The pain management predicament

[LSN80]

About three months ago, there was a doctor in Pittsburgh who was over-prescribing pain medication to about 25% of his patients-all on Medicare and Welfare- medications such as Vicodin and Percocet. The silent agreement he had with said patients was that he would then buy the excess pills back from his patients at a vastly reduced price from what they would go for on the street. In his mind, this solved two problems:

1. A drug addict, it would fulfill his need for the medications he otherwise could not get, as he had no visible injuries on him, nor any pain related disorders. He was simply an addict.

2. It helped the financial situation of those patients, as all of them were poor and living-Welfare or Disability-check to check. Speculation was that the unnamed doctor, whose name I actually tried to get for this story, actually saw himself as being altruistic.

I emphasized the word medication in the story three times here, and for a very specific purpose. Used properly, these medications can have tremendous benefit for people who suffer from pain related disorders or injuries. Medications such as Vicodin, Percocet, Morphine, Dilaudid, Fentanyl and Opana can bring great relief and often in combination with physical therapy can help increase the quality of a suffering patient's life, studies show. Unfortunately, similar studies show that about 40% of patients in Pennsylvania(my state)either:

A. Abuse their medication because they're not getting the relief they desire, rather then discussing it with their physician.

B. Sell their medication, as some of the patients in this very article have done.

Further, I would bet my next's week of meals that at least50% of us here on Wrestlezone have friends or family with drug and alcohol problems. Because of what we've seen and the other problems I've noted above, it places a stigma on the pain management community as a whole. Tougher laws have lead to crack-downs on how much and what pain management doctors will prescribe, understandably protecting their license's.

I can imagine that's what the doctors who turned away all of the offending doctor's patients had in mind when they turned them away. One young woman had four doctors turn her away.

Said Holly Pedder, 31, who had seen the doctor since she had been 18:

"They would not see me. They didn't want to go to jail. I said, 'I don't understand.' They said, 'I can't see you.' Soon as I mentioned he had been my previous doctor, they refused to see me. I didn't do nothing wrong, but they said it's the doctor's right to turn away anyone he wants to for any reason. I didn't do nothing to give any of them a reason."

48 year old Ruth Brown went to see her PCP(Primary-Care-Physician)on a temporary basis after the doctor's arrest:

At least five other doctors or their staffs, I lost track after a while to be honest, turned me away before my PCP agreed to prescribe for me on a 3 month basis. And he cut my pain medication in half. He didn't trust that I wasn't getting too much and selling it neither.

One doctor, Anthony Graham, actually agreed to see some of the patients of the former doctor, not wanting to see them suffer for another man's "sins".
At the same time, said Thomas:

We've taken between ten and fifteen, yes, to be honest. Unfortunately, I have to look with a very, very jaded eye. Most of the patients were on large doses of short-acting medications such as Vicodin or Percocet. I changed their medication to a combination of a few of those(Vicodin, Percocet), to two-a-day long acting pain medicines, such as Morphine, Dilaudid, or Opana.

Arguments rage in the pain-management community among patients as to both the efficacy and difference in abuse potential of long-acting medications as compared to those that are short-acting. Since the long-acting medications are stronger, some argue that the addiction potential of them is higher. Graham disagrees:

"Not if they are taken as prescribed. They are less harmful, with a lower potential for abuse. Simply put, amongst physicians, that's the standard of care recommended across the board."

Pain medication is a slippery slope. Dont get me wrong, many go to Palliative Care doctors(pain management docs) for legitimate treatment. However, recent studies have shown that to be around 60%. That's a terrible number, because it shows that 40% are going to them for reasons that aren't on the up-and-up. That could be to abuse for pain-related issues,to use to get high, or to make a profit off of(As in selling). Despite this, pain medication and the doctor's who prescribe them can be a wonderful thing and an excellent benefit to any community-should they be used properly.

Unfortunately, as is the case in this example, they are often used for the wrong reasons, giving these medications and the people who prescribe them a bad name. I found it intriguing that Methadone clinics in the Pittsburgh and surrounding areas showed an 11% (temporary) spike in clientele after the good doctor of this example was put out of business.

If I were to tell you(only an example) that I was on Morphine and Vicodin, would your knee-jerk(automatic opinion of me change any before you found out why?

If you were a pain management doctor, would you take a chance on one of the patients of the doctor in this story? Why, or why not?

A 2011 study showed that around 70% of prisoners in County(not counting State or Federal) prison in the USA are there because of a drug-related offense. That is, they were on drugs while in the commission of the crime, or were buying and selling drugs. If you were a pain-management physician, would this alarming number cause you to place restrictions on who you would treat? What would they be?

As always, I'm missing much with these questions. Your input on which is a highly-debated topic is greatly appreciated and I'm looking forward to it. I'll save my opinion until we get a few responses.

 

[Slash-LN]

Just to start. At a job I was at a few years ago a couple of us were talking about our addiction issues. One of the people had been in rehab together and the other person had a long running addiction history and had been off and on different types of drugs for a large portion of her life.

According to them at one of the free clinics here you could walk into the place and meet with the doctor and walk out with a prescription for pretty much anything you wanted. I have no idea if that's true and I've never heard anyone else say that.


If I were to tell you(only an example) that I was on Morphine and Vicodin, would your knee-jerk(automatic opinion of me change any before you found out why?

Having gone through addiction myself and having addict friends and a heroin addicted brother I probably wouldn't change my opinion. I'm probably in the minority in that. And if someone were to have a knee jerk reaction and change of opinion I wouldn't blame them or think they were a bad person for it.

If you were a pain management doctor, would you take a chance on one of the patients of the doctor in this story? Why, or why not?

I probably would. As the doctor said it's not right to deny people based on what a previous doctor did. I do think there would be some hesitation though because you don't know if someone is lying and using that doctor as a cover story to hide their addiction.


A 2011 study showed that around 70% of prisoners in County(not counting State or Federal) prison in the USA are there because of a drug-related offense. That is, they were on drugs while in the commission of the crime, or were buying and selling drugs. If you were a pain-management physician, would this alarming number cause you to place restrictions on who you would treat? What would they be?

I don't think so but it's really hard to know what I'd do in the position. Also being ignorant to a lot of that stuff I'd probably need more information besides 70% are in for drugs. I can only assume that not all of those are for pain pills.

 

[Mustang Sally]

If you were a pain management doctor, would you take a chance on one of the patients of the doctor in this story?

Y'know, one of the toughest things I've spent my life trying to reconcile is how much people lie.

They lie at first, lie in the middle, lie at the end.......and for an encore, they lie some more.

They lie to their families and significant others. They lie to their teachers, the police, the judge, their bosses........they lie when it benefits them.....and they lie even when the truth sounds better.

Consider all that and ask what a doctor should do when dealing with people in the matter of prescribing drugs. If the doctor hesitates in treating them because they might be giving him a line of garbage as to what happened in their dealings with the crooked doctor mentioned in this topic, they'll say: "Why would I lie?" My answer to that might be: "Why would you tell the truth?".....even understanding that many of them are telling the truth and were just unlucky in drawing a crooked doctor.

They want what they want when they want it. Hopefully, most of the people who seek pain medication want it for legitimate purposes and use it accordingly. But as you point out, many want it for bad purposes; they might be in pain, but are over-using it on purpose because they like the way they feel when under it's influence. Others want an ample supply so they can sell some or all of it.....yes, they're not hurting their bodies with the stuff but they're still not doing things the way they're supposed to be done.

As for the doctors, I suspect the vast majority prescribe pain medication in the proper manner. A bad apple like the doctor you mentioned spoils it for everyone else; now, it becomes fashionable to suspect every doctor because we don't know who the few are that do the wrong thing. That's tough, but can't be avoided.

There's no sure solution, but since you're asking, the only thing I can think of is for doctors to prescribe supplies of this powerful stuff only for short duration. Don't give them an economy-sized 6 month supply, for gosh sakes.....but if you do, monitor whether they're coming back too soon for more (or waiting too long if they're selling their pills to someone else). Someone in the medical office has to be watching.

Make the patients submit to blood tests every 6 months to measure what's in their system. You can argue that they "clean out" their systems in the days before the blood test.....and that would be true, but if some of them are so addicted they can't stay off it long enough to clean up, the doctor will nail them that way.

As with so many medical decisions, the judgment of the doctor is the crucial point. If the occasional bad doctor gets caught and banished, I would think it's up to another doctor to take over the patients the bad one left behind. Most of them are in legitimate pain, aren't they? I say, take them on and pay special attention to what they're seeking, given their former association with the bad physician.

Every case is separate; there are no blanket solutions for everyone when it comes to pain management. But if we're going to prosecute doctors whose patients are blatantly lying about what they're doing, I would ask the authorities to be cognizant of this fact when going after the doctor. I imagine it's easy for them to tell the doctor: "You should have known better" but the authorities should be aware that it's hard as hell to put in practice.

 

[Dagger Dias]

If I were to tell you(only an example) that I was on Morphine and Vicodin, would your knee-jerk(automatic opinion of me change any before you found out why?

No, it would not. I'd allow you, or whoever the individual is who stated they are on Morphine/Vicodin, to explain any reasons for why before something like that would change my opinion of them. The better I know the person, the tougher it would be for something like that to make me change my opinion of them though. If my first impression of someone is that I'm walking into Wal-Mart from the parking lot and some random rude runs up to me and says "hey, I'm on Morphine and Vicodin!" then yeah I'm going to think he's weird and something may be wrong with him; compared to someone I've known for years and think highly of, I'm much more inclined in the latter scenario to think there must be a logical reason for why they would need to use Morphine/Vicodin. If said reason ends up being one I disagree with, then that's different. That might change my opinion of the person in question. Them being on Morphine or Vicodin in the first place really won't unless it's an extremely random first impression such as my Wal-Mart parking lot example. Most in their right mind wouldn't run up to a stranger stating that in the first place.

If you were a pain management doctor, would you take a chance on one of the patients of the doctor in this story? Why, or why not?

Depends on their history, I guess. Everyone deserves a second chance but if the patient has proven to abuse pain management then I would be skeptical. I am not a doctor so I am unfamiliar with the protocol, but if it were up to me I'd find out what history of pain management abuse may be there, and if there are too many proven cases of it, then that's the only time I might consider not taking a chance on the patients. Keep in mind though, I track shipments for a living, I'm not in the medical industry so I'm not an expert in this area. Just me offering thoughts based on the article LSN shared.

A 2011 study showed that around 70% of prisoners in County(not counting State or Federal) prison in the USA are there because of a drug-related offense. That is, they were on drugs while in the commission of the crime, or were buying and selling drugs. If you were a pain-management physician, would this alarming number cause you to place restrictions on who you would treat? What would they be?

It might. This deals with the skepticism I addressed in my answer to the previous question. The more suspicious the patient's history may be based on information given to me if I was a doctor offering pain management, the more skeptical I would be of risking treatment options to the individual. Maybe try to have some type of strike policy. Give a chance to those who may have slipped up before but want to prove that they are not coming to me for the wrong reasons. If they have a proven track record of abusing the pain management far too much, too bad you will be declined. Again, take this with a grain of salt as I am no doctor and openly admit to not having much expertise in this subject matter.

 

[SSJPhenom]

Situations like this have totally ruined things for pain patients, such as myself, who actually need the medications and use them as prescribed.

When I was 18 years of age I was involved in a very bad car accident in which I broke my back(5th vertebrae to be exact). The injury required surgery to be corrected, however, my insurance at the time wouldn't cover the operation. So I had to let the injury heal on it's own the best way it could. Long story short it didn't heal correctly and now I have chronic back pain. Situations like the subject of this thread lead to the DEA to pass new laws on the issuance of these pain medications. On October 6th of this year, hydrocodone(the active ingredient in medications such as vicodin, lortab, and norco) was rescheduled to 2 on the Controlled Substance Act. This limits the amount of medications that pharmacies can pass out. While thats theoretically a good idea to limit the abuse and illegal sales of hydrocodone, it makes things difficult for pain patients such as myself. It took me 3 weeks to refill my monthly prescription because the local pharmacies had reached their quota for the month on what they could distribute. I'm not an addict. I don't abuse my medication, I only take it as prescribed, however, I've been taking it for so long that I am dependent upon it. There was absolutely nothing my Dr. could do to help me except to try and prescribe me another type of pain medication temporarily until I could fill my regular prescription.

So while they are lowering the amount of pain pills that the pharmacies can distribute, they're not lowering the amount of pain pills being prescribed and thats the problem. People being prescribed these medications when they probably don't need them. Thats what the DEA should focus on.