Fox News: Pain Patients Driven to Despair and Suicide

[drusso]

Is this "fake news?"

As doctors taper or end opioid prescriptions, many patients driven to despair, suicide

"Many pain patients say they understand the urgent need of political leaders and government agencies to fight the drug overdose epidemic. But targeting the millions who legitimately suffer from chronic pain is grasping for a solution that doesn’t address the preponderance of illegal drugs, they argue - or the rate of overdoses caused by them."

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[TheLoneWolf]

Having patient dictate their care against the physicians wishes and concerns under threat of suicide is unwise. A dictum that falls flat to most patients. No psychiatrists would keep a patient who forces their care upon them, they would simply form them for inpatient care.

I feel terrible at the loss of this patients life though as above, perhaps a referral to inpatient detox and rehab would have been better. Perhaps we should be able to form patients for substance rehab.

Pushing complex medical decision making on the public for their input is not good. What can they contribute other than empathy for the patient when we are both empathetic and legally charged with their care.

Fake news.

Same as the AP article on SCS dangers.

 

[Ducttape]

so far, I have read 4 articles written about suicides after forced opioid taper.

all of them included the story of this 1 person, Jay Lawrence. and that was the headline story in each of them.

as soon as I saw his name, I knew further along in the article would be comments and discussions by 1 Doctor Stefan Kertesz. an addiction doctor who works at the #1 highest opioid prescribing VA in the country, who prescribed zero prescriptions to Medicare/Medicaid in the last 5 years.

its the same story written over and over again.

 

[244913]

Multiple studies out there showing higher suicide risk for patients on chronic opioids.

Tapering saves lives. Throw more $$$ at addiction and detox so these people have something to break their fall.

 

[Orin]

This is a real thing

Chronic Pain Among Suicide Decedents, 2003 to 2014 | Annals of Internal Medicine | American College of Physicians

In the last year, I've seen it once so far that I'm aware of in my patients, not even in a forced taper scenario. I was trying to get the patient screened prior to replacing an implant, and they decided it was too onerous and opted to OD on pills.

 

[lobelsteve]

This is a real thing

Chronic Pain Among Suicide Decedents, 2003 to 2014 | Annals of Internal Medicine | American College of Physicians

In the last year, I've seen it once so far that I'm aware of in my patients, not even in a forced taper scenario. I was trying to get the patient screened prior to replacing an implant, and they decided it was too onerous and opted to OD on pills.

Just think if they OD'd on post-op meds after device swap?

 

[Aether2000]

It is now far beyond the point of whether the risk of suicide in patients being tapered from opioids matters. Their government has deemed any overdose of a patient being prescribed opioids by any doctor for chronic non-malignant pain as a criminal felony by the physician worthy of prison. We did not spend nearly a decade in training to have some accidental or non-accidental overdose destroy our lives and land us in prison. Suicide by withdrawing patients is just an unfortunate casualty in the war on physicians.

 

[emd123]

Is this "fake news?"

As doctors taper or end opioid prescriptions, many patients driven to despair, suicide

"Many pain patients say they understand the urgent need of political leaders and government agencies to fight the drug overdose epidemic. But targeting the millions who legitimately suffer from chronic pain is grasping for a solution that doesn’t address the preponderance of illegal drugs, they argue - or the rate of overdoses caused by them."

The ultimate in manipulation for pills is to threaten suicide if you don't get them.

 

[Mad Jack]

Having patient dictate their care against the physicians wishes and concerns under threat of suicide is unwise. A dictum that falls flat to most patients. No psychiatrists would keep a patient who forces their care upon them, they would simply form them for inpatient care.

I feel terrible at the loss of this patients life though as above, perhaps a referral to inpatient detox and rehab would have been better. Perhaps we should be able to form patients for substance rehab.

Pushing complex medical decision making on the public for their input is not good. What can they contribute other than empathy for the patient when we are both empathetic and legally charged with their care.

Fake news.

Same as the AP article on SCS dangers.

Many doctors are being pressured to prescribe in a way that does not fit with the manner in which they would prefer and is rather driven by politicians who do not practice medicine dictating what they believe the public needs. While most patients do not need chronic opioids, there is a significant subset that do and whom cannot reasonably function without them. States such as Oregon, which are looking to ban chronic opioid treatment entirely are choosing to turn their backs on these patients and their doctors for the sake of "the greater good"

 

[TheLoneWolf]

No physician can be forced to write anything for any patient, especially the scheduled substances. If a business model is "pills for shots" then that's on the physician and the employment they chose. Coerced by the patient? Let's make this clear, no one is being forced to write for opiates at gunpoint.

 

[emd123]

No physician can be forced to write anything for any patient, especially the scheduled substances. If a business model is "pills for shots" then that's on the physician and the employment they chose. Coerced by the patient? Let's make this clear, no one is being forced to write for opiates at gunpoint.

Guns or not, attempted coercion by patients is rampant. It absolutely is. Maybe not by physical force, but usually by intimidation. I agree that it's our job to resists that and that you are complicit when you cave and go along with it out of mental weakness, laziness or for profit. But there absolutely is rampant attempted coercion by patients to get opiates.

 

[Ducttape]

Many doctors are being pressured to prescribe in a way that does not fit with the manner in which they would prefer and is rather driven by politicians who do not practice medicine dictating what they believe the public needs. While most patients do not need chronic opioids, there is a significant subset that do and whom cannot reasonably function without them. States such as Oregon, which are looking to ban chronic opioid treatment entirely are choosing to turn their backs on these patients and their doctors for the sake of "the greater good"

please post documentation and give examples of patients that do need chronic opioids.

I have yet to see a genetic mu receptor agonist deficiency syndrome. you and the patient may think that they need chronic narcotics. that is different from physically needing chronic narcotics.

 

[Mad Jack]

please post documentation and give examples of patients that do need chronic opioids.

I have yet to see a genetic mu receptor agonist deficiency syndrome. you and the patient may think that they need chronic narcotics. that is different from physically needing chronic narcotics.

A patient with a severe genetic condition that had left her with 22 spinal surgeries, paralysis, and 10/10 pain constantly comes to mind- we are talking screaming levels of pain that were brought down to just barely manageable on opioids to the point that she wouldn't kill herself. Opioids are the only humane treatment we have for someone like her, where unbearable pain is her reality and she will most assuredly kill herself without treatment because she is in blinding pain the likes of which you and I should hope we never have to experience

 

[SommeRiver]

For anyone to say that opiates play no role in chronic pain management of certain individuals is to label his or herself a fool.

Whether someone NEEDS a 5/325mg Norco QD/BID isn't the question...Tje question is whether or not that little touch of Norco adds an objective benefit to their life, which I see here and there. I have ppl that CLEARLY benefit from chronic opiate therapy. Individuals, not populations of pts.

You have a 72 yo with severe stenosis and multilevel facet disease who simply can't have an L2-S1 fusion, they do well with intermittent epidurals and ablations but still go through life with moderately severe pain, I see no reason why an occasional Norco is wrong.

You just monitor it and take that Rx seriously and don't do anything stupid. There are rules in place for this stuff. Follow them...

 

[drusso]

Part II...

Doctors caught between struggling opioid patients and crackdown on prescriptions

Not only is the government legislating the way we care for chronic pain patients, they are substantially taking away our ability to do it.

— Dr. Steve Nadeau, a professor of neurology at the University of Florida College of Medicine

 

[Ducttape]

my exposition was not about whether there is a role of opioids in chronic pain. opioid use to improve and maintain high levels of functioning and quality of life is beneficial and indicated.

my argument is against the belief that opioids are the only solution.

A patient with a severe genetic condition that had left her with 22 spinal surgeries, paralysis, and 10/10 pain constantly comes to mind- we are talking screaming levels of pain that were brought down to just barely manageable on opioids to the point that she wouldn't kill herself. Opioids are the only humane treatment we have for someone like her, where unbearable pain is her reality and she will most assuredly kill herself without treatment because she is in blinding pain the likes of which you and I should hope we never have to experience

it means that you have bought the "candy" espoused by the prior generation of pain docs paid off by big pharma.

suppose I told you about a case of a patient that had a gunshot wound to his spine, shattering L3, transecting the cord completely, then somehow migrating up 2 levels above so that it is causing severe stenosis at that upper level. who refused tramadol because it was a narcotic.

or the heroin addict who is suffering from pain exactly as your patient describes, but it is due to addiction and overdrive of the same mu receptors as your example.


pain is subjective. your case draws my sympathy because clearly her providers see no alternative but doping up their patient to the point of unconsciousness.

 

[Mad Jack]

my exposition was not about whether there is a role of opioids in chronic pain. opioid use to improve and maintain high levels of functioning and quality of life is beneficial and indicated.

my argument is against the belief that opioids are the only solution.

it means that you have bought the "candy" espoused by the prior generation of pain docs paid off by big pharma.

suppose I told you about a case of a patient that had a gunshot wound to his spine, shattering L3, transecting the cord completely, then somehow migrating up 2 levels above so that it is causing severe stenosis at that upper level. who refused tramadol because it was a narcotic.

or the heroin addict who is suffering from pain exactly as your patient describes, but it is due to addiction and overdrive of the same mu receptors as your example.


pain is subjective. your case draws my sympathy because clearly her providers see no alternative but doping up their patient to the point of unconsciousness.

I am a harsh critic of opioid use, but I recognize that for a certain subset of patients, it is the best option we have. You can opine all you like about oh but it is subjective oh but there are other options, but for some people, this is the option that brings them the most relief with the least functional impairment.

 

[SommeRiver]

I am a harsh critic of opioid use, but I recognize that for a certain subset of patients, it is the best option we have. You can opine all you like about oh but it is subjective oh but there are other options, but for some people, this is the option that brings them the most relief with the least functional impairment.

Yes. To say otherwise is insane.

 

[Aether2000]

Opioids not only cause functional impairment, they cause neuronal cell death in the dorsal horn, the cortex, and the amygdala. Is this really the "best option we have" for people- killing their brain and spinal cord cells?

 

[Timeoutofmind]

For anyone to say that opiates play no role in chronic pain management of certain individuals is to label his or herself a fool.

Whether someone NEEDS a 5/325mg Norco QD/BID isn't the question...Tje question is whether or not that little touch of Norco adds an objective benefit to their life, which I see here and there. I have ppl that CLEARLY benefit from chronic opiate therapy. Individuals, not populations of pts.

You have a 72 yo with severe stenosis and multilevel facet disease who simply can't have an L2-S1 fusion, they do well with intermittent epidurals and ablations but still go through life with moderately severe pain, I see no reason why an occasional Norco is wrong.

You just monitor it and take that Rx seriously and don't do anything stupid. There are rules in place for this stuff. Follow them...

What you need to acknowledge if you are taking this approach is:

1. There are no medical studies showing long term benefit of opioids
2. There are many studies showing they do not work or make pain worse, including a large recently published RCT (SPACE)
3. There are many studies showing weaning does not result in worsening pain or disability
4. They have a plethora of negative physiologic effects, especially on the immune, endocrine, and psychiatric systems
5. They are highly addictive, highly misused, and a choice drug of abuse for many Americans
6. Americans are consuming an enormous and disproportionate percentage of the world's prescribed opioids
7. They interact with many other drugs in a dangerous way
8. Patients may not be a reliable judge of if the opioids are helping them due to subconscious bias because these drugs are euphoric, and also because dysphoria results during subclinical withdrawal with regular dosing
9. Physicians have a financial incentive to prescribe opioids in order to grease the wheels of their practice, and many have faced criminal action for such activities taken to the extreme

If you are clearly informing the patient of all of this information, and documenting this, than I dont have a problem with your approach

But in my opinion, any drug with the above issues is basically the medical definition of CONTRAINDICATED

 

[emd123]

Opioids not only cause functional impairment, they cause neuronal cell death in the dorsal horn, the cortex, and the amygdala. Is this really the "best option we have" for people- killing their brain and spinal cord cells?

True. However, according to your government, they are "A OK per FDA" and have "legitimate medical use." Seems 50,000 deaths per year would getcha banned, but nope. "Bad doctor." "Bad patient." is their game plan, and they're running with it.

If opiates were banned that would take the blame off the doctors and entirely put it on the Federal government to enforce their drug ban. And they know they can't and will fail and then will have no one to blame. So, the path of least resistance for them is to keep them legal and continue to let massive amounts of fentanyl come through US mail from China, both of which amount to de facto legalization, so they have an easy scapegoat to blame for the carnage, people in white coats.

 

[TheLoneWolf]

Anyone every read an opioid product insert. It's just pages and pages of contraindications, warnings, and is just short of saying "this will probably kill you in the short or long term". It would be prudent to have every patient read and sign the product insert of his meds.

 

[lonelobo]

Anyone every read an opioid product insert. It's just pages and pages of contraindications, warnings, and is just short of saying "this will probably kill you in the short or long term". It would be prudent to have every patient read and sign the product insert of his meds.

Your patients can read?
About 50% of mine I think are questionable in that category

 

[Ducttape]

Every physician has to decide at what point a drug does harm over perceived good. The “do no harm0 adage.

Unfortunately once a doctor gives a patient an opioid, and the patient takes it for long enough, the treatment may be as much for the underlying condition as it is for side effects from the drug (dependence).

We kid and trick ourselves in to believing otherwise, and tell patients “don’t worry it’s safe and effective “ or “you will have to be on these drugs for the rest of your life”. Both of these statements are fallacies.

 

[TheLoneWolf]

Your patients can read?
About 50% of mine I think are questionable in that category

Is there a billing code for interprative dance?

 

[drusso]

Part III:

Health experts offer solutions for unintended consequences of opioid crackdown

"The root of the problem, according to dozens of pain patients, doctors, scholars, and others who spoke to Fox News for this story, are the Centers for Disease Control and Prevention (CDC) guidelines for opioid prescribing that were issued in 2016. While the guidelines are credited with focusing attention on prescribing practices, critics say they’ve been adopted by too many as hard and fast rules that must be enforced across the board, rather than serve their intended advisory purposes."

 

[emd123]

Part III:

Health experts offer solutions for unintended consequences of opioid crackdown

"The root of the problem, according to dozens of pain patients, doctors, scholars, and others who spoke to Fox News for this story, are the Centers for Disease Control and Prevention (CDC) guidelines for opioid prescribing that were issued in 2016. While the guidelines are credited with focusing attention on prescribing practices, critics say they’ve been adopted by too many as hard and fast rules that must be enforced across the board, rather than serve their intended advisory purposes."

The Feds are now mad at us for following their rules too well. Heh. You can't make this stuff up.

 

[drpainfree]

Part II...

Doctors caught between struggling opioid patients and crackdown on prescriptions

Not only is the government legislating the way we care for chronic pain patients, they are substantially taking away our ability to do it.

— Dr. Steve Nadeau, a professor of neurology at the University of Florida College of Medicine

My comment on this, neurologist should stay away from opioid meds, and stay focused on TCA, neuroleptics, etc.

 

[drpainfree]

A patient with a severe genetic condition that had left her with 22 spinal surgeries, paralysis, and 10/10 pain constantly comes to mind- we are talking screaming levels of pain that were brought down to just barely manageable on opioids to the point that she wouldn't kill herself. Opioids are the only humane treatment we have for someone like her, where unbearable pain is her reality and she will most assuredly kill herself without treatment because she is in blinding pain the likes of which you and I should hope we never have to experience

why not IT pump instead of oral opioids?

 

[callmeanesthesia]

why not IT pump instead of oral opioids?

Why not just send her for a cingulotomy?

 

[Mad Jack]

why not IT pump instead of oral opioids?

This is fine too