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Feb 20, 2003 to Feb 6, 2013

Opioid Policy Compromises Doctor-Patient Relationship


I don’t know how many lives will be saved by the official response to the opioid crisis. In the past, government reactions to illegal drugs have been expensive, heavy-handed and ineffective.

Vermont and the nation have never been able to reconcile themselves to the fact that it is normal for people to actually want to use drugs.In the case of opioids, the crackdown is already having collateral damage to patients legitimately in bona-fide need of the relief opioids provide that other pain medicine cannot adequately control. Doctors are more reluctant to prescribe, even censured for prescribing opioids, and patients who really need it are suffering because of the few who abuse the dispensing and usage.

When you factor in the insidious pushers in corporate Big Pharma who abuse distribution because of the almighty quest for profitability, people suffer and die who are outside of the range of legitimate patient need.

The problem is that the doctor-patient relationship suffers because officialdom throws a blanket of severe measures over both the legitimate and illegitimate uses of oipiods. Patient-by-patient, officialdom is no match with doctors who are trained to do their job. And, the weight of consideration should fall to doctors, not officials.

The challenge is to separate the opioid abuse regulations from the doctor-patient relationship so that doctors and their patients can know the opioid prescriptions will match the needs of the patients.

Last but not least, decriminalize all opioid personal use and possession so that opioid use, not as prescribed by doctors or on the black market, will be treated solely as a medical problem, not criminal.

Vidda Crochetta

Also published: www.commonsnews.org/site/assets/PDF/COMM-0415.pdf


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I'll bite

Need a "yes, but..." ? : )

Some of those trained doctors gave addictive medication to some people who didn't understand what they were getting into, and then those trained doctors cut off that supply with no good plan for easing off it, leading new addicts to find relief on the streets. "Officialdom" didn't do it. (Also, some officials are doctors! See Terry Schiavo.)

There are very few cases where extreme pain medication is required. It has been over prescribed for decades, and we're going to change out ways now that the problem is more clear. Doctors must stop over prescribing things they don't understand.

(I don't agree doctors always know what is best, and I doubt any good one would claim they do. Doctors should be required to try any medication they give to others....)

I put this on patients, as well, who will pay anything to avoid aging. Knees, hips, fingers, and so on wear out with long use. It is not historically normal to get replacement body parts - that's a new invention.

These patients believe in doctors and the medical system and will do as told, often without much understanding of odds, or without even researching what the medication will do to them. Blind faith in the person wearing a lab coat.

It isn't all or nothing. Just about every person I know who has had hip or knee work ended up worse off, and on painkillers - but everyone I know who has had laser eye surgery has had vision improved without side effects and no need for pain meds.

I agree the criminal aspect should be taken out of the equation. But it already is a medical problem. Medicine, and medical professionals, and scientists, and patients, made the problem worse. Patient by patient.

No one can sell illegal pain pills unless a scientist concocts them and a pharmaceutical company makes them. No one can get them legally without a doctor involved. Each patient/person decides when and if to ease their pain.

Final thought - the body produces natural pain relief when it is really necessary - we go into shock, our systems react. I'll go out on a limb here and suggest that we should toughen up a bit and not turn to artificially developed pain killing, life-numbing alternatives quite so much or so quickly.

I think we'll get there. What's going on right now - no matter who to blame or not - is not acceptable. You have a good starting suggestion there: "The challenge is to separate the opioid abuse regulations from the doctor-patient relationship so that doctors and their patients can know the opioid prescriptions will match the needs of the patients."

 
 #

I don’t swallow

I think when you are in intense pain, short-term and chronic, you should go out on a limb and “toughen up a bit and not turn to artificially developed pain killing.”

It’s a case-by-case situation that does not need the proverbial “blanket” thrown over everybody, as I referred to above. If that is the operative choice for you, and or, you and your doctor agree with, then go for it.

However, I am face with word-count constraints in some newspaper, but I could have been clearer that I was referring primarily to chronic long-term pain where there is no healing. (That means taking pain relievers, possibly including opiods, for the rest of your life, in combination with or not, any alternative options the patient and or the doctor-patient wishes to employ).

Secondarily, short-term pain (roughly 8 weeks or less) related to different conditions and surgeries, and in this second case, is where the dosage is reduced over the last several weeks.

In these cases, the pain reduction, including possibly with opiods, is important to either quality of life and or the healing processes.

Your statement “Doctors should be required to try any medication they give to others” is an emotional response that is not possible or practical. (I didn’t see a smiley so I assume you’re being serious.) Of course doctors should not face such a requirement.

Moreover, you are wrong when you state that “There are very few cases where extreme pain medication is required.” In fact, there are too many cases. The question, again, best answered by doctors, is how to go about it on a “case-by-case” analysis.

You say, “It isn't all or nothing. Just about every person I know who has had hip or knee work ended up worse off, and on painkillers - but everyone I know who has had laser eye surgery has had vision improved without side effects and no need for pain meds.” You also claim that “replacement body parts - that's a new invention” However, knee replacement techniques began in the early 1970s.

Anecdotal evidence is not always valid, but I’ll employ my own. Just about every person I know who has had hip or knee work ended up better off, and effectively managed painkillers. Additionally, laser eye surgery may or may not need pain relief, but is easily controlled with low dose NSAIDS for a day or so. (Also, I clearly wasn’t suggesting a “all or nothing” response to the crisis.)

Really, in the cases of both of our anecdotal experiences, there is no such thing as “just about everybody,” which is way too broad to be applied to clinical analysis of what's best for public policy making.

I have a date in town, so I’m off. There are a couple of comments I need to yet address.

 
 #

Papers, please...

I don't see a Dr in front of your name, either, so you are also as wrong as I am. Neither of us should say anything.

Thanks for reminding everyone to ignore what we say, unless we are suitably qualified. No one can have a view or opinion unless credentials are presented. That's my view or opinion. So it is wrong. I am not a writer, or a doctor, nor do I play one on TV, so this sentence is wrong, too.

It's also a joy to have every word dissected! By the way "early 1970's" proves my point. Very new and experimental in the grand scheme of things. Bugs have not been worked out.

Of course there are cases where deep pain relief is called for. We overdo it these days, though, and that's a problem that needs treating. That's my point. Which (I'll save you the effort) is wrong and invalid.

: )

 
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To be sure I reviewed our comments

To be sure I reviewed our comments. I never accused you of not being a doctor, and I never claimed that I was a doctor.

Moreover, I made no point about, nor said anything even close to “No one can have a view or opinion unless credentials are presented.” My article and these comments are under the “OpEd” section. All opinions, therefore are welcome, as they should be. No one person of the 214 viewers of this page so far, would confuse me with being a doctor, nor would they think they can only comment if they have credentials.
Where are you going with that??

Every word of your comments was not dissected, but as a patient with long-term doctor relationships much of what you said is in error. I am a patient with chronic severe pain everyday when years of taking alternative pain therapy was fruitless and ineffective. I am aware of other patients who are suffering because their genuine needs are being threatened by policymaking and public opinion.

That you think that “We overdo (deep pain relief) these days” is too simplistic to pursue as a line of reasoning. Of course you’re right addiction is a problem that needs treating but your comment points went far beyond that.

There are many cases in the past when I agreed with you and have admired the work you do in a variety of areas. This is one of the cases where I adamantly disagree with you. Please do not, then, suggest that my disagreement is in any way censorial.

I am the wrong person to accuse of or even hint that I'd engage in any kind of suppression of free speech.

 
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As a local social worker in

As a local social worker in the mental health and addictions field, I think it is important to identify that, first of all, doctors first trying every medication they prescribe their patients is a ludicrous notion. Would you ask a physician to take insulin if their pancreas is working just fine? To subject themselves to chemotherapy when they don't have cancer? That comment, if not sarcastic, is ignorant at best.

Furthermore, I don't think that the majority of people become addicts from being prescribed pain medication. I think that the amount of blame being slapped on doctors is out of proportion. Many people take opioids because they are convinced they will like the way that it feels, much like kids drinking alcohol or smoking pot or using other recreational drugs. A large part of the problem is addressing a society that seeks to alter mental faculties in any way possible, for fun, not realizing at the outset that it ruins lives.

And I'm not sure why joint replacements are being mentioned - that seems out of place here. Why shouldn't we be amenable to technology that improves well-being and quality of life? This seems to be a comment for a different discussion. You know of people who have had bad experiences with joint replacements. I know of several people whose lives its changed for the better - both young and old. The plural of anecdote is not data.

 
 #

Hub and Spoke

(AP) The state's "hub and spoke" system was formed to ensure that patients can receive effective and coordinated opioid addiction treatment and care no matter where they live in Vermont, according to the state Health Department.

The hubs are regional treatment centers while the spokes are clinicians, such as physicians and nurses who treat opioid use disorders in their own practices. The two work together with specialists working to stabilize people who need the most care and primary care physicians managing a patient's ongoing needs over the long term, according to Ben Truman, a spokesman for the Health Department.

Full text: http://www.reformer.com/stories/drug-czar-says-vermont-opioid-treatment-...

 
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In terms of access to

In terms of access to treatment, the system in Vermont is abominable. We should be able to offer treatment to someone who asks for it the minute they ask for it. Unfortunately, due to a lack of funding and service providers in our rural state, many have to wait months, sometimes over a year, before being able to get into a Hub or Spoke. We also have a shortage of residential rehabilitation beds in the state of Vermont since Maple Leaf Treatment Center closed last year. While Valley Vista has picked up some of the slack, opening up more beds at their facility, they do not accept people who are homeless which serves as a greater barrier.

 
 #

Oregon to decriminalize possession cocaine and heroin

Oregon may be changing its policies on drugs, and supporters hope it marks a step toward ending practices that disproportionately affect people of color in the state.

State lawmakers on Thursday approved a bill that would decriminalize possession of small amounts of drugs like cocaine and heroin, the Washington Post reported on Tuesday.

The move would reclassify possession of the drugs as a misdemeanor rather than a felony. Proponents of the bill hope it will help people with addiction issues get medical help.

The bill passed the Oregon house and senate. Now it heads to the desk of Gov. Brown. A spokesperson for the governor said she is looking forward to signing the bill once it undergoes standard legal review.
Aaron Knott, the legislative director for Oregon’s Office of the Attorney General, told theWashington Post on Tuesday that one of the issues the bill hopes to address is lack of access to drug treatment programs.
http://www.businessinsider.com/oregon-may-decriminalize-small-amounts-of...

 

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