See also:
FDA rewrites opioid narcotic labels to tighten use for pain (LA Times
Goal of Label Changes: Better Prescribing, Safer Use of Opioids (FDA update)
You wouldn’t believe all of the precautions I have to take in order to prescribe opiates to patients with chronic pain. The over-riding concern I have is maintaining my license and DEA number. Therefore, I do urine drug testing on each visit, frequently check the state court site for drug crimes, check the state database for doctor shoppers, and have patients sign paperwork holding me harmless for side effects/death. On each visit, patients must sign that they are not under investigation for drug and drug related crimes, and that they have not gone to another doctor for narcotics for chronic pain. I have camera surveillance for the public areas (we have observed non-patient individuals asking patients about their prescriptions in the office) and an armed security guard (very helpful for discharges).
I order to stay in practice, because of the DEA, I must consider that any patient could become an informant for the DEA. I must also profile new patients to determine whether they could an agent on a sting.
We have had patients bringing in urine in condoms, or trying to get their child to produce urine for them in the bathroom. We have had tandem teams come in with one person going to the bathroom and leaving urine for the patient who comes in next. We have patients shaving in opioid to test positive on the rapid screen to prove that they are taking the medications. We have had a patient use their cell phone to record activity in the clinic. (this patient told me this, so we don’t allow cell phones in the exam rooms) Nothing surprises me now.
“Did you really think we want those laws observed?” said Dr. Ferris. “We want them to be broken. You’d better get it straight that it’s not a bunch of boy scouts you’re up against... We’re after power and we mean it... There’s no way to rule innocent men. The only power any government has is the power to crack down on criminals. Well, when there aren’t enough criminals one makes them. One declares so many things to be a crime that it becomes impossible for men to live without breaking laws. Who wants a nation of law-abiding citizens? What’s there in that for anyone? But just pass the kind of laws that can neither be observed nor enforced or objectively interpreted – and you create a nation of law-breakers – and then you cash in on guilt. Now that’s the system, Mr. Reardon, that’s the game, and once you understand it, you’ll be much easier to deal with.”
- Ayn Rand, 1957 -
I was chatting with my older brother the other night and he told me he was doing a property insurance inspection at a liquor store that is near several large retirement communities near the NJ shore and while he was there he noticed quite a few elderly folks buying whiskey and brandy. The owner of the liquor store told him that business has definitely increased among the older folks, a lot more elderly folks coming than ever before. When my brother asked him why that was; the liquor store owner said that a number of them told him that they couldn’t get their pain medications anymore so they pop several aspirins and wash it down with some booze in order to get some pain relief.