"Hillbilly Heroin???"

[BonnyW]

Originally Posted by cpfstich

Oxycontin is one of the most abused drugs nowadays.

It is a huge problem in Universities right now too.
So sad...

[cpfstich]

Originally Posted by BonnyW

It is a huge problem in Universities right now too.
So sad...

Yes it is, we even see a few cases of it here.

[Tommygurl]

Originally Posted by cpfstich

I disagree, but simply because I respect you too much and I don't want this thread to go somewhere it shouldn't, I won't. Someday when we meet, we will discuss the pros and cons of weed, then have a drink or two and go on with life.

Okay
Although I am all talk really.
Wine is my drug of choice.

[Jo]

Originally Posted by Ginger

Prescription pain meds can be the evil and downfall of many people. Unfortunately, I believe responsibility befalls in the lap of the physician to be able to recognize when a patient is a proper candidate to handle the responsibility and heavy psychological pounding that can be inflicted by prescription pain medication. If the physician doesn't know the patient well enought, then they shouldn't be prescribing the medication.

I don't want to go into too many details, but this subject hits very close to home for me on various levels. In the immediate here and now, it beleagures me both for myself and someone who is very close to me. Myself, I suffer with pain on a daily basis but I refuse to take anything stronger than codiene as I don't want to become dependant, and I have had dependancy issues in my past. With the person who is very close to me, they suffered a very serious spinal cord injury a few years ago that put them into an extreme amount of daily pain. Their doctor put them onto a daily regiment of intense pain killers, which resulted in this person becoming very addicted to morphine and other meds. This persons life went downhill, even moreso than it did as a result of his injury. Other serious health issues started to arise, and now this person is on a regimen of daily methadone to get off of his other meds. It is hardly believable that this person is doing methadone...that this person could have gotten to this place in their life. And it's hard to believe that somehow this could not have been avoided. Very sad.

The problem with all pain-meds is not only twofold but multifold, really.
To touch only the two aspects you mentioned- the physicians responsibility and morphine et al gone bad on someone:
1. Aside from when you have someone sitting in front of you that has known abuse issues it is often almost impossible to tell how someone will handle such meds.
The one thing you can do as a physician is to put a lock to it as soon as you see that the person is taking more than prescribed (which is easy as they come back earlier than intended....). Problem here is though that if you want to get them off the meds then- if that is possible with their pain level- what they may do is just change the doc.
I remember such a case- a mother and a daughter, both addicted to sleeping pills. My former boss tried everything to get them off- talked to them directly, wanted to sign them up for a program etc.- to no avail.
So we had orders only to give out a recipe in the planned time frame- the excuses started popping up..... lost the recipe.... lost the pills.
Boss spoke to them again.
In the end she was faced with two options: kick them out, knowing they'd go to another doc and that doc would probably take some time to catch on or not care and just prescribe (yep, quite a number of them do)- or leave them in our care, talk to them again and again, give them as little pills as possible etc..
I don't know how the case ended as I left the clinic.
But it shows how hard it can be to deal with this if the patient doesn't work with you.

The alternative would be to give NO patient painmeds or sleeping pills- which isn't a solution either. In fact most patients I have seen so far deal with such meds responsibly - as far as I could tell at least.

2.As for morphine and the likes: used and prescribed in the RIGHT way they are super and still the best painkiller around.
Problem is that even many physicians do not prescribe them the right way.
One thing that often is made as a mistake is to give out morphines "on demand". While every pharmacologist will tell you that key in morphines is to establish a set regimen this is often still done- and then can spiral out of control easily.
Also the form in which they are given can change a lot- pills are a lot less easy to control and easier to abuse than patches f.e..

It is really easy under the wrong circumstances for such meds to spiral out of control- on the other hand they are often the only way to treat pain.
It takes responsibility on both sides.

[Jo]

One thing I am wondering about now after reading up on the US regulations for passing out morphines/ opiates and their derivates: do I understand correctly that Oxycontin and the likes can be prescribed on a recipe by any doc, only limitation being that there are no refills and no call in orders can be placed to the pharmacy?
Or is there any other tracking system I missed out on?
If there isn't I personally see that some changes in that system may be healthy as it has way too many loopholes.

F.e. over here if you want to prescribe Oxycontin (which is called Oxygesic here....) or opiates/ morphines and the like there is a lot of tracking involved.......
The doc has to have a special registration number with the agency that controls those substances. Not every doc has one of those.
The docs that do get special recipes for those substances- they are numbered, so loss of one can be tracked and has to be reported accordingly.
Those recipes come threefold - one copy stays with the doc, one with the pharmacist and one goes to the agency. I doubt that they can be faked, due to the tracking system on the numbers that are on them- if you just made a number up the pharmacist would hopefully catch on. Also the material and colours are very......strange.
The recipes have to be kept in a safe in the clinic, only accessible by authorized personell.

Due to this tracking system even the docs only have a certain bit of leeway before the agency catches on. If you prescribe a bit too much they are on you, send you letters asking for the why and which and what have you.......if you can't account for that you will loose your number and your recipes.

Of course this system has loopholes as well, for sure, still- with a system like that you need a good reason to prescribe stuff to someone that is a bit more "hardcore".
Maybe establishing something like that could help in the US in the future?

[DavidB]

Originally Posted by cpfstich

Well said Leasa There MUST be accountablity on both sides of ANY drug that is prescribed. I have handled cases of "Doctor shopping" where it was blatantly obvious what the so called "patient" was doing that the doctor should have known. Very frustrating!

We get Dr. shopping in the ER. Some DR.s are easier touches for narcotics. Patients will come into the ER and if certain Dr.s are working they will leave and come back later after the DR.s have their shift change. One of the new DR.s is now making the Patients asking for pain meds take a drug test to see what else is in their system. If they have street drugs she won't give them pain meds. Some of the patients refuse and just leave.

[Donna]

Originally Posted by sctx

yeah..........won't find any in my house

poor scotty ... call me i will try to console you today. want to do lunch?

[Ginger]

Originally Posted by Joana

F.e. over here if you want to prescribe Oxycontin (which is called Oxygesic here....) or opiates/ morphines and the like there is a lot of tracking involved.......
The doc has to have a special registration number with the agency that controls those substances. Not every doc has one of those.
The docs that do get special recipes for those substances- they are numbered, so loss of one can be tracked and has to be reported accordingly.
Those recipes come threefold - one copy stays with the doc, one with the pharmacist and one goes to the agency. I doubt that they can be faked, due to the tracking system on the numbers that are on them- if you just made a number up the pharmacist would hopefully catch on. Also the material and colours are very......strange.
The recipes have to be kept in a safe in the clinic, only accessible by authorized personell.

This is how it is done here, also. Certain drugs have to have what's called the triplicate form just like you described, and the prescribing doctor has to have a certain license to be able to prescribe those kinds of meds.