Posted by Heidi on behalf of Mermie "There is no justification fo saying that opioids don't work and should not be given to FMS patients. That is not evidence based medicine, it is peer-pressure based medicine!" - Robert Bennett MD, FMS researcher, Oregon Health Services University, Portland OR Chronic, unremitting pain not related to cancer is a facet - a serious, debilitating and costly facet - of many diseases and disorders. It is an unfortunate fact that numerous fallacious stereotypes (such as "too much pain medication always causes addiction") and cultural socializations (fact: women, children, and people of color are routinely prescribed less pain medication than white adult males; "only sissies complain about pain") have conspired to keep people suffering from chronic severe pain from getting the medication they need. Between the people who have no clue as to how bad severe pain can be, to those doctors who believe pain is to be "managed" instead of suppressed despite the fact that such "management" does not enable the patient a modicum of functionality without screaming agony, to those who blame the victim for not getting better, the fact is that we give more consideration to the humane and painless euthanizing of animals and state executions of criminals than we do to helping, truly helping, people whose lives have been devastated by unrelieved pain If your doctor's not breaking the law, why is he so paranoid about prescribing the appropriate pain medications for you? Interesting question, eh? I have been having a problem assimilating two very disparate inputs: people whose doctors refuse to give them necessary pain meds, even when they see that the medications work, because "the feds will breathe down my neck" or "they don't work" or "they will addict you" on the one hand, and the feds - in the form of legislation already on the books and as discussed by a Department of Justice drug enforcement agent - saying "prescribe what is necessary to treat the patient." Granted, I'm having trouble assimilating most things nowadays, like when I wake up and struggle for a half hour or so to remember my name and where I am (and I'm not even on drugs!). But this clashing discordant tune played by patients and doctors was getting to be too much. So I started digging. A trip to the library yielded a copy of the California Intractable Pain Law (B&P 2241.5). A hand-out from the Interstitial Cystitis Pain Conference last September revealed a copy of the hard-to-find California Pain Patient's Bill of Rights. It also provided some good quotes, which you will find salted throughout this and future newsletters, as well as a talk by Dale Ferranto, Special Agent in Charge, California Department of Justice. Underfunded, Understaffed and Spread Way Too Thin This about sums up why the DOJ and DEA have not been able to look long and hard at all 250,000 Schedule II prescribers licensed in California nor the 5,000 pharmacies licensed to fill these scripts. The triplicate system, which was put into effect decades ago, is cumbersome, inefficient, and simply not working. Not only do the prescribers have to keep a paper copy on file for three years, so do the pharmacies filling these scripts (and having been behind the counter at a couple of them, I can tell you there simply isn't a lot of file space for anything but stock); the pharmacy sends the third copy to Sacramento. There the information on the form is supposed to be entered into a system, but they are so far behind that it effectively isn't being done, certainly not on anything resembling a timely basis. If an agent should want to review the scripts written by a particular physician, or for a particular patient, or filled at a specific pharmacy, weeks of manual searching through all those little pieces of paper must be done. Hardly an effective system. And hardly one that an agency also responsible for shutting down crack cocaine houses and clandestine methamphetamine labs, and trying not to get themselves killed when going after drug dealers armed with automatic weapons and explosives, is gonna have a lot of time to deal with. In fact, there are only one or two people who have time on any regular basis to do such monitoring and observation. What follows is a summary of Special Agent Ferranto's talk: - There is a real problem out there with health care professionals, whether it is real or perceived to them, thinking the regulatory enforcement authorities of the government, both state and federal, are always looking down from above to meddle and interfere with the practice of medicine, particularly when it comes to the prescribing and distribution of controlled substances. - The real facts of the matter are that there aren't enough of us out there to monitor the activities and behaviors of the 100,000 physicians in California, for instance, nor do we have any desire to do so. - What we are most interested in as an enforcement authority are the dishonest doctors or prescribers. There are a small percentage of prescribers who are dishonest, selling their scripts to make a little extra income. Other doctors are duped by patients who don't need the medication or need it to maintain their addiction. Another category of concern are those physicians who are themselves addicted to controlled substances because that interferes with their ability to practice medicine. Finally, we are concerned with those doctors who a danger to their patients because they haven't kept up with the required continued education. For some reason, they can be scammed easier or they've just fallen into the habit of prescribing just for the sake of saying that they are practicing medicine.
on 8/23/2007, 8:09 am
Chronic Unremitting Pain
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