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So what are we going to do for those who really needs this? Like me.
My VA HIV doc (who for some reason refuses to prescribe pain medications ("see your regular doc") recently told me to stop using naproxen (Aleve) which I have been using for a long time due to pain in a bad hip. (I already had one hip replacement.) I have been taking two pills a day and it works pretty well for me. He told me to stop taking the naproxen (due to kidney toxicity) and instead use acetaminophen or Vicodin for pain. (With liver toxicity?) BTW my liver and kidney tests are all normal. And I dont drink at all. My regular doc already refused me Vicodin once before and instead put me on morphine pills which I hated because they messed up my thinking so bad. So I instead kept using the naproxen which he approved of. So now I have to go back to him and ask him for the Vicodin he doesnt like to prescribe (because they are short acting vs morphine which lasts 12 hours). Since my pain is for a chronic condition that is what he wants to prescribe. And now they might remove Vicodin (which works well for me) from the market. What a mess!
Also medical mj should be legalized. Republicans under Bush 1 stopped providing it (the Public Health Service used to provide it to people with wasting due to HIV, cancer pain, glaucoma and pain from some other disease - they grew it in Louisana)around 1989, on bogus, cooked data re it's being harmful and no better than available alternative, legal meds. How do they have the right to tell someone in pain - particularly if they're dying - what feels better for them. Clinton's admin decided to keep the ban in effect - no doubt due to a hostile Congress. The DEA's fear (fantasy?)that kids will use mj as a gateway to addictive drugs like heroin or chrystal meth etc,needs to be publicly examined and weighed against the harm the ban does - the pain it causes and the societal cost of encouraging drug cartels we must fight and the cartels' funneling money to terrorists.
Good article. Opioids are incredibly important medications. Perhaps a newly patented pain medication is coming along at an outrageous price and they need to clear the deck of cheap competition? (Gosh, perhaps I'm cynical.) But a note--acetaminophen (or paracretamol) causes its liver toxicity by wiping out glutathione. The antidote for overdose is N-acetylcysteine (NAC). Scads of good studies on that! I think there are other analgesics that may be a better bet in general (wben not necessarily needing to resort to opioid therapy). But if acetaminophen is the one for you, use NAC. I use it anyway as part of a comprehensive strategy to manage Hep C infection. And I NEVER use Tylenol.
Over the years I'd come to hope that the FDA would do something like this, as I've found that almost no one appreciates the dangers of acetaminophen...people take it to cure hangovers, people take compounded meds like Percocet n Vicodin with alcohol, take overdoses via several different cold remedies, etc. I applaud this article for expressing my own concern about our failed and ever-failing "Drug War"..this war is what couple opioids and acetaminophen together in the first place. the DEA has no reason to be involved in medical decisions, and they have hounded and prosecuted patients and their healthcare providers needlessly and often ruthlessly. since we supposedly have a new kind of Executive in office, it would be wise to lobby the new administration publicly and relentlessly...because the DEA will certainly keep rolling over the sick and their caregivers otherwise. my impression is that Obama is very much like Clinton in that he'll seek the path of least political resistance. patients in pain and their doctors must NOT lay down so Obama can appear "tough on drugs". a good place to start would be to demand that hydrocodone NOT be rescheduled into category 2. As we consider revamping our healthcare system, the time to quarantine the DEA's influence and power over Medicine is now.
Well as I prescriber of opioiods every day of my clinical practice I must say bravo to your well articulated points. However, let me clarify a a vital element here that is lost to most people - especially those patients who ARE INDEED drug seekers and DO NOT care what the consequences are for the person writing the script. There are hundreds of stories of very caring doctors and nurses who end up in jail and then the "poorhouse" because of patients that lie, steal, and cheat their drugs from us. I believe I practice very good HIV and PAIN control medicine. It is nothing for me to write an appropiate script for 300 TABLETS of methadone for one patient. (The reasons would fill another yet much needed POZ article.)I long ago let go of the fear of jail and loss of license (and trust me it has come close at times) because I simply cannot let people suffer. Do I get suckered by con artists even through we have a very comprehensive monitoring program for compliance and diversion that most practice would marvel at? Damn right I do and I get it a lot. This is not a black and white problem with good guys and bad guys. It is very complex and those of us brave enough to risk everything (including our very lives at times - did I mention the countless times guns have pointed at me by "patients" or my loved ones threatened?)are left holding the bag. And just to make sure everyone is clear...the bag we are left holding typically contains the tatters of our lives mixed in with some shit. But we do it anyway because it is the right and, dare I say - Godly - thing to do. Also be assured that the DEA and virtually every drug manufacture knows EXACTLY what every signal licensed clinician prescribes on a near daily basis. Every one is tracked if they prescribe penicillin to morphine. Down to the last pill. If anyone even THINKS that there is some minute level of medical (especially when it comes to medications) privacy they are simply diluting themselves. Medical privacy went out the window a good ten years ago. I can find out anything about anyone I care to - it isn't hard. And what medications people take and who prescribes them might as well be posted on the Internet...oh, wait, I forgot, it is actually.
Could not have said it any better. If we continue to allow the DEA to run rampant and control even our healthcare--the very essence of privacy and dignity!-- there will be no turning back. And for WHAT, I ask? We continue to live in an imaginary world where citizens truly believe giving DEA cowboys control and making laws will prevent drug use? Is ending drug use THAT important? And if it IS, I gotta ask WHY is it? Why have Americans suddenly become obsessed with out lawing anything and everything that could POSSIBLY hurt us--and where has personal risk assessment and responsibility gone>? Why not focus on making the use of drugs as safe as possible, like we do with all other forms of ADULT entertaiment? We have already given the DEA too much power over our lives and our bodies-now they want our healthcare too? And we are just sitting back and letting it happen!
Casper Evade
I have a hard time with articles like this. While I think it was well written, it is hard for me to agree that having the DEA involved is a bad idea. I have grown up in the medical community, nearly everyone in my family works in the medical profession, and I chose to be a drug addict as an adolescent, and now am a private contractor for a federal agency to help with the "war on drugs", so I have a pretty good understanding of all sides in a case like this. I think that pulling these substances from the self would be a good idea, over the years of the evolution of medicine, narcotic or not, the goal alike has been to "retard-proof" medication, make it effective in its purpose, and have a very low overdose / negative side effect rate. While drugs like these are a good low dose pain killer / effective means of getting high for a beginning drug user, the amount of damage they will do to your kidneys / liver if taken to manage pain / get high, will (a) damage your kidneys / live much faster than being an alcoholic (b) you will need more and more and more for it to become effective. I had a piece of a grenade removed from my spine not to long ago, and the dr.'s suggested that even when I wasn't in pain, the idea was to stay ahead of the pain, and to maintain taking them every 4 hrs., I thought this was odd, so I contacted a family member and they said that most people are instructed to do the same, and while it was absolutely terrible for you to do so, it was common practice to place patients into this liver / kidney destroying cycle and good people were becoming addicts / creating issues in their "medical lives" because of the damage these people were doing to them selves even though they were following doctors orders to the "t". I believe there was an individual that had commented about using these drugs to manage pain caused be hep c, I'm no doctor, but to me, that sounds counter productive, hep c destroys the kidneys and I believe isn't great for the liver either, and yet it taking, I'm sure, a strict regimen of these pain killers instead of taking the equally effective and much less damaging tramadol (probably misspelled) which from my understanding is MUCH healthier for you and SUBSTANTIALLY better at killing pain. I switched to tramadol after a week of the Percocet (Oxycodone 5/325 apap) regimen and although I have to admit it was a much-less "fun" way of dealing with my pain, it was equally as effective and was much better for me. My advice, pull the drugs from the counter, if your pain is to terrible to be dealt with above a tramadol / naproxen regimen, then take the more strictly regulated stuff (morphine, oprana, oxycotin, etc.) Because knowing the dangers associated with this drug, drs will be less likely to give it out and half educated people will realize that unlike vicodin / percocet, if you decide to self medicate / double up on your pain meds. you are at a high risk of death / addiction, so maybe people will think twice. As far as fed involvement in the regulation of medications, for the dr's that are doing everything right, ya, its never pleasant having someone looking over your shoulder all of the time, but, it really has 0 effect on your practice and really doesn't create any head ache unless you start showing suspicious patterns of behavior. On the other side of the line those who have faced drug addiction or have children / loved once who are currently or have battled a drug addiction, imagine a world where the dr's didn't have to answer to the DEA for the amount of narcotics they were prescribing, I know for me personally, if that accountability wasn't set up, I would have been able to pay off a lot more dr's, to get a lot more drugs, and more than likely wouldn't be here today to ramble on and on and on on some article I stumbled upon at 3 am while laying in bed. I guess if you take anything from my rambilings, know that while the DEA involvement is kind of a kick to the teeth of good, honest medical staff, imagine a world with 0 accountability, I promise you, those few people we all know that have dabbled in or been addicted to pain killers would more than likely be dead today. No one likes the FED's, no one, not even the FED's like the FED's, but, they are a necessary nuisance.
April 12, 2010