Very good description of what passes for DEA management of controlled substances. There are many patients who have been on controlled substances for 30 years and who act responsibly in their use of them. But the DEA has turned everyone into a drug seeker, often forcing physicians to stop providing what was reasonable pain relief managed well. Every patient is different. Physicians know this, but the DEA has done a good job of prevening many physicians from providing the care they know their patents need.
Right on Edwin. And then there was the expert who told us that no one becomes addicted if they really need the medicine. Turns out he worked for Purdue.
I remember it well! We were constantly monitored to make sure we gave out LOTS of narcotics. This was JCAH coming down on the hospitals, and the hospitals coming down on us. We knew it was wrong, and that we were prescribing too many narcotics. Then suddenly the powers realized they had an addiction problem, and who did they blame? The physicians!
Wow, you are correct. Fewer people are in the ED seeking opioids. Why fight when you can get it cheaply on the streets (the other day I bravely decided to actually walk onto the “streets” outside my hospital to see where “they” are actually getting the fentanyl; outside of littered discharge instruction sheets, masks, and empty big gulp containers, I couldn’t find any drugs at all)? Yet I am now a poly substance ED toxicologist, droperidol/midazolam administrator, and provider of bad news to families clinician. These times they are a changin. When we handed out opioids, everyone seemed happy. Patients felt better, hospital administrators were happy (more positive reviews), and we were happy. Now patients are caring for themselves because the healthcare system failed them (no preventative health, no one cares, and the system is dysfunctional). Time to retire.
Ed, you have stated what has been apparent for years. Thank you for putting it right out there in plain sight - without politicization! It’s real. Only thing that I can add is that we have had an amazing decrease in presentations for dental pain and HA’s due to our mid level providers making rules like “no narcotics for dental pain or HA’s”. I am still able to over-ride that, but they really just don’t come much with those complaints. If they do- it is probably legit.
I can relate to this. My brother died from fake pills with fentanyl. Everyone shrugged. The folks selling the drugs just go right on with their business.
Your article head the head on the nail!! The opioid epidemic was started by our federal government and the Joint Commission. Physician pay for Medicare and reimbursement was tied to scores that included how well your pain as a patient was controlled. Bad score on pain management less payment by the government. As an RN, I rounded on patients--pain control became more emphasized at the for profit hospitals than trending vital signs. Funny thing, several years ago I had a severe trauma accident in a foreign country. The first thing the trauma surgeon said to me after many hours of surgery was "You are an American, I want you to know we do not give narcotics but we will control your pain. They did and my injuries were severe. I notice that opioids are still routinely prescribed for pain over 5 in our area..so I guess we really have not changed the US system much. The US remains one of the largest consumers of opiod pain medication and other illegal pain medications.
Very good description of what passes for DEA management of controlled substances. There are many patients who have been on controlled substances for 30 years and who act responsibly in their use of them. But the DEA has turned everyone into a drug seeker, often forcing physicians to stop providing what was reasonable pain relief managed well. Every patient is different. Physicians know this, but the DEA has done a good job of prevening many physicians from providing the care they know their patents need.
Right on Edwin. And then there was the expert who told us that no one becomes addicted if they really need the medicine. Turns out he worked for Purdue.
The worst insult - the pain scale that we used to use - was sold to JACAH by Purdue - yep, the OxyContin Purdue
I remember it well! We were constantly monitored to make sure we gave out LOTS of narcotics. This was JCAH coming down on the hospitals, and the hospitals coming down on us. We knew it was wrong, and that we were prescribing too many narcotics. Then suddenly the powers realized they had an addiction problem, and who did they blame? The physicians!
Wow, you are correct. Fewer people are in the ED seeking opioids. Why fight when you can get it cheaply on the streets (the other day I bravely decided to actually walk onto the “streets” outside my hospital to see where “they” are actually getting the fentanyl; outside of littered discharge instruction sheets, masks, and empty big gulp containers, I couldn’t find any drugs at all)? Yet I am now a poly substance ED toxicologist, droperidol/midazolam administrator, and provider of bad news to families clinician. These times they are a changin. When we handed out opioids, everyone seemed happy. Patients felt better, hospital administrators were happy (more positive reviews), and we were happy. Now patients are caring for themselves because the healthcare system failed them (no preventative health, no one cares, and the system is dysfunctional). Time to retire.
Ed, you have stated what has been apparent for years. Thank you for putting it right out there in plain sight - without politicization! It’s real. Only thing that I can add is that we have had an amazing decrease in presentations for dental pain and HA’s due to our mid level providers making rules like “no narcotics for dental pain or HA’s”. I am still able to over-ride that, but they really just don’t come much with those complaints. If they do- it is probably legit.
I can relate to this. My brother died from fake pills with fentanyl. Everyone shrugged. The folks selling the drugs just go right on with their business.
And here we are, still having to rate pain in Medicare patients to close their “care gaps”...
Your article head the head on the nail!! The opioid epidemic was started by our federal government and the Joint Commission. Physician pay for Medicare and reimbursement was tied to scores that included how well your pain as a patient was controlled. Bad score on pain management less payment by the government. As an RN, I rounded on patients--pain control became more emphasized at the for profit hospitals than trending vital signs. Funny thing, several years ago I had a severe trauma accident in a foreign country. The first thing the trauma surgeon said to me after many hours of surgery was "You are an American, I want you to know we do not give narcotics but we will control your pain. They did and my injuries were severe. I notice that opioids are still routinely prescribed for pain over 5 in our area..so I guess we really have not changed the US system much. The US remains one of the largest consumers of opiod pain medication and other illegal pain medications.