Why is it that all of the research on chronic opiate use is ignored? Time and time again, it is shown that chronic opiate use for non-cancer pain has very poor efficacy and massively high morbidity/mortality. For those of you who always fall back on the argument of "why do you want to see these people in pain, don't you care?" have really fallen into the trap of kicking the can down the road.
If you were a parent and your child was addicted to cocaine and one day came to you to ask you for money to buy more because he/she does not have a job/is a loser, would you give them the money? Ok most people would say no to this, but how about the child that is just lazy, comes to you begging for money because they "need" a car to get to work, would you give it to them? Pain management is exactly the same thing, if there is a massive bump in the road (surgery, broken bone etc) give what is needed to get over that hump, but you don't keep feeding the problem a person's entire life until you have created an empty shell of a human being.
I'm not saying this because you're wrong, you're right. But you have to pick and choose your fights if you are going to remain in practice. As a prescriber, what are you going to do with a patient that you have your 15 minute CPT ratio that you have to clear? Sure, treat them with the standard factory algorithm, then ship the uncontrolled off to "pain specialists" who some of them blithely ignore the research for all the wrong reasons and all the right reasons together.
The situation you define as a parent is one where there is a relationship beyond the transactional one between pharmacist and patient/customer. So, yes, you're supposed to intervene, not just because you're a pharmacist, but as a responsible parent, you have certain responsibilities. But which ones cause you to act in your child's case, your responsibility to the profession or patient, or your responsibility as a parent, or as a human being? All three can apply, so it's probably going to be heartless not to intervene.
But, there's limits. For every felon in prison, they did have a mother and a father, and not all of those felons came from broken homes. Some of them came from people like you and me, and it's not always irresponsible parenting that causes it as well. You raise your children with the hope that they turn out to be respectable citizens, but implicit in the freedom of adulthood is a choice to go down the wrong roads. Yes, we do have the responsibility of doing what we can even to the point of self-harm, but there's such a situation as not salvageable.
This pharmacy dean had a problem with this choice:
Dad unfit for trial on charges of aiding fugitive killer son – Twin Cities
Anoka County / Mother of fugitive will avoid jail – Twin Cities
Doesn't matter how good you are, and it doesn't matter how bad your child is, there are conflicting expectations on what is the responsible conduct in these situations. In Larry and Dee Weaver's case, what does career success mean if your children don't become useful? What use are you to the people you care about if you sink all of your time in people who couldn't care less about you or anyone as that's what addiction is really about. Better than sex, and better than life, how are you really going to argue with that in the end? And while some are treatable, it should not be at the expense of your own well-being. You owe too many people that deserve your care more to overpriortize these patients.
But patients? Sure, there is a responsibility to do the right thing for each patient. However, that does conflict with your greater responsibilities to make sure that your co-workers aren't stressed out due to you (think of the pharmacists who take forever to verify causing the rest of the staff to have to run around to make up for the slowpoke) and your responsibilities to your own sanity and relationships with people that are not transactional in nature, so you really have realistic limitations on what you can do for a patient clearly screwed by the system or by themselves.
While trying to care, it's that choosing of if and when to intervene for actual effectiveness and results that separates new practitioners and midcareer. I am not a junior social worker, there are risks and benefits that you have to consider and the ability to have perspective on the ones that you want to fulfill gives the focus to do the best good. It's those who try to be all things to all people who tend to end up falling apart as the little things catch up with them.
