What would happen if we decriminalized drug use and made opioids available to everyone who wanted them? Would more people end up addicted? Is the law the only thing preventing universal addiction?
" I had a neighbor who was a surgeon and she actually told me, “If a patient doesn’t ask for pain relief, he or she doesn’t need it so I don’t prescribe it and if a patient does ask for pain relief, he or she is a drug seeker and I don’t prescribe it.”
Wow, that seems a bit broad way of handling that !
What about moms in labor who have know that they aren’t going to handle the pain without something ?
My daughter is graduating in May and will be a NP. She has told me about some of the patients she has had to deal with in the hospital setting that are drug seeking . She says she has witnessed Drs caving because they know that they won’t cure the addiction and drug addicts are very disruptive and make a lot of threats as NrdsB4 stated
No. If it follows the trend of legalization of pot, more will use but with fewer problems associated with it. If you have followed some if the problems with Spice (synthetic cannabinoids) and Molly (MDMA and its many counterfeits), there is more danger in the uncontrolled nature of the drug trade than the drugs themselves.
I am super paranoid about appearing to be drug seeking. In fact, I am rather stoic. For years, I’ve seen a pain specialist for my back and I don’t think he has ever offered me narcotics. I don’t know that I have ever ASKED but do know I have cried in his office in pain. I’m more likely to hit leftovers from prior surgeries, which I’ve told him. I tend to think the fact that I have leftovers probably means I am not drug seeking.
I do get injections and they help tremendously.
I got the idea from my SIL who is a PA that there was a “list” of people they cross reference?
Post 119–Hope I never run into that surgeon. What that shows is poor education (and extreme arrogance) of the medical profession on controlling pain.
It’s not just a problem of education though. There simply aren’t the studies needed about addiction and research into possible solutions. Alternative solutions to pain (like acupuncture, possible herbal remedies etc) have not been studied (no money in it) and are not covered by medicare or insurance if someone did want to pursue that alternative.
It can be a nightmare for someone who does want to get off narcotics even if you use them legally for chronic pain.
You’ll need:
- Alternative pain relief of some kind. Tough to find. No studies. No money.
- Options? Acupuncture? Not covered. Alternative medicine is not covered. Herbal remedies are not covered. Yoga?
There aren’t the studies to support it. Not covered. Can’t even do your own research and depend on anything you find.
Companies do not put research money into things they are not going to profit from directly. - Does medical marijuana work for you? Live in the right state. And it is just another alternative medicine. And illegal in every state according to federal law.
Personal rant (I apologize) —the best research available is by the drug culture that has been perfecting it for years rather than scientists who should’ve been up on this with at least 40 years research. - Withdrawal? Not pleasant. Nobody hands out those meds either. Another rant-- Weird system–you can’t get drugs and then nobody lets you get off them.
Tried to cut down on your own? Or asked doc about it?
First admit you are an addict with all that implies. Sign right here so we can take care of you. Not happening.
While I agree with this for the most part, many large pharmaceuticals out there have teams working on neglected diseases… those found mostly in third world countries. They may not be pursuing them with the timing and resources of other money-making drugs (or drugs that have higher populations of sick patients), but this is a real thing. Yep… drug companies actually can be philanthropic!
@Consolation I think I know the young man you referred to. What a horrible, unnecessary loss. My son – who knew this man (or another with the same story) very well – just had knee surgery. We were all worried, but my S assures me that he needed the pain meds at the time and is now off them managing residual pain with Tylenol.
What an arrogant jerk. Imo, the specialty that contains the most you know whats in medicine is surgery. I’ve also known some absolutely wonderful human beings who are surgeons. 
But even some of the worst I’ve known have well understood the necessity of pain medicine after having one’s body cut open and anatomy changed. Hopefully that surgeon experiences karma someday when she wakes up in pain after having surgery performed by a doc with the identical philosophy.
That seems incredibly unethical and cruel.
Note to self: ask surgeons their policy on pain meds prior to any future surgeries.
Re: #114, #117
Is the instruction given to physicians and nurses on how to distinguish between addiction-based drug-seeking and non-addiction pain relief needs formalized and consistent, or is it more of informally being told by other physicians and nurses and using their own anecdotal experiences?
I learned a lot of what I know about pain and pain behaviors in nursing school. They either aren’t teaching it, students aren’t learning it, or nurses, being people, bring their biases with them into the work place.
I have an extremely small, biased sample size but the nurses (BSN) who were in my MPH program universally said that they received very little to no instruction on how to sort out addicts from people in pain.
For whatever reason my cohort had quite a few nurses who wanted to work in addiction and ER interventions so the topic came up quite a bit.
ucb- The databases have made it much harder to use the old prevalent method of filling every 30 days but having more than one doctor and pharmacy. Like other industries, they trade in shared knowledge. Pain management seminars tend to cover the topic. Similar to the providers, though, the addicts trade info on what to say and where to go for the best result.
Important - guard your DEA number because the forgeries are pretty common. States are tracking prescribers who are loose with the prescription pads. The first thing to check with the patient is the prescription history. Second, check the medical history for a consistent story. Third, gauge the reaction when you suggest a non-narcotic. There can be other “tells” in the interaction. Only once was my wife fooled for more than a few months.
Romani - I’m sure that surgeon was not 100% serious about never prescribing narcotics. Like the guy who recorded his doctor during his colonoscopy, a jaded view of patients is a common trait of the many burnt-out healthcare workers.
Oops, what I was referring to in my post was that in nursing school, I learned to understand the signs of pain and how patients with chronic pain will not necessarily exhibit those symptoms. But this is where a lot of nurses go wrong. They see a patient who has normal vital signs, isn’t rolling around and groaning in agony, who can manage to smile and engage with loved ones, etc., and decide they are faking it. When the fact of the matter is that people with chronic pain syndromes have often learned to compensate. The catecholamine response may very well be absent. Nurses who either refuse to recognize this or never learned it begin with are the ones interpreting this lack of overt signs of pain as addiction. We didn’t necessarily learn to diagnose an addict vs. someone in legitimate pain, because that’s really not officially in our scope.
Well, sure, but that interaction showed an appalling lack of compassion for patients in pain. I’ve seen it countless times.
Even if not “100% serious” it still shows an alarming dismissal of his patients and an extremely cold attitude.
I tend to take people at their word even if they’re exaggerating.
(X-posted with nrdsb4)
He’s paraphrasing Catch-22 and trying to be funny would be my guess. Having been around lots of nurses and doctors the past 25 years, you learn to ignore how they talk dispassionately about their patients. The sick sense of humor does not translate well to the general population.
Surgeons, anesthesiologists, ER staff, and pain specialists are all front-row witnesses to the effectiveness of opiates.
I’m the one who posted about the surgeon; I guarantee she never read Catch-22; she had zero sense of humor. She had an extremely jaded view of humanity. She no longer practices surgery; she has retired. She was always a sculptor first and a doctor second. But she was dead serious about the pain meds.
Thanks for clarifying, wellspring.
Thanks @Wellspring . Just a terrible doctor to her patients - unfortunately I know some of those, too, but like to think they are not all that common.
Btw, acupuncture is covered by some insurers, under various circumstances. You need to check your own plan.