“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, medicine’s good housekeeping seal of approval authority, along with major medical organizations have accused clinicians of undertreating pain. “Pain is the fifth vital sign,” they said.
This was accompanied by professional society leadership and academic researchers receiving grants from pharmaceutical companies touting the newer longer-acting pain medications which “have very little addictive potential.” We were then informed we would be receiving evaluations and scores of our treatments of pain which would influence our reimbursement if we under treated pain.
In my current concierge medical practice, I see 10 or fewer patients per day. In my previous general practice, I saw 30 patients per day. I could go days without prescribing a narcotic pain medication. In most cases when I wrote out a script for a narcotic pain medication it was for a patient with a severe chronic pain problem, seeing a specialist for that problem, and requiring a pain pill because there were few effective alternatives. The patient visits to doctors and physical therapists and massage specialists and other alternative pain therapies were well documented in the medical record and mostly unsuccessful in attempts to relieve the pain.
This contrasts markedly with the opening of pain clinics in nearby counties with their own in-house prescribing pharmacies. One or two physicians wrote thousands of pain pill prescriptions per day. Patients lined up around the block to see these employed physicians of the pain clinic with many arriving in cars from other states. The cash flow generated was so vast that the clinics needed private security to protect the profits. Many of the security hired were off-duty city and county police officers trying to supplement their income.
It’s hard to imagine that law enforcement and the DEA were unable to recognize the difference between pill distributing centers and legitimate practices prescribing medications on a limited basis to individuals with documented needs. City, county and state governments gladly accepted the tax benefits, occupational license fees, and pharmaceutical license fees from these sham clinics while drug dealers drove in and out of our state to obtain prescription pain medications for sale in their hometowns. Of course, the blame for this was placed on the doctors and dentists.
Florida tightened up its laws, and somehow law enforcement was given the tools to see and eradicate what was occurring right under their very noses. As prescription drugs dried up, the Mexican drug cartels got smart and flooded the market with cheap, strong heroin. It was obviously the fault of the physicians and legitimate pharmacies that white working class people were buying plastic bags full of dope and inserting needles into their veins to avoid the pain of life.
As drug addiction soared, city and county governments found it in their hearts to sit as zoning boards allowed drug rehabilitation centers to open up in the heart of their communities. There was little or no effective investigation of who was running these clinics and or their previous experience, methods and or success rates. If you want to read about where the soaring number of narcotic overdoses occur in our community, follow the zoning board’s placement of rehab centers and sobriety houses. What better way to increase your drug overdoses than to encourage unsuccessful addicts to come to your community and leave their money and their family’s money to improve the tax base and create new headaches for EMS and police officers?
Somewhere there should have been a higher level of thought by our elected and appointed officials about the consequences of bringing hundreds of drug-dependent individuals into our area before they permitted these facilities to open.
Recently, my advanced pancreatic cancer patient with severe back pain tried to purchase a controlled substance prescribed by his oncologist to relieve his suffering. Six pharmacies no longer stocked the product due to their fear of liability. It took hours to find a pharmacy that would order the medication for the patient. Physicians, pharmacists and law enforcement accessing our state narcotic registration website clearly can see that this patient only uses his medications as prescribed by one physician. This patient, and others like him, are victims of the government legitimizing of pain pill mills and drug rehabilitation centers in their communities.
As a physician, we all have our failures in this area as well. I painfully recall the doctor’s wife I sent to a disciplined pain doctor to wean her off narcotics prescribed by a rheumatologist, urologist, and gastroenterologist for legitimate reasons documented by tests and biopsies. I refilled the prescriptions for her convenience and ease never dreaming I was contributing to her problems.
I feel for my colleagues in the emergency department and in orthopedic offices having to daily differentiate acute pain requiring intervention with controlled substances as opposed to individuals with drug seeking personalities. This being said, the opioid crisis was caused by the most trusted members of the academic medical community in cooperation with the medical inspection and certifying agencies in concert with public officials and law enforcement looking the other way. They all made a great deal of money at the expense of the public. Now as they struggle to clean it up, they give us medical and recreational marijuana.
Steven Reznick is an internal medicine physician and can be reached at Boca Raton Concierge Doctor.
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