Doctors For Death? 17,000 deaths prescribed a year

[+ stevenkesslar]

https://instagram.com/p/3jvsM_q66e/

 

I could not post the whole TIME cover story, but this gives you a snippet and if you are a TIME subscriber you can Google it. A sad companion piece to the one on sobriety.

 

An estimated 17,000 Americans die of overdose every year from prescription opioid overdoses. Side effects include local epidemics of HIV transmission from dirty needles.

 

I realize this is complex because an estimated 100 million Americans suffer from chronic pain. But it is being fed by a rich and powerful drug industry that seems to have mostly captured the FDA. If this many Americans were being killed by ISIS every year, we would without question be at war.

[mike carey]

I haven't read the Time article—I'm not a subscriber—and I also realise that it is a complex issue. It's difficult to know how many of the deaths are from accidental self-administered overdoses and other 'mistakes', how many from recreational use and how many in clinical settings. The needle exchange item cited in the Instagram piece is a bit worrying. As far as I know, needle exchanges here are one-for-one, not handing our bags of needles. I'm also surprised that a medical user would need dozens of needles, as there is no risk of cross-infection. Still, I wouldn't know, they may be designed as single use. The side effect of HIV transmission would seem to indicate recreational rather than therapeutic use of the drugs.

 

One clinical setting is where a doctor has to increase the opiate dose as the drug loses its effect. In states and countries where euthenasia is illegal—or where the patient for religious reasons sees euthenasia as suicide and therefore unacceptable—doctors can and do ask patients if they want to increase the dose even if their death may be a 'side-effect'. I'm not suggesting this accounts for a large proportion of the deaths, but it does cover some.

 

Overuse of opiates (oxycontin a case in point) is a concern in Australia, partly for the risk of addiction, but also because of the significant black-market diversion of the drugs for recreational use. For those reasons, the number of doses that can be dispensed in one script is controlled. With a centralised single-payer pharmeceutical system excessive prescribing or dispensing of the drugs can more easily identified. (As an aside sales of over-the-counter cold medications like sudafed are also limited with mandatory reporting of suspected multiple sales because they can be used as precursor chemical for ice etc.)

 

I agree with Steven that the number of deaths is a serious concern. If the drug industry in cynically pushing sales knowing that a lot of the drugs will move onto the black market, that is reprehensible. If the regulatory system can minimise the leakage, then it should do everything it can. And if single-payer systems, like ours, and large health care providers, such as those in the US, can negotiate lower prices if usage increases they should do that too. It reduces the cost to legitimate users and reduces the incentive for the drug companies to encourage sales destined for diversion to the illegal market.

[+ honcho]

With a centralised single-payer pharmeceutical system excessive prescribing or dispensing of the drugs can more easily identified. (As an aside sales of over-the-counter cold medications like sudafed are also limited with mandatory reporting of suspected multiple sales because they can be used as precursor chemical for ice etc.)

 

(Decidedly off topic --) The reporting of Pseudoephedrine is also mandatory in California. It hasn't been universally successful in controlling meth production. You still read about people causing explosions in the newspapers.

 

The combination of it and chloritrimeton is still a cheap and pretty darn effective way of dealing with cold symptoms the sedative tendency of the latter was nicely balance by the stimulant of the former, and works a lot better for me when I fall prey to the common cold than the replacement.

[+ stevenkesslar]

Actually, in the longer TIME story it was made clear that the needle exchange stopped HIV transmission. The problem was people were sharing needles to shoot up pain killers. Giving them single use needles and educating them on their use made a difference, since if I recall correctly some of them were using needles to shoot up pain killers over a dozen times a day.

 

The current Indiana Governor, Mike Pence, had to be persuaded by the local Republican sheriff to suspend his moral judgment against needle exchanges and hand out needles to stop HIV transmission.

[+ purplekow]

My area of NJ is an upper middle class neighborhood with the highest rate of opiate addiction in the state. In the last 4 years, 5 doctors have been arrested for illegal prescribing practices. One of the doctors was the #1 prescriber of Oxycontin in the country and the pharmacy near him was the #1 pharmacy in filling oxycontin prescriptions. When he was arrested, the first of the five, my office was flooded with dozens of teenagers looking for pain medications for back pain, headache etc. One patient, who was looking for referral to a facility to get off drugs, mentioned that a new name was going around and for $500 cash, he would write a prescription of up to 120 pills of whichever drug you prefer. Street value about $3000 for Percocet. He was the fifth one arrested. But for a physician, 10 scripts a day, $5000/day or $1.2 million a year in cash. Easy to see why some would opt for that. Also easy to see why some would not be circumspect in writing only 10/day but 20/day or 30/day or 50/day.

In NJ you can prescribe electronically but not opiates. Those have to be written. It would be very easy to say you need a written and electronic prescription that are identical in order fill and opiate prescription so as to easily track opiate prescribing. In addition, you could require that people utilize insurance and not pay for these in cash, but cash is the preferred means of paying for these medications.

17000 is about the same number of known overdose deaths, is about 1 per state per day, small price to pay for big Pharma profits.

Obamacare has only made this problem worse. I am now working for a corporate medical group which accepts what used to be termed Medicaid. I will be leaving because the drain of people looking for pain medications, benzos, and other drugs of abuse has my this practice a joke. We are hardly better than the $500 buffet.

By the way, 100 million chronic pain people is exaggerated. That would be 1 in 3 people in the country, hell I am not sure 1 in 3 in this country are conscious, but it is likely that 1 in 3 are in school or preschool, again, not necessarily conscious.

[+ stevenkesslar]

Wow, PK, that confirms things are as scary as TIME reported.

 

The 100 million figure was from TIME. They did say only a % of them have bad enough pain that this might be viewed as a legitimate option. My point in including it is that what makes it complex is there is a legitimate basis for people seeking pain relief.

 

Thanks for the post.

[ZhenXBear]

https://instagram.com/p/3jvsM_q66e/

 

I could not post the whole TIME cover story, but this gives you a snippet and if you are a TIME subscriber you can Google it. A sad companion piece to the one on sobriety.

 

An estimated 17,000 Americans die of overdose every year from prescription opioid overdoses. Side effects include local epidemics of HIV transmission from dirty needles.

 

I realize this is complex because an estimated 100 million Americans suffer from chronic pain. But it is being fed by a rich and powerful drug industry that seems to have mostly captured the FDA. If this many Americans were being killed by ISIS every year, we would without question be at war.

 

That's an interesting find, Steven. It would be interesting to see the breakdown of those people, and what the circumstances were surrounding the death (e.g. suicide, mismanaging the medication, or addiction). I can tell you this, that "technically" the numbers are likely higher. I know that in geriatric medicine when death is near patients are often given higher and more frequent doses of morphine or other pain meds to aid in the death process and hasten them along. I don't really consider this an OD situation...more like, mercy in a person's final days. The difference though is reducing their death process from days to hours; I hope someone does it for me when I'm finally there.

[wisconsinguy]

That's an interesting find, Steven. It would be interesting to see the breakdown of those people, to see what the circumstances were surrounding the death (e.g. suicide, mismanaging the medication, or addiction). I can tell you this, that "technically" the number likely higher. I know that in geriatric medicine people when death is near patients are often given higher and more frequent doses of morphine or other pain meds to aid in the death process and hasten them along. I don't really consider this an OD situation...more like, mercy in a person's final days. The difference though is reducing their death process from days to hours; I hope someone does it for me when I'm finally there.

Regarding the writing of scripts for pain meds. Wisconsin has for a number years now, been part of a network, that is available to all states to keep track of number of opiate prescribing issues. They include monitoring the prescribing practices of those practitioners that can write scripts for the oxy's and Vic's. Many PC practitioners are referring to legitimate pain clinics. If they choose to treat patients on their own, they are having patients sign a pain contract. Allowing them to call a patient in for a random drug screen. It allows the doc to see a number of things. If a patient says they are taking a prescribed pain killer routinely, and you come back negative, you are probably gobbling them up right away, or selling/giving them away. It also prevents doctor shopping. Personal example. About 14 yrs ago I had a misdiagnosed back issue. Massive amounts of steroids and a very liberal dose of Vicodin. During that time I had a muscle biopsy. And, the surgeon gave me another script for Vicodin. A small number to carry me through a few days. Mind you, I already had a script. I got it filled. Within two days, I got a call from the the nurse practitioner from the original prescriber's office. Wanting to know what was up. He said the office got a call from "someone" saying it appeared that I was doc shopping. He said if it happened again, they would not script write again. My point is that there are many states that follow these practices. Some do not.

 

Many of you know that I favor physician assisted suicide. I am aware that this and making someone's last days more comfortable is different. It has been interesting to the see the evolution of pain management, especially those last days of a persons life. There have been many positive advances. One of which is hospice care. That care actually now extends into hospitals/long term nursing facilities/private home. The nurses that come into these places are well versed on types, strengths, and timing of these meds. There are private docs out there that are still concerned about being accused of over prescribing.

However, the younger groups of docs are a more concerned about keeping the patient comfortable, and just helping them, "let go."

[JDXXX]

Wow, PK, that confirms things are as scary as TIME reported.

 

The 100 million figure was from TIME. They did say only a % of them have bad enough pain that this might be viewed as a legitimate option. My point in including it is that what makes it complex is there is a legitimate basis for people seeking pain relief.

 

Thanks for the post.

 

+1.

 

What TIME has reported according to sources, is an informative piece of information that apparently need to be shared with the public for future reference of what's going on in the medical profession regarding corrupt doctors prescribing patients unnecessary prescriptions to help feed into what will cause in the end unforeseen consequences of a form of slow suicide possibly.

 

A friend of mine about eight years ago, had an appendix operation, and while recovering from the operation, she was prescribed vicodin to help deal with the pain. After she recovered from the surgery, she unfortunately submerged, and horrifically became addicted to vicodin taking them on a daily basis.

 

After long talks with her on the phone, and she eventually fell into a depression, I finally convinced her to get into rehab for which she did. Me, and the assigned psychotherapist that was treating her along with other patients in the rehabilitation facility at the time conveyed to her it's a good thing she's was in rehab getting treatment for her painful addition knowingly if she continued with the ongoing daily drug abuse, she were to encounter some possibly deadly consequence in the end and as a result she would have suffered a severe heart-attack due to inflammation of the heart or possible Cardiomyopathy.

Cardiomyopathy:

Damage to the heart muscle from causes other than artery or blood flow problems, such as from infections or alcohol or drug abuse.

These additions I have seen unfortunately, do occur at times within mental patients who suffer severe mental illnesses such as Bi-Polar depression or Schizophrenia do large quantities of drug intake prescribed by they're physician on a daily basis as a slow form of suicide to help dissolve and evaporate the illness they're enduring frequently and just want a way out of suffering.

 

Of Course Zhenbear has good point as well as said below:

 

That's an interesting find, Steven. It would be interesting to see the breakdown of those people, and what the circumstances were surrounding the death (e.g. suicide, mismanaging the medication, or addiction). I can tell you this, that "technically" the numbers are likely higher. I know that in geriatric medicine when death is near patients are often given higher and more frequent doses of morphine or other pain meds to aid in the death process and hasten them along. I don't really consider this an OD situation...more like, mercy in a person's final days. The difference though is reducing their death process from days to hours; I hope someone does it for me when I'm finally there

[BabyBoomer]

Where I live the doctor must write the Dx code on all scripts for Percocet & Vicodin or the pharmacy will not fill them.

 

~ Boomer ~