[quote]
If you’re thinking about getting into pain management using opioids as appropriate: DON’T. Forget what you learned in medical school – drug agents now set medical standards.
…
If you are already prescribing opioids:[ul][li]Do thorough physicals, even if unnecessary and not helpful…[]Refer patients early and often to addictionologists, orthopedists, pain specialists, psychologists, regardless of expense or your opinion of helpfulness…[]Consider phasing out this part of your practice, giving patients plenty of time to find another doctor…[/ul][/li][/quote]
Cute, huh?
The DEA can’t eliminate drug use, but fuck it, doctors are easier targets than criminals anyway, what with their public practice and deep pockets and compelling desire to stay in practice and all. :rolleyes: Fucking fish in a barrel, really.
The war on drugs will NEVER be won. In fact I think that by now they should understand that they have failed miserably and spent billions of tax payers money in the process.
I’m sure there are some doctors out there who abuse their power and hook people up. But targeting every doctor who subscribe pain medicine is fucking wrong. :mad:
Are you going to start denying cancer patients there pain relievers? Or how about someone with a broken limb?
We should go back to the days without pain killers and just feed the patient alcohol before operating. :rolleyes:
Fight crack and crank. Try to stop heroine(sp?). But pain medicines are a must.
Seriously fucked up. Who are these DEA douche bags helping out in this situation? How can people be so think headed!?
Make physicians scared shitless of old people with a dibilitating illness in constant pain. Great job DEA shit-moppers, you win the award for dumbest plan of 2003.
The sad thing is, the DEA has a large pool of very talented agents. You’d think some senator would make some hay with the suggestion that they would be better off fighting terrorism in the DHS…
Not for nothing, but I’m not buying this “Association of American Physicians and Surgeons” as a legit medical orginization. I can’t remember how much time he served, but he was excluded from Medicare and Medicaid ?? WTF? And the fact is that there is a subset of doctors and not-doctors claiming to be docs prescribing pain drugs for non-pain applications. Whilst I’m sure the DEA is in fact making some errors here, I’m skeptical that it’s nearly as bad a claimed here.
Does someone have some background on this AAPS that would mark them as a legitimate organization (i.e., that a normal doctor might actually take their “advice?” Alternatively, is there another medical organization talking about this? I’d like to learn more before joining the jihad here.
Frankly, I’m dubious of these claims. I took a 4 day seminar on prescribing controlled drugs. We heard from district attorneys, DEA agents and policymakers, and doctors who run legitimate pain clinics. They were uniform in stating that if proper medical procedure and documentation is used, including proper diagnosis, proper test results, and therapy plans, there was no problem.
Frankly, there are a number of my “colleagues” (I hate to call some of them that) do not practice good medicine, and see a high volume of patients to whom they give narcotic prescriptions with little evaluation or investigation. It can be quite lucrative, takes little office time or resources, and gets re-imbursed well. It’s also unethical, and illegal.
When I treat a chronic pain patient with opiates, I document what I believe to be the cause of the chronic pain, the studies performed to support this diagnosis and exclude other diagnoses, and I document possible other diagnoses and how I plan to evaluate for them. I document what medications and treatments they’ve had for their pain in the past, and the effectiveness of said treatments. I write down just why I am choosing a narcotic for them, the expected results, the anticipated length of need for them, and what I expect to do with their medication if further studies indicate they are not warranted.
Often I get a patient new to me on opiate pain killers for chronic pain. I generally don’t take them off until I receive records about why they’re on them in the first place.
All this is a pain in the ass to do, but practicing good medicine is sometimes a pain in the ass. But if a practitioner takes these steps, I don’t believe they have anything to fear from regulatory authorities. And I am not the kind of guy who normally trusts regulatory authorities.
True, but I’m in a special circumstance, as a prison doc. I don’t have the luxury of saying to the patient: “sorry, find another doc, I don’t want to deal with this”. So I document that my narcotic treatment is presumptive, ie based on preliminary evidence or hypothesis that it is necessary, and that I am working towards obtaining further evidence. As long as I don’t prescribe to “maintain an addiction” which is not allowed, but rather “treat pain” it’s doable.
Not to mention that, I’d think you’d be concerned in some cases that there might be serious withdrawl and in some cases would go on a step down process.
And the concern is, if one of your patients (pretending you aren’t in your current position) is a doctor-shopper, the DEA would be quite happy fucking you over while you were trying to get those tests rather than approach you and say, “We have a suspicion that one of your patients lies to doctors about their conditions in order to obtain narcotics.”
Withdrawal I can deal with, once the decision is made that narcotics are not medically indicated. A rapid taper, or even cold-turkey, with the use of meds like clonidine to blunt the discomfort, is not a big deal. The nice thing about opiate withdrawal is that it is not life or health-threatening in and of itself.
But I don’t see that happening out in the real world. The physicians who are getting entangled with the DEA or local district attorney (at least in the cases I’ve been aware of) have looooong histories of medicating tons of patients with narcotics for long periods of time, with inadequate documentation in their own notes.
I’m not saying over-zealous DA’s and others aren’t doing inappropriate things at times. I’m saying that if the physician follows the guidelines and documents, documents, documents, these things shouldn’t go far. I’ve worked with the district attorney for my own state medical board in the past, and he’s spoken quite clearly about what the medical board expects, and it mirrors what I’ve said. And while the board DA doesn’t have jurisdiction over the criminal courts, his opinion will definitely have some impact on whether the criminal courts pursue these things or not.
Frankly, the DEA’s primary interest vis a vis physicians seems to be to make sure drugs are not getting diverted to the streets for profit, which happens in the disreputable “pain-clinic mills”. They’ll pursue a physician who’s self-prescribing narcotics, but generally don’t care to follow further once said physician has gotten into drug treatment under the supervision of the medical board.
I just haven’t seen any statistics saying that this is a real issue for most practicing physicians. I’d expect to hear it from my advocacy groups like the American Academy of Family Practice, or my state Medical Society, or the American Society of Addiction Medicine. AAPS, which you cited, is not one of the bigger or well-known physician associations.
I’ll be going to a conference this summer whose focus is addiction medicine. I’ll ask some of the folks in the know there if this is an issue.
Well that’s fair, Qadgop, I’d happily defer to your judgment over links I get from pro-legalization sites, but my cynicism about the DEA and drug war forbid me from thinking it is all on the up-and-up.
Well, I think the drug war is damned stupid too, erislover. And I don’t trust our current administration to not use extreme measures to advance their social agenda for all “right-thinking” people. So I do plan to check it out. And if the people I trust and who should be in the know about this sort of stuff agree that this is a problem, I will most assuredly oppose the official actions in this area.
Can you get this in writing for me? I got into an argument with my drug & alcohol therapist where she claimed alcohol and benzodiazepines are the only two drugs that cause mortality as a direct result of withdrawal. I mentioned barbiturates and she told me I wrong. The next time I saw her, she calimed to have confimed this in a medical journal that barbiturates interact with GABA receptors in a different manner than benzos and alcohol. I asked her “What medical journal?” and then she changed the subject saying I was using defense mechanisms and trying to be a “professional patient”.
But pain medicines are a must.