opiods – Weary Wretch

The complexity of Death Panels

For those that don’t know, I have asthma. No biggie, I just use my medicine as I should and I’m OK. The symptoms come on, seemingly in a random fashion. In other words, I can’t (nor can doctors) predict when or why I have a flare up and have to have these medicines at hand.

Want to know why that matters to me, and will to you, eventually?

The first issue came about on obtaining the medicines. In an effort to curb the rapid rise of health care costs and to stop evil patients from abusing the Medicare/Medicaid/private insurance industry, Congress and Obama decided to put the crunch on wasteful prescribing and use of medicines.

This is the pharmaceutical side of death panels, by the way.

This is how it works. The doctor sees the patient and prescribes medications that are felt to be needed for up to the next 3 months. At the time of the doctor-patient visit, the doctor is under pressure to prescribe for the symptoms or diseases that need treatment, and in some cases, may need treatment in the next 6-12 months. As I pointed out to my doctor one year, he/we were dead wrong in our predictions on the degree the asthma would affect me that spring. I ran out of medicine, couldn’t get an appointment to see my doctor and had to resort to all manner of probably illegal methods of obtaining what I needed. I survived and we talked about this and he offered a solution.

Horde!

So my doctor’s solution to this congressional-caused chaos was to cheat the system. So I did. I insured that I had several inhalers on hand, in case the asthma symptoms returned at an inconvenient time for my doctor. But, here is a white elephant in the room. Packaged medicines don’t have an infinite shelf life. They expire. The co pay for the drug may be nothing or $75. Now what does one do? Use the expired drug and hope it works, or at least doesn’t kill you? Or, try to replace the expired drug with an unexpired unit?

The prescribing pharmacy refused to replace the unopened, unused and expired drug.

Enterprising fellow that I am, I decided to trace down the manufacture. In the old days, whenever that was, it was common practice for the pharmacy to replace expired, unused medications. The manufacture of one particular drug that I needed was GlaxcoSmithKline of Canada. I googled (which makes it official that I’m a google doc) GSK and read their online replacement policy.

Great, “No return authorization required.”

Just send the drug(s) to the address provided. So, I grabbed up the 4 unopened, unused units of medicine and went to the post office. That’s the United States Postal Service. The one that requires me to fill out a United States Customs Service form to declare what I was sending to this foreign country. Oops, another white elephant in the room. As of just recently, they, the USPS, will not ship prescription drugs through their service, by act of Congress. Sorry bud.

Do you know why our august Congress decided to make it illegal to ship prescription drugs?

Well, let me tell you. It’s for a variety of reasons but the last straw is the opioid crisis. Truthfully, a little more than just opioids, but drugs of abuse in general. See, one of the major avenues of illegal drugs into the US is only partly due to the absence of a wall on our southern border. Other major avenues include the USPS, UPS, FedEx and the like. The WWW, the Internet, Google. K2 (synthetic marijuana), anabolic steroids, opioids, Viagra and a host of other medications have been flowing south for years. It’s a cost issue as well as an access issue.

My expired, unused asthma medication cost me a pretty penny in co-pay ($300). It was prescribed by a US doctor, dispensed from a US based pharmacy (probably the largest in the US) that had obtained it from a Canadian based USCS approved importer of pharmaceuticals into the US and I can’t get it replaced through the company approved system because our US Congress thinks I’m importing (exporting?) illegal drugs, or at least facilitating others to do so!

Now we are down to the point of all this. We’ve all heard the phrase, “Be careful what you ask for, you might get it and then what would you do?” There are versions in all the major religions and folklore. In the mid-twentieth century, Robert K Merton, an American Sociologist, coined, “The law of unintended consequences.” Plagiarism at its best.

Another witticism. We want to stop illegal drug abuse, illegal immigration, gun violence, rolling stops at busy intersections or whatever. Just pass another law, that’ll fix it.

Your grumpy Uncle Dave.

Weary.

Death Panels

I received a 7 page double sided letter from CMT. Care Management Technologies, which sounds real official. It is part of Missouri Department of Social Services that monitors drug claims, diagnoses and ER visits. It is also part of Missouri Medicaid Audit and Compliance Unit (MMAC, read Death Panel). Probably a whole lot more, but I’ll come back to that.

The purpose of the letter was to bring to my attention that a patient I saw and gave narcotic medication (opioid narcotic, gasp) to who had also received narcotic prescriptions from 5 other doctors. Of course 2 of the others were hospitalists that had taken care of the patient while he was in the hospital.

I had given the patient one hydrocodone tablet while we were waiting for lab results in the ED. No other medication was given by me and no scripts were given by me.

In contrast, he received 334 tablets from the 4 other physicians over a 3 month time frame. That sounds like a lot, but it is 25% less than the maximum recommended dose over 98 days.

And, the pain the patient was being treated for was metastatic prostate cancer. Prostate cancer metastasizes to bone and is the most excruciating cancer pain known. There is no cure and treatment options include estrogen hormone supplement and castration to lessen testosterone which stimulates the prostate cancer to grow. Otherwise the only thing modern medicine has to offer is relief of pain.

So, you must be wondering why I am going on about all this trivial and complex issue. If you remember, we have suffered a few years of Obama Care and the rationing of health care that was predicted to result. Here is evidence that the pundits were right to predict that the “Death Panels” were coming. And, they are here. Actually, they’ve been here for a lot longer, they are just more functional since Obama.

And last week, President Trump signed the “Omnibus Budget Act” leaving Obama Care intact. And, President Trump vowed to stop all the opioid abuse, like my giving this patient one pain pill in the emergency department.

I have been writing about the pending doom of this opioid hysteria for a couple of years. Again will I stress;

There is no opioid crisis, there is only opioid hysteria.

There is a crisis of poor law enforcement, poor government regulations, poor prescribing habits and poor management of psychiatric health issues in America.

There is no opioid crisis.

Venting from your grumpy Uncle/Brother Dave.

Weary

Team Dream Busters

December, 2017

A street dose of heroin or carfentenyl might costs $5-100. Good for 1-2 good times. Unless…

It’s too strong. Since this stuff isn’t regulated by the FDA, DEA, CDC, or Pharmaceutical Industry standards and what not, it might be anything. If it’s too weak, the next dose might be too strong. Because you might try to compensate for the strength of an unregulated drug and shoot up more the next time, bam, you’re out to lunch. Comatose. Soon to be dead meat and no longer a chain around society’s neck. Unless…

You come to see me, where I and my hot-shot team of nurses and techs, quickly establish an IV and shoot you with a dose of Narcan (naloxone, an opioid antagonist, and in layman’s terms the antidote to opioid overdose) and you lose all the wondrous effects of the drug you worked so hard to purchase and carefully use. Unless…

You go into withdrawal, just the opposite of your desired effect.

Team Dream Busters.

From your grumpy Uncle/Brother Dave.

The Government is Out to Get Me

The Attorney General, Jeff Sessions, is out to get me. Well, maybe not me specifically, but anybody and everybody that is complying with the law in regards to drug prescribing and distribution. What I just said is not paranoid hyperbole.

Sessions has designated 12 federal prosecutors to go to cities that have a high impact from the “opiod epidemic”. These prosecutors are to seek and destroy anyone deemed to be prescribing opiod narcotics, and profiting from the process. Their targets include doctors and other health care practitioners, pharmacists, hospitals, clinics and just about anybody or anything that is legally involved in the drug trade.

In his own words in a speech to the Columbus Police Academy in Ohio, he stated, “If you are a doctor illegally prescribing opioid drugs for profit or a pharmacist letting these pills walk out the door… we are coming after you,” Sessions declared. The Opioid Fraud and Abuse Detection Unit, as Sessions referred to the 12 attorneys, will … work in conjunction with the FBI, Drug Enforcement Administration and Health and Human Services to identify and arrest the violators.(2)

Now, why is that? There have been drug crises ongoing in this country and most of the developed world in one form or another, forever. Why would the government decide that the opioid epidemic is worthy of it’s attention, as opposed to, say, methamphetamine, peyote, heroine or marijuana?

Because of the Willie Sutton Syndrome. The bank robber that replied that he robbed banks because that was where the money was.

You see, all of the aforementioned entities are regulated, licensed and insured out the wazoo. Which means that they can be further regulated with licenses, permits, fines and the like. To a point that money may actually be collected.

So, do you think the War on Drugs has produced anything of substance, yet? No. In fact, the only thing the War on Drugs has produced has been a dependent culture and extreme expense to the taxpayers for detention and incarceration, rehabilitation (failed and otherwise), dependent support, medical expenses and on and on.

But, are these legal entities actually responsible for the “opioid epidemic”? Even the liberal New York Times doesn’t think so. “… opioid addiction, now made more deadly by an influx of illicitly manufactured fentanyl and similar drugs.” (1) Overwhelmingly, these drugs are obtained illegally. They may be stolen, purchased on the street from nefarious sources or obtained by malingering (presenting false symptoms for the express purpose of obtaining these drugs).

It doesn’t matter, the government has finally realized that they are more likely to collect their fines from someone making a 6 figure income and dependent on said government for the “right ” to practice their vocation than someone that is on welfare.

One drug dealer’s opinion from your grumpy-drug-dealing Uncle/Brother Dave.

1. https://www.nytimes.com/interactive/2017/06/05/upshot/opioid-epidemic-drug-overdose-deaths-are-rising-faster-than-ever.html

2. http://www.rollingstone.com/culture/news/jeff-sessions-targeting-doctors-profiting-off-opioid-epidemic-w495603

Hunting Fentanyl

August, 2016

I saw a patient tonight that was about 40 years old. He came in for other reasons, but in the interview, he said he was on a Fentanyl patch for chronic back pain. My patient commented that he went out in the woods this morning to put up his deer stand.

Fentanyl is a synthetic form of morphine. It is a mind altering substance, meaning that it clouds judgement, alters reaction time and just plain messes with the mind. Yeah, just like alcohol.

I can see it now. Come November my patient will come in from a hunting accident;

“I fell out of my deer stand and broke my neck.” or,

“I thought he looked like a deer so I shot him. I didn’t realize that it was my Brother-in-law.”

or some other ridiculous story.

So, these Doctors (this is not an unusual occurrence) are sending him out to work as a welder and hunt while this trans-dermal patch makes sure he has sufficient narcotic in his body to relieve his pain 24/7

I’m often embarrassed by my colleagues.

Your grumpy Uncle/Brother Dave.

Weary