Drug testing

[Trooper]

One thing could be done, limit who can prescribe pain medication. There are pain specialists like anesthesiologists. Not every doctor is qualified to treat pain. Just as we limit who can treat mental health problems.

 

[DeadeyeChrista'sdad]

I guess I've been lucky. In the last five months I've been given two prescriptions of fairly strong stuff because of injury. Before that I don't remember ever having to use any. Told to use them as needed. Typically I'll only use one if I'm really feeling it and aleve, ibuprofen, or plain old aspirin won't do it. I don't notice any psychoactive effects, so I guess I don't understand that aspect of it. Like one of the previous posters I don't use the stuff everyday, so testing wouldn't work, but then again I'm hoping to be able to throw the last of them away.

 

[88GT]

One thing could be done, limit who can prescribe pain medication. There are pain specialists like anesthesiologists. Not every doctor is qualified to treat pain. Just as we limit who can treat mental health problems.

At what point will some of you realize that there is no solution short of absolute control over our lives? People should be free to screw up and die. And I shouldn't be limited in my choices because they didn't use theirs wisely.

 

[Trooper]

At what point will some of you realize that there is no solution short of absolute control over our lives? People should be free to screw up and die. And I shouldn't be limited in my choices because they didn't use theirs wisely.

Maybe, maybe not. In some cases it helps to have a little supervision. Medicine does not have to be as regulated as it is now.

I have no problem with letting people screw up and die. But as long as we have so many crybabies, so many victims blaming others, we will have some form of supervision.

BTW, before Prohibition we did have a huge alcohol problem that was way out of control. Just as soon as women got the vote they then campaigned for prohibition due to the abuse. Far larger than our current drug culture. If abusing your freedom harms your family, your children, someone will make a case to regulate you. So it is not just you who is effected but many around you as well. At least today women can divorce your ass and get a job. Back then that was much more limited. Abusing freedom often means that the rest of us have to clean up the mess you leave behind. If I have to clean up after you, I have the right to judge your behavior.

 

[freekforge]

So since i turned my bottle of 100 strong narcotics into the police pill turn in 3 days after my very intrusive and painfull surgery i would fail a test and be in trouble because i felt i didnt need them?

 

[Bill of Rights]

I disagree with the drug test. I have a kidney stone right now but the pain is intermittent. I haven't had a pain in three days and only take the medication(hydrocodone) when I have pain. I still have most of the pills in the prescription bottle. I guess I would fail the test because the drugs aren't in my system. How is that fair?

I don't think this is really to go after acute users of pain medication. For a one time diagnosis such as a kidney stone, it means nothing to you. For the chronic low back pain jackboot on disability at the age of 35 and prescribed hydrocodone 4x a day for 10 years, it means a lot more.

True. Also, if you can show you still have the pills (as opposed to having illegally sold them), a low level should be understandable.

That's what I'd guess, anyway. Nothing to back it up.

Blessings,
Bill

 

[hoosierdoc]

As stated above, this is not to limit those with acute pain conditions. It's for the guy/gal getting 1000+ pills/year. Everyone is free to screw up their own lives. Just don't involve a third party (doctor) in facilitating your self destruction. Many docs are nailed by the DEA for over prescribing. Do you want your medical license revoked and your family's security taken away because you treat chronic pain patients in your FP office? Nope. So you stop treating them unless they adhere to the pain contract which now includes mandatory testing.

most of you are completely naive to the severity of the problem. These guidelines are there to ensure the medication is available to those truly in need. The other solution is for everyone to just stop prescribing it.

Your pills were stolen? Sorry, should have locked them up. No early refill. You dropped them on the street and ran over them? Sorry, no refill. Your cat knocked them into the sink? Sorry, no refill. Your are out of pills but filled 180 a week ago? you haven't gotten a narcotic filled in months but the state shows you filled five scripts this month so far? You just moved to indiana and have no medical history but google is littered with your arrest records for controlled substances? Your doctor is a quack and you're never going to him again? 'Cause I just called him and he said you failed two drug tests and are taking cocaine so he kicked you out of his practice for violating the narcotics contract.
You have a high pain tolerance so you need something strong? But I found you take Suboxone for narcotic abuse and my pills won't work, so no. Oh, you have no medical history but are on full disability at age 33? Why? Oh, you have chronic back pain and are on massive doses of narcotics and ran out early. Gotcha. The lies are unending. The deceit is rampant and blatant.

Wasted my time and energy and ticks me off before I go see the next patient. Then when they leave un satisfied they complain to hospital administration and I get to hear about it. I would LOVE to have my narcotic prescribing limited so I can stop being the "bad guy" and actually treat sick people.

 

[hoosierdoc]

At what point will some of you realize that there is no solution short of absolute control over our lives? People should be free to screw up and die. And I shouldn't be limited in my choices because they didn't use theirs wisely.

I hate the speed limit too.

 

[GodFearinGunTotin]

Accepting this mindset is part of the problem. They can ***** and moan and demand "somebody" do "something" all they want. The only reason this kind of behavior continues to maintain traction is because we let them get away with it. We are subsidizing stupidity. And the unintended consequence is more nanny statism.

Of course, none of this is an issue if people were free to determine what to put in their bodies.

We don't let them get away with anything, they get to vote and their votes count as much as the next guy or gal's. And no piece of paper written back at our nation's or state's founding can prevent them from enacting such laws. As I've often said, taking responsibility for your own actions is the self correcting mechanism for using your freedom foolishly. And I stand by that. But I also recognize the fact that many, if not most of our laws are a result of people acting foolishly, not governing themselves, and visiting the collateral damage of those behaviors on others.

I'm not quite so naive to believe there are no exceptions to the statement above. But if you don't want to be governed by others, govern yourself.

 

[DoggyDaddy]

I suppose I can see the testing to make sure that you have the "appropriate" level of the prescribed medication in your system. "Appropriate" being open to interpretation I suppose... But I cannot see casting a dragnet via the drug test to see if someone smoked a joint on the weekend. Yeah, yeah I know it's illegal, but it's gradually becoming less so, at least in other states. In fact, marijuana has been shown to have benefits when it comes to reducing chronic pain, which may in turn reduce the need for the legally prescribed pain medication. I'm not trying to turn this into a pot legalization thread, but it is my contention that the presence of THC in someone's body is not indicative of an opiate addiction. Want to test? Fine. But test ONLY for the medication being prescribed. Anything else is, IMHO, nunya business. Should they be allowed to test for alcohol use? If anything, a patient having indications of alcohol abuse is much more likely to have a problem with addiction. That won't happen of course because alcohol (while causing MUCH more damage to society in terms of car accidents, abusive behavior, health issues, etc.) is socially acceptable.

There was talk on this forum not so long ago about doctors being "required" to ask if you have guns in your home, because it could predict... well, I don't know what it could predict (other than you having a hobby), and folks were up in arms about that invasion of privacy. I don't really see this as being any different.

 

[hoosierdoc]

Doggy, you think it's nunya business if they smoked a joint, snorted some coke, or dropped some LSD when they are in a pain management contract? The whole point of the contract is to give meds to appropriate patients, not drug addicts.

I love how everyone wants doctors to "do their job" and treat the patient instead of just tossing pills at them, but heaven forbid they check to see if they are simply giving an addict a fix. Now it's become "shut up and provide the pill doc"

 

[DoggyDaddy]

Doggy, you think it's nunya business if they smoked a joint, snorted some coke, or dropped some LSD when they are in a pain management contract? The whole point of the contract is to give meds to appropriate patients, not drug addicts.

I love how everyone wants doctors to "do their job" and treat the patient instead of just tossing pills at them, but heaven forbid they check to see if they are simply giving an addict a fix. Now it's become "shut up and provide the pill doc"

I'm saying it's no different from prescribing meds to a chronic alcoholic. What say you doc? I'm not criticizing the doctors, I'm criticizing what I see as another case of government overstepping its boundaries. I did say I didn't have a problem testing for the specific drug being prescribed.

 

[hoosierdoc]

It's different. If a guy drinks beer all day and is an alcoholic, I wouldn't give him vodka. If a guy is a drug addict, I would not give him drugs.

if someone has a recent history of using drugs inappropriately, best to not give them more opportunity. Guess who will be sued when a patient shows up dead that a doc gave oodles of narcotics to when "he should have known they used drugs! He killed her! She was trying to turn her life around but that damn doctor just kept giving her pills to collect the co-pay!"

 

[DoggyDaddy]

It's different. If a guy drinks beer all day and is an alcoholic, I wouldn't give him vodka. If a guy is a drug addict, I would not give him drugs.

if someone has a recent history of using drugs inappropriately, best to not give them more opportunity. Guess who will be sued when a patient shows up dead that a doc gave oodles of narcotics to when "he should have known they used drugs! He killed her! She was trying to turn her life around but that damn doctor just kept giving her pills to collect the co-pay!"

And if a doctor prescribes Xanax or hydrocodone to an alcoholic and they inadvertenly off themselves due to that drug interaction, it's different how exactly? And you as a doctor should know that alcohol IS a drug. It just so happens that it's readily available at the corner liquor store, supermarket or quicky mart.

 

[hoosierdoc]

And if a doctor prescribes Xanax or hydrocodone to an alcoholic and they inadvertenly off themselves due to that drug interaction, it's different how exactly? And you as a doctor should know that alcohol IS a drug. It just so happens that it's readily available at the corner liquor store, supermarket or quicky mart.

Alcohol is a drug?

I thought you were arguing for free love for all, now you want to restrict prescribing more? I'm an ER doc, I don't prescribe long-term narcotics or benzos to anyone. I will do a few refills on BP meds or psych meds if they don't have insurance to bridge them a bit to find another prescriber.

Here's how I handle things...

Patient: 39 year-old in the ER with chronic back pain, helped a friend move a couch five days before and flared up his back pain. Has a family doctor, has not called them about the increased level of pain and comes to see me at 6pm (after PCPs office closes for the day). I ask about prescribing history of drugs, recent doctor and hospital visits, the nature of the back pain,why didn't you call your family doctor, etc... I search to see if you've been to other ERs in the city recently. I look at your narcotic history on the state's website. If the data I discover is inconsistent with the history you provided, I inform you of that and question why you are lying to me and you get nothing. I then follow the visit up with a letter to the PCP informing them of the deceit attempting to obtain narcotics from me (which is a felony BTW). If your provided history matches your statement and you do not have a history of chronic narcotics, I offer a day or two of pain control and recommend exercises, stretches, PT, etc as better treatment options. If your history matches but you DO have a history of chronic narcotics, then I need to determine if you should have pills available or not. If you should, I reassure you that you have no serious, emergent condition and you can simply increase the dosing frequency of your existing pill supply. If you tell me that you are out of your pills early because the pain got too bad, I tell you that is a budgeting issue and you should have notified your prescriber of the increased usage. You had a week to tell you were running low and now have been out a week. I do not prescribe meds for chronic pain, which this is. If you are out of pills but on a chronic regimen from a prescriber and just haven't had a refill yet, I inform you that unfortunately you have a chronic pain condition and that is not treated in the emergency department. you need to call your PCP in the morning to obtain a refill. I'll give you a pill in the ED or maybe two to go home with too to tide you over until your doctor's office opens.

If you want pills from me you are going to be nice to me and my staff. If you swear at the nurses and complain the whole time about how long it took to be seen, you can follow-up in the morning and take some Motrin.

All of that takes an extraordinary amount of time to do the research and document everything. I can't stand it. Then there's a good chance you'll get pissed at the lack of meds, yell at me, curse me, sometimes take a threatening posture, call my hospital administrator, threaten to call the department of health (i have no idea what that would accomplish) and call my boss (self-employed).

There you go. How to save money and have appropriate expectations from your ER visit if I'm working.

 

[Trigger Time]

Ibuprofen (Motrin) is hard on your kidneys.

Acetaminophen (Tylenol) is what's deadly to your liver.

The rest of your post is spot on.

Thanks. I knew it was one of those I get all of them pills mixed up. Take these 4 pills for pain and this pill for your diabetes and this pill for high blood preasure and this pill for cholesterol ..... but this one can hurt your liver and that one can hurt you kidneys so take this pill to protect your kidneys and this pill makes you sick so take this pill for nausea and then take one of these to flush your system and and and and ......... Some people wish they wasn't on anything but have no way around it. They wonder what will kill them first the meds or health

 

[DoggyDaddy]

Alcohol is a drug?

I thought you were arguing for free love for all, now you want to restrict prescribing more?

Wow. Perhaps a little more reading comprehension is in order in the medical curriculum. No doc, alcohol isn't a drug. It's safe as mother's milk. I don't know why there are all these silly laws against consuming it and driving. What could go wrong? (apply purple as needed)

Once more, slowly...
1) I have no problem testing for the drug that is being prescribed to make sure that it is being used as prescribed.
2) I see no reason to test for something that has no bearing on whether or not a patient has addictive tendencies.

I see this as a privacy issue. You see it as covering your behind. I get that. Really, I do.

 

[forgop]

As stated above, this is not to limit those with acute pain conditions. It's for the guy/gal getting 1000+ pills/year. Everyone is free to screw up their own lives. Just don't involve a third party (doctor) in facilitating your self destruction. Many docs are nailed by the DEA for over prescribing. Do you want your medical license revoked and your family's security taken away because you treat chronic pain patients in your FP office? Nope. So you stop treating them unless they adhere to the pain contract which now includes mandatory testing.

most of you are completely naive to the severity of the problem. These guidelines are there to ensure the medication is available to those truly in need. The other solution is for everyone to just stop prescribing it.

Your pills were stolen? Sorry, should have locked them up. No early refill. You dropped them on the street and ran over them? Sorry, no refill. Your cat knocked them into the sink? Sorry, no refill. Your are out of pills but filled 180 a week ago? you haven't gotten a narcotic filled in months but the state shows you filled five scripts this month so far? You just moved to indiana and have no medical history but google is littered with your arrest records for controlled substances? Your doctor is a quack and you're never going to him again? 'Cause I just called him and he said you failed two drug tests and are taking cocaine so he kicked you out of his practice for violating the narcotics contract.
You have a high pain tolerance so you need something strong? But I found you take Suboxone for narcotic abuse and my pills won't work, so no. Oh, you have no medical history but are on full disability at age 33? Why? Oh, you have chronic back pain and are on massive doses of narcotics and ran out early. Gotcha. The lies are unending. The deceit is rampant and blatant.

Wasted my time and energy and ticks me off before I go see the next patient. Then when they leave un satisfied they complain to hospital administration and I get to hear about it. I would LOVE to have my narcotic prescribing limited so I can stop being the "bad guy" and actually treat sick people.

Winner winner chicken dinner.

 

[88GT]

I hate the speed limit too.

Nice non-sequitur. What a sob story you present about enough meds making docs co-conspirators. If the drugs weren't regulated in the first place, none of these issues would exist.

We don't let them get away with anything, they get to vote and their votes count as much as the next guy or gal's. And no piece of paper written back at our nation's or state's founding can prevent them from enacting such laws. As I've often said, taking responsibility for your own actions is the self correcting mechanism for using your freedom foolishly. And I stand by that. But I also recognize the fact that many, if not most of our laws are a result of people acting foolishly, not governing themselves, and visiting the collateral damage of those behaviors on others.

I'm not quite so naive to believe there are no exceptions to the statement above. But if you don't want to be governed by others, govern yourself.

This is the problem. I DO govern myself. This is identical to gun control laws. I shouldn't be governed in the possession and carry of firearms because others use them criminally, but it's acceptable to force me to jump through ridiculous hoops and prove my innocence because others make different decisions? Yeah, that makes perfect sense.

And I thought we had already established as fact that the laws, no matter how righteous, don't actually prevent behavior. They simply codify a penalty that can be meted out under the guise of due process.

 

[hoosierdoc]

Nice non-sequitur. What a sob story you present about enough meds making docs co-conspirators. If the drugs weren't regulated in the first place, none of these issues would exist.

No, it's an appropriate comment. Your freedom to drive whatever speed you want is being limited because others have driven inappropriately and gotten into trouble. So to keep the masses safe they put speed limits in place that you are forced to comply with or pay a fine. Same with narcotics.

I don't get the sob story reference. Regarding regulation of drugs, what are you looking for here? Or are you just saying drugs of abuse should be legalized? Get rid of the FDA and allow anyone to sell a drug to anyone else? Should Joe Bob be able to manufacturer his own opioids and sell them on the sidewalk? Are you willing to support legislation that would indemnify any producer or prescriber from liability from prosecution or civil judgement if a faulty drug was given to a patient? That would save one heck of a lot of money in this country and make all medical care significantly more affordable so I can see the benefit in that legislation.

As it stands now, many pharmaceutical companies stopped advertising their meds because the lawyers would buy the 60s spot available after a particular drug airs and troll for injury lawsuits from that drug. We all want wonder drugs cheap and freely available on the street corner, but want to be able to sue for billions if a drug has an unintended side effect. I want a unicorn too.