We worship at the feet of pain and pills

We worship at the feet of pain and pills

I just finished reading Neil Gaiman’s fascinating novel, Gods of America.  I first learned about his work by watching the movie Stardust, then reading the novel.

One of the themes of Gods of America is that the deities of the old world came to America in the hearts of their followers, but over time lose their followers and thus their power.  A war is arranged between the ‘old gods,’ and the new ones that Americans have instituted.  In the story, media, technology, entertainment and others are the new deities for a new age.

I thought about it as I considered my work.  It seems that every day of my life is an endless discussion about narcotics in the emergency department.  Or is it a kind of liturgy to another new god?

“Can’t I get no Lortabs?”

“I can’t take Percocet, all I can take is Dilau, Dilaud, what is it called? Dilaudid? I don’t know anything about those drugs, you know!”

“I’m allergic to the 5mg Vicodin, but I can take the 1omg Vicodin just fine!”

“Somebody stole my Fentanyl patches and my morphine pills, and all of my Oxycontin and all I have left is my methodone, and I only have a few but I don’t see the pain doctor for another month. Now what am I supposed to do, doctor, just suffer?”

“My nerves are torn up.  I’m out of Xanaxes and my brother’s friends came over and stole all of my Klonopin and Valium!  Sure, I still got some Ativan, but look at how I’m shaking!  Oh, and I’m out of Suboxone.”

“See, doctor, I have the degenerating disc disease.  I guess I’ve had chronic back pain since I was, oh, 14.  That’s ten years I’ve suffered!  Nobody will do anything for me, so I just take pain pills wherever I can get them.  Can I get some Percocet?”

I could go on.  It’s dialog in a bad novel.  It’s a sonnet to somnolence.  It’s an endless homage to anesthesia.  It’s all but worship.

So it must be a religion.  The people I see are worshippers of pain medication and anxiety medication.  Or maybe, they worship pain and anxiety, and the offer up the drugs to their deities.  Or perhaps they are slipping into amazing dream states, sleeping all the time, and having epiphanies of wonder and delight.  Scratch that.  They’re dreaming of television and snack food. Of reality shows and disability payments.

And the object, or objects of their worship are taking a terrible toll in lives lost, as epidemic prescription drug abuse sweeps across the land. It’s enabled by a culture that in its own way worships disability and victimization, incapacity and the medicalization of all things.

It makes sense, really.  We cannot possibly suggest that anyone isn’t telling the truth, because a) truth is relative and defined by each person and b) to suggest that would be poor customer service, or discrimination or to be ‘judgmental.’   Furthermore, we reject anything that might suggest an individual take responsibility, or make good moral decisions because morality is relative and faith is irrelevant.

Thus, the internal discord and evil and even legitimate suffering of the human heart must be medical, must be made somatic and mechanistic so that it can be treated mechanistically, and so that no one need concern themselves with uncovering the layers of difficulty and untruth in the human heart, no one need ask hard questions or suggest that one may have guilt or fear for good reasons.  All we want to do is call it a “pain” and offer it a “pill.”

Well there you are, America.  We worship at the feet of pain and pills.  We offer our young and our old and our middle aged and vital to the sleepy gods who accomplish so little and cost so much and offer only restless dreams and ultimately breathless deaths.

I will not worship them.  I hate them.  But I acknowledge their power.

Edwin Leap is an emergency physician who blogs at edwinleap.com and is the author of The Practice Test.

Image credit: Shutterstock.com

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  • Alexander

    Just a friendly fyi, the novel is “American Gods” not “Gods of America”

    • http://www.facebook.com/profile.php?id=1536821513 Edwin Leap

      Alexander, thank you! I don’t know how I did that. Whoops.

  • ninguem

    Doctors who trained and practiced outside of America, who immigrate here, tend to be appalled by the amount of opiate prescribed here, and for the relatively trivial indications.

    Things that would get a NSAID and acetaminophen there, get opiates here. And I’m talking about doctors from the developed world, not some Third World country where the drug is not available at all.

    • SarahJ91

      My husband and I had four surgeries in four months, after a lifetime of nothing like that. We ended up with scrips for 60 vicodin and oxycodons we never bothered to fill. It was very tempting to sell them to our neighbour, who is a prescription drug addict, thanks to a shoulder injury that went untreated because she didn’t have insurance.

      We were horrified by the amount of pain pills the docs were pushing at us at every turn.

      • southerndoc1

        No doc in the world has the power to turn a patient into an addict.
        If you’re not having severe pain, don’t pop the candy. Very simple.

      • Guest

        Maybe I’m the odd man (woman) out here, but I’ve never had the experience of hordes of doctors just “pushing” scripts for controlled substances I’d neither requested no needed at me. The only time I’ve been prescribed an opiate was right after my knee replacement, and my doctor explained what he was prescribing me and why and what to look out for when taking it, as he was writing the script.

        Just out of curiosity, as all these doctors were “pushing” all these scripts for 60 vicodin and oxycodons at you, had it not occurred to you to let them know that you’d already been prescribed those drugs recently, and you didn’t require any more? When I saw the NP four days after surgery, she didn’t actually offer me any more painkillers, but if she had I’ve have let her know that Dr. Kneefixer had already given me some.

        Doctors certainly have to try to be responsible in their prescribing practices, but patients have to step up to the plate too and do their bit.

      • Cardionp

        Excuse me, you wanted to sell them to a prescription drug addict? I find that morally disturbing!

      • Mike M.

        “It was very tempting to sell them to our neighbour, who is a prescription drug addict”

        This is why it’s hard for REAL pain patients to get relief. Because of people like you.

        If that addict you sold your pills to – the pills your doctor prescribed you IN GOOD FAITH, were to die, it wouldn’t be YOU who got sued, it would be your doctor.

        People like you wreck the system.

    • Payne Hertz

      As a chronic pain advocate for two decades I have spoken to thousands of pain patients. It is rare indeed to meet someone who was able to get adequate pain treatment from the word go. They usually get nothing. If they do get treatment, it will usually be the standard 30 Tylenol 4 or 5 mg Vicodin. Most people who are on long-acting opioids and have reasonable pain control took years before they could find a doctor who would treat them.

      The idea that it is easy to get pain medications from a doctor is a fantasy.

      • f. lusu

        the dr. has a right to be disgusted with lying drug seekers that show up in his ER. however, the problem is if dr.s put people into permanent categories; drug seekers or people with terminal illnesses to whom they will grace the proper pain relief. it would be helpful if dr.s would acknowledge and respect the small group of people who have exhausted other options; physical therapy, massage, TENS,etc.- the people you are talking about have lost their quality of life because they deal with physical pain every day and who would, i’m sure, be thrilled to trade meds for a normal life. it would be ideal if a family dr. would have referred the patients to pain management specialist for education along with careful monitoring. just as important is for the patient to have some therapy sessions to help life issues which might be making the person withdraw. pain creates depression which creates pain. educating patients with a respectful dose of reality might stop a lot of the abuse. it worked with smoking.

        • Suzi Q 38

          If the patient is that bad, an evaluation needs to be done.
          How can we better manage his or her excruciating pain??
          Through surgery? One of those epidural packs? Rest?
          Controlled and supervised opiate control with eventual or concomitant other non-opiates to try?

          It is uncomfortable to titrate down at some point.
          But telling the patient and supervising the patient should be in order, instead of blatantly handing out prescriptions of such at will.

    • Suzi Q 38

      I just had a cervical anterior dissection done on my spine.
      I got heavy duty IV opiates for the first 24 hours, then Norco to go home after 30 hours in the hospital.
      After about 2 days at home, I consciously substituted the Norco with plain Tylenol 500 mg, with the intention of titrating the dose down.
      Within two weeks, I eliminated the Norco entirely. Now I still take the Tylenol, but I take only 500mg during the day and 250mg at night.
      I could have said to myself: “OOHHH this Norco feels so great if I need some sleep at night.” I fought the urge to use it in that way.

      I was lucky; it worked. I recognize that some people have had bad surgeries where the outcome was not as easy as mine. I guess it depends on the location of the surgery.
      My bottle of Norco, is still hidden in a drawer, ready for use in an emergency. I just haven’t had one lately.

      • Cardionp

        Greed! It’s an easy unethical way to make money. Some people are criminals. Most, are not!

    • Mike M.

      So because poor powerless patients have to live with unnecessary pain in other countries, Americans should too?

      Awesome idea, let’s aim for the lowest common denominator when it comes to alleviating our patients’ suffering. In fact, let’s just go back to the good old days of giving patients a shot of whiskey and a wooden dowel rod to bite down on when they’re in pain.

  • ninguem

    The countries that tend to get held up as models for healthcare. Canada, France, etc………I’ve met my share of docs who have practiced there. Patients who complain about being denied narcotics over the sort of stories described here, get told to go pound sand.

    You can be respectful to the patient about it, but the docs don’t get punished for doing the right thing.

    • Payne Hertz

      The sort of stories presented here are evidence of nothing but the bias and lack of critical thinking skills of the people who believe this nonsense. A five-year-old could debunk most of the sloppy reasoning underlying this idiocy.

      “Just because I know what asparagus is doesn’t mean I am addicted to it. I hate asparagus!”

      “Just because the teacher thinks I am pretending to be sick to avoid school doesn’t mean I am not sick. I really do feel horrible!.”

      “Just because someone else lied about the dog chewing their homework, doesn’t mean everyone is. The dog really did chew my homework!”

    • Homeless

      Every few months my grandfather would make a trek across the border to buy “Canadian aspirin.”

      • ninguem

        I’ve always thought that was a reasonable OTC med, it should be available OTC in the USA.

    • Caitlin Peebles

      Just for the record, you can get painkillers containing codeine (combined with either aspirin, paracetamol or ibuprofen) at the chemist without a doctor’s prescription in Australia (another country sometimes held up as a model for healthcare). You do have to ask the chemist, though – it’s not just on the open shelves. There’s a whole list of pharmacist-only medicines which are known as S3 (Schedule 3) and lie somewhere in between needing a doctor to prescribe them and being able to just place an armful of them in your shopping trolley and hit checkout.

      But the big guns, like oxycodone, hydrocodone, fentanyl, morphine and methadone, are S8. That means that in most cases treatment needing more than a few day’s worth must be initiated by a specialist (and you would have had to have been referred by your GP – there is no “self-referral”). [Although in some cases a GP can apply for a special authority to prescribe them]. Your name, Medicare number and prescription details do go into a Federal database every time you’re prescribed an S8, no matter where you are or who you see (one advantage of a single-payer system… and a relatively small population base), making the whole “doctor-shopping” thing a bit tough I would think.

      It seems like a pretty decent system. If you have pain so severe that it requires one of those drugs for more than a few days, you really should probably see a specialist for the underlying problem anyway, and your GP would be happy to give you a referral in that case. So people with serious problems do indeed have proper access to the level of pain relief they need. But on the other hand there are enough hoops to jump through to get the serious stuff in any kind of quantity that it sort of keeps a lid on over-prescribing. And of course a benefit to doctors is that the average 1st-line GP *cannot* hand out opioids like lollies, and everyone knows that… so no-one even bothers to try it on.

      Sorry to be so long-winded, but I just thought your point was worth expanding on. Cheers.

      • ninguem

        What’s the dose of the Australian OTC codeine/paracetamol thing, is it the 8-mg stuff like in Canada? I wouldn’t mind seeing that OTC in the USA.

        • Caitlin Peebles

          The various combos come in different strengths – most popular would probably be 8mg for the Panadeine, for instance, and 12.8mg for the Nurofen Plus. Nothing over 15mg, though.

  • doc99

    When a symptom became a sign, all hell broke loose.

    • Payne Hertz

      All hell broke loose a hundred years ago when people in pain were robbed of the ability to treat themselves. The Orwellian nightmare we now face is a direct result.

      • Guest

        In 1900, the average life expectancy for American men was 46.3, and for American women it was 48.3. A hundred years later, in 2000, it was 74.1 and 79.3 respectively. Consumers’ inability to buy cocaine and opiates over the counter today hasn’t appeared to have set us back much.

        • http://www.facebook.com/people/Tom-Fitzsimmons/1405121136 Tom Fitzsimmons

          These stats are due to infant mortality and childhood diseases. I hope you don’t work in any of the sciences.

        • Payne Hertz

          If you’re creative enough, you can find all kinds of correlations that have no basis in reality. People are fatter today than they were in the early 1900s. Clearly, obesity has led to an increase in life expectancy, or at the very least, hasn’t appeared to set us back much.

          The rise in life expectancy as already pointed out here is due to decreases in infant mortality, vaccination against the major killer diseases, clear drinking water and public sanitation and improved nutrition.

          There is no evidence whatsoever drug prohibition has increased life expectancy. Indeed, there is plenty of evidence it has increased the harms associated with opioid abuse while doing nothing to reduce the rate of addiction, which is roughly the same today that it was in the 1900s.

  • lisa lee

    What alternative treatment is actually offered? maybe if we didn’t bow down and worship at the feet of the big pharm, as the almighty cure to nothing but continuing of prescription drugs we could afford to research alternative natural healthy options

    • PCPMD

      1) You’re 60 pounds overweight. Loose 60 pounds and your knee/hip/back/feet/toes/whatever will feel a hell of a lot better.
      “Sorry, I’ve tried, its too hard. You wanna give me weight loss pills? No, then gimme my Norco!”
      2) Your chronic neck pain with a normal MRI is likely functional from poor posture, your stressful computer job, and is compounded by your ongoing and untreated anxiety. Please work on stress reduction following ___ techniques, add therapeutic yoga, bio feed back, see your consellor regularly, take the SSRI that I offered you last time, tell your bozo BF who adds nothing but misery to your life to take a hike/dead-beat kid who steals your money and refuses to leave that you’ll call the cops.
      Then start working with the physical therapist. When thing’s aren’t oging well, go back to them and let them know.
      “All of that sounds way too tough. And the Norco’s not working. What about that “Oxycontin” thing – any good?”
      3) You’re 35 years old and your knees are shot. You need to either find another line of work than construction, loose at least half of the excess 80 pounds you’re carrying, or see the orthopedist and start talking about your options.
      “Doc, that’s not really what I’m into. I’m gettin’ by fine with the Percocet. Can’t I just keep taking them for a while longer?”
      These are the things most docs are frustrated by. The # of true chronic pain patients, who’ve actually taken advantage of ALL of their options, IMO is quite small. Sorry, but that’s been my experience over the last decade or so, and its pretty consistent with that of my colleagues.

      • Kris61

        It would be nice if you doctors cared half as much about reducing deaths from medical errors as you do about playing Nanny or Morals Police. It really seems to be a power trip with alot of you, it’s not about wanting to save lives because you could save WAY more lives fixing your own issues than trying to dictate how everyone else lives their lives. Why do you all seem to really get off on all your tales about how many people you’ve denied pain relief to?

        You’re no different to the tut-tutting purse-lipped bony blue-fingered neo-puritans of the Ladies Temperance Union.

        • adh1729

          I recommend that you lead by example. Go to medical school yourself. Become an outstanding, perfect, error-free physician. Then come back here and run your mouth.

      • Suzi Q 38

        I have the same knee pain, and i just take Tylenol.
        If and when it gets really bad, I will ask for an MRI of the knee, and if my meniscus or Acl is in need of repair, I will get the surgery. No Norco for me.

      • Cardionp

        My own mom, 82, got hit by a car walking and fractured 24 bones…including the odontoid. She recovered like a rose b/c I did a lot of damage control (I’m an NP). One thing that i had to do, when she finally left rehab, was take the oxycodone away. She was furious and told me that this is the only way she could sleep. This made me more nervous and determined…so I took it away…weaning her off with the use of tylenol to nothing. She would have been hooked if I didn’t remove it. It was horrifying just thinking that MY mom was hooked and was a member of the “oxycodone club.”

  • Helen

    Thank you- the streets to hell aren’t paved with gold, although part of this, it’s paved with Soma.

  • SarahJ91

    Or maybe their doctors overprescribe them into addiction.

    • Guest

      The label on any painkiller, be it OTC or prescription, always has how often you are allowed to take it (every 4-6 hours, twice a day, etc), followed by AS NEEDED. Since most acute pain goes away on its own after a bit, if you only take the tablets when they’re actually needed to make your pain more bearable, as the pain becomes less frequent you’ll be taking fewer and fewer of them and I can’t see how you’d get addicted like that.

      I will only believe the popular “What could I do? My doctor prescribed them to me; I HAD to keep taking them!!” argument when I see the same patients following everything ELSE their doctor has advised them to do, to the letter. I.e. your doctor has advised you to completely cut out salt. Have you? Your doctor has advised you to lose 20 pounds. Have you? Your doctor has advised you to start walking 30 minutes a day. Have you? Well if you’re capable of disobeying your doctor on /some/ things, you’ve just proven that you’re not some mindless automaton who was “simply following orders” by taking 4 months’ worth of opiate analgesics when the pain they were meant to be alleviating had actually gone away after 2 weeks.

      For almost a decade of my life (until my knee-replacement wakeup call), I was overweight to the point of borderline obesity. SARA LEE DID NOT OVERFEED ME INTO FATNESS. I did it to myself. Holey moley, America, let’s grow up and take responsibility for our own stuff-ups.

      • Suzi Q 38

        I agree. I still though have empathy for some people that are truly in severe pain. I have never felt that.
        On the other hand, the pain and source of it needs to be addressed straight on.
        Pain is telling you that something is very wrong. I wouldn’t keep taking addictive drugs without at least knowing what was happening with me. You could have pancreatic cancer, for example. Severe back pain is one of the symptoms.

    • N N

      You need a prescription of personal responsibility.

  • Lynne Lee

    This article is not backed up with facts or statistics. I find this type of statements to be dangerous, as they reach farther than their apparent intended audience. Taking opiods for someone in chronic pain is not always a choice, it can be medically necessary. The answer is not for doctors to sound off about how they are put upon to prescribe “unnecessary opiods” for patients but to promote solutions through things like doctor and patient education and awareness. To have doctors take the time to discuss the problems associated to their chronic pain patients, to have their patients learn self management techniques and have them work on self advocacy. This problem is not just a mess in the US, it exists all over the world. Removing opiods is not the answer but informed use of them is.

    • MM

      Facts and statistics? The US has about 5% of the world’s people, but uses about 80% of the world’s supply of opioid analgesics. Pain pill prescriptions here are up 600% in the past 10 years. And overdoses are killing thousands upon thousands of Americans each and every year, 75% of them involving opioids. [Medscape]

      Assuming other first-world countries (England, Germany, France, Switzerland, Japan, Australia & New Zealand, for instance), have just as many pain sufferers as we do, but hand out just a fraction of the opioids we do, you have to assume that most of our global peers – even the chronic pain sufferers — somehow survive without anywhere near the numbers of dangerous and addictive narcotics our pain patients seem to require.

      You put the phrase “unnecessary opioids” in quotes, like you’re averse to that phrase, but if opiates in America kill more citizens here than un-opiated (not a word but you know what I mean) pain does in the rest of the world, really you have to question whether the cure isn’t worse than the disease, and whether a lot of opioid prescriptions here are, indeed, unnecessary.

      • Lynne Lee

        You apparently read only the parts of my comment you chose to.

  • Payne Hertz

    Pain is the number one reason people go to see their doctors. You think that might have something to do with the large number of people going to the ER looking for pain treatment?

    The pursuit of pleasure and the avoidance of pain are the two main drivers of most human behavior. Just about everything we do can be attributed to one or the other of these two basic drives. This is perfectly normal and natural behavior. In fact, pain behaviors in humans are remarkably similar to all other mammalian species. When a dog is injured , it cries out, whimpers and moans, gives you the sad puppy dog look and becomes depressed and withdrawn. Humans do the same except that we are socialized to suppress these behaviors. The technical term for this is “sickness behavior.”

    The difference is that dogs don’t have some arrogant, cold-hearted puritan running around telling them they’re immoral for reacting the way they do to pain. You have to be a human and go to a doctor to get that.

    The other difference is that no sane, civilized, humane person would treat a dog the way Americans with chronic pain are treated.

    No sane, civilized and moral person has anything but compassion and empathy for people who suffer from chronic pain. They recognize what a horrible ordeal it must be to live with severe pain all the time.

    What about those who have no compassion or empathy, or feel the need to judge people based on how they perceive the person with pain deals with this ordeal? I find it difficult to accept that such people are sane, civilized or moral.

    This begs the question: Why do so many doctors hate and demonize chronic pain patients? Are they insane?

    I am afraid the answer is “yes.”

    The way doctors abuse, humiliate and deny treatment to pain patients while publicly stigmatizing them is definitely both insane and immoral. Reading the hateful rhetoric directed at pain patients not only in medical blogs but even in published literature in peer-reviewed journals, it would be difficult to deny that hatred of chronic pain patients is a severe problem in this system.

    But it is not just the sadists, sociopaths and malignant narcissists who are a sizable percentage in this system. The kind of people who get off on abusing people would behave the same way in any other job you put them in, like cop, prison guard or soldier.

    But in the medical system, I believe that there is an institutionalized mentality of viewing people with pain as drug addicts, whiners and morally degenerate and that this mindset has become the dominant paradigm for doctors to hold. This mindset encourages destructive behaviors and attitudes among those doctors who are not sociopaths or sadists, but merely risk averse and self-serving.

    The mentality goes like this: I am uncomfortable prescribing narcotics, therefore these drugs and everyone who asks for them are evil. Because you are evil, I hate you, and therefore it is morally acceptable for me to abuse, humiliate and deny you treatment. Because I abuse and humiliate you, you must have done something to deserve it.

    Ditto for malpractice victims, hospital administrators, or anyone else perceived to be an inconvenience or threat to doctors.

    This is insane, of course. But rational thinking and sanity are so important to ethical human behavior that without it, you cannot function in a moral and civilized fashion. This is the problem with so many doctors today.

    They demonize people in pain because this is easier than facing their own moral cowardice and barbarism for treating people like criminals for no other reason than the perfectly normal desire to be free from pain.

    • Mike M.

      Doctors are petty tyrants who get off on denying “mere patients” pain relief and such. Look at all their blogs, they brag on it daily.

      Never do you see them brag about steps they have taken to reduce the hundreds of thousands of medical errors that harm and even kill their patients.

      This focus on “patients want relief, it’s in our power to deny them this and we LUUURVE playing this game” is disturbing. I wish they cared as much about washing their hands, and being more careful, and not screwing up their patients’ lives. A fixation on THAT would save alot more lives than denying everyone relief lest they maybe-possibly get addicted.

  • Elizabeth Rankin

    After reading your submission Dr. Leap and the posts by many who were driven to write; it seems to me this issue in medicine is “evidence-based” critical mass sentiment, which indicates to me, and should be enough for frustrated physicians, to finally get the medical world to realize how important it is to have “an integrative medical model” for both study and practice. If all medical professionals were educated & trained to study along with all other health care professionals in their undergraduate years and residency years and all worked together in teams upon graduation, I believe we could produce better results for patients who develop chronic illness patterns than having a population “prescribed to death” on “every kind of class of drug” currently out there!
    There are very good “alternatives” to drugs but the medical establishment only understands, or rather, only believes, for the most part, to continue to prescribe toxic substances, that taken over time “will do harm!” When the professions basic tenet is “first do no harm” it behooves physicians of all stripes to “listen to the patient” very carefully and know enough about what other “options” besides the coveted drugs to assist to reduce the problems the patient is facing. The health care system among professionals has been silo’d both in its approach to study and practice and has, therefore, not been properly equipped to deliver health care in the most meaningful and beneficial or cost efficient way for patients.
    While patients do need to understand it is up to them to take responsibility to eat proper foods that suit their biochemistry, manage their weight with moving, exercising, and emoting to relieve their worries and so on. We have not encouraged this way of learning to be self-sufficient! Everyone comes to experience their life from a different set of circumstances and this critical part of problem-solving is needed for both the professionals and the population at large. Life issues present themselves very early in life and travel with children all their lives and so they need to be addressed early in school so children, along with their parents, have a leg up when faced the making choices and for difficult problems. There is no model that addresses anything so comprehensively but it is something we could all wish for by recognizing we could all do better with a “model for health,” something more than what we have and working more toward a broader approach than only continuing to “serving the gods,” the Pharmaceutical industry, which currently supports, influences and shadows the world of medicine.
    We recognize the value of drugs and devices for what they can offer at the right time and we are thankful for this. Like many things in life we can be “overdosed” because we want to take the easy way out, rather than do what we can to help ourselves. Helping those who’ve gotten to the point they don’t see self-help is essential, requires more than drugs, it requires a new model.
    Elizabeth Rankin BScN
    Author: THE PATIENT WILL NOW SEE YOU: How Listening To The Patient Will Redefine The Patient-Doctor Relationship
    [book to be published later this year, I hope!]

  • http://www.facebook.com/people/Tom-Fitzsimmons/1405121136 Tom Fitzsimmons

    Such arrogance. You have little to offer us but pills and BS. Most of medical theory falls by the wayside in a very short time. We don’t completely trust you and THAT seems well placed here. You come off like another pompous libertarian. I have no insurance.Here’s my effin money, give me my effin’ pills and keep your half assed philosophizing for the family.

    • Kris61

      Doctors have eagerly appointed themselves as Very Important Front-Line Soldiers in successive governments failed and still failing “WAR ON DRUGS” , they seem to enjoy the power to push Unimportant people around. But the War On Drugs is hurting more people than it helps!!!!

    • Clara T.

      “You come off like another pompous libertarian.”

      Just for the record, most libertarians are AGAINST nanny-state drug prohibitions, and have been very consistent on that point.

  • http://www.facebook.com/people/Tom-Fitzsimmons/1405121136 Tom Fitzsimmons

    Meprobamate is still used. It’s far superior than the diazapam sleep pills and easier on the liver. The carbamates were a useful class of drugs that got pushed out by barbiturates. My great great uncle (Bayer) was the first to synthesize barbituric acid. A few years later (100 or so) all hell broke loose. Bad uncle! Bad!

    • Suzi Q 38

      You can use an old drug like Doxepin. Sinequan is not as addicting, and can take the “edge” off of the pain.
      There are a lot of old drugs that are generic like that.
      They work. They just are not as addicting and not requested because they are generic and cheap.

  • MR, retired nurse.

    Good read! Who are these narc pushers? I’m in pain all the time, & my only Rx is Ultram! Doesn’t work! I don’t want to sleep all the time, so it’s ok! I mostly just wake & smell the coffee!

    • Cardionp

      I think, truthfully, after a certain point of the med not working, pain management specialists step in. Counseling should couple the narc. But what is interesting is that their are different kinds of pain specialists: Anesthesiologists, Psychiatrists, Physiatrists. Only Psychiatrists could do this.

      • MR, retired nurse.

        Thank-you cardioNP. When I’m cleared by my heart Dr., it’s the hip-it’s worn out! The post surgical site from my shoulder has good days & bad days, I exercise and just deal with it!
        I have no respect for “drug seekers” as in the article. I’ve pushed too much morphine and dilauded for that group! Glad to be done with that!

        • Cardionp

          it is a scary group!

  • http://www.facebook.com/shereneebaby Sherene Chen-See

    I guess my question is… do you offer alternatives to pain killers, to your patients? Or do you just dismiss what they are going through? Because honestly, it sounds like the latter. It is the way you wrote the article – as if you are dumbing down your patients. I have mild lupus (no organ involvement) and my daughter has fibromyalgia, and neither of us take pain killers because we both have great doctors who are keen on exercise, sleep hygiene, etc. My daughter does not need a doctor who will readily prescribe pain killers – that would be awful at her young age, considering the side effects – but she needs a doc who will listen to and not dismiss her symptoms.

  • http://twitter.com/NYCPatient NYC Patient

    As a patient, I have been horrified at how quickly doctors, PAs, and NPs are at prescribing pain killers. Granted, I don’t think there are many that do so with the intention of getting patients hooked. Yet, in today’s health care system, there are no mechanisms in place to help prevent it. Each time I have had a Rx thrown at me, not one doctor or medical professional has said: this is addictive and I suggest taking it x, y, z, for x days. If you don’t notice improvement by day x, call me, schedule an appointment, etc.

    Healthcare professionals need to realize that this is an issue, that there are not mechanisms in place, and be proactive (I know, with the thousands of other things demanding their time) in putting some in place.

    Not one of the doctors that has been eager to prescribe reached out to my PCP. There’s all this talk about primary care yet specialists rarely include them in decision making, etc. After questioning a NeuroSurgeon for months without getting answers for imaging HE did, his office told me to talk to my PCP yet they NEVER reached out to him the past 8 months…and of course when I did he had no idea why I was told to reach out to him and contacted the neurosurgeon who then finally spoke to me. Specialists only seem to bring in the PCP when they don’t want to treat the patient anymore instead of including them in the process. My situation in particular has the neurosurgeon and PCP as part of the same hospital.

    Since life insurance companies are able to check prescription records for new applicants, why can’t pharmacists and doctors? The red tape in the US needs to go….

    • Cardionp

      You bring up excellent points. Patients need to be taught about their meds, esp these!

      I know that starting soon, providers will have to call up to check a persons history for “doctor shopping” for narcs in ny before prescribing a narc. But, this system is relying on the good judgement of the provider. It does not tell you what to do.

      • http://twitter.com/NYCPatient NYC Patient

        I certainly do not expect doctors to call every single PCP or other provider when prescribing something for a patient but there definitely needs to be a central system in place to prevent patients doctor hopping for prescriptions. As a patient with extreme back related pain (13 herniated discs), I feel free to say that something has to be done as opioid addiction will only continue to exponentially increase if something drastic is not put in place. Also, there needs to be an overall different approach to patients with pain that focuses more on addressing the source (s) rather than the symptom of pain. It may be more difficult short term, but long term it’s better for everybody – doctors, patients, dr-pt relationship, healthcare costs in general, etc.

  • Sammy

    I know heaps of people that started taking a small does of Panadol for a migraine or a injury. Then as weeks went by they were increasing the dose to a full strength 24pack a day. Then a year or 2 later they start adding large doses of other over the counter pain killers. Now all these people make up stories to the doctor to get even stronger pain killers (1person I know is on medical marijuana for depression they do not have). All these people are now on disability allowance. They claim depression is their disability, and their doctor is able to prove to centre link the “pain” that they have been living with. The doctor does not know the patient is just using them. With some people I know I think they are now starting to believe that they are in constant pain and need painkillers. When they do not have a painkiller they get angry and start complaining about there pain and believe it or not their child hood. I do not pay attention to surveys about how bad depression really is. If people with depression really told the truth about their health they would no longer receive the benefits they get. The doctors will lose trust in their patients.

  • CRT1981

    I just wish there could be a simple test for pain, just like you can do a blood test and see that someone has anemia, you could do a blood test and see that a patient is in pain, and even have that reading quantified (i.e. a 4 or a 6 or an 8).

    That way the frustrated patients who are truly in pain would not get undertreated, and no one who just wanted painkillers for kicks or to sell on the street would get them.

    The “hunt” to find and punish “drug seekers” is ruining a lot of doctor-patient relationships.

  • ButDoctorIHatePink

    It hurts me to hear you say that you “hate” them.

    Does that include me? I have terminal cancer. I need my pain meds to get through what few days I have left.

    I acknowledge that there are some who just want them for whatever “high” they might give. (I don’t know what that might be, never having experienced it, despite regular high doses of di….dil…dilaudid, or whatever it is..)

    I have experienced alcoholism in my family, so I understand the harm of addiction.

    I have also spent time in the hospital, in Intensive Care, listening to doctors outside my door complain about patients who need pain meds, including a woman with lung mets down the way and wasn’t getting pain control. The disdain for those who need painkillers does not seem to distinguish between those who legitimately need them and those who don’t, (which I venture to say is fewer than you imagine). Your misspellings and deliberate poor grammar when you supposedly quoted them gives away your disrespect – not that it needed a lot of hiding.

    You are a doctor. Educated, smart, in the power position, and supposedly compassionate. If somebody doesn’t need pain meds, don’t give them. If they are addicted and will suffer without, give enough to get them through the next couple days and refer them to social services or a rehab program. Or, let them go through withdrawal while referring them to rehab. It’s up to you.

    There are certainly many who rely on drugs and don’t need them, and I don’t know the answer to the problem except that it is a problem as long as human history and can’t be solved. Clearly, you don’t know the answer either. I do know you should think from a different perspective. Perhaps more people are in need then you know. Back pain DOES hurt. Cancer hurts. Having been raped when you were ten also hurts.

    Maybe most don’t worship anything but relief from pain, of whatever type. Maybe that is their religion – living a pain-free life. We manage to have a variety of religions in this country and still respect each other. But I think you have a skewed viewpoint and need a break from your job. I would not want you as my doctor.

    I do worry that many are addicted and go to the ER to get drugs, making doctors “hate” their patients, and making the government want to make it harder for us legitimate sufferers to get what they need. (Yes, need.) I worry that doctors are unable to tell legitimate sufferers from others and are swayed because of grammar and IQ, and even disease doesn’t seem to matter. I worry that I will be left suffering at the end because of this problem; that somehow doctors or government interference will not be willing to give me what I need to die in as little pain as possible. I should not have to worry about it – I should feel confident that those who go into medicine have more compassion than most. Yet, from conversations I’ve overheard in the hospital and some I’ve been privy to elsewhere (doctors are in my social circle) – that isn’t always true.

    I confess to shock when a doctor publicly demonstrates such disdain for human frailty and uses the word “hate.” You don’t offer one solution in your screed. Just a rant. My suggestion would be for you to take a break from your career, or at least, switch your specialty. I doubt that dermatologists have this issue, although then you might “hate” all those women who want long eyelashes and ask for Latisse.

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