How Doctors Turn Their Patients into Drug Addicts
When I was a young doctor, which is now a long time ago, patients who were close to death were often denied drugs like morphine for fear of turning them into addicts during their last weeks of earthly existence. This was both absurd and cruel; but nowadays we have gone to the opposite extreme. We dish out addictive painkillers as if we were doling out candy at a children’s party, with the result that there are now hundreds of thousands if not millions of iatrogenic — that is to say, medically created — addicts.
An editorial in the New England Journal of Medicine asks why this change happened, and provides at least two possible answers.
The first is that there has been a sea change in medical and social sensibility. Nowadays, doctors feel constrained to take patients at their word: a patient is in pain if he says he is because he is supposedly the best authority on his own state of mind and the sensations that he feels. This certainly meant that at the hospital where I worked you could see patients, allegedly with severe and incapacitating back pain, skipping up the stairs and returning with their prescriptions for the strongest analgesics to treat their supposed pain. In the new dispensation, doctors were professionally bound to believe what the patients said, not what they observed them doing.
The automatic credence placed in what a patient says — or credulity, if you prefer — is deemed inherently more sympathetic than a certain critical or questioning attitude towards it. And since it is now possible, indeed normal, for patients to report on doctors adversely and very publicly via the internet and other electronic media, doctors find themselves in a situation in which they must do what patients want or have their reputations publicly ruined. When in doubt, then, prescribe.
Perhaps this is insensitive of me. Is fibromyalgia overdiagnosed? It seems to be the go to disease for drug seekers.
I have been prescribed painkillers a few times. I can see how they could be addictive. They really do feel nice. On the flip side, there are those occasional headaches or whatever that Tylenol or Advil just don’t touch. For these rare situations, it would be nice to be allowed something like 10 pills per year to use at your own discretion.
I’ve often thought that dietary intolerances should be completely ruled out before diagnoses like these are made. Maybe they are, but I doubt it.
For those headaches I suggest you try Ben-Gay applied to your neck, forehead, and temples. If you don’t like the smell of methyl salicylate (wintergreen) then just use an aspirin cream instead, although it’s not quite as strong it does work.
Gets to the pain fast.
When I entered the engineering field thirty years ago, the plant dispensary issued pharmaceutical travel kits to those of us going to third world sites. Contents included a broad range of narcotics and antibiotics in addition to various prescription treatments and remedies. We were treated as, and behaved as, adults.
The doctor’s unwillingness to withhold deadly narcotics from addicts to avoid unpleasant scenes is indicative of the culture in general, where “adults” are becoming an endangered species due to a government hell bent on being the only adult in the room full of dependent children. Dependant on what matters not to them, as long as is not dependent on self.
When I was 10 years old, I had my appendix out. They prescribed half doses of some pain killer for me. I remember the pain of the scar being tugged at and hurting. Then I took one of the half-doses and I couldn’t feel a thing. To most people, that would have been just fine. But to my 10 year old mind, it was scary.
Ever since then, I have had a healthy respect for pain killers but also a healthy respect for the dangers.
That’s how I look at it, too. Acute surgical pain (like appendicitis surgery) isn’t usually how people get hooked, but it is how people find out about the incredible power of these drugs. For some people, it engenders respect for the drugs, but for others it attracts them. Strongly.
Chronic pain leads to even worse situations. I know medical colleagues who aren’t as wise as you, and have gotten hooked, (and, gratefully, rehabbed) due to stuff like hip pain they couldn’t take a few months off to treat. Especially since I have a condition that leads to chronic pain, I stay away from these, even though my doctor also hands them out like candy.
I’ve had surgery twice. Both times, the painkillers really didn’t take away my pain, I still hurt but I didn’t care. I quit them after a day and just used ibuprofen. I’m due to have a wisdom tooth out and will do the same thing.
I’ve got a friend who is on a LOT of painkillers. It’s ruined him. His health is still bad and he still has pain, poor guy.
1) You are aware the painkillers aren’t supposed to address his bad health?
2) If he isn’t taking more then he needs, or even if he is and he’s a functional addict, who cares? That’s his business, law enforcement should not be involved in it until and unless he commits a crime against someone person or property, and the drug use is involved.
The bigger problem by far is the DEA putting doctors in jail for treating their patient’s pain. Dr. Dalrymple seems to under the delusion pain is commonly treated appropriately in this country.
Same thing for me after shoulder surgery. The pain pills didn’t seem to help very much, but they kept me somewhere between the ability to get normal sleep and the desire to do very much. One day of that and I was asking my Dr. how to safely dispose of the rest of the bottle.
Because of a little fender bender I’ve had 7 operations. Everytime I get pain killers, I’ve never had a high feeling, I get sleepy or nausea (Dramamine helps). It’s not surgical pain or a broken bone that causes the problems but soft tissue injury. You can’t really see them on an X-ray,and unlike a break which heals in a linear fashion, soft tissue injury doesn’t follow a linear path & can take 2-3 times the time of a bone to heal. It seems that there really isn’t a middle route for drugs. There’s aspirin, amped up aspirin and narcotics. I always asked why doesn’t the meds numb the pain instead of making me through up. No answer. The last time I had surgery on my foot the dr insterted a catheter behind my knee that provided the numbness and pain relief that I was looking for but not every dr is willing to work with a patient.
I started getting migraine when I was just in grade school. By the time I was formally diagnosed with it, the go-to solution was to prescribe a narcotic painkiller. By the time I was in junior high, I was routinely taking prescription-grade narcotic painkillers at least once every month to month and a half, and as I got older the frequency only increased. I also have the sort of physiology that gains tolerance to such things rapidly. By the time I was in high school, I was popping pills like a seasoned pro. They had all the effect of candy. I had already completely exhausted the effectiveness of one type and moved on to a stronger one.
“Fortunely” for me, I was saved from addiction by a quirk of my migraine disease, out of all migraine patients, roughly 10% of us develop what is called chronic migraine. That means that our bodies’ reponse to painkillers is to create more of the condition that prompted the drug in the first place. So, taking narcotics to get rid of the migraine only made my body lock into the pain cycle to get more drugs. I guess you could say I was addicted in a way, but it was in a way that made it completely easy to never want to take another painkiller ever again.
I’ve spent over five years working with a neurologist on identifying triggers and finding other medications that control my migraines. Now, I have migraines like a normal migraine sufferer again, which is to say one episode every couple of months or so. However, he has my painkillers strictly rationed even down to things like aspirin and Tylenol – no more than five doses in any month for any reason, unless I have a major need like a surgery or something similar because it could be like falling off the wagon and starting the chronic migraine cycle up again.
As a result of this, I have a healthy respect for painkillers, and I’ve learned how to simply live with pain when necessary. Trust me, better living with relatively minor aches and pains than the agony of migraine an average of two days out of every three. The really scary thing about it all? Thanks to my prescription pill-popping youth, I don’t notice the effects of morphine and demerol even though I haven’t had them. They do dull pain, but I don’t feel the side effects, or high.
Sounds like you got appropriate individual care. That’s harder to do than to say, “Painkillers are over-prescribed, we need to not stand there and just do something about it!”
I do not see in Dr. Dalrymple’s post a recognition that individual characteristics as they are observed should dominate medical care.
The best thing a doctor facing a chronic pain patient can possibly do is to have the office number of a pain specialist at their fingertips. That kind of referral can be lifesaving for the patient and sanity-saving for the doctor. And God bless the doctors who treat people with that kind of problem.
Yet only a few years ago, the problem regarding painkillers was that doctors were being too stringent about them — that it was getting harder and harder to convince a DEA-phobic doctor to prescribe them. If the pendulum has swung that dramatically toward the other extreme, what has changed to make it do so?
Fortunately (?) the issue doesn’t arise for me. Except for Ibuprophen, all the known painkillers make me violently ill, so when I’m in pain, I face a choice of torments — and enduring the pain isn’t just safer, it’s also cheaper and less messy. Not a big win, but still…
I remember that well. Mid to late 90′s. I was having these discussions at work and all the sensitive liberals were talking about all the untreated pain out in the world and oh, why won’t we just let patients take more drugs. Reminds me of the other 90′s topics of how low-income people and those in red-lined neighborhoods couldn’t get home loans. Interesting how all this stuff works out.
Personally I just eat my daily 40g of dark chocolate and I never need medical care.
This article would have been more appropriate even just 6 months ago. The current pressure on opiate prescribers by the DEA is almost indescribably severe. As a libertarian it galls me to see some special agents in Washington with an accounting or law enforcement degree inserting themselves into the decisions Dr.s make in consultation with their patients. As a chronic pain patient, my attitude is that far too few folks understand the unique relief that modern pain medication provides. There really is no second line treatment for many of these conditions. Shouldn’t these decisions by made medically and not as part of social policy?
As a doc in the southeast, I am acutely aware of the undesired attention from the DEA and state prescribing authorities that is drawn by trying to take patients at their word and trying to prescribe pain meds liberally. The result here is that I’m sure many patients in chronic pain are not treated adequately due to fear of official reprimand or loss of licensure. I’m glad there are pain specialists out there, but I can’t fathom the type of risk they run of drawing the attention for the Drug Control Regime.
Umm, not quite on the mark.
I work in the Social Services and, as such, deal with numerous clients who have many acute issues with their health. I also have direct healthcare experience.
Since “Capitation” of the late 80s/early 90s (the first major attempt to gain control of costs that were constantly increasing), the push in healthcare has been to cycle the patient in and out of the doctor’s office as fast as possible. They began to try to maximize number of people the doctor sees in an average day (plus of course these are billable hours).
Throwing a medication at the patient has become their almost a reflex. “Here’s a pill for what ails ya.” It’s the fastest, easiest response for most ailments.
I have literally seen a client begin to be seen by a physician and at that time are on no medications. Within six months, some of them end up on dozens, with all of the consequences mentioned in the article. Many of them become very dysfunctional in short order. And the doctor’s response to this? Throw another medication at them, or, at best, “adjust” the one’s they’re now taking.
Fast. Efficient. Over-medicated.
Welcome to modern healthcare.
Ungrammatical. Apologies.
(We really need a functional edit fu8nction here, and a “like” button would be great too, please)
The very ugly secret, Tramadol is addicting, even in low doses (25 & 50mg), and within a short period of time. It also has some anti-depressant (Selective serotonin re-up-take inhibitors or SSRI) properties as well.
I was prescribed tramadol (50mg) for a broken ankle, for a couple days took it both day and night, and then for another 6 weeks, just at night before sleep. As the daytime pain lessen (I was only taking OTC ibuprofen) I wanted to stop the tramadol at night.
I was NOT in the severe pain that I had in the first few days after I broke my ankle. I needed to get back to my life. Over a week of being in bed, getting up being a laborious process, done only when needed and the side effects … I think I watched a bunch of movies that my husband set up for me, but the days merged and I don’t remember much at all.
I was in bed too much and needed to get back to “normal,” it was hard. Although I was not hurting as much, I was so very tired and apathetic about every thing, so it was time to ween off. I discussed it with my physician and he was not concerned about addiction, because it was a low dose and I had been on it for only 6 weeks.
I had a seriously disturbed night the first night. I called the practice and talked with another physician (mine was off) about it and he wanted me to come in and get another prescription! I was not “out” I wanted to stop. He did not understand. I did a second night without, and although I KNEW if I only took one small pill it would stop. I did not. The second night was hard, but the third and fourth nights, no problems.
It was only AFTERWARDS and talking about it with a pharmacist that I found out how addictive it is, even at low doses.
I actually have a new understanding about how people can get “hooked” on prescription drugs and just how life altering they can be. That can make them very attractive to any number of people.
I have a bad back and sciatica. I good day is a pain level below 5. Advil, believe it or not, helps quite a lot, but I take more than the bottle recommends. I also have a prescription for 20mg Vicodin and they work quite nicely. Too nicely. I allow myself two, sometimes three Vicodin’s during an average week, always one on Saturday and one during the middle of the week. My greatest fear is addiction and, worse, having doctors refuse pain killers AFTER they’ve helped create the addiction. I fear giving control to others who have no real concern for my well being. As long as I can look forward to a few hours a week without pain, then I’m fairly happy. I have a high tolerance for pain so such a regimen might not work for others with REAL pain. I’m also retired so I don’t have to go to work in pain.
A doctor may face malpractice lawsuits for not prescribing a common “cure”.
Absolutely True! Lots of criticism will come to a doctor from all sides if he or she is unwilling to write Vicodin for everyone. Our 4% of the worlds population consumes 80% of all the narcotics last article I saw. #9 I have not seen much addiction to Tramadol because it does not give euphoria. It is however, an SSRI like drug and all of the SSRI’s affect personality, and have withdrawal symptoms. In that sense they may be habit forming for those who take them regularly in the same way Zoloft, or Cymbalta or Paxil have withdrawal symptoms.
Our country is in the middle of an addiction epidemic driven by education paid for by the manufacturers of Pain meds and by the increasingly drug friendly mentality of our people. The idea that no one should suffer pain is not balanced against the considerable risks associated with addiction to Narcotics.
I’d like to know where these overprescribing doctors practice. Mine refuses to offer anything but ibuprofen, which I can’t take because I already take a related medication for a chronic inflammatory condition. Recently I pulled a hamstring and was in quite a bit of pain. All I wanted was maybe 5-19 Vicodin to get through the week, but he wouldn’t even consider it. Then he informed me that a hamstring injury can take MONTHS to heal. I did two sessions with a physical therapist, which didn’t help much. I resent being treated like a drug addict and I will be looking for a new doctor.
I use fairly (for most) potent stuff for l4-l5 and l5-c1 disc damage, I also have a high tolerance which causes disbelief and issues.
the dr and I spent a lot of time dealing with meds, we often erred (at my insistence )on the side of me going without.
been many times I have requested a cut in either dosage or mg to test myself.
theres no one answer that fits everyone, and there needs to be a trusting relationship between the dr and patient. there have been times I had meds stolen, so I had to go w/o for almost 2 weeks. it sucked but nothing said life should be easy. the dr had little choice there, was nothing he could do but he did check in on me a few times during that.
there are people out there gaming the system just to get euphoric feeling.
meds do not do that for me, they just give a reduction in the pain.
these people hurt others by doing that.
I do also have 2 busted up knees from army, bone anchors holding right shoulder together which scrape the tendons, tendonitis in both shoulders as well as fibromyalgia being diagnosed early in the early 90′s.
I never used medication (except for the surgeries) for these.
#10
same, l4-l5 and l5-c1 tears/holes
sciatica in both legs and hypersensitivity from hips down…more pronounced on left side but (if you get my drift) it affects everything…
I use the scale where 10 is me passing out from pain which happens.
a good day is (with medication) a 6.5 to 7.5
I dislike needing meds and use them as a tool. I get no good feeling from them.
I am a control freak and really hate using them.
I joke about using them but thats to mask my disgust,
I had a really bad experience with painkillers after my wisdom teeth were removed. Those were some miserable days and I’ll leave it at that. Since then I have been prescribed some pretty strong stuff a few times but I took over the counter meds first. Fortunately they have worked. Repeating that experience wouldn’t be fun.
There’s also another point here. Doctors will often prescribe medicines and try to force patients to stay on them even though they create harmful side effects. If such effects are reported they may try a different drug or they will prescribe another drug to treat the side effects of the first, which usually causes MORE side effects and the cycle repeats. Who really knows what all these drugs are doing to people.
I had all four of my wisdom teeth removed in boot-camp (1980).
I got 8 tylenol and a 1/2 day bed-rest chit.
Truthfully, that’s all I needed.
That probably would have done for me as well.
Obamacare will fix all this over-prescription of pain killers.
For those of us who are military vets, we know first-hand how Uncle Sam does medical care i.e. the cheapest way possible.
There are “pain clinics” throughout this country which specialize in turning normal people with pain into drug addicts. I know this from personal experience.
My wife had two abdominal surgeries 7 years ago which resulted in a very painful condition in the ensuing weeks. Her surgeon, doubtless because it was the easiest way to deal with it, referred her to a pain clinic which has turned out to be nothing more than a legal drug pushing operation. She has been regularly visiting this pain clinic for 7 years and has been on oxicodone, oxicotin, and methadone in a continuous ever since. She has had no followup diagnosis to speak of, no counseling or any other medical treatment. She is pretty much given whatever she asks them for.
As far as I’m concerned, these scumbag pushers have turned my wife into an opiate addict and have no intention of doing anything to rehabilitate her. This woman who was once a very successful banker and a vibrant personality is now a barely functioning drug addict who has four basic modes of life: drugged up, sleeping, sick or bitchy. None of her other medical problems (and there are many) are being taken into consideration by the pain clinic doctors. She hands over her insurance card and her co-payment and walks out with a prescription for another 30 days of zombie-like stupor.
Pain killers have a place in medicine. They should not be a medical business unto themselves, particularly when such businesses attract unscrupulous doctors who care more about accumulation of wealth than the well being of their patients.
I can’t do much about my wife’s situation while she is alive as she is regarded as a functioning, competent adult who is entitled to make her own decisions. When she dies, which unfortunately will be sooner than later, I intend to go after those bastards who destroyed her life for every penny they have.
I would rather 100 people get pills they don’t “need” than one person be denied it who needs it. I don’t think it’s anyone else’s business what I chose to put in my body, personally, unless I cause a danger to others.
Fybromyalgia does exist and so do plenty of other chronic pain diseases. I have had periods in my life when my entire body felt like I had been beaten with a bat. For weeks on end. For no discernable reason. I’ve never been diagnosed with anything and I won’t even ask for pain meds when I REALLY need them because in the past I have been treated like a drug seeker for asking. For no reason. A person with no history of asking for pain meds prior to this is NOT a drug seeker, people!
People who need glasses to function aren’t addicted to their glasses. People who need pain management to live a decent life aren’t addicted, either. Theya re merely using a tool of modern life to improve their lives.
I wouldn’t tell anybody about those 100 pills you don’t need.
One of the scary things about the extent of the addiction to pain killers is the number of people who will break in to steal them from people they learn have any of the conditions for which painkillers are commonly prescribed. When I was hobbling around on a walker with a broken leg I was astounded by how many questions I got about what I was taking for the pain. Addiction to prescription painkillers is a huge problem near me and I was very careful to let people know I hadn’t taken any after the first three days and had disposed of the remainder of them.
I watched addiction to painkillers destroy a neighbor’s wife and hook one of his daughters.
We’ve got one painkiller that is very effective for a lot of people, physically addictive for very few, cheap, and easy to come by. Sounds like a dream, right? Yeah, that would be why it wasn’t mentioned here. The answer to a lot (not all, but a lot) of the painkiller problem is medical cannabis. Thousands, probably millions, of people in this country use it successfully, some with the blessing of their state gov’ts, despite what the feds think, others without even that. In states where it IS legal, there is an emerging supply and demand system that is an amazing thing to see. People are even breeding different strains that work best for different problems.
My husband fell on ice a few years ago and hurt his back, and he’s had problems ever since. He won’t take prescription painkillers for all the reasons mentioned by many of you. Weed, however, takes away the pain and lets him be up and doing. And choosing the variety carefully maximizes painkilling while minimizing the psychological effects (being “stoned”). But cannabis makes no money for pharma companies and fedgov itself holds the patent on its medical use (while simultaneously continuing to claim in the face of mounting evidence, that it has none). Time for our gov’t to admit that it can’t afford to keep up the miserably failed drug war…by which our gov’t directly and indirectly finances mayhem, murder, and all manner of other crime, in this country and many others.
I’m glad pot helps him. I wanted badly for it to help my bone pain (from cancer) because I was also on chemo which made me very nauseous and then the pain killers they gave me were opioid analgesics (OraMorph) which also cause nausea (not to mention constipation, ugh). The pot helped my chemo nausea even better than prescription anti-emetics, and for longer, but did nothing for the pain.
If people find that pot helps their pain though they should be able to have it, it CAN’T be worse for them than opioids, those are some nasty drugs with a LOT of side effects.
This is similar to a problem I have as the owner of an automotive repair shop. Very often I get a customer that comes in with a problem that requires very little labor and no room for mark up on the parts charge. My minimum labor is 1/2 hour, but that barely covers the time it takes to put a car on the lift. Throw in the paperwork, cost of garage space, talking to the customer, etc. and I lose money. So I usually tell these people they need something where I make more money — like a trans. rebuild or major engine work.
It’s easier that way, and I make more money. After all, I am not in this to help people, but to sell. If anyone ever complains, I either blame it on unfair competition (the body shop owner across the street just bought a boat!) or on my parts distributor since they require me to meet certain monthly minimums to qualify for the discounts i need to make a profit.
Working backwards the root causes become apparent. Doctors prescribe to save time. They feel the need to save time because they must see more patients to remain profitable. They must see more patients because insurance reimbursement rates are constantly falling. Rates fall because insurance companies are being charged more. They are charged more because Medicare and Medicaid rates are below market value, driving costs to the private sector. Medicare and Medicaid are financed by the federal government.
Going down another road…doctors see more patients because doctors are in short supply. They are in short supply because medical school is expensive. Medical school is expensive because colleges receive free money in the form of student loans. Banks give out student loan funds like candy because the federal government absolves them of any financial responsibility to lend irresponsibly.
I could also go down a third route involving medical malpractice, but I think we know where all these paths begin. Government intervention in the free market. Funny how that works, isn’t it?
As a retired physician, I have multiple perspectives on this issue.
While in practice, I found that few patients were adequately medicated for postoperative pain (I am a surgeon) because of longstanding prejudices of nursing personnel, who would find any excuse to avoid administering narcotics. To achieve adequate analgesia for my patients, I had to remove nurses’ discretion. The advent of Patient Controlled Analgesia (PCA) permitted patients to decide on their narcotic dosage, which was self-limited by the effects of the drugs themselves, and most used less, with greater pain relief, that if someone else had regulated their dosage. Even then, nurses had to learn that they would face my wrath, if I found that a patient had suffered all night, from an inadequate dosage of medication.
I have also practiced, in the past, addiction medicine as a sideline, for several years, and have extensive experience and observation of the nature and consequences of addiction. There is no question in my mind that addiction is a form of disease, and that those physicians who sneer at this concept do so out of willful ignorance, rather than careful scientific observation and compassionate understanding.
I was myself forced to retire from practice for painful physical reasons. I now take multiple medications for relief, including narcotic analgesics on a daily basis. I am not physically dependent, in the sense that I do not experience withdrawl symptoms when I take a holiday from the medications, but I am dependent upon them: if I do not use them, I can only be comfortable thru complete inactivity, lying in bed and reading. I choose to be dependent, in order to be able to enjoy some limited physical activity. I never get a “high” from the dose I use, I get relief — the antidote to narcotics is pain.
Certainly, there are persons who misuse narcotics for their euphoriant effects. Far more persons continue to suffer from inadequate analgesia, as a consequence of medical prejudice and ignorance, particularly of my fellow physicians and of poorly trained nursing personnel. My significant other, a hospice nurse, frequently comes home to me in tears, to describe how ignorant family, as well as intolerant physicians, decline to allow narcotic administration to dying persons, who consequently die in an agony of pain and suffocation (narcotics also relieve the air hunger of terminal suffocation), for want of an adequate and comforting dose of narcotic analgesics.
Years ago, when an intern, I had a patient who was dying of terminal lung cancer. Oxygen, antibiotics, and respiratory treatments progressively failed, and at last she was gasping for air in a panic, and nothing I did could help her. At wits’ end, I called the operating room for my mentor, Dr. Stranahan, who was in the midst of a delicate lung surgery. His solution was a guttural grumble: “Give her morphine!” This beautiful woman died peacefully, just a few minutes later, after a dose of morphine just sufficient to bring her comfort. I have carried that lesson, and the very sound of his voice, within my heart, for almost 50 years.
The biggest problem of addiction is not the effects of the drugs, but of the desperate antisocial measures that addicts resort to, to meet their “needs”: burglary, robbery, and violence. Where drugs are made available legally, such as with methadone replacement, much of this behavior is averted, and addicts become able to function at some level in society. The most noteworthy example is that of Dr. William Halstead, the “father” of American surgery, who reached his successful pinnacle while severely addicted to morphine, which he used on a daily basis while performing revolutionary surgery. He was not “normal”, but he was supremely functional, and his addiction was extreme — he originally became a cocaine addict, while exploring the anesthetic effects of this drug, which was not then known to be addictive. Morphine was a substitute for the more damaging effects of cocaine, and permitted him to remain professionally functional. Addiction is a disease. It’s consequences are the fault of our mismanagement.
I respectfully but vehemently disagree with my colleague, Dr. Dalyrymple. Addiction IS a disease. The inconvenience of treating it, managing it, and those who suffer from it, does not alter the facts, nor does it justify self-serving ignorance.
With all due respect, legalizing drugs and handing them out free through state dispensaries merely replaces theft by the addicts directly with theft by the state of the taxpayers on their behalf. It also means another self-serving government bureaucracy which will have no vested interest in curing the addicts.
By all means have clinics to help addicts clean up, but there is a limit. It can’t be just another government handout for life.
I made no mention of state-run drug dispensaries giving out free drugs. However, the present process provides huge profits for illegal producers, as well as $billions in losses from thefts to support illicit purchases. If the government were in charge of it, then there would shortly be a severe shortage of drugs (“If the government were in charge of the Sahara desert, in 5 years there would be a shortage of sand.” — M. Friedman).
When what you are doing does not work, don’t keep doing it. Do something else!
Also,
Addiction is a disease process. If you think otherwise, you should re-examine your definition and understanding of the meaning of “disease”.
Addiction is accompanied by demonstrable alterations in the structure and function of the brain, some of which are irreversible.
Addiction is treatable, but is not curable.
Cleaning up or detoxification is almost 100% ineffective as a sole treatment strategy. Without adequate and intensive treatment, relapse is inevitable.
Unlike most illnesses, addiction causes its victims to become terrified of getting well.
Many addicts become useful and productive citizens when treated with methadone replacement as therapy. This approach accepts as fact the irreversibility of chronic addiction, just as we accept that Type 1 Diabetes is irreversible, and requires lifelong insulin replacement.
one thing that scares me about ACA is “templating” of patients.
one size does not fit all on pain management, dose that knocks most for a loop is often a half dose for me due to my high tolerance issues.
My father, who died 2 days ago at the age of 95, lived over 65 years with an excruciatingly painful complete brachial plexus injury incurred during the 2nd world war. He had no use of his right arm at all as a result – it was withered completely. Till he was 90 (when he entered a ‘retirement’ home) he took nothing but a scotch in the evening and an occasional regular Tylenol for pain (the latter did little but sometimes he would cry out and just do ‘something’). His pain was too often a 10 on the scale of 10, coming as a result of spasms that, over the years, got closer and closer together. Despite all however he lead a very active and productive life.
Over the years, he was sent to a number of pain management specialists … NONE of whom seemed to grasp that it was pain caused by spasms, not spasms causing pain, not even when he was on his deathbed suffering intensely. They continued to feed him morphine derivatives till his last breath though it was obviously not working – you could see when he was clenched up in pain, feel his shoulder and the spasms.
When my father entered the retirement home, the doctor there, against my POA wishes, continually drugged up my father with one narcotic after another. I could not get them to stop – he merely changed to another narcotic if I complained. So, for the last 5 years of his life, while my father’s pain got worse and worse, he lived a semi (worse at some times than others) drugged life with all the side effects (including constipation almost constantly and delirium occasionally). Believe it or not, for HIS pain, a hefty draft of scotch was one of the most effective things he could take – because it relaxed him and his muscles so the spasms were alleviated.
I know that narcotics help some people for some kinds of pain and do not begrudge them what they need, at all. But, doctors PUSHED pain meds on my father and I am sure on some others, even under protest, and I find that despicable. What they did certainly convinced me never to take any narcotic for myself ever, no matter what. I will bear the pain ‘naturally’, whatever the level.
From reading most of these responses, I get the impression a lot of people think many of us who live every day with chronic, intractable pain, take this stuff for fun! I broke my back in 2 places in 90, after 5 inpatient surgeries to repair that I returned to work as an electrician, but the pain never went away…still hasn’t, almost 22 years later! In all, I have had 17 in-patient, invasive surgeries, and far too many outpatient for blocks of one type or another, but this pain is NOT going anywhere, so it and I have become friends of a kind! Every day, all day, I live through level 6 to 8 pain, low back, mid back, and left thigh sciatic nerve burn! I take reasonable doses of vicodin and 90 mill. of morphine sulfate and still, this pain will not go away! I am currently using my 3rd implanted neuro-stimulation device (TENS unit)which helps, but to assume we take this stuff because we have nothing better to do, is ridiculous!
I agree that there are a great many who do, but for every 100 of them, there’s one of me who takes a beating because I take heavy narcotic pain meds!
Attribution bias.
And the idea of patient as consumer came from across the big pond.
What is Doctor Dalrymple’s medical specialism again?
“When in doubt, then, prescribe.”
Hasn’t this always been the motto of biopsychiatrists? And, if the patient resists attempts to medicate them, then psychiatrists can have them forcibly medicated.
Where’s the ‘Mea Culpa’ in this article?
” Iremember very well that when I refused to prescribe either strong painkillers or other addictive drugs such as benzodiazepines (for example, valium), some of the patients would start to shout that I was not a doctor but a murderer. ”
Did you get some kind of sadistic kick out of this?
And if you refused to prescribe meds to your mentally ill patients, then what exactly did you do? What was your raison d’être? Because prescribing meds is pretty much all they do. Therapy is a no-no for them because they see it as ‘talking to an illness’. I guess we can count ourselves lucky that you only occupied that post for fifteen years.
I’ve met more stupid people on drugs like benzodiazepines than I’ve meet mentally ill ones, particularly among women. They do stupid things and surprise, they feel bad about themselves. But of course it can’t be their fault. Instead of wising up about life they start on psychoactive drugs. Soon they feel better even as they continue to do stupid things, which only reinforces the need for the drugs.
Interesting.
But I can’t see the relevance to my post.
Just a few factual inaccuracies:
The good doctor’s main point was about painkillers which is strange because psychiatrists aren’t qualified to deal with long term pain management.
He also mentions Valium, which has been taken off the market.
Now, let’s talk about Ritalin, 85% of which is taken in the good old U.S. of A.
You folks really need to deal with that.
I am a pharmacist. Valium, in its generic form diazepam is still very much on the market, although the more popular BZDs are generic Xanax and generic Klonopin. Most people take the generics because Medicaid wont pay for brand.
Yes, but the good doctor specifically singled out Valium. As did NC Mountain Girl. (who got it from a neighbour who probably wasn’t qualified to dispense medications. That was an intuitive leap, by the way.)
;
Had any of these people been forcibly medicated?
When I broke my leg in 2008 my experience was that everyone pushed pain pills on me. I left the emergency care clinic with a temporary cast, an appointment to see an Orthopedist and a prescription I never filled for Darvocet. A couple of Tylenol were all I needed. I specifically said I wanted to use the least potent drug necessary for me to function. So as soon as I told the nurse all the drugs from the surgery seemed to be wearing off she reached for the morphine, which I refused. Every time I visited the surgeon he kept asking if I needed a prescription refill. He didn’t seem to believe I’d used six of the first 5 mg Percocet and then disposed of the rest. I needed it the first 24 hours and then just at bedtime the next two days. I actually found the Flexeril more useful. My problem wasn’t pain. For the first couple of weeks my other leg and my arms would try to cramp from being unused to the walker.
I loathe any drug that effects mental function. I once had a doctor prescribe Librium because I was too anxious to get much sleep. After two nights of dreadful bad dreams I decided insomnia was better. A few years earlier when my father had died suddenly while out of town and I was actually tired beyond being able to sleep trying to make all the arrangements my neighbor, an RN, gave me a Valium. I think if the house had caught on fire that evening I would have said “Look a the pretty flames.” No way. Never again.
Over the year I have gotten into it with several single women I know on various psychoactive drugs. What was mostly wrong with them is they keep making stupid decisions, especially about men. Of course they feel bad. So I would I if my boyfriend was a married man and I was working for an alcoholic loser who was running his business into the ground. I’d also walk away from both before I’s take that stuff. It seemed to me he drugs allowed these women to feel good while behaving stupidly instead of learning from their mistakes.
I perform periodontal surgery and have found that most of the pain my patients feel is from inflammation. As a result, treatment with a steroid and Ibuprofen prevents the pain patients used to experience. I surveyed my patients a few years ago and found over 80% were not filling their narcotic prescriptions. So extreme is the effect of preventing pain that the local DEA investigator has commented that he knew every dentist and surgeon in the area, but after meeting me socially, had to look me up to learn I practice surgery.
The mouth heals very quickly, and while anti inflammatory therapy is not appropriate for many medical conditions, could it not be used more often after medical surgeries or traumatic injuries? It seems to me the medical community responds to pain with a prescription for a narcotic and a shrug.