7 ms·

Have you ever sought a particular prescription from a doctor? Many general practitioners in the United States are glorified drug dealers. You will probably get

by rtl49 11y ago

Have you ever sought a particular prescription from a doctor? Many general practitioners in the United States are glorified drug dealers. You will probably get whatever you ask for if you can afford the copay.

bunnymancer 11y ago
Disturbingly easy to get class II drugs without any proof of need.
- tertius 11y ago
  Most of what a Doctor uses to make a choice on "proof" of need is oral testimony from a patient.
- rtl49 11y ago
  I have no direct experience seeking a prescription, but I do know a doctor who has repeatedly complained to me about patients coming to him with the expectation of receiving a particular drug. He's considered giving up his DEA license to reduce this problem.
  - FireBeyond 11y ago
    One I see in the field as a paramedic? "Any drug allergies?" "Aspirin, Tylenol, Tramadol, etc" "Oh, so you're allergic to 'all' non-narcotic pain medication? That must be ... inconvenient."
    - MichaelGG 11y ago
      How do you respond to such a thing? If a patient is allergic to aspirin, concerned about liver toxicity from APAP, doesn't want stomach issues from NSAIDs, etc.? Do they just have to suffer or do you "give in" and provide them desired relief?
      - FireBeyond 11y ago
        There's certainly a cynicism present in some providers - we're definitely not a perfect bunch, and some areas will have more explicit policy on the use of narcotic pain relief. For me: I look at physiological symptoms. You tell me you're in 10/10 pain (the "worst of your life"/"worst you could imagine") and you're in no visible distress with normal vital signs, then I'll factor that into the decision. That being said, I believe it is unethical, immoral to withhold something that could benefit a patient who is in genuine distress, regardless of anything else. For those patients, we have options, too. Fentanyl, for one, is used a lot pre-hospital as it is both an effective analgesic with a short lifetime in the body. There used to be (probably still is) doctors in the ED who don't want a patient to come in with pain meds onboard because they want to see a "baseline presentation". Again, I think this falls into the realm of poor provider care. We have diagnostic tools for objective analysis, and having a patient in pain just so we can measure it is inhumane. Bottom line: if a patient requires pain medication, they will get it from me, subject to analysis of circumstances. In your example above, if it's not "drug seeking" but concerns about side effects, then the patient and I can have a discussion about benefits versus risks (the flip side to that being if a patient has a broken femur, for example, that conversation is likely to be limited to 'give me the damn drug!").
      - GoodOldNe 11y ago
        "Do they just have to suffer or do you "give in" and provide them desired relief?" No. There are plenty of other options for treating their pain without using opioids -- first I would educate them about the relative risks and benefits of, say, acetaminophen/APAP. I could use something like intravenous lidocaine or low-dose ketamine, or if it's a traumatic type of pain some kind of regional anesthesia. If it's more neuropathic, you can use tricyclics or drugs that work on GABA pathways. Beyond all that, I try to talk to people about the harms associated with opiates/oids such as hyperalgesia that develops in many long-term users, which is a really significant and underappreciated harm alongside things like addiction and potential respiratory depression.
    - rtl49 11y ago
      I was taken in an ambulance to the hospital once for a dislocated limb. I never understood why the paramedics seemed to find new satisfaction in life when I rejected the narcotic painkiller. Must have come as a pleasant surprise.
      - agarden 11y ago
        I was hospitalized for a bit a few years back. Several nurses commented passionately on what a relief it was to take care of someone who actually needed help, instead of the many people they have who come in complaining of pain just so they can get their morphine fix.
  - GFK_of_xmaspast 11y ago
    Then maybe you should hold off on statements like "Have you ever sought a particular prescription from a doctor? Many general practitioners in the United States are glorified drug dealers. You will probably get whatever you ask for if you can afford the copay." until you have direct personal experience with this.
- MichaelGG 11y ago
  This is a good thing in one way. People should be free to buy chemicals at will. The disturbing part is that it's a forced tax paid to doctors to get RX's written each month. Even worse, this further kills equality. A worker desiring to boost performance can easily afford top-notch medicines -- speed's only $20 a month for a starting dose at a pharmacy. But the prescription alone can be 10x that, and sometimes may be required every month. Not to mention the cost of a higher-end doctor that will assist customers. Poorer patients are thus denied medicine, creating a negative feedback loop.
  - zzzeek 11y ago
    > People should be free to buy chemicals at will. this would introduce a myriad of acute public health issues and do great harm to the public good, costing taxpayers billions of dollars for remediation. Edit: the DHHS's report on prescription medication abuse is good reading in this area: http://www.cdc.gov/drugoverdose/pdf/hhs_prescription_drug_abuse_report_09.2013.pdf http://www.cdc.gov/drugoverdose/pdf/hhs_prescription_drug_ab...
    - rtl49 11y ago
      I don't claim this myself, but I believe his or her argument is that the freedom to choose should take precedence over the cost to taxpayers, regardless of the cost.
    - Igglyboo 11y ago
      I really don't think it would, alcohol is pretty heavily used in the USA and it's a pretty dangerous substance. There are definitely more dangerous drugs than alcohol but legalization of all drugs isn't going to destroy society.
      - enraged_camel 11y ago
        Are you not aware that 88,000 people die from alcohol-related causes every year in the US and that alcohol is the third leading preventable cause of death? http://www.niaaa.nih.gov/alcohol-health/overview-alcohol-consumption/alcohol-facts-and-statistics http://www.niaaa.nih.gov/alcohol-health/overview-alcohol-con...
- bcoates 11y ago
  Good? They're at least getting informed consent and an opportunity to be diverted towards harm reduction. Ideally if a patient stubbornly demanded a particular drug they'd be warned in graphic detail of why that was a bad idea, asked to sign a "Prescription AMA" form, and that'd be the end of it. If nothing else it would keep them in the system and out of the grasp of hucksters and literal druglords. The guys in the park selling opiates at unspecified dosage and purity are available 24/7 and don't even ask questions.

by rtl49 11y ago

bunnymancer 11y ago

Disturbingly easy to get class II drugs without any proof of need.

tertius 11y ago
Most of what a Doctor uses to make a choice on "proof" of need is oral testimony from a patient.
rtl49 11y ago
I have no direct experience seeking a prescription, but I do know a doctor who has repeatedly complained to me about patients coming to him with the expectation of receiving a particular drug. He's considered giving up his DEA license to reduce this problem.
- FireBeyond 11y ago
  One I see in the field as a paramedic? "Any drug allergies?" "Aspirin, Tylenol, Tramadol, etc" "Oh, so you're allergic to 'all' non-narcotic pain medication? That must be ... inconvenient."
  - MichaelGG 11y ago
    How do you respond to such a thing? If a patient is allergic to aspirin, concerned about liver toxicity from APAP, doesn't want stomach issues from NSAIDs, etc.? Do they just have to suffer or do you "give in" and provide them desired relief?
    - FireBeyond 11y ago
      There's certainly a cynicism present in some providers - we're definitely not a perfect bunch, and some areas will have more explicit policy on the use of narcotic pain relief. For me: I look at physiological symptoms. You tell me you're in 10/10 pain (the "worst of your life"/"worst you could imagine") and you're in no visible distress with normal vital signs, then I'll factor that into the decision. That being said, I believe it is unethical, immoral to withhold something that could benefit a patient who is in genuine distress, regardless of anything else. For those patients, we have options, too. Fentanyl, for one, is used a lot pre-hospital as it is both an effective analgesic with a short lifetime in the body. There used to be (probably still is) doctors in the ED who don't want a patient to come in with pain meds onboard because they want to see a "baseline presentation". Again, I think this falls into the realm of poor provider care. We have diagnostic tools for objective analysis, and having a patient in pain just so we can measure it is inhumane. Bottom line: if a patient requires pain medication, they will get it from me, subject to analysis of circumstances. In your example above, if it's not "drug seeking" but concerns about side effects, then the patient and I can have a discussion about benefits versus risks (the flip side to that being if a patient has a broken femur, for example, that conversation is likely to be limited to 'give me the damn drug!").
    - GoodOldNe 11y ago
      "Do they just have to suffer or do you "give in" and provide them desired relief?" No. There are plenty of other options for treating their pain without using opioids -- first I would educate them about the relative risks and benefits of, say, acetaminophen/APAP. I could use something like intravenous lidocaine or low-dose ketamine, or if it's a traumatic type of pain some kind of regional anesthesia. If it's more neuropathic, you can use tricyclics or drugs that work on GABA pathways. Beyond all that, I try to talk to people about the harms associated with opiates/oids such as hyperalgesia that develops in many long-term users, which is a really significant and underappreciated harm alongside things like addiction and potential respiratory depression.
  - rtl49 11y ago
    I was taken in an ambulance to the hospital once for a dislocated limb. I never understood why the paramedics seemed to find new satisfaction in life when I rejected the narcotic painkiller. Must have come as a pleasant surprise.
    - agarden 11y ago
      I was hospitalized for a bit a few years back. Several nurses commented passionately on what a relief it was to take care of someone who actually needed help, instead of the many people they have who come in complaining of pain just so they can get their morphine fix.
- GFK_of_xmaspast 11y ago
  Then maybe you should hold off on statements like "Have you ever sought a particular prescription from a doctor? Many general practitioners in the United States are glorified drug dealers. You will probably get whatever you ask for if you can afford the copay." until you have direct personal experience with this.
MichaelGG 11y ago
This is a good thing in one way. People should be free to buy chemicals at will. The disturbing part is that it's a forced tax paid to doctors to get RX's written each month. Even worse, this further kills equality. A worker desiring to boost performance can easily afford top-notch medicines -- speed's only $20 a month for a starting dose at a pharmacy. But the prescription alone can be 10x that, and sometimes may be required every month. Not to mention the cost of a higher-end doctor that will assist customers. Poorer patients are thus denied medicine, creating a negative feedback loop.
- zzzeek 11y ago
  > People should be free to buy chemicals at will. this would introduce a myriad of acute public health issues and do great harm to the public good, costing taxpayers billions of dollars for remediation. Edit: the DHHS's report on prescription medication abuse is good reading in this area: http://www.cdc.gov/drugoverdose/pdf/hhs_prescription_drug_abuse_report_09.2013.pdf http://www.cdc.gov/drugoverdose/pdf/hhs_prescription_drug_ab...
  - rtl49 11y ago
    I don't claim this myself, but I believe his or her argument is that the freedom to choose should take precedence over the cost to taxpayers, regardless of the cost.
  - Igglyboo 11y ago
    I really don't think it would, alcohol is pretty heavily used in the USA and it's a pretty dangerous substance. There are definitely more dangerous drugs than alcohol but legalization of all drugs isn't going to destroy society.
    - enraged_camel 11y ago
      Are you not aware that 88,000 people die from alcohol-related causes every year in the US and that alcohol is the third leading preventable cause of death? http://www.niaaa.nih.gov/alcohol-health/overview-alcohol-consumption/alcohol-facts-and-statistics http://www.niaaa.nih.gov/alcohol-health/overview-alcohol-con...
bcoates 11y ago
Good? They're at least getting informed consent and an opportunity to be diverted towards harm reduction. Ideally if a patient stubbornly demanded a particular drug they'd be warned in graphic detail of why that was a bad idea, asked to sign a "Prescription AMA" form, and that'd be the end of it. If nothing else it would keep them in the system and out of the grasp of hucksters and literal druglords. The guys in the park selling opiates at unspecified dosage and purity are available 24/7 and don't even ask questions.