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Originally posted to Comics on Tue Mar 04, 2014 at 02:50 PM PST.

Also republished by Daily Kos.

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Comment Preferences

  •  I'm betting they are the ones who (3+ / 0-)
    Recommended by:
    wader, slowbutsure, Stentor

    are most likely to go to jail.

    Something tells me it's people poorer than doctors.

    If knowledge is power and power corrupts, does that mean that knowledge corrupts?

    by AoT on Tue Mar 04, 2014 at 02:57:29 PM PST

    •  I've heard that dealing in prescription drugs is (2+ / 0-)
      Recommended by:
      Santa Susanna Kid, Stentor

      quite the business model for middle aged folk in Florida.

      When I was in college, I got a prescription for amphedamines from a (probably alcoholic) doctor.  Turns out that stuff if terrible for me!

      ...Son, those Elephants always look out for themselves. If you happen to get a crumb or two from their policies, it's a complete coincidence. -Malharden's Dad

      by slowbutsure on Tue Mar 04, 2014 at 04:53:13 PM PST

      [ Parent ]

    •  Re:Drug Enablers (4+ / 0-)

      If the Doctors are the dealers, then guess who the Supplier Cartel is?

      Big Pharma

      The only 2 rhetorical tools Republicans ever seem to use are the logical fallacies of false dichotomy, and false equivalence.

      by Stentor on Wed Mar 05, 2014 at 11:41:33 AM PST

      [ Parent ]

    •  If it's the study I'm thinking of (3+ / 0-)

      It listed as provided by doctor if someone gave away or sold their opioid narcotics as the same as if the doctor prescribed several hundred opioid narcotics unnecessarily.

      It all makes it that much harder for my wife to get opioids for her otherwise uncontrollable pain.

      •  Yeah, there's a big problem on both sides (3+ / 0-)

        My mother used to work as a nurse in a clinic specializing in pain management. Every patient they had to sit down and try to figure out if they really needed medication or if they were just lying to get the drugs. Many conditions that cause pain are absolutely impossible to verify the existence of, making it far worse.

        Some doctors do prescribe to everyone who walks through their doors because they make money that way, and some doctors are so stingy with their prescription pads its impossible to get more than a few ibuprofen from them. There really is no right answer. Either way they'll possibly be hurting someone, whether its enabling a chronic abuser or not giving someone in severe pain the medication they need.

        In any case, the Doctors who willingly or knowingly prescribe to abusers, or the doctors who don't bother even asking the most basic questions to establish that the patient is actually experiencing the pain they claim... Greed has no place in the saving of lives and the treatment of disease.

  •  The doctors are merely enablers (1+ / 0-)
    Recommended by:
    Stentor

    doing big pharm's dirty work.

    "Onward through the fog!" - Oat Willie

    by rocksout on Tue Mar 04, 2014 at 03:01:50 PM PST

  •  In (mild) defense of the doctors, (6+ / 0-)

    they are often lied to/gamed/deceived for their pills.

    Mitigating that defense: There are plenty of doctors who don't exactly try too hard to verify things either.

    "Much of movement conservatism is a con and the base is the marks." -- Chris Hayes

    by raptavio on Tue Mar 04, 2014 at 03:02:02 PM PST

    •  Yes and no (2+ / 0-)
      Recommended by:
      Wee Mama, chrisculpepper

      Most primary-care doctors now will consult state-wide and nation-wide pharmacy clearinghouse data before prescribing opiates to a patient about whose self-reported pain they feel uncomfortable.   The data is readily available to physicians and frequently (though certainly not always) used.  

      And "pain contracts", wherein the patient agrees not to go doctor-shopping and pharmacy-shopping, but stick to opiates from THIS source only, are common tools.

      Patients are considered to have a right to pain control and you will find many people who will report a hard time getting their pain appropriately managed.  Of course these are not the scammers but usually the more meek and  compliant patients.  

      The real culprit IMO is that as a culture we WANT a pill to fix it.  It's so much easier than following good advice about weight loss, exercise, meditation, and the like.  And really, what CAN doctors do?  Cut you, medicate you, or give you advice, period.  

      "The extinction of the human race will come from its inability to EMOTIONALLY comprehend the exponential function." -- Edward Teller

      by lgmcp on Tue Mar 04, 2014 at 03:16:03 PM PST

      [ Parent ]

    •  They would often lose their patients... (1+ / 0-)
      Recommended by:
      lgmcp

      and their livelihoods if they always did what they thought best, especially in the US. How else to explain perscribing antibiotics for viral infections, everywhere? Well the patient feels they've been treated, so the visit to the doctor was worthwhile, also no 'untreated whatever' malpractice lawsuits... nevermind the MRSA...

      I ride the wild horse .

      by BelgianBastard on Tue Mar 04, 2014 at 03:28:07 PM PST

      [ Parent ]

    •  Yes indeedy (3+ / 0-)

      In my experience, it's the surgeons who are the worst. Primary care physicians are usually much more aware of their patients because they see them more often. Surgeons usually see you just the one time for whatever surgery you need.

      My husband just had minor surgery last week, and we were both shocked when we saw the prescription he wrote out for post-op: 40 Vicodin. 40! My husband has taken exactly one the entire time and barely even needs advil now.

      Time is of no account with great thoughts, which are as fresh to-day as when they first passed through their authors' minds ages ago. - Samuel Smiles

      by moviemeister76 on Tue Mar 04, 2014 at 04:32:21 PM PST

      [ Parent ]

      •  Dentists, too! (1+ / 0-)
        Recommended by:
        moviemeister76

        I got four (or five) prescriptions for Vicodin back when I had to have a slew of fillings and caps that went bad removed and each tooth root-canaled.  I kept saying that Motrin worked fine, didn't need the Vicodin, but kept getting prescriptions for it "just in case".

  •  FDA OK super painkiller (0+ / 0-)

    10  times stronger than Oxycontin , Limbugh salivating a the mouth

  •  I've met some physicians who give out (2+ / 0-)
    Recommended by:
    Cali Scribe, Wee Mama

    prescriptions and refills with minimal followup or oversight, but most I know give out whatever seems appropriate for reasons they think are worthwhile . . . not always considering the side-effects or impacts of adding to a patient's mix until complaints come up.  Especially in situations where multiple doctors are prescribing for the same person.

    "So, please stay where you are. Don't move and don't panic. Don't take off your shoes! Jobs is on the way."

    by wader on Tue Mar 04, 2014 at 03:09:13 PM PST

    •  Most physicians I've seen (8+ / 0-)

      would rather see a patient suffer than prescribe painkillers.  They are either smug moralists, or are so cowed by DEA thugs that they no longer prescribe opiates except in the most extreme cases.

      They also are quick to prescribe alternatives like NSAIDS which when used long term can cause horrific side effects like stroke, heart attack, and permanent hearing loss.  When used responsibly, opiates are FAR safer than NSAIDS.

      "When I was an alien, cultures weren't opinions" ~ Kurt Cobain, Territorial Pissings

      by Subterranean on Tue Mar 04, 2014 at 03:12:54 PM PST

      [ Parent ]

      •  Forgot to add stomach ulcers (3+ / 0-)
        Recommended by:
        sillycarrot, rbird, Tempus Figits

        to the NSAID side effects, along with rectal bleeding and other GI tract changes.

        "When I was an alien, cultures weren't opinions" ~ Kurt Cobain, Territorial Pissings

        by Subterranean on Tue Mar 04, 2014 at 03:14:17 PM PST

        [ Parent ]

      •  ahhh (2+ / 0-)
        Recommended by:
        sillycarrot, wader

        another medical expert!

        Where did you get your pharmacy degree again?

        Oh yes, Ibuprofen is much more dangerous than oxycontin...

        •  Besides having a strong background in (5+ / 0-)

          biological sciences, I have lost much of my hearing to taking an NSAID.  I can no longer listen to music or watch movies without ear pain and extreme tinnitus.

          I think I know what I'm talking about.  Why are you so bothered by people having their pain treated?

          "When I was an alien, cultures weren't opinions" ~ Kurt Cobain, Territorial Pissings

          by Subterranean on Tue Mar 04, 2014 at 03:30:58 PM PST

          [ Parent ]

          •  Wow... (0+ / 0-)

            A strong background. Well then never mind if you have a "strong background".

            How many patients do you see a year again?

            Anecdotes are not evidence.

            •  People die from taking NSAIDS as directed (2+ / 0-)
              Recommended by:
              TiaRachel, Tempus Figits

              Remember the problems with cox-2 inhibitors killing off patients?  There are still cox-2 inhibitors on the market, although doctors at least know the risks.  

              When taken as directed, opiates do not kill people.

              Obviously, neither class of drugs is perfectly safe.  But long term, opiates are less harmful than NSAIDS.

              "When I was an alien, cultures weren't opinions" ~ Kurt Cobain, Territorial Pissings

              by Subterranean on Tue Mar 04, 2014 at 04:00:04 PM PST

              [ Parent ]

            •  Also should add, (1+ / 0-)
              Recommended by:
              Santa Susanna Kid

              many doctors have limited knowledge of the drugs they prescribe, often relying on biased pharmaceutical company literature for their knowledge.  That's by no means true of all doctors or even most doctors, but it's dangerous to assume that if someone is a doctor, he is informed about the drugs he prescribes.

              "When I was an alien, cultures weren't opinions" ~ Kurt Cobain, Territorial Pissings

              by Subterranean on Tue Mar 04, 2014 at 06:54:43 PM PST

              [ Parent ]

        •  Literature (1+ / 0-)
          Recommended by:
          Subterranean

          We are all practicing medicine... Over time w/ certain circumstances and OTC abuse knowledge abuse NSAIDS.. yes that bad..

          Ya know... I heard on the tubes that someone spontaneously combusted while taking an NSAID for the first time... jusk like the vamps in BladeII with that anti-coagulant.. splat.. brutal.. that sucks.. /S

          Moderation. Adult moderation my friend.

          And we have no idea & cannot paint with broad brushes. I back up most (see how I did that) sub-t's data. I could be wrong. Just like know. I dunno.

        •  Ibuprofen can definitely cause tinnitus. I needed (5+ / 0-)
          Recommended by:
          wader, lgmcp, rbird, Subterranean, TiaRachel

          high doses for a while for osteoarthritis. The ibuprofen controlled the pain, but left behind some tinnitus. Mine is fairly mild compared to some but if they could find an equally good pain killer without that side effect it would be a great blessing.



          Is it true? Is it kind? Is it necessary? . . . and respect the dignity of every human being.

          by Wee Mama on Tue Mar 04, 2014 at 03:45:17 PM PST

          [ Parent ]

          •  I first experienced tinnitus from Lyme (1+ / 0-)
            Recommended by:
            Wee Mama

            But, concentrated intake of NSAIDs for an extended period possibly increased the symptoms at one point.  Or, maybe it was due to the concentrated intake of antibiotics with the same side-effect which I took in parallel.

            This was only a specific time in my life and I still take NSAIDs on a semi-regular basis, with no increase in this symptom that I am aware of.  Of course, different people will have varying reactivities, I understand.

            "So, please stay where you are. Don't move and don't panic. Don't take off your shoes! Jobs is on the way."

            by wader on Tue Mar 04, 2014 at 03:51:29 PM PST

            [ Parent ]

            •  Certainly, not everyone suffers the same (2+ / 0-)
              Recommended by:
              wader, TiaRachel

              side effects - which says something interesting about our biological diversity.  

              For my own case, I just wish the doctor had taken the same attitude towards the NSAID she prescribed as she does towards opiates.  If she had, my hearing would be fine.  But the drug war has warped her mind as surely as it has many here at dKos, to the point where she mistakenly believes that if a drug is not a controlled substance, then it must be ok to prescribe with abandon.  She made a few other comments about drugs which belied a profound ignorance of medication, which in hindsight should have sent me running from her office.  And I bear some responsibility as well for insufficiently researching the NSAID I was taking.

              In defense of doctors, there are many who do recognize the dangers of NSAIDS.  

              But back to the original point:  opiates generally harm people via overdose, i.e., not taken as prescribed.  The negative effects of NSAIDS are experienced when taken exactly as directed.  So while opiates have potentially acute dangers, when used responsibly they will not leave a person crippled or dead.  

              "When I was an alien, cultures weren't opinions" ~ Kurt Cobain, Territorial Pissings

              by Subterranean on Tue Mar 04, 2014 at 04:09:27 PM PST

              [ Parent ]

          •  I didn't know they could cause tinnitus. Asprin (0+ / 0-)

            can and does.  I used to take alot of asprin for arthritis pain, got really bad tinnitus, doctors never told me it could cause that and I found out on my own, in a magazine article.  I stopped taking asprin and it went away.  But I then switched to Ibuprophen. I have had no problems with it, it is absolutely neccesary for me to take it or I would be in constant agony from my arthritis.  I can't take celebrex and other drugs.  I have not had tinnitus with ibuprohen.  Maybe it is something that only happens to some people and not others.  I take 800 mg twice a day, which is alot, but if I don't, pain and swelling in my joints becomes unbearable.  I don't like the narcotics, though my doc offered them.  They don't help the pain, just make me wozzy, unable to function.  

            •  Me neither. (0+ / 0-)

               I'll have to bring that up with my Dr.  I do have an annoying tinnitus.  I always attribute using earphones and that Jefferson Airplane at the Fillmore East back in '67.  They hit a note so overamped, I saw white.  But when I need it, I take the Ibuprofen or Alleve liberally.

        •  The old "R U an expert? No? Then SHUT UP!" (2+ / 0-)
          Recommended by:
          chrisculpepper, enufenuf

          routine.  If you have something to say, by all means say it and add to the conversation, but don't use this sad old routine to shut down a thread just because you don't agree with something someone wrote.

          Ibuprofen can destroy your liver among other things, and you'll never see it coming.  It's not the safe/happy-times drug the makers and sellers of ibuprofen would like us to believe.

      •  I've met quite the opposite - most doctors (1+ / 0-)
        Recommended by:
        lgmcp

        we've known will throw painkillers at almost any, seemingly legitimate, complaint.  For as long as we request.  Including opiates.

        I've tossed far more prescriptions for serious painkillers than have been filled.

        I believe your perspective, but different experiences from my family's (and, my pre-med days) working with doctors of all different specialties, it seems.

        "So, please stay where you are. Don't move and don't panic. Don't take off your shoes! Jobs is on the way."

        by wader on Tue Mar 04, 2014 at 03:27:08 PM PST

        [ Parent ]

        •  I find that very difficult to believe. (0+ / 0-)

          What region of the country is this?

          "When I was an alien, cultures weren't opinions" ~ Kurt Cobain, Territorial Pissings

          by Subterranean on Tue Mar 04, 2014 at 03:32:00 PM PST

          [ Parent ]

          •  Well, that's generous of you (1+ / 0-)
            Recommended by:
            lgmcp

            This is the NYC metro and suburban region - I've lived here and was an ER assistant in two hospitals through high school and college (in a different state, similar attitudes).

            Multiple Internists, Neurologists, Orthopedists, Endocrinologists, at least one Physiatrist, etc.

            "So, please stay where you are. Don't move and don't panic. Don't take off your shoes! Jobs is on the way."

            by wader on Tue Mar 04, 2014 at 03:36:22 PM PST

            [ Parent ]

            •  If you say so (0+ / 0-)

              You just go to these doctors and they shower you with opiate painkillers?  Sounds pretty fishy to be honest.  The DEA could bring the hammer down on them and ruin their careers.

              "When I was an alien, cultures weren't opinions" ~ Kurt Cobain, Territorial Pissings

              by Subterranean on Tue Mar 04, 2014 at 04:15:11 PM PST

              [ Parent ]

              •  I say so because it's my observation (0+ / 0-)

                And, of course it doesn't work in the silly manner you portray, but it's the eventual effect: opiate painkillers have not been tough to come by, and we've rarely had to ask vs. their being prescribed for us, friends and other patients that I've seen.

                Controls always exist for specific treatments in terms of recurrent prescriptions, but that's never been a permanent limitation or steady process in my experience.

                I've avoided most painkillers, personally.  There was a three-year old bottle of hydrocodone in my medicine cabinet that was filled out of habit and never used, finally tossed it a month ago during a cleanup.  It was certainly the mildest opiate I've been offered by multiple physicians - tip of the iceburg.  They hear trigger words and the Rx tablet flies open.

                "So, please stay where you are. Don't move and don't panic. Don't take off your shoes! Jobs is on the way."

                by wader on Tue Mar 04, 2014 at 04:32:01 PM PST

                [ Parent ]

                •  Well the doctors in my area (3+ / 0-)

                  require patients to sign forms declaring that they are not seeing other doctors for painkiller prescriptions.  The pharmacies will flag anyone who gets painkiller scripts from more than one doctor, for further DEA investigation.  Any doctor who is too freewheeling with opiate prescriptions is automatically investigated by the DEA.  The papers regularly report doctors who have lost their licenses for prescribing opiates.

                  It's basically a pharmaceutical Gestapo climate, and it puts a chill on pain treatment.  As a result, people suffer from pain due to doctors being fearful of losing their livelihoods.  The problem is under-prescription of opiates, not the reverse.

                  So please forgive me when I show skepticism towards claims of opiates being "easy" to get from doctors.  It sounds ludicrous.

                  "When I was an alien, cultures weren't opinions" ~ Kurt Cobain, Territorial Pissings

                  by Subterranean on Tue Mar 04, 2014 at 04:38:38 PM PST

                  [ Parent ]

                  •  "Gestapo"? Interesting perspective (0+ / 0-)

                    I've been given Ultracet/Tramadol, Vicodin (and more) scripts at various times, different doctors.  All in parallel?  No, but sometimes.  So, let's offer a reminder of what was previously mentioned: I haven't filled most of them (which means that the pharmacy had nothing to track).  In terms of signing forms related to multiple doctors prescribing opiate-style pain relievers, that has not happened in processes I've been a part of.

                    Further, none of this is willy-nilly, e.g., one person I know has been living with worsening spinal stenosis in the lumbar region for over a decade.  They have a Percocet prescription which is perpetually re-upped, in addition to physical therapy treatments and so forth.  Another has a painful hip-region issue that impacts mobility and simply day-to-day activities.  And so forth.  Nobody is hoarding or attempting to play multiple doctors for these things - their respective doctors prescribe what they feel is needed and/or helpful for the cases, involved.

                    I have lived with pain at the 8-9 level for days at a time, dropping to level 3-4 for a day or so, then back up again, over the majority of months in a year; give or take a level or two and then multiply that across four years and my symptoms apparently set off all sorts of alarms during doctor visits across that timeframe - it was not the only course of treatment recommended by each who prescribed for me, just part of a larger set of tactics envisioned by each.  And so forth.

                    Simply because I have seen and experienced what sounds to be a different perspective does not mean I am somehow making up or exaggerating the sincere medical help I've often (not always) seen in trying to deal with pain symptoms.

                    I'm sorry to hear that you or your loved ones+friends may not be gaining access to what you feel are better medical options at this time, and hope that situation improves.

                    "So, please stay where you are. Don't move and don't panic. Don't take off your shoes! Jobs is on the way."

                    by wader on Tue Mar 04, 2014 at 05:30:43 PM PST

                    [ Parent ]

                    •  In Florida, they actually go after pharmacys who (0+ / 0-)

                      dispense too many pain killers.  So some pharmacys are refusing to fill valid prescriptions.  I had surgery last year, uterine cancer, had hystorectomy. My doctor gave me a prescription for hydrocodone.  I took it to 4 pharmacies and all said they no longer carry that drug.  I had to take it to Walmart, my least favorite store to get it filled.  Even surgical patients have trouble.  Yes in some areas, people who really need these drugs can't get them, or have to jump through hoops to do so. Makes me think they are driving it underground, which is worse.   My husband, who is very ill and in pain, has had a prescription through the VA for oxycodone.  He has now been cut back to one pill a day, not enough for his pain.  They are getting heartless, he is slowly dieing and they know it, and he is not being given relief.  

            •  Doesn't work that way out here in SoCal (3+ / 0-)

              My partner has CRPS/RSD and a constellation of other ailments, and is more likely to be treated as a drug seeker by health providers and dismissed, even when presenting with specific, unrelated complaints and a doctor's note stressing that she's NOT looking for pain management.  Most recently, she was dismissed by a gastroenterologist shortly before being diagnosed with severe gastroparesis.  Days before that, she was hidden in a supply closet on a hard chair, ignored completely for four hours by ER doctors, six months after she had two of her vertebrae removed, a shunt inserted into her spinal cord, and the vertebrae replaced and fastened together (this is the visit she took her doctor's note to; she was presenting with severe abdominal pain but wasn't there for pain management. The ER "lost" the note after she was admitted and assumed she was an addict who should just sit there in pain.

              Those are just the most recent incidents. This happens on a regular basis with doctors who aren't familiar with her case.

              •  That's awfully sad and amazingly incompetent (3+ / 0-)

                care for her, I feel - very sorry to hear.

                I hope her situation manages to improve, however that may occur.

                "So, please stay where you are. Don't move and don't panic. Don't take off your shoes! Jobs is on the way."

                by wader on Tue Mar 04, 2014 at 05:33:27 PM PST

                [ Parent ]

                •  Thank you (2+ / 0-)
                  Recommended by:
                  wader, Tempus Figits

                  And it is pretty incompetent, but I see the problem mostly coming from the preconceptions and stereotypes about the use of pain drugs. There are people who don't (or no longer) need them that are on them, and some doctors that are irresponsible, but I'd really rather some people be on them inappropriately than those who do need them be forced to suffer in pain, without cause, you know what I mean? that's why I bring up the examples, as a counterpoint, not to say your experiences are invalid but to illuminate some of the consequences of heightened skepticism towards pain patients and their doctors

          •  It's kind of a catch 22. (4+ / 0-)

            If you appear to want opiates or directly ask for them, you are LESS likely to get them.  If you express a lofty disinterest and a determination to soldier on, then you have a higher chance of being offered them.

            "The extinction of the human race will come from its inability to EMOTIONALLY comprehend the exponential function." -- Edward Teller

            by lgmcp on Tue Mar 04, 2014 at 03:58:23 PM PST

            [ Parent ]

            •  Makes sense, (1+ / 0-)
              Recommended by:
              lgmcp

              although to my knowledge, I've never shown any interest in opiates at a doctor's office.  I guess I figure a doctor is the last person I'd see for opiates.

              "When I was an alien, cultures weren't opinions" ~ Kurt Cobain, Territorial Pissings

              by Subterranean on Tue Mar 04, 2014 at 04:13:12 PM PST

              [ Parent ]

      •  As someone who suffers from chronic pain... (2+ / 0-)
        Recommended by:
        ozoozol, Tempus Figits

            I agree with this comment 100%!

             While I have nothing against Keith Knight and I usually enjoy his cartoons, I really bristled at this one.  We really don't need another cartoon that perpetuates the myth that everyone who relies on pain medication is an addict, and every doctor that prescribes pain medication is a drug dealer.    

             Medical dramas like ER are always telling the same cliché story: patient asking for pain medication is really a secret drug addict looking for a fix.  They NEVER tell the story of all the patients who suffer needlessly because they can't get their doctors to LISTEN to them.  Usually the scare-mongering stories the medical dramas tell have no basis in reality.  They often tell the story of someone who started out with a legitimate need for pain medication, who then inevitably turned into a helpless addict.  People with no genetic or psychological predisposition for addiction or history of substance abuse are statistically unlikely to become addicted to pain medication which is used to treat actual pain, and it is a fallacy to suggest otherwise.  One of the most memorable ER storylines, the addiction of Doctor Carter, follows this fallacy.  Carter is brutally stabbed, receiving the kinds of injuries which could very well leave him in need of pain medication for the rest of his life.  His character had been depicted with no addictive personality traits or history of substance abuse.  So, OF COURSE, he became an addict.  An unlikely scenario.  Even less likely than it was for a heterosexual character to flip over to being a lesbian because ER's writers decided that would make for more interesting stories.  

             So because the story of the deceitful, manipulative addict makes for such easy drama, that is the story that is told so often that everyone believes it.  Doctors believe it, and they take self-righteous pride in allowing patients to suffer by withholding needed pain medication "for their own good."  Even patients believe it, and are afraid to ASK for the relief they need, either because they are afraid they WILL automatically become addicts if they adequately treat their pain, or because they are afraid their doctors will THINK that they are addicts.  

             I don't deny that there are people who abuse prescription drugs, but I don't really see why it should be the responsibility of doctors to do the job of the Drug Enforcement Agency.  Why are innocent patients with real pain treated like criminals, required to sign onerous contracts, submit to background checks, and pee in a cup just to get relief from their pain?  Medical ethics are guided by the principle of Informed Consent.  Patients are advised of the risks and benefits of a particular treatment, and then it is the PATIENT's responsibility to either accept or refuse treatment, and to accept the consequences of that choice.  When the doctor overrides the patient's judgement in favor of his own, it's an ethical violation of Informed Consent.  Not one person should have to suffer simply to prevent OTHER people from making bad choices.  Blackstone's Ratio ("It is better that ten guilty persons escape than that one innocent suffer") applies equally well to denying patients their right to pain management:    

            It is better that ten prescription drug addicts go free than to let one innocent patient suffer.
             You also nailed it with your point on doctors trying to substitute ineffective drugs like NSAIDs for REAL pain management.  I remember when I was first beginning to experience chronic pain, before I had been diagnosed, and I was BEGGING a doctor to prescribe me something that would actually HELP me, and he said: "Sure, I can give you something for your pain.  I can prescribe some Ibuprofin."

             Brilliant.  I paid money to go to an Urgent Care center so that the doctor could prescribe something that I can buy over the counter.  Let's see now.  You can prescribe a 50 milligram dose of Tramadol, and I'll get real relief and be able to function and have a life.  OR, you can prescribe 1000 milligrams of Ibuprofin, I won't get real relief, I won't be able to function or have a life, and I'll destroy my liver in the process.  But hey, at least you don't have to worry that I MIGHT become an addict.  Absolutely brilliant.  

        •  You are forgetting that in our society, (0+ / 0-)

          there is no such thing as personal responsibility. Also, physicians have a fiduciary responsibility to their patients not to harm them, nor allow them to harm themselves. Turning someone into an addict or letting them OD is definitely harming them.

          •  Actually, not so much... (0+ / 0-)

                It's the responsibility of doctors not to intentionally or recklessly harm their patients, but the fact is, every decision a doctor makes entails some risk of harm, which is why it is considered the PATIENT's responsibility, and RIGHT, to decide if he wants to risk that harm.  Getting surgery entails the risk that complications will occur and the patient will be harmed.  Not getting surgery entails the risk that an untreated condition will get worse, and the patient will be harmed.  But it is ALWAYS considered the PATIENT's right to make the final decision.  Even if it is a certainty that refusing surgery will result in suffering and death for the patient, it is the patient's right to refuse.  Likewise, even if the risks of a procedure might outweigh the possible benefits, a patient may decide that he wants to accept those risks, and that is also his right.  

                 Of course a doctor should not intentionally allow someone to become an addict or OD.  But that doesn't entitle doctors to refuse a patient's right to pain management, based on the remote possibility that the patient MIGHT become an addict, or even on the unfounded assumption that he might already BE an addict.  Doctors should inform patients of the risks and benefits, just like they do for surgery or any other medical treatment, and respect the patient's right to make the decision, just like they do for surgery or any other medical treatment.  

                 And in fact, a doctor who fails to provide adequate pain management to a patient IS doing harm to that patient.  This quote from a New York Times article from a few years ago exploring the issue of ethical pain treatment says it well:  

            Contrary to the old saw, pain kills. A body in pain produces high levels of hormones that cause stress to the heart and lungs. Pain can cause blood pressure to spike, leading to heart attacks and strokes. Pain can also consume so much of the body’s energy that the immune system degrades. Severe chronic pain sometimes leads to suicide.
                And going back to the point about NSAIDs: Prolonged use of high doses of NSAIDs is FAR more harmful to patients than the risks of addiction to an opiate pain reliever.  Unless you have a natural tendency for addiction, the odds are you WON'T become addicted to opiate medications.  And even if you DO, your addiction can be treated.  Opiate addiction is something that people can recover from.  Recovering from renal failure or a liver destroyed by excessive use of NSAIDs?  Not so much.  

                 In any case, I appreciated your comment.  Wanted to click the rec radio for you, but it looks like I'm too late for that as the rec radio is unavailable.  So consider my reply a rec!  Your comment is appreciated!

    •  One effect that needs to be taken into account: (0+ / 0-)

      an awfully lot of continuing medical education is conducted/sponsored by pharmaceutical companies and more than a few doctors make "consulting" fees.

      LG: You know what? You got spunk. MR: Well, Yes... LG: I hate spunk!

      by dinotrac on Tue Mar 04, 2014 at 03:14:05 PM PST

      [ Parent ]

    •  One reason I really like (3+ / 0-)
      Recommended by:
      wader, lgmcp, Wee Mama

      the medical foundation Mr. Scribe and I go to is that they were fairly early adopters of electronic technology -- you can go to any doctor in their system and they can pull up your medical history and prescription drug record so they can make sure they're not prescribing anything that would counteract with any other drug I'm taking, and they can send the prescriptions electronically to our pharmacy so often it's filled by the time we get there.

      But in the cases of individual doctors with private practices, it's relatively easy to get the same prescription over and over, just make sure to use different pharmacies to get them filled (take one to Wal-Mart, a different one to Walgreens, etc.).

      There's only one rule that I know of, babies -- goddammit, you've got to be kind. -- Kurt Vonnegut

      by Cali Scribe on Tue Mar 04, 2014 at 03:20:25 PM PST

      [ Parent ]

      •  However be aware that Walmart, Walgreens, etc. (2+ / 0-)
        Recommended by:
        wader, Wee Mama

        all contribute a continuous data feed on ALL the meds they dispense, to a data clearinghouse.  The clearinghouse data does not feed directly into any hospital's electronic medical record, however.  Instead, a physician must consult it as a separate step.  Once in there, they can mark prescriptions of interest and import them into the patients medical record as an external or historical med.

        "The extinction of the human race will come from its inability to EMOTIONALLY comprehend the exponential function." -- Edward Teller

        by lgmcp on Tue Mar 04, 2014 at 03:27:05 PM PST

        [ Parent ]

  •  So who cast Michael Jackson's and Elvis's proxies (0+ / 0-)

    in this survey?

    LG: You know what? You got spunk. MR: Well, Yes... LG: I hate spunk!

    by dinotrac on Tue Mar 04, 2014 at 03:11:13 PM PST

  •  We're Primary care physicians for Pete's sake! (0+ / 0-)

    I am not a doctor but I do play on my TV

    I ride the wild horse .

    by BelgianBastard on Tue Mar 04, 2014 at 03:15:34 PM PST

  •  Truth (0+ / 0-)

    All chronic, controlled substances should go thru certified pain treatment centers and psychiatrists; no exceptions.

    •  Chronic, yes (1+ / 0-)
      Recommended by:
      happymisanthropy

      but it usually starts with an acute or post-surgical need for analgesia.  And there aren't enough slots at the typical health system's specialty clinic for chronic pain management.

      "The extinction of the human race will come from its inability to EMOTIONALLY comprehend the exponential function." -- Edward Teller

      by lgmcp on Tue Mar 04, 2014 at 03:20:09 PM PST

      [ Parent ]

    •  THis is absolute nonsense.... (1+ / 0-)
      Recommended by:
      dewolf99

      I have tried "pain management centers" and they all were pushing the newest, trendiest, surgical solution and refused to offer pain meds as needed. First one wanted to locate and chemically BURN the nerve endings that were the source of the pain! This would be insanity for my conditions and would cause GREAT HARM over time! Possibly leaving me paralyzed.

      The second one wanted to fuse my spine in two places which would have put additional stress on areas above and below the "fused areas" and those areas above and below had lots of stress fractures already! This would be insane and result in continued damage resulting in more fusing operations until my spine was just one big stick!

      At my age and situation pain management through medication allows me to have a fairly normal, active life and is much better quality of life than the options that those so called "pain centers" offered. Without the meds I would be house bound and in bed most of my days plus need help for shopping, going to doctors, etc. What kind of life is that? My primary care physician has acknowledged my search for answers and agrees with me that my decision is best for my circumstances. I have been on opiods for over ten years now and have not escalated very much in that time. I still have much more room to move up as needed (a good sign and one that indicates no abuse). My primary care doctor is just fine with managing my case and in fact does a much better job than the so called specialists that want to DEFORM MY BODY in order to avoid prescribing the medications that the DEA hates!

      •  and furthermore (0+ / 0-)

        It is deeply frustrating that most doctors in my area are afraid to practice their medicine because the DEA has worked over so many doctors around here. And I feel trapped and afraid to move because I may not be able to find a doctor in other states that would be willing to help me. I would love to move closer to my daughter, but they have a huge crack down going on in her area and all of the doctors are afraid of losing their ability to prescribe thus ruining their practice and livelihood. So I am stuck in Missouri and cannot move because of the DEA's witch hunt and crack down on doctors!

        •  additionally (0+ / 0-)

          In my area, heroin has gotten much cheaper and easier to get than prescription opiods so the drug abusers are switching over but the DEA is so obsessed that many actual pain patients are resorting to it as well since they cannot get relief from most doctors around here! THIS MEANS THAT THE DEA IS CREATING AN ILLEGAL DRUG PROBLEM OUT OF LEGITIMATE PAIN PATIENTS!!! Talk about twisted logic and dangerous side effects of their witch hunt!

  •  I generally like Keith's cartoons... (5+ / 0-)

    but this one is not really a deep thought.

  •  We've got to be very careful (9+ / 0-)

    not to promote an environment where patients in pain are denied  medicine due to preconceptions about access and need.

  •  I'm 56 and on 7 prescriptions (2+ / 0-)

    clonezapan (genreric Klonopin)
    fluoxetine (generic Prozac)
    rabeprazole (generic AcipHex)  (stomach)
    sucralfate    "
    hysocyamine sulfate "
    ramipril (High blood pressure)
    and some water pill I forget the name of

    Wonder how many I'd be on if was was sick?

    Walgreen's gets their cut after the Doc gets his kickback.

    Thanks God AcipHex went generic this year...my co-pay dropped from $55 to $15.  

    A $40/month raise. Yippee!

  •  Mine come from the garden. Or forest. (1+ / 0-)
    Recommended by:
    Santa Susanna Kid

    Need more mushrooms. STAT.

    Damn, that shit is funny!

    Up my Statins! I'm dancing with Unicorns in jack cheese!

  •  Pharma (1+ / 0-)
    Recommended by:
    Santa Susanna Kid

    Pharmaceutical companies, I read a couple of decades ago, know that many of their drugs are misused but base their production on said abuse and over-use.  Doctors prescribe to the addicted and the companies produce the drugs for the addicted.  They both make money and the addicted get to feed their addictions.

    I've also read that prescription drug addiction is more prevalent than illegal drug addiction - think oxycontin rather than heroin.

    But let's keep locking up (darker skinned) marijuana smokers.

  •  As a physician... (4+ / 0-)

    As a physician who prescribes pain medicine on a routine basis due to the nature of what I do, surgery, I can assure you that the vast majority of physicians are neither dealers nor inhumane providers who expect patients to suffer.  We often find ourselves in a catch 22 between patients with legitimate complaints and those who are seeking meds. Those of us who are concientious about our prescribing habits keep in close contact with local pharmacies and keep detailed documentation of what we are prescribing.  Those who would make a buck off of opiate meds are few and far between...just my 2c

    “Too often we honor swagger and bluster and wielders of force; too often we excuse those who are willing to build their own lives on the shattered dreams of others.” ― Robert F. Kennedy

    by docreed2003 on Tue Mar 04, 2014 at 04:57:09 PM PST

  •  So what the hell's your point? (2+ / 0-)
    Recommended by:
    misslegalbeagle, Tempus Figits

    Other than that you think the War On Some Drugs is a good thing, what are you driving at? Would you prefer that addicts get their drugs from the mafia? That doctors, for fear of being called "dealers", deny pain meds to people who need them?

    Is it too late just to retract this cartoon?

  •  What's the point? (1+ / 0-)
    Recommended by:
    Tempus Figits

    Is there actual science here, or is this just more propaganda?  In my experience most physicians are loath to take a chance on being accused of "dealing" drugs.  There are bad apples in every crowd, but mostly it's just propaganda.  I wonder where the evidence would lead if we followed the money behind the "War on Drugs" instead of the "Drug Lords".

    What, me worry? I read MAD Magazine.

    by Bill Roberts on Tue Mar 04, 2014 at 06:34:38 PM PST

  •  Well Duh! (0+ / 0-)

    Gee, I thought that the point of the cartoon was "Well who else do you think is writing prescriptions?"

  •  How is this new to people? (2+ / 0-)
    Recommended by:
    chickenfarmerwood, Simian

    Of course doctors are the ones who write the most prescriptions.  So they also write prescriptions that get into the hands of "prescription drug abusers".

    I think the person who wrote this cartoon misunderstood.  Maybe they thought the results showed that doctors are the source for most chronic abusers of drugs, period.  Nope.

    There is nothing in the quote to suggest that doctors are the DIRECT source.  If I get oxycontin and the guy who house-sits for me steals it, then the doctor's prescription was in fact the source of those drugs… but the doctor did nothing illegal, immoral, or even vaguely wrong.  I might have, for trusting the guy (a friend of the family), but according to the cartoon's author it is the doctor who is to blame.

  •  Patient responsibility. (1+ / 0-)
    Recommended by:
    fitonkpo

    I detect a common theme in these comments.  Namely, the passivity with which patients accept their doctor's so-called orders.  I realize not everybody is a biochemist with medical and pharmaceutical experience like myself.  But you really do have to be aggressive in questioning, following up and choosing your primary care physician.  If the doc is under-medicating your pain, find another one.  Question prospects like they were job applicants, sort of.  Ask them about their philosophy of pain treatment, if that's important to you.  Personally, I prefer a more aggressive approach to my treatment, one where doing a little too-much is preferred over taking 3 aspirin and making an appointment in 3 weeks if the pills don't work.  If my approach is what you prefer, but your doc seems to be signalling a suspicion that you're a hypochondriac, ask her outright and if the answer isn't persuasive, find someone else.  If you don't think you understand what he's saying or doing, talk to a trusted and more knowledgeable  friend or take him to your appointments.  You have to take charge.  That's my advice, lots of other folks give it, and I'm sticking to it.  

  •  hmmmmmmmm - - - (1+ / 0-)
    Recommended by:
    Simian

    From the tone of the comments here, people seem to be taking the cartoon at face value.
    WTF?
    I read it as snark, myself.  Like - blaming Docs because people need help managing their pain.  And creating yet another conspiracy theory.  So what else is new?

    Maybe I missed the point.  Or, maybe, the literalists did.
    Dunno.

    The price of apathy is to be ruled by evil men - - Plato . . . . . . . . . . . . . . . . . . . . We must be the change we wish to see in the world - - Mohandas Gandhi

    by twocrows1023 on Thu Mar 06, 2014 at 10:06:32 AM PST

  •  GD the Pusher Man (0+ / 0-)

    As I got older the more these morons try to push drugs on me!  Steroids caused a major weight gain which at my age and total joint replacements is damned near impossible to lose!  Doctors play this game with Advance Men/Women who are the reps for Pharmaceuticals who reward those Docs with Med Insurance Formulary listings based on how well they push their drugs for them.  Talk about a Conspiracy.  People don't understand how hand in hand Ins Co's,  Drug makers, and Docs are in collusion!  Many drugs are not adequately tested by the ADA before being released on an unsuspecting public.  Thalidomide, Valium, Prozac are just three examples for proof of this fact!

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