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My wife had to have a full spinal fusion. You probably don’t even have the mental tools necessary to start thinking about that kind of pain. The sort of pain th

My wife had to have a full spinal fusion. You probably don’t even have the mental tools necessary to start thinking about that kind of pain. The sort of pain that causes people to consider suicide as a preferable alternative. Because of the intense back pain leading up to the surgery she was already taking high opiate doses. After the surgery she was taking doses of hydromorphone (5x as strong as morphine) that would kill you or me with a single dose. I would appreciate it if the HN peanut gallery would take a moment to stop and consider others before spouting off. Take this opportunity to do some research into the humiliating procedures the war on drugs has visited upon patients and doctors, then ask yourself if we really need more of the same. For example: did you know my wife had to hobble into the pain management office and pee in a cup on several occasions? Just to make sure she was taking the drugs (the torso-length scar on her back being insufficient). The fact that someone selling the pills could have simply taken some the morning of the test made the farce even more absurd.

alkonaut 9y ago
I think this example would be one of the cases where the most potent opioids would be prescribed in any country. I'm not advocating never prescribing them - only to do it in exceptional cases.
- spraak 9y ago
  Then that differs from what you'd said of "terminally ill"
  - alkonaut 9y ago
    Right - that wasn't the correct formulation. The formulation used is of course "exceptional cases", and terminal cancer is just one such example. I edited that my post above (sorry if your reply looks odd after the edit)
cperciva 9y ago
For example: did you know my wife had to hobble into the pain management office and pee in a cup on several occasions? Just to make sure she was taking the drugs (the torso-length scar on her back being insufficient). The scar really isn't sufficient. There have been many cases of relatives (usually spouses, but sometimes children or parents) stealing pain medication which was prescribed for post-operative pain, and then coercing their victim into not reporting the theft. As horrible as it is, the drug testing was there to protect your wife.
- groby_b 9y ago
  "many case" [citation needed]
  - deleted 9y ago
    [deleted]
  - astura 9y ago
    Seriously? The industry term for this is "drug diversion," and it happens pretty frequently and is very under reported. The patient may not even be aware it's happening because a health care employee, real estate agent, teenager child, nanny, guest, etc may be stealing the medicine. It even happens in a hospital setting, with deadly results - https://www.medscape.com/viewarticle/825801 https://www.medscape.com/viewarticle/825801 That's why if you have drugs someone may want to steal it's recommend you keep them locked up. Not even dying in hospice care stops family: https://www.washingtonpost.com/national/health-science/dying-at-home-in-pain-doesnt-keep-relatives-from-stealing-the-pills/2017/08/18/d262b9ba-8105-11e7-902a-2a9f2d808496_story.html https://www.washingtonpost.com/national/health-science/dying...
- sgift 9y ago
  People here get their pain medication in quantities which have to suffice for a specific time, so if they need new medication before that time has run out this leads to questions and checks. No painful hobbling, no peeing, simple math.
JackFr 9y ago
> You probably don’t even have the mental tools necessary to start thinking about that kind of pain. As I don't know your story, you don't know mine. Get off your high horse before you lecture the peanut gallery. With great sympathy to your wife, to those who've had lives taken and families destroyed by an addiction which started with a doctors over prescription, maybe hobbling to pee in a cup doesn't sound so bad.
lovich 9y ago
I think one of the problems is that the medical and legal community seem to be incapable of doing anything but extremes. About 5 years ago I went to the doctors for headaches and was given a subscription for 90 pills every month of fioricet and expected to only take it when I needed it and not more than 3 a day. About a year and a half ago after I got a new doctor who was appalled, asked me if I would consider going down to 30, and was surprised when I told him I had no problem with that because it was unneeded and I was already only refilling it 1-2 times a year anyway. Now in the past year I hurt my shoulder pretty badly, to the point where I was having difficulty using it due to the pain and was dropping light weights. I was told physical therapy and aspirin and if it still hurt too much to use I could try more aspirin. We seem to swing wildly between giving out a ridiculous amount of drugs(90 a month no questions asked) to giving out none, even when people are in pain. Why can doctors not prescribe something like 3 pills a month to someone? Its not nearly enough to get addicted on, but can help someone experiencing severe but temporary pain. Is it something in our legal framework that only allows doctors to prescribe a months worth at a time with the assumption that its taken every day? Is it some pressure from insurance companies who don't want to deal with paying out small claims like for 3 pills?
- cperciva 9y ago
  There's two issues here. The first is that "as needed" is really hard for pharmacies and insurance companies to handle; the only way they can avoid arguments (and potential lawsuits) is to dispense the maximum allowed. So even if your doctor expects that you're only going to need an 1 pill/day on average, if he writes "as needed up to 3 polls/day", you're going to be given 90/month. The second issue is deliberate overprescription. Most insurance companies have rules on the amount of medication which can be dispensed -- 100 days is a common limit, but some limits are as low as 30 days. The justification for this is that they don't want you to end up with lots of unneeded medication if your needs change; but usually the real reason is that they don't want to end up covering costs which can be offloaded to your next insurance company if you change insurers. In response, some doctors will deliberately inflate prescriptions -- e.g., if your doctor thinks you need one pill/day and trusts you not to abuse the medication, he might write a prescription for 3 pills/day so that your insurance company will approve an amount which will last you for longer.

alkonaut 9y ago

I think this example would be one of the cases where the most potent opioids would be prescribed in any country. I'm not advocating never prescribing them - only to do it in exceptional cases.

spraak 9y ago
Then that differs from what you'd said of "terminally ill"
- alkonaut 9y ago
  Right - that wasn't the correct formulation. The formulation used is of course "exceptional cases", and terminal cancer is just one such example. I edited that my post above (sorry if your reply looks odd after the edit)

cperciva 9y ago

For example: did you know my wife had to hobble into the pain management office and pee in a cup on several occasions? Just to make sure she was taking the drugs (the torso-length scar on her back being insufficient). The scar really isn't sufficient. There have been many cases of relatives (usually spouses, but sometimes children or parents) stealing pain medication which was prescribed for post-operative pain, and then coercing their victim into not reporting the theft. As horrible as it is, the drug testing was there to protect your wife.

groby_b 9y ago
"many case" [citation needed]
- deleted 9y ago
  [deleted]
- astura 9y ago
  Seriously? The industry term for this is "drug diversion," and it happens pretty frequently and is very under reported. The patient may not even be aware it's happening because a health care employee, real estate agent, teenager child, nanny, guest, etc may be stealing the medicine. It even happens in a hospital setting, with deadly results - https://www.medscape.com/viewarticle/825801 https://www.medscape.com/viewarticle/825801 That's why if you have drugs someone may want to steal it's recommend you keep them locked up. Not even dying in hospice care stops family: https://www.washingtonpost.com/national/health-science/dying-at-home-in-pain-doesnt-keep-relatives-from-stealing-the-pills/2017/08/18/d262b9ba-8105-11e7-902a-2a9f2d808496_story.html https://www.washingtonpost.com/national/health-science/dying...
sgift 9y ago
People here get their pain medication in quantities which have to suffice for a specific time, so if they need new medication before that time has run out this leads to questions and checks. No painful hobbling, no peeing, simple math.

JackFr 9y ago

> You probably don’t even have the mental tools necessary to start thinking about that kind of pain. As I don't know your story, you don't know mine. Get off your high horse before you lecture the peanut gallery. With great sympathy to your wife, to those who've had lives taken and families destroyed by an addiction which started with a doctors over prescription, maybe hobbling to pee in a cup doesn't sound so bad.

lovich 9y ago

I think one of the problems is that the medical and legal community seem to be incapable of doing anything but extremes. About 5 years ago I went to the doctors for headaches and was given a subscription for 90 pills every month of fioricet and expected to only take it when I needed it and not more than 3 a day. About a year and a half ago after I got a new doctor who was appalled, asked me if I would consider going down to 30, and was surprised when I told him I had no problem with that because it was unneeded and I was already only refilling it 1-2 times a year anyway. Now in the past year I hurt my shoulder pretty badly, to the point where I was having difficulty using it due to the pain and was dropping light weights. I was told physical therapy and aspirin and if it still hurt too much to use I could try more aspirin. We seem to swing wildly between giving out a ridiculous amount of drugs(90 a month no questions asked) to giving out none, even when people are in pain. Why can doctors not prescribe something like 3 pills a month to someone? Its not nearly enough to get addicted on, but can help someone experiencing severe but temporary pain. Is it something in our legal framework that only allows doctors to prescribe a months worth at a time with the assumption that its taken every day? Is it some pressure from insurance companies who don't want to deal with paying out small claims like for 3 pills?

cperciva 9y ago
There's two issues here. The first is that "as needed" is really hard for pharmacies and insurance companies to handle; the only way they can avoid arguments (and potential lawsuits) is to dispense the maximum allowed. So even if your doctor expects that you're only going to need an 1 pill/day on average, if he writes "as needed up to 3 polls/day", you're going to be given 90/month. The second issue is deliberate overprescription. Most insurance companies have rules on the amount of medication which can be dispensed -- 100 days is a common limit, but some limits are as low as 30 days. The justification for this is that they don't want you to end up with lots of unneeded medication if your needs change; but usually the real reason is that they don't want to end up covering costs which can be offloaded to your next insurance company if you change insurers. In response, some doctors will deliberately inflate prescriptions -- e.g., if your doctor thinks you need one pill/day and trusts you not to abuse the medication, he might write a prescription for 3 pills/day so that your insurance company will approve an amount which will last you for longer.