US crackdown on chronic pain patients prescribed opioids

[mr_colt]

I just watched the documentary video the crackdown on Doctors and patients involved in the use of opoids for chronic pain in the US:

Pain Relief Network » Media

I certainly found it's content to be very "chilling" to say the least; and I highly recommend you watch it too.

Does anyone else think it's starting to creep in over here? As a chronic pain patient myself; I have had to move counties just to get a buprenorphine dose higher than 5mcg/hr! It sort of tells me that something is going on when GP's wont script any anything other than Codeine, DHC or tramadol even on advisement of a pain consultant.

Despite our socialised medicine system methinks that the drug companies might be pulling a few strings behind the scenes; after all they don't make a lot of profit from "nasty cheap opioids."

Any opinions welcome and please do watch the video; It's highly interesting stuff.

mr_colt

[pharout]

Re: US crackdown on chronic pain patients prescribed opioids

I just watched the documentary video the crackdown on Doctors and patients involved in the use of opoids for chronic pain in the US:

Pain Relief Network » Media

I certainly found it's content to be very "chilling" to say the least; and I highly recommend you watch it too.

Does anyone else think it's starting to creep in over here? As a chronic pain patient myself; I have had to move counties just to get a buprenorphine dose higher than 5mcg/hr! It sort of tells me that something is going on when GP's wont script any anything other than Codeine, DHC or tramadol even on advisement of a pain consultant.

Despite our socialised medicine system methinks that the drug companies might be pulling a few strings behind the scenes; after all they don't make a lot of profit from "nasty cheap opioids."

Any opinions welcome and please do watch the video; It's highly interesting stuff.

mr_colt

I haven't watched the video, but can personally speak of one who is involved with the care of chronic pain patients. In the U.S., overall, we are more willing to accept a pt's complaint of pain and treat it with opioids as it is a subjective state that cannot be truely quantified other than with the use of pain scales. This is in contrast to Europe in general, which is less likely to treat pain with opioids and this has been documented in the literature. Those that do treat, treat with less appropriate choices, per se. For example, if one knows about any pertinent pain guidelines out there, you would not choose codeine as a pain reliever because it is simply a poor choice and has a ceiling pain relief of approximately 65mg. The other issue is tolerability of it. Tramadol is more legitamate, however, it too has caveats. It is better for neuropathic pain, is not a good choice for someone with mod-severe pain, can lower the seizure threshold especially if one is on another med which may do the same, and also must be renally dose for those with chronic kidney disease. I have personally found pain to be a double-edged sword. Those here in the U.S. willing to treat do, however, patients are just as apt to take advantage of the willingness in certain cases. They know the exact questions to ask and answers to give. Subsequently, doctors become more apprehensive with prescribing. Here we have narcotic contracts, where "problem" pts are required to agree, otherwise docs won't prescribe. I have also found discrepancies in willingness to prescribe based on past experiences of the doctor and comfort level with the agent being prescribed. This varies across the board as I'm sure it does there. I wonder, if you don't mind, what type of pain you are treating? Buprenorphine is not an agent that would be considered first-line in the treatment of chronic pain. As a side note, both fentanyl patches and oxycodone extended release tablets here in the U.S. are still quite profitable for the drug companies and maintain an impressive street value.

[johnep]

Re: US crackdown on chronic pain patients prescribed opioids

Standard cancer pain relief was always diamorphine or morphine. With the crop problems in Tasmania, diamorphine has been in short supply (legally) for past three years so that fentanyl patches and oxycodone much more used,

Generic fentanyl now available but oxycodone still only available from one supplier.

johnep

[mr_colt]

Re: US crackdown on chronic pain patients prescribed opioids

I have seen evidence of patients who goto pain clinics in the states are required to sign a pain contract before even getting the first consult. This is regardless of whether the walk out with a script at any point or not. Regardless of if their medical records have addic...cough "drug-seeking" behaviour marked on them or not.

In florida; a lot of Doctor's clinic's display policies that they will not script oxycodone, morphine, vicodin, percocet etc. Regardless of how long they have known the patient or what treatment is required. They are all too afraid of the DEA jailing them in order to bolster it's statistics on fighting "drug crime."

I don't see it as "normal" in most countries for patients to give supervised urine samples just to pick up the repeat Rx for pain meds at the local GP's surgery; or be given 25 years in prison for being prescribed to much oxycodone to help control their pain. Yes prescribed!

I agree buprenorphine is probably not the best front line treatment for chronic pain but; I have to make do with what the docs are willing to script. My consultant acknowledged that slow-release morphine or fenatyl patches would probably be better but; he says even the bup would have to be supervised by visiting macmillian nurses to keep him safe legally if anything went wrong.

I guess at 19 everyone thinks you are an addicion risk; it's hard for non-medics to see the difference between dependance and addiction. Not to mention most chronic pain sufferers couldn't get high on their normal opioid doses even if they wanted to.

C.P. suffers may depend on a certain dose of opioids to function normally but the dose remains constant. Whereas an addict needs an ever increasing amount just to stop drug withdrawls. (This is the opinion of the British Pain Soceity.)

mr_colt.

[Jeff]

Re: US crackdown on chronic pain patients prescribed opioids

Whereas an addict needs an ever increasing amount just to stop drug withdrawls. (This is the opinion of the British Pain Soceity.)

And it's bollox.

It's possible (and possibly best practice) to stabilize addicts by giving them enough opiates.

Jeff

[mr_colt]

Re: US crackdown on chronic pain patients prescribed opioids

IF they are put onto a substance matinence course they yes but; do you think every single addict you dispense methadone to has stopped shooting up H entirely?

Perhaps I phrased my earlier post wrong; my intention was to point out the myth that long-term CP patients on strong opioids are addicts to those opioids. Not to mention the fact that addiction and dependance too oftern are viewed as one and the same.

mr_colt.