Opiophile.org

[PMR2008]

I am sure some of you know about opiophile.org. I read it once in a while and I am honestly shocked at the sort of things people do (It is helping me clinically because nothing really surprises me anymore)
An example
http://forum.opiophile.org/showthread.php?41056-Guess-who-just-got-their-first-bottle-of-oxyfast!!!

I am honestly never going to prescribe Opiates for longer than 2 weeks.

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Members don't see this ad.

 

[pmrmd]

Love that site. The entertainment value is second to none.

 

[Ducttape]

i love their use of the term "SOTM", which invariably means "Me"...

 

[mid|ine]

Sotm?

 

[PMR2008]

Some one told me. For other acronyms you old folks should check out http://www.netlingo.com/acronyms.php/ jk

 

[mdvol]

I check opiophile out at lunch a few times a week for the entertainment value

 

[olivercall]

I am sure some of you know about opiophile.org. I read it once in a while and I am honestly shocked at the sort of things people do (It is helping me clinically because nothing really surprises me anymore)
An example
http://forum.opiophile.org/showthread.php?41056-Guess-who-just-got-their-first-bottle-of-oxyfast!!!

I am honestly never going to prescribe Opiates for longer than 2 weeks.

Don't let an Internet message board full of drug addicts scare you from treating the people who really need your help
You have to be a member to see the pain management section on there. Trust me, it is really sick. Just sick. the amounts of drugs these people con out of their doctors. There was this one guy who posted pictures of his Fentora boxes and OxyContin the day he came home from the pharmacy just bragging away about the fun he was about to have. I take Fentora (currently have 8+ brain tumors) so stuff like that makes me really mad.

 

[PMR2008]

Don't let an Internet message board full of drug addicts scare you from treating the people who really need your help
You have to be a member to see the pain management section on there. Trust me, it is really sick. Just sick. the amounts of drugs these people con out of their doctors. There was this one guy who posted pictures of his Fentora boxes and OxyContin the day he came home from the pharmacy just bragging away about the fun he was about to have. I take Fentora (currently have 8+ brain tumors) so stuff like that makes me really mad.

To be clear I was talking about not prescribing Opiates for longer periods of time for non cancer pain.

 

[olivercall]

^^ I know you didn't mean nothing bad by it. I mean if I was a doctor, stuff like that would scare me too and make me think twice before prescribing. This is why i only deal with animals, ha! I am a member of that board but have never posted there. The people there make me sick to my stomach but it sure can be good entertainment!

 

[mille125]

^^ I know you didn't mean nothing bad by it. I mean if I was a doctor, stuff like that would scare me too and make me think twice before prescribing. This is why i only deal with animals, ha! I am a member of that board but have never posted there. The people there make me sick to my stomach but it sure can be good entertainment!

hmmm

 

[SmartDoc9]

Yea, drug addicts are just filthy sub-humanoids who not only DO NOT deserve to be treated as a human being in help, but also DESERVE our undeniable rage and any afflictions that come across their path. I can't wait until the various anti-narcotic vaccinations make it out of clinical testing and into anyone who wants to go to public school.
Think about it like we are the Jews being persecuted by those Nazi-ass junkies.

 

[michaelrack]

 

[Jcm800]

Yea, drug addicts are just filthy sub-humanoids who not only DO NOT deserve to be treated as a human being in help, but also DESERVE our undeniable rage and any afflictions that come across their path. I can't wait until the various anti-narcotic vaccinations make it out of clinical testing and into anyone who wants to go to public school.
Think about it like we are the Jews being persecuted by those Nazi-ass junkies.

what are you talking about!!??!?!?

 

[Jcm800]

i think we should officially CLOSE this thread. it is going to go south fast

 

[PMR2008]

I second that!!

 

[PMR 4 MSK]

Godwin's law after only 11 posts! Good job!

 

[ghost dog]

Yea, drug addicts are just filthy sub-humanoids who not only DO NOT deserve to be treated as a human being in help, but also DESERVE our undeniable rage and any afflictions that come across their path. I can't wait until the various anti-narcotic vaccinations make it out of clinical testing and into anyone who wants to go to public school.
Think about it like we are the Jews being persecuted by those Nazi-ass junkies.

Quite the first post.

I highly doubt you are a psychologist.

 

[SmartDoc9]

I know that I am saying what everyone here is thinking, but are just too afraid to let their real opinions be known. Drug addiction is a disease worse than Hepatitis(ironic how most junkies get that too!) and just as contagious. We, the vanguard of future healthcare, must take an extreme position in order to truly accomplish what we have all desired: a quick and painful death for drug addicts.

 

[Apollyon]

Yea, drug addicts are just filthy sub-humanoids who not only DO NOT deserve to be treated as a human being in help, but also DESERVE our undeniable rage and any afflictions that come across their path. I can't wait until the various anti-narcotic vaccinations make it out of clinical testing and into anyone who wants to go to public school.
Think about it like we are the Jews being persecuted by those Nazi-ass junkies.

I know that I am saying what everyone here is thinking, but are just too afraid to let their real opinions be known. Drug addiction is a disease worse than Hepatitis(ironic how most junkies get that too!) and just as contagious. We, the vanguard of future healthcare, must take an extreme position in order to truly accomplish what we have all desired: a quick and painful death for drug addicts.

Which side are you on? Are you the addict (who, by the way, is flying off the handle much more extremely than anyone else in the thread, who, ironically, have the "golden ticket" to what the manipulators and criminals on opiophile.org want), or an actual provider, or, the worst - an impaired professional?

Doctors are not perfect, by any stretch, and few profess to be. However, at the same time, well, take me for example - 26 years of school and training. No felonies, licensed by the government to prescribed these selfsame drugs of abuse, and no tracker around my ankle. I don't show frank disrespect to professionals by lying about everything I say to get my hands on mind-altering and addictive substances. I don't commit petty, or major, crimes to fund my life, and not violent crimes, either. I don't steal from my mother.

And, how do I know that you are not a psychologist? Because we, as doctors, have a nearly quixotic duty to patients that actively try to harm themselves. The simple idea that we wish "you" would die is foolhardy, and tragically insulting, because, if "we" wanted "you" dead, you would be. There is no wishful thinking about it.

If you think of yourself as a "filthy sub-humanoid", that's on you. I am more likely (based on history) to think of you as "pitiful" (as in, "deserving of my pity") or "pathetic". I would not wish you dead, I do NOT want to feed into your addiction, and would only think you filthy if you literally were dirty and unwashed, with a foul smell about you (I speak from experience with that description).

 

[Doctodd]

Some one told me. For other acronyms you old folks should check out http://www.netlingo.com/acronyms.php/ jk

I thought "someone" was one word? I guess I'll go back to 5th grade English.

As for drug addicts.....it's not always their fault. I've had family members who were addicted to cocaine regain their life and stay sober....for 20 years.

 

[ghost dog]

I know that I am saying what everyone here is thinking, but are just too afraid to let their real opinions be known. Drug addiction is a disease worse than Hepatitis(ironic how most junkies get that too!) and just as contagious. We, the vanguard of future healthcare, must take an extreme position in order to truly accomplish what we have all desired: a quick and painful death for drug addicts.

Opioid dependence ( not addiction - that's a lay term BTW ) is a significant problem, which chronic pain physicians are confronted with not infrequently. As a group, we are often frustrated with the fact that this population will do just about anything in order to get their hands on their drug of choice.

Do we want them dead ?

Of course not. However, opioids are not indicated in this population, with the notable exceptions of methadone or suboxone. Our frustration stems from the fact that they waste our time and theirs, which would be much better spent in the office of an addiction physician. The unfortunate problem is that the majority of these people are not ready for this step.

 

[Ligament]

Actually i disagree any opioid especially methadone and including suboxone should be given to opioid addicts....

 

[lobelsteve]

Actually i disagree any opioid especially methadone and including suboxone should be given to opioid addicts....

I believe the data deals with mtd and heroin addicts with less mortality and morbidity. But if someone is addicted to oxycodone....his is suboxone or mtd any better.

Mr. Jones is addicted to alcohol and drinks 12 martinis every day. If we could just replace that with tequila he'd be better off?

 

[Ducttape]

I believe the data deals with mtd and heroin addicts with less mortality and morbidity. But if someone is addicted to oxycodone....his is suboxone or mtd any better.

Mr. Jones is addicted to alcohol and drinks 12 martinis every day. If we could just replace that with tequila he'd be better off?

tequila? no.

single malt, now thats another issue...

 

[ghost dog]

Actually i disagree any opioid especially methadone and including suboxone should be given to opioid addicts....

My above statement is from a harm reduction perspective.

There is a fair amount of data to support this statement in respect to reducing mortality and morbidity. There should be a significant amount
of counselling in conjunction with medical management of opioid dependence, which unfortunately does not always occur.

Of course, some will take issue with these substances on other grounds.

 

[PMR2008]

I thought "someone" was one word? I guess I'll go back to 5th grade English.

As for drug addicts.....it's not always their fault. I've had family members who were addicted to cocaine regain their life and stay sober....for 20 years.

That's actually my fault. SOTM actually stands for " Someone Once Told Me"

 

[ghost dog]

Actually i disagree any opioid especially methadone and including suboxone should be given to opioid addicts....

I had a patient a few weeks ago who was using 50 ( fifty) Tylenol #1 tablets per day for her FM pain. Needless to say, she had a Hx of polysubstance abuse, and needed subtstance abuse Tx.

Her daily Acetaminophen intake = 16,250 grms / day = 400 % the toxic dose !

This is the type of population that would benefit from methadone maitenance Tx, if only to avoid fulminant hepatic failure.


Side note : Tyl #1 / with codeine is available in Canada ( 8 mg of codeine) over the counter.

 

[Ducttape]

is she on the schedule for a liver transplant?

or might she be exaggerating a little?

 

[olivercall]

She must have been doing a cold water extraction on those T1's because if not she would be dead for sure or at least needing a new liver!

 

[Apollyon]

That 7.5g is for acute intoxication. Can't someone more slowly ramp up, giving the liver time to meet demand? To get the CYP450 going? I was taught the 4g/day level is for healthy folks, but, as I search, I can't find anything about tolerance.

 

[lobelsteve]

That 7.5g is for acute intoxication. Can't someone more slowly ramp up, giving the liver time to meet demand? To get the CYP450 going? I was taught the 4g/day level is for healthy folks, but, as I search, I can't find anything about tolerance.

How about the N European data on staggered overdose at lower doses in the 3g per day range causing death from fulm hep.

Doubles risk of renal failure,but greatly increase risk of increased LFT's.

Increased risk does not equal certain death.

 

[Ligament]

I had a patient a few weeks ago who was using 50 ( fifty) Tylenol #1 tablets per day for her FM pain. Needless to say, she had a Hx of polysubstance abuse, and needed subtstance abuse Tx.

Her daily Acetaminophen intake = 16,250 grms / day = 400 % the toxic dose !

This is the type of population that would benefit from methadone maitenance Tx, if only to avoid fulminant hepatic failure.


Side note : Tyl #1 / with codeine is available in Canada ( 8 mg of codeine) over the counter.

LOL give her methadone and she'll STILL use 16,250 grms/ day of Acetaminophen in addition to the methadone and whatever else she can get her hands on...

 

[Apollyon]

How about the N European data on staggered overdose at lower doses in the 3g per day range causing death from fulm hep.

Doubles risk of renal failure,but greatly increase risk of increased LFT's.

Increased risk does not equal certain death.

I keep reading this, and I can't understand it.

North European data showing 3g per day causing fulminant hepatic failure. I don't know what you mean by "staggered overdose", as 3g is less than the limit in healthy adults.

In the second sentence, it is the "but" - wouldn't an "and" be better?

And then, increased risk does not equal certain death.

I am trying to put these together, and I don't get it. I am not insulting you. Can you clarify?

 

[lobelsteve]

http://updates.pain-topics.org/2011/11/beware-of-staggered-acetaminophen.html
http://www.toxicologyexpert.net/index.php/Dr.-Gustin-s-Blog/chronic-acetaminophen-toxicity.html

Tylenol can double risk of renal faiure at doses over 2500mg per day chronically.
Tylenol can cause irreversible LFT elevations.
Tylenol at 4-5 g per day for a few days can be worse than 10g in a day.

Just because the risk of death or liver failure is higher in these folks, does not guarantee that they will get liver failure or death. What we never hear about is the addicts who take 20 Lortab per day for a whole year and don't die.

SML

 

[Apollyon]

Much clearer. Thank you.

When I was in SC, I noticed the same thing, and I would say to the drug seekers that it wasn't the opiate, but the lethal dose of APAP in the Lortab that they were taking in.

That's why I wondered about ramping up cytochromes - if 15 extra strength Tylenol at once is a lethal dose, why doesn't the guy taking 20 Lortabs - 10g APAP - at one time die? As you say, we don't hear about those.

 

[ghost dog]

LOL give her methadone and she'll STILL use 16,250 grms/ day of Acetaminophen in addition to the methadone and whatever else she can get her hands on...

Wrong, my friend.

I actually took a fairly detailed substance abuse hx, and she had previously been on methadone in the past for just this reason. Of course, it's difficult to prove she had not been taking the codeine concurrently, but I doubt it considering she would be receiving considerably more opioid by way of methadone.

I believe I've made my point.

MMT makes sense from a harm reduction stand point, for a variety of reasons.

 

[Ducttape]

so did you prescribe her methadone for fibro pain?

if that were the case, whats to stop anyone presenting to you and saying "i take 20-80 tylenol #1s, i deserve to get (insert opioid du jour) so i dont get liver failure!"

(just like they think that, if they buy it off the street, i should rightly prescribe. or if their prior pain doc - who recently got their license revoked - thought it was "the only thing that will help")

this patient has issues with coping, and i would argue that any opioid is dangerous for her.

 

[ghost dog]

so did you prescribe her methadone for fibro pain?

if that were the case, whats to stop anyone presenting to you and saying "i take 20-80 tylenol #1s, i deserve to get (insert opioid du jour) so i dont get liver failure!"

(just like they think that, if they buy it off the street, i should rightly prescribe. or if their prior pain doc - who recently got their license revoked - thought it was "the only thing that will help")

this patient has issues with coping, and i would argue that any opioid is dangerous for her.

I don't think I am making myself clear.

I never prescribe potent opioids for FM mediated pain, and I don't prescribe methadone period.

This particular patient had previously been prescribed methadone ( i.e. by someone else ) for her opioid dependence issue. This was the indication for methadone in her case. I offered to refer her again for MMT for an evaluation, which she refused. I was not going to prescribe her opioids for chronic pain management, as this would be inappropriate. At her ( stated ) level of opioid consumption, the only opioid that would be appropriate would be that of MMT.

For managing opioid dependence, MMT is one Tx option in conjunction with counselling, NA, etc.

 

[Aether2000]

To clarify even further: any physician (without a DEA special license for suboxone or methadone) prescribing opioids for "opioid dependence" or for pain in a person with "opioid dependence" is endangering their license to practice medicine and their DEA license. It is very very hazardous to be prescribing opioids for pain in anyone with opioid dependence, even if they are concurrently being treated by addictionology or in a suboxone/methadone clinic. It is just too difficult to parse out the pain/dependence issues, and in these situations a person should be prescribed opioids only by a suboxone or MMT program, or not at all.

 

[Deoxyribose]

So you're going to deprive patients of the pain relief they need (and thus the ability to live their lives without being in constant agony) because some other people happen to abuse opioids? Real sensible. This is the problem with the medical system, patients often have to go through idiots like you to get the medication they need. They pay a large sum of money just to see you then they have to depend on your opinion as to whether or not they can get the medication they need.

Also, what is so shocking about someone using a drug to enhance their mental state? Many people who use drugs like opioids out of a a medical context do so because they have a mental ailment(s) and are forced to self medicate because the commonly prescribed druigs (i.e. SSRIs, SNRIs, MAOIs etc.) do not work for them.

 

[Ligament]

So you're going to deprive patients of the pain relief they need (and thus the ability to live their lives without being in constant agony) because some other people happen to abuse opioids? Real sensible. This is the problem with the medical system, patients often have to go through idiots like you to get the medication they need. They pay a large sum of money just to see you then they have to depend on your opinion as to whether or not they can get the medication they need.

Also, what is so shocking about someone using a drug to enhance their mental state? Many people who use drugs like opioids out of a a medical context do so because they have a mental ailment(s) and are forced to self medicate because the commonly prescribed druigs (i.e. SSRIs, SNRIs, MAOIs etc.) do not work for them.

We are not depriving people of the pain relief they "need," rather we are not giving them addictive narcotics when it is not appropriate for them and will cause further health decline.

You say "need" but you have no idea what you "need." That is why you see a physician. You do have an idea what you "want," which is very different than a medical indication. You "want" to get high. You "need" to be safe and get healthy.

Using opioids out of a medical context is illegal, and highly dangerous. Self medication for mental disease is also highly dangerous and should not be attempted by patients.

Therefore, as physicians, we are fully opposed to junkies like you doing this.

We all prescribe opioids for legitimate uses, none of which include treating "mental ailments," nor the desire to meet the "wants" of our patients.

 

[Aether2000]

100% agree.

 

[SSdoc33]

We are not depriving people of the pain relief they "need," rather we are not giving them addictive narcotics when it is not appropriate for them and will cause further health decline.

You say "need" but you have no idea what you "need." That is why you see a physician. You do have an idea what you "want," which is very different than a medical indication. You "want" to get high. You "need" to be safe and get healthy.

Using opioids out of a medical context is illegal, and highly dangerous. Self medication for mental disease is also highly dangerous and should not be attempted by patients.

Therefore, as physicians, we are fully opposed to junkies like you doing this.

We all prescribe opioids for legitimate uses, none of which include treating "mental ailments," nor the desire to meet the "wants" of our patients.

Great post

 

[Deoxyribose]

We are not depriving people of the pain relief they "need," rather we are not giving them addictive narcotics when it is not appropriate for them and will cause further health decline.

You say "need" but you have no idea what you "need." That is why you see a physician. You do have an idea what you "want," which is very different than a medical indication. You "want" to get high. You "need" to be safe and get healthy.

Using opioids out of a medical context is illegal, and highly dangerous. Self medication for mental disease is also highly dangerous and should not be attempted by patients.

Therefore, as physicians, we are fully opposed to junkies like you doing this.

We all prescribe opioids for legitimate uses, none of which include treating "mental ailments," nor the desire to meet the "wants" of our patients.

You clearly haven't had to live live with severe pain or you would have no qualms about using the word "need" in this case. NSAIDs do not work for severe pain. Cannabinoids, substance P antagonists and the various other classes of analgesics that I know of aren't available so people with various types of pain have very few options. I would take becoming physically dependant on a drug over living my life in pain any day. My grandmother is constantly in pain and all the doctors prescribe her are aspirin and difene. She says the difene works but the side effects (such as stomach aches) outweigh the benefits.

You're clearly just another ignorant, box thinking medical practioner who is only capable of parroting off the things memorised in medical school rather than actually thinking logically about matters. I'm not a junkie, I don't use any drugs, I don't even drink coffee. I'm a chemistry student but I'm thinking of going to medical school after this degree and becoming a doctor because the world needs more doctors who are capable of thinking outside the box rather than blindly conforming to the consensus which is clearly profoundly flawed. Every doctor I have met so far seems to be incapable of thinking pharmacologically, but rather they only think in terms of what is commonly prescribed for what.

Since doctors don't help them, patients are willing to take the risks and attempt to self medicate and they should have the right to do so. You ignorant doctors assume the patients don't have the mental capabilities to find solutions for their own problems, solutions that actually work for them, as opposed to "solutions" that doctors think should work for them because its what they learned in medical school. You obviously have a very limited understanding of opioids. Using opioids out of a medical context isn't really that dangerous. Without considering drug interactions (i.e. serotonin syndrome in patients on SSRIs, additive sedation of patients on anxiolytics etc.), the main danger is risk of overdose which is something any semi intelligent individual should be able to avoid. IMO anyone who uses opioids (whether prescribed or not) should keep some naloxone nearby in case of emergency.

You say prescribing them for mental ailments is not a legitimate purpose. This is exactly what I mean by box thinking and the sheep/herd mentality. It doesn't matter to you what works and doesn't work, all that matters to you is whether something is commonly accepted. In other words, whether the rest of the herd is in accord with it. Cannabinoids aren't a medically accepted analgesic but that doesn't change the fact that they are safer and more effective than any of the analgesics commonly prescribed today. When I fractured my scaphoid, they had to operate and put pins in to hold the bones in place. They prescribed me dilaudid (hydromorphone) and it did absolutely nothing for me. It may work as an analgesic for others but it had absolutely no effect on me so I stopped taking it. I was in constant pain then a friend offered me some cannabis so I accepted his offer. The pain completely abated. This is an example of different people having different neurophysiology and consequently, benefitting from different substances. Opioids might work as analgesics for most people but not all people. Similarly SSRIs might work as antidepressants for some people but not all people.

 

[Ducttape]

Also agree with ligament.


One of a physician's "prime directives" is to do no harm. its part of the hippocratic oath we all take.
"I will prescribe regimens for the good of my patients according to my ability and my judgment and never do harm to anyone... I will neither give a deadly drug to anybody who asked for it, nor will I make a suggestion to this effect."

chronic pain patients dont "need" opioids. if the benefits of opioids outweigh the risks - to the patient, their family and society, then a physician may consider prescribing them.


and btw, the vast majority of pain patients are not paying a large sum of money. you are clearly thinking of pill mills.

the reason we are in a prescription abuse epidemic now is because of what you are saying.

it is estimated that opioid overdose is the leading cause of non-natural cause of death. these are exactly the people who you say are and have the right to selfmedicate.

 

[Aether2000]

Opioids ARE used outside of a medical context at least in 35% of those prescribed the drug. Over 50% of those that overdose and die from opioids are due to stupid people that get drugs for free from so called "friends", and believe opioids are ok for non-medical usage. No one has a right to opioids for any reason whatsoever, even for terminal cancer pain, if they cannot control their use of the prescription opioids in a prescribed manner, if they give away drugs, sell the drugs. Physicians absolutely cannot and will not permit themselves to be agents of death for those that lack control over their use of the drugs. There are 20,000 people overdosing and dying every year from prescription opioids....that is an entire moderate size city wiped out every year because of drug abuse. We will take whatever steps we feel is necessary to protect the public from themselves, even if it perceived as torture by the ignorant that care only about themselves and don't give a damn about the 20,000 per year that meet their demise due to opioids.

 

[emd123]

You clearly haven't had to live live with severe pain or you would have no qualms about using the word "need" in this case. NSAIDs do not work for severe pain. Cannabinoids, substance P antagonists and the various other classes of analgesics that I know of aren't available so people with various types of pain have very few options. I would take becoming physically dependant on a drug over living my life in pain any day. My grandmother is constantly in pain and all the doctors prescribe her are aspirin and difene. She says the difene works but the side effects (such as stomach aches) outweigh the benefits.

You're clearly just another ignorant, box thinking medical practioner who is only capable of parroting off the things memorised in medical school rather than actually thinking logically about matters. I'm not a junkie, I don't use any drugs, I don't even drink coffee. I'm a chemistry student but I'm thinking of going to medical school after this degree and becoming a doctor because the world needs more doctors who are capable of thinking outside the box rather than blindly conforming to the consensus which is clearly profoundly flawed. Every doctor I have met so far seems to be incapable of thinking pharmacologically, but rather they only think in terms of what is commonly prescribed for what.

Since doctors don't help them, patients are willing to take the risks and attempt to self medicate and they should have the right to do so. You ignorant doctors assume the patients don't have the mental capabilities to find solutions for their own problems, solutions that actually work for them, as opposed to "solutions" that doctors think should work for them because its what they learned in medical school. You obviously have a very limited understanding of opioids. Using opioids out of a medical context isn't really that dangerous. Without considering drug interactions (i.e. serotonin syndrome in patients on SSRIs, additive sedation of patients on anxiolytics etc.), the main danger is risk of overdose which is something any semi intelligent individual should be able to avoid. IMO anyone who uses opioids (whether prescribed or not) should keep some naloxone nearby in case of emergency.

You say prescribing them for mental ailments is not a legitimate purpose. This is exactly what I mean by box thinking and the sheep/herd mentality. It doesn't matter to you what works and doesn't work, all that matters to you is whether something is commonly accepted. In other words, whether the rest of the herd is in accord with it. Cannabinoids aren't a medically accepted analgesic but that doesn't change the fact that they are safer and more effective than any of the analgesics commonly prescribed today. When I fractured my scaphoid, they had to operate and put pins in to hold the bones in place. They prescribed me dilaudid (hydromorphone) and it did absolutely nothing for me. It may work as an analgesic for others but it had absolutely no effect on me so I stopped taking it. I was in constant pain then a friend offered me some cannabis so I accepted his offer. The pain completely abated. This is an example of different people having different neurophysiology and consequently, benefitting from different substances. Opioids might work as analgesics for most people but not all people. Similarly SSRIs might work as antidepressants for some people but not all people.

1-If self prescribed cannabis "eliminates all your pain" then you don't need a pain doctor. So I don't know why you would waste your time with one. We can't achieve what you apparantley can achieve (100% pain cure.)

2-We have the authority to prescribe controlled substances only at the pleasure of the DEA. We don't write the rules. The DEA has made it clear that those that "think outside the box" and refuse to follow the rules as you suggest, lose their licenses, go bankrupt and may go to jail for drug trafficking.

To expect us to "think outside the box" at those risks, is just frankly so stupid, I really shouldn't have even responded to this post.

 

[Ligament]

All your posts thus far have clarified one thing:

1. If you become a physician, you will kill a lot of patients if you continue your current thinking of "give 'em what they want"
2. There is no quality literature on the use of Cannibinoids for chronic pain
3. Marijuana is federally illegal so you cannot give it to yourself nor to your presumed future patients
4. You say you don't use any drugs yet have admitted to doing so when taking your friends illegal marijuana
5. You have zero medical experience and to claim "Using opioids out of a medical context isn't really that dangerous" is outright insane and proves how naive you are. Wait till your first night in the ER as a med student and you are running a code on a couple opioid overdoses per night on the weekends.

There is a massive, massive, difference between your perception of pain care and the realities that we see, all of us having had at a minimum 13 years of training doing this.

 

[Deoxyribose]

Also agree with ligament.


One of a physician's "prime directives" is to do no harm. its part of the hippocratic oath we all take.
"I will prescribe regimens for the good of my patients according to my ability and my judgment and never do harm to anyone... I will neither give a deadly drug to anybody who asked for it, nor will I make a suggestion to this effect."

For people sworn to that oath, you cause quite a lot of harm to patients. In the US, doctors often have no problem prescribing benzodiazepines and SSRIs and consequently, cause long term harm to the patient.

chronic pain patients dont "need" opioids. if the benefits of opioids outweigh the risks - to the patient, their family and society, then a physician may consider prescribing them.

If the pain interferes with their ability to live, then yeah they need analgesics. Only the patient knows whether the benefits outweigh the risks, but good luck to them convincing a doctor that they do.

and btw, the vast majority of pain patients are not paying a large sum of money. you are clearly thinking of pill mills.

In my country it costs €50 to see a doctor.

it is estimated that opioid overdose is the leading cause of non-natural cause of death. these are exactly the people who you say are and have the right to selfmedicate.

lol, where are you getting these estimates from?

1-If self prescribed cannabis "eliminates all your pain" then you don't need a pain doctor. So I don't know why you would waste your time with one. We can't achieve what you apparantley can achieve (100% pain cure.)

2-We have the authority to prescribe controlled substances only at the pleasure of the DEA. We don't write the rules. The DEA has made it clear that those that "think outside the box" and refuse to follow the rules as you suggest, lose their licenses, go bankrupt and may go to jail for drug trafficking.

To expect us to "think outside the box" at those risks, is just frankly so stupid, I really shouldn't have even responded to this post.

Well, I don't have a problem with chronic pain so I'm not looking for a pain doctor. I agree with you on your second point. Its unfortunate that Americans have to follow the rules set in place by a silly prohibition enforcing organisation organisation like the DEA. When I started this thread, I was disagreeing with the attitude of the OP.

Physicians absolutely cannot and will not permit themselves to be agents of death for those that lack control over their use of the drugs. There are 20,000 people overdosing and dying every year from prescription opioids....that is an entire moderate size city wiped out every year because of drug abuse. We will take whatever steps we feel is necessary to protect the public from themselves, even if it perceived as torture by the ignorant that care only about themselves and don't give a damn about the 20,000 per year that meet their demise due to opioids.

Instead, they'll be agents of slow and painful death by prescribing them NSAIDs and for mental ailments, SSRIs, TCAs, atypical antipsychotics etc. Just as long as the patient doesn't feel good in the process. The thought of a patient experiencing a better mental state just makes me sick. Its clearly you thats the ignorant one here. If people choose to take risks, its their choice to do so, not yours. One day this whole corrupt system will come down and people will no longer have to go through arrogant doctors such as yourself. The fact that you believe you have the right to decide whats best for everyone else is a clear indication of your arrogance.

 

[lobelsteve]

End scene.