great story in the NYT today re Nebraska doctor having to tell his chronic pain patients he must

[CTyankee]

limit their pain meds to meet the new guidelines...

Many DUers have been highly critical of attempts to limit pain pills for such patients. http://www.nytimes.com/2016/03/17/health/er-pain-pills-opioids-addiction-doctors.html?hp&action=click&pgtype=Homepage&clickSource=story-heading&module=second-column-region®ion=top-news&WT.nav=top-news&_r=0

This is heartbreaking.

[Omaha Steve]

1. I have inoperable neck pain, both shoulders from accidents and my hands from arthritis (updated)

Last edited Thu Mar 17, 2016, 12:13 PM - Edit history (1)

Update to add I had both thumbs injected with steroids yesterday. I will have the first of my thumb reconstruction surgeries later this year. I put it off twice. Don't ask.

My pain clinic just a week ago told me they won't continue my opioids. I'm terminal! Who cares about addiction. I had the same argument with my mom before she died.

OS

[CTyankee]

2. oh, steve, I'm so sorry!

What is the matter with us in this country? Suffering patients for no good reason!

What will you do?

[Ilsa]

3. There may be an exception in prescribing for cases

like yours. The guidelines are meant to confront widespread, long term debilitating addiction, not cases for pain relief from terminal diseases. At least, that's my understanding from what I read yesterday.

Please visit with your doctor about this. I'm so sorry. I hope you can manage to keep what works best for you.

[Omaha Steve]

13. I don't have pain from my FTD or terminal illness

The state won't allow my GP to even write addictive pain killers anymore. Overseen by the state patrol.

A couple good links from when I came out to the DU almost a year ago: http://www.democraticunderground.com/10026641619+

FTD

[dixiegrrrrl]

25. Wait.....overseen by the State Patrol????????

What state are you in?????


We are seeing more and more health concerns being turned into crimes.
Just read a long article about Tenn. jailing mothers if there babies test positive for any kind of drug.
Thus the hospitals are the police now.
so mothers are not seeking pre-natal care, and the rate of problem births not related to drugs is increasing.
Ala. has that same law, so poorly written that a 9 months preg. woman was arrested and jailed because she was not wearing the seatbelt
that she could no longer get around her.
Did not matter, "harm to the fetus" was broadly defined.

[Omaha Steve]

28. Nebraska

Yep!

[woodsprite]

58. In DE, I had to be drug tested because I had "precipitous labor" 5 wks early with my son.

Never mind the fact that he was my 2nd child, I had been high risk during the whole pregnancy (on heparin) and had fallen on my stomach on the driveway at my BILs a week before. I was in the hospital the entire week before on magnesium IVs to stop the preterm labor brought on by the fall. They released me Thursday night, I went into full blown labor on Friday morning. He was born in 3 hours. While the dr. was getting me stitched up so I wouldn't bleed out (hadn't had time to stop the heparin), he was also apologizing because a nurse was trying to take a blood draw from my arm to test me for drugs due to the labor being so fast and early. He said it wasn't his choice, but was required by the state.

[dixiegrrrrl]

62. When was this?

Makes me wonder if my annual blood draws are being tested.
Not that I have anything to hide....

[woodsprite]

63. Almost 16 years ago. I was really surprised. n/t

[zazen]

9. are you not eligible for Hospice at this point?

I just dealt with them with my dying mother (who passed in January) and they were very generous with pain meds for her--she was constantly taking less than what was available. I hope Hospice at least will be immune to this sort of thing.

Mom had COPD and most people wouldn't have thought she would have qualified for Hospice but I managed to make it happen. I'm sure you've thought of all of this but I'm surprise you don't qualify--the "six month" limit is more of a strong possibility than a prediction. Some patients are on Hospice for 2-3 years.

I've got pain from a genetic condition but it's usually manageable with ibuprofen, but when it's awful I'm treated like a drug addict. However, I'm not in a situation as dire as yours. I'm thinking of you and thanks so much for continuing to improve our lives with your animal welfare posts!

[mopinko]

11. yeah, it depends on the disease.

i do some hospice volunteering and we have patients that have been in hospice for a couple years. i had a case that had als.

[Omaha Steve]

31. Time to my death is probably 5 years (at best) Originally I was given 5 years 2.25 years ago

Hospice is for 6 months or less.

I keep telling everyone I will go out by suicide before going out on FTD's terms. I need all the witnesses I can get to protect Marta when the time comes. I promise it won't be violent!

OS

[Punkingal]

34. Oh Omaha Steve!

I admire your courage.

[dixiegrrrrl]

39. Steve, this may sound strange to others here

but I totally agree with your decision, and it is one I reserve for myself, in necessary.
Mr. Dixie and my kids are very aware , and totally supportive of my feelings about the matter.

for you......

[ashling]

41. I have said

that suicide is a treatment option ...

[Hortensis]

52. I believe timely suicide would often be the best choice

for terminal patients, and like Steve I believe I would make that choice.

But suicide just to escape pain is a whole other matter. I'm glad this article at least spoke of suffering. I heard yet another NPR discussion on this last night. All the oxycodone-heroin stats were discussed at length, but not one question about the stats for people who kill themselves to put an end to lives filled with pain.

We need new methods of pain control, and we need them 40 years ago when new technologies started suggesting whole different ways of approaching intractable pain.

[vkkv]

42. Oh man, Omaha Steve, very sorry to hear this.

Perhaps as the new guidelines settle in it will be obvious that changes are needed to allow for chronic cases and of a certain age, such as those who aren't going to be having kids at this point in their lives. Our system is so screwed up. If it's not the greed, it's the incompetence and bureaucracy. Doctors and nurses DO HAVE influence on medical legislation so hopefully it's only a matter of time where certain exceptions are made. I sure hope so, for you and every one. - Victor

[Skittles]

65. be leery of those estimates, Omaha Steve

they've been proven wrong time and time again........we are here for you

[csziggy]

48. Have you tried anti-inflammatories? Not TOC but prescription ones?

Before I had my knees replaced I use Piroxicam (brand name is Fedene) and my husband is now using Meloxicam. For both of us the anti-inflammatories were more effective at controlling the inflammation that cause the pain than the opiods were.

Neither of us used all the opiods that were prescribed for various surgeries - I have bottles in my freezer from after the knee replacements and the carpal tunnel surgeries that followed and from my husband's foot surgery. But I used the Piroxicam until my recovery was over and still have most of a bottle in the freezer from the last carpal tunnel and arthroplasty on my left thumb. My husband still takes Meloxicam for his knee that is not bad enough for surgery but that hurts him whenever he walks much.

On the other hand, when my back acts up, I want the strongest pain relief out there - or something that will knock me out completely while the muscles stop spasming.

Opiods have their use and for chronic, untreatable pain they should be available. But there are alternative drugs that might be as or even more effective for some conditions.

If the government is going to restrict access to the painkillers they need to help doctors find alternatives that might give the patients relief. Since not every alternative medication will help they need to relax the restrictions on the dispensation of variations while they see if they do. If nothing else works, let the patient have what does!

[Omaha Steve]

49. Yes and tart cherry juice or powdered pills

The juice does seem to help. Flip side is my dementia acts up with pain killers. Not a win win.

When I do my first hand surgery I will be pretty useless (even more than Marta would say today).

My neck s the worst.

OS

[csziggy]

51. Yeah, sometimes nothing much helps

I called Vicodin my "stupid pills" because they made me so dumb - and lot of stupid things I did here on DU were while I was taking them. While the piroxicam helped, the pain in my knees finally forced me to get them replaced. The knees hurt less the day after the surgery than they did the day before.

I had arthroplasty in the left thumb - they took a piece of tendon and put it in the joint to replace the cartilage that was no longer there. Although I had carpal tunnel surgery on the right hand the year before and on the left hand at the same time as the arthroplasty, that damn thumb was more debilitating than almost any other injury or surgery I have had! The shoulder that was reconstructed was not as much hassle.

I had to wear a brace on it for six weeks so I didn't have use of it. When you are used to having two mostly working hands, having a thumb that is non functional really gets in the way - especially when it's sticking out all the time. I couldn't fasten a bra or my pants. Wearing elastic waist pants was OK but I really can't go out in public without a bra.

Good luck with the hands - just be ready for the inconvenience.

[Omaha Steve]

53. My hand will be in immobilizer for 3 months

So I will have an excuse for Marta and my zipper? Hadn't thought of that.

[csziggy]

54. Yes! Give Marta my condolences.

[virgogal]

56. I just read the entire Guideline link and

there is nothing mandatory.

Could it be an insurance thing?

[Omaha Steve]

59. Nope

My GD was the one in January that told me the state patrol now oversees the narcotic line.

Flip side is before I retired I wrote a lot of police reports for stolen and lost narcotics. IF you have a party, lock the damn things up.

OS

[Bluenorthwest]

4. Our government is consistently abusive to the sick and even to the dying, it is an aspect of the

American way of life.

This is what America under Ronald Reagan did to people with HIV/AIDS. A great wrong this country has yet to admit and make amends for. Some Americans still refuse to even admit what they did.

[Moostache]

21. Which is precisely why you can tell so much about us as a collective society...

from the manner in which we treat our most vulnerable.

Infant mortality in the United States should be the shame of our existence...in a country as wealthy and prosperous as the USA, to have such an abysmal record on infant mortality is hideous, but it does not stop there....or even slow down.

Incarcerations of teens and mentally ill
Forced bankruptcies from medical expenses
Wage slavery for new college grads

If there is a segment of society that NEEDS protection and assistance from the government via legislative means, you can bet on the special interests OPPOSING such assistance to rule the day.

This country sold its soul decades ago. What we are seeing now is the rot at the core of the once great American Dream, and it ain't pretty.

[CTyankee]

5. some people are more impervious to pain than others...my husband for instance.

He rarely takes painkillers, even after surgery. I don['t have that but sometimes I wish that I did...

[iandhr]

6. There has to be a common sense balance...

... where we can combat the problem of addition and allow people who deal with chronic pain to have the medicine they need.

I read I think that the problem often begins at the dentists office. About 6 years ago I had my wisdom teeth pulled. I was given about a two weeks supply of pills when I was only needed them for two days.

I took them back to the office a week later for my follow up appointment and the office disposed of them. I read that many states are thinking of ways to allow people to safely dispose of their unused pills.

I read somewhere that one of the suggestions is to allow people to choose a partial fill of prescriptions.

[brer cat]

10. I have done a partial fill for rx

and have seen others do it. They won't where a full course of treatment is necessary such as antibiotics. I don't know if that is at the discretion of the pharmacy, but it certainly makes sense with anything that is prescribed "as needed" such as pain meds.

[Omaha Steve]

37. I had 4 wisdom's pulled on a Thursday probably 35 years ago

They wrote a script for 2 days worth of Percodan Demi: http://www.webmd.com/drugs/2/drug-5467/percodan-demi-oral/details

Marta called to get me a refill on Saturday. The drug store called and said it has to be written because it is a narcotic. The dentist office was a good 30 minutes away and was getting ready to close at noon. She was pissed they didn't write enough to get me to Monday considering everything.

OS

[Coventina]

7. Yet even here on DU we get lectured about how we are somehow morally defective for needing them.

Just check out some of the posts on the current LBN thread....

[zazen]

8. truly heartbreaking--I'm so glad there's this immediate national coverage

And hope there's a lot of pushback. Truly, those in chronic pain shouldn't have to suffer even more because of addicts and drug dealers.

[mopinko]

12. egad. my daughter is gonna die.

she is only 22, but has some serious problems. because of her age, she is targeted heavily. she gets hassles from the insurance company all.the.fucking.time.
i take some of the exact same meds, but i never get any grief. on the same policy.

[ScreamingMeemie]

18. Oh mo... that has to be so heartwrenching to watch her go through that.

I'm so sorry.

[mopinko]

29. its a long sad story, that is for sure.

so complicated, and especially at her age, gets so much shit from docs.
went to a lower back specialist who asked if it would be ok for him to talk to her shrink about what kind of pain meds would be best w her psyche stuff. dude called the shrink and asked that she be put on antidepressants.

has bad fibro, and already getting arthritis in her spine. such a mess. such a huge mess. every time the poor kids starts to get her feet on the ground, something new explodes.

been in pain since age 6.

[Gormy Cuss]

14. Pain mismanagement is more like it. n/t

[Shrike47]

15. This is so depressing. I have been taking 1 hydrocodone pill a day for years for chronic pain.

I guess that means I am an addict and should be stopped or saved or something.

Why are they pushing people in to illegal buys or marijuana? Why are they pushing people in to heroin?

[ellennelle]

16. um, hold on here

i'm a healthcare provider. in MA. the epidemic is overwhelming, so much so the legislature has just passed ground-breaking laws to curb things.

and it most definitely needed to be done. seriously.

i have seen more patients than i can count who suffered some injury or back pain or or post-surgery or whatever, and the doctors handed out the oxy's like candy. so not kidding you; there is pathetic follow-up on these cases, and the docs just keep refilling till they get nervous their patients might get addicted, and then just cut them off.

yup; cut. them. off. cold turkey. their patients are so freaked, and in withdrawal on top of their pain, they start looking for it online and on the street, and then they switch to heroin because it's cheaper, and ....so it goes.

those of you who dismiss this as a problem of 'addicts' and 'pushers' do not have all the facts. and one of those facts might end up being that this article was 'pushed' by the drug companies. think about that; not only does it serve their profiteering purposes, but they have the power to do that at the NYTimes. and sadly, we have seen too often - and as recently as just yesterday - the grey lady can be a whore.

what is the real shame is that there is such resistance - most notably from big pharma - to legalizing and supporting medical marijuana. there are alternatives to opiates, and opiates - imho - should only be administered to patients while they are in the hospital, and can be observed as they are tapered off and transitioned to less addictive and gentler alternatives.

this epidemic did not exist prior to the candy store oxy proliferation; think about that. seriously, that is the tell as to where the fault lies in this nightmare. and it was predictable; this has come up time and again in conversations i've had for years with non-prescription doctors (i.e., phd's in mental health), and we all saw it as a nightmare ready to explode.

voila. don't let this story fool you; there is money afoot, and big pharma is on it.

[freebrew]

30. Good points...

not too many years ago, opium was available OTC with a signature for anyone 18+.

The drug war stopped any OTC drug that the Pharms could control and the drug war gave them that opportunity.

In reality, opium is cheap, and available on the black market. That's why pharm is having such a fit about it, IMO.

Same with cannabis, cheap(well, it was), easy to grow and fairly effective and NOT addictive.

So, what to do? Pain patients could give a rat's ass about addiction if their pain is gone.

Get the $$$ out of these decisions. A reasoned solution cannot be found if we have to gauge in terms of money.

[dixiegrrrrl]

33. I agree with you, and I am one of those who worked with those addicted patients.

First of all, we have this baby with bathwater mentality that hydrocodone is t be treated the same as ocycontin, when actually one is much milder.
then we have docs who will look at this issue as all or nothing, and cut people off with no concept of tapering off.

I have seen so many elderly patients who were just following their dipshit doctors orders and taking pain meds for YEARS, suddenly the doc cuts them off, and they end up in the hospital because of the withdrawal.
Sadly, down here in Ala. most people will not even consider medical marijuana.

Your comment about big pharma pushing the issue....I think you are correct, because all of sudden the issue is EVERYWEHRE, out of the blue.
And I am betting they have created one of their "non-opiate" pills just for the occasion.

btw....Generic Toradol and Tramadol, 2 of the non-opioids, has suddenly gone from 10.00 for 30 day script to 65.00.

And....my script happy doc has given me 3 refills, despite all the warnings about repeated use.
She most likely would not give me more than 1 script for an opioid, even tho they are less dangerous than the warnings on Toradol.

[One_Life_To_Give]

35. Does handing out like Candy include Pain Management Centers?

My wife visits the Boston Pain Care Center. Which requires her to come in monthly, does injections etc. That level of monitoring does not strike me as handing our like candy. I wouldn't advocate year long prescription like my cholesterol and BP meds. But there should be a compromise to ensure we take care of those who truly need it. Even with the meds some days the Mail Box is a trip too far. Why don't we have a middle ground?

[mr clean]

47. +1000

Follow the money.

[xloadiex]

17. Yet these states

Continue to try and ban kratom which is a natural, safe, alternative to pain medication. It has also helped tens of thousands kick their opiate habit.

[Trust Buster]

19. The opiod epidemic ís out of control. Doctors are dispensing them like candy.

Tighter guidelines are called for IMO.

[NashuaDW]

44. It's easy to have that opinion when you're not in pain

I had a bad motorcycle accident in Sept '15 and was on serious pain killers into Dec.
I had plenty, but only because I saw doctors in three states and all wrote prescriptions.
Haven't taken one since the New Year but when I needed them --- I REALLY needed them.

One good fall and I suspect your opinion will change quickly.

[Curtis]

20. I find it amazing

Here in the British Virgin Islands you can purchase Tylenol with 8mg of codeine over the counter without a prescription. They have no addiction problems what so ever.

I have neck and back problems which I will have surgery on when I get back to California this summer. I even went to a doc here in the BVI and got a prescription for something called Arcoxia and some Tyelnol with 30mg of Codeine. No problems. Back in California, even before these new rules, it was so hard to get anything from my doc for the pain because of the addiction problem. Our county, Plumas, is so riddled with opioid addition it's crazy.

Is it something in the American psyche that makes us more susceptible to addiction? I'm no psychologist so I'm really curious

[Francis Booth]

22. I've been on a low dose of opiates for three years now, for chronic back pain.

I'm 60 and have suffered from terrible back pain for 20 years. I have inoperable stenosis and lumbar degenerative disk disease. All my lumbar disks are paper thin and either ruptured or herniated. I can only stand or walk for a few minutes; longer with a walker.

I had been taking physical therapy, which made my pain worse, and taking Ibuprofen for years - 1200mg per day - until I started shitting blood. My primary care doctor will not prescribe opiates, under any circumstances - even for terminally ill patients.

Fortunately, I live near a pain management center, where I am under long-term care. My treatment includes steroid injections and radio-frequency neuroablation, which burns the nerves in your back to kill them. These treatments have been very helpful, but the're very rough to get through, as they insert multiple 6" needles into your spine. I was also prescribed a low dose of opiates for the residual pain.

I've never increased my dosage - 15mgs of extended release morphine sulphate, 3X per day. I believe that's the lowest dose available.

As of the first of this year, I now have to take a urine test every time I get my prescription refilled at my pain clinic. The cost of the lab tests is over $2500 per month, which Medicare pays - for a $5 prescription.

I've never abused my meds; I've never asked for an increase, and I've never shown up early looking for a refill. I've never gone to the ER to get them. My pain doctor says I'm an ideal patient.

This is just going to get worse. Opioid patients are being treated like criminals and malingerers.

[woodsprite]

61. Not just opioid patients. I tried to self-checkout with a bottle of liquid Coriciden HBP

from the regular grocery store, and the darned manager almost tackled me. I told the guy it didn't even have the ingredient that he was saying (pseudofedrine), but I had to show ID before he'd let me leave the store with it.

[brer cat]

23. I have followed your accounts of the pain and suffering

from your very severe case of shingles. I can't believe anyone with an ounce of compassion and empathy would deny whatever pain medication is necessary in cases like yours and millions of others with chronic pain. "Suck it up" is not the solution to the problem.

Pill mills that indiscriminately hand out drugs, and anyone with authority to write prescriptions can abuse that privilege, but throwing out the baby with the bathwater is cruel and inhumane.

[CTyankee]

46. I was on percoset and it wasn't doing too much good for the pain.

I never thought I'd become addicted but I did fear getting dependent. Doc said opioids like vicoden didn't work on nerve pain. I was successfully weaned off of hydrocodone by my doc after surgery sseveral years ago. I'd just as soon not take anything at this point...

[Texasgal]

24. I had to sign a contract

and submit a urine test for AMBIEN! ARRRG!

[dixiegrrrrl]

36. When was this???????????

[Texasgal]

40. Just started at the first of the year

Ambien is considered a class C drug.

[HelenWheels]

26. The answer--medical marijuana. nt

[B Calm]

38. +1 Now if the next president would only be on the side of legalization!

[Wounded Bear]

27. Doesn't affect me personally, but the VA has a new policy...

Many pain meds come in registered mail. A fellow vet has to go to the post office to sign for his medications.

[ChairmanAgnostic]

32. my problem is that they don't help me at all.

They simply badly affect my memory.

[AlbertCat]

43. All this does is hurt people who NEED the meds

Those who deal them illegally will still get them and deal them. It might curtail it a little, but not as much as it will merely hurt .... literally hurt... those who actually need them. It's just like "the War on Drugs"... which as we know is a big failure.

I'm all for restricting use... they shouldn't be in the grocery store. But if a Dr prescribes them then aren't there enough hoops to jump thru? Here in NC they made them so you had to get a new script each time.... no refills. This seems like an acceptable restriction.

[elljay]

45. We know what will happen

Capitalism has a solution to this problem. It will be drug cartels peddling cheap heroin to people who never, ever would have come into contact with a dealer, let alone consider doing business with one.

[Francis Booth]

50. And like all other legislation intended to regulate human behavior,

… This will be a first step, which will not work, and will subsequently be followed by a never ending escalation until we have a brand-new front in the drug war.

[KamaAina]

55. From the FB page of one of my all-time favorite human beings

This is truly terrifying for those of us with disabilities and chronic pain, needing these drugs. I'm not a regular user, but when I need them I NEED them. Already we have to go to the doc to get a script, no auto-refills. The CDC is so detached from actual people, so often.

[nichomachus]

57. The problem is doctors who overprescribe opioids

I have a good friend who was on heavy doses for serious back problems. He was in excruciating pain and could barely walk. So they had him drugged to the gills -- with good reason.

Finally, he had surgery that solved the back problems remarkably -- no more pain. But by that time, he was hooked on the opioids. None of his doctors dealt with that. In fact, his primary care doc kept renewing his prescriptions. My friend had learned all the right words to say to get the prescriptions, as many people who are hooked do, but the doc never caught on.

Finally, the roof caved in. My friend's partner -- who was not from the US and had limited English -- called me in a panic in the middle of the night. My friend had finally freaked out. He was running around the house talking about suicide. His partner hid all his pills, but he didn't know if he'd taken any or how many, although he did have an empty bottle. I showed up and it was a disaster. He wouldn't listen to me. He was pushing me out of the way, talking about killing himself, screaming, opening and closing cabinets and drawers, throwing things around the house. I was frightened -- and I'm a former EMT. I've seen a lot of shit.

Finally, I had to call 9-1-1. The cops and medics came. They decided they needed to take him in and put him on a 72-hour psych hold in the hospital. He did get off the opioids, but I blame the doctor for just writing script after script after script even after the back issues were resolved.

[shraby]

60. When are tptb going to realize that one size does not fit all.

[alarimer]

64. I was afraid to take pain meds when I needed them.

I had my gall bladder out last fall and there were a rough few days but I was so afraid I would get hooked I didn't take as much as I should have. Mostly just to help me sleep. But as a result I was not up and active like they wanted me to be in the days following surgery. I guess I'd had it in my head that if I took took them, I would automatically get hooked on them because that is the message we hear all the time about these drugs. It's not true, I know, but just part of the war on drugs propaganda.

I think they need to be part of the arsenal and I think it's just tragic that people who truly need them cannot get them without jumping through so many hoops.

[Dont call me Shirley]

66. They need medical MJ. Screw the bush poppy empire!