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Sat Dec 17, 2016, 10:29 PM

Working While Poor and In Pain in the United States

First off, let me make one thing clear. This diary is about the United States and other so called first world countries. If you are poor and in pain and living in a third world country, your pain will not be treated. Period. Because international drug policy says that morphine (which is dirt cheap) is much too dangerous to put into the hands of health care workers in poor countries. They will divert it to the black market (we are told). And so their patients dying of cancer get acetaminophen and a pat on the hand and a “Maybe if you were good in this life you will be reincarnated into a new life in a more prosperous country and you won’t have to suffer this way next time.”

Ok, enough about our neighbor’s problems. Let’s talk about our own problems. What’s that you say? You are not poor? You are not in chronic pain? And none of your friends or family are poor or in chronic pain? That’s what we call denial. Or willful blindness. Because the woman waiting on your table at Waffle House has two eroded knees. She can barely hobble out of bed each morning, but she spends all day on her feet for tips and minimum wage. She pours your coffee with a smile, even as her hydrocodone wears off. She won’t take another pill until she gets home. It is going to be a long day. The doctors want her to get knee replacements, but she does not have insurance. And if she gets insurance, she won’t be able to afford to take off work for the surgery, because she does not have disability insurance. The hydrocodone allows her to go to work each day so she can pay the rent and buy gas and groceries and take care of her kids.

She knows her doctor secretly thinks of her as a drug addict. She has seen the pharmacist roll his eyes when she comes in for her monthly refill of hydrocodone. She does not list her pain medication when she sees other doctors for fear of what they will think. Because pain is shameful and people who get treated for pain---unless they are children (innocent) or cancer sufferers (unfortunate)---are weak and selfish and should be ashamed of themselves.

Your Waffle House waitress is not alone. The woman working the cash register at Walmart has carpal tunnel syndrome. If she slows down while checking you out, you fume. You tap your foot. She is going as fast as she can---she can’t afford treatment for her carpal tunnel syndrome so she relies on pain medication to get through the day---but your time is valuable. If she can’t keep up, Walmart should fire her and hire someone younger and healthier---

An aside. The recession of 2008-2010 was a godsend to industry which adopted a first hired first fired policy. A fair number of 40 and 50 something middle managers with some seniority and a good salary and benefits with health problem found themselves downsized and reduced to waiting tables, flipping burgers and checking groceries. Jobs that were much more physically demanding than the jobs they lost, jobs with no benefits. That’s how I met them. I was doing family practice at a county clinic at the time. I met a lot of people who had always had good jobs and good benefits until the recession. For the first time in their lives, they had to hold their noses and seek publicly funded health care. And among their many medical problems, chronic pain was often near the top as a barrier to returning to the high paid with benefits work force.

But enough with the up close and personal. What about the public health? What about our right to live in a country where there is no drug addiction problem adding to crime and the rising cost of uncompensated health care? What about our right to make sure that no pill pushers sell our babies prescription drugs without a prescription?

The medical director of a large, county funded clinic for the uninsured stated publicly that “Poor people should not have their pain treated with opiates. They will be tempted to sell their medication.” That doctor was not being cruel. She was looking out for the public health. She was determined to stop the flow of drugs at its source---the waitress who works at Waffle House. The cashier who works at Walmart. The former realtor who kept putting off her knee replacement surgery when she had good insurance because she did not want to miss work but who started slowing down because of the pain so she got downsized and now that she is out of work and has time to get her knee replaced has no insurance, so all she can afford is pain medication. I’ll bet you didn’t know that woman is a (potential) drug pusher. Public enemy number one.

Good news! The GOP is looking out for your kids. One Republican is floating a plan to have Medicaid stop paying for opiates. Cut off the supply, that will dry up the demand. Several states have already capped the amount of pain medication that Medicaid covers. That should help with the awful problem of the working poor selling their pain medications. If we eliminate the ACA, a lot of people will lose their Medicaid benefits, making it even harder for them to obtain pain medication—and if they can’t get medication for their pain, they won’t be tempted to sell it. If we dismantle the Veterans Administration which treats a lot of chronic pain—being blown up by a land mine can have lasting, painful effects---that will further reduce the supply.

Poor people were not put on this earth to enjoy themselves. They were put on this earth by God to remind us that the wages of sin---and being born female or Black or Latino or joining the military and being sent off to fight in a foreign war---are suffering and poverty and pain. They were put on this earth to change the sheets in our luxury hotels and trim the lawns at our golf courses and clean dishes in our four star restaurants. And they will do all this while their knees, backs, hands are killing them, because their suffering is their atonement for the sin of not being born among the Elect. God loves the Trumps of the world and He hates the poor and every time a rich person crushes a poor person under his foot, God gets a great big grin across His bearded white face. Amen. So sayeth Calvin.

Yes, that was sarcasm. Now, some honest emotion. Be careful. What follows is true and may make you cry or at least want to punch something.

Put yourself in someone else’s shoes. A hard worker who, for no fault of her own, was standing in the wrong place when a truck at her job went into reverse instead of forward. She got crushed. Her neck was broken. Through some miracle, she was able to regain the use of her arms and legs, but from that moment on this 20 something lived in chronic pain. Her neck injury also made her blood pressure unstable. That plus her pain would drive her blood pressure up dangerously high.

One day, while in the emergency room for one of her hypertensive crises, she overheard the emergency room physician refer to her as an N-word junky. She left. She called her family doctor. In tears, she described what had happened.

The American health care system, the so called best system in the world failed that woman. It shot her in the heart. It made it impossible for her to ever trust a doctor again. Because that emergency room doctor was not looking out for her good. He was looking out for the public good.

There is no easy solution for the problem of opiate addiction in this country. But there is an easy solution to the problem is stigmatizing people who have real pain for seeking relief from their pain. You wouldn’t deny a poor asthmatic an inhaler because she might sell it. Why deny your Waffle House waitress treatment for her pain?


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Arrow 22 replies Author Time Post
Reply Working While Poor and In Pain in the United States (Original post)
McCamy Taylor Dec 2016 OP
guillaumeb Dec 2016 #1
stevenleser Dec 2016 #2
dixiegrrrrl Dec 2016 #6
Buckeye_Democrat Dec 2016 #3
PatrickforO Dec 2016 #4
stevenleser Dec 2016 #5
MissB Dec 2016 #8
PatrickforO Dec 2016 #21
stevenleser Dec 2016 #22
Kittycow Dec 2016 #7
raging moderate Dec 2016 #9
Warpy Dec 2016 #10
dubyadiprecession Dec 2016 #11
kag Dec 2016 #12
colsohlibgal Dec 2016 #13
TygrBright Dec 2016 #14
Lyric Dec 2016 #15
loyalsister Dec 2016 #18
zippythepinhead Dec 2016 #16
TheFrenchRazor Dec 2016 #17
moonscape Dec 2016 #19
madokie Dec 2016 #20

Response to McCamy Taylor (Original post)

Sat Dec 17, 2016, 10:34 PM

1. Recommended. Very well written.

And one facet of this is that access to healthcare is something that nearly every industrialized country has already solved. In a single payer system, that hypothetical (in this post) patient would not have to visit the emergency room. That patient would visit a primary care clinic at no charge.

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Response to McCamy Taylor (Original post)

Sat Dec 17, 2016, 10:40 PM

2. Fortunately for me, my incidences of recurrence of back pain virtually stopped a few years ago.

 

What worked best for me was Percocet. From March 1999 - March 2000 in order to get through the day I was taking two pills every four hours. I was going to work, even traveling, taking flights for work and carrying around luggage and a laptop with severe pain in my spine at C6-C7.

Eventually a shot of steroids and a week of bed rest took the pain away and I stopped taking Percocet. Percocet and two other meds were kept on hand, but not taken for the next 12 or so years except for recurrences that typically lasted 3-21 days. One recurrence in around 2007 required another shot of steroids and bed rest. I never became addicted to Percocet and had no desire to take it outside of recurrences of pain. I have a 3/4 full bottle in my closet now that is from around 2011 (who knows whether the pills are still good). I've been told by doctors that if I get another attack of pain and I run out, no one is willing to prescribe Percocet to anyone anymore even though that is what works for me and I have no issues with addiction.

I hope I never get an attack again, but if I do, why can't I have what works for me? Like you said, this is all silly.

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Response to stevenleser (Reply #2)

Sat Dec 17, 2016, 11:01 PM

6. Mr. dixie is getting adequate pain meds for his broken back

and his doc seems comfortable writing the re-fills
but
because of all this hype about opioids, Mr. dixie feels guilty asking for refills
and worries about being addicted even tho he takes less than he really should, so is still in pain on the meds but now is anxious and tense to boot.
He had another MRI this week, which will cover the good dr.'s ass for prescribing the meds
and hopefully help Mr. dixie feel better about taking the correct dose.

and funny thing is, he has half the tolerance that I do, so his meds work better than the prescribed dosage for me after my surgery this summer.

i do not know anyone our age who is not hurting from one thing or another, which is pretty common for us boomers by now.

fortunately, we are seen as nice white senior citizens and I doubt the good dr, ( young enough to be my grandson) would ever envision us as selling our meds.

what a fucked up system.

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Response to McCamy Taylor (Original post)

Sat Dec 17, 2016, 10:46 PM

3. Pain is horrible. I'll be blind in both eyes eventually, but that still seems better than...

... chronic pain, at least the really intense kind that makes it nearly impossible to sleep or divert your thoughts away from it.

I see lots of older people at my local grocery who hobble around with hurt expressions on their faces like they played in the NFL for years. I'm guessing that many of them had their bodies wrecked by repetitive factory jobs, though.

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Response to McCamy Taylor (Original post)

Sat Dec 17, 2016, 10:50 PM

4. Two words for everyone who reads this.

SINGLE


PAYER

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Response to PatrickforO (Reply #4)

Sat Dec 17, 2016, 10:52 PM

5. And in the meantime? nt

 

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Response to stevenleser (Reply #5)

Sat Dec 17, 2016, 11:05 PM

8. Suffering for all in pain.

Double for the poor.

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Response to stevenleser (Reply #5)

Wed Dec 28, 2016, 05:42 PM

21. In the meantime?

What meantime?

We leave the ACA in place with two changes in policy:
1. Government can now negotiate cost with healthcare providers and pharmaceutical companies.
2. People can choose a public option and get on Medicare.

Would we need a tax increase? Sure. Would it be big? Sure.

But, hey, right now I pay 'taxes' out the nose for shitty, rationed healthcare that has financially crippling copays. Seriously. Those 'taxes' are called premiums and go either to profits (in the case of a for-profit company providing the goods or services) or retained earnings (in the case of not-for or non-profit service providers). My HMO, for instance, is non-profit.

However, its primary 'value' that it beats all its employees over the head with is cutting costs. Why? Because they want to retain earnings so they can build more giant edifices and collect more premiums. Because they sure aren't providing us with much in the way of accessible (or affordable) healthcare.

So you know what? I'd MUCH rather be taxed more heavily, and have everyone have access to enough healthcare. The British system is pretty good. Our system is not.

And you know, I'm pretty sick of being told, "oh, well, that's pie in the sky," or "you are SUCH a unicorn," or "that's just downright impractical." The only reason for these counterarguments to doing the right and moral thing is that the big healthcare companies and big pharma companies that line our politicians' pockets with campaign contributions don't want us to have single payer. Because that, Steven, takes profit OUT of healthcare (where it belongs) and instead focuses on providing a service that is a RIGHT for all of us.

But hey, according to the US Census American Community Survey 2015 1-Year Estimates, 29,757,544 people DON'T EVEN HAVE COVERAGE. Twenty-nine million people! How is that not odious and immoral???

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Response to PatrickforO (Reply #21)

Wed Dec 28, 2016, 08:54 PM

22. Once again, and in the meantime? nt

 

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Response to McCamy Taylor (Original post)

Sat Dec 17, 2016, 11:04 PM

7. As a severe chronic pain sufferer, thank you.

It seems nobody ever thinks about us except to blame us for drug abusers. And then we get squeezed up against the wall again as Dr. Government steps in to micromanage our cases often to our detriment while not solving the problem of the abusers.

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Response to McCamy Taylor (Original post)

Sat Dec 17, 2016, 11:13 PM

9. McCamy Taylor, may your heart be blessed forever!

Both of my parents worked in pain at low level jobs. I worked in pain, but gradually worked my way into better pay so I could at least retire by age 65. How my heart goes out to those who did not manage to do this: I know that much of my achievement was just good luck! I wish them some good fortune too. Please, everybody, think about how horrible this suffering is that is going on silently all around us, with Republicons jeering at these people as though they deserved their agony! Jesus said, "Do you think those people the tower fell on were worse sinners? Do you think those people the Romans massacred the other day were worse sinners? No!" he said. He said that was not true. He said something about the glory of God that could be shown in our reaction to misfortunes. Please, everybody, don't give up on the dream of working together.

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Response to McCamy Taylor (Original post)

Sat Dec 17, 2016, 11:28 PM

10. Thank you for this

Before the Harrison Act of 1914, opium compounds, usually in the form of laudanum, were over the counter in most drug stores. State and city laws covered the sale and it was basically legal. There was social pressure against the overuse of laudanum, especially, probably more for the alcohol than the opium.

After the Harrison Act, doctors who rarely saw patients in chronic pain were inundated since these people suddenly had no means to manage their own pain. Few of these people were addicts. Most were physically dependent on the drug because of pain.

People in those days worked 14-16 hour days in mills, in mines, and on farms. They were able to keep going because they had adequate treatment for their not inconsiderable pain. Our forebears were not Supermen. They just had appropriate, self regulated treatment.

This is what I want to go back to. People should have the ability and the right to manage their own pain. The search for non opiate painkillers has turned up a lot of drugs later found to have deadly side effects, none suitable for daily use for chronic pain sufferers for years at a time. It's time to throw in the towel, admit the drug war has been a dismal failure for addicts and the general population together, leading only to tyranny with too many people left miserably in pain until they commit suicide to make it stop.

What we are doing now is cruel, wasteful, expensive, and does not work. Prohibition will never work.

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Response to McCamy Taylor (Original post)

Sun Dec 18, 2016, 12:26 AM

11. Our healthcare industry loves getting all that gravy money!

Hell! They have enough money from overcharging, that they can afford to pay big bucks for spokemen like Don Shula and Dan Marino.

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Response to McCamy Taylor (Original post)

Sun Dec 18, 2016, 12:27 AM

12. Thank you sooooo much!

I understand that we have a heroin problem in this country, but judging people because they have to medicate their chronic pain just to get through the day can't be the solution.

Thank you again, so much, for your beautifully written article.

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Response to McCamy Taylor (Original post)

Sun Dec 18, 2016, 01:16 AM

13. Greed And More Greed Is The Issue

One of the Kochs summed it up by saying he just wanted his fair share...which is all of it.

The rich are getting richer the poor are getting poorer.

Watch Michael Moore's "Where To Invade Next" and see how average citizens live in other nations.

Not here, the rich just want to get richer and the Hell with the poor.

The sad thing is that many who are poor vote for those keeping them poor.

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Response to McCamy Taylor (Original post)

Sun Dec 18, 2016, 01:46 AM

14. The fact that we give people pain medication that gives them more pain is purely diabolical. n/t

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Response to McCamy Taylor (Original post)

Sun Dec 18, 2016, 01:54 AM

15. And this is how half of supposed drug "abusers" are made.

Poor people being forced to buy pain pills (or worse, heroin) on the black market because nobody will prescribe it for them, and they HAVE to be able to work.

Trust that I know what I'm talking about here. Some would classify my best friend as a drug abuser just because she has no choice but to buy Percocet pills from a local dealer. She has major back and leg pain, but her income is necessary for her kids to survive, and she is allergic to NSAIDs. So she spends a huge chunk of her meager paycheck buying pain relief, just so she can keep the job that puts food on the table. It would be a really GOOD job if she didn't have to give up a quarter of her earnings every week to the pill guy. But no physician in this part of West Virginia will touch a pain patient who is also a Medicaid patient--at least not with a narcotic prescription.

My poor mother laid in agony for years until her condition was finally deemed "terminal" so Hospice could step in. My sister was on the verge of starting Mom on heroin, just because none of us could stand to watch her suffer anymore. Thank God for Hospice. They made my mother's last year of life bearable, finally.

The way that poor people with pain are treated is abhorrent, but what can we do? Doctors know that we aren't likely to have the resources or knowledge to sue them, and they are far more concerned with being harassed by the DEA than they are with alleviating a poor person's pain and suffering.

Then there is the phenomenon of "pseudo addiction"--where poor, suffering patients fake a painful medical condition in order to get pain medication for a *different* painful condition that is being ignored or undertreated--for example, faking a kidney stone in order to get painkillers for terrible back pain that they are suffering. They aren't lying about being in pain. But their REAL pain is relentless and horrible and is not being treated properly, so they do whatever must be done in order to get that medication.

Frankly, pain treatment for the poor in this nation is just horrific. Almost 12th century horrific. We all ought to be ashamed of allowing it to come to this. The suffering I see just within my own family is unimaginable to people who have always had their pain treated promptly and well.

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Response to Lyric (Reply #15)

Sun Dec 18, 2016, 04:47 AM

18. The stigma gets in the way of effective treatment

Just because a person builds up a tolerance and experiences physical withdrawal symptoms, does not necessarily mean they are in the stereotyped mode of opioid addiction.

I much kinder view is one where not everyone with a physical dependecy is an overdose waiting to happen who must be "cleaned."

If it is managed well, even heroin could be used in a way that alleviates pain and helps a person maintain, at the very least, a tolerable standard of living. Or, maybe even better? It would be so much more productive and helpful to provide guidance for living with a physical dependency rather than demonizing people to a point that gives permission to throw them away and let them suffer.

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Response to McCamy Taylor (Original post)

Sun Dec 18, 2016, 03:54 AM

16. Well said

 

I know lots of people who fit that category of being stigmatized by, so called, opiate "addiction", mainly because they are poor.

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Response to McCamy Taylor (Original post)

Sun Dec 18, 2016, 04:30 AM

17. Spot on; i am there myself, and it's a constant struggle to get any kind of pain meds. it's BS. nt

 

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Response to McCamy Taylor (Original post)

Sun Dec 18, 2016, 05:01 AM

19. And earlier this year the problem became a whole lot worse, as

regulations changed and things got a whole lot tighter.

I'm fortunate. I've had low-level chronic pain for decades and have been going to the same rheumatologist (Director of Rheum at a noted hospital clinic.) He knows I don't abuse, and prescribed about 5x the Vicodin I took. Back then, there'd be a script in house and I could refill at will. I filled a fraction of what he prescribed, but still warehoused. A friend would have back pain and I'd be able to share a few.

Then, Vicodin was replaced with Norco several years ago, but I still have a boatload of Vicodin - enough for a couple of years. Got cancer and was given oxycodone. Again, I don't take as much as prescribed but resumed my habit of warehousing. Thank goodness!

This Spring, regulations changed, and I've heard scattered reports of even fellow cancer patients not being prescribed what they need. WTF? I was at my GP of 25 years last week, and told her I was getting edgy. Said I didn't need more pain meds but was warehousing and she was very sympathetic. She said since she doesn't write many scripts for narcotics, and knows the local druggist, she has no problem (whipped out her pad and wrote me a big script), but the issues are real. She's hoping things will calm down a bit and become more rational, but for now ... it's really tight.

Gone are the days of faxing scripts. One now has to hand-carry everything.

I have been a pain patient for decades but have never been an addict. I didn't expect meds to get rid of my pain, only to snip the sharpest knife-tip off.

I'm fortunate to be prepared, that I can continue filling what I need and maintain my stash, but I'd be in a crazy panic if in the more vulnerable situation of so many others.

It's wrong. Wrong wrong wrong.

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Response to McCamy Taylor (Original post)

Sun Dec 18, 2016, 05:24 AM

20. I live with pain 24/7

afraid to ask the doctor if I could go to a 10 from the 7.5 I'm taking now. That I've been taking for 10 plus years now. I don't take 5 pills a day or sell any, I take a pill every 6 hours as prescribed. The high that some gets from Hydrocodone was gone 10 years ago and it is not part of the why of my taking my meds. No one that I know even suspects that I take a pill every 6 hours as needed due to the fact I never take two pills at a time to get high. I simply take one pill to stave off some of this pain so I can go through my day half assed feeling like a human and not a wretched old man with a hydrocodone prescription.

I pretty much gave up my future for this country all for a lie, 'gotta stop 'em over there before they get over here.' Remember that one, well I sure do.
As I look back I came home a mess and in a lot of ways I'm still a mess today but I get by. About drank my self to death self medicating and not knowing what the hell that was all about but I know now it was to forget, mostly.

Anyway McCamy that is a well written piece you shared with me, with us. Now I hope its ok if I share it with a few others in my life.

Peace

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