The Danger of Opioid Prescriptions for Vets
Not long ago doctors were so afraid of turning their patients into addicts that they sometimes refused opioids even to the dying. Nowadays, they are so afraid of not treating the pain of their patients that they are careless of whether or not they turn them into addicts.
A paper in the Journal of the American Medical Association for March 7 describes the pattern of opioid prescription for veterans returning from the wars in Iraq and Afghanistan. Of the 291,205 who enrolled for VA health care between October 2003 and December 2008, 141,029 received a diagnosis of a painful condition not caused by cancer; and of that number, 15,676 received a prescription of an opioid drug that lasted at least 20 days.
Of those veterans with pain who had no psychiatric diagnosis, only 6.5 per cent were prescribed such a drug; for those with post-traumatic stress disorder the figure was 17.8 per cent. Patients with non-PTSD psychiatric disorders had an intermediate rate of prescription, at 11.7 per cent.
The prescription of opioids was associated with a variety of unfortunate outcomes. It is hardly surprising that those prescribed the drugs were more likely to take deliberate or accidental overdoses of them than those not prescribed them; but they were also more likely to injure themselves deliberately, to suffer “violence-related” injuries, other forms of injury, or other kinds of overdose or alcohol-related harms. The difference was more marked among those with psychiatric diagnoses.
Of course, a statistical association does not establish causation. There is nothing in the paper that excludes the possibility that the patients prescribed opioids had a worse prognosis in a case than those not prescribed them. Physical injury is associated, not surprisingly, with the development of later psychological difficulties. Nevertheless, there is reason for unease.
The paper tells us in its introduction that:
Nationwide, the prescription of opioid analgesics has nearly doubled since 1994 because of a greater recognition of the importance of treating pain.
My last job was on staff as an Operations Supervisor, running a zero-tolerance Veteran’s Shelter. So I can say with more than a bit of confidence that your article is spot-on. Of those thousands of clients I had dealt with over the years (all utilizing the VA healthcare system), over-medication – particularly Opioids – was an endemic problem.
I have quite literally watched a Client’s medications (thrown casually at them by the nearby VAMC) grow hugely in just months, and in a direct inverse relationship to their purported “quality of life.” They simply traded the original problem for generalized dysfunction via over-prescription. But that was always fine with the VA, because, well, the original complaint had been dealt with effectively.
And, yes, many others became quite the accomplished addicts, courtesy of the easily prescribed “good stuff.” One guy who stands out in my mind had been prescribed Fentanyl patches for chronic back pain – and ended up saving the used patches and then chewing on them to get high. Apparently that works, as I’d found him on one occasion passed out on a bathroom floor, with the half-gnawed patch still in his mouth.
And there was a thriving Black Market going on for each others medications as well.
In answer to your question, “what is going on?” – it is simply more cost effective for these physicians to see more patients per/hour by having minimal interaction with them. Throwing medications at the patient as a “solution” for what ails them has become routine. Patient in–>prescribe–>patient out. Next! I cannot count the number of times I was informed that this was a Client’s most recent interaction with their Doctors.
So they’ve gone a good distance down the road of no longer attempting to treat the cause of whatever medical issue a Veteran may have to treating the effects. That is, no real attempt made to make the actual problem go away, but damn! that guy feels fine, so we’re good! Don’t worry about the consequences of over-medication, just kick that can down the road.
I have no solutions.
For me, I finally had to get out of working within this environment, when I’d had to identify a Veteran I had known for a long time. He had finally gotten out of the shelter system after many years, and gotten a room in the SRO (Single Room Occupancy) we ran for guys who had “grsduated.” He was on many, many medications including Opioids, and now that he had his own place, he began to drink as well. And then no one saw him for several days. Which is when I got the call to enter his room and see what was up.
No need, I could smell him from the elevator doors when they opened. He’d been dead about five days. And the saddest thing of all, he had rented the room – his first home in many years – for only a bit over a month.
The only sage advice I can give is 1) Doctors are not Gods, no one should be in awe of them or their opinions; 2) medications may sound swell, but the long-term consequences frequently make taking them not worth it.
And if you have to make a trade off, suffer some low-level or chronic pain so as to remain drug-free, do it! I am a disabled Veteran (Army, 77-83), with multiple mobility issues…and do NOT take a damned thing for them. And will not. Not if you hold a gun to my head. I’ve seen the consequences of doing otherwise.
Besides, pain merely indicates that you’re alive.
’nuff said.
“Besides, pain merely indicates that you’re alive.”
This is very serious statement by a professional.
I am an entertainer by profession. I also did a 20 year stint (concurrent) as an engineer in Corporateville.
What the doctor and Allston are seeing is what police officers see. The worst outcomes. They are seeing people who have other life situations that may or may be part of what they are basically treating, by their own diagnoses, addiction.
Where I live many, many people use opioids to ease discomfort, recreationally or otherwise, and to change their state of conscious. I know many of these individuals quite well and have seen them work under pressure, in less than ideal conditions, over long periods of time. Pressures in both of these fields that I am familiar with can be great. Not that this is exclusive, we all feel it one way or another.
Another surprise to some might be is that most people do not work “loaded”. By that I mean where the drug(s) is not present or even slightly dominant. They may have a drink, or a toke in the case the entertainers, or pump up on caffeine in the case of engineers (there are vague preferences), but it is well known (from experience) that some drugs are something that can cause you to lose your edge for the task at hand. Opioids are in that category.
Away from the task, as a way of relaxing, opioids are used and are quite useful in breaking the cycle of being on “11″, from intense concentration and physical exertion required with work. You can’t perform at levels that I have witnessed, that some push themselves to, without recreating. And you can’t perform “loaded” for very long. You burn out. You lose what you have gained. So, there is self regulation. A drink or two after work? One or two Percodan? Run laps? Watch TV?
The usage is by and large self regulated. Nearly all recreational users know their limits, and if they don’t their working peers and others sound alarms loud and clear. Hey, you’re too wired there, back off on the cokes and coffee. Some cannot control themselves anymore that some cannot stay within the speed limit or prevent themselves from others risks that they might choose. Users are far more conservative about usage than is generally recognized. No one talks much about that, and excess is to be avoided.
One can think back, observing people, and the very same individuals that you knew early in life, from childhood, teens, and 20′s and on, some seemed to always have a hard time with life. Opioids are maybe just another situation that they cannot handle. The stereotypical, pills “for 20 days” or more does not hold well with my observations. Most people take it or leave it, over years of use, and function quite well in everyday life. Yet the notion of “The Man With the Golden Arm” persists. Very few get there, and that is because that level of use is never useful. Anecdotal, yes, but what about this?
There is very little in the way of research in this area that I know of, the benefits derived form drug usage of this type. We could move away from this “bummer rules all” view of life and the moral implications contained in that, and put more effort into far more devastating outcomes, such Type II diabetes.
I sympathize with Allston and the doctor and those who do see and face some very bad outcomes. However, there are different experiences and outcomes, which may be more applicable to the general population.
Lots of people are addicted to experiencing pain because the body produces opioids called Endorphins to deal with them see: https://en.wikipedia.org/wiki/Endorphin.
Hence you get the spectacle of masochists and self-harmers, ranging from kids with razorblades to people who run marathons to self-destruction.
Wouldn’t it be ironic if the opium that was used to manufacture most opioids came from the poppy fields in Afghanistan? Perhaps the fastest way to end the opium trade in Afghanistan is simply to buy the crop from the farmers. To the farmers and the warlords, money is money, no matter who it comes from. So if we bought more of the crops and gave the opium to our pharmaceutical firms, we would be doing two things. We would be taking a huge amount of opium off of the illegal drug market and we would be supplying our pharmaceutical firms with cheap opium for their medicines. The Afghan warlords and farmers would be happy, and our pharmaceutical companies could produce cheaper drugs. But I never thought our own doctors would be giving our own vets so much of the stuff!
I think a lot of it does ultimately come from Afghanistan, although a long time ago I read that most Afghan opium ends up in Europe.
There were US programs/attempts to get the Afghans (post 2003) to stop growing all the poppies, to make it lucrative for Afghan farmers to produce actual crops, stuff you can eat.
I read at the time that a hectare of poppies was worth at least 5X as much to the farmer as a hectare of wheat or corn or something else. Also that poppies grow well in that arid terrain, without much water or care, so are far easier to grow.
(Haven’t I read of a connection between Oxycontin and hearing loss ? These drugs are far from benign.)
“Sam Stone’s welcome home didn’t last too long
After serving in the conflict overseas…
There’s a hole in Daddy’s arm where the money goes.
Jesus Christ died for nothin’ I suppose…”
From “Sam Stone” by John Prine
You are suggesting that if “we” bought the drugs then this would reduce the illegal drug market. How so? We will have just increased the aggregate demand. The farmers in Afghanistan are unlikely to say they are rich enough and not plant enough to meet both illegal and illegal markets. Markets are not a fixed cake and no one can corner the market.
Nationwide, the prescription of opioid analgesics has nearly doubled since 1994 because of a greater recognition of the importance of treating pain.
Really ? It’s that responsible ?
I tend to doubt it when there are some physicians’ practices (such as one recently exposed in California) that consist entirely of sitting in the back room and writing prescriptions.
More responsible serial prescribers at least make a passing attempt to actually see the patient, at least once.
The attorney general of Florida is making a valiant attempt to shut down that state’s reputation as a “pill mill”.
Along with unscrupulous everything else, don’t forget about unscrupulous doctors.
Hmmmm, kind of funny, I was reading some historical books and documents earlier this year and I came across the fact that our forebears grew their own drugs for their own usage. I guess back then they should of had an FDA to make sure that drugs available cost 50-100 times what it takes to market them.
Oh well, like Benny always said, it is better to have a totalitarian system than to be free, oh wait.
Completely agree with you David. George Washington and Thomas Jefferson grew hemp cannabis for various uses. Farmers at the time were required to grow hemp. It’s ridiculous that hemp cannabis is demonized by our government, but doctors can write right prescriptions for pharmaceuticals on a continual basis, which ultimately destroy the person. Crony capitalist and politicians once again working together to make huge amounts of money off of our vets. Study why hemp cannabis is illegal today and it will open your eyes a little bit more.
But didn’t you claim in many earlier blog posts that a heroin addiction was trivial and a deliberate lifestyle decision by the patient/criminal, and thus easily dealt with by ‘will power’ and cold turkey, without any need for therapy?
To support you in this, let me say that line of thinking, if you don’t mind me using a professional term, is a load of Horsecrap. Will power. Cold Turkey. I can count on the fingers of one hand, sans thumb, the people I know who have done this. I have dealt with…conservative estimate, 10k Clients in the aforementioned job…do the math as to how successful this method of addiction breaking/relapse prevention is.
Now if you’re talking willpower as meaning “in my head I am now determined to quit,” sure. Whole different thing. You’ll never quit a thing if you’re not first determined in your head to do so. Simple as that. But that’s virtually always with serious relapse prevention, detox, AA, etc. The addiction breeds “familiar” behaviors, and even if you kick the physical habit, the psychological “rut in the path” you’ve developed remains.
Hory Clap, I am officially now PJM’s “Homeless/Social Work World” guy.
What do you guys pay, anyways? Cheese sandwiches?
Allston, RightWingHippychick is right about what Dalrymple has said in past essays. I’ve been reading him for years and distinctly remember him saying that kicking a heroin addiction is NOT the wall-climbing experience that we have seen in TV programs and movies. In fact, I remember him saying that the symptoms are no more dramatic than a mild flu and rarely need close medical supervision. Alcohol addiction, on the other hand, if far more serious in terms of the stress on the patient. Kicking alchol requires close and serious supervision, according to Dalrymple.
I don’t doubt that attitude is the key to all of this: if you want to quit anything, you can and will do so. The problem is that few people want to.
David Simon, in The Corner, the miniseries he did before The Wire, follows the lives of heroin users in Baltimore and has one of his characters explain that the first use of heroin is a staggeringly good experience. Everyone who has had that high is inspired to try it again and again and again in the hopes that they will recapture that first high. A great many destroy themselves in the process.
Dalrymple’s argument regarding Heroin addiction, if I have understood it correctly, is that:
1) The physical symptoms of withdrawal are trivial, and comparable to a common cold. Reports of terrible physical symptoms are usually lies to wrangle another Methadone prescription from a sympathetic doctor.
2) Addiction (psychological addiction, that is) to Heroin is a slow process, usually occurring over a few dozen usages of the drug.
3) Addiction to Heroin usage is usually a result of a life of crime, and not the cause of it.
It does not follow from this that abandoning use of Heroin is an easy endeavor, and Dalrymple does not make this claim. But since the physical symptoms are trivial, it is, in fact, solely a matter of Will.
Unfortunately, the only thing that is new is addiction to synthetic opiates rather than the real thing. Laudenum, opium mixed in alcohol, use and addiction was rampant during and in the aftermath of the US Civil War. Confederate General John Bell Hood had lost both an arm and a leg, had to be tied into his saddle and was addicted to laudenum, which goes far to explain some of his actions around Atlanta. Despite all the “bite the bullet” mythology, chloroform for anesthesia and morphine for pain relief were widely available to the surgeons of both armies and many, many Civil War veterans lived out their days as morphine addicts. A bottle of laudenum for treatment of “female problems” was standard equipment for many women of the Victorian Era both here and in GB.
And you don’t have to be a vet to get opiods thrown at you these days; any old injury or complaint will get the Doc to hand you a scrip for a benzo or an oxy. It’s a wonder we don’t have more addicts and use of these “downers” is rampant amongst younger people. I sustained a calcaneous (heel bone) fracture last August and for awhile needed something stonger than ibuprophen/acetomenaphine painkillers. I had to keep my oxycodone in my gunsafe, because my kid has a sure sense for the shallow end of the gene pool and couldn’t be trusted not to either take them himself or go out and sell them. Oh, and don’t ever break your heel; first thing the ER Doc said was that I’d have been a whole lot better off if I’d just broken my leg. Doc says “with luck” I might be able to wear a normal shoe by late summer – a year after the injury – but I might never be able to. And I had a clean break that didn’t require surgury. The injury is commonly referred to as a “lover’s fracture” because it usually occurs as the result of a fall or jump from a window or balcony – and I don’t even have a good story to go with mine!
“And you don’t have to be a vet to get opiods thrown at you these days; any old injury or complaint will get the Doc to hand you a scrip for a benzo or an oxy.”
Exactly correct.
Mr. Chance, did you become addicted to oxycodone because of your injury? I doubt it, you don’t seem like the type. Like most people.
Questions to Allston, using Mr. Chance’s experience. Hypothetical, but more common than junkieism.
Chance takes his medication and heals, therefore ending his need for in that sense. He takes all of the pills during this time period. Next, a year later, his wife injured, and receives pain medication. His wife offers him a couple (very common) and Chance says sure, I could use some relaxation, and the feeling that comes with the medication. He takes the pills, they have their effect, and the next day Chance thinks nothing of it, besides, it’s time to rag on the Liberals on PJM. The pain subsides for Chance’s wife and several pills are left over. Several months later, Chance has been busting his ass out the yard all day, and is quite sore and tired. He reaches for the ibuprofen/acetomenaphine painkillers, and notices the prescription pain killers. He knows from experience that these will work better right now, so he takes one, and 4 hours later he takes another. Several pills remain.
He leaves it at that and the next day returns to ragging on Liberals on PJM.
The pills remain untouched until….
First, is he addicted?
Second, if so, did he quit cold turkey, more than once?
Third, should he be incarcerated, or in the least enter Allston’s rehab program?
Fourth, could his ragging on Liberals be attributed to his drug use?
No, unlike so many lefty idiots, I’ve never been addicted to any drug to the degree that I couldn’t put it down with a little willpower. The hardest one was nicotine, but I did it after I retired and wasn’t living the “stress junkie” life oppressing the proletariat in their public employee unions. In my working days I had a pretty well developed taste for Chivas Regal, but never to the degree that it interfered with my life and work and there hasn’t been a bottle at home since I retired. I do like my wine still – In Vino Veritas – but I can do without it. In fact, I can do without most anything if I need to; it is a part of growing up and not becoming a lefty idiot.
I’m a child of the ’60s, so to borrow some Jimi Hendrix, I am experienced, but haven’t done that kind of drugs since my ’20s, you have to grow up or you become a lefty idiot. Cocaine was Alaska’s way of telling you you were making too much money back in the Pipeline Era and I dabbled a bit in the drive a red Porsche and wear a gold coke spoon on a chain around your neck lifestyle, but you have to grow up or you become a lefty idiot.
It is beyond my comprehension why people use benzos and oxys recreationally; I can’t stand to take the things, and only took them at night for the first couple of weeks after my injury so I could get some sleep. Then I threw them away so that there was no chance of the kid getting into them and becoming a lefty idiot.
I guess I have a bit of a different view than most, having lived through 23 operations by the time I was 50 (some caused but untreated during my time in the military). Most narcotic analgesics have ZERO effect on my pain, but cause a host of side effects that effect my health and healing in a negative way.
I have four regular doctors that help me manage my health. I’ve been through dozens of lousy M.D.s over the years, but through study and trial and error, have a good team now, all pulling in the same direction.
I’m almost always in that small percentage of patients that have the severe reactions to medications. I’m in the 1%< who have extreme reactions to general anesthesia, so the anesthesiologist who is assigned to me while having surgery not only has to really know what he is doing, but has to be at the top of his game that day.
Because of how difficult I can be, I try to get a consensus between my team and me before proceeding with something like surgery.
This last bought of surgery in December, all four doctors agreed that I should have both front and rear procedures done at the same time. It was the least bad of the evil I was going to have to suffer through.
I was using a new neuro-surgeon. We had discussed and came to an understanding of my medical needs during the pre-preop appointment, he even called me at home and talked to me twice about it (it was my neck, in some potentially risky positions). He offered doing the anterior and posterior (front and back) at the same time, but would prefer to do one, then come back and do the other…I told him in my final pre-op that I would prefer he do both concurrently,
He acted irritated, but agreed.
The morning of my 9 hour procedure, we talked about everything again, including the post operative pain management. IE, the script he was going to provide me after my 5 days in the hospital.
I awoke from the surgery, my anesthesia was mismanaged so I was violently ill for 24 hours, and unable to swallow to boot (a really bad combination). When the anesthesia wore off, I was introduced to severe, post operative pain. It would not let up. The intensive care ward nurse came in on day two and introduced herself, verbatim: "Hi, I'm the ward nurse. Are you just very tired (I was) or is that the way you "think" someone in a lot of pain should look like?"
Day five, my surgeon shows up acting like a petulant child. He drops a script for the staff infection they gave me (thank you…I had a temp of almost 102), a muscle relaxer that I had previously told him was ineffective and that was it. He turned and walked out of the room. When I barked at him about a script for the pain medication (we had talked and agreed upon), he turned and told me "We discussed that, and we think if you need pain management, you should go see your "team" about that". Then he left.
This was right near Christmas. Generally, all my doctors were on holiday.
It turned out that one wasn't, happened to be working in his office, and wrote me a script.
The problem here (of which there are many), is that the FDA has got these doctors practices scared to death of being audited and fined. You get a guy like me who is a difficult case (You can't just phone my pain meds in), and these practices are terrified to take a chance on coming under the scrutiny of some over ambitious government bureaucrat looking to make a name for him/herself under the guise of "protecting" the great unwashed.
Just my .02 cents.
Sounds like it’s a good move to have the prescription (and resulting meds) in place before giving them your business.
And for added security a written agreement to ensure the nurse applies the prescribed painkillers in a timely and appropriate manner.
Humans in general are addicted to being as pain-free as possible…
As an aside, I know of nobody who does not reach for the paracetamol when they have a blinding headache, despite paracetamol killing lots of people due to misuse.
Yeah, acetaminophen over-dosage is the leading cause of liver failure in the US.
And I had to look up what you were talking about, calling it paracetamol. You’re not from around here
I learned something today.
I have first hand knowledge of that liver failure from using too much Tylenol. I am allergic to Motrin, and it was the only thing they offered me in the Marines. I took Tylenol, not knowing the side effects. I would take 5 500MG doses several times a day. I have migraine headaches, the Tylenol did nothing for me, so I stopped after a few tries to get rid of the pain. But the damage was already done. Doctors who are unwilling to prescribe proper pain killers probably force many people into situations like mine, and many, like me do stupid stuff. I get Vicodin now, it takes the pain down about 3 steps, but it takes an act of congress to get the pills.
OK doctor.
What is the best alternative, other than not treating pain and suffering?
The benefits and negative consequences of opioid treatment are well known and old as recorded medicine. This is not the result of misinformation. Opioids still have a useful function and you present no evidence that they are over prescribed.
Patients with PTSD are at higher risk for many comorbid conditions. It is no suprise that adverse outcome secondary to opioid use are among those.
Yeah, we should prescribe things properly. Now why exactly are you trying to make an argument that will prevent doctors from making the right choices. I know I know, you are arguing that you are trying to help them make the right choices, but when the ends are weighed, what you are trying to do is force doctors to cut back on prescribing pain medications for people who are suffering, PAIN. It is already hard enough for people with chronic pain, like myself, to get the drugs we need in order to live a reasonably close semblance of a normal life. As with all things, abuse is up to the person, even for addictive items. it is called personal accountability and personal choice. Here the choice has to be made between a doctor with medical training and a patient with varying levels of pain. Next you will be calling for there to be a LAW! cause you are totally about people’s individual liberty.
The cost of post-combat drug addiction is another one of those budget items the neocons didn’t tell us about when they were cooking up these stupid wars in 2002 and telling us they would pay for themselves.
All I can say is that all the other VA facilities must be a heck of a lot laxer with any painkiller than the one I use. They think a 500mg Tylenol is the hydrogen bomb of pain relievers.
Joe, I am going to guess that you’re white, cleancut, and work for a living?
That’s another thing I have noticed about the VA system. The more you present yourself as down on your luck/scruffy – and particularly if you’re an “ethnic” – the more likely you are to get good treatment, have your disabling conditions taken seriously, and be rated as disabled.
God help me, but this is the truth.
Really? Really?
Let me see. I constantly read about how easy it is to get prescriptions for ms-contin & percocet. Constantly read about it, with read being the operative word, because while we PCS-ed all over the US, I’ve never actually witnessed it.
What I have witnessed is doctors afraid that they’ll get their ticket pulled b/c they’re taking on a new chronic pain patient and they’ll suddenly have to write regular scripts for pain meds… and in many places it takes at least a year, and as many as 3 to get into a pain clinic ― if they’re accepting new patients… a big “if”.
I haven’t seen these doctors with itchy pain med prescription pads.. where are they hiding? My wife’d like to know,too. When I asked about it she thought I was being sarcastic.
My wife, since retiring from AD, and wanting to help other Vets, is now head RN in a VA clinic… and she’s told me she doesn’t see Dr.s loose with pain meds.
What she has witnessed are variations on this theme: a Dr. leaves, (often w/o warning, btw…) and those pain patients enpanelled[sp?] (assigned) to that Dr., are re-assigned to another while the clinic tries to get a replacement for the Dr. who bolted. All well & vood so far, right?
The chronic pain patient though ― who, more often than not, has been faithful to the pain medication contract they signed, receiveas nice “surprise” when they come to their mandatory monthly pain med renewal appointment.
The new doctor often give some spiel that boils down to the new Doctor assigned refusing to continue the treatment that the patient signed the pain med contract for any saying “sorry, you have to get re-assessed by the pain clinic/specialist before I’ll prescribe your monthly renewal ― yes, I know you had an assessment 3 mo. ago, but that wasn’t for me.” AND it’s a 3-6mo. wait for pain clinic re-assessment. Most these vets have been stable on their pain med regiment for extended periods of time. There have been quite a few times the doctor tried to palm it off a psych eval – even when the pain was purely physical in origin. To their credit, the psych unit doctors will often represcribe the pain meds, but kick the case back saying that opiates for used for physically based pain are theirs to prescribe under protocol… which both sets of doctirs know.
Often, psych will just refuse to see the Vet, standing on protocol.
So then, a nurse, if she cares about the Vet, will start “climbing the ladder”, trying to pester a bureaucrat to interceed and force the VA (and the doctors they employ) to follow their own protocols, and continue the monthly pain meds until the Vet can get into a pain clinic.
The number of hrs my wife’s there “after” work, trying to help & get help for these poor souls… and she does it b/c she knows how difficult things can get…
Because I am a chronic pain patient. I’ve tried TENS units, surgery, everything & anything so I don’t have to take percocet & ms-contin ― though I’ve not asked for the dosage to be increased in 10yrs, instead I live at a pain level 6 on good days and 9 on less good ones. I have idiopathic neuropathy. 30% of my left side has no feeling, and the right side “lets me know its alive”, as one commenter put it. The pain is akin to standing in a bucket of boiling water, and w/o the meds I writhe in agony. Constant agony.
I remember at one posting, I expressed a concern that they get my pain meds correct… the actual thrust of my question was that I did not want to change from an SR (slow release) to an IR (intermediate release) because of the increased sedation effect. The idiot put in my file that I was “a drug seeker” ― b/c I didn’t just sign off.
Yes, I seek to stop pain, or even just mute it! I see a lot of Progressive-like “we know what’s good for you! And you’ll listen b/c we’re smarter than you opiate addicted morons!”
Well, go stand, or put your arm, or groin, in boiling water for 15 minutes. Then we’ll talk about you knowing what’s in my best interest…
After all, pain is how you know you’re alive, right?
Please see my response to “Joe,” above. The system is capricious and arbitrary. And yes, there are numerous who have to practically pull teeth to get pain relief from the VA; others walk in and right back out with it.
Fwiw, what taught me to deal with my pain without medications is that I have always fallen into that category myself, that of not even being offered care for it. Including periods where my own disabling condition prevented me from even being able to walk; still not offered.
I can only tell you what I have experienced and observed on the job, but that does involves (as mentioned) thousands of Veterans within the system. I suspect I have a larger baseline on which to base my opinions than most.
I became addicted after a broken arm/torn rotator cuff surgery. I am almost elderly, was in extreme pain and I was taking 80-100 mg of hydrocodone per day. I continued to teach and work 10 days after surgery. If not for the pain meds, I could not have. The physical therapy was very painful and I probably could’ve waited to begin, as I am a slow healer.
Bottom line – I was addicted and didn’t realize it for four months. Had no idea, as I was treating real pain. The dr. lowered the dose from 10 mg to 7.5 and I went into withdrawal immediately. I researched and realized what was going on. The pain localized in my lower back…I went to work and spent days teaching, bent over a table…went home and paced…restless leg syndrome.
It was the most horrible experience of my life. I had no resources, no treatment centers around, no drugs to help…cold turkey as an old woman.
People become addicted without meaning to…and there are few resources to help them through it. I can see how they remain addicted or fail to get through the withdrawals. Good luck to those who suffer…you can do it. This old lady did.
The VA Health Care system cannot handle the care for the traumas brought on by war. They do what they can for the blunt force trauma and loss of limbs. But for everything else they only take care of the symptoms. So over using addictive drugs to make the pain go away in a soldier is accepted therapy.
We drugged the Vietnam veterans and look what it did to them. And we are on the way to drugging our kids who fought in these past two wars.
I cry inside everytime I see one of these young men who have had their live irreparably ruined.
Blotto,
I’m a VA patient, and generally am pretty happy w/ VA care, though it’s gotten really crowded since ’96, when Clinton opened care to non-service connected vets. They do well with common problems, but like any bureaucracy, they have an awful time dealing with the unusual. Overall, they are as good as civilian hospitals, which have bureaucracies, too, and also schedule far more patients than a doctor can reasonably give first class treatment to in a day. Still all about $, and will get worse as us boomers retire in droves.
As far as the main subject of the article, my own experience is that the VA docs are pretty careful with the pain relievers. Don’t expect a refill before it is due. They may be a little too careful in cases where serious, chronic pain is involved, from what I’ve seen from the problems a VN Marine I know goes through. And there’s very little appeal from an individual doc’s or pin-headed administrator’s decision.
I suggest that the problems reported by the author have more to do with the combinations of PTSD and chronic pain from wounds, and of alcohol and pain relievers- self medicating with booze for PTSD while taking the pain pills.
I’m afraid that the effectiveness of other meds for PTSD may be less than they ought to be, and of course, they, too, shouldn’t be mixed with booze and probably not opioids (sp?). These folks coming home from three, four or five tours, and serious injury at the end, face problems we one tour VN vets in the same MOS’s mostly didn’t have to deal with- some surely did, but that was rarer, I think, than it is with the current class of vets.
God Bless ‘em All!, and help us to live up to the promises we as a Nation made them!
“I look forward to a reproduction of this study among ex-Taliban fighters.”
Considering it was their bosses that grew the stuff…
Oh, that’s right. The ex-Taliban are, uh, “not available for comment.”
I work in a public hospital and we take care of military, medicare/medicaid, prisoners, indigent and working poor. I am very sensitive to those who live with chronic pain as I do so myself. Drug seekers and many genuine sufferers very often act exactly the same: They bark at you and demand drugs. All day long I have people who check in with very minor issues that demand heavy narcotics immediately. I think this is more a reflection of the extra-medical availability of narcotics than anything else. I have patients throw prescriptions at me, spit at me, curse and scream so loud security comes on their own and I have had patients throw punches. All freakin day long. I have to follow our policies or I get reamed by my superiors and the DEA. If you have a broken leg or renal stones you get lortabs or similar and if you have cancer and are already on mscontin you get more. These are not just rules I developed in med school but actual guidelines my bosses demand I follow.
If you check in to my ER, costing +$600 just to be there, demand free care and start off by telling me what I have to prescribe for you chances are I’m not giving you what you want but only what is medically indicated and appropriate and if you are a complete jerk you may get treated with a minimum of respect. If you are complaining of back pain, say you are out of drugs and a plain film shows mild degenerative problems I’m not going to refill your 90 lortabs and soma you just got from someone else; if I find a real issue you get a refill for enough until you see your regular doc. That is just the way it is. I don’t have time to argue, I don’t have your full history and I am not your regular doc. If you can convince me in a very reasonable way (why I need to defend my performance and my job for you and) that I am not meeting your pain needs when I don’t see an objective reason to, I’m open to the discussion and I have changed my mind many times.
Just so you know.
My wife was in the hospital for a hip replacement a couple of months ago. She was given a script for Percoset to manage post-op pain and some back pain that was generated by the procedure. Took them for about two and a half weeks.
Bam, withdrawl, physicological and psychological. We had NO IDEA how quickly this junk can hook someone. Scary as all get out.
Ever heard of Methadone?
I think the busybodies so concerned with the addition many chronic pain sufferers endure should walk a mile in their shoes. Getting pain medication for my wife who suffers from chronic rheumatoid arthritis many times requires a doctor’s visit for each refill ($75 dollar doctor visit on top of the $10 prescription). This poor soul does not feel like walking across the floor, much less going back and forth to the doc every 30 days. Do you suppose the totalitarians who enact these rules suffer the consequences of their meddling? No, they get whatever they want. If only people could learn to quit carrying the dog by the ears, and mind their OWN business, we might be able to return to some semblance of what was at one time a free country!
Addiction is a terrible thing, but busybodies who are not in pain should leave these decisions to the patients and their doctors. Someone with inoperable cancer who have a short time to live are usually not that concerned with the possibility of addition. At least the suffering may be somewhat abated in the time they have left.
So, no, I will not join in your jihad against those who suffer. We all know the lawbreakers will get their dope anyway. Nanny state issues should be left to the commies and fascist, not defenders of liberty.
If we are going to complain about schedule II controlled substance scripts we should talk about uppers, not opiates. There are a few doctors running pill mills in a few states with lax laws where most of the OC’s, percocet, opana etc. on the street is coming from. For most people with genuine conditions they either have to jump through hoops to get their medicine due to DEA and state laws or end up stuck in excruciating pain if they can’t get a prescription. “Anti-abuse” CIII meds like tylenol 4 or vicodin/percocet are worse for both pain patients and drug abusers than slow release OxyContin, methadone etc. When you’re in constant pain which your monthly lortab script isn’t dealing with any more, and your doc refuses you a CII med to avoid all the paperwork and “abuse risks”, you can easily end up taking more tablets. Which means more APAP, and more liver damage. APAP overdoses are far more horrible than opioid overdose and less easy to reverse. Narcan shot does the trick for a straight OD, no stomach pump required. As for abusers someone on 240/mo vicodin is more likely to sell their script than 10 fent patches or 60 OC’s/mo and many of them are not so careful what they put into their bodies in search of a high. Which causes the same problem.
I am diagnosed ADD and prescribed amphetamines myself. I was diagnosed by three psychs and it was not until I reached the age of 18 and got my third diagnosis that I was prescribed anything. The doc wanted to give me Rits at the age of five or six and my parents insisted no child that young should be on speed. The side effects and the idea of a boy growing up to think pills are the answer to difficulties are what fazed them- not the addiction potential. I obviously know that these drugs are necessary then and the people who deny attention deficit disorder ignore a pile of evidence. The number of scripts for stimulants are about 10-20 times higher per capita than Europe, however. It just happens in the nation with the biggest drug profits, highest level of physician bonuses and DTC advertising we have millions of youth on speed. The percentage could be cut some.