Agraphia Medical Tragicomedy

8Jun/1325

How To Fix The Prescription Drug Problem

As I am wont to do lately, I've been thinking an awful lot about prescription drug abuse.  My last shift, I saw a guy who got in two car wrecks in the space of a few hours while taking his 2mg prescription Xanax "bars" six times a day as prescribed.  I saw a woman with over 300 prescriptions (each of which contained 30-120 individual pills) for opiates and benzos in the past 3 years from around 40 different doctors.  Another woman lamented that she ran out of pain meds just in time for the weekend, and her primary doctor wasn't going to give her "Roxi 30's like I asked for" - street slang for oxycodone 30mg, the highest-value street drug currently on the market.

I've said it before, and I'll say it again.  Prescription drug abuse in this country is a massive issue.  There were over 16,000 fatal overdoses in 2010 and the number continues to rise.  More people are dying from overdose than from car wrecks in some states.  While I care about alcohol abuse and illicit substances to a lesser degree, I'm fixated on prescription abuse because it is preventable.  One source states that the USA uses 80% of the world's opiate supply and 99% of the world's hydrocodone.

There are several issues at play.  One is that no physician wants to be confrontational if they don't have to.  I think ER docs do it by necessity, but primary care doctors can't afford to antagonize their patients - and thus, jeopardize their revenue stream.  When someone comes in and has been on Xanax three times a day for the last 10 years, you throw up your hands and write the script plus refills.

This particular behavior needs to stop.  We ER docs see the overflow from the primary care physicians, the psychiatrists, and the dentists who turn into unwilling pill mills.  As long as there is no oversight, this will continue.   Aside from the nebulous concept of "doing the right thing", there is no reason for any individual provider to wean patients off these meds.  In fact, the opposite is true - patients would simply leave your practice and go to another provider who will give them their fix.

I believe the solution lies with the state medical licensing board.  Here's my plan.

  1. The state board sends all physicians an alert "Your license may be in jeopardy!  Statewide, physicians must come up with a plan to wean all of their patients off prescription opiate medications and benzodiazepines, unless there is a documented and valid reason to keep doing so.  You have 1 year to comply."
  2. At the six month mark, remind physicians that they are coming up on the deadline. Give them a progress report.
  3. At the year, patients on chronic Xanax, Klonopin, Ativan, Valium, Percocet, Oxycodone, Vicodin etc have all had this discussion with their primary doctor "The government is cracking down on physician controlled substance licenses.  Neither myself nor other physicians can prescribe controlled substances on a recurrent basis any more."
  4. Any physicians not playing ball get 3 notices, then lose their controlled substance license.
  5. The end goal is to have meds prescribed as intended, with short courses written for acutely painful or stressful episodes.  Long-term opiate management would be tightly restricted to the setting of cancer, fractures, and a few other conditions.  Long-term benzo use should be flat outlawed.

I'd love to hear your thoughts.  Soon here I'm thinking of marching on Capitol Hill.

Comments (25) Trackbacks (0)
  1. No long term benzos even for anxiety disorders refractory to SSRIs?

    • I think it depends what you’re talking about. Occasional, PRN doses for anxiety is one thing. The scheduled and routine use of Xanax/Clonopin/Ativan/Valium (dosed 2-3 times per day) is the equivalent of telling someone you want them to stay drunk all day, every day. My understanding is that long-term use of benzodiazepines paradoxically increases anxiety and reduces efficacy.

      There are a lot of people out at my shop who are on Xanax TID for “anxiety” without being on an SSRI, SNRI, or any other type of neuromodulator. I’m not a psychiatrist, but I’m pretty sure we’re just creating benzo addicts.

      I don’t have time for an exhaustive literature search, but here’s one recent article: http://www.ncbi.nlm.nih.gov/pubmed/23671484

      • My understanding was that Clonopin was a once daily med for anxiety, and was useful because it didn’t have a rapid onset/offset and carried less risk of addiction. I know people who take it every day for GAD, and hold jobs — in academia even. And xanax is supposed to be used for panic disorder. That is actually a valid indication of the med. None of the people I know on these meds is making frequent trips to the ED to get high. Your proposed rules seem like they have the potential to harm a lot of people, and I’m not sure they would solve the problem.

        (Please don’t cite crappy studies at me. Come on Zac.)

        Look, I know prescription drug abuse is a problem, and I’m not a psychiatrist. I

      • I am on Klonopin and have been for maybe 15 yrs. I have benign familial tremor and have tried other meds. I am not addicted to this med. I take as directed and even 1/2 dose in the afternoon. I also have anxiety and have been to therapy w/many Drs. Please don’t generalize. I need this drug to function my hand tremor especially. I am 46 and started noticing this at 19. Grandmother, Dad, sister and daughter also have the same problem. This is the only drug that has worked for me and I do not OD on this and never will. Actually, I wish I didn’t have to take it at all. It doesn’t get me “high” if that’s the answer you want.

      • Zac, I am glad to see someone with your vantage point speaking out against the prescription drug industry. I have never experienced it from where you are sitting, so my opinions are based on the following three points of view:

        1. Having a sister-in-law who worked in clinical trials and became a hard core prescription drug addict
        2. Having chronic PTSD myself from long-term sexual and physical child abuse and military life overseas
        3. Working in advertising for pharma and seeing how forcefully they market “compliance” to consumers

        Firstly, there is an epidemic and you are right to address it as forcefully as you are. My nephew was born addicted to benzos because my Sister in Law (SL) was a chronic addict for years. My brother initially believed she was suffering and “all these damn doctors were being unsympathetic because they couldn’t find the cause of her illness(es)” The very tricky part for consumers to understand about the ‘legal’ drug industry is that unlike heroine or meth, these drugs are sold as a ‘cure’ to a problem, not that they ARE an additional problem. For the average family member of a prescription drug addict, they are caught up in the chaos like a frog in a pot of boiling water. They don’t know their loved one is addicted as they are initially supportive of their medical needs. They may have experienced jaded, uncaring doctors themselves so they believe their loved one is getting the care and attention they need. Its especially easy to get roped along when there was a legitimate illness that spawned the initial addiction – in this case a gall bladder surgery. The loved one is panicked thinking the fatigue and low energy may be more complications from a surgery gone wrong, unable to detect the difference between legitimate illness symptoms vs. the signs of someone “being high” or overdosing. The initial incident that spawned the addiction wore out its course as an excuse for drugs so the addict thinks up new excuses and mysterious illnesses. Having also worked in the medical industries in drug trials, my brother trusted she just new all the drug names and side effects so she was educated in asking for what she wanted. I was alarmed when I came to visit and found literally a toolbox filled with prescription drugs. She started using their autistic son to gain access to additional drugs like Riddlin (don’t know how to spell it). Again, because autism is a legitimate condition and she was the one going to the doctor visits while my brother worked, he thought she new what she was doing. Then the overdoses and emergency room visits came. The first couple of times my brother assumed all the doctors were idiots because they couldn’t still find the cause of her mysterious illness that was causing her to collapse like this and become unconscious. Finally a straight-shooting doctor (much like yourself thank goodness) just told him she had overdosed and told him the blood test were undeniable. He was in severe denial at first, but their home life was also falling apart and for the sake of his autistic son, he had to take a cold hard look at the situation and the more he learned about ‘doctor shopping’ the more the picture became clear. But then he felt he had to hide it from everyone so they wouldn’t judge her because now she was a new kind of victim, she was an addict with a new ‘disease’ and the codependent disfunction continued as he tried to still hold it all together by himself. Then he caught her getting high and overdosing while pregnant with their latest child. Already knowing the work required raising a special needs child he was beside himself. He sought an intervention, the child was born addicted to benzodiazepines and kept in NICU. Fast forward and he’s much happier with custody and the divorce finalized.

        The drug companies market all times of the day to addicts and their unknowing families about the wonders of living the life you’ve always dreamed of (with rainbows and meadows and a wide circle of friends where you are now the center of attention) if you just stay compliant on their drugs. Funny how close these commercials are to the beer and car commercials we also make.

        For my own PTSD (more background at the end of this) I take 20mg of Flouxotine (Prozac) and ran into issues trying to find a new doctor because of this when my primary physician moved. My employer also mandates mail order 90 day prescriptions for any maintenance drugs. I went down the insurance list of doctors in my area and found the same routine every time:

        Me: Are you taking new patients?
        Assistant: Yes, what is it you would like to see the doctor for?
        Me: My regular doctor moved and I’m looking for a doctor that will continue to monitor my PTSD prescription of Prozac for anxiety (I ask this up front because I don’t want to make an appointment which takes two weeks, sit in a waiting room for two hours, then be told the doctor doesn’t treat anxiety or what not)
        Assistant: We can’t take you as a patient.
        Me: Why not?
        Assistant: The doctor can’t see you for anxiety
        Me: Well can I still see the doctor for annual check ups then? I’m still looking for a new doctor in my area anyway, so if I have to go somewhere separate for anxiety that’s fine.
        Assistant: No, I’m sorry, we can’t accept you as a patient. The doctor has concerns you will be a drug addict
        Me: You know Prozac is an SSRI not a benzodiazapine right?
        Assistant: I’m sorry, we can’t accept you.

        So I found a psychiatric nurse who now manages that script, but I would have liked to have a single doctor who nows me better be the one to manage it. But then again, the doctors that turned me away weren’t very good if they can’t tell the difference between an SSRI and a benzo anyway, so it was a good screening process for who was really qualified or not.

        In Texas they’ve initiated new drug abuse laws which I think are pretty sound. They put the responsibility for drug abuse on BOTH the patient AND the doctors. On the one hand I’m glad to see doctors declining to prescribe so easily, on the other hand it’s clear there needs to be better education for doctors to truly know the difference between the drugs (SSRIs vs. Benzos and others)

        Texas makes it a felony for a patient to knowingly lie on their patient form when asked if they are taking any other medication. Texas is also improving the central patient database and will begin mandating pharmacies check a central database for any overlapping prescriptions especially from more than one doctor.

        I think your recommendations may be a little black and white regarding conditions, but it does hit on the point that a doctor’s primary job is to discuss the cause and what near-term AND long-term (drug and NON-drug) treatments are needed to solve the actual cause of the problem, not drug up and mask symptoms. I also think there needs to be strict regulations on advertising pharma products – the same restrictions put on the tobacco industry and that the pharma companies should be subsidizing addiction treatment (much like the tobacco industry has to pay for no-smoking PSAs)

        Regarding the background of my own anxiety, for years I didn’t even know about PTSD. I was suicidal and cutting with chronic nightmares and hypervigilant everyday issues. Since my siblings were the same way I thought it was just our genetics, that we all had mental issues like bipolarism or something. I had been prescribed Effexor for anxiety after seeing siblings having some success with it, but suicidal thoughts and hypervigilance still remained, and I wasn’t always compliant with SSRIs. Thank goodness one of my siblings was diagnosed with PTSD by a psychologist after evaluating the symptoms and hearing about our upbringing on a base overseas. Everything lined up and with the help of BOTH cognitive behavior therapy AND SSRI’s (Prozac in my case, though beta blockers have worked for my other siblings) over the course of several years the symptoms have greatly subsided.

        I had a doctor prescribe both Ambien and Xanax before and could see how someone could become addicted. The Xanax helped initially, but then my anger increased as soon as it wore off. Had I not been so trained to monitor my emotions thanks to the PTSD cognitive behavior therapy, and seen my SL’s prescription drug addiction, I might not have recognized it was Xanax actually causing increased panic attacks, but rather thought I needed it more. I only take 20mg of Flouxotine now, and not as consistently as I should.

        Long post, but I wanted to end by saying continue to shout out about it as you are doing while staying patient-centered and continually educated as you have. The profession needs more people like you.

        • Folks on long term benzos- they stopped working a long time ago. You now have a dependence. Benzos alter brain chemistry in a way the body can compensate for, so after a short while (read: a month) they no longer work the way they did. Instead, your dose gets you to baseline. Same goes for many of the sleeping pills and hypnotics. This also means a missed dose means you are worse and more off baseline than when you first started taking the med. This means you are unmedicated if on a steady dose.

          You don’t want benzos. Unless you have epilepsy, you don’t want to take them chronically.

          For anxiety, look up seriously old school beta blockers they used to prescribe for stage fright. They actually work. And in some cases, permanently, not requiring long term medication.

        • They might be knee substantial or leg high shoes or boots as well which might be laced up the entry to make them as tight as they can. It is bisacally a right line from the knee as a result of the foot. Once a issue of only fetish trend, they’ve currently fully in progress their cross into core runway plus celeb vogue. Alexander McQueen included the 10 inch taller Armadillo shoe in their Spring/Summer 2010 design shoe. Products, Abbey Lee Kershaw, Natasha Poly along with Sasha Pivovarova quit this show throughout protest but it was a enormous controversy. Of course this merely spawned a brand new generation regarding dare devils when Kesha and Beyonce was wearing them.

    • No. They stop working at a steady dose within a month orr two. Unless you are a person with epileptic seizures, no. The dose you take only gets you to baseline prior to treatment – that’s why suddenly stopping the med can give you seizures. Because your brain tries to keep its chemistry in balance. You can only unbalance it for so long.

      Anxiety needs a different long term solution.

  2. I’m a patient with chronic use of Xanax because nothing else works for my panic disorder and PTSD and Xanax barely cuts it as it is. I never sell it. I understand your concern about addiction, but please don’t compare people like me (1 in 3 people with PTSD are treatment resistant, just to give you an idea) with people who use street slang for drugs they’re scamming and selling.

  3. I am appalled by your opinion of chronic pain patients. You are basically saying that unless a patient had cancer, “or a few other issues”, you want to take the medication away that helps them cope with the pain? I have had chronic pain for most of my life. I won’t go into my medical diagnosis here, but I will let you know that I take my medication responsibly. I am treated by a pretty strict pain management doctor, that tests every visit for illegal drugs, as well as drug levels. I take non narcotic pain meds along with my pain meds, and have been stable for awhile now. To think that may be jeopardized, because of fear of drug seekers/addicts. With all respect, this proposal to threaten doctors with losing their licenses, for treating patients that have a valid need is not the way to go.

  4. On another note, my mother takes Xanax, and has since I was a young child. She has severe panic attacks, so severe, as when I was a child she couldn’t even leave the house. She has spent many many years in counseling, and has come so far. She currently takes Xanax, only at bedtime, as the sound of her own heartbeat when trying to sleep will throw her into a panic. She was recently diagnosed with a blood clot in her leg, as well as constant Afib, which without the bedtime Xanax, she will surely regress. Again another responsible patient, that you are pushing to have her progress in jeopardy. These notes are probably meaningless, but just wanted to give the patients that rely on these medications a voice. I pray that you fail in this. I know there is a huge pill problem. But there has to be another way.

  5. You know what? I actually think this is a swell idea. At least you are trying to come up with ideas on how to slow down these drug seekers. The E.R is a modern day crack house. There are plenty of things that were ruined because of a few bad apples. This is why we have laws in place. Narcotics need to become much harder to get for everyone. Really sorry about those who really need it but this has become an epidemic now. Something drastic NEEDS to be done.

  6. I also work in the field. I also understand the frustration. Making the drugs harder to get and the hard wean I don’t think will work though. I would love to call it what it is to a patient’s face and say “You are an addict”… But prohibition has repeatedly just created more incarceration, a larger DEA, more spending, larger black market, ect.

    Two solutions:
    Hard: Execute anyone who goes outside the law to obtain drugs prescription or otherwise. Make the laws extremely strict and punishment swift. within a very short amount of time, drug problem over. Of course we then live in a draconian society and other laws may see an increase in such harsh penalties.

    Liberatarian: Legalize them. Get the seeker out of the ER by letting them have access to the over the counter. You will see them in the ER in form of overdose and the chronic illness associated with these behaviors. Have people understand the addictive nature of these drugs and allow them to take the chance of addiction. Offer Rehab to those who want it in the drug stores that sell the drugs… Messy I know…. But nothing else resembles America to me…. Land of the Free

  7. As an RN in the ER, I see two sides to the addiction coin. The chronic pain sufferers who are trying to get their lives under some semblance of control and manage the pain no one seems to be able to cure; and those who are addicted through abuse of legal meds. I wish there were an easy solution to the problem, but sadly it is very complex and has many shades of grey. I htink the intent of the original post wasn’t to discount those who are in legitimate need. In fact, the writer specifically mentions those patients who are under treatment for actual issues (the tremor, chronic pain, GAD, etc) as those who clearly need the medications discussed. I feel frustrated when I see the same “drug seeking” patients come in on the shifts that certain doctors work, knowing that they wil get their “fix” until next time. I can only do so much in my role as nurse and have little choice but to hand out the meds as ordered and try to counsel/health teach as best I can. Hopefully there will be more frank and honest dicussion on this topic and more ideas/solutions can be discovered.

  8. As an ER doc myself, I applaud this post. I too have seen my fair share of chronic pain patients and addicts. I’m not sure which ones frustrate me more.

    “My pills were stolen.” “I can’t get a refill of my Dilaudid until next week, what am I supposed to do?” “I have fibromyalgia and I hurt everywhere!” “I’m just moved to town and I don’t have a doctor yet to give me my Percocet.” “I’m visiting family and forgot to bring my meds.” These are just a few examples of the complaints we here every day.

    I especially love it when the chronic pain patients lie about their pain contract. At least then I can tell them no and show them the door and be justified.

    Prescription drug abuse is a very real problem and unfortunately we will remain on the front lines. Fortunately, our ED recently came up with a form to give all our chronic pain patients that explains why coming to the ER for refills and pain that is their norm (not any different or worse) is not a good idea.

    I wish I could sympathize with the chronic pain patients, but I cannot. I deal with back pain on a daily basis as a result from scoliosis and working on my feet all day. My mother has one of the worst cases of rheumatoid arthritis and got through knee replacement surgery with only Toradol! Opiates are not the solution to the problem.

    I firmly believe that the main reason for the chronic pain problem in the U.S. is the lazy, sedentary lifestyle most people live. If more people got off their ass and into the gym they wouldn’t hurt so bad.

    • Absolutely!!!! Very well written doctor! I to have worked in a community where some of the facilities have enlisted case management and created a way of identifying patients who abuse the ER drug seeking. These patients are approached by the case managers and informed that the ER will not write them for anymore narcotics that it is their responsibility to follow up with their managing physicians to do that. They sign a contract and then when they preset to the ER, any of the ER’s in that same system, they are not written for narcotics. Obviously depending on the complaint the MD will treat it appropriately but if they have chronic pain issues they will not get a prescription. It’s amazing what addicts will do to themselves to get medications and if you’ve been in the ER for even a minute you become a little jaded! I like your mother even having kidney stones have refused narcotics and have asked for Toradol. I was written up because I wouldn’t give IV narcotics to a frequent flyer who came in with the same complaint because she didn’t have a ride at the bedside. We don’t have a policy for administering IV narcotics to stable patients. I informed the MD that the patient didn’t have a ride and asked for a non-narcotic intervention for this stable frequent flyer until her ride arrived. I’ve been told that we are in the “people pleasing business” and the majority of the patients that leave the ER are given a prescription for a narcotic! It’s ridiculous! Hospitals are into the money making and we don’t have enough respect for patients to do the right thing and instruct them to take Tylenol and motrin for pain. It’s disgusting!

  9. As someone who works in the addiction field, I also know and see every day the effects prescription drugs have on people, the number one cause? Doctors. Over and under treatment of pain. Oh, and more diversion comes from hospitals (not patients) and pharmacies than anywhere else.
    Sadly, the ER docs are the ones getting the bad raps on this.

    Here is a scenario; and a true story from a patient I once treated in my rehab…all names changed ofcourse…

    Rex was a flower delivery driver by day, made regular stops at the local small community not for profit hospital. Rex was also drug dealer and addict. He also got to know a couple of nurses who also developed drug habits and or money problems(addiction knows no bounds) . These nurses would either skimp on what they gave their patients or found ways to divert narcotic meds and sold them to Rex who would in turn, sell and or take them himself. Ofcourse in time, everyone involved were eventually caught. These things can’t go on forever……many meds were put out into the community through this avenue, and others like it.
    Rex eventually kicked his habit pretty well unfortunately he died of lung cancer some time later.

    Can’t always blame the PC doc, and the undertreatreatment of pain will do nothing but send people straight to heroin. That happens everyday, more often than one would like to admit.

    And still, We have no solution.

    On a somewhat related note, I’m a healthy 40 something with no history of headaches…. who suddenly started developing headaches, after having a 3 day whopper my PC doc told me to go to ER. ER doc looked at me with complete shock when I refused narcotics…..they made my headaches worse. I wondered why he looked shocked, now I know. No one refuses these days…..I guess.

  10. Whenever a new function, law, or regulation (in any study or topic) is implemented, the body responsible for creation of the new procedure heavily weighs the pros and cons of what they are trying to fix. There may be 90 people they are trying to target and successfully do so, thus fixing the problem. Then, there may be the other 10 people who are negatively affected and complain about it.

    So ask yourselves, would you in the United States, want 16 year olds able to purchase alcohol as they could in a few other countries? All of those under 18 are going to lean on ‘yes’ and all those over 21 are going to lean on ‘no’ and any law enforcement or medical professional is going to lean on ‘absolutely not.’ So there may be 90 teens that would be negatively affected if they could purchase this substance, and 10 that are mature enough to handle it.

    This is not about alcohol abuse, but the above statement does clarify a point. Some people would complain about it and suggest they NEED these substances, but there is just too many people who are simply addicts or sell it on the street to think about. The greater good would be preventing this, and reviewing continued use cases heavily to prove there is or is not a benefit for long term prescription.

  11. WOW an ER doctor who isn’t a people pleaser….. can you do some talks and speak with some of your peers because it is getting out of control!!!! Both my sisters are addicts and it’s disigusting!!!!! I have heard on more than one occasion an ER doctor say “we’re in the people pleasing business.” After they have looked the patient up and saw that they have had many prescriptions written for narcotics by several different physicians! When we made pain the 5th vital sign we went wrong. I can assure you I am alllll about treating some pain!!!! I have had many kidney stones requiring interventions with internal and external tubes. I have refused IV narcotics and asked for Toradol, I do not like all the side effects of the narcotics. I get pain! I’ve had 3 C-sections so I get the need for narcotics needed for a short period of time! Seriously patients need to take some personal responsibility and change their lifestyles….. exercise, lose weight! Seriously do some PT get off the couch and stretch ect!!!!! I realize this isn’t all patients but the things patients present to the ER with and expect to be given narcotics is RIDICULOUS and just like you stated concerning. We are creating a society of addicts and when the patients with real conditions come in we are so jaded at times we cannot see it and treat them as the jaded professionals we have become!

  12. I am an Opiate addict, not by choice, but because of listening to my Doctor & not educating myself! I grew up being told, “Listen to your doctor.” And, “Doctors orders!” So when I was first prescribed narcotic medication I truly had no idea that this medicine would destroy my life! I don’t blame my Doctor though! I blame myself and the makers of Oxycontin! Look back at when this drug was introduced on the market, they advertised in every doctors office, magazine, hospital, they even had a poster in my gym! “Oxycontin will change your life!” Well… Yes it did! I think the cure would be to have cost effective Suboxone Therapy, or better yet how about the cure being used in many other countries: Ibogaine! No way! A cure! Big Pharm would’t allow a CURE! Too big of a business i. the Good Ole USA! I wouldn’t wish opiate addiction on my worst enemy!
    Wish I could afford treatment to get off this roller coaster! Soon I think I’ll just check out of my life! Thanks Big Pharm!
    To everyone treating addicts so horribly, do you REALLY think someone would choose ti be an addict? Everyone should be treated with compassion, even the Crack smoking Heroin addict living on the streets!
    I’m sure many of you are good Christian folk? Would Jesus treat someone so humanly? Or are you better than him?
    WWJD
    PEACE

  13. Hi!

    My name is Sarah. I have a couple of friends who have been struggling with oxycodone. It’s ruining their relationship and poisoning their financial situation. I don’t think either of them ever had a prescription; they just got hooked via repetitive recreational usage.

    Anyways, I’ve been working on an article about recognizing the signs of prescription drug abuse and was wondering if you’d be interested in publishing it. Let me know what you think. Hope to hear from you soon!

  14. We don’t need yet more government regulation of our practice. We need to prescribe that which we feel is reasonable and safe for the patient. If the patient is not happy with our management, they are perfectly free to seek the services of someone else whose philosophy is more to their liking.

    We certainly don’t need “Boards” and “authorities” telling what to do or how to manage our patients. I use my judgement as to what is right and reasonable for a particular patient under the particular circumstances presented. If I can’t help the patient or meet the patient’s goals using my level of expertise then I refer the patient to someone with more expertise in that area of medicine. I have a perfectly functioning brain and I am very capable of using it. I don’t need an outside “authority” telling me how to treat the patients who seek my services. When I don’t know something, I will be the first one to tell the patient as much and arrange for that person to see someone else with more expertise than I.

  15. Hmmm.. A great deal of judgment going on. To the “ER doc”above who commented that his mom got through surgery without opiates and he lives with the pain of scoliosis, all I can say is “wow, you must be an expert on the pain I and others experience..”. All I can say to you is that you and your mom haven’t experienced pain that requires opiates. You’ll know it when you do, and I’m not mean enough to wish it on you, because I live with it every day. If we learned nothing from Prohibition, keep on making rules and regs that keep pain meds out of the hands of the truly deserving patients and watch as druggies will continue to abuse them. It is shameful that a doctor would basically tell people to “buck up” when they have no idea what kind of pain people are experiencing…I know you see your share of abuse, but, there are as many people that need these meds that cannot get them, or enough of them.


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