When the “opioid crisis” is mentioned, most people think of heroin, prescription pills like oxycodone, or — more recently — the powerful synthetic opioid fentanyl. Fewer people would think of novel opioids like tianeptine, although an increasing number of Americans have taken this substance in the form of over-the-counter supplements like ZaZaRed or Tianna – often without knowing that the substance has opioid properties that can cause dependence and overdose. …
In the waning days of the Trump administration, a surprising announcement came down from the Department of Health and Human Services (HHS) that the barrier required to write buprenorphine prescriptions for opioid use disorder would be lifted via reform of the so-called “X-waiver.”
The X-waiver is a rare regulation in American medicine that requires an 8-hour training and documented DEA permission before a medical doctor can prescribe Suboxone to …
Family lore recalls that my grandfather, succumbing to stomach cancer in the mid-1960s, “died addicted to morphine.” Decades before the AIDS crisis sparked the hospice and palliative care movements, the confluences of pain, dependence, and addiction were confused and regrettably moralized. Since then, the science has excelled, but our clinical understanding of how pain and addiction intertwine remains limited by stigma, assumptions, and the separation of the underlying science …
“The patient is 15 minutes late. Can you still see her?”
“He missed an appointment yesterday because the bus ran late, and he’s out of Suboxone. He’s getting agitated in the waiting room, and other patients are complaining. Could you see him right away?”
“Therapy group has already started. Is the facilitator willing to let one more patient in?”
In the halcyon days before COVID-19, these questions plagued the …
Mary first took oxycodone after a minor surgery and found she liked it. Returning to her surgeon a month later with vague ongoing pain, she received another prescription. Her primary care provider took over from there — until one day that physician checked a urine drug screen and a prescription monitoring program (PMP) report, only to find that she was obtaining various opioids from several providers. The physician cut her …
The British Medical Journal recently published a paper boasting the astonishing conclusion that medical error is the third leading cause of death in the United States. Headlines aside, the study suffers from questionable statistics that serve up alarmist conclusions about the prevalence of serious medical errors and obscure the road to addressing the tragic phenomenon of death by medical error.
The analysis cites four observational studies on incidents that occurred …
People lie. Patients lie. Patients tell blank untruths, patients misunderstand truth, patients confabulate with the damage of a thousand fifths of vodka of yesteryear.
A core conceit of medicine posits that health care providers expect pure honesty from patients from first handshake on. Violating every social norm around encounters with strangers, we expect that patients with no grounds for trust reveal all.
Providing primary care to patients on the furthest margins of …
As with any disease, prevalence of this narcotics abuse is region-specific; an hour north of the office where I practice, Rio Arriba County in New Mexico is home to one of the highest opioid overdose rates in America – up to five times higher than the national average. Our patients routinely lose family to addictions; our clinic has been home to a …
Aside from creating redundancy in the market (with some very rural exceptions, patients can act as agents of their own satisfaction by voting with their feet), there are serious limits to physicians as agents of pure …
