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medpundit |
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Tuesday, March 30, 2004Indeed, various media outlets-from NPR to the New York Post-claim that numerous new OxyContin addicts have been created by doctors who cavalierly prescribe the drug.? Articles or news segments assert that overdose frequently occurs among the innocent patients of careless doctors, but the profiled "victims" are overwhelmingly prior drug users who now get their fix by snorting or shooting OxyContin.? The featured subjects almost always turn out-like the Sentinel's-not to be "accidental" addicts but just plain druggies.? ( In a 2001 story about the supposed "epidemic" in Appalachia, the New York Times Magazine didn't cite a single case of doctor-caused addiction; instead, it portrayed "casual" drug users who faked pain or otherwise illegally obtained OxyContin in a sympathetic light, claiming these "accidental addicts" didn't know that prescription opiates are addictive! ) While it's true that most people who abuse prescription narcotics have a history of substance abuse, it's also true that in this day and age it's much easier to dupe a doctor into giving you the good stuff. Now that pain is touted as the "fifth vital sign," (an unmeasurable vital sign, I might add) doctors are reluctant to seem insensitive, even though there may be plenty of signs that all is not on the up and up with the patient. I once worked with a colleague who had a patient tell him that one of his other patients was selling her narcotics at their workplace, yet he kept refilling her prescriptions. When I asked him why he said , "That's just hearsay. She's in pain and needs them." He felt as the physician who had interviewed and examined her he knew what he was doing, and it was the right thing in his mind. He just didn't believe his other patient. But there is another sort of misuse of narcotics that occurs by patients who are not intentional drug addicts but who have doctors as eager as my former colleague to eliminate all pain - and those are patients whose pain is magnified by their psychology. I admitted one such patient just this morning for a colleague. The ER called to say she had fallen in the night. They couldn't find any broken bones, but she refused to move for them. Wouldn't sit up, wouldn't stand up, wouldn't roll over. The pain was too much. They said she had a history of multiple falls, ever since she had a stroke last year. And a history of chronic pain. When they read me the list of her medication, it became obvious why she's been falling so much. She was not only on Oxycontin, but on a sleeping pill and a sedative for anxiety. No doubt, she's in pain, but its root is not likely to be physical since all of those pain medications aren't alleviating it. And in fact, they are probably harming her by impairing her ability to walk safely and to think clearly - clearly enough to come to terms with the impact of her stroke, which is most likely the true source of her pain. It's people like this who are harmed the most by the belief that all pain is created equal. That's why I find it hard to get too worked up by DEA efforts to hold doctors accountable for their narcotic prescribing habits. posted by Sydney on 3/30/2004 08:56:00 AM 0 comments 0 Comments: |
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