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Thread: Impact of harsh laws on chronic pain patients...interesting article

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    Default Impact of harsh laws on chronic pain patients...interesting article

    I know many have posted articles about the adverse impact of these crazy laws enacted restricting pain meds and scaring doctors away from prescribing pain meds for chronic pain patients. I remember in my own state when they were pushing their new laws through that they emphasized how current chronic patients would NOT be impacted. Riiiiight...

    Maybe by law but reality is that doctors are getting pressured to not prescribe. Meanwhile, prescriptions have gone down but deaths are rising and are predicted to continue to rise. Why? Because many people need pain relief and if a doctor won't prescribe, some will go to the streets and they're getting heroin/fentynal or in my state the newest and #1 is cocaine/fentynal. In any case, this story is a good (?) read but definitely read the comments below the article...

    https://www.healthleadersmedia.com/c...cribing-debate

  2. i don't live in arizona, but dr. cara crist hasn't heard many complaints? that might be because no one knows she's responsible. perhaps we should send her some information on the agony caused by her policies. they say they intended this policy for primary care docs, but didn't make that clear. oops is their reaction. it's ghoulish but now they will have to explain the increasing overdoses without their favorite targets, doctors. this will be challenging because medical doctors have no control over the street drugs that some of their ex-patients will use. they'll pat themselves on their backs when heroin overdoses hit the stratosphere because they are not at fault and have refused to treat patients.

    they only care about liability, which translates to insurance, proving once again out healthcare system is about profit, not patients.

    in two years the news will be all about heroin and other street drugs, as it always should have been. nothing will be said about the thousands losing their quality of life or their lives.

  3. #3
    A (small) handful of physicians have begun writing op-ed pieces and posting on some blogs about how patients who genuinely need pain medication are becoming collateral damage to the overly aggressive, and overly political, restrictions that are being placed on prescribing. So SOME physicians are beginning to push back. At some point the pendulum will stop, and it will begin to swing back a bit (I hope) toward physician autonomy and individualized prescribing.

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    Looking back over the last two decades or so, I have to say that getting the meds I know work for me has probably been the most difficult part of handling my various maladies. I can deal with the physical pain, if I'm allowed to. And if I can quell my physical pain, then I can lead a full life.

    It doesn't surprise me that Dr. Crist hasn't heard many complaints. First of all, she's probably not listening too hard to hear them. But mostly, it's because we don't want to bring attention to ourselves. My avenues of self-medication opportunity are getting increasingly narrow, especially now that the US government is rediscovering its penchant for regulating plant matter. The FDA & DEA are acting like kratom is something to atone for MMJ, their consolation prize. From what I've read, they're headed right back down the prohibition path with it, fast as they can, having learned not a G/D thing from alcohol or "The War on Drugs." I can think of a couple other items they're taking a hard look at -- to the point that I really don't want to write it out here.
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    @Ellyn, if you can provide the links to those doctor-authored blogs, I would really appreciate it! I am, unfortunately, moving toward palliative care; hospice is the next step. I can use all the insight there is available in how to deal with my doctors, to ensure I can get pain relief when I am no longer able to negotiate the internet to get my own...
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    Quote Originally Posted by blueroan17 View Post
    @Ellyn, if you can provide the links to those doctor-authored blogs, I would really appreciate it! I am, unfortunately, moving toward palliative care; hospice is the next step. I can use all the insight there is available in how to deal with my doctors, to ensure I can get pain relief when I am no longer able to negotiate the internet to get my own...
    One of them was in the Washington Post - I'll see if I can find it again. I saw another on the RealClearHealth website, and one on a blog I stumbled across. I'll see if I can find that one too.

    In the meantime, if you're on Twitter, follow Thomas Kline, MD. He has a lot to say about the adverse consequences to pain patients of involuntary taper and discontinuation of pain medicine, and the faulty science on which some of this is based. You can Google him to find his Twitter.
    Last edited by Ellyn; 02-04-2019 at 10:58 PM.
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    Quote Originally Posted by Ellyn View Post
    One of them was in the Washington Post - I'll see if I can find it again. I saw another on the RealClearHealth website, and one on a blog I stumbled across. I'll see if I can find that one too.

    In the meantime, if you're on Twitter, follow Thomas Kline, MD. He has a lot to say about the adverse consequences to pain patients of involuntary taper and discontinuation of pain medicine, and the faulty science on which some of this is based. You can Google him to find his Twitter.
    Holy Moly @Ellyn, that Dr. Kline sure has a lot of articles on our plight! He appears to be a Pharmacy Reviewer hero! I googled him and have many things to read now. Thank you so much for sharing. I always love to know about doctors that advocate for us and he is the real deal.
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    @Ellyn, thank you so much for passing along the info re: Dr. Kline, RealClearHealth, etc. As @jakemoe says, it is wonderful to hear about the doctors who are advocating for us (it's good to know they still exist!)
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  9. Quote Originally Posted by blueroan17 View Post
    @Ellyn, thank you so much for passing along the info re: Dr. Kline, RealClearHealth, etc. As @jakemoe says, it is wonderful to hear about the doctors who are advocating for us (it's good to know they still exist!)
    @H20shed65 isn't on here as much as he used to be, but he works in hospice. from what he says, these policies have zero effect on hospice care. in that situation you would not need extra help, as the doctors have access to much stronger meds. no one in palliative care or hospice should have to worry about pain control, and i would make sure to find docs who shared that philosophy.
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    I take issue with primary care physicians being pushed out of prescribing and that is what my primary care is threatening is going to happen. Now whether or not I believe her I'm not 100%. I can believe that with the laws they've already passed that my state may do this ... on the other hand it could be an excuse for her to say she can't prescribe anymore.

    That is exactly why I am self tapering...because I'll be damned if I do it on her schedule or some politician's schedule

    Why should everyone go tromping off to a pain clinic to get over evaluated, forced through the motions of PT, injections, mindfulness etc etc that most of us have already tried.

    The number ONE reason that people go to their doctor is because of pain! I'd like someone to explain to me what exactly is wrong with treating pain? Isn't that why these medications were developed?

    And I like any doctor to just look up the side effects of ANY non narcotic med they want to shove at you vs say OxyContin. OxyContin - may cause constipation, may cause drowsiness until you adjust, and MAY in a very small percentage cause addiction...which can be recognized and treated.

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    Quote Originally Posted by Bawston View Post
    I take issue with primary care physicians being pushed out of prescribing and that is what my primary care is threatening is going to happen. Now whether or not I believe her I'm not 100%. I can believe that with the laws they've already passed that my state may do this ... on the other hand it could be an excuse for her to say she can't prescribe anymore.

    That is exactly why I am self tapering...because I'll be damned if I do it on her schedule or some politician's schedule

    Why should everyone go tromping off to a pain clinic to get over evaluated, forced through the motions of PT, injections, mindfulness etc etc that most of us have already tried.

    The number ONE reason that people go to their doctor is because of pain! I'd like someone to explain to me what exactly is wrong with treating pain? Isn't that why these medications were developed?

    And I like any doctor to just look up the side effects of ANY non narcotic med they want to shove at you vs say OxyContin. OxyContin - may cause constipation, may cause drowsiness until you adjust, and MAY in a very small percentage cause addiction...which can be recognized and treated.
    Amen to that sista!
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    I read a lot on this subject and I believe things are changing albeit slowly.
    Some doctors actually do have hearts and are speaking out to the FDA. One I follow
    is Dr. Lawhern Ph.D. who has petitioned the FDA. The main take away points in the petition;


    People in Pain Petition the FDA: Cease, Halt, and Refocus!

    - FDA is chasing the wrong opioid crisis

    -FDA should stand down from further regulation

    – Take a breath before doing even more harm

    – Focus on recall and revision of the CDC opioid guidelines

    - Politically biased against opioid therapy

    - Weak evidence for most recommendations


    So there is someone out there fighting for us. Doctor's hands have been tied. I believe this will all eventually change to our benefit.

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    Quote Originally Posted by Bawston View Post
    I take issue with primary care physicians being pushed out of prescribing and that is what my primary care is threatening is going to happen. Now whether or not I believe her I'm not 100%. I can believe that with the laws they've already passed that my state may do this ... on the other hand it could be an excuse for her to say she can't prescribe anymore.

    That is exactly why I am self tapering...because I'll be damned if I do it on her schedule or some politician's schedule

    Why should everyone go tromping off to a pain clinic to get over evaluated, forced through the motions of PT, injections, mindfulness etc etc that most of us have already tried.

    The number ONE reason that people go to their doctor is because of pain! I'd like someone to explain to me what exactly is wrong with treating pain? Isn't that why these medications were developed?

    And I like any doctor to just look up the side effects of ANY non narcotic med they want to shove at you vs say OxyContin. OxyContin - may cause constipation, may cause drowsiness until you adjust, and MAY in a very small percentage cause addiction...which can be recognized and treated.
    Seems to me that euphoria is the side effect that has the "Enemies of Opioids" most concerned. They definitely would prefer people to suffer than catch a buzz from their meds! So pain meds with all sorts of serious side effects get a pass: NSAIDs and corticosteroids invite stomach & intestinal bleeding, tachycardia, loss of bone density, liver failure and more. But that's okay, because they do NOT make a tiny percentage of patients feel extra cheery the first several times they take them.
    (By the way -- Why is it so hard for the anti-opioid folks to understand that the euphoric reaction to narcotics that some patients experience is ever diminishing until it finally disappears altogether? I think if they could wrap their heads around that, they could relax a little bit and perhaps this hysteria would die down. But I won't be holding my breath...)
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    Quote Originally Posted by blueroan17 View Post
    @Ellyn, if you can provide the links to those doctor-authored blogs, I would really appreciate it! I am, unfortunately, moving toward palliative care; hospice is the next step. I can use all the insight there is available in how to deal with my doctors, to ensure I can get pain relief when I am no longer able to negotiate the internet to get my own...
    Here are a few that I saw recently.

    http://www.therepublic.com/2018/12/2...ateral_damage/

    https://www.statnews.com/2018/12/06/...ing-guideline/

    https://www.clinicalpainadvisor.com/...rticle/810711/

    https://www.usnews.com/news/best-sta...tients-doctors

    - - - Updated - - -

    One more - I read this one quite a while ago. This one was in the Washington Post, and it's pretty compelling.

    https://www.washingtonpost.com/graph...=.35cddce2e8c8
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  15. #15
    Quote Originally Posted by blueroan17 View Post
    Looking back over the last two decades or so, I have to say that getting the meds I know work for me has probably been the most difficult part of handling my various maladies. I can deal with the physical pain, if I'm allowed to. And if I can quell my physical pain, then I can lead a full life.

    It doesn't surprise me that Dr. Crist hasn't heard many complaints. First of all, she's probably not listening too hard to hear them. But mostly, it's because we don't want to bring attention to ourselves. My avenues of self-medication opportunity are getting increasingly narrow, especially now that the US government is rediscovering its penchant for regulating plant matter. The FDA & DEA are acting like kratom is something to atone for MMJ, their consolation prize. From what I've read, they're headed right back down the prohibition path with it, fast as they can, having learned not a G/D thing from alcohol or "The War on Drugs." I can think of a couple other items they're taking a hard look at -- to the point that I really don't want to write it out here.
    And they don't even mention cigarettes....highly addictive.....probably kills more people then any other drug. But it's legal. And it's a money makes.
    Imo
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    @blueroan17...and who hasn't had someone say..."oh man, I had a broken leg and they gave me Vicodin and I was flying!"

    Yeah, well did your stupid broken leg hurt? Were you planning on going skiing and had to change your plans? Can I kick you in the leg and see what your reaction is?

    I think these stories and reactions come from people who've had an acute injury and been given something like Vicodin (seemed to be the one of choice after oxycodone got a bad rap because it started with oxy). So they're opioid naive and feel a buzz, fall asleep - which is probably a good thing when you're in pain, then they assume that every chronic pain patient is walking around high.

    I had 2 days of feeling unsteady when I started on OxyContin, then it was like the pain just sucked up all the med and I was fine to do so much more than I had for years.
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  17. part of the so-called euphoria is also relief, @Bawston. it feels good to have the pain lessened. i've also read online about people having extensive dental work or breaking a bone and getting a script for 8 vicodin: "well i didn't take them because i don't want to be addicted." that is some powerful propaganda people now believe, with pain medications thoroughly demonized. i woke up at 3:30 last night with a throbbing hip, and after an hour, was glad i could take something for relief and go to sleep. somehow people just fail to realize that taking a level 8 pain to a 6 is not a high.
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    Quote Originally Posted by notcharlotte View Post
    part of the so-called euphoria is also relief, @Bawston. it feels good to have the pain lessened. i've also read online about people having extensive dental work or breaking a bone and getting a script for 8 vicodin: "well i didn't take them because i don't want to be addicted." that is some powerful propaganda people now believe, with pain medications thoroughly demonized. i woke up at 3:30 last night with a throbbing hip, and after an hour, was glad i could take something for relief and go to sleep. somehow people just fail to realize that taking a level 8 pain to a 6 is not a high.
    Excellent point that has gotten completely lost in all the hysterical brouhaha, thank you!!

    I recall vividly the first time I ever took oxycodone, when all 4 wisdom teeth were taken out; abnormally large, they had to be broken up to be extracted; it was a long procedure. Back at my mother's house, I took my meds, threw up, settled my stomach with a few Saltines and clear broth, and slept for 2 days.

    Oh yeah -- Obviously, I was hooked, because just a mere 5 years later, there I was taking it again!

    Is being able to "take the pain" a peculiarly American thing, or something that all Western civilization buys into?! Or humankind in general? What are we trying to prove? Kinda like how proud we are about the little amount of sleep we manage to get by on (then we get to deal with a freeway full of drowsy drivers, oh goody).
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    Quote Originally Posted by notcharlotte View Post
    part of the so-called euphoria is also relief, @Bawston. it feels good to have the pain lessened. i've also read online about people having extensive dental work or breaking a bone and getting a script for 8 vicodin: "well i didn't take them because i don't want to be addicted." that is some powerful propaganda people now believe, with pain medications thoroughly demonized. i woke up at 3:30 last night with a throbbing hip, and after an hour, was glad i could take something for relief and go to sleep. somehow people just fail to realize that taking a level 8 pain to a 6 is not a high.
    @notcharlotte, funny you should mention dental work. A friend of mine has a lot of inherited dental problems and had to have an extraction that required them to cut into the bone. For some reason they couldn't do the whole procedure so sent her home with a gaping, bleeding mess in the back of her mouth. This is someone who is no sissy either but they refused to give her anything.

    She got home and thought her head was going to explode, called and begged them to prescribe something but they still refused and said to take ibuprophen. Now think of having a bleeding hole in your jaw and being told to take ibuprofen which increases bleeding!
    @Blueroan...I think yes, we have this image that you're supposed to deal with pain and it makes you stronger, builds character...or something like that. Too many movies if you ask me!
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  20. #20
    What’s been really interesting to me lately is the severe focus of solely opiates. For many years I had a small monthly rx for both Percocet and tramadol. The tramadol I take regularly and the Percocet only PRN. For years no issues. I have a wonderful pcp who truly cares about his patients and I’ve stayed with him. I’m young but have a lot of health problems and he’s familiar with them. Last year the large medical corporation where he practices started requiring him to make his patients come every 3 months if they were on a scheduled narcotic. Not long after that it requires periodic drug testing. All of which I complied with. Now under further pressure he has to further limit RXs and we had to stop the Percocet rx. I’m understanding, it’s not really his fault and he was very apologietic. When I filled my last RX of tramadol at my pharmacy the new insurance company is forcing a 1 week supply at a time for the initial rx and then I have to go back in another week to pick up the remaining 3 weeks! The kicker for me is that I also have a sleep disorder that my pcp treats with adderall. No problem with me taking that schedule 2 by either the insurance or the medical corporation. Sigh. What good is scheduling medications on the lower end if you’re going to treat them worse than a schedule 2. The pharmacy was just as annoyed about having to break up the RX
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