3 ms·

I dont know the details of her situation, but I think chronic pain management goes something like this: * patient such as your friend has excruciating pain, re

I dont know the details of her situation, but I think chronic pain management goes something like this: * patient such as your friend has excruciating pain, requiring the heaviest of the narcotics (say oxycodone/oxymorphone, instead of a "mere" hydrocodone that you'd get for wisdom teeth or something ). * these narcotics are so incredibly dangerous that they must be taken exactly as prescribed for the following reasons. 1) Patients have a temptation to take an extra one (or snort one) to achieve a euphoric and addicting "high" that can be irresistible once its experienced. 2) In some cases taking even one or two extra pills can kill the patient. 3) Patients have incentive to Not take them because some pills can fetch up to $40 EACH on the black market. 4) not taking them exactly as planned can cause a tolerance buildup or reduction, which can stymie the physician's efforts to find the safest minimal and effective dose for continuous pain management. * To combat all 4 of these factors, pain management specialists enter into "contracts" with their patients that they will treat their pain, if and only if, they agree to take the pills EXACTLY according to plan. To affirm compliance to this plan, the patients are subjected to random drug testing. Not just to see if they are getting high (over using them ), but also to see if they are using them at all, (i.e. not selling the pills for a massive profit ). IIRC, if you show up to your test and they find no painkillers in your urine, you can be taken OFF the plan, i.e. no pills for you. tl;dr they drug test patients to make sure a precise plan is being followed because there are at least 4 separate "failure modes" to chronic pain management. I learned most of this from news articles and reading junkie's tales on /r/opiates. I'm not an expert, nor user, but I just find the whole topic very interesting. Please correct me if I've said anything wrong.

merpnderp 11y ago
The person I was referring to was so traumatized by the experience she went to a surgeon two days later and begged for the surgery, even though she was strongly advised to give the pain pills and anti-inflammatories time to work. The surgeon scheduled her 12 hours later and she's been better than new for several years now....Luckily. People have agency. And should be allowed to make their choices. Especially in cases where not allowing them to make their own choice starts hurting innocent people. And by hurting, I mean that very very literally in this case. The type of pain that causes people to end their lives. Caused by a system more afraid of a bad decision than of leaving people alternating between howling and sobbing in pain for days.
- digler999 11y ago
  > People have agency. And should be allowed to make their choices. That also includes physicians. Their asses are on the line for every patient they treat. If one of their patients OD's, a full death investigation will be done, possibly including DEA, possibly including the medical board. If any perceived misconduct is found on behalf of the doctor, s/he could be sued, censured, fired, or perhaps even jailed. When you study for 12-15 years to get a single job, the emotional pain from losing it all isn't far from the physical pain of what your friend went through. Not to mention that doctors have empathy, and would also feel guilt and remorse if their actions killed a patient. Even though it was a painful, humiliating ordeal for your friend, that's better than cavalierly throwing opiates at her which could have possibly killed her. > People have agency. And should be allowed to make their choices. I am not trying to sound like an asshole here, but with pain pill addiction, you don't have agency. that's precisely what addiction is ! You lose agency, willpower, and even develop narcissistic defenses (in some cases) to provide a psychological pathway to defend the addiction. You become a slave. This is exactly why they are regulated!
  - merpnderp 11y ago
    "That also includes physicians." That is exactly my point. Doctors shouldn't have to make patients jump through hoops in order to prescribe medicine. Maybe I should have stated it clearer, the remedy I want is for doctors to be able to prescribe as they see fit without the DEA raiding their office and throwing them in jail. As for over prescribing, that should be no more dangerous than any other medicine. If my doctor gives me 800mg ibuprofen and I take 10 of them in the morning, he isn't responsible. As it should be for pain killers. As for addiction sucking, I also already agreed it is a problem, but when I weigh it against innocent people, who didn't make a conscious decision to do something wrong, I find it the lesser of evils to let people make that very bad choice. Do I really need to say I don't have a problem with doctors monitoring patients for addiction? But extreme measures are being taken, not out of an over abundance of caution for patients but because the DEA is throwing doctors in jail.
    - digler999 11y ago
vidarh 11y ago
... and a good chunk of these people end up on heroin instead when they get taken off these plans, because it's far cheaper to buy heroin on the black market than oxycodone when their doctor throws their toys out the pram. To the point where this is one of the main avenues pushing people to use heroin in developed countries today. It's a fucked up way of dealing with people we suspect have a health problem to take an action we know makes the problem substantially worse for a large proportion of them. The irony is that medical grade heroin in predictable doses is one of the safer alternatives, and far cheaper again. But of course these people do not get medical grade heroin - they get street heroin cut with anything from cheaper drugs to brick dust.

merpnderp 11y ago

The person I was referring to was so traumatized by the experience she went to a surgeon two days later and begged for the surgery, even though she was strongly advised to give the pain pills and anti-inflammatories time to work. The surgeon scheduled her 12 hours later and she's been better than new for several years now....Luckily. People have agency. And should be allowed to make their choices. Especially in cases where not allowing them to make their own choice starts hurting innocent people. And by hurting, I mean that very very literally in this case. The type of pain that causes people to end their lives. Caused by a system more afraid of a bad decision than of leaving people alternating between howling and sobbing in pain for days.

digler999 11y ago
> People have agency. And should be allowed to make their choices. That also includes physicians. Their asses are on the line for every patient they treat. If one of their patients OD's, a full death investigation will be done, possibly including DEA, possibly including the medical board. If any perceived misconduct is found on behalf of the doctor, s/he could be sued, censured, fired, or perhaps even jailed. When you study for 12-15 years to get a single job, the emotional pain from losing it all isn't far from the physical pain of what your friend went through. Not to mention that doctors have empathy, and would also feel guilt and remorse if their actions killed a patient. Even though it was a painful, humiliating ordeal for your friend, that's better than cavalierly throwing opiates at her which could have possibly killed her. > People have agency. And should be allowed to make their choices. I am not trying to sound like an asshole here, but with pain pill addiction, you don't have agency. that's precisely what addiction is ! You lose agency, willpower, and even develop narcissistic defenses (in some cases) to provide a psychological pathway to defend the addiction. You become a slave. This is exactly why they are regulated!
- merpnderp 11y ago
  "That also includes physicians." That is exactly my point. Doctors shouldn't have to make patients jump through hoops in order to prescribe medicine. Maybe I should have stated it clearer, the remedy I want is for doctors to be able to prescribe as they see fit without the DEA raiding their office and throwing them in jail. As for over prescribing, that should be no more dangerous than any other medicine. If my doctor gives me 800mg ibuprofen and I take 10 of them in the morning, he isn't responsible. As it should be for pain killers. As for addiction sucking, I also already agreed it is a problem, but when I weigh it against innocent people, who didn't make a conscious decision to do something wrong, I find it the lesser of evils to let people make that very bad choice. Do I really need to say I don't have a problem with doctors monitoring patients for addiction? But extreme measures are being taken, not out of an over abundance of caution for patients but because the DEA is throwing doctors in jail.
  - digler999 11y ago

vidarh 11y ago

... and a good chunk of these people end up on heroin instead when they get taken off these plans, because it's far cheaper to buy heroin on the black market than oxycodone when their doctor throws their toys out the pram. To the point where this is one of the main avenues pushing people to use heroin in developed countries today. It's a fucked up way of dealing with people we suspect have a health problem to take an action we know makes the problem substantially worse for a large proportion of them. The irony is that medical grade heroin in predictable doses is one of the safer alternatives, and far cheaper again. But of course these people do not get medical grade heroin - they get street heroin cut with anything from cheaper drugs to brick dust.