***Originally published at http://onlinelpntorn.org/2014/more-vitriol-against-withholding-pain-medications/***
The pain medication hysteria has officially gone too far. What are we doing, and why? Is hydrocodone really the boogeyman all of a sudden? I work in a jail, and I have it on good authority that "real" drug users don't want anything to do with hydrocodone. They want OxyContin and similar; they will stoop to Percocet if it's a dry day, but Lortab? Puh-leeze. Waste of good money.
That's a single-case scenario, but as I flip back through the overdose cards in my head from my years in the ER, I can't think of any from hydrocodone either. Oxycodone, OxyContin, and Fentanyl patches, yes, but never Lortab. Is this a pharmacy thing? What did the FDA mean to accomplish with this October switch of hydrocodone to a class 2 medication?
I don't have a theory about what the intent was, but the effect is criminalizing people who have moderate pain: pain that over-the-counter medications don't quite work well enough for, but pain that doesn't need heavy-hitting narcotics. I've heard two mental health professionals say that their clients have been pushed to buy Norco online because after years of giving them this medication, with responsible use and no early refills or dose increases, suddenly their physicians have cut them off.
At first blush that seems hinky, right? "It's not my fault I have to buy this illegally!" I am not recommending purchasing drugs illegally, but I do have to get really annoyed at my chosen profession for creating this situation. We all, nurses and physicians, have sworn to alleviate suffering. Snatching pain-relieving medications from those who need them violates our promises, our intents as professionals.
I myself have some crazy intermittent but horrible arthritis pain left over, we think, from one of those mosquito-borne viruses. I don't have it all the time, but when I do, it's stay-in-bed bad. Of course, I waited until I couldn't stand it before going to the doctor, where I learned (from a receptionist, not a nurse) that I had to sign a pain agreement and only see one doctor. Fine. Well, but he won't be here for 6 days. What am I supposed to do for 6 days? When you're in joint-splintering pain, that is a long time!
Then came the criminalizing part. The receptionist, who was making the decision that I did not need pain medication, got snippy. "You will not be receiving any narcotic pain medications today, or tomorrow, or any other day until you sign this agreement and see the appropriate doctor." Okie dokie, lady. Funny, when I was last in to see my doctor and offered to sign this paper, he said they weren't enforcing it on people who used medications responsibly. And where, I queried, is the licensed person in this scenario deciding whether or not my pain requires treatment? I never saw one. Just the receptionist.
So to me it seems I'm being punished both for requesting the Norco and, ridiculously, for using it responsibly (otherwise I would have had my paper signed and been good to go). I tell this story because it is people like me who are getting inappropriate medical care as a result of the prescription drug addiction frenzy. Just because people take medications that can be addictive does not automatically mean that they are misusing those medications.
I need to repeat this so it gets the necessary attention.
Just because people take medications that can be addictive does not automatically mean that they are misusing those medications.
Also, ironically, how is that patients know that these medications are a good solution for their pain? Because the doctors taking them away originally prescribed them. Because they are a good solution. Why aren't they being shamed? ("My bad; I'm so sorry I prescribed this medication that works so well and now I'm taking it away and making you beg and humiliate yourself to get it.") Why aren't nurses or physicians fielding situations like mine, rather than a receptionist? What if the next person who has severe pain has an acute reason to need the medication and someone ought to know about it other than desk help?
People are getting really angry about this. After my interaction today, I understand why. People treat you like you're doing something bad, and you start feeling as if you are. This is not medicine; it's politics, and it has no place in the physician's office. It is also bad medicine. We health-care providers have got to level the playing field and stop making assumptions. And this business with letting receptionists decide who gets to have their pain treated? That's got to stop. It's a gigantic liability.