 10,000 people suffer than one person get addicted.

+1. This is what society has become in so many facets.

 

[Meadbh]

I thought you might be interested to see the 2017 guideline on opioid prescribing from the CMA (Canadian Medical Association). This applies to CMA members everywhere in Canada, though individual Provinces have their own regulations.

https://www.cma.ca/En/Pages/opioids.aspx

The screenshot is a paragraph relevant to this discussion. The tone is a typical Canadian one: compromise.

 

[Meadbh]

Just to give you an idea of the magnitude of the problem: opioids now kill more people than breast cancer. We got into this situation because the drug companies encouraged doctors to prescribe opioids and doctors could see that their patients had better pain control. Meanwhile, they were getting addicted in their thousands and some were selling their prescriptions on the street.

https://www.cnn.com/2017/12/21/health/drug-overdoses-2016-final-numbers/index.html

http://www.cbc.ca/news/health/opioid-deaths-canada-4000-projected-2017-1.4455518

 

[aja8888]

If you watch some of the episodes of Drugs, Inc recorded on the National Geographic Channel, (now found On Demand) you will see that the drug cartels are stepping up heroin supply to meet the needs of the people who can't get opioids anymore, but are still hooked. (thanks, Doc!)

 

[Sunset]

Some doctors are drug pushers, and they give the rest of doctors a bad rep. Just like a street corner drug pusher, some doctors are selling drugs

In 'pill mill,' Pa. doctor prescribes millions of opioids, 5 patients die: feds | PennLive.com

Shouldn't the punishment for him be a lot worse than a fine and loss of license in 1 State (which means he could still get a license for the other States).
How about 20 yrs in the prison, as is done to "regular" drug pushers.

This is not prescribing 5 extra pills to someone, no it is prescribing an average of 900 pills per patient in 1 year!!

 

[Meadbh]

Some doctors are drug pushers, and they give the rest of doctors a bad rep. Just like a street corner drug pusher, some doctors are selling drugs

In 'pill mill,' Pa. doctor prescribes millions of opioids, 5 patients die: feds | PennLive.com

Shouldn't the punishment for him be a lot worse than a fine and loss of license in 1 State (which means he could still get a license for the other States).
How about 20 yrs in the prison, as is done to "regular" drug pushers.

This is not prescribing 5 extra pills to someone, no it is prescribing an average of 900 pills per patient in 1 year!!

I agree!

 

[harley]

Just to give you an idea of the magnitude of the problem: opioids now kill more people than breast cancer. We got into this situation because the drug companies encouraged doctors to prescribe opioids and doctors could see that their patients had better pain control. Meanwhile, they were getting addicted in their thousands and some were selling their prescriptions on the street.

https://www.cnn.com/2017/12/21/health/drug-overdoses-2016-final-numbers/index.html

Opioid deaths in Canada expected to hit 4,000 by end of 2017 - Health - CBC News

It's not prescription opioids that are killing people, it's street drugs (heroin) mixed with fentanyl. Prescription opioid deaths have Overdose Deaths Fall in 14 States been falling, but fentanyl and heroin related deaths have skyrocketed. This is a direct result of the war on drugs and the crackdown on prescription drugs. Shutting down the supply is not a solution to the problem. It just drives addicts into the black market, resulting in more deaths. There's no easy solution, but 40 years of the war on drugs should show that pushing people into an unregulated black market is pretty much the worst possible solution.

 

[Meadbh]

It's not prescription opioids that are killing people, it's street drugs (heroin) mixed with fentanyl. Prescription opioid deaths have Overdose Deaths Fall in 14 States been falling, but fentanyl and heroin related deaths have skyrocketed. This is a direct result of the war on drugs and the crackdown on prescription drugs. Shutting down the supply is not a solution to the problem. It just drives addicts into the black market, resulting in more deaths. There's no easy solution, but 40 years of the war on drugs should show that pushing people into an unregulated black market is pretty much the worst possible solution.

I don’t disagree with you, but it’s important to understand that many of those addicts were “normal” people who became addicts after being prescribed opioids for chronic pain.

 

[harley]

You're definitely right about that. However, I'm willing to bet that making people come in once a month or whatever method is used to try to fight the epidemic will not work to end the addiction crisis. And having addicts die because the black market drugs they are buying are laced with fentanyl while still leaving legitimate pain sufferers in agony is not a good solution. Especially old people who will live the rest of their life in pain due to their condition. Personally, I'd take addiction (with medically supplied legitimate painkillers) over living my last few years in constant pain.

However, I admit I don't know what a good solution would be. I'm not that smart. I just know a bad one when I see it.

Edit: By the way, Meadbh, I don't blame the doctors one bit for all of this. This is obviously a government initiated edict, and I'm sure doctors will do as they always have and try to work within (or mostly within) the rules while doing the best they can for their patients. I like doctors, but I'm not a fan of strict rules and policies. Especially ones that don't accomplish their intent.

 

[MRG]

Aa someone who has lived with severe pain, been treated with opiods, and have had them withheld, I have opinions.

Severe pain is better with opiods, than without. My doc in 2000 was too busy counting the pills to listen to my complaints. I could have been given effective treatments 3 weeks sooner if they'd have listened to me say, "I can't feel my left hand anymore"!

He was worried about me becoming dependent on opiods. I was fantasizing about self amputation of my left forearm and suicide.

Amputation seemed reasonable. Then I realized there's nothing wrong with my arm, I could remove it and still experience the same pain. Suicide seemed to be a good option, if it was just me and no DW?

Finally month's after my accident, I get to pain management and a cervical epidural.
Minutes later, the pain is subsiding. Yes, despite the fact my PCP withheld pills, I was addicted. The pain management doc said reduce your dosage by 25% every 3-4 days. It wasn't terrible to come off, once the pain was managed.

I do believe more education for the public would help. When that doc wasn't treating my pain, I still was. Mixing benzos, muscle relaxers, opiods and alcohol is a sure fire way to die.

 

[travelover]

................He was worried about me becoming dependent on opiods. I was fantasizing about self amputation of my left forearm and suicide.....................

The pendulum swings back and forth. Thirty years ago, I recall my then wife, a nurse, recounting that docs withheld pain killers from cancer patients in their last days on earth for fear they would become addicted.