Tuesday, 22 November 2016

Where's The Common Sense With Opioids And Chronic Pain?

Today's post from kevinmd.com (see link below) kind of reflects the world we live in, now that the media and politicians have whipped up hysteria about opioid pain killers to the point where they're more of a national threat than an ISIS attack. Now don't get me wrong, nobody is denying that there is a problem with opioid medication but it's more a social problem than a health problem. There are abusers of most medications and there are also criminals who will exploit supply and demand leading to unnecessary addiction but the vast majority of patients who are prescribed opiates are people who genuinely need them and live in mortal fear of abusing either the system or their bodies. It's simple; opioids should never be prescribed unless the doctor is prepared to follow through with close checks as to how the patient is doing and if necessary, adjust the dosage so that problems are avoided. They are safe and effective if handled in the right way - it's that easy. However, as is shown in this article written by a doctor, the system itself is putting people in a position where they are regarded as suspects and are denied the medication to help their chronic pain, with unnecessary suffering as a result. Well worth a read.

There is something wrong with a system that punishes legitimate patients in pain 
Judy Salz, MD | Physician | November 12, 2016

Overwhelmed by the insanity of the bureaucratic bungle surrounding the dispensing of narcotic pain medication, I’m not sure where to begin. So I will begin with my experience.

I am a licensed physician in the state of Nevada. I retired from full-time practice in California and moved to Las Vegas, where I work part time. I have a friend who recently underwent a nephrectomy. She was discharged with a prescription phoned in for oxycodone, which was filled at her local pharmacy.

I accompanied her to an urgent care facility today because of a cough. She took her last oxycodone this morning. I asked the doctor seeing her to write her a prescription for more. She wrote a prescription, but informed me that most of the pharmacies in the city are out of narcotic medication. I called my friend’s pharmacy and was told that they could not disclose over the phone whether or not they had any in stock. We would have to come to find out.

By now the morning’s pain medication had worn off, and my friend was in pain. Nevertheless, we drove to the pharmacy and were told that indeed they had no narcotic medication in stock. I asked her to call other pharmacies in her chain to find out which store had any. She told me that even the pharmacists were not permitted to tell each other about availability. We were told to come back in a few days and ask again.

Really? Patients in legitimate post-op pain need to wait until they can return another day to ask again if it is in stock? And what if it isn’t? Go home, be in pain and wait some more? What bureaucrat dreamed up this scenario? Certainly no one with family members in need of pain control.

There had to be some way my friend could get medication. I called the pharmacy at the hospital where she had her surgery. The hospital pharmacist explained to me that he was not permitted to dispense medication from an outpatient prescription and that no hospital in the city could.

I called my pharmacist and was told that not only could he not tell me if it was in stock, but the prescription could be filled only at the original pharmacy. My friend would have to sign a contract with my pharmacy and never go back to hers again.

Bound and determined that my friend would not return home without pain control, I asked the pharmacist what other options there were. He then suggested that a prescription for tramadol could be phoned in and filled. I called the urgent care where she had been seen and asked that the physician who had seen her phone in a prescription, which she was kind enough to do. And my friend went home with tramadol. I hope it holds her pain.

Had I not been with her, my friend would have just been turned away with a shrug.

There is something seriously wrong with a system that punishes legitimate patients because of others who are abusers.

Yes, there are drug abusers who rob pharmacies for their narcotics. Yes, there is legitimate fear from those who dispense these medications. Yes, there needs to be a way to control the abuse, but not at the expense of the patients who really need it.

This is cold, cruel and unbefitting of the medical community. It demonstrates the willingness of those creating these rules to turn a deaf ear to the needs of the ill. Perhaps when it comes home to roost for them and their families, they will see the error of the ways. I would prefer it come sooner.

Judy Salz is an internal medicine physician.


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