More nanny state stupidity, because politicians are smarter than doctors

[Thunder 57]

I had major surgery several months ago and was prescribed 2 different opiods for pain. I took them for a few days and then started taking Tylenol for several weeks. I even had a post op infection.

That's great that your pain was rather manageable. That is not always the case.

Seems obvious. Why do you think that Trump chose a different enforcement response?

This wasn't Trumps doing. Trump called attention to the overdose problem. And then politicians came up with stupid, feel good responses to try to help.

 

[Shmee]

My friendly cacodemon, instead of taking pain meds you should take a Soulsphere. They are very healthy!

 

[Thunder 57]

My friendly cacodemon, instead of taking pain meds you should take a Soulsphere. They are very healthy!

Yes, I hear they give you a 100% health boost. That would still never be near enough to have a chance against a Spider Mastermind, though. Oddly enough those are my two favorite demons from the game. I don't know if I could even pick a 3rd. Baron of Hell? I always kind of liked the "Bruiser Brothers" nickname.

 

[BoomerD]

When I was dealing with my knee and back injuries, my neurosurgeon, pain management doctor and ortho were ALL prescribing opioids...and the work comp insurance company REQUIRED me to get them all filled...or they’d cut my benefits for failing to follow doctor’s orders...I think I still have a 55 gallon drum full of oxycontin, percodan/percocet, and several different formulations of hydrocodone...plus valium, lunesta, and ambien...(I took the pain meda for about a week after my knee surgery...then switched to OTC meds)

 

[ch33zw1z]

That's great that your pain was rather manageable. That is not always the case.



This wasn't Trumps doing. Trump called attention to the overdose problem. And then politicians came up with stupid, feel good responses to try to help.

Trump is a politician now, lol....

He must be putting together the replacement for the ACA, it's been a year since their second failed attempt to repeal. Can't wait, less expensive, better coverage, lots of competition, just the best.

 

[interchange]

I'm a doctor, and I'm glad states are implementing these kinds of controls.

 

[sdifox]

Up here the problem is phentanyl. Due to clamp down on legit pills, a lot of strret drugs are laced with that shit and it is what kills. Docs here are saying maybe it is time to decriminise all drugs and just handle it from harm reduction side. That will certainly reduce chance of getting something laced with fentanyl.

 

[Exterous]

I'm a doctor, and I'm glad states are implementing these kinds of controls.

A 3 day supply though? I think requiring someone to travel to get a prescription filled that often is overly onerous

 

[TheVrolok]

A 3 day supply though? I think requiring someone to travel to get a prescription filled that often is overly onerous

To be fair, that's because they probably shouldn't be on that prescription much longer than 3 days anyway.

There is a large volume of research on opioids and the management of pain. The verdict is that opioids are not the answer for pain in the vast majority of circumstances. Partially because they just don't work for the risk (sure they may make you feel good, getting high does feel good, but they generally do not lead to sustainable pain relief or increase in function.. At least not in the face of the significant risks).

A big problem is that in the 90s we decided pain should be a vital sign and lumped a subjective measure in with a bunch of objective measures. Then, of course, we as a culture decided that the only acceptable level of pain is 0. Unfortunately, that's not realistic. Life hurts. And here we are.

Are there exceptions? Of course. There are tons of people who take a low dose of opioids here and there and it provides benefit. However, at a population level, this just isn't the answer. (sucks to be a minority, doesn't it?)

 

[MagnusTheBrewer]

That's utter bullshit. The pharma companies can't force doctors to do anything. They have no control and write no scrips. This is pure greed on the part of the American medical community. The goal is to see as many patients as possible because the more you see the more you bill. It's a conveyor belt that churns patients in and out of the office without stopping for time wasters like finding out how they're really doing. In, write scrip for painkillers, they fell better, out, NEXT!! This is 100% on doctors, they're the ones responsible for the patients long-term well-being, they're the ones signing the prescriptions and they're the ones who place fees over their Hippocratic Oath.

Not true. If there's almost nothing to prescribe between aspirin and opioids for pain, then pharma is indeed forcing doctors to prescribe opioids to try and give patients relief. There are doctors who abuse the system as there are patients who abuse the system but, it's not all on the doctors.

 

[TheVrolok]

That's utter bullshit. The pharma companies can't force doctors to do anything. They have no control and write no scrips. This is pure greed on the part of the American medical community. The goal is to see as many patients as possible because the more you see the more you bill. It's a conveyor belt that churns patients in and out of the office without stopping for time wasters like finding out how they're really doing. In, write scrip for painkillers, they fell better, out, NEXT!! This is 100% on doctors, they're the ones responsible for the patients long-term well-being, they're the ones signing the prescriptions and they're the ones who place fees over their Hippocratic Oath.

While I appreciate your point from an idealistic point of view and don't entirely disagree with it, it simply isn't practical and does not reflect the real world. Unfortunately, the real world is the one in which we live. Now, I would love to work on getting us closer to the ideal (and, admittedly, this is part of my job in my own little part of the world).

Just as a small point of fact, pharmaceutical companies don't necessarily dictate prescribing practices, but insurance companies sure do. I am somewhat amused that many think commercials are effecting prescribing practices... This certainly may have been the case (and the literature would say that it was) before the ubiquity of tightly managed care. Now, though, what is prescribed is whatever is covered.

 

[interchange]

A 3 day supply though? I think requiring someone to travel to get a prescription filled that often is overly onerous

I'm really not sure of the exact rules. I'm not in Florida. For people who are managed on chronic opioids who can be well-established are adherent to care and seeing a single provider, not taking other high-risk medications (e.g. benzodiazepines) in combination, and at low risk of abuse, I do think that such an intervention is wholly unnecessary and presents a hassle to both patient and provider. I believe that those restrictions aren't universal, but I would have to check on them. Regardless, in general, this is well outweighed in my mind by the benefit of that keeping in check the haphazard prescription of opioids in ways that aren't evidence-based. It could be a wholly different discussion to say what is the right treatment path for chronic opioid patients who are not addicted, but that is not what drives my approval (generally) of laws instituted to regulate the opioid prescribing industry. I should also throw in caveat that I am a psychiatrist and thus do not prescribe opioids (although I do co-manage patients on them), and there is a bias for me because I am more likely to encounter people who are either addicted or unwittingly harmed by opioids than someone who is treating pain directly. Nonetheless, there is a bounty of evidence on these treatments overall and a plethora of other developed nations who use them far less to compare to. It is clear that the US way overuses these medications, that it correlates to addiction risk, and that opioids are more medically dangerous than other controlled substances. I do not have any desire to discriminate against people using them as indicated, but I am well willing to tolerate hassles in that department to prevent exposure to people who do not need them.

Edit: I looked at some info on the new Florida law. It's extremely strict. Not sure how it will end up working out in practice, but I'm certain a whole lot fewer people are going to be on opioids there as a result. Certainly some will turn to the street and be exposed to risk, although I'm confident there will be better outcomes overall by the converse restriction to those at risk. I wouldn't choose to be that restrictive legislatively.

 

[deathBOB]

Systemic problems require broad solutions.

 

[Vic]

That's great that your pain was rather manageable. That is not always the case.



This wasn't Trumps doing. Trump called attention to the overdose problem. And then politicians came up with stupid, feel good responses to try to help.

As President of the United States, Trump is a politician and has executive oversight of the government policy with regards to this issue.

 

[1sikbITCH]

That's utter bullshit. The pharma companies can't force doctors to do anything. They have no control and write no scrips. This is pure greed on the part of the American medical community. The goal is to see as many patients as possible because the more you see the more you bill. It's a conveyor belt that churns patients in and out of the office without stopping for time wasters like finding out how they're really doing. In, write scrip for painkillers, they fell better, out, NEXT!! This is 100% on doctors, they're the ones responsible for the patients long-term well-being, they're the ones signing the prescriptions and they're the ones who place fees over their Hippocratic Oath.

Well this is unfortunately not true. Doctors are getting millions in kickbacks from the drug companies. It's all legal and disclosed to the public:

https://projects.propublica.org/docdollars/
Click on your state to see who is raking in the most and from who.

Search for your doctor here:
https://openpaymentsdata.cms.gov/

 

[zinfamous]

That's utter bullshit. The pharma companies can't force doctors to do anything. They have no control and write no scrips. This is pure greed on the part of the American medical community. The goal is to see as many patients as possible because the more you see the more you bill. It's a conveyor belt that churns patients in and out of the office without stopping for time wasters like finding out how they're really doing. In, write scrip for painkillers, they fell better, out, NEXT!! This is 100% on doctors, they're the ones responsible for the patients long-term well-being, they're the ones signing the prescriptions and they're the ones who place fees over their Hippocratic Oath.

No, not true at all. Oxycodone was long pushed as non-addictive by Purdue pharma, based on early, weak data, and long oversold by marketing reps to be prescribed for all manner of treatments. You shove the data in the doc's face, continually tell them that nothing has changed...despite long-knowing, years later, that this stuff is super addictive.

That's not to say that over-prescribing docs aren't culpable, but Purdue pharma, especially, is at least but almost certainly more culpable in this disaster. The docs have been making absolute peanuts compared to what Purdue has made out of this catastrophe. Docs can only work with the data they have and from the results that they see--usually "quite good" from patients with legitimate pain. What Purdue knew and hid about the problems with Oxy, long, long before anyone else, is tobacco industry level greed over health. Patients were addicted to this stuff years before the medical community understood that to be an actual possibility, because Oxy was only ever sold as completely non-addicting.

 

[TheVrolok]

Well this is unfortunately not true. Doctors are getting millions in kickbacks from the drug companies. It's all legal and disclosed to the public:

https://projects.propublica.org/docdollars/
Click on your state to see who is raking in the most and from who.

Search for your doctor here:
https://openpaymentsdata.cms.gov/

The number of docs making millions from pharma is an incredibly small group of content experts and consultants.

By and large, docs are not making big bucks off big pharma.