Anger directed at drug abusers

The typical state law allows prescribing narcotics for 7 day’s worth for acute pain. The rules change for chronic pain management with narcotics. If I would have to prescribe for more than 7 days I have to verify in the pharmacy database that I am the only prescriber. I also have to have solid documentation of the need for such based on patient interview and physical examination/testing.
 
OneCharlieTango said:
Two years ago I fell off my airplane and sustained 14 fractures of 11 ribs, a collapsed lung and 5 vertebral fractures. Without oxycodone I’d be dead now.

The current stinginess with narcotics is unconscionable.
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omg.
You. Win.
 
Half Fast said:
Maybe we could all scrounge through our medicine cabinets and send our leftovers to @Let'sgoflying! .

Better yet - one of the mods could create a sticky where we could keep a running list of our unused meds as a resource for POA members who can't get what they need from their PCPs.
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I would have paid $1000 for one 7.5 hydrocodone last night to ease her pain
 
My FIL was a periodontist. He often complained about incessant cold calls from prospective patients requesting pain medication. Abuse was clearly rampant. Not surprised there's an overcorrection.
 
dbahn said:
That's a logical guess, because it's certainly not a federal law. But I don't think it's a law at all. And if I were practicing in a state that had that law I'd be ********, even though I prescribed narcotics very sparingly in my own career in orthopedic surgery. But that's not a policy that should be decided by elected laypersons, no matter what.

Doctors often overprescribe narcotics for two reasons. First, they don't want to be bothered at all hours by desperate patients dealing with pain thinking a "pain killer" will eliminate it and second, they don't want to lose patients who might consider them "uncaring" or not in touch with the patient's feelings. I also knew a few docs who just liked the power they perceived they had for having the prescribing privileges in the first place. "But doc, I'm in severe pain." "OK, I can fix that."
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I have a problem with my GP and my ortho - they WANT me to take the pain killers, and I emphatically resist. They both finally gave up, left it to me to decide if I need them. While in the hospital, I didn't have a choice. Nurse Ratchet stood there to make sure. My GP gives his home number to all his patients, one reason I like him.
 
robin ardoin said:
The typical state law allows prescribing narcotics for 7 day’s worth for acute pain. The rules change for chronic pain management with narcotics. If I would have to prescribe for more than 7 days I have to verify in the pharmacy database that I am the only prescriber. I also have to have solid documentation of the need for such based on patient interview and physical examination/testing.
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How far away is the OP from Robin in LA? A day's drive or more?
 
murphey said:
I have a problem with my GP and my ortho - they WANT me to take the pain killers, and I emphatically resist. They both finally gave up, left it to me to decide if I need them. While in the hospital, I didn't have a choice. Nurse Ratchet stood there to make sure. My GP gives his home number to all his patients, one reason I like him.
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That was the issue I ran into in the ER after breaking my wrist. They were trying to get me on a morphine drip and I refused (as I was standing around with my wrist hanging there clearly not aligned properly). "Advil would be fine, I've had worse headaches." So I just went without for 5 hours because they wouldn't let me have Advil (they later explained that this was because they wanted my stomach empty in case they sedated me to set the bone - which they eventually did). Walked out with a script for oxycodone and naproxen (I specifically said I had zero interest in oxycodone and if they were going to prescribe something, I'd prefer something not so strong - got that anyway). After surgery got a script for hydrocodone. Ended up taking a total of one pill. I am also fortunate to have a high pain tolerance and recognize that I may not be normal (not that anyone on here would likely accuse me of being normal anyway).

The whole experience struck me as a heroin addiction starter kit, and it was easy to see how someone who was prone to addiction could end up down that path. One of my best friends from high school was a psychiatrist who specialized in addiction, and had told me that sort of situation is how it often starts if you have someone prone to addiction.
 
murphey said:
I have a problem with my GP and my ortho - they WANT me to take the pain killers, and I emphatically resist. They both finally gave up, left it to me to decide if I need them.
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One of the sad outcomes of the Sackler/Oxycontin fiasco is that part of their deadly marketing scheme was directed at nurses, doctors, and other providers. It was a huge con job. They insisted that Oxycontin was not addictive, which "might" have been true in small doses but clearly wasn't as it was ultimately prescribed and miss-used.

What your GP and ortho docs were doing was exactly what the Sacklers wanted them to do, and the nurses were drinking the same kool-aid. That marketing scheme was well planned and executed and made billions of dollars for an addictive drug that had already been in use for years but was then re-branded with a different coating.
 
I'm not an expert on the topic. But, I would've thought whatever trauma center is in her EMS (the level I or II that she sees most often as part of her job) would have trauma doc buddies that would give her the gouge on how to legally work the system. The only downside is what the insurance company will cover. There's gotta be a way!
 
I don’t envy OP’s/spouse’s situation; I’ve been there on the pain spectrum before. I don’t share anger at the abusers though. The script farming docs and pharmacists who knew or should have known better have my ire. They’ve killed more than a few of my former airmen ny making them addicts.
 
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charheep said:
...they thought the pain pills was too strong and insurance and the pharma wanted to double check...
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That's the US health system for you. The profits of insurance companies and "healthcare providers" are the priority. The aim seems to be to keep people alive just long enough to drain their wallets.

Having lived in a few countries, the system in the US is just...execrable. It's outright predatory. The endless variety of overcomplicated "insurance" policies designed to confuse the consumer, the systems set up to auto-deny claims by the hundred at a click of a button, the byzantine billing practices that lead to consultancies set up purely to coach providers in how to bill (I know a guy who does this and flies a $1mln+ airplane, paid for out of money that should be going to treat people). It's a disgrace.
 
Let'sgoflying! said:
My wife broke her leg in three places plus shredded ankle and knee ligaments - on Sunday during a emergency call to help downed hikers. (she's a paramedic).
The ER gave her three days of pain meds, "the law only allows us to do 3 days".
You can't get an ortho appointment til the 20th (2 weeks) and they only give pain meds to post op patients anyway!
The PCP says this morning, "we can't help you". WTF?!?

So she is in pain level 5-8, is not sleeping, all because the medical system has slammed the door shut on people who have a bonafide need for pain medicine! Thanks a lot, effing drug abusers.

She is already icing, elevating, resting, CBD, lidocaine patches, acetominophen (can't take nsaids). She needs hydrocodone!
I'm going to punch the next drug abuser I see in the nose!
Why does the medical system have to way over-react in this way? There is sometimes a bonafide need for certain medications and anyone can tell from the radiographs, 'yeah, that's gotta HURT'.
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It seems the legal limit in Texas is ten days. But da **** kind of Ortho won't see her until two weeks from now? That's insane. Find a surgeon who will see her now. Where in Texas are you?
 
As stated above, there is in fact a law in Texas limiting a prescription of opioids for acute pain to 10 days:

Texas Health and Safety Code Section 481.07636 - Opioid Prescription Limits

Statutes Title 6, Food, Drugs, Alcohol, and Hazardous Substances; Subtitle C, Substance Abuse Regulation and Crimes; Chapter 481, Texas Controlled Substances Act; Section 481.07636, Opioid Prescription Limits. Refreshed: 2023-07-23
texas.public.law texas.public.law

There may be other reasons the prescriber limited it to 3 days, such as hospital or department policy. The insurer I do some work for, the largest in TX, has a limit of 7 days for a new prescription for an opioid-naive patient. That's for payment though.

There is some scientific validity to keeping an introduction to opioids to three days, as that is the time fame at which dependence may begin to develop/ I am not saying that limit is a appropriate for a major traumatic injury which has not yet been treated with the needed surgery.

Jon
 
4CornerFlyer said:
As stated above, there is in fact a law in Texas limiting a prescription of opioids for acute pain to 10 days:
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. . . which makes the 3 day explanation given to the OP a blatant lie. Someone in that department is being unethical at the patient's expense.

Besides, even the law seems to have no teeth when you read Subsection (d):

(d) A dispenser is not subject to criminal, civil, or administrative penalties for dispensing or refusing to dispense a controlled substance under a prescription that exceeds the limits provided by Subsection (b).
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So that seems to say that the provider is off the hook for either under prescribing over prescribing a controlled substance. How would that law be enforced?
 
when I drove through TX a few months ago I remarked a shocking number of urgent-care places that looked like drive-thru hamburger stands. They're freaking everywhere. I assume they exist to fill in this gap?
 
dbahn said:
Look at the Sackler family. Their irresponsible marketing of Oxycontin created thousand of addicts, many of whom died, but they ruined the lives of countless others. They paid out a massive amount of money in a settlement and laughed all the way to their own banks.
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That whole crime family belongs in a deep dark prison hole for the rest of their lives.
 
Let'sgoflying! said:
My wife broke her leg in three places plus shredded ankle and knee ligaments - on Sunday during a emergency call to help downed hikers. (she's a paramedic).
The ER gave her three days of pain meds, "the law only allows us to do 3 days".
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Sorry to hear about your wife...

So my question is why wasn't there an orthopedist on call for a consult? A broken leg in three places, to me, screams instant admission with the possibility of an open reduction internal fixation at the worst. She is going to have a bigger issue on her hands waiting 20 days to see a bone cutter. If they didn't have the capability, why was she not transferred to a facility that did?

From what I remember from the Texas Medical Board, they allow for a 10-day Rx, and if needed can get another 10-day Rx with an in-person consultation. I can't imagine an EM doc looking at her films and saying, "yeah, we're going to release ya, take two aspirin, and call your MD in the AM..."

Hope the best for your wife...
 
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I would responded with the cell phone my hand recording the conversation
“For the record, Dr would you explain why you refuse to treat my wife’s pain from her leg injury?”
When they ask what are doing, I would respond Collecting evidence to have your license revoked and then I will file a lawsuit against you, the hospital, and city.
 
Sorry your wife is going through this. There are so many problems with our systems. Probably the most serious is the insurance industry. We treat health insurance companies as if they are legitimate and ethical businesses, and clearly they're not. IMHO we don't have a healthcare crisis in the US as much as we have a health insurance crisis. I don't know how to fix it. "Stalinesque" would be too kind for them, in terms of the institutions, and I don't mean that as hyperbole.

Another problem is that the very first sign of an addict, in my experience, is someone that cannot accept responsibility for their own actions. There is a programmed need to blame their situation on outside causes. Some people listen to that, and we end up with systems that try to protect them. None of which work. Opioid regulations don't help anyone except both legal and illegal drug manufacturers and distributors.

Or in other words, we'd be better off if you could walk down to the local pharmacy and buy a bottle of codeine, just like you could around 100 years ago. We have not improved the situation over time. It's prohibition, but far more expensive in terms of dollars, human suffering, and violence associated with the illegal trade and everything associated with it. As a society we think we're smarter and more advanced, but we're really not in this area.
 
Let'sgoflying! said:
I would have paid $1000 for one 7.5 hydrocodone last night to ease her pain
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And this is the thing that makes me mad, too. People suffering that really don't need to. We have doctors being managed by insurance companies and what are effectively law enforcement agencies, and to what end? Addicts will always, always find drugs.
 
I don't think the problem is the addicts. The problem is the system that assumes everyone is an addict and doesn't take responsibility for helping the addicts that the very system created.

Sorry you're going through this. Sad. It's by far easier to get good medical care for a pet than it is for a human.
 
Albany Tom said:
There are so many problems with our systems. Probably the most serious is the insurance industry. We treat health insurance companies as if they are legitimate and ethical businesses, and clearly they're not. IMHO we don't have a healthcare crisis in the US as much as we have a health insurance crisis. I don't know how to fix it. "Stalinesque" would be too kind for them, in terms of the institutions, and I don't mean that as hyperbole.
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The fact that it’s so much cheaper to get health care if they don’t have to deal with insurance is rather telling.
 
It would be interesting to see a breakdown (an honest, factual, breakdown) of the costs for complying with various requirements from "healthcare" insurance companies, malpractice insurance, and the other costs to operate a hospital or practice. e.g., how much labor is expended filling out the forms, rejecting forms, resubmitting forms...
 
Bob Noel said:
It would be interesting to see a breakdown (an honest, factual, breakdown) of the costs for complying with various requirements from "healthcare" insurance companies, malpractice insurance, and the other costs to operate a hospital or practice. e.g., how much labor is expended filling out the forms, rejecting forms, resubmitting forms...
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I'm sure it would be a complex calculation, but having been in medical practice for 40 years before retiring and having formerly served on a hospital board of directors, I can tell you that it's NOT going to the doctors, nurses, and other professionals that actually provide the care. Hospital and other administrative costs have ballooned during my lifetime as have vendor costs, which includes medicines, hospital equipment, and many other supplies. Liability insurance (including malpractice insurance) also factors into those calculations.

Years ago Medicare/Medicaid began reducing reimbursement for services so, in order to continue funding the bloated industry, charges were raised and passed to other insurers (the so-called "cost shift"), all while payors were demanding more complex documentation for billing charges, which further raised the already high administrative costs.

It's very hard to reverse that kind of fustercluck.
 
MooneyDriver78 said:
I would responded with the cell phone my hand recording the conversation
“For the record, Dr would you explain why you refuse to treat my wife’s pain from her leg injury?”
When they ask what are doing, I would respond Collecting evidence to have your license revoked and then I will file a lawsuit against you, the hospital, and city.
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Respectfully, that would solve nothing. You would have to approve abandonment and the PCP never engaged to treat the condition to start with. A wast of time and effort better spent on looking for another provider of care for the orthopedic injury.
 
Bob, we live in Illinois. Politically correct, Illinois. Somebody promotes a "guideline" and with state regulation the way it is, everyone is afraid to overstep. It's reverse McCarthy-ism at it's worst.
 
MooneyDriver78 said:
I would responded with the cell phone my hand recording the conversation
“For the record, Dr would you explain why you refuse to treat my wife’s pain from her leg injury?”
When they ask what are doing, I would respond Collecting evidence to have your license revoked and then I will file a lawsuit against you, the hospital, and city.
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Good luck getting that recording into evidence as you may have noticed these signs all over. And a stunt like that will get you kicked to the curb.

61c4jogyDLL._AC_UF894,1000_QL80_.jpg


EM docs as a whole are pretty much no-nonsense people and know BS when they see it.. We'll just leave it at that.
 
I’ve heard of people (teenagers) getting oxy from their dentist, so I’m a bit surprised. But some docs will give you whatever you want, some will over offer, some will not offer drugs as they don’t want to contribute to the addictions (oxy is very addictive!)
 
4CornerFlyer said:
There is some scientific validity to keeping an introduction to opioids to three days, as that is the time fame at which dependence may begin to develop

Jon
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I find that hard to believe. I’ve read 30 days, but never 3. And even the 30 days is suspect. The number that gets thrown around is 7%. That is, 7% of postoperative patients who take narcotics >30 days after surgery will be addicted to narcotics. The implication is that it could be anyone, any random 7%. But I don’t buy that. For one thing, I’ve read that something over 10% of Americans are addicted to narcotics already. If that’s the case, the 7% after surgery is meaningless; it suggests surgery is protective against addiction.

But for another, I really don’t buy that it could be any randomly selected 7%. I used to think it was, and said so often and openly. Then I had a major trauma and took various narcotics off and on for most of a year, after which I didn’t, and my opinion changed quite a bit. I believe that most of those who become addicted could be predicted by close friends and family.

In the case of the OP, it could well be that his wife’s status as a paramedic caused doctors to be more stingy with the narcotics, figuring that she has access to them every work day, and is therefore at significant risk of addiction. It’s ridiculous, but I heard such talk from the ICU doctor when I was a patient [I’m an anesthesiologist]. My family doctor, a personal friend for many years, laughed out loud when he heard it. My wife, who hadn’t had reason to laugh in a couple of days, also laughed and said, “you’re about the only person I know who isn’t addicted to anything.” It’s probably the sweetest thing she’s every said, but the point is I don’t believe narcotic addiction attacks randomly.
 
mandm said:
I’ve heard of people (teenagers) getting oxy from their dentist, so I’m a bit surprised. But some docs will give you whatever you want, some will over offer, some will not offer drugs as they don’t want to contribute to the addictions (oxy is very addictive!)
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Don’t confuse oxycodone with oxycontin. Same drug but different delivery forms and intended usage. Nothing illegal, unethical with prescribing oxycodone for short duration acute pain. Oxycontin, which has the bad reputation, is a sustained release form intended to treat chronic mod/severe pain. This drug was overprescribed and highly desired on the street market and crushed then snorted or injected. Many overdose deaths occurred with oxycontin but it pales in comparison with fentanyl od’s. Prescription analgesics are much harder to get legally and illegally but overdose deaths continue to rise. This shows that the blame certainly does not rest hard on the manufacturers and prescribers at this point.
 
Morgan3820 said:
Law or no law doesn’t really matter if they are not going to write you the prescription. Unfortunately also while I’m sure that your wife does not look like a drug abuser, the fastest growing segment for drug addictions is the over 50 crowd.
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Citation?
 
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2 weeks for surgery for that kind of injury? Are they waiting for swelling to subside or something? I just had a leg injury in July that required me to be taken off the mountain strapped to the back of a UTV after being carried to the UTV. Then taken to local ER by ambulance to be sent to another ER by ambulance about two hours away. I was out of surgery in less than 18 hours from time of accident. And more than enough pain medication, actually I never used it.

You’re problem isn’t the drug abusers, it’s your local medical care, insurance companies, and/or local leaders.

Edit, if going through workers compensation since it sounds like it happened on the job , that is probably making it more complicated.
 
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This is interesting

"The Texas Medical Board interprets this section to mean a practitioner may write an opioid prescription for up to 10 days without a refill."
 

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