Dr. Satel does a good job of describing the public-health and law-enforcement conundrum that is created by intractable pain:
The red flags that rightly alert regulators to potential misconduct by doctors are, paradoxically, the very features that can also mark responsible care for intractable pain. These include prescribing high volumes of narcotic painkillers for extended periods, prescribing potentially lethal doses or prescribing several different drugs. In some regions, patients use several different pharmacies, at their doctor's instruction, because some pharmacists are reluctant to dispense large quantities of the medications.To complicate matters further, doctor shopping can also be a sign of what is called pseudo-addiction: the efforts to obtain drugs look on the surface like drug addiction, but in fact represent the patient's attempt to attain an adequate level of pain control. Once that is achieved, the patient no longer presses for more narcotics.
All of this makes responsible law enforcement tricky, even difficult, but not impossible. It means that traditional red flags should not be ignored, nor should they be relied upon entirely when deciding whether to bring a case. Only careful, detailed, and expert analysis of the facts of each case can reveal whether the red flags are red herrings.
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In San Antonio, Texas it has become a sport for the Narcotics Division of the State to take away a Doctors License for prescribing medications such as Morphine, Methadone (which I must take) and any other Class I drug. This has cause me personnaly to lose my pain control Physician, the charge against him was 'dispensing narcotics to a Known drug user and distributor.' Problem is the Doctor didn't know, the State Narotics Division were the only ones that knew.
Even Mr. Dan Rather on his 1 hour expose on MS Contin revealed that only 2% of the people that are prescribed this medication possibly abuse it. Problem, out of a 1 hour show that statement was 20 seconds of the program and never repeated. The program did however film a young man crushing, disolving and injecting the MS Contin. The program also told how individuals hang around the pharmacy counter to see if MS Contin is mentioned by a patron or employee, then they mug them outid of the store or just follow them home and break in.
I do know it took 4 months to find my present Pain Specialist and 8 months to find my previous Doctor, the one who lost his license.
My wife, an E.R. Nurse has said if any patient mentions pain and is not bleeding or presenting with broken bones a Red Flag is assigned to the patient. Also if they mention the name of any pain relief drug, they get 2 Red Flags and most assuredly won't get a shot or a single pill other than Tylenol.
So to everyone out there with Chronic Pain, Good Luck. If you do accidently find a Doctor who does dispense Narcotic Pain medicine and has an excellent reason to give it to you it most likely will be about 3/4 of the dose you need. If you are in an HMO, Canada and Mexico are nice places to live.
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