Doctors and opioids, a troublesome connection.

[SpankyMcFarland]

A story that hit the headlines in NL last week:

http://www.cbc.ca/news/canada/newfoundland-labrador/hollohan-drug-arrest-1.3783772

This is the same clinic as that used by Dr. Sean Buckingham, an extraordinary coincidence?

What strikes me is that the local medical board (CPSNL) has not been involved in disciplining many doctors for prescribing offences. In both these cases, it was left to the police to make the bust and, in Buckingham's case, the whole story was widely known long before anything happened. Canada has a very serious problem with opioid abuse and some doctors must be crossing the line but our regulators down here don't seem to be very pro-active.

[drummindiver]

^^^^^^^ not off topic at all


The regulations are in place and there are very serious consequences to the few Drs abusing this for their own purpose. There seems to be this big kick on to blame Big Pharma and Big Medicine for a abuse issues. These medications are meant to relieve pain and auffering. If a person misuses them, that's on them. I've been in several serious accidents in my life where pain meds were necessary and was very thankful for them. I've also seen friends and family dying from cancer, and the pain meds were their only coping mechanism.

[moderator's note: the 'off topic' posts pointed to here were hidden by the mods]

Edited October 3, 2016 by Michael Hardner
added note

[SpankyMcFarland]

^^^^^^^ not off topic at all

The regulations are in place and there are very serious consequences to the few Drs abusing this for their own purpose. There seems to be this big kick on to blame Big Pharma and Big Medicine for a abuse issues. These medications are meant to relieve pain and auffering. If a person misuses them, that's on them. I've been in several serious accidents in my life where pain meds were necessary and was very thankful for them. I've also seen friends and family dying from cancer, and the pain meds were their only coping mechanism.

Their use for cancer pain is widely accepted across the world. What distinguishes North America is their use in many other situations where they are both less effective and more liable to cause addiction. This has created a cohort of young addicts.

In Atlantic Canada, we have seen a massive in opioid use that we are only now getting to grips with. Relatively few doctors have actually been disciplined. Some of the criminal cases were previously neglected by the regulatory bodies.

Edited October 3, 2016 by SpankyMcFarland

[Machjo]

Perhaps it's time we required any prescription for a particularly addictive drug like an opiod to get two physicians' signatures? Just a thought.

[drummindiver]

Their use for cancer pain is widely accepted across the world. What distinguishes North America is their use in many other situations where they are both less effective and more liable to cause addiction. This has created a cohort of young addicts.

In Atlantic Canada, we have seen a massive in opioid use that we are only now getting to grips with. Relatively few doctors have actually been disciplined. Some of the criminal cases were previously neglected by the regulatory bodies.

I divide my time between Atlantic Canada and southern Ontario, and am well aware of the problems. However, cancer is not the only time opioids are indicated for pain.

The reason few Drs have been disciplined, is because they are doing their job of helping their patients. Should they not help a person in pain on the gamble that person may decide to misuse medication? How does a dr know? They are not psychic. As I've said, I've had three accidents and one oral surgery where I have required narcotics, and am thankful for them.

[drummindiver]

Perhaps it's time we required any prescription for a particularly addictive drug like an opiod to get two physicians' signatures? Just a thought.

A good idea if the intent is to treat pain effectively and not as censorship.

[Machjo]

I think the good thing with two physicians' signatures is that a physician won't prescribe it if he thinks another physician might refuse to. Looks bad on him. As a result, he'll prescribe it only if he is certain another physician will sign it too.

If he's not certain, then he'll probably prescribe something weaker that he knows any other physician will sign. Might make the system less efficient at the front end, but more so at the back end by reducing addictions, etc.

[drummindiver]

Yes, but some physicians are too afraid to prescribe anything for fear of pros cut ion, even if it means having a patient in pain. If you are the secondary signee, what are the chances do you think they would sign off, not knowing the patient?

[Machjo]

The second pysician might have to re-assess the patient for a second opinion. He he agrees with the first one, then he'll sign off on it. As it stands now, it would seem we're prescribing opiods like candy. Honestly, I'd rather suffer a little pain until I'm healed than possibly suffer opiod addiction for life.

I'm not an opioid addict, and I'd never want to become one either. From what I've read, withdrawal from opium is no walk in the park.

[SpankyMcFarland]

I divide my time between Atlantic Canada and southern Ontario, and am well aware of the problems. However, cancer is not the only time opioids are indicated for pain.

The reason few Drs have been disciplined, is because they are doing their job of helping their patients. Should they not help a person in pain on the gamble that person may decide to misuse medication? How does a dr know? They are not psychic. As I've said, I've had three accidents and one oral surgery where I have required narcotics, and am thankful for them.

It's not the only time (heart attack, renal colic etc.) but you've got to be very careful using opioids for CHRONIC non-cancer pain. In Britain, for example, physicians are much more cautious about this and their death rates prove it.

I've quoted two examples where physicians were not stopped by their medical boards. In one of those cases the physician WAS disciplined but was allowed to return to practice and went straight back to doing what he was doing before until the police stepped in years later. It's a little hard to believe these are the only examples.

[drummindiver]

It's not the only time (heart attack, renal colic etc.) but you've got to be very careful using opioids for CHRONIC non-cancer pain. In Britain, for example, physicians are much more cautious about this and their death rates prove it.

I've quoted two examples where physicians were not stopped by their medical boards. In one of those cases the physician WAS disciplined but was allowed to return to practice and went straight back to doing what he was doing before until the police stepped in years later. It's a little hard to believe these are the only examples.

It's up to the police to stop law breakers. If the board had any info, they would have passed it on to the police anyways, so end result is appropriate.

So do you have links that state UK Drs are more cautious? I looked, couldn't find. I do believe their harm reduction system works better than most for existing addicts. This is very likely the reason for disparity of death rates.

Edited October 4, 2016 by drummindiver

[SpankyMcFarland]

It's up to the police to stop law breakers. If the board had any info, they would have passed it on to the police anyways, so end result is appropriate.

So do you have links that state UK Drs are more cautious? I looked, couldn't find. I do believe their harm reduction system works better than most for existing addicts. This is very likely the reason for disparity of death rates.

Here's one article that mentions the difference between US and UK which would apply to Canada too:

In the United States, opioid analgesics have increasingly been prescribed in the treatment of chronic pain, and this trend has accompanied increasing rates of misuse and overdose. Lawmakers have responded with myriad policies to curb the growing epidemic of opioid misuse, and a global alarm has been sounded among countries wishing to avoid this path. In the United Kingdom, a similar trend of increasing opioid consumption, albeit at lower levels, has been observed without an increase in reported misuse or drug-related deaths. The comparison between these two countries in opioid prescribing and opioid overdose mortality underscores important features of prescribing, culture, and health systems that may be permissive or protective in the development of a public health crisis.

https://www.ncbi.nlm.nih.gov/pubmed/25190034

Here is another one:

https://www.ncbi.nlm.nih.gov/pubmed/23692335

PubMed is a good place to look.

I will look for better references.

Here's a scary article that relates max prescription dose to risk of death:

https://www.ncbi.nlm.nih.gov/pubmed/21467284

We certainly have a prescription opioid crisis in Canada:

http://healthydebate.ca/2014/01/topic/politics-of-health-care/prescription-opioid-crisis-canada

http://www.huffingtonpost.ca/david-juurlink/opioid-addiction-epidemic_b_8691624.html

One of the problems is that we have been very slow to gather data nationally on this problem and usually compare ourselves to the world's worst performer, the US.

Edited October 4, 2016 by SpankyMcFarland

[Machjo]

We need to protect the presumption of innocence too. It is very difficult to prove the distinction between honest overprescription of a drug and drug trafficking. That's where simply requiring two physician's signatures for some drugs can avoid at least some problems at the front end and solve more problems than it causes.

[Machjo]

We should add that some people are probably more prone to opiod addiction than others. For example, why a healthy-minded patient might not develop an addiction from one simple prescription, a person soffering from post-traumatic stress or transgenerational post-traumatic stress could be far more prone to it. And just think of how many people in society can suffer post-traumatic stress. Professionally alone, post-traumatic stress can affect soldiers, police officers, paramedics, fire fighters, and others. Many indigenous survivors of the Indian residential school system can suffer it too, along with sexual-assault victims, parents to whose a child, those who have gone through a really bad divorce, refugees coming from a war zone, and many others. Plus any of their children can suffer transgenerational traumatic stress too. In Canada, we often attribute trans-generational traumatic stress to the children of the survivors of the Indian residential school system, but in reality the child of any person who suffers PTSD can develop trans-generational PTSD, so that includes the children of soldiers, police officers, paramedics, fire fighters, and many others.

For these reasons, before a physician prescribes an opiod, he has to consider not only the physical ailment but also the history of the patient. If there is any reason to believe that the person may suffer any form of PTSD, then he should prescribe with extra caution.

[SpankyMcFarland]

http://www.canadaka.net/link.php?id=98643

This is not an isolated example. I have heard of many cases over the years. At least it was for personal use here. 

[Bonam]

Any individual is the final guardian of their own health. While there are things that we can do to tweak how and when physicians prescribe opiods, and clearly physicians that specifically facilitate addicts getting their high should be dealt with, in the majority of cases it really all comes down to individuals taking initiative in thinking about their own medicine use and monitoring their own propensity to get addicted to something. A culture of introspection, critical thinking and self-reliance is what is missing in this issue like in so many others. 

[SpankyMcFarland]

On October 4, 2016 at 9:47 AM, drummindiver said:

It's up to the police to stop law breakers. If the board had any info, they would have passed it on to the police anyways, so end result is appropriate.

So do you have links that state UK Drs are more cautious? I looked, couldn't find. I do believe their harm reduction system works better than most for existing addicts. This is very likely the reason for disparity of death rates.

It is up to the medical, dental and pharmacy colleges to monitor practitioners for inappropriate prescribing much more aggressively than they do now. For example, kids can become opioid addicts after wisdom tooth surgery if they are prescribed opioids. These drugs are incredibly dangerous for young people. In older patients, back pain is frequently mismanaged with excessive opioids that fail to treat the problem. create addiction and cause death from intoxication or accident. 

[Bonam]

13 minutes ago, SpankyMcFarland said:

 For example, kids can become opioid addicts after wisdom tooth surgery if they are prescribed opioids. These drugs are incredibly dangerous for young people. 

See this is the kind of statement that just inherently assumes that personal responsibility isn't even a thing. Where are the kid's parents? Why would any remotely reasonable parent assume that continuing to give their child opiod painkillers months after a wisdom tooth removal and long after the original prescription has runout is a good idea? Google is always only 1 second away. "How long should I take painkillers for after wisdom tooth removal?" A cursory examination of the results clearly shows the answer is a few days, and that it is up to the patient's judgement to ease themselves off the pain medication as soon as it is no longer needed. Special cases that involve long term complications can exist but these are clear when they are encountered. 

 

People have brains and need to use them. 

 

I took opiod painkillers after my wisdom teeth were removed. For two days. Then I felt like I didn't need them any more and stopped taking them. I'm not some special hero, anyone can and should act accordingly in a similar situation. 

Edited October 12, 2016 by Bonam

[drummindiver]

Again, without these meds many people would suffer incredible pain. As Bonam points out, people need to take responsibility for their usage. Your dr prescribes them to ease your suffering. Use them wisely.

 

 

 

 

On 10/11/2016 at 11:58 PM, SpankyMcFarland said:

It is up to the medical, dental and pharmacy colleges to monitor practitioners for inappropriate prescribing much more aggressively than they do now. For example, kids can become opioid addicts after wisdom tooth surgery if they are prescribed opioids. These drugs are incredibly dangerous for young people. In older patients, back pain is frequently mismanaged with excessive opioids that fail to treat the problem. create addiction and cause death from intoxication or accident. 

 

Edited October 14, 2016 by Charles Anthony
fixed mal-formed quote

[SpankyMcFarland]

On 2016-10-12 at 1:41 AM, Bonam said:

See this is the kind of statement that just inherently assumes that personal responsibility isn't even a thing. Where are the kid's parents? Why would any remotely reasonable parent assume that continuing to give their child opiod painkillers months after a wisdom tooth removal and long after the original prescription has runout is a good idea?

It's a thing, but not a reliable thing for humans. 

Edited October 14, 2016 by SpankyMcFarland

[SpankyMcFarland]

On 2016-10-13 at 10:33 AM, drummindiver said:

Again, without these meds many people would suffer incredible pain. As Bonam points out, people need to take responsibility for their usage. Your dr prescribes them to ease your suffering. Use them wisely.

 

 

 

 

 

If you're driving, you exercise due caution but you do also expect a system of rules and personnel around you who are tasked with making driving as safe as possible. 

[Argus]

What this boils down to is punishing people in great pain, a lot of them, in order to protect idiots who overdose. I'm not fine with that.

We cut Oxycodintin, now we're cutting Fentanyl and warning doctors to prescribe less of what remains. What next? Addicts will always find something to abuse. Are we going to let people suffer in agony to protect addicts?

 

[eyeball]

Unfortunately people have to suffer because of the way we prosecute addicts.  This is apparently a sacrifice that people in our society should be willing to make in the War On Drugs.

Maybe one day we'll have a Substance Use Act that deliberately squelches out the moral panic around recreational use but the addiction to morality is so very strong.

[SpankyMcFarland]

On 2016-10-21 at 6:18 PM, Argus said:

What this boils down to is punishing people in great pain, a lot of them, in order to protect idiots who overdose. I'm not fine with that.

We cut Oxycodintin, now we're cutting Fentanyl and warning doctors to prescribe less of what remains. What next? Addicts will always find something to abuse. Are we going to let people suffer in agony to protect addicts?

 

Many people in pain are more effectively treated without opioids. Those who are treated with opioids can become addicted and it's impossible to know who will become addicted. In such cases, the physician has caused serious harm. I imagine we will see more litigation in this area. 

 

 

Edited November 4, 2016 by SpankyMcFarland

[SpankyMcFarland]

Some action in Ontario:

http://www.cbc.ca/news/canada/toronto/narcotic-fentanyl-oxy-ontario-doctors-investigated-1.3834874