Re: POTUS 45.22 - The Genius of Donald Trump
Not this. Because no one is saying you can’t prescribe. We’re saying regulations need to be enacted because the entire medical industry has failed on this issue. They have failed to self-police. They have failed to remove narcotics as a first line protocol. They have failed to punish doctors by removing licenses. They have failed training the industry.
The problem is here because we have under-regulated and the industry can’t control itself. The government needs to step in because it’s out of control. We can cover exceptions on a case-by-case basis. Medical marijuana, for example. We're experimenting with it. We’re seeing if there actually is medical benefits. It’s high regulated and we are still managing.
This isn’t a personal attack.
Maybe your State is different but in mine all of the things you are talking about are happening. Part of what I wrote was to explain why this had developed into what it did. I don't mind regulation. I mind when the legislatures/ leaders wants to put in laws or regs without the medical knowledge to know what the f they are talking about or how it might affect people. Example- our dear Gov saying we absolutely couldn't write prescriptions for longer than 3 days without the patient having an appointment. Not taking into consideration that for those with legitimate chronic pain (stuff like cancer or other chronic dx) might mean a 30-50$ co-pay every 3 days plus the $ for the med, arranging transport (because you are considered impaired and can't drive self), transport not only to the appointment but able to wait for the med to be ready because it can't be called in or sent electronically in most places.
I have no problem with limits for Short term problems. There is significant pressure from within Medicine to not prescribe. If you want to regulate anything go after Pharma/Insurance cos. They are responsible for all sorts of propaganda saying the meds are safe, advertised directly to consumers for yrs. And the insurance co who fostered the expectation that pain was something you shouldn't let a patient experience at any level. They give the patient the ability to indirectly penalize the Provider by giving poor reviews for someone who is giving good medical care and doing what everyone knows they should.
Very common example~ I see a patient for back pain. I tell them to take an OTC NSAID, ice, stretch, educate them on the usual course of symptoms and recovery, offer them a follow up appointment if they aren't improving in a week. They are mad I won't give them pain meds. They have seen the ad for [pick your poison]. They want it. I refuse, explain why. They cannot understand why I don't give them something to make the pain go away so they can [fill in the blank- bowl, go on a date, work as a meat packer, ...].
They go to the ER (sometimes straight from the office, other times they wait for the office to close). Them going to the ER results in me being penalized for a patient who is showing up for something I should have 'handled by the PCP'. The implication being I should have waved the magic wand to keep the patient happy because I have done everything I should have.
The pt, now in the ER says they have horrible pain, have done what I said and the pain is unbearable. The ER works them up, comes to the same conclusion I did. They say the same things I did. The patient takes the Satisfaction Survey and is dissatisfied. The ER and the Provider get poor marks. Reimbursement is dependent on how satisfied the patients are. Now the insurance has managed to keep 2 chunks of $ even tho the correct medical protocol has been followed. The hosp calls the Provider on the carpet for not 'treating' the patient and they get a black mark for poor patient satisfaction. (this happens with antibiotics too). Enough write ups and you are gone. Providers are stuck between a rock and a hard place. Practice good medicine in Primary Care and take significant financial hits for doing so. In the ER you can put your job on the line by refusing enough people and having them complain.
This is all starting to get better but it is completely ridiculous that one can get penalized for not giving in to someone who is drug seeking. I used to fight with my boss all the time about this. Refuse to give med enough times and the Hospital rep calls the practice to meet with you and chastise you because the patients are in the ER- you are failing at primary care.
I consider myself lucky- pain pills don't work on me. I'm missing an enzyme or two, at least that's what docs theorized. First noticed issue when I had wisdom teeth out and the codeine didn't help the dry sockets. Years later I tried a Vicodin and then an oxy for some pain- neither worked. No high, just nothing. Kind of wondering what I'll need to try someday if I have real pain issues.
They have blood tests for the genetics of this. Fascinating stuff. You can not clear metabolize the med well so you don't get the benefit but if you get drug tested your levels can be high. If you take other meds/foods in that affect the metabolic pathways you can get toxic really quickly, drug tests will be so high you look like you have been double dipping on very little med.
This times a thousand. It is a straw man to pretend we dont want opiodes prescribed at all, we just think it is ridiculous how they are prescribed for almost everything. I guarantee you I could get a Vic prescription tonight without any real hard work or having to prove any real level of pain. It isnt that hard and Junkies have been doing it for years...
Look, you break your leg or ribs or something perfect ibuprofen wont be nearly enough give them something for the pain. But speaking as someone who has seen it first hand (and whose gf works with addiction every day) I can tell you that if we dont start regulating this better more states are going to be like Ohio (and other Red States) where they have already all but given up trying to stop the epidemic. They dont have enough room at the morgues for the bodies over the weekend and that isnt hyperbole...
Again no one is saying you cant prescribe narcotics for pain but it is time to start auditing what many of the doctors and care providers are labeling as enough pain to warrant these drugs. And it is time for there to be real regulation in how often people are being prescribed these drugs. Again if I have to show a license cause they are clocking OTC meds because a bunch of numbnuts' in Des Moines and Minot are cooking meth in their barns then the same should be done for harder core drugs. And when doctors over prescribe they should be held accountable.
100% correct. Again, this was the push that was happening industry wide fed by insurance telling people they couldn't let people experience pain or lose $ and by Pharma trying to tell anyone who would listen that they weren't addictive- hence the lawsuit against them now. Again- there are many States that are changing how things are done drastically. Most of them are the Blue states. The Live Free or Die/Libertarian States aren't doing as well. My State has a website that you have to sign up for. Any time you write a narcotic you are required to check to see what the patient has had prescribed in the past. Providers have always been audited. There aren't enough auditors to monitor things correctly. No one funds them. Many States are attempting to remedy this by having their registries give reciprocity for other Registries.
I am in no way demeaning the Opiod epidemic. I, too, have taken care of patients who died from ODing, have had their lives and those of their loved ones ruined. I have knelt at the casket of kids who I cared for in utero, through their childhood, who told me when they were younger that drugs and cigarettes were disgusting and stupid. I have watched people cry because they can't get sober, catch STDs prostituting themselves for the money for a fix, have HIV, Hep B, C, get cellulitis, get septic, (the list is long and bad).
We need to go back to educating kids young about what can happen. We need to educate families to be careful with storage. We need to stop telling people that pain is something they should never have. We need to stop letting Pharma advertise and insurances penalize those who set limits. You can regulate until the cows come home but until you change the mindset nothing is going to improve.
