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Addict or pseudoaddict, the solution is the same. Give them a supervised dose as necessary and provide support and encouragement for them to stop if they wish.
by mnm1 7y ago
Addict or pseudoaddict, the solution is the same. Give them a supervised dose as necessary and provide support and encouragement for them to stop if they wish. Anything else and the patient will turn to the black market. It's that simple. You want to stop people dying, provide them with opiates so they don't get fentanyl laced garbage from some street dealer. Anything else is, frankly, just torturing the patient, often in the name of morality when this is not at all a moral issue. One day people will realize this. Until then, addicts will die by the thousands. Some places have already realized this (Portugal, Switzerland, Vancouver BC, and even the US before the war on drugs started early last century).
- peteretep 7y ago> Addict or pseudoaddict, the solution is the same. Give them [it] Exactly. If someone shows up at your clinic wanting drugs that you think they're addicted to -- especially ones that are cheap generic -- are you really preventing harm by not giving it to them?
- projektfu 7y agoUnfortunately we carry a second responsibility to help the DEA control drugs, and the scope of our liability is ill-defined. We need to make medically justifiable choices at each point to retain the privilege of legally prescribing or dispensing controlled substances. I will err on the side of not dispensing opioids to someone I don’t know or a case I’m not familiar with.
- peteretep 7y agoSure, I appreciate the hands of actual doctors are tied
- kunday 7y agoGlad to hear from an actual doctor. Is it common practice to get previous medical history and notes if you are seeing someone for the first time who has been under someone else's care? Or are there strange laws preventing you from getting the continuity information from the other doc? In Australia once we give consent, the other clinic/hospital would release notes electronically. Sometimes it's also a quick check with state PBS registration to get confirmation on dosage already being prescribed. PS: based on my personal experience in Australia, not for opioids but for other controlled substances like amphetamines or ritalin.
- projektfu 7y agoI'm a veterinarian by the way. Yes, you can get medical records. They're not as easy to get in an emergency situation, which is how drug-seeking (and I assume pseudoaddiction) presents itself. Sometimes the bizarre extremeness of the situation makes you skeptical enough. For example, "The dog needs the meds for a trip tomorrow from Georgia to a remote part of the Pacific Northwest and it will be in excruciating pain and anxiety if you don't prescribe three months worth right now," and it's 6pm on a Friday evening.
- kunday 7y agoGotcha, that’s super shady. My friend who used to be pharmacist said, he can guess fraudulent prescriptions, because they were always the one just before the pharmacy was about to shut doors and has a prescription that will lead him to empty the full pill box behind the counter.
- kunday 7y agoI agree with you on principle. In real terms but a PCP who sees you regularly is more likely to take steps towards tapering dosage. If you see someone for the first time and you ask for a particular medication that's scheduled, unless they call the previous PCP to get old diagnosis and dosage etc to make sure things are in order. PS: I'm not in the states, but in Australia, where things are quite different. Edit: fix grammar and typo
- kunday 7y agoYup! I am still lost with the approach to treating opioid addiction. For example, benzodiazepine class drugs have a very defined dosage reduction schedule and it's never discontinued right away just because of drug seeking behavior. Same with anti-depressants(the Wellbutrin kind) where dependance Is very real and expected.