“Do not get caught” seems to be the real rule of the law in South Florida, where I live. I was trained to limit the use of controlled substances, narcotics, hypnotics and sedatives. Their use can affect consciousness, ability to drive a car and work.  More severe consequences include respiratory depression and overdose from too high of a dosage or mixing too many medications and over the counter items. The Joint Commission, ...

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How can we combat the opioid epidemic? One of the government’s most recent suggestions is to take Opana ER, an opioid indicated for very severe pain, off the market. The request, filed by the U.S. Food and Drug Administration in June, was linked to concerns of abuse-related HIV and hepatitis C outbreaks. But removing access to opioids altogether isn’t the solution. There are individuals suffering from ...

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In order to fully understand the issues surrounding opioid prescribing practices, it is important to review a brief history of how these drugs came to market. Opium was the first opioid, derived from the sap of opium poppies whose growth and cultivation dates back to 3,400 BC. In the 18th century, physicians in the U.S. used opium for multiple ailments. Towards the end of the 18th century, the addictive qualities of ...

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"The doctors who did this should be hanged." It's a statement the came at me with a bang. It stood out in its thread, in the accusatory way of old courtroom scenes of black and white movies, where the heroine dramatically screams out at the jury, seated wide-eyed in their box nearby. But it was merely a response to a Facebook post on the topic of the opioid epidemic, typed in nonchalantly, ...

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Nothing seemed to help the patient — and hospice staff didn’t know why. They sent home more painkillers for weeks. But the elderly woman, who had severe dementia and incurable breast cancer, kept calling out in pain. The answer came when the woman’s daughter, who was taking care of her at home, showed up in the emergency room with a life-threatening overdose of morphine and oxycodone. It turned out she was high ...

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To listen to all those desperate to reform health care, you get the impression that physicians are pretty horrible people. We are all sexist, greedy, money grubbing tyrants who will perform unnecessary tests and procedures just to make money. We don't care about quality or cost. We are killing off 250,000 patients every year with our ignored "errors." We purposely keep our patients in pain, or we addict them to ...

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What is it like living in pain? Those of us who have ever experienced unremitting pain for months or years know that it is enveloping and all consuming. I struggled with intractable pain for several difficult years, and I am fortunate because my pain finally got better — what if your pain never did? That is a horrible reality millions of people are living in right now. The chronic pain population ...

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I am an interventional pain physician. I spend most of my days doing spine injections with a fair amount of kyphoplasties and spinal cord stimulators thrown in as well. It seems to me that these are minor procedures that shouldn’t evoke anxiety in patients, but they do. Patients get nervous. They get anxious. I am also a singer. I had the privilege of being classically trained through my college years. Like ...

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Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians. A 36-year-old man is evaluated for a 1-year history of fatigue, intermittent headaches, sore throat, and joint and muscle pain. He reports no difficulties falling asleep and gets 10 hours of uninterrupted but nonrestorative sleep each night. He has seen several physicians over the past year. Evaluation ...

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Good pain physicians are dying. Recently, Dr. Todd Graham was shot dead in a parking lot over refusing to prescribe opioids to a man’s wife. Physicians who care deeply and try to do the right thing are being murdered for not prescribing opioids. I prescribe very few opioids in my chronic pain practice. I do so in a judicious and safe manner for my patients. I have excellent training, and I ...

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