Help me not be cynical

mtsteelhorse · Jun 17, 2014

Trust me, there are a LOT of these types out there. I work in a detention center and it's a growing problem. They doctor shop, pharmacy hop, "lose their scripts," leave them in their vehicle back in podunksville...the list goes on and on. Interestingly enough when they come to jail, supposedly on large quantities of pain meds, yet don't display s/s of withdrawal. Hmmm...what's the street value on oxy??? Or, they consume large quantities IV and do suffer withdrawal in addition to criminal charges. I know there is a legitimate need for pain medication and long term management of chronic pain, but the abuse is a huge problem nationwide. It's a tough business to be in. Curious as to your prescribing practices in the clinic. Some providers prescribe just enough for a week at a time. What kills me is the "I'm filing for disability" due to back pain...23 years old, remote injury and no substantial physical findings. Makes me crazy. And we wonder why health care costs are so high.

Psychcns · Jun 17, 2014

Pain medicine is tricky. I read several posts on student doctor network in the pain and rehab medicine section on "the opioid epidemic" . In response to an article in the NY times. It looks like the direction in pain management is away from opioids and more toward antiinflammatories, trigger point injections, psych treatment, meditation etc. Does your clinic have a overall treatment philosophy? Or a way to address potential abuse.

mountainaireNP · Jun 24, 2014

There would be a riot here if we started telling people to meditate for their pain or take Naprosyn. I agree the movement should be away from opioids, I just don't want to be around here to see it.

It's so mentally draining to see these people. I had one just know who came in with his grandmother, who of course paid for it and no doubt babies him until you'd want to throw up. And I'm supposed to humor these people...

mlbarnes · Jun 24, 2014

In our practice we do not accept patients without documented medical evidence of chronic pain condition/s. Until the records are reviewed and we have made the decision to accept the patient they will not be seen much less given a prescription. We have established narcotic contracts that are specific and explicit with random Ameritox and in office drug screens. If a patient is diverting instead of taking the med, the drug screen is very helpful. We also have a strict policy of no second chances if the patient is diverting the medication or not adhering to their contract. We have found that patients with legitimate conditions do not have problems providing us with records and having a narcotics contract which many times includes agreeing to try different options such as non-opioids both as primary and as adjuncts, and other meds as indicated by assessment and by exhausting all other pain management options first.

It is very difficult not to allow ourselves to be influenced by the poor behaviors of others, such as the MA to whom you refer. I have had one MA such as this and I finally had to speak with her about how her attitude was making it difficult for me to do the best job possible for my patients. I did include the clinic manager/HR in this conversation and it was well recieved. It is up to you as the educated professional that you are to set the example. Do not allow yourself to fall into this trap and have a zero tolerance for behaviors which demean the patient. Pain management is a legitimate discipline but because of the nature of the medications it is also very easily abused. Help your clinic develop a plan for patient intake and management if you can, this will help you maintain a positive attitude.