Perhaps the patient has a right to ask for certain classes of medications – but not opioids. Why? Simple. Because unless there is a legitimate pain condition, for which opioids are indicated, there would be no need to prescribe this class of medications.

The government has a legitimate purpose in limiting drug diversion. When a patient cannot be established as having a pain condition, he doesn’t need the medication; therefore, what is he going to do with it? Sell it? None of us know the answer.

But, as a pro-opioid pain specialist [ which everyone knows by now ] I cannot condone or allow illicit drug diversion – because that medication may fall into the hands of an innocent person who may die from an overdose.

This is unacceptable under the “First do no harm” rule.

The REAL question is; why does the state and federal government prosecute a pain specialist for prescribing in a legitimate fashion, based upon that doctors clinical impression that a patient requires, and would benefit from, opioid medication?

That’s the real issue these days.

William Mangino II, M.D.

Most lawyers do act parental with their recommendations, I think. They tell you their opinion for the best course of action and you take it. For example, how many people argue with their lawyers about handling tax audits? Probablynot many because the layperson using the lawyer doesn’t know enough about tax laws to make that decision, so they defer to the lawyer. Just the way most people defer to the judgment of a doctor.

Curious arguments from this lawyer. In reality, the legal system is substantially more opaque than medicine. The body of knowlege the comprises medicine is huge, constantly evolving, but has one constant, unchanging human physiology that must invariably follow the laws of physics, chemistry, biology. The law, by contrast is an ever changing confabulation of wills created not to be ultimately understood, but rather, to be misunderstood, to grant favor to some parties, and to be changed at the wims of the legal/legislative systems.

Reading lawyer sites suggests that most believe that representing one’s self is quite a folly, more so than I would consider treating one’s selfe medically for most conditions.

Unfortunately this is something that not only the general public is not equiped to do, but a great many of the ancillary personel now allowed to play doctor. Psychologist are given Px priveleges in two states–and they are university trained social scientists without any medical or natural science training except for the weekend courses to fullfill the RX requirements–requirements that they themselves wrote ( how would they know?).

In this return of pre-Flexnerian medicine, in which the state no longer protects the public from inadequately trained chalatans–and actually gives them liscenses–I would just as soon they take off all controls and leave it to a purely free market.

For example, if you don’t know much about mushrooms, it is a very bad idea for you to to buy a book and start gathering mushrooms and eating them. Yet there is no law that would prevent you from doing it without any “mushroom-gatherer” license. At least nobody asked me for this license last time I did it, and I’ve been doing it since I was 5, first – abroad, then – in the US:-).
This is the argument here.

I am kind of on the fence here. On the one hand, I don’t believe the government should have a right to dictate what we can do with our bodies as long as we are not harming anybody else. On the other hand, if you allow drugs (excluding those which present public health issues) to be sold without prescription, nothing would prevent people from giving them to their kids. So it is difficult to ensure in practice that anybody other than the person involved will be harmed.

BTW – my PCP had no clue what Renova was when I asked for it. He looked it up on the computer, asked me which dose I want, and gave it to me.

That’s why I visit my doctor and get a prescription, or not, depending on what he says. He knows; I don’t.

But if the only person that ends up hurt is the patient himself, there really is no difference between allowing to self-prescribe and other risky behavior. And in some cases, the rules do seem to be over the board. Why is Renova wrinkle cream prescription-only when virtually any doctor, not even a dermatologist would say “sure” to any woman who asks for it anyway (and a zillion pharmacies in the internet would sell it with online doctor consultation)? A friend of mine gots Renova prescription from her dentist boyfriend. The package insert clearly explains its risks and side effects. Why 4% hydroquinone creams are prescription-only in the US (they are over the counter in Canada, I got Lustra from there myself)? These things are not covered by insurance anyway, so who is going to get hurt other than the person himself from using these drugs improperly?