Blood, Meds, and Tears

Putting the numbers in perspective (or trying to, anyway)…5.6 deaths per 100,000 in 2012 are due to opiate painkillers, down from 6 per 100,000 in 2011, according to the very people who are screaming about the 2011 stats (from the same Medscape article I just cited above) – and this, mind you, is a study of only 28 states.

I think someone is going to an awful lot of trouble to cherry-pick their information.  I am getting a headache just tracking all this stuff down.  You decide for yourself if these numbers warrant the kind of fearmongering going on now.

But back to PA…in order to get a script for pain meds, you usually (at least around here) have to get a referral from your primary care doctor for a pain clinic.  Oh, sure, you might get a small Percocet script one time from your doctor if you come in with a painful injury, but the kind of thing these folks are talking about are high doses over a fairly long period of time.

Anyway, you go get an evaluation at the pain clinic, they look at your records and usually send you off for some tests of their own, and give you a drug test.  IF that all works out, then you go monthly to see a doctor and get your prescription.  EVERY month.

They won’t call prescriptions in, and if you refuse a drug test, do not bring your meds in for a pill count, or come up short on your pill count without a damn good reason, too bad – no meds for you.  Miss 2 pill counts or test positive for illegal drugs, you’re out.  Not only are you out, it will state the reasons for it in your medical record, making it virtually impossible for you to get any more opiates from anyone, as you will then (forever more) be known as a drug seeker.

You have to sign a contract to this effect or they won’t treat you.  And it seems to work because I haven’t seen anyone at the pain clinic I attend exhibit drug-seeking behavior.  But addicts are still getting painkillers.

If not from their doctor, and not from the pain clinic, then from whom?

And who helps them make the transition from pain pills to heroin?  Doctors?  Pain clinics?  How do people know where to go to get heroin?  From legitimate pain patients?  Um, that would be a big, fat NO.

Contrary to what people cavalierly say – “It’s easy to find heroin” – it’s really not, not for the average person.  Most people do not hang out with criminals.  Most people do not approach strangers and ask them to sell them drugs.  And most people are not criminals themselves, thankfully.

Oh and in case someone reading this is reminded of the tv shows about Florida “painpill mills”, and the news stories about a certain national chain pharmacy whose parking lots were routinely found to contain dealers who hassled people on their way out of the store in order to buy their pain meds (I witnessed that myself in Memphis, where I used to live), I still contend that is NOT “most people”.

There are no drug dealers/addicts hanging around the entrance of the pain clinics or pharmacies here, and I don’t think PA is atypical in that respect.

Ok so let’s think about it – these procedures are in place in 2014.  The death stats are from 2011 and 2012 (where we see a DECREASE).  So I would extrapolate from that info that the somewhat ridiculous (to me, anyway) measures taken by the PA medical community are working, if ever so slightly.

But it’s not a huge change and the reason is, I suspect, that meds are being diverted at some other level besides the patient and/or doctor.

On this issue, the internet is deafeningly silent.  I’ll let people draw their own conclusions here as to whom I think might be putting the drugs out on the streets.  Until that’s looked into, I don’t know that it’s going to slow down anytime soon.

But if I had to pick the number one major reason for prescription drug deaths, it would be the big-time dealers who are getting wholesale opiates from somewhere.  It’s easier to pick on the people farther down the supply chain, however.

Dr. Franklin, though, sees it differently.  He is convinced that opiates are not effective for long-term pain, but cites no reasons for that except that people continue to take them for many years.  But if the pain is chronic, and there is no way to correct it (for degenerative disc disease, as an example – oh unless someone wants to send me the $40,000+ for an artificial disc implant to replace my flat ones), then what is a patient to do?  Just suffer?

Dr. Franklin doesn’t address this.  His solution is to not only make it more difficult for people to get opiates (by making what PA does the national standard), he wants to tell doctors how long they can prescrbe them and at what doses.  I think that doctors should determine what’s the right dose and for how long – without fear of losing their licenses – not legislators.

Ok, so back to that 55% of people getting drugs from friends or family (cited in the 2010 report, above).  In my last job, I heard every lame excuse for why a client tested hot: the doctor got them addicted with the very first prescription (ok, so the fact that you took 60 pills in 2 weeks has nothing to do with it?); they were in such pain they had to buy street drugs to deal with it (because their doctor cut them off for taking 60 pills in 2 weeks); or their friend/family member encouraged them to take the pills.

I don’t know if any of you have chronic pain, but if you do, you know that NO WAY will someone just give their pills to another person, because they know they will be in a world of hurt when they come up short at the end of the month (not counting the withdrawal).

So, that 55%?   I think they stole the pills from their friends or families.  Why doesn’t the study just say that?  Ok, what addict do you know is going to admit he/she got the drugs by stealing them?

And why is this distinction so important?  Because it puts the problem squarely back on the shoulders of one set of people who are making pain management a nightmare for the rest of us – the addicts.

I will go a step further.  I blame doctors also.  I mean the doctors who are so hell-bent on getting legislation passed to restrict opiates, because they show they have a misunderstanding of the difference between addiction and dependence, and also that they think there is no way to identify drug addicts or people who divert meds.

Hey, we can’t tell so let’s just assume everyone is drug-seeking!

But the fact is, you CAN tell, and if you are running a practice where no one can do this, hire me – I’ll i.d. the addicts for you.  I can do that all day long and it won’t cost you nearly the amount of money it would to defend wrongful death lawsuits, if that’s a big concern for you.

It’s not a mystical mind-reading thing, there are actual signs you can observe, and “not having enough time to assess the patient” is a very bad excuse for laziness and an unwillingness to take responsibility for decisions regarding prescribing opiates to addicts.

Legislate the problem and let’s just not think about it anymore, it’s too hard. Bullshit.

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2 thoughts on “Blood, Meds, and Tears

  1. AndyDrew Heyman

    Our afflictions and journey to pain relief are so similar it is scary. I also have degenerative disc disease for which I was on prescription opiates and getting the runaround from Medical practitioners regarding dispensing of meds, therapy, etc. My adventures with post-chemo pain, suffering and medication could be used for an entire entry of your blog here. Life for the truly suffering among us is a nightmare and pain inducer all of its own. I look forward to further misadventures with, up and against big Pharma.

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  2. Victoria Post author

    It’s a nightmare, indeed. I’m sorry you have had to have these experiences – I don’t know why a lot of places don’t have patient advocates (like they do in Minnesota). It’s really hard to deal with this mess when you don’t feel well, and that’s sometimes hard for other people to understand. When they get too cold-hearted about it (such as our fine Dr No-Opiates), I can’t help but think, “You’re going to really regret being this way whenever you become disabled.” Because, let’s face it, all of us – if we live long enough – will eventually get some kind of disability (at least deafness from all those Grateful Dead concerts!).

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