Is It Acceptable To Test Chronic Pain Sufferers

[UglyGreed]

People who have chronic pain are sent to pain management and are tested to see if they are abusing/selling their medication even though they never broke the law and are just victims of circumstances. Is this fair to single out those who are suffering?

[Arkansas Granny]

1. Test them for what? I'm not following you.

[Jackpine Radical]

2. Presumably for narcotics?

Much better that they should suffer a little excruciating chronic pain than be allowed access to opiates, after all.

[UglyGreed]

3. I'm sorry

People who have chronic pain are sent to pain management and are tested to see if they are abusing/selling their medication. Just was wondering if most people find that practice acceptable.

[ScreamingMeemie]

4. Tested how?

[UglyGreed]

5. They are

tested to see if they have the prescribed medication in their system.

[ScreamingMeemie]

15. ...and if they don't, it's assumed they're selling the drug?

You've given us little to no information as to the intent of your post.

Here's the thing, bottom line: This has NEVER happened to me, and I had a standing script for pain medication for several years. Yes, I understand that this is anecdotal (what I have written), but you've really just thrown something out there with no background.

I can't see how anyone could be busted for selling his/her narcotics based on a drug test.

[UglyGreed]

21. I've been tested over five years

Last edited Sun Aug 24, 2014, 03:02 PM - Edit history (1)

and have seen many others including 80 year old women being tested. They test me to see if I have more or less of the drug in my system.

[ScreamingMeemie]

25. ... and if there's less in your system, they hand

you over to the cops? For selling? My script was as needed, so there wouldn't have been any levels to test for. outside of an overdose if I were unresponsive. I suspect there might be more to this. Have you ever contacted the doctor for an early refill?

[UglyGreed]

29. If you don't

have the drug in your system they believe you are selling it and may stop your prescription. And as your question of early refill, nope never had to do such a thing since going to pain management for 14 years. But of course it must be the person who is suffering fault

[ScreamingMeemie]

33. That's not what I said, dear.

One, they test for interactions.
Two, they don't believe you are selling it if it's not in your system.
Three, if testing other than for possible overdose/drug interaction is going on at your clinic, you need to turn them in—outside of the other causes for concern I have already listed.

It would have helped to hear the whole story.

[UglyGreed]

43. Well I was told

by the NP that they check for levels of the drug and if none are present it raises a red flag.

[BaggersRDumb]

77. Now our idiotic MASTERS have decided to make it much harder to get Vicodin

Look, I get it, opiates are terribly addictive, but basic pain meds like Vicodin requiring a triplicate form?

insanity

No more refills can be given, no more phoning it in, etc

To get a second prescription you have to go back to the Dr and get another form, no refills

I wonder if tylenol 3 will remain level 3 or 2 however that works

[REP]

86. Norco doesn't require a triplicate; I get mine by mail

The only one of mine that requires a triplicate is Dilaudid, and I have to pick it up in person. Fortunately, I don't need it very often.

[BaggersRDumb]

87. that is changing, norco will be triplicate soon

[REP]

89. So they've been saying for how long?

[BaggersRDumb]

90. google it

[yeoman6987]

27. Apparently they are going to have

A doctors visit to get the prescription so maybe less testing. However they could be testing to ensure liver and kidneys are not being comprimised.

[UglyGreed]

32. No just the limits

of the drug prescribed. I read the paper work while heading down the testing area in the hospital.

[fadedrose]

41. Me too, they do a urine specimen test periodically,,

and I have to sign a document swearing that I do not have a prescription for the drug from any doctor other than my pain management doctor...

Am taking one called Norco (but I use the generic, and it works okay), and I use only when needed...never exceed the prescribed amount....

It doesn't bother me, though. That's how Rush Limbaugh got into trouble, by getting prescriptions from several doctors. I doubt he sold any of the pills, he was just in pain. He should have been permitted to take more pills or a stronger dosage, IMO.

[TBF]

52. Who is testing you?

Nobody has done this to me and I take strong arthritis meds.

[REP]

85. I have a standing script for over a decade

And I've never been tested or sent to a pain management clinic. The causes of my chronic pain are clearly apparent on xray. The only direction I've ever received is to take at least one pill a day, even if my pain isn't very bad.

I have heard of methadone patients being tested, but not chronic pain patients.

[UglyGreed]

95. Well mine have been noted

Last edited Thu Sep 18, 2014, 12:41 PM - Edit history (2)

on multiple MRIs, CATs and disco grams two lower back surgeries, one neck fusion and shunt surgery for Hydrocephalus. I have a total of 11 herniated discs, stenosis of the spine in four areas, degenerative disc disease and spinal arthritis plus bone spurs and such.

Treating people who are suffering like drug seekers is not fair and in IMO has caused myself more pain because I am afraid to speak up for the fear of being labeled as such. I don't know where you live or if you know your doctor well but you are lucky.

[jen63]

123. There are many regular GPs now

who refuse to prescribe any form of painkiller. My doctor included. If you need those kind of medications, you are referred to a pain management clinic. Your pills are counted, you are given a urinalysis among other things, to make sure you aren't "diverting" your prescriptions. In other words, you are treated like a common drug addict, even with an MRI, xrays etc., to back up your diagnosis. Many pharmacies won't fill the scripts either. It's become ridiculous. Thank you war on drugs.......

[Arkansas Granny]

6. I've known people who got hooked on pain meds by taking too many and I've known people who sold

their pain meds to others who got hooked on them. I've also known people who are monitored on a regular basis for other meds to make sure their dosage is correct. I don't really have a problem with it. Just part of the treatment, I suppose.

[UglyGreed]

10. Kinda like the welfare

lady who drives a caddy and buys lobsters with food stamps I suppose?

[Arkansas Granny]

11. I wouldn't know. I've never met the woman.

[ScreamingMeemie]

16. Thread win.

[UglyGreed]

23. Well I never met

anyone selling or abusing their medication so we must be even.

[onecent]

35. I have met people who sell their food stamps for street pain killers and xanax,

I got away from those people fast, cuz i was helping feed their hungry kids...I felt so sorry for them. i learned real quick, they were also buying cigarettes and acting like they didn't get enough food stamps for 4 kids.

[Downwinder]

54. I have heard that. My SNAP came on a plastic card,

Never could find a way to use them illegally without a merchant's compliance.

[daredtowork]

58. I'm tired of stories about "people sell their benefits"

This is why people on General Assistance welfare can't get funded bus tickets in Oakland. Supposedly they will sell bus tickets for drugs. So how are they supposed to get around then? They have $0 direct cash income to buy bus tickets - all the General Assistance money goes to their landlord for shelter!!!

How do they get to required appointments? How do they get to services and nonprofits that might help them? How do they get to the Dept. of Rehab? How do they get to job interviews? How do they get to the grocery store? How do you get to medical appointments? How do they get to Social Services itself?

The next time you see someone begging for money for a bus ticket in Oakland, CA, it's because THEY ACTUALLY NEED IT!

In Oakland, CA, the only way you can get a subsidy for public transportation is if you are disabled and you register with the Department of Rehabilitation and signify you are making progress toward working again despite being disabled. Then you can get a small subsidy for public transportation.

But if you are merely destitute, not only do you get General Assistance welfare (a LOAN that GOES TO YOUR LANDLORD) for only 3 months out of the year... you get NOTHING to help get from place to place. NOTHING to get to places you are required to be at!

THIS IS F'ING GOSH-DARNED CRAZY AND NO ONE IS NOTICING OR DOING ANYTHING ABOUT IT!

Some over-caffeinated astro-turfer just peppers the Internet with "they are selling the bus tickets for drugs!" and now people on welfare can't get anywhere they need to go.

What are their options now?

Begging. Prostitution. Criminal Activity. Gang participation. And for heaven's sake - I'd be seeking the relief of drugs, too, if you left me on the streets in that condition!

Oakland, CA, you are producing these problems and sneakily hoping the result is that these people are driven off or kill themselves. It is an indirect form of genocide. And it all starts with these f'ing troll posts about "selling drugs" with whatever few resources are left.

THE PROBLEM IS ASSUMING THAT ALL POOR PEOPLE ARE POTENTIAL DRUG ABUSERS/SELLERS! TRY TREATING THEM AS POTENTIAL GOOD HUMAN BEINGS FIRST AND THEN SEE WHAT HAPPENS!

[Downwinder]

59. +1

[JustAnotherGen]

106. Thank you for this

I'm on the other side of the country - I did not realize that about assistance in CA. If I were there - I would pay heed.

[daredtowork]

108. You're Welcome - It's An Invisible Problem

The media doesn't report on it, our political representatives not only ignore it, they routinely LIE about it because it's so convenient to play on people's ignorance to use welfare as a political football!

The problem is that people who have never been on welfare don't know anything about it. And people in different counties are on different kinds of welfare, so they don't know if what's true for them is what's true for the person across the county line. And people in different family situations are on different kinds of welfare. So the whole thing is so fragmented and obscure that no one knows anything about anything - and Republicans can make political hay just saying ANYTHING they want about it and draining the system of its remaining resources. Actually it's not even Republicans. The ostensibly Democratic Governor of California Jerry Brown will shore up a visible political issue at the expense of the invisible poor any day of the week! This problem is crushing people and spewing out their bone dust at the bottom!

[onecent]

61. The stepdaughter who got the card for food stamps, gave the actual card to the dealer

and she kept it for her...It was a nightmare. When I found out I approached the grandmother of the 4 children and found out quickly that the girl would also buy give them cash for cigarettes..I don't know how it all went down. I'm a senior citizen and the stepdaughter was helping me clean for some time...when I realized what was going on I knew she was always wanting drugs from her stepfather (he was legitimately on Percocet) but never saw many of them as she would steal them. So I decided I had too many things in my home she could sell...so I stopped cold turkey helping this family IN ANY WAY.
They even kept texting me. I would report them but I don't want to get involved, and pls don't anyone jump on me for that...but if you do, I can handle it. I'm too old to be fussing with all that business.

[daredtowork]

64. If that happened

That was stupid. That card is tied to her Social Services case number, and if it's abused she would become permanently ineligible for food stamps. No more food or cigarettes.

But frankly, if this is in Oakland, I wouldn't blame anyone for trying to find creative ways around the system. This is a system that gives people zero cash and no side benefits for stuff like public transportation. If they aren't scamming to get the non-food stuff they need, then they are scamming for some sort of "mini-vacation" from all the stress, indignity, and physical pain and suffering that Oakland is inflicting on its poorest citizens right now.

If I wasn't lucky enough to be in a situation that had enabled me to hold on to my housing this long, I'd probably be looking for a way to trade my food stamps for cigs, too. Hell, I'd be going for opium, because I have an under-treated pain condition! The mainstream world doesn't give a frak about me, so, yes, give me a hit of opium, and let me sink into a dreamworld for a while where I can have the experience of good life for an hour or so.

Oakland could change that outcome by actually providing a base income/work/shelter/food (all with dignity) safety net. If you can afford to hang flower baskets everywhere, Oakland, you can afford this!

[Dustlawyer]

79. Addicts overuse their pain meds and may not have any by the end of the month.

The disabled sell what they can to supplement their meager incomes. I get tested periodically for both a level check (how much of my meds in system) and checking for illegal drugs. The system has caused me more than a little pain over the years, all because some doctors like to make their money writing scripts to addicts. The addicts need treatment they cannot get anywhere. It's one screwed up system!

[Ghost in the Machine]

91. I've been in pain management since 2010 and have known many people who abuse the system by

getting meds they don't really need, then turning around and selling their pills. I've turned a few of them in myself! When you're using Medicare to go to the doctor and pay for your scripts, if you even have a co-pay, that is called FRAUD! People around here are paying $4/bottle of 120 oxycodone 10 mg.... and selling them on the street for $10-$12 EACH! Roxicodone 30 mg?? Try $30-$40 EACH.

I'm on meds even stronger than that and have been offered $125 for ONE PILL!.... and told them not just NO, but HELL NO!!!! I *really* could have used the money at the time, but it's not worth the risk of getting caught! I don't even know how the person found out that I was going to the doctor, or what I was prescribed! All I know is that, being on disability, that's a Medicaid fraud charge AND an insurance fraud charge, along with sale of a schedule 2 narcotic (felony). I'd lose my disability, lose my insurance and be sitting my ass in jail. Ain't NO AMOUNT OF MONEY worth that! Period!

Pain Clinics are required BY LAW to do a urine drug screen once a month to make sure you are NOT taking any illegal street drugs, or other forms of prescription drugs not prescribed to you. They can test the levels in your system right down to the nanometers per milliliter to see if you are taking your meds correctly. I had a friend a couple of years ago who went to a pill mill where she was prescribed 120 Roxi 30's on a wednesday.... they found her dead on friday with less than 20 pills left. I also personally know 3 other people who have died from overdoses since I've been going. It's a shame and a waste of life.

I have NO PROBLEM with them testing me because I have nothing to hide. You can also be called in at random for a drug test and pill count. That is all covered in the CONTRACT YOU SIGN when you join a pain management office.

There is a BIG difference between someone being *dependent* on opioids to ease pain and live with some quality of life by being pain free, an addict who abuses their meds and the people who are just in it for the money. Urine tests and pill counts weed out (most) of the bad apples. I'm all for that!

Peace,

Ghost

[UglyGreed]

93. Let me ask you

do you believe that the main source of prescription drugs on the streets are from so called patients selling their medicine?

[Ghost in the Machine]

117. Personally, that would be a YES! Like I told one doctor at a clinic that was cash only.....

"Anyone on disability who can afford to pay $350/mo to go to a doctor, then $100+ it costs to fill the script without insurance has GOT to be selling at least some of their pills. Even if it's just 15 to 20 of them to recoup their money it cost to go to the doc. Let me know when y'all start taking insurance!"

I've seen people talk their elderly parents and/or grandparents into going to the doctor just to get their scripts. What the smart ones do is they'll get their first script, sit on it all month, then about 4 days before it's time to go back to the doctor they'll take some pills to have in their system, keep enough in their bottle to have their count, then get a new script. Once they have that new script, they'll sell the whole bottle because they can still cover their ass on a pill count and have some to take before the next visit.

If I didn't NEED my meds to be able to function throughout the day, and if I were so inclined as to break the law and sell them, I could make over 8 THOUSAND DOLLARS A MONTH.... instead of sitting here right now wondering if I can afford the gas and co-pay to fill my script tomorrow, and still have money to buy dinner for me and the kids... and figure out how to make it until my next check comes on the 3rd. Believe me, if I *COULD* work, I *WOULD* be working. My monthly disability is less than what I used to make in a WEEK! I'm just glad that I paid in to the system for all those years before I got disabled in a construction accident. It's a small safety net and I'm glad to have it. I'd be on the streets without it, and I'm damned sure not going to risk losing it over selling a pill. With my luck, I'd sell ONE pill and get busted over it.

You want to know what's funny? I've watched people *limp* into the clinic on a cane, then be *running* to their car when they left... script in one hand, phone to their ear in the other!

Peace,

Ghost

[UglyGreed]

118. I go to a hospital

for my pain management and for all those years I have seen maybe 5 to 10 people I might question just the way they are able to go about. I have never seen or heard of the things you wrote, if so many are doing this I expect that we are all in danger of losing what little relief we might be receiving in a few years. Thanks for the reply.

[IdaBriggs]

97. One of my relatives used to supplement her income by selling her medications.

She went on medical disability at a very young age due to relapsing/remitting MS, and finances can charitably be described as "tight."

If you do not know anyone selling or abusing medication, it might be because you are not privy to the private actions or financial situations of other people. Based on conversations I have had in real life, my sister's choices were very common.

My sister passed away at age 39 due to complications from her MS. She left behind two young daughters (18 and 20 at the time).

It has been over ten years, and we still miss her.

[UglyGreed]

99. Sorry for your loss

I am homebound for the last three years so perhaps you are right. I still can not see patients selling medication are the main cause of prescription drugs hitting the street.

[seaglass]

100. It's patients and shady greedy doctors. n/t

[UglyGreed]

103. How about

adding theft? If there is so many on the street patients can not be the only one supplying the demand. There is more to the story than meets the eye.

http://www.nwitimes.com/news/local/porter/portage/cops-portage-pharmacy-tech-stole-painkillers/article_fa38a8c1-aae1-5cab-b527-c79102b950a6.html

http://www.securingindustry.com/pharmaceuticals/actavis-opiate-shipment-hit-by-cargo-thieves-in-usa/s40/a1073/#.U_tn8KbD85s

http://www.pbs.org/newshour/updates/mexico-texas-risk-illegal-trade-prescription-medicine/

http://globalnews.ca/news/1441882/how-pilfered-canadian-pills-become-a-hot-u-s-commodity/

I think these are the main sources not fake patients. Chronic pain sufferers are the Scapegoats.

[IdaBriggs]

101. From my non-druggie observation, the selling was more subtle

than that portrayed in the movies with furtive exchanges of money and cash in the public streets. They were "private" transactions; we are suburbanites, so "hitting the streets" probably means something different to me.

I did not ask for details, especially once I found out my sister was involving her teenage daughters in her marketing efforts. (Yes, we got into a fight about it at my grandmother's funeral - sigh - and NO, I did NOT instigate the discussion.)

I have been told that many senior citizens supplement their income by selling their prescriptions to those with "higher incomes", and the source was credible. I have never heard of drug busts taking place at the local senior center, though - "everyone knows" drug abuse is something Old People don't do. Plus they are all celibate. Oh, and nice - they all bake cookies.

and

You asked a question in your original post, and I am sorry, but my answer is "yes, I think responsible physicians should do regular testing for efficacy and absorption of the prescriptions they prescribe, as well as making sure that chronic pain suffers who are already at high risk for organ damage as a side effect are being monitored for these potential problems."

I do not think this should be a criminal issue, but rather a health related one. And because we *know* a certain percentage of the population will indulge in "bad decision making" (or have a relative or guest who will steal from them - sorry, but it happens), then responsible physicians who care about their patients will test / monitor / double check.

If you wish to frame it as "criminal behavior" (the pill counting, for example), you can do so, but as I said, I prefer to think of it as "common decency" -- you have several people in this thread who report they do not use all of their pills, and might be shocked to discover visitors have raided their medicine cabinets.

(Yes, some people suck. )

If you are housebound due to pain, perhaps you can make arrangements for a visiting nurse to come to your home for the testing / pill counting? It would probably make you happy (by keeping you out of a waiting room where you are exposed to every germ on the planet), and keep your doctor happy, plus verify to the world you are still alive and kicking.

Just a thought.

Best, Ida

[UglyGreed]

114. Thank you for your

reply and once again sorry for your loss. You made some very good points.

[lunatica]

7. Do you mean smoking pot?

I haven't ever heard of people who suffer from chronic pain taking heroin or speed or other illicit drugs and since doctor prescriptions are still considered legal, what are you referring to?

[UglyGreed]

12. Nope

they are tested for the level of the drug prescribed by the doctors.

[magical thyme]

26. could they be monitoring the levels to determine what level is or is not

effective?

I can think of a number of purposes in monitoring TDMs. One is to ensure people are taking as prescribed. Another is to determine the level compared to relief obtained. People's uptake, metabolism and response may vary. By measuring the levels -- especially if you are reporting insufficient relief -- they may have a different drug that might work better for you, or be able to increase the levels to obtain relief. Or if your uptake is inadequate, they may be able to prescribe something that will improve it so you obtain relief from current levels.

[UglyGreed]

36. I wish that was the case

since I am still in pain.

[Warpy]

8. It's also to make sure they're not using street drugs

or doctor shopping for medication that increases the effect of the narcotics from the pain service, practices that can be dangerous to the patient's health.

But yes, mostly it's a dance they have to do to please the plug-uglies at the DEA.

End the drug war. We lost. The drugs won. All it's doing now is ruining lives.

[UglyGreed]

14. But is that fair?

It is fact that most people who suffer do not do this sort of thing.

[Warpy]

116. It can save lives.

Considering the state this country is in, I suppose that's terribly unfair.

[daredtowork]

45. I had to shift my thinking on this

I used to think Big Pharma was automatically bad, and most drugs didn't really do anything but get people hooked on them. Most problems could be handled through adjusting my diet and taking the right vitamins, etc. I had taken some big name anti-depressants during a stressful time in grad school: not only did they do nothing to lift my mood: they caused a ton of side effects, and I suspect were partly responsible for my decision to leave grad school just short of getting my doctorate. So I have reasons not to be a fan.

(Tangent: When it was announced Robin Williams had Parkinson's Disease, I realized something from my own experience: if a psychiatrist had prescribed him SSRIs for his depression, but his depression was caused more by dropping dopamine levels from the PD - which SSRIs would exacerbate - well, perhaps the wrong prescription for depression played a role, just as it messed me up in grad school.)

Anyway, I was on board with the Big Pharma Prozac Nation conspiracy. But then recently, I got a particular drug that took care of a lot of my problems for real. So now I believe the right drugs can do stuff and patients should get them. And doctors should make the effort to learn about them and prescribe the right ones instead of using patients as guinea pigs (which may cause them to drop out of grad school or lose their job or otherwise mess up their life). But the right drugs can make a huge difference, and not all of them make you a zombie or a pot head. I'm a believer now.

Now to figure out how to get the prices down!

[Warpy]

56. We're in the infancy of studying brain chemistry

and, as you found out, depression is a brain chemistry problem.

As of yet, there is no test to determine what brain chemistry a person has, only lists of symptoms in the DSM and a list of medications to try to relieve it.

It takes time and trial and error to get to the right drug or combination of drugs. That is the last thing a depressed person wants to hear since it's taken all of his/her strength to get to the first appointment. However, this is the only way we now have of doing it.

Had you gone back during grad school and said the drugs weren't working, you might have had the right combination years sooner. Unfortunately, depressives seldom think in those terms. If the first drug doesn't work, then their sense of hopelessness is confirmed and they sink a little lower into depression.

Docs need to be clearer about this, stressing that the drug might not work the first time and to come back if it doesn't, it's not the patient's fault.

[daredtowork]

63. I wasn't in a position to do that

The thing I was depressed over was a professor switching my name for a fellowship so it would go to his student. I found out at the last minute, leaving me without funding at a time when it was too late to apply for more. So going back to grad school to experiment with more anti-depressants would have involved a lot of huge loans that I was unwilling to take out.

Perhaps I would have made the same decision if I had been on the right drugs, but it's all hindsight now.

The reason I suspect I was on the wrong ones is that I have essential tremor (dopamine side of the spectrum), and things like topiramate and gabapentin proved to be strong mood boosters as well as useful for other neurological problems I have. This changed my whole outlook on whether psych drugs actually "work". This is also what made me suspicious (I know - I'm not a doctor...) that when I got stressed out over the grad school fellowship, the depression actually fell on the dopamine side because of my undiagnosed medical problems. Just a speculation in lieu of any House-like medical providers to actually discuss these things with...!

[Lurks Often]

9. Who is sending them to the pain management doctors or clinic?

Some more detail would be appreciated

[UglyGreed]

17. Well I was

sent to pain management by a neurologist after my first back operation failed.

[Lurks Often]

18. The neurologist sent you to pain management

The doctor can't force you to go, but equally he no longer has to continue to write prescriptions for pain killers if you chose not to go. If you are unhappy with this you may want to consider another doctor.

[UglyGreed]

37. I was not on

any pain medication prior to being sent to pain management.

[bettyellen]

94. mine did this knowing there was a three week waiting list, and that I was in extreme pain

he pretty much told me to do nothing- no PT or chiro. I went to a chiro.

[JDPriestly]

19. A doctor may be testing the person receiving pain killers so as to

insure that the doctor will not prescribe a drug that is incompatible with the drug or drugs the patient is taking. That is one very good reason to test patients for the drugs they are taking.

I, for example, took a part of an aspirin and then curcumin -- both blood thinners. I got such a severe nose bleed that I had to go to the hospital. It was a bit of a fluke. Naturally, they tested me for other drugs that could have caused my problem.

Doctors do not want their patients to overdose or to have a drug reaction. If you ever had a reaction to a drug that was very uncomfortable or serious, you would not worry about the testing. It is a good thing and in the patient's interest.

The doctors in a hospital are very aware of the fact that patients do not always know or understand how drugs can interact with each other. Also, they want to know what level of say a painkiller you have in you before they give you a lot more.

[daredtowork]

20. Lucky to get pain management

Medi-Cal rejected my PCP's attempt to refer me to the pain management clinic in San Francisco. I really wanted this because I had gotten into scary/experimental drug territory that would be hard to come off of.

In fact, this last month I got a particular set of symptoms back in one fell swoop. I can tell only one medication failed because I still get the benefits (and feel the side effects which the other medication was formerly suppressing) from the other. I have questions. Was it because I was under an unusual amount of stress that caused it not to work? Did I get a bad batch? Do these pills have a lower dosage than it says on the bottle or are they placebos? Were they switched somewhere in the supply chain (they do sell on the black market), were they tampered with, if potency decreases over time would it decrease all at once for all symptoms, would some food or condition counter the drug, etc. Also, when I asked the pharmacy to test my last refill (they wouldn't), they told me it came from a different manufacturer: could the different formula of "generic" work differently? Could it be less digestible?

When I first went on this drug I actually took less than the doctor prescribed because I thought it might be dangerous. I was trying to hold out for the Pain Management Clinic or some other form of closer monitoring that would help me adjust quickly if something unexpected happened. But because I'm on Medi-Cal, I didn't get that. So I've been left several weeks with pretty horrible symptoms and no one listening that I need something done about it.

I wish I had access to a Pain Management Clinic and some testing was happening!

[frankieallen]

22. absolutely yes.

opiate abuse is an epidemic, it is ruining peoples lives. Not just those that get hooked but also their family members. Not to mention the cost to taxpayers for the arrests, court cases, public defenders, jail time, etc.
Big pharma is getting rich off the suffering of others as well.
based on the way you worded your post, I am assuming you don't agree with the practice that people who are prescribed these drugs should be monitored to make sure they are taking the meds properly, and not selling them on the street.
I disagree, I think they should be closely monitored, and if they are asked to do a pill count in the middle of the month and they don't have half the medication left, they need to answer for that.
If you are prescribed powerful pain meds for chronic pain, and you follow the Dr's instructions, you have nothing to worry about.

[UglyGreed]

24. Well I suffer enough

that I don't need the added burden of being looked at as a criminal. I am sick not a crook.

[daredtowork]

42. well

I was baffled by the fact that my doctor was doing nothing about the pain component of my symptoms when I was on welfare, and it seemed to me that the role of the doctor was to make the patient feel better and to try to do something that might enable them to become more active and get back to work. Pain is a big obstacle to functioning in everyday life - even getting up in the morning! I was all the more frustrated because I had an underlying genetic condition that made it inadvisable to take over-the-counter pain relievers (not that I could buy them with $0 cash income - see my welfare post).

Anyway, I understand the point about opiates and narcotics. If a person is falling asleep or otherwise not mentally present, they aren't going to be able to function in the mainstream world either. I'm definitely not advocating that approach. But doctors should also understand that acupuncture and "more exercise" talks don't work either when there are physiological sources of pain going on.

Again, doctors need to understand they are at the service of the patient. They are supposed to be doing something for the patient.

While researching why a particular drug I have been taking suddenly stopped working on this refill, I came across a statement that doctors loved to use this drug because it often worked on patients "whining about vague symptoms". WHAT THE HECK IS THAT ATTITUDE???!!! You mean patients who have been painfully dragging themselves into the doctor's office for years while the doctor will only listen to one symptom at a time and refuse to make a solid diagnosis while they are less and less able to work and end up on welfare? Is that the "whiners" we are talking about here? Those "vague symptoms" are symptoms of SOMETHING that cannot be diagnosed by one-symptom-at-a-time visits: and if this particular medication works on it, that something was probably neurological in origin and the patient was "whining" about something physiologically very real. So f' you and the high horse you rode in on for torturing your "whining" patients with "vague symptoms" for god knows how many years Mr. High And Mighty Doctor.

Can we agree there are some doctors who just suck out there? And when they get on the "all patients are potential addicts" bandwagon, they forget their job is to actual treat patients and use a couple brain cells to think about what's wrong with their patients. And we, the patients, need to stop paying the rubes who think their only job is to look down on us and make lifestyle speeches.

[UglyGreed]

53. The funny thing is

many suffer and feel they should not speak up due to the fact they are seen by the doctors as drug seekers and such behavior is grounds for breaking the pain management contract.

[frankieallen]

111. The government has made it very tough on Dr's when it comes to prescribing these drugs for patients.

If the DEA has the slightest hint that a DR is over-prescribing, that DR is threaten with loss of license and jail time. The looser in all that is the legitimate patient suffering from chronic pain that really does need 130 / 30mg percs every month to function.
You should be blaming the government, not the DR's.
And, you need to consider the pill shoppers that DR's have to deal with on practically a daily bases. I have a VA nurse in my family, and a good friend who is a Physicians assistant. They are inundated with people every day who have an immediate need for some emergency percs, because they are alergic to codene, or it makes them ill.
So, between the dr shoppers, and the DEA, it's amazing the DR's prescribe any opiates at all.

[daredtowork]

115. hmm - I was wondering why it took forever

It took forever for me to get an alternate pain reliever (I can't take NSAIDs) even though I was in so much pain I was having mobility problems and wasn't able to work. Now I know why, lol.

[UglyGreed]

46. So then

you would be in favor of breathalyzer/interlock system on all cars?

[daredtowork]

50. I don't drive

I don't know what you mean by an interlock system.

I might be in favor of a breathalyzer if it would prevent accidents. I'm vision impaired, and I've almost been hit by a car several times.

I'm an extremely pro-freedom person, but your freedom is limited to where it starts inhibiting my freedom. Threats to my safety will inhibit my freedom, so if a breathalyzer will protect me from drunk drivers, I think it's something that can be implemented without calling it a token of the Totalitarian State.

Having to pee in a cup in order to enter a public park might be a better example. I'd object to that on human dignity and freedom grounds.

[UglyGreed]

55. That is my point of

this thread and the one I posted about Breathalyzers on cars. People are always in favor of limiting or putting a burden on others but once it interferes with their own lives it is off limits. I wish you the best.

[daredtowork]

60. limiting others

As a person on General Assistance welfare, I'm in the place where everyone else's agendas has rolled down hill and I'm feeling all the "limits" that have been unfairly, and often contradictorily, placed on me. For instance, my access to public transportation was denied because somewhere uphill someone speculated about people selling bus tickets for drugs. Everything in my life is documentation and limits. Believe me, I understand.

But it doesn't hurt anyone to have a breathalyzer in a car, and it might save my life when I cross the street: so I think in the balance of freedoms, it would be okay to have a breathalyzer in cars.

I currently have a CPAP machine with a chip in it that transmits to the supplier to show whether I'm using it or not. Medi-Cal will stop funding it if I'm not using it. Though that's a "monitoring" of me, I believe that's fair because the taxpayers are paying for that machine for me. If I'm not using it, it should be returned.

Regarding this drug testing, I'm not sure if it's an invasive limitation on your freedoms or not. I've been trying to ask more questions to find out.

[Ms. Toad]

81. Constitutional due process rights, be damned!

(Which require individualized probable cause prior to a search).

Not to mention that requiring a monthly doctor's visit for everyone in chronic pain requires (1) an additional cost of $90-$150 each and every month (absent insurance), (2) the monthly hassle of getting to the doctor - which may, depending on the debilitation caused by the pain and/or meds, require finding someone to transport you to the doctor, wait, and transport you back home.

The bottom line - medical care is a matter that should be solely between the doctor and his/her patient. Policy concerns should not be dictating medical care. We understood that in the context of abortion - when an anti-abortion policies which placed barriers to access to abortion were being pushed as concern for emotional and physical safety of women having an abortion. Why is it so tough to understand when anti-drug policies are placing barriers to access to pain management medication by citing concern for the potential addiction of people who use medication for pain control?

[frankieallen]

107. possession of one Oxycontin without a proper prescription is a felony.....A FELONY

We are not talking about medical care, we are talking about a small inconvenience to legitimate pain patients to try and curb some of the deaths, overdoses, jail terms, not to mention the ruined lives that happen every year due to these powerful drugs.
But, heaven forbid your just a little bit inconvenienced, kinda selfish of you don't ya think?

[Ms. Toad]

119. My doctor-patient relationship has NOTHING to do with people who commit felonies -

unless there is individualized probable cause to believe I am providing illegal substances to people who are not authorized to have them. An across the board standard does not constitute individualized probable cause.

Not selfish - just a little thing called the Fourth Amendment to the Constitution.

Not to mention that the $600 - $1500 extra you are asking individuals who need narcotics for pain control to spend every year on doctor's visits is hardly a "little bit inconvenienced." Nor is requiring my 90+ year old grandmother who was on round the clock narcotic pain medications for the last 11 years of her life, to hire someone to drive her to monthly doctor's appointments (or requiring her family to drive her) a "little bit inconvenienced."

Why is it so hard for you to understand:

1. If it is wrong for the conservatives to interfere with the doctor-patient relationship in order to further their policy interests, it is just as wrong for us to interfere with the doctor-patient relationship just because we happen to like the policy being promoted this time.

2. The constitution prohibits searches (drug testing) absent individualized suspicion. You don't get to trample the constitution just because it is inconvenient for you - or at least progressives normally feel that way.

[frankieallen]

105. unfortunately it's always the few who ruin it for the rest of us. why do defensive?

opiates are one of the most addictive, abused and dangerous drugs on the planet. Some, not all, will take their meds to quickly, running out before the end of the month, and then turn to illegal drugs to keep from going into withdrawals until their script can be filled again.
Sorry you find it so humiliating to have to give a little blood and have your pills counted that you would rather kill yourself.
Sounds a little ridiculous to me, but that's just me.

[ileus]

28. My DW writes dismissal letters all the time to patients who claim to suffer

from chronic pain.

I tell her all the time not to dismiss them but to instead just stop treating "pain" type claims. At the rate of 200-400 a year they'll be down to 3 patients before long. A few of her providers will just stop Rxin' pain meds and continue to see them as a normal patient, others won't.

[UglyGreed]

44. Is it that she does not

believe them or is she afraid of repercussions from the DEA?

[WinkyDink]

68. "claim to suffer".... "'pain' type claims"....Obviously, neither you nor she has ever "claimed" to

feel pain.

But there will come a day........

[ileus]

83. I wish you were correct.

http://en.wikipedia.org/wiki/Trigeminal_neuralgia

My wife suffers from TM, even on as nice a day as we had yesterday she still had to eat pain meds because of the slightest of breezes, on top of the 12 pills she takes every morning and night. And that's just to try and keep the pain bearable.


http://en.wikipedia.org/wiki/Mixed_connective_tissue_disease

On the other hand I suffer from this. It's been years since I had a pain free day. I don't have any RX pain pills, just the normal treatment meds. Of course I do take 800mg x2 daily of Ibuprofen. The time I put in on the bike or out with the kids I know I'm going to pay for the next few days so I have to increase that to 800x3 or 4 depending on how bad my joint pain becomes.


On the other hand neither of us sells our Rx meds like almost most every patient she dismisses.

[Laffy Kat]

84. Boy, hope you're watching for GI symptoms with that high a dose.

Short-term may not be too bad, but long-term...just be careful.

[REP]

88. GI hell - that kind of NSAID use will kill the kidneys first, especially with MCTD

[Laffy Kat]

92. Yes, yes. You are right.

[UglyGreed]

96. HMMM

{On the other hand neither of us sells our Rx meds like almost most every patient she dismisses}

And she knows for a fact that these people are selling the pills? Now I know why you refused to reply to my question.

[azmom]

30. I have had chronic pain

For 10 years. I can usually do without pain meds, but at times it flares up and need pain meds. It makes me really angry that I can't get the proper medication without being suspected of being a drug addict. The physical and mental pain is enough to deal with on a daily basis, I don't need people making me feel worse than I already do. What I need is pain relief and compassion and understanding.

[UglyGreed]

39. Exactly

This is no way to be treated unless you have done something to warrant testing. I wish you the best of luck.

[sarisataka]

31. I have chronic pain

And have bottles of three different narcotics. I also have a high pain tolerance and rarely take them. My doctor always tells me I should use them more; I prefer to obly take pain killers only when it is a really bad day.

How would I prove my innocence when no drugs are found in my system? Alternatively I could just take the medication for a day or two and test positive...

[blue neen]

38. They could also have you do a pill count.

SOP these days.

[sarisataka]

49. That's nuts imo

Unless you have a history of abuse a bit over the top

[blue neen]

67. Agree.

There is little that can be done about it, though.

[UglyGreed]

40. Do you go to the

VA? If so I believe the guidelines are different.

[sarisataka]

51. I've been there

But avoid the runaround when I can.

Typically I see an elderly gent from Mumbai. He believes in assited holistic treatment. He recommends exercise and natural curatives backed by standard painkillers to allow the exercise of painful joints.

[blue neen]

34. Acceptable? Probably yes. Fair? Possibly no.

This is what the DEA is requiring of Pain Management doctors now. In general, these doctors usually know who is a risk, but they have to test anyhow. We do have serious pain pill abuse in this country. It's now turning to heroin abuse, because the pain pill supply is drying up, so to speak.

They're testing for illegal as well as legal drugs. I understand why it has to be done, but it is unfair to those who are not abusing the medications. There are extra costs involved to the patient, which definitely is not fair.

[daredtowork]

47. What is involved in the testing?

I'm not sure what the problem is here, beyond the implied dignity issue which comes with any suspicion of drug use.

Wouldn't this testing be done while the patient is getting a general panel of other tests? Is the patient being obliged to drive or take public transportation somewhere way out of the way? Are we talking needle or pee in the cup?

Since I was denied Pain Management from Medi-Cal, I don't think drug testing would be much to ask in exchange for it. But perhaps I just don't understand what the big issue is...?

[blue neen]

65. It's a big issue to come up with an extra $200 or so for every test.

It's specific testing, and it depends on how the doctor writes the script as to what is tested and how it's tested. That's up to the doctors' discretion.

Many people who have chronic pain problems may also not be able to drive re: arthritis, post-accident, trauma. So yes, transportation can sometimes be very difficult to come by.

The people who have abused the system have made it very difficult for those who did not.

[daredtowork]

70. WTH? Why does the patient have to pay for it?

That doesn't make sense. If it's a system/institutional/government requirement then that system/institution/government entity should pay for it.

[blue neen]

71. Uh, yes. The patient pays for it.

Do you really think that you'd get the likes of Rand Paul, Ted Cruz, and Paul Ryan to pay for drug testing?

Not. Going. To. Happen.

[daredtowork]

74. Wow that makes no sense at all. Is this the VA?

Okay, I'm on board. That needs to be stopped.

[NutmegYankee]

75. Many regulations require the person impacted to pay for them.

It's one of the leading reasons why so many American's have come to dislike government. They are forced to pay for a burden that they find stupid or draconian. I often wonder if it's intentional to undermine our participation/consent in government.

[daredtowork]

76. Well, if it counts, I object to that

And I've seen a lot to object to in my recent experiences with the General Assistance welfare system. Government has really been torn apart at the local level, but there doesn't seem to be much political will to actually DO anything about it.

[KT2000]

48. the worse problem

is people in pain who are not believed and not given any pain meds. A real catch-22. Friend was not believed as he did have a problem with drugs in the past. No one bothered to examine him until about the fourth doc he went to. Finally they did exams that showed he really was in excruciating pain and they immediately scheduled him for a new shoulder joint. He is OK now and resumed his life.

It just looks like being in chronic pain is becoming criminal.

[KarenS]

57. Absolutely not. Good grief. n/t

[Tikki]

62. Wish to hell there was something else for my chronic pain...The pills make my head and stomach ache

and I only take them when I know I'm going to be on my feet and moving around for a while.

The year's worth of the epidural procedure gives me close to 7 and a half months of some relief...I am thankful for that.

I would never sell my painkillers.


Tikki

[Skittles]

82. I can't figure what people like about pain pills other than to get rid of pain

they make my stomach and head hurt too

[WinkyDink]

66. Tested WHERE????

[yallerdawg]

69. In Alabama...

anyone with pain killer prescriptions including hydrocodones is randomly tested for illegal non-prescribed substances, including marijuana. Starting next month, all these types of prescriptions will have to be hand-carried by the patient from the doctor to the pharmacy - no more telephone or fax prescriptions.

[Sheldon Cooper]

72. A friend of mine lost his meds for chronic pain after being routinely tested

for urine levels of oxy and vikes. He was pill-counted as well and one day the urine levels vs the pill count didn't add up and he was cut off cold turkey. It's been six months and he is still being tested at least bi-weekly to make sure he's not buying it on the street, or using weed, or whatever. He's been made to go to the pain clinic on several occasions as well. He is hoping that they will return his meds in some form in September.

This is all done through the VA - he has no other health insurance and is subject to VA treatment.

[loyalsister]

73. I think it depends on the policy

I have a friend who is an alcoholic and goes to a pain management clinic keeping in mind that she has a risk of addiction and abuse. She feels like it is in the interest of her own protection for them to monitor the levels. In that case, she was in on making the decision to do it and I don't see a problem.

On the other hand, if it is a policy born out of suspicion, I'm not as comfortable with it. There are reasons to be concerned, but I'm not sure that the situation is being handled well.

A friend's father was dying of cancer and when they asked them to increase his pain medicine, the Dr. said "do you want him to die an addict?" As opposed to live in pain???????

Then there is the lack of tracking in MO that puts everyone under suspicion. They track purchases of over the counter sudafed, but when it comes to opiates there is not documenting procedure that alerts pharmacies and Dr.s when a person sees multiple doctors to get as much pain medicine to support their own addiction or sell. There are pharmacists who employ some kind of community justice to try to catch people. And, the ERs and Dr.s assume people are selling or abusing when someone wants them.

I don't like the registry system much, but at least the information they are using is objective. I could see how that might be for testing, but I'm still not absolutely sure about it.

[RiffRandell]

78. Yes, and they aren't being singled out; they signed a contract if it's a legit

pain clinic that states they may be given random drug tests.

[Ms. Toad]

80. Tested by whom, and for what purpose?

Many drugs require regular tests to verify whether the medication is in your bloodstream at a therapeutic level. Vancomycin and warfarin sodium are two I can name off the top of my head. If physicians determine that it is appropriate to monitor the levels of pain medication in order to better treat you (tweaking the levels of medication, for example), then it is perfectly appropriate.

Testing for purposes of law enforcement, on the other hand, is completely inappropriate without probable cause, specific to you as an individual, to believe you are giving your drugs away.

I.e. for medical purposes, as determined by the treating physician - yes; for any other purpose - no.

[Hoyt]

102. If you saw a lot of the screens that come back, you'd be amazed at how much stuff folks are taking.

Drug screens help ensure those who need them -- and are taking them properly (without a bunch of other stuff not prescribed, or stuff doctor shopped) -- get them.

Unfortunately, a lot of folks don't really need them for pain (although I agree addiction can produce a lot of pain), or might need them while tapering off with counseling. Addicts should be treated, but the doctor needs to make sure they aren't mixing meds with a lot of other stuff.

Too many pain management clinics out there are just pill mills. Hurts all those who really need pain meds for pain, rather than addiction. Addicts need/deserve treatment.

[stevenleser]

104. I have a badly herniated disc at C6-C7. It acts up 2-3 times a year. When it does...

the pain is excruciating. One orthopedic surgeon I was going to said that the women patients he has that have given birth at some point in their lives and have badly herniated discs say the pain of a bad flareup is comparable to labor pains. Of course I have no way of knowing if that's true, I just know it is really bad.

I was prescribed Percocet for this back in 1999. I always have a bottle of the stuff. My current bottle was prescribed 3 years ago. The 2-3 flareups I have per year last from 2-5 days each. I end up taking around 15-25 pills a year. I don't need the pills between flareups.

Each new doctor I have had over the last 15 years, and there have been several because I have moved a couple of times, has given me grief about getting a Percocet prescription. I hate taking Percocet and for that reason, I like having it as my pain medication. I am never tempted to abuse it. I hate the way it feels other than the fact that it takes my pain away so I stop taking it at the first opportunity when an attack subsides.

I may go to a pain management doctor to find an alternative because of how difficult it has become to get Percocet, and because I am a little worried about pain relievers that have acetaminophen, which Percocet does in combination with a narcotic. I understand that pain relievers that have acetaminophen can cause liver and kidney issues.

But it is a shame that people who find relief with a given medication who are not abusing it have to go through all of this crap to get the medication that makes life liveable for them.

[hifiguy]

109. This is the second poll-type question you have posted

from a pretty disturbingly authoritarian viewpoint. Your point?

[UglyGreed]

112. First off I am

a chronic pain suffer who is tested while I never broke the law. So I thought how would people feel if they needed to be tested even though they did not do anything wrong. I came up with Breathalyzers in cars since driving is privilege not a right. And guess what, I was right, people do not like to be labeled or punished for things that others might do.

[Warren DeMontague]

110. I'd rather have doctors free to aggressively and compassionately manage pain

Than the system we have now, which treats everyone involved as a potential criminal.

http://www.huffingtonpost.com/maia-szalavitz/cruel-and-disgusting-pain_b_43216.html

[UglyGreed]

120. missed this

yesterday. Imagine having to be throw in jail for suffering and then receiving better pain relief in jail. Thank you for the link.

[Nye Bevan]

121. Interesting thread. I was not sure of my feelings on this question,

but having read the responses I think it's a fair bargain if doctors can prescribe strong painkillers for patients who need them, in the quantities they require, but in return patients are subject to periodic urine testing to ensure compliance. When someone can make thousands of dollars a month by reselling their medications that is too much of a temptation where people can simply be trusted.

[UglyGreed]

122. So then

you are fine with testing those on ADD medications and those who are on anti depressants since those medications are also wildly abused?

[lillee]

124. My doctor sent a letter/ form for me to sign. The bottom line was sign this and get my urinalysis or

I wont get a refill. I am taking Norco because I have degenerative disk disease which has cost me 5 inches in height. I have pain nearly all the time.
Last year I complained about invasion of privacy and didn't have to take the test. I think it might be the dr's. prerogative at Kaiser. I asked the lab tech about it and he said they test for Tylenol a component in Norco.
Just a guess that the former stays in your system longer. I think opiates only stay in your system about 3 day's. Does anyone know more about this? or is it even true?

[UglyGreed]

125. I'm sorry I missed your post

Please be careful with acetaminophen.

Not only is acetaminophen, the active ingredient in Tylenol, the deadliest over-the-counter pain reliever on the U.S. market, but its dangers are being overlooked by members of the public and health officials, according to a new joint report by ProPublica and public radio program "This American Life."

http://www.huffingtonpost.com/2013/09/24/tylenol-overdose_n_3976991.html

The U.S. Food and Drug Administration has long been aware of studies showing the risks of acetaminophen – in particular, that the margin between the amount that helps and the amount that can cause serious harm is smaller than for other pain relievers. So, too, has McNeil Consumer Healthcare, the unit of Johnson & Johnson that has built Tylenol into a billion-dollar brand and the leader in acetaminophen sales.

Yet federal regulators have delayed or failed to adopt measures designed to reduce deaths and injuries from acetaminophen overdose, which the agency calls a “persistent, important public health problem.”



http://www.propublica.org/article/tylenol-mcneil-fda-use-only-as-directed

[tridim]

126. I wish they had tested my dead friend. :( nt

[UglyGreed]

129. I wish

your dead friend did not abuse his medication

[tridim]

130. As do I. A simple test might have saved her life. nt

[UglyGreed]

131. sorry if I was

harsh but sometimes the truth in the matter comes down to the individual who choose that path. I don't know what your friend suffered from but perhaps in her eyes it was not an accident but a final solution to a problem that no one could give her an answer for. I don't want anyone to suffer or die because they have been left behind, but also I don't want to be blamed/ridiculed or labeled because of what others have done.

IMO a test every six months or so is not going to stop someone from overdosing or abusing their medication. They are going to do what they are going to do and no one will stop them if they are determined.

[riverwalker]

127. yes

As a nurse of 30 years, hell yes.

[UglyGreed]

128. why

just don't hit and run please explain.

[UglyGreed]

133. Well thank you

for that, it has added a great deal to the conversation.