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It's troubling the way this article presents the issue. Treating chronic pain is an enormously complex problem that clinicians have to deal with, especially as
by jrapdx3 11y ago
It's troubling the way this article presents the issue. Treating chronic pain is an enormously complex problem that clinicians have to deal with, especially as it gets bound up with collateral pitfalls of drug dependence, politics of health care delivery systems and conflicting pressures from patients, government regulators and others.
While unethical prescribers (not all are physicians) contribute significantly to rising misuse of opioids, the vast majority of practitioners want to do what's best for patients. As the article notes, there are few options for managing chronic pain, leaving opioids the only realistic choice in many instances.
None of the providers I know think opioids are preferable, but more like a necessary evil. They prescribe opioids sparingly, reluctantly, diligently. Patients have told me it's become increasingly difficult to get prescriptions for quite modest doses of opioid agents they've used for years without dose escalation. The tendency to throw babies out with the bathwater is not unique to this situation, but no less problematic.
Blaming pharmaceutical companies doesn't seem a constructive approach. Probably there's a lot of R&D going on in this domain without much success, meaning it's a very hard problem to solve. I'm certain that a major breakthrough would be eagerly marketed, highly likely the profit margins would be huge. Meanwhile, we're left with the status quo, and manufacturers are meeting market demands. Isn't that how our economy works? Pharma sales are already more highly regulated than nearly all other industries, what more should be done?
Few legal drugs are as controlled in the US as schedule II opioids. If there were no such controls it's likely that the number of overdose-related deaths would be higher than it is. No one knows what solution will work, the need to be being careful about changing "rules" should be obvious.
The article's advocacy of "medical marijuana" as an alternative is IMO inappropriate. Simply enough, research on the uses of cannabis components for pain treatment is in very early stages. Specific indications and side-effect risks are inadequately understood. Recommending use of these components as treatments for pain is premature.
- jacobwcarlson 11y ago> Patients have told me it's become increasingly difficult to get prescriptions for quite modest doses of opioid agents they've used for years without dose escalation. The tendency to throw babies out with the bathwater is not unique to this situation, but no less problematic. I have experienced this as well. Not only are doctors now reluctant to prescribe opioids, but you as a patient are suspected to be a drug-seeking addict by everyone in the chain: doctors, nurses, and pharmacists. People complaining that it's too easy to get pills clearly haven't had to manage a chronic pain condition in the past couple of years.
- LanceH 11y agoI dropped a glass bottle of something restricted. Dr prescribed another one for me, but the insurance company told the pharmacy, "no" and the pharmacy wouldn't dispense after that. Even with me paying the full price. I'm still a little steamed to think about it. They received both prescriptions from my doctor and made made a medical decision to withhold based upon the word of the insurance company which should not have been a party to the second purchase. I couldn't get the prescription back either, since it was sent directly to the pharmacy. I have always had a chuckle thinking about what would happen if the government called the medical marijuana supporters claims out and legalized it. I think it would become a pill with none of the high and turn into something quite boring.
- jrapdx3 11y ago> ... Dr prescribed another one for me, but the insurance company told the pharmacy, "no" and the pharmacy wouldn't dispense after that. ... This sort of thing happens all the time where medical decisions are "second guessed" by insurers. It may be in the form of payment restriction, or requiring "pre-authorization", just another way to make it difficult to get treatment that costs more than the absolute minimum. I believe such maneuvers are counterproductive, that is, it will wind up costing more if patients don't get what they need to improve their conditions. Not quite sure why the pharmacy wouldn't fill the Rx for cash. Maybe afraid of regulatory criticism for the "double fill". Of course there are instances where people are frequently "losing" medication supplies and requesting replacement prescriptions. Then we might rightly suspect medication misuse, but if such requests for extra prescriptions are rare, as in your case, it's wrong not to honor it.