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> Doctors are taught to be hypervigilant regarding "drug seeking behavior" which is pretty much a 1:1 list of behaviors of people whose suffering is "genuine."

> Doctors are taught to be hypervigilant regarding "drug seeking behavior" which is pretty much a 1:1 list of behaviors of people whose suffering is "genuine." Slate Star Codex wrote about this: https://slatestarcodex.com/2019/09/16/against-against-pseudoaddiction/ https://slatestarcodex.com/2019/09/16/against-against-pseudo... Basically, an addict wants to look genuine, so a lot of genuine patients have to put up with stuff designed to cut off addicts. Like the scary "FBI warning" that only shows up if you actually pay for a DVD.

deleted 6y ago
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watertom 6y ago
Flinging yourself from a 5 story building in order to “look genuine” get fentanyl must be pretty common in NYC.
- intricatedetail 6y ago
  Some doctors take pleasure in telling patients in pain that they make it up and suggest they are just drug junkies looking for a hit.
  - brooklyndude 6y ago
    I have worked with with healthcare professionals for decades, have never once met seen an MD or nurse take pleasure in seeing a patient in pain. I’ve interviewed over 10,000 people to date. We live in two different computer simulations I guess.
thaumasiotes 6y ago
> Basically, an addict wants to look genuine, so a lot of genuine patients have to put up with stuff designed to cut off addicts. It's much stupider than that. Addicts want the drug. So all of the indicators of addiction are actually indicators of wanting the drug. So anyone who wants the drug is, ipso facto, an addict. There's no element of addicts trying to look more genuine. Look at that list of red flags: - Complaining of a need for a drug. - Asking for more of a drug. - Asking for a particular drug by name. - Sometimes taking a drug on your own initiative.
- klyrs 6y ago
  Moreover, addicts suffering withdrawal are... suffering. This is the reason I put quotes around "genuine" in my original comment. The distinguishing factor between suffering from withdrawal and suffering from another source of pain is a moralizing judgement call on the doctor's part.
  - srtjstjsj 6y ago
    Would you also say that a painful cleaning of an infection is also a moralizing judgment against a patient who wants to avoid short term pain?
- srtjstjsj 6y ago
  Let's not go too far to one-sided cherry picking. https://intervention911.com/common-signs-of-drug-seeking-behavior/ https://intervention911.com/common-signs-of-drug-seeking-beh... - laiming they need more drugs to replace a lost or stolen prescription - Misrepresenting their symptoms - Frequent visits to multiple doctors, including a willingness to travel to a different city or state to see a new physician – a phenomenon called “doctor shopping” - Unwillingness or inability to provide a complete health history or contact information for previous physicians It's possible for a non-addicted person to do this, but actual statistics matter.
  - curryst 6y ago
    Many of these things are uncommon, but not particularly rare among non-addicts. > Claiming they need more drugs to replace a lost or stolen prescription Have you really never lost a prescription? I've lost portions of mine once or twice (i.e. I had a week left and lost the bottle). Luckily not having mine is more of an annoyance than anything, but I can empathize for someone in pain who lost theirs. Stealing medications is common in addicts as well, and for every addict that steals a prescription, there's someone that legitimately did have their prescription stolen. > Misrepresenting their symptoms If this can be shown objectively, I can't see any way a non-addict would do this. I fear that it sows distrust between the patient and the doctor, though. The doctor is always looking for signs of the patient misrepresenting symptoms, and the patient is always worried that the doctor is going to think that they're misrepresenting their symptoms. > Frequent visits to multiple doctors, including a willingness to travel to a different city or state to see a new physician – a phenomenon called “doctor shopping” Uncommon, but it wouldn't be entirely shocking for someone to travel for access to a better doctor. This wouldn't be that out there for someone who has cancer, for example. > Unwillingness or inability to provide a complete health history or contact information for previous physicians I've moved a few times in my life. My complete health history probably involves 30 or so doctors if we go back to childhood. I don't think I could even name all of them, much less have contact info for them. The statistics do matter, but we're talking about subjecting people to pain here. The evidentiary bar should probably be higher than "you did a thing that addicts are statistically more likely to do". I think especially so when the worst case scenario is that we give an addict a fix. I'm not advocating drug use, but the harm caused seems pretty minimal, beyond the cost of administering that dose in a hospital.

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watertom 6y ago

Flinging yourself from a 5 story building in order to “look genuine” get fentanyl must be pretty common in NYC.

intricatedetail 6y ago
Some doctors take pleasure in telling patients in pain that they make it up and suggest they are just drug junkies looking for a hit.
- brooklyndude 6y ago
  I have worked with with healthcare professionals for decades, have never once met seen an MD or nurse take pleasure in seeing a patient in pain. I’ve interviewed over 10,000 people to date. We live in two different computer simulations I guess.

thaumasiotes 6y ago

> Basically, an addict wants to look genuine, so a lot of genuine patients have to put up with stuff designed to cut off addicts. It's much stupider than that. Addicts want the drug. So all of the indicators of addiction are actually indicators of wanting the drug. So anyone who wants the drug is, ipso facto, an addict. There's no element of addicts trying to look more genuine. Look at that list of red flags: - Complaining of a need for a drug. - Asking for more of a drug. - Asking for a particular drug by name. - Sometimes taking a drug on your own initiative.

klyrs 6y ago
Moreover, addicts suffering withdrawal are... suffering. This is the reason I put quotes around "genuine" in my original comment. The distinguishing factor between suffering from withdrawal and suffering from another source of pain is a moralizing judgement call on the doctor's part.
- srtjstjsj 6y ago
  Would you also say that a painful cleaning of an infection is also a moralizing judgment against a patient who wants to avoid short term pain?
srtjstjsj 6y ago
Let's not go too far to one-sided cherry picking. https://intervention911.com/common-signs-of-drug-seeking-behavior/ https://intervention911.com/common-signs-of-drug-seeking-beh... - laiming they need more drugs to replace a lost or stolen prescription - Misrepresenting their symptoms - Frequent visits to multiple doctors, including a willingness to travel to a different city or state to see a new physician – a phenomenon called “doctor shopping” - Unwillingness or inability to provide a complete health history or contact information for previous physicians It's possible for a non-addicted person to do this, but actual statistics matter.
- curryst 6y ago
  Many of these things are uncommon, but not particularly rare among non-addicts. > Claiming they need more drugs to replace a lost or stolen prescription Have you really never lost a prescription? I've lost portions of mine once or twice (i.e. I had a week left and lost the bottle). Luckily not having mine is more of an annoyance than anything, but I can empathize for someone in pain who lost theirs. Stealing medications is common in addicts as well, and for every addict that steals a prescription, there's someone that legitimately did have their prescription stolen. > Misrepresenting their symptoms If this can be shown objectively, I can't see any way a non-addict would do this. I fear that it sows distrust between the patient and the doctor, though. The doctor is always looking for signs of the patient misrepresenting symptoms, and the patient is always worried that the doctor is going to think that they're misrepresenting their symptoms. > Frequent visits to multiple doctors, including a willingness to travel to a different city or state to see a new physician – a phenomenon called “doctor shopping” Uncommon, but it wouldn't be entirely shocking for someone to travel for access to a better doctor. This wouldn't be that out there for someone who has cancer, for example. > Unwillingness or inability to provide a complete health history or contact information for previous physicians I've moved a few times in my life. My complete health history probably involves 30 or so doctors if we go back to childhood. I don't think I could even name all of them, much less have contact info for them. The statistics do matter, but we're talking about subjecting people to pain here. The evidentiary bar should probably be higher than "you did a thing that addicts are statistically more likely to do". I think especially so when the worst case scenario is that we give an addict a fix. I'm not advocating drug use, but the harm caused seems pretty minimal, beyond the cost of administering that dose in a hospital.