The Opioid Crisis

[The Greater Fool]

So your doctor was prescribing X, until the rule Rule changed and the doctor switched it to Y rather than make the effort to jump through the hoops for X?

Sure.

Regardless of the law, I would seriously question that doctor's judgement, even around the original prescription.

It's really not about jumping through hoops, as they are used to doing that.

The two separate and unrelated doctors said that they don't want go over because AZ and DEU would be up their arses looking into EVERY patient. This would be an invasive time and resource drain, and frankly they should not be a party to my spouse's medical care.

[Edit: Hopefully more readable:]We've talked to several PCP (Primary Care Physicians) and to a person they recommended my spouse's Pain Doctor as the one to go to, which is why my spouse goes there.[ee] So they know their ****.

Additionally, "Doctor Shopping" is frowned on as it is a drug seeking behavior, and oddly in this case it would be drug seeking behavior. Further, no NEW doctor is going to prescribe double what the law indicates out of the gate. Imagine the initial conversion:

"So Doc, may I call you 'Doc'? So, Doc, I need 180+ MME for my four crushed vertebrae, and my old Doc reduced me to 90. Will you do the 180+ MME today?"

I'm told it's easier to find a drug dealer that will do it, and we won't need 10 years of medical records and current imaging to get it.

 

[Giordano]

So your doctor was prescribing X, until the rule Rule changed and the doctor switched it to Y rather than make the effort to jump through the hoops for X?

Regardless of the law, I would seriously question that doctor's judgement, even around the original prescription.

Doctors who prescribe opioids at all already feel the hot breathe of both governmental and professional organizations peering closely and very suspiciously over their shoulders. To ask for exemptions to the new limits is not just filling out some forms or jumping through some hoops. It generates suspicion, and is asking for one's entire practice to be reviewed in minute detail by people looking for violations of any kind. It is asking for detailed audits of your finances and patient paperwork, the unannounced arrival of auditors, the questioning of you, your personnel, and your patients, etc. etc. I believe that in many states undercover investigators may arrive at the medical office, possess as patients, and try to convince one or more of your staff to knowingly or unknowingly violate the rules. They will often choose the least experienced to target as the most vulnerable. And if you are found to have tripped over some aspect of the complex rules regulating opioid dispensing, or it can be made to look that way, your practice and your career may be over. Even if you avoid jail.

Most doctors will just say- forget it. No way I'm going to go down that road.

 

[Klimax]

Obtuse?

I was unable to find the text of the actual law. However, this PDF from the AZ Governor website should do you the trick. Page 14 is the one that clobbers my spouse, who was at about 180 MME. The exemptions spoken of are for cancer or dying patients. Basic Chronic Pain folks don't qualify.

The new max = 90 MME. As I said, and no I have no documentation, the 2 certified Pain Specialists (my spouses and mine) both are not inclined to go over that value as they don't want AZ and DEA in their lives. My spouses Doc is already acting on this max, reducing my spouses meds.

This law is virtually forcing me to get the illegal drugs they are trying to limit, if I can't move to a more enlightened state.

Yeah, you're right, I'm being obtuse.

Why doesn't first exception apply to you?

This does not apply to a continuation of a prior prescription order that was issued
within the previous 60 days. The limit also would not apply to cancer patients, trauma
patients, burn patients, hospice, end-of-life care, or medication-assisted treatment for
substance use disorder.

ETA:

9.) What if I am on a dose higher than 90 MME now? Will I have to taper down?
The law does not require you to reduce your dose, but health officials recommend you
proceed with caution and consider keeping Naloxone on hand in case of an overdose

You shouldn't be affected.

 

[BobTheCoward]

Most doctors will just say- forget it. No way I'm going to go down that road.

Which calls into question their entire methodology for treating you. They are not acting as a fiduciary, so to speak.

I guess it is more accurate to say to have a healthy understanding that your treatment by your doctor is currently limited by time and resources.

 

[sadhatter]

Obtuse?

I was unable to find the text of the actual law. However, this PDF from the AZ Governor website should do you the trick. Page 14 is the one that clobbers my spouse, who was at about 180 MME. The exemptions spoken of are for cancer or dying patients. Basic Chronic Pain folks don't qualify.

The new max = 90 MME. As I said, and no I have no documentation, the 2 certified Pain Specialists (my spouses and mine) both are not inclined to go over that value as they don't want AZ and DEA in their lives. My spouses Doc is already acting on this max, reducing my spouses meds.

This law is virtually forcing me to get the illegal drugs they are trying to limit, if I can't move to a more enlightened state.

Yeah, you're right, I'm being obtuse.

Read your pdf and you are severely misrepresenting the situation.

First this wasnt just pulled out of a politicians ass. Second it is seeing guidelines and review based on real scientific evidence not telling doctors they can't prescribe.

A doctor can prescribe over the guidelines but must consult with a group of pain specialists. This is to prevent doctors who just write prescriptions to shut people up or the shadier guys who are operating pill Mills.

If you expect to convince me you are right, you are saying you know more about pain management that not only 1 doctor but an entire group of specialists. Feel free to show your credentials.

But you are going to sassy how you know your love one so that doesn't matter.

Let's de personalize this.

You are essentially saying pain management should be loved one managed. Let's say I agree you are the one person who can do this without any issue.

How do you think things would go for other people if love ones managed pain medication? Do you think people would get better care? Do you think there would be any abuse?

 

[The Greater Fool]

You shouldn't be affected.

The Docs think otherwise. All that we've talked to. I'll let them know they are wrong.

I'm sure knowing knowing this will help my spouse when she is writhing in pain because the Docs don't know how the law affects them.

Read your pdf and you are severely misrepresenting the situation.

First this wasnt just pulled out of a politicians ass. Second it is seeing guidelines and review based on real scientific evidence not telling doctors they can't prescribe.

A doctor can prescribe over the guidelines but must consult with a group of pain specialists. This is to prevent doctors who just write prescriptions to shut people up or the shadier guys who are operating pill Mills.

If you expect to convince me you are right, you are saying you know more about pain management that not only 1 doctor but an entire group of specialists. Feel free to show your credentials.

Feel free to provide your credentials.

I am representing what the Docs have told my spouse. They recognize she needs the meds, but "can't" prescribe them. I've pointed out the document above, and they explained what happens when they want to do it. As they are the Professionals, I have to accept their word rather than yours.

This is not a unique story with my spouse. There are many reported in news stories, but the vast majority must suffer quietly, or get relief elsewhere.

But you are going to sassy how you know your love one so that doesn't matter.

Let's de personalize this.

You are essentially saying pain management should be loved one managed. Let's say I agree you are the one person who can do this without any issue.

How do you think things would go for other people if love ones managed pain medication? Do you think people would get better care? Do you think there would be any abuse?

You've really gone down the rabbit hole here. Where did I say it should be loved one managed?

I said the Doctors acknowledge she needs the meds, but they can't or won't expose themselves to having the DEA up their collective asses.

I'm not saying "loved one managed" I'm saying let it be "Doctor Managed" without obstructive and intrusive legislative control of medical decissions.

Sure, I am just a voice on the internet. But my spouse isn't. I will do what I must to help, and the law is my obstacle one way or t'other. I can bang my head against the legal wall, or go around it.

 

[Klimax]

The Docs think otherwise. All that we've talked to. I'll let them know they are wrong.

I'm sure knowing knowing this will help my spouse when she is writhing in pain because the Docs don't know how the law affects them.
...

Yes, they are wrong. Alternatively, their hands are dirty and are guilty of over prescription or at best strongly problematic/questionable and thus want to fly as low under radar as they can or their deeds would be uncovered.

And cut that sympathy BS. Doesn't help your argument one iota. makes you look suspect in case of opioid abuse epidemic.

 

[The Greater Fool]

Yes, they are wrong. Alternatively, their hands are dirty and are guilty of over prescription or at best strongly problematic/questionable and thus want to fly as low under radar as they can or their deeds would be uncovered.

And cut that sympathy BS. Doesn't help your argument one iota. makes you look suspect in case of opioid abuse epidemic.

Thank you, I could not have demonstrated my point better.

 

[kellyb]

She has 4 cracked/broken vertebrae in her back?

 

[TomB]

I think The Greater Fool's point is that while there may be a way to continue the medication his wife needs, it puts the doctor on a government list he doesn't want to be on. The response for some seems to be: "If they aren't doing anything wrong they don't need to worry." That's the same argument used in support of warrant-less wiretaps and the like.

Doctors who are not doing anything wrong don't want the government poking around, not because of what might be found, but because justifying treatments when being second guessed (by those who have never met the patient) costs time and money.

Also, the starting point in these discussions is not "What is the best way to manage pain for this patient?" It's "What is your justification for using a treatment that we have decided is bad?" That's backwards.

 

[JoeMorgue]

So do people just honestly think there's a statistically significant population of chronic pain suffers living agony in Europe and Japan and other countries that are more restrictive of opioid use?

In Alabama, Arkansas, Tennessee, West Virginia, Mississippi, Oklahoma, Kentucky, and Louisiana there are literally more opioid prescriptions than they are people in the state. That's insane.

Japanese doctors treated acute pain with opioids in 47% of cases - compared to 97% in the US.

Unless you can show me that 50% of Japanese pain sufferers are living in agony... what is even being argued?

Links:
https://www.vox.com/policy-and-politics/2017/8/8/16049952/opioid-prescription-us-europe-japan
https://qz.com/1198965/the-surprising-geography-of-opioid-use-around-the-world/
http://www.politifact.com/new-york/...e-states-have-more-opioid-prescriptions-resi/

 

[BobTheCoward]

So do people just honestly think there's a statistically significant population of chronic pain suffers living agony in Europe and Japan and other countries that are more restrictive of opioid use?

Yes

ETA: though I'm wondering if you mean something other than "statistically significant". Because a small number can be statistically significant.

 

[kellyb]

That's crazy about the "more opioid rx's than residents" states.

 

[kellyb]

Yes

ETA: though I'm wondering if you mean something other than "statistically significant". Because a small number can be statistically significant.

That's true. Just 1% (or less) can be "statistically significant".

 

[BobTheCoward]

That's true. Just 1% (or less) can be "statistically significant".

And the first article does suggest that there are people in Japan living with pain they would not have to with opiods.

 

[JoeMorgue]

- I put terms like "statistically significant" in my posts whenever figures, stats, or numbers come up in a hopeless attempt to the pedantics from demanding we stop to discuss meaningless exceptions that don't matter.

- If the argument is going to turn to "Other countries have more chronic users in pain" even if true that raises its own fair share of questions.

 

[dudalb]

That's crazy about the "more opioid rx's than residents" states.

It has to do that opiods can get you high, and many wealthy patients basically "bribe" their doctors to prescribe opiods for that reason.
Particualry bad in California. Most notorious case was Michael Jackson. Socal has along history of "Doctor Feel Good" abusing their licence.
I think there has to be a sane middle point between the Government sticking it nose where it does not belong and allowing greedy MD's to abuse their power for the sake of making a buck.

 

[BobTheCoward]

- I put terms like "statistically significant" in my posts whenever figures, stats, or numbers come up in a hopeless attempt to the pedantics from demanding we stop to discuss meaningless exceptions that don't matter.

- If the argument is going to turn to "Other countries have more chronic users in pain" even if true that raises its own fair share of questions.

Whether it raises its own fair share of questions or not, my answer is still yes.

 

[kellyb]

It's worth noting that the opioids aren't working all that well over here, either.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4545568/

Only 15% of patients with chronic pain on opioids say their pain is well-managed. I really worry that "opioid-induced hyperalgesia" is a big factor there.

 

[kellyb]

It has to do that opiods can get you high, and many wealthy patients basically "bribe" their doctors to prescribe opiods for that reason.
Particualry bad in California. Most notorious case was Michael Jackson. Socal has along history of "Doctor Feel Good" abusing their licence.
I think there has to be a sane middle point between the Government sticking it nose where it does not belong and allowing greedy MD's to abuse their power for the sake of making a buck.

I don't think the rich bribing their doctors can account for more opioid prescriptions than residents, can it?

I'd guess the primary cause is people (of all social classes) seeing multiple doctors for multiple prescriptions, as well as ER "frequent flyers", primarily.