Posted on 10/19/2003 2:08:48 AM PDT by Cincinatus' Wife
Someone send this guy a pair of Birkenstocks, a foxhole conversion is under way.
Beyond the damage Limbaugh has done to his highly burnished conservative credentials, his sensational fall has added to the woes of another group: those in chronic pain who rely on OxyContin to relieve their torment. This kind of adverse publicity will only make it harder for patients to get access to the pain medication they need.
As chair of the Department of Pain Medicine at Presbyterian Hospital in Charlotte, N.C., and past president of the American Academy of Pain Medicine, Dr. Gerald Aronoff has seen the way hysterical news accounts of OxyContin as the "new crack" have resulted in more limited access. He says every high-profile story about how OxyContin or other pain medication has addicted some public figure makes physicians even more skittish about prescribing what is needed to control very real pain.
"My legitimate chronic pain patients don't have medical problems related to OxyContin. They get therapeutic benefit from these medications," Aronoff says. "The people who are using it to get high are not taking the medication as it was meant to be taken based on the pharmaceutical recommendations."
But doctors who prescribe heavy doses of OxyContin to a large number of patients risk drawing the attention of the Drug Enforcement Administration and state medical boards. For patients, this means doctors are less ready to provide them relief.
Skip Baker, a longtime pain activist, says he has heard from thousands of pain patients who couldn't find a physician willing to prescribe OxyContin in the needed doses. According to Baker, his own doctor "quit treating pain patients entirely" due to his fear over potential law enforcement action.
But OxyContin is not some evil chemical street brew. It was brought to market by Purdue Pharma in 1995 and is a synthetic opioid, just like Percocet and Percodan, except it is time-released over 12 hours. The long-term relief allows many patients with otherwise debilitating pain to return to almost normal functioning. For many, it is life-changing.
Abuses occur when people defeat the time-release by chewing the tablets or through injection, resulting in what is described as a heroinlike high.
Last year, Florida doctor James Graves became the first physician in the nation to be convicted of manslaughter for prescribing the drug. He was given a 63-year prison sentence after four of his patients died from overdosing on OxyContin. He argued that his patients would not have died had they taken the medication as prescribed. But prosecutors said his practice was really just a front for drug dealing.
The particulars of Graves' case aside, to my mind, prosecuting doctors when their patients overdose is like jailing gun dealers when a firearm they sold is used to kill someone. The culpability is misplaced. Individuals have personal responsibility for what they ingest, not the doctor who supplied a lawful product to someone who claimed to be ailing.
It is one thing if a doctor's office is truly a glorified drug market. It is quite another when a doctor is being lied to by a handful of his or her patients about the level of pain being experienced and whether the drugs they get are being used as prescribed. No doctor should automatically fall under suspicion in those circumstances, even when overdose deaths occur.
Here, the story of a Virginia pain specialist, Dr. William Hurwitz, comes to mind. Hurwitz was hounded out of medicine by the nation's drug warriors. In 1996, his medical license was suspended after the DEA accused him of overprescribing OxyContin. Only after dozens of patients and pain experts rallied to his defense was it reinstated. But Hurwitz nonetheless left his practice last year. Again he found he was being investigated by the DEA.
In his goodbye letter to patients and colleagues he wrote about the trend in prosecuting pain doctors: "I have discovered that neither the honesty nor the competence of the physician is any substantial protection against prosecution, as the investigating and prosecuting officials neither know or care about the accepted principles of treatment for chronic intractable pain."
Reputable physicians need some kind of safe harbor from this kind of harassment. Limbaugh may not have known when to say when, but that shouldn't condemn thousands of others with debilitating pain to a life of suffering because doctors are too scared of the DEA to minister properly.
Once again, the conservatives get blamed for anything that goes wrong, askew, or odd. Poor Rush, he didn't realize he was hurting doctors, too. /sarcasm
What, pray tell, is the criterion by which a doctor knows that the patient is treating something other than the pain which originally presented the patient to him? Seems like the patient is in pain, at least in some sense, either way. Looks like we need another model.Maybe loss of privacy--certainly Rush has no privacy on this issue now--should be considered the firs line of defense. Yes you can get the pills, but you have to wear a scarlet letter on your chest saying how much controlled substance you are taking. Just an idea, but it appears we need to do something different . . .
I have been taking Oxycontin for 5 years. I have severe pain in my lower back and neck due to disc degenerative disease or arthritis. I take 2, 40mg a day. I have never crushed or bitten the pills.
I am sure my body is physically dependent on the Oxy's, but not what I would say addicted. If, I had to take enough Lortabs to get the same amount of pain relief as the Oxy's give me, I probably couldn't continue to work or drive a vehicle.
Oxycontin is really a miracle drug for patients that don't abuse it and really need long term pain medication.
You can easily test by doing a drug screen on the patient if you suspect he is getting the drugs simply to re-sell on the street. It is amazing how many test negative.
several clues. They manipulate. They insist "only " oxycontin or lortabs relieve their pain, but then don't go to physical therapy, or take the non narcotic medicines we give (to treat depression/ muscle spasm, NSAIDS for anti inflammatory), and they "double dip"...see different doctors. Often they appear intoxicated when they come in. Their X Rays and physical findings dont' suggest pain..
Pain Management Vs. Addiction
Gerald M. Aronoff, M.D., DABPM, FAADEP, the medical director of the North American Pain and Disability Group in Charlotte,N.C., offered perhaps one of the more basic distinctions. A person's functioning improves with successful pain relief, he told Psychopharmacology Update. When the line is crossed to addiction, functioning is not enhanced; it suffers, he said. An April advisory on Oxycontin from the Center for Substance Abuse Treatment(CSAT) -- the government's first breaking-news advisory for treatment professionals -- also weighs in on the distinction.
"Addiction is characterized by the repeated, compulsive use of a sub-stance despite adverse social, psychologic and/or physical consequences. Addiction is often (but not always) accompanied by physical dependence, withdrawal syndrome and tolerance."
Since opioid analgesics often cause sleepiness, calmness and constipation, withdrawal often involves insomnia, anxiety and diarrhea.
"Research sponsored by the National Institute on Drug Abuse has found that most patients on prescribed opioids will not become addicted. But they may become dependent on the narcotic, and will require a qualified physician for withdrawal.
"For these patients, gradually decreasing the medication dose over time "brings the former pain patient to a drug-free state without any craving for repeated doses, "according to CSAT. The addict, though, "continues to have a severe and uncontrollable craving that almost always leads to eventual relapse in the absence of adequate treatment," the advisory states."
You always seem to undermine your credibility by saying the dopiest things. Please post your sources as to what constitutes a MAJOR culture. Seems to me Rush's situation has brought out far more closet opiate users who are using for chronic situations than the salacious "druggies" that you refer to.
Your use of the term "druggies" is as moronic as when Tom Clancy used that term in Near and Present Danger.
Just at the time when all clinicians are needed to calm down the hysterical REEFER MADNESS foam at the mouth types, you join in with your silly rants.
What damage?
The only damage I see is that blowhards like the Swimmer will get a free ride for a month or two.
ML/NJ
The Media and all others that have absolutely no clear facts will go on an on until it is removed from the pharmacies.
Those that have written about the Rush/OxyContin abuse are spouting nothing but guesses/theory and using it to beat a dead horse to death.
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