Opioid crisis - pretty remarkable whistleblowing story by ex-DEA agent...

[Pam in CT]

that ran on 60 Minutes this weekend.

 

What it's mostly about is how thoroughly a handful of prescription drug distributors have been able to thwart LEO efforts to contain opiates... beginning with resistance to Controlled Substances Act legislation to track and red-flag pharmacies issuing a suspicious volume of drugs proportionate to their regions' population... moving to the establishment of shady pill-mill pain clinics convenient to interstate highways... and on to DOJ slow-walking even very clear cases (one pharmacy in Mingo County WVA, in a town of 11,000 people, dispensed 28 million pain pills -- 2,500 pills for every man woman and child)... and on to the successful gutting of the DEA's enforcement mechanism under the Controlled Substance Act.

 

 

...In 2013, Joe Rannazzisi and his DEA investigators were trying to crack down on big drug distributors that ship drugs to pharmacies across the country.  He accused them of turning a blind eye as millions of prescription pain pills ended up on the black market.  Then, a new threat surfaced on Capitol Hill. With the help of members of Congress, the drug industry began to quietly pave the way for legislation that essentially would strip the DEA of its most potent tool in fighting the spread of dangerous narcotics.  

 

JOE RANNAZZISI: If I was gonna write a book about how to harm the United States with pharmaceuticals, the only thing I could think of that would immediately harm is to take the authority away from the investigative agency that is trying to enforce the Controlled Substances Act and the regulations implemented under the act. And that's what this bill did.

 

The bill... was promoted as a way to ensure that patients had access to the pain medication they needed.

 

Jonathan Novak, who worked in the DEA's legal office, says what the bill really did was strip the agency of its ability to immediately freeze suspicious shipments of prescription narcotics to keep drugs off U.S. streets -- what the DEA calls diversion. 

 

 

 

While the focus of the story is the influence of pharma and (particularly) distributor money on Congress and the DOJ, there's blame to hurl in all sorts of other directions as well.  

 

But I dearly hope we are able to move past the blame game and on to solutions.  200,000 lives and it's getting worse every year.

[goldberry]

Meanwhile, I just found out this week that my 84 year old mother with moderate to severe arthritis in just about every joint of her body... her pain management clinic wants to "wean her off" meds that she's been on for the last 20 years.  ??!!!  Not to replace, just because maybe she doesn't really need them that much.  Of course she's freaking out, because she needs them mentally at this point.  While there may be physical benefits, it's not worth the emotional trauma and upset it's causing and going to cause.  When just the size and shape of her pills change, it takes her months to calm down about it.  

 

I think the clinics are under pressure to reduce the amount they prescribe and she's an easy target.  

[Janeway]

that ran on 60 Minutes this weekend.

 

What it's mostly about is how thoroughly a handful of prescription drug distributors have been able to thwart LEO efforts to contain opiates... beginning with resistance to Controlled Substances Act legislation to track and red-flag pharmacies issuing a suspicious volume of drugs proportionate to their regions' population... moving to the establishment of shady pill-mill pain clinics convenient to interstate highways... and on to DOJ slow-walking even very clear cases (one pharmacy in Mingo County WVA, in a town of 11,000 people, dispensed 28 million pain pills -- 2,500 pills for every man woman and child)... and on to the successful gutting of the DEA's enforcement mechanism under the Controlled Substance Act.

 

 

 

 

While the focus of the story is the influence of pharma and (particularly) distributor money on Congress and the DOJ, there's blame to hurl in all sorts of other directions as well.

 

But I dearly hope we are able to move past the blame game and on to solutions. 200,000 lives and it's getting worse every year.

The extreme influence of big pharm on our government is why I stopped blindly trusting any drugs, including vaccinations.

[Sneezyone]

It sounds remarkably like the gun lobby. Is there a lethal product playbook or something?

[Pam in CT]

re pressure to reduce prescribed #s 

Meanwhile, I just found out this week that my 84 year old mother with moderate to severe arthritis in just about every joint of her body... her pain management clinic wants to "wean her off" meds that she's been on for the last 20 years.  ??!!!  Not to replace, just because maybe she doesn't really need them that much.  Of course she's freaking out, because she needs them mentally at this point.  While there may be physical benefits, it's not worth the emotional trauma and upset it's causing and going to cause.  When just the size and shape of her pills change, it takes her months to calm down about it.  

 

I think the clinics are under pressure to reduce the amount they prescribe and she's an easy target.  

 

 

Good grief.  That is seriously messed up.

 

My 84 year old father is (sigh) in the final weeks of a long and ghastly bout with cancer, and only in the last two weeks has he (thankfully) needed or been prescribed with any paid medication at all.  I don't think it's mostly a senior citizen phenomenon.

[FaithManor]

The docs around here are afraid to prescribe anything. So when dh had his surgery to repair his tendons, he was offered exactly nothing.

 

Ds with the severe arthritis in his disabled leg can't get anything either.

 

An acquaintance just had major abdominal surgery. She laid in the hospital crying in severe pain, and got exactly SQUAT. Not.one thing. The nurses were so upset. But nope. Here's some tylenol, hope it helps otherwise suck it up buttercup.

 

So that's the new wave. Instead of exercising discernment and caution and carefully monitoring patients, they will let the pendulum swing in the extreme other direction so we go back to the dark ages of suffering. 

 

None of this is good. We need regular, common sense people in charge of this. Not the nut jobs and greed goblins we have making policy now.  Sigh....

[goldberry]

 

 

My 84 year old father is (sigh) in the final weeks of a long and ghastly bout with cancer, and only in the last two weeks has he (thankfully) needed or been prescribed with any paid medication at all.

 

I'm sorry Pam.... :grouphug:

[goldberry]

It sounds remarkably like the gun lobby. Is there a lethal product playbook or something?

 

Well, the cigarette industry finally got taken down a few notches after all those years, so maybe there is hope. 

[Pam in CT]

The docs around here are afraid to prescribe anything. So when dh had his surgery to repair his tendons, he was offered exactly nothing.

 

Ds with the severe arthritis in his disabled leg can't get anything either.

 

An acquaintance just had major abdominal surgery. She laid in the hospital crying in severe pain, and got exactly SQUAT. Not.one thing. The nurses were so upset. But nope. Here's some tylenol, hope it helps otherwise suck it up buttercup.

 

So that's the new wave. Instead of exercising discernment and caution and carefully monitoring patients, they will let the pendulum swing in the extreme other direction so we go back to the dark ages of suffering. 

 

None of this is good. We need regular, common sense people in charge of this. Not the nut jobs and greed goblins we have making policy now.  Sigh....

 

 

There does seem to be a growing dynamic between a large number increasingly skittish medical professionals who are overly wary about fueling the epidemic, vs a small number of unscrupulous doctors & distributors who are feeding and enabling, if not actively creating, the monster.   The 60 Minutes piece, which was followed up yesterday by another article in the Washington Post, focuses in particular on just three distributors, Cardinal, McKesson and AmerisourceBergen as the principal supplier of "pill mill" clinics and also, unsurprisingly, as lobbyists seeking looser enforcement.

 

 

Under the Controlled Substances Act of 1970, drug companies are required to report unusually large or otherwise suspicious orders. Failure to do so can result in fines and the suspension or loss of DEA registrations to manufacture or distribute narcotics.

 

When the DEA suspected that a company was ignoring suspicious sales, the agency filed an “order to show cause.†That gave a company at least 30 days to explain why the agency should not revoke its registration.

 

In the most egregious cases, the DEA employed an “immediate suspension order,†allowing the agency to lock up a distributor’s drugs. The orders instantly halted all commerce in controlled substances on the grounds that the drugs constituted an “imminent danger†to the community...The DEA soon began bringing enforcement actions against distributors. In 2007, the agency moved against McKesson, the nation’s largest drug distributor and the fifth-largest corporation in the nation, for failing to report hundreds of suspicious orders placed by Internet pharmacies. McKesson settled the case, paying a $13.2 million fine.

 

The DEA would ultimately bring at least 17 cases against 13 drug distributors and one manufacturer. The government said it assessed nearly $425 million in fines over a decade. Those fines reflect only a small portion of the hundreds of billions of dollars in revenue the companies receive each year.

 

It was such fines, and the disruptiveness of the suspension order/seizures on the ongoing flow of lucrative business, that sparked distributors' lobbying effort to gut the Controlled Substances law of its enforcement teeth.

 

The Post article has a very good graphic of the timeline of DEA and DOJ people (a total of 56) leaving the agencies and going over to the distributors to help them in their targeted lobbying efforts, vs when the legislation was loosened (near the bottom of the rather long article).

[goldberry]

 I don't think it's mostly a senior citizen phenomenon.

 

Yeah, those who really need pain meds are taking them, not selling them.  I think most seniors fall into that category.

 

[Jean in Newcastle]

*note: what I have to say are my own feelings about my own pain and health. I have no insights into anyone else or their loved ones.

 

I have had chronic pain for almost 30 years now. I'm allergic to opioids. I'm also on an opioid antagonist but I already knew that I couldn't have them anyway.

 

I think that many people and their doctors have ignored non opioid meds and non pill treatments for pain. I shouldn't have to beg for PT when it's actually more effective. Same for alternative treatments like biofeedback, heat, acupuncture etc. There are ways to treat the cause of the pain in some cases instead of just the symptom (pain). That seems like a no brainer but doctors often just treat the symptoms. My opioid antagonist (low dose naltrexone) actually helps my pain levels.

 

I have friends with the same diagnoses as I have who are dependent on opioids. We do the same things. Yes, I have some level of pain all the time but honestly so do they-as well as the added side effects from opioids. Their doctors are trying to move them to the same treatments that I have used for years but my friends are resistant. (I don't say anything about this to them but just listen. )

 

 

Sent from my iPhone using Tapatalk

[Lanny]

Pharmacies like the one mentioned in WV should be closed by the DEA and the Pharmacists who work there should get long prison terms.  From some of the comments I read here, people with a real need for Pain relief (coming out of surgery, for one example) are being denied pain relief. That seems cruel. If I or my wife or my DD had to have surgery, and there was no pain relief available after the surgery, I would consider that to be very cruel.  That is cruel.  On the other hand, many of the people who are now dependent on Opiods say they began like that, with an honest need for pain relief and then got addicted.

 

And then the huge amounts of those drugs shipped into the USA from China, via the Postal system. It is incredibly profitable.  

 

I have read (and/or seen on TV) about the "Pain Clinics" in FL (and other states) where they are issuing huge amounts of prescriptions to people who walk into the door, pay, and get a legal prescription. Those places should be shut down and the doctors there sent to prison.

 

And those drugs are so much more powerful than Heroin. And, some of them are adulterated and extremely dangerous.

 

Many many problems.  I was not in front of this computer, but there was something in a video a few minutes ago, I think from the White House. I think they are going to propose something in a week or so. I hope to God it will be something with a chance of success against the horrible drug use problem in the USA.

[Pam in CT]

re reluctance of many medical professionals to consider non-medication routes of treatment

*note: what I have to say are my own feelings about my own pain and health. I have no insights into anyone else or their loved ones.

I have had chronic pain for almost 30 years now. I'm allergic to opioids. I'm also on an opioid antagonist but I already knew that I couldn't have them anyway.

I think that many people and their doctors have ignored non opioid meds and non pill treatments for pain. I shouldn't have to beg for PT when it's actually more effective. Same for alternative treatments like biofeedback, heat, acupuncture etc. There are ways to treat the cause of the pain in some cases instead of just the symptom (pain). That seems like a no brainer but doctors often just treat the symptoms. My opioid antagonist (low dose naltrexone) actually helps my pain levels.

I have friends with the same diagnoses as I have who are dependent on opioids. We do the same things. Yes, I have some level of pain all the time but honestly so do they-as well as the added side effects from opioids. Their doctors are trying to move them to the same treatments that I have used for years but my friends are resistant. (I don't say anything about this to them but just listen. )


Sent from my iPhone using Tapatalk

 

 

That is an excellent insight, and possibly related to the influence of money on medical decision making.  Physical therapy, diet, heat, acupunction don't generate the volume of profit, nor have the associated lobbying organization and power, of prescription drugs.

[LifeLovePassion]

The docs around here are afraid to prescribe anything. So when dh had his surgery to repair his tendons, he was offered exactly nothing.

 

Ds with the severe arthritis in his disabled leg can't get anything either.

 

An acquaintance just had major abdominal surgery. She laid in the hospital crying in severe pain, and got exactly SQUAT. Not.one thing. The nurses were so upset. But nope. Here's some tylenol, hope it helps otherwise suck it up buttercup.

 

So that's the new wave. Instead of exercising discernment and caution and carefully monitoring patients, they will let the pendulum swing in the extreme other direction so we go back to the dark ages of suffering.

 

None of this is good. We need regular, common sense people in charge of this. Not the nut jobs and greed goblins we have making policy now. Sigh....

That's horrible. I just had surgery and they were on top of pain management while I was still in recovery. I filled prescriptions for muscle relaxers and narcotics the week before so they were available from the moment I got home. I'm thankful these docs haven't swung that far back yet.

[mlktwins]

I had oral surgery in August.  I was prescribed pain meds (heavy duty ibuprofin and tylenol with codeine).  I filled them both, but didn't take the Tylenol with codeine.  The dr. encouraged me to only take it if absolutely necessary.  

[nixpix5]

The saddest thing I ever saw was when my grandmother was alive about 10 years ago and was living in a rent controlled apartment complex for seniors. Her next door neighbor was an 86 year old woman who was sweet as pie. She and my grandma would hang out together. However, her social security benefits were so low that she couldn't afford the basics so she would get her pain pills and sell them to local addicts. I was stunned. It was how she was affording to eat and keep her cable. It was beyond eye opening to me. Some of the people buying from her were her nursing staff too. It was crazy.

[Pam in CT]

The saddest thing I ever saw was when my grandmother was alive about 10 years ago and was living in a rent controlled apartment complex for seniors. Her next door neighbor was an 86 year old woman who was sweet as pie. She and my grandma would hang out together. However, her social security benefits were so low that she couldn't afford the basics so she would get her pain pills and sell them to local addicts. I was stunned. It was how she was affording to eat and keep her cable. It was beyond eye opening to me. Some of the people buying from her were her nursing staff too. It was crazy.

 

 

Wow.  That is so many layers of messed up it's hard to figure where to start.

[Murphy101]

re reluctance of many medical professionals to consider non-medication routes of treatment

 

 

That is an excellent insight, and possibly related to the influence of money on medical decision making. Physical therapy, diet, heat, acupunction don't generate the volume of profit, nor have the associated lobbying organization and power, of prescription drugs.

Not to mention there’s a huge segment of our country who don’t have insurance at all or are underinsured and even without both those problems, there’s many who can’t afford to use their insurance. Combined with the huge problem that our country doesn’t have any healthy work balance protections. PT requires frequent time off work, often without pay and with an angry boss. Most people who have opiate addiction didn’t plan it. They were just trying to get through another painful day at work in the futile hope that someday they’d get ahead enough to properly treat the problem. For most that doesn’t happen, and even when it does it cost them significantly in health, but they are shamed for not working hard enough anyways.

[kroe1]

Weaning the elderly from narcotics, even when they have been used for many years, has nothing to do with cruelty or an opioid epidemic. It has to do with preventing a fall risk.

 

As we age:

 

1. We lose a sense of balance. After about age 65 or so, we lose the ability to stand on one foot. This progresses to a wider based gait and some shuffling of the feet, the older we get.

 

2. The liver and kidneys do not process medications the same way it did 30 years before.

 

3. Weight changes. We lose more muscle mass with a disproportionate increase in adipose tissue. This also changes the drugs are processed and stored in the body.

 

4. Elderly have more comorbid conditions and more interacting drugs. For example, someone may be on a blood thinner to prevent another stroke. A simple fall on the tile floor can be life threatening.

 

5. Hip fractures in the elderly can mean a 50% chance of death in the next year.

 

There has been a big push to get elderly off of all sedating medications, not just pain medicines. This has been going on for at least 10 years.

 

Also, pill mills in Florida were shut down about 3 or 4 years ago, at least the bulk of them. Florida has been quite progressive in attempts to end the opioid crisis. But, now it seems it will just be replaced with a marijuana one. Sigh.

[Pam in CT]

re uninsured and underinsured people without access to paid time off self-medicating rather than getting proper care

Not to mention there’s a huge segment of our country who don’t have insurance at all or are underinsured and even without both those problems, there’s many who can’t afford to use their insurance. Combined with the huge problem that our country doesn’t have any healthy work balance protections. PT requires frequent time off work, often without pay and with an angry boss. Most people who have opiate addiction didn’t plan it. They were just trying to get through another painful day at work in the futile hope that someday they’d get ahead enough to properly treat the problem. For most that doesn’t happen, and even when it does it cost them significantly in health, but they are shamed for not working hard enough anyways.

 

 

Yes.  Like nixpix' example above, the opioid problem didn't gestate in a vacuum; it absolutely is connected to other, broader, social safety net issues.

[ChocolateReignRemix]

It sounds remarkably like the gun lobby. Is there a lethal product playbook or something?

Yes but it’s just one page.

 

$$$$$$$

[Pam in CT]

Weaning the elderly from narcotics, even when they have been used for many years, has nothing to do with cruelty or an opioid epidemic. It has to do with preventing a fall risk.

 

As we age:

 

1. We lose a sense of balance. After about age 65 or so, we lose the ability to stand on one foot. This progresses to a wider based gait and some shuffling of the feet, the older we get.

 

2. The liver and kidneys do not process medications the same way it did 30 years before.

 

3. Weight changes. We lose more muscle mass with a disproportionate increase in adipose tissue. This also changes the drugs are processed and stored in the body.

 

4. Elderly have more comorbid conditions and more interacting drugs. For example, someone may be on a blood thinner to prevent another stroke. A simple fall on the tile floor can be life threatening.

 

5. Hip fractures in the elderly can mean a 50% chance of death in the next year.

 

There has been a big push to get elderly off of all sedating medications, not just pain medicines. This has been going on for at least 10 years.

 

Also, pill mills in Florida were shut down about 3 or 4 years ago, at least the bulk of them. Florida has been quite progressive in attempts to end the opioid crisis. But, now it seems it will just be replaced with a marijuana one. Sigh.

 

 

That is a good point about fall risk.

 

With respect to Florida's success in curbing its opioid problem, to what practices and/or policies do you attribute that success?  

 

I'm not familiar with this source, but this is a rundown I found of what Florida did to stem its pill mill problem:

 

 

...Government oversight became more common in the early 2010s, when the state of Florida and federal law enforcement cracked down on pill mills. Law enforcement prosecuted the most flagrant offenders, including Dr. Weed. According to the DEA, opioids are now harder to get.

 

The state government also took action. In 2011, the legislature passed a law that limited the amount of opioids individual patients could receive. Before 2011, crooked doctors routinely sold blank prescriptions to opioid users and street dealers. With the new personal limits, pharmacies can’t dispense outrageous amounts of opioids anymore.

 

Enforcement has also been stepped up. When patients are prescribed opioids now, their doctor has to check a statewide database that tracks how many opioids any person has been prescribed. Law enforcement can now keep tabs on and arrest flagrant pill pushers.

 

The crackdown has succeeded. Pill mills have closed down statewide. The number of new opioid prescriptions has gone down. Public health officials believe that opioids are no longer gaining hard-core users as quickly as they were.

 

 

Are there other actions that Florida took that you see as important?  And would you say they are replicable elsewhere on a national scale, or did Florida's actions just sort of... shift the issue over to different states like West Virginia which now seems to be a hotspot?

 

 

 

 

 

 

eta missing link

Edited October 16, 2017 by Pam in CT

[AimeeM]

If narcotics make my 92 year old great-grandmother's quality of life better, it's worth the other risks, in my opinion. 

 

Most elderly fall at some point -- including those who aren't on narcotics. My FIL fell and it's what landed him in-patient hospice... and he had refused all pain medication.

 

Why are we trying to save an 85 year old's kidneys and liver? Let's assume that this elderly person is essentially being given medical care as a comfort, not a cure to anything that ails them.

 

What I'm getting out of this is that we want people to live absolutely as long as they possibly can, with zero regard for their quality of life. Never mind that they are often past the "standard age" or that they're in pain daily -- as long as we prevent death, save their hips and organs, we can call it a good day.

 

Weaning the elderly from narcotics, even when they have been used for many years, has nothing to do with cruelty or an opioid epidemic. It has to do with preventing a fall risk.

As we age:

1. We lose a sense of balance. After about age 65 or so, we lose the ability to stand on one foot. This progresses to a wider based gait and some shuffling of the feet, the older we get.

2. The liver and kidneys do not process medications the same way it did 30 years before. 
3. Weight changes. We lose more muscle mass with a disproportionate increase in adipose tissue. This also changes the drugs are processed and stored in the body. 

4. Elderly have more comorbid conditions and more interacting drugs. For example, someone may be on a blood thinner to prevent another stroke. A simple fall on the tile floor can be life threatening.

5. Hip fractures in the elderly can mean a 50% chance of death in the next year.

There has been a big push to get elderly off of all sedating medications, not just pain medicines. This has been going on for at least 10 years.

Also, pill mills in Florida were shut down about 3 or 4 years ago, at least the bulk of them. Florida has been quite progressive in attempts to end the opioid crisis. But, now it seems it will just be replaced with a marijuana one. Sigh.

 

[AimeeM]

re reluctance of many medical professionals to consider non-medication routes of treatment

 

 

That is an excellent insight, and possibly related to the influence of money on medical decision making.  Physical therapy, diet, heat, acupunction don't generate the volume of profit, nor have the associated lobbying organization and power, of prescription drugs.

 

I think it has to do with logistics, and not just lobbying power and profit.

 

You can just take a pill with a glass of water. Many of these very elderly folks (or severely physically disabled folks) have no way to get to the frequent appointments that would be necessary for the amount of PT and acupuncture they would need for those to be effective methods of pain relief. 

 

My daughter is in the middle of genetic and rheumatology testing. They know she has a connective tissue disorder and they are relatively certain she has also has an autoimmune issue. She's in pain constantly -- her knees and feet turn so far inward at this point that walking is hard. 

 

PT does wonders for her... but/and we are blessed to live literally down the street from an excellent PT office and an excellent gym with a year-round indoor pool she has access to. If we didn't have the aforementioned, I have zero clue how I would get her to the recommended PT appointments (3+ weekly) or to swim (when she doesn't have PT), considering she is one of three children and the other kiddos have appointments to get to as well.

 

I get it for the younger crowd with issues that allow for other methods of pain relief. What I have a really hard time wrapping my head around is what these methods can possibly do for the elderly. No amount of PT or acupuncture is going to fix what's broken with an 80-something-year-old cancer patient. PT and acupuncture would do nothing for a 20 year old recovering from, say, an abdominal surgery (c-section or similar) -- this is typically where a couple weeks' of narcotics and ibuprofen come into play. Some of the stories I've heard are just cruel. 

 

 

Edited October 16, 2017 by AimeeM

[Pam in CT]

:grouphug: Aimee.

 

Of course your great grandmother deserves as good a quality of life as she is able to have.

 

It does not seem that the scope of the national issue is driven by 92 year olds actually dealing with pain (though seniors selling their pain pills in order to pay their rent or food, as nixpix described upthread, may contribute to a small corner of the problem.  It seems like a handful of quite large players are driving the bulk of the problem as well as, at least according to the original whistleblower feature, impeding legislators' willingness to tackle it. 

 

 

 

 

 

'ETA we just crossed posts.  I fully concur with your point about the practical difficulty of older patients getting out to PT and other therapies... my dad is in the same situation at the moment.

Edited October 16, 2017 by Pam in CT

[Sandwalker]

*note: what I have to say are my own feelings about my own pain and health. I have no insights into anyone else or their loved ones.

 

I have had chronic pain for almost 30 years now. I'm allergic to opioids. I'm also on an opioid antagonist but I already knew that I couldn't have them anyway.

 

I think that many people and their doctors have ignored non opioid meds and non pill treatments for pain. I shouldn't have to beg for PT when it's actually more effective. Same for alternative treatments like biofeedback, heat, acupuncture etc. There are ways to treat the cause of the pain in some cases instead of just the symptom (pain). That seems like a no brainer but doctors often just treat the symptoms. My opioid antagonist (low dose naltrexone) actually helps my pain levels.

 

I have friends with the same diagnoses as I have who are dependent on opioids. We do the same things. Yes, I have some level of pain all the time but honestly so do they-as well as the added side effects from opioids. Their doctors are trying to move them to the same treatments that I have used for years but my friends are resistant. (I don't say anything about this to them but just listen. )

 

 

Sent from my iPhone using Tapatalk

This times a million.

[Sandwalker]

Pharmacies like the one mentioned in WV should be closed by the DEA and the Pharmacists who work there should get long prison terms. From some of the comments I read here, people with a real need for Pain relief (coming out of surgery, for one example) are being denied pain relief. That seems cruel. If I or my wife or my DD had to have surgery, and there was no pain relief available after the surgery, I would consider that to be very cruel. That is cruel. On the other hand, many of the people who are now dependent on Opiods say they began like that, with an honest need for pain relief and then got addicted.

 

And then the huge amounts of those drugs shipped into the USA from China, via the Postal system. It is incredibly profitable.

 

I have read (and/or seen on TV) about the "Pain Clinics" in FL (and other states) where they are issuing huge amounts of prescriptions to people who walk into the door, pay, and get a legal prescription. Those places should be shut down and the doctors there sent to prison.

 

And those drugs are so much more powerful than Heroin. And, some of them are adulterated and extremely dangerous.

 

Many many problems. I was not in front of this computer, but there was something in a video a few minutes ago, I think from the White House. I think they are going to propose something in a week or so. I hope to God it will be something with a chance of success against the horrible drug use problem in the USA.

They closed the pain clinics in Florida a few years ago, so now we have this huge heroin epidemic. These clinics were on every corner of the cities, and people walked in with a spine mri they got online, and walked out with a huge bottle of oxycontin. These pills had no Tylenol like percocets do, they were tiny and so easily crushable, not like normal pills. Easily crushable for snorting or shooting up. We lost so many young people here to these. The drug company definitely formulated these on purpose to be basically heroin in a pill. I would see people right in the parking lot of the pain clinics selling half the bottle to another.

 

I worked in the NICU then, and one of the docs was doing a study, and they drug tested all the babies in the NICU. FORTY-TWO PERCENT tested positive for opioids (not counting the babies who had been given pain meds or whose breastfeeding mother had.) This study helped get the lawmakers off their behinds to clean things up. But now what? Heroin addicts and suffering post-op patients.

 

It all really started when some idiot decided that "pain is the fifth vital sign", and we nurses were to assess pain extremely frequently. If the patient said 4 out of 10 on the pain scale, one percocet. If they said 5 or above, 2 percs. When I was working postpartum, 2 percs were given every four hours to women who had given birth vaginally and were intact, if they said they were cramping.

 

The medical industry and the pharmaceutical companies created this epidemic. One recent study shows that if you give 10 postop patients 10 days worth of opioids, SIX of those patients will still be taking narcotics A YEAR later. Addiction is easy with these meds.

 

ETA sorry I repeated a bunch of stuff before I read the whole thread.

Edited October 17, 2017 by Sandwalker

[MotherGoose]

My recent narcotics experience: I had a copperhead snake bite ten days ago. Admitted to ICU for three days, and in extreme pain. Much worse than my three c-sections for sure. I was on .3 mg dilaudid, iv, every six hours I think. I had the pain pump. The pain never went away entirely, but it was manageable so I could rest. Stepped down to lortab and Advil every six hours. Was discharged on one Percocet every six hours. I normally take two a day total but am about done taking them as the swelling is going down and non rx drugs are taking care of things. The doctor initially discharged me with twelve total pills for pain relief to last three days--and i knew it would last longer than three days. I was hoarding those pills and staying in pain because I was afraid I'd run out. This was some severe pain. My entire leg was swollen to twice it's normal size and it felt like one giant, horribly sensitive, bruise. Went back to dr a couple of days later and she gave me more pills, so that I expect I will have some left over when I'm done. This was 28 pills. The doctor said, "they are making it so we can't help people," by which she meant they are cracking down on prescribing meds so that people like me with acute, severe pain have trouble with adequate treatment. I do have adequate treatment. Whenever I think about pain, I remember what my vet told me when my dog had back trouble...you want to alleviate the severe pain, but you don't want to get rid of all pain entirely, because then he will forget he is ill and run around and hurt himself again. In my experience, people do want pain eliminated entirel, but, especially for conditions that have an end in sight, it would be safer for people to be content with pain reduction to a manageable level. If you have no hope of ever being pain free again I can see how it's tempting to want to entirely eliminate it. I am on a very low dose of meds, and really feel very little effects from them. Definitely not some high I want to repeat. I know I may be in the minority though. I agree that some sort of regulation is needed but people who have legitimate pain need treatment, and opioids are often the best treatment. I am definitely in favor of alternative treatments.

[Jean in Newcastle]

I did go into one of the pain clinics a couple of years ago. I had wondered why none of my doctors had ever recommended one. After all, I'm in pain and the clinics say "pain management " right in the name. But the receptionist said that all they did to "manage" the pain was to prescribe narcotics. I was disappointed. I still see those clinics around so they must not be shut down around here.

 

I have had ER docs suspect me of being a drug seeker until I point out to them that I couldn't take narcotics even if they offered them. I don't think that there are the abuse potentials for antibiotics and other non narcotics.

 

 

Sent from my iPhone using Tapatalk

[BlsdMama]

Meanwhile, I just found out this week that my 84 year old mother with moderate to severe arthritis in just about every joint of her body... her pain management clinic wants to "wean her off" meds that she's been on for the last 20 years. ??!!! Not to replace, just because maybe she doesn't really need them that much. Of course she's freaking out, because she needs them mentally at this point. While there may be physical benefits, it's not worth the emotional trauma and upset it's causing and going to cause. When just the size and shape of her pills change, it takes her months to calm down about it.

 

I think the clinics are under pressure to reduce the amount they prescribe and she's an easy target.

This past week the same scenario played out with a woman on Stiff Person Syndrome forum. The only way to control the spasms is through Baclofen and Valium in regular doses. ER meets well meaning doc. The spasms tore a thigh muscle. She's lucky no broken bones. Can you imagine that pain?

[RootAnn]

I've had a couple of surgeries recently. Each time, I've been sent home with two prescriptions - one for Ibuprofin (800 mg) and one for a narcotic (two different types). I was pretty amazed at the scripts since I've heard so much about opioid addiction among women lately. They didn't have very many total pills - to keep you from getting addicted?

 

My pain was managed well post-surgery. There must be a state by state difference for some of this.

[Laura Corin]

If narcotics make my 92 year old great-grandmother's quality of life better, it's worth the other risks, in my opinion. 

 

Most elderly fall at some point -- including those who aren't on narcotics. My FIL fell and it's what landed him in-patient hospice... and he had refused all pain medication.

 

Why are we trying to save an 85 year old's kidneys and liver? Let's assume that this elderly person is essentially being given medical care as a comfort, not a cure to anything that ails them.

 

What I'm getting out of this is that we want people to live absolutely as long as they possibly can, with zero regard for their quality of life. Never mind that they are often past the "standard age" or that they're in pain daily -- as long as we prevent death, save their hips and organs, we can call it a good day.

 

Yes.  My 93yo mother has opioid pain patches.  They may shorten her life for one reason or another, but long life is not her priority: comfort is.

 

[Pam in CT]

Turns out there's a significant Pill Mill story around the corner from me...

 

 

Last July, a woman in a neighboring town who had used an urgent care facility a few years ago was surprised when federal agents came to her door and asked if the facility doctor had been making house visits.  House visits?  2017?  That's a thing?  Uh, no.

 

 

"He had charged 300 home visits saying he had come to my house. I was of course shocked and blown over by that. I had never seen him at my house. I didn't know doctors made house calls anymore," Jordan said.

 

Investigators said Mansourov "defrauded the state's Medicaid program of more than $4 million by billing for home visits that he never made."

 

They believe some of that money is in a Swiss bank account.

 

 

Subsequent local press have reported that two doctors were involved -- one allegedly working the larger scale Medicaid fraud over an interval of years, at a multi-million Swiss bank account scale (so he's also been charged with money laundering and associated charges), who fled to Canada and has been picked up there:

 

Federal officials located the other doctor, Dr. Ramil Mansourov, accused of fleeing the country after being named a suspect in an investigation into what authorities are calling the largest ever health care fraud enforcement action by the federal Medicare Fraud Strike Force in the country last week. He was found outside a hotel in Montreal, Canada. Canadian authorities said Mansourov had a hearing and is slated to have another hearing in the coming days.

 

... and another smaller-scale operator, who has allegedly been more directly hands-on involved with the opioid supply chain side of the scheme:

 

On numerous occasions, PATEL provided prescriptions to patients who paid him $100 in cash for each prescription.  In certain instances, PATEL would write prescriptions for individuals who were not his patients in exchange for cash.,,  PATEL and MANSOUROV also regularly provided post-dated prescriptions to individuals, sometimes with dates that matched future dates when the doctors would be out of the country.

 

It is alleged that certain individuals who paid PATEL cash for prescriptions paid for the filled prescriptions by using a state Medicaid card, and then illegally distributed the drugs.  The investigation revealed that in 2014 alone, more than $50,000 in cash deposits were made into PATEL and his wife’s bank accounts, and that some of these funds were used to purchase PATEL’s current residence.

 

and who has been arrested and charged here in CT and is being held in a federal facility awaiting trial, having been deemed a flight risk at his bail hearing.

 

 

It sounds like in this case, it was the *Medicare fraud angle,* rather than opioid supply chain red flags. that brought the pill mill operators to federal authorities' attention.

[G5052]

This hits so close to home. I've seen first hand what over a decade of prescribed opioids can do to someone.

 

The hard reality is that even when prescribed carefully, they are indeed addictive and can create long-term brain and other physical damage if you take them daily for a long period of time. I'm not ruling that out of course for anyone who truly needs them, but they come with a price. In some individuals, the damage is permanent and cannot be reversed after a period of time. There's a lot of research about that going on. Frontal lobe damage is a particular concern because that area affects executive function.

 

Locally, they will usually give you a low-level narcotic following major surgery, but after that they will refer you to the pain clinic. The pain clinic here thankfully is very holistic in their approach, but I know that they have some long-term patients who take narcotics daily. Apparently they have significantly cut back on that though. Over a decade ago they were telling people that you didn't get addicted from long-term narcotics for chronic pain and that most people were fine with doing that for years as long as they were monitored. That isn't the case now.

 

Edited October 17, 2017 by G5052

[hornblower]

Esquire this morning: "You’re aware America is under siege, fighting an opioid crisis that has exploded into a public-health emergency.

 

You’ve heard of OxyContin, the pain medication to which countless patients have become addicted.

 

But do you know that the company that makes Oxy and reaps the billions of dollars in profits it generates is owned by one family?"

http://www.esquire.com/news-politics/a12775932/sackler-family-oxycontin/?utm_content=buffer9133b&utm_medium=social&utm_source=twitter.com&utm_campaign=buffer

[goldberry]

Weaning the elderly from narcotics, even when they have been used for many years, has nothing to do with cruelty or an opioid epidemic. It has to do with preventing a fall risk.

 

 

Well, with my mom it would definitely prevent falls... without her medication she would probably have been in a wheelchair over 10 years ago.  Her medication has kept her moving and enabled her to get out in the backyard and pick at her plants, which is one of the few things she has left that she enjoys.  So yes, more risk of falls than being in a wheelchair!  

 

I just wish doctors would look at patients individually instead of trying to apply blanket rules to everyone.

[Pam in CT]

Well, with my mom it would definitely prevent falls... without her medication she would probably have been in a wheelchair over 10 years ago.  Her medication has kept her moving and enabled her to get out in the backyard and pick at her plants, which is one of the few things she has left that she enjoys.  So yes, more risk of falls than being in a wheelchair!  

 

I just wish doctors would look at patients individually instead of trying to apply blanket rules to everyone.

 

 

It's the balance between the micro patient-centered picture, in which I absolutely agree with you and other pp that there is no substitute for an extremely specific patient-centered individual approach, vs the macro picture where it really seems that law enforcement can and must do a better job with large scale pattern-spotting.

 

Like other medical epidemics like influenza and polio and cancer clusters here, and malaria and dengue and ebola elsewhere, have required.  

 

Earlier this year Eric Eyle, a journalist with the Charleston Gazette-Mail, won a Pulitzer for his series of investigative reports on the opioid crisis in West Virgina.  (Those articles, which are well worth reading, are all linked here.)  One of the rural towns he reported on had 392 people; one distributor delivered over 9 million pills to that one town.  If authorities don't have the tools to spot those kinds of *patterns*...

 

... and the response to such red flags don't include medical professionals focused on treating the addicted on the demand side of the problem...

 

... as well as LEO rounding up the complicit doctors and Medicare fraudsters and money launderers on the supply chain side of the problem...

 

... as well as the pharma and distributor interests focused on profiting from the problem...

 

... and the legislators into whose coffers their associated lobbyists are pouring money...

 

 

then there's no containing the many-armed octopus.  It's a strange new meld of legitimate medical businesses wandering across an unmarked line; it seems to me that BOTH the public health side and ALSO the law enforcement side need different pattern-spotting capability than prior health epidemics and prior (illegal throughout the supply chain) drug problems have required.

 

With senior citizens like your mom and other patients caught in the crossfire.

[Forget-Me-Not]

Some of the docs are in a hard position. I’m not defending all of them, but in my area the DEA has cracked down hard and the pharmacies are literally getting less stock and it’s supposed to get worse. Additionally, at least one of the big chain pharmacies has stated they will only fill a 7 day supply at a time. So yeah, they’re trying to wean their patients down in anticipation of a drop in availability in our area. It has nothing to do with targeting the elderly or anyone else. It’s about prepping the patients to be able to get by with less because *they're going to have to get by with less.*

Edited October 17, 2017 by Forget-me-not

[kroe1]

The hospital I work for has stated morphine will not be available until January. Yes, the shortage is here. Of course, morphine ran out last year, too. Crazy world we live in.

[Denise in Florida]

The saddest thing I ever saw was when my grandmother was alive about 10 years ago and was living in a rent controlled apartment complex for seniors. Her next door neighbor was an 86 year old woman who was sweet as pie. She and my grandma would hang out together. However, her social security benefits were so low that she couldn't afford the basics so she would get her pain pills and sell them to local addicts. I was stunned. It was how she was affording to eat and keep her cable. It was beyond eye opening to me. Some of the people buying from her were her nursing staff too. It was crazy.

 

She is not unusual. It is an open secret around college campuses that senior citizens will sell their meds for cash.

[LBK]

I worked in the NICU then, and one of the docs was doing a study, and they drug tested all the babies in the NICU. FORTY-TWO PERCENT tested positive for opioids (not counting the babies who had been given pain meds or whose breastfeeding mother had.) This study helped get the lawmakers off their behinds to clean things up. But now what? Heroin addicts and suffering post-op

 

It all really started when some idiot decided that "pain is the fifth vital sign", and we nurses were to assess pain extremely frequently. If the patient said 4 out of 10 on the pain scale, one percocet. If they said 5 or above, 2 percs. When I was working postpartum, 2 percs were given every four hours to women who had given birth vaginally and were intact, if they said they were cramping.

 

The medical industry and the pharmaceutical companies created this epidemic. One recent study shows that if you give 10 postop patients 10 days worth of opioids, SIX of those patients will still be taking narcotics A YEAR later. Addiction is easy with these meds.

 

ETA sorry I repeated a bunch of stuff before I read the whole thread.

At first that pain scale made me laugh when it showed up a few years ago. Then I heard being implicated as part of the opioid crisis, and it made sense, and made those stupid posters look a little more sinister.

 

It's horrible to hear of people being denied painkillers after surgery. I've only had the opposite experience, over and over--narcotics being offered after very minor procedures. Another one of those things that used to make me laugh. For my recent postpartum experience at a well regarded hospital there was Percocet and ibuprofen on offer for my uncomplicated natural (as in not c-section) delivery. For after pains. Which were not nothing, but ibuprofen took the edge off. The midwife at least counseled me to avoid the Percocet if possible. I guess there's still some policy in place where it has to be offered.

Edited October 17, 2017 by LBK

[eternalsummer]

my grandmother was on long-term oxycontin after she got shingles at, oh, maybe 80.  She took the pills for maybe 5-7 years after that - sometimes for pain that was ongoing, but hard to say if it could have been managed another way or not.  At any rate, when she died of oral cancer, my mom says they couldn't control her pain at the end (she went through hospice and died at my mom's home) because she had already so much tolerance to painkillers.  Eventually she just told the hospice nurse can we please please give her something, I don't care what, she's screaming and has been for 2 days, and the hospice nurse basically said that the amount of morphine necessary to touch the pain at this point would put her in a terminal coma.  Mom consented and that is what they did.

 

When my dad died, he had not been on prescription painkillers (although he'd had back pain every day of his life for the past 20 years), and his death was much easier - it was complications of COPD, though (pneumonia, basically), so not as painful a thing to start with, I guess.

 

 

Anyway, all of that has always made me very leery.  Also my mom said she almost got addicted herself - she had an old pack from someone's dental something, I think, and took one for a bad backache, and then took another the next day, and the next, and then the day after that threw them all away (along with everything else she could find in the house).  Freaked her out how easy it was to just keep taking them.

[MotherGoose]

my grandmother was on long-term oxycontin after she got shingles at, oh, maybe 80. She took the pills for maybe 5-7 years after that - sometimes for pain that was ongoing, but hard to say if it could have been managed another way or not. At any rate, when she died of oral cancer, my mom says they couldn't control her pain at the end (she went through hospice and died at my mom's home) because she had already so much tolerance to painkillers. Eventually she just told the hospice nurse can we please please give her something, I don't care what, she's screaming and has been for 2 days, and the hospice nurse basically said that the amount of morphine necessary to touch the pain at this point would put her in a terminal coma. Mom consented and that is what they did.

 

When my dad died, he had not been on prescription painkillers (although he'd had back pain every day of his life for the past 20 years), and his death was much easier - it was complications of COPD, though (pneumonia, basically), so not as painful a thing to start with, I guess.

 

 

Anyway, all of that has always made me very leery. Also my mom said she almost got addicted herself - she had an old pack from someone's dental something, I think, and took one for a bad backache, and then took another the next day, and the next, and then the day after that threw them all away (along with everything else she could find in the house). Freaked her out how easy it was to just keep taking them.

My friend is an ER nurse and tells me the same thing: opiod pain meds don't help addicts with pain. Which makes being seriously injured as an addict truly awful because nothing relieves their pain.

[Reefgazer]

My elderly uncle (86), who was a WWII vet and had serious pain from injuries from that war, was on so many drugs (painkillers, psychotropics, others) that he was admitted to the hospital for a week to wean him off the meds he was addicted to.  He had multiple docs prescribing all sorts of meds and at his advanced age, his body couldn't clear them as fast as a younger person and he would up addicted, non-functional, and in danger of being put in a nursing home because his 85 pounds wife couldn't handle him when he was angry, out-of-it, and stoned.  So this wasn't just about my uncle's pain, it was about preserving their family unit and keeping uncle out of (expensive) nursing home care.  Sometimes getting off those drugs, even when they are for pain, is the better option.

Weaning the elderly from narcotics, even when they have been used for many years, has nothing to do with cruelty or an opioid epidemic. It has to do with preventing a fall risk.

As we age:

1. We lose a sense of balance. After about age 65 or so, we lose the ability to stand on one foot. This progresses to a wider based gait and some shuffling of the feet, the older we get.

2. The liver and kidneys do not process medications the same way it did 30 years before.

3. Weight changes. We lose more muscle mass with a disproportionate increase in adipose tissue. This also changes the drugs are processed and stored in the body.

4. Elderly have more comorbid conditions and more interacting drugs. For example, someone may be on a blood thinner to prevent another stroke. A simple fall on the tile floor can be life threatening.

5. Hip fractures in the elderly can mean a 50% chance of death in the next year.

There has been a big push to get elderly off of all sedating medications, not just pain medicines. This has been going on for at least 10 years.

Also, pill mills in Florida were shut down about 3 or 4 years ago, at least the bulk of them. Florida has been quite progressive in attempts to end the opioid crisis. But, now it seems it will just be replaced with a marijuana one. Sigh.

 

Edited October 18, 2017 by reefgazer

[Reefgazer]

Getting off disabling over-medication was the key to allowing my aunt and uncle 8 more years together, independently, in their home.  Had my uncle not been weaned off those meds, he would have been separated from his wife and forced to live his last years in a home because he was not manageable when he was on the excessive doses of meds that he was on.  He is not an unusual case;  many elderly are over-dosed, especially in hospitals and nursing homes, which attempt to shut the elderly up and keep them quiet and compliant (read:  borderline catatonic with excessive meds).

I think it has to do with logistics, and not just lobbying power and profit.

 

You can just take a pill with a glass of water. Many of these very elderly folks (or severely physically disabled folks) have no way to get to the frequent appointments that would be necessary for the amount of PT and acupuncture they would need for those to be effective methods of pain relief. 

 

My daughter is in the middle of genetic and rheumatology testing. They know she has a connective tissue disorder and they are relatively certain she has also has an autoimmune issue. She's in pain constantly -- her knees and feet turn so far inward at this point that walking is hard. 

 

PT does wonders for her... but/and we are blessed to live literally down the street from an excellent PT office and an excellent gym with a year-round indoor pool she has access to. If we didn't have the aforementioned, I have zero clue how I would get her to the recommended PT appointments (3+ weekly) or to swim (when she doesn't have PT), considering she is one of three children and the other kiddos have appointments to get to as well.

 

I get it for the younger crowd with issues that allow for other methods of pain relief. What I have a really hard time wrapping my head around is what these methods can possibly do for the elderly. No amount of PT or acupuncture is going to fix what's broken with an 80-something-year-old cancer patient. PT and acupuncture would do nothing for a 20 year old recovering from, say, an abdominal surgery (c-section or similar) -- this is typically where a couple weeks' of narcotics and ibuprofen come into play. Some of the stories I've heard are just cruel. 

 

[Pam in CT]

re (very) senior citizen checking into hospital to wean off opioids:

My elderly uncle (86), who was a WWII vet and had serious pain from injuries from that war, was on so many drugs (painkillers, psychotropics, others) that he was admitted to the hospital for a week to wean him off the meds he was addicted to.  He had multiple docs prescribing all sorts of meds and at his advanced age, his body couldn't clear them as fast as a younger person and he would up addicted, non-functional, and in danger of being put in a nursing home because his 85 pounds wife couldn't handle him when he was angry, out-of-it, and stoned.  So this wasn't just about my uncle's pain, it was about preserving their family unit and keeping uncle out of (expensive) nursing home care.  Sometimes getting off those drugs, even when they are for pain, is the better option.

 

 

That is remarkable.  How did he come to the decision to do this -- on his own in a cogent interval, or in response to urging from his family, or under the recommendation of a doctor?

 

I ask because one of the immense frustrations I've had over the last 2 years as my father has struggled with cancer and become increasingly impaired both physically and cognitively is the realization that there is no quarterback -- while he's had good care overall under Medicare coverage it's massively complex to navigate between specialists and PT and OT and SLT therapists, and there really is no medical professional who has a holistic vision into his *total* medical circumstances... everyone has a slice, no one has the whole...

[Laura Corin]

re (very) senior citizen checking into hospital to wean off opioids:

 

 

That is remarkable. How did he come to the decision to do this -- on his own in a cogent interval, or in response to urging from his family, or under the recommendation of a doctor?

 

I ask because one of the immense frustrations I've had over the last 2 years as my father has struggled with cancer and become increasingly impaired both physically and cognitively is the realization that there is no quarterback -- while he's had good care overall under Medicare coverage it's massively complex to navigate between specialists and PT and OT and SLT therapists, and there really is no medical professional who has a holistic vision into his *total* medical circumstances... everyone has a slice, no one has the whole...

Is there a role for the primary care physician in this situation?

[eternalsummer]

My dad was the same way; he had a primary care physician but that doctor seemed to not really understand what was going on with his heart, lungs, acid reflux, overall frailty, etc.  He had a general idea but the specifics were just too much information for him, I think.  Dad liked him because he didn't try to talk Dad into trying new things or doing anything particularly difficult.

 

Once he got involved with the specialists (when he was dying but we didn't know it yet), it was very clear that no one at the hospital knew what anyone else at the hospital was doing, ever.  At one point the doctor came in for the swallow test and looked down his throat and said I can't do it now, his throat/esophagus is completely full of phlegm, what has he been eating?  And the nurse said, oh, we're tube feeding now, he had x ml of whatever they put in feeding tubes 30 minutes ago.  The swallow doctor said, you shouldn't have fed him 30 minutes before the appt, and wait, doesn't he have acid reflux?  It says here on his chart he has acid reflux.  Nurse says, oh, right!  shouldn't have given him x ml, should have given him x/3 ml, oops!  Guess that's what the prevacid is for in his chart.

 

 

!!!!

 

stuff like that happened constantly.

 

 

Ugh, I don't like remembering it, it was a hard time.

 

I think this is also why elderly people tend to not like to move more than absolutely necessary - it is so hard to get a new doctor to understand the constellation of medical issues some elderly people have acquired.

[Pam in CT]

re geriatric  and particularly end-of-life patients not having a quarterback

Is there a role for the primary care physician in this situation?

He *has* a lovely PCP physician who he adored for decades... but when my father went into oncology, his oncology doctor took the reins, and he stopped doing regular appointments with his PCP.  And that too worked (reasonably -- the unrelated cardio bit started to wobble a bit) so long as he was in active cancer treatment.

 

But when he opted back in April to forego further "active" cancer treatment, he fell into a kind of black hole.  He was (is) a cancer-ridden mess, riding out the progression of a process that's very much driven by cancer... but what cancer doctors do is TREAT CANCER not palliative care.  He kinda-sorta has a palliative care doctor, through whom we organize Medicare covered ancillary services like PT and OT and SLT and (back when he was still home with my mother) visiting nurse, but that guy knows nothing about, for example, my father's pre-existing heart issues.

 

And when he falls, or contracts pneumonia, he goes into the hospital, and then:

My dad was the same way; he had a primary care physician but that doctor seemed to not really understand what was going on with his heart, lungs, acid reflux, overall frailty, etc.  He had a general idea but the specifics were just too much information for him, I think.  Dad liked him because he didn't try to talk Dad into trying new things or doing anything particularly difficult.

 

Once he got involved with the specialists (when he was dying but we didn't know it yet), it was very clear that no one at the hospital knew what anyone else at the hospital was doing, ever.  At one point the doctor came in for the swallow test and looked down his throat and said I can't do it now, his throat/esophagus is completely full of phlegm, what has he been eating?  And the nurse said, oh, we're tube feeding now, he had x ml of whatever they put in feeding tubes 30 minutes ago.  The swallow doctor said, you shouldn't have fed him 30 minutes before the appt, and wait, doesn't he have acid reflux?  It says here on his chart he has acid reflux.  Nurse says, oh, right!  shouldn't have given him x ml, should have given him x/3 ml, oops!  Guess that's what the prevacid is for in his chart.....

 

 

This, over and over -- in the hospital, the doctor on the floor becomes the presiding doctor, and a "complex" case like my father with 3,465 issues OTHER than the pneumonia that brought him in is just too much for a quick scan of the charts to absorb.

 

And then upon hospital discharge he twice went in to "rehab" -- really a step-down between hospital and Someplace Else -- where there's a different presiding floor doctor who's also unfamiliar with the complex difficult cases and who also has no idea about say long pre-existing heart issues.

 

 

It's a mess.  I honestly have NO IDEA what happens to older patients who don't have two sentient (well mostly sentient) advocates on hand like my father does.

 

 

 

 

(This is only very tangentially related to opioid issues, I realize... although possibly it loops back around to pitching a pill is often the easiest thing for a medical professional to do, so becomes a sort of default?)

[TravelingChris]

Yes, there are pill mills.  The actual deaths are primarily caused by Heroin and even more specifically Fentanyl.  Long-term low dose opiods are doing a lot less harm than the high dose NSAIDS I was prescribed before.  Currently and in the last few years, I have not had to take opioids daily since my arthritis was better controlled.  But it has gone back to being not well controlled and steroids- what I used much more of when I was using fewer opioids- are worse than opioids too in terms of side effects-- not only have I developed high blood pressure from steroids but now osteoporosis I guess since I broke a rib/ribs yesterday with no trauma. Many of the alternatives and helps are basically out of reach for me too.  I barely drive currently because of brain fog, dizziness, etc that can happen pretty much anytime especially if a building had fluorescent lights.  So I will be fine to drive, and then I get bad brain fog and general ill feeling due to my lupus.  Things like massage and acupuncture also need transportation and they are not covered by insurance so more costs.  I am also no longer a pain clinic patient because I got so sick I couldn't keep appointments.    But the pain clinic I did attend had multiple types of pain controls- PT, psychological, surgeries, pain patches- machines, steroid/pain med injection into joints, etc, etc   Fortunately I have a concierge doctor and he is helping me by prescribing low dose Norco and my rheumatologist is going to start me on a biologic that may increase my mobility and improve my quality of life.  I have no addiction- I don't go out shopping for drugs- I have had long periods without narcotics-- if my pain isn't at a certain level and not causing a certain level of restrictions of movement, I don't take the 1/2 of a pain pill or the muscle relaxant.  

 

As to falls, I am well aware of risks and fortunately and with better arthritis management, haven't fallen in the last 3.5 years.  But arthritis is the fall risk much more so than any of my meds.  THe slight lightheadness I get from the anti hypertensive, sleep and muscle relaxant combo I take at night is nothing compared to the risk when my foot or knee joints give out.