Sunday, February 8, 2009

I Think They Give Out Controlled Pain Medication Just a Little Too Easily

I'm nearly 27 years old. I've played sports my whole life. I've broken my nose and had surgery on it twice. I've had several other surgeries when I was little regarding an issue with my tear duct. I had my wisdom teeth removed. I had osgood schlatter's disease and patella tendinitis. I've severely sprained each ankle at least 3 times. I've had countless other minor to moderate ankle sprains. I've had thigh contusions that have caused my entire thigh to swell up. I've been hit in the jaw so hard that I couldn't chew food for 3 days. I sprained my left foot so badly that it took me over a month before I could walk on it without limping and over 2 months before I could jog normally on it. To this day, when I run my finger over the top of that foot, it sends a tingling sensation shooting down to my toes.

Despite all these surgeries and injuries, I've never taken a Vicodin. I've never taken Perococet. Nor Norco. Nor Lortab. Nor ANY hydrocodone or oxycodone product. The strongest pain medication I've ever felt the need to take is 800mg of ibuprofen.

Now, I don't think I have some great level of pain tolerance. Far from it. I'm just not a baby about pain. When you get injured, I realize that you're going to have a bit of discomfort, so I deal with it. I feel like a lot of people don't understand that concept. Moreover, I feel that a lot of prescribers jump to the controlled pain medications (mainly Vicodin and Percocet) far too quickly.

I realize that many people do need these medications. A ruptured disc can be excruciatingly painful and debilitating without pain meds. Knee and hip replacements, I can understand. You break your leg in 5 places, yes, you probably need some strong pain medication. And obviously, cancer patients need their pain meds.

However, most other instances shouldn't require anything stronger than ibuprofen, at least to start out. I'll give you an example... A friend of mine recently got into a car accident. The accident wasn't too major. A lot of damage was done to his vehicle, but he walked away from the accident just fine with only a couple minor bruises. Regardless, the police urged him to go to the hospital to get himself checked out just to make sure. He went to the hospital, told them he had a couple bruises but felt mostly fine. Know what they gave him? DILAUDID! For a couple minor bruises, he walked out of the emergency room with a prescription for Dilaudid!

It's those kind of prescribing habits that make pharmacists pause for a couple of extra seconds every time we come across a Percocet prescription. Those prescribing habits are what make it so easy for drug seekers to have access to prescriptions for their CII's of choice. Those kind of prescribing habits make us question even people who get pain meds regularly for legitimate reasons.

We all have those patients who have been getting a month's supply of Perocet (or similar narcotic) every month on the dot for years. You see them come into the pharmacy, and they walk just fine. They talk to you just fine. You try to find any sign of pain or discomfort, and you just can't do it. You're left wondering just what the hell they're getting all this Percocet for, but you can't even begin to guess. These are the patients that make us suspicious of everyone.

I guess my point in all this is that there should be no reason that we dispense as much Vicodin and Percocet as we do Lipitor and hydrochlorothiazide. There simply cannot be that many people that have such severe pain that they can't be treated with ibuprofen, naproxen, or even just Tylenol.

14 comments:

Frantic Pharmacist said...

Dilaudid!! -- Holy crap. My nephew recently had an uncomplicated wisdom teeth extraction -- Rx for #30 Vicodin with one refill! I think he used about six of them...
I know what you mean -- CII's used to be relatively rare, now we dispense buckets of them. I don't think doctors get enough training in pain management, and I find some nurse practitioners and PA's to be a soft touch where narcotic pain meds are concerned. Prescribers start people on the stuff with no clear plan as to how they're going to get off it.

Carla said...

Amen!

I am always shocked when I go to urgent care for any common ailment and they try to push Vicodin or Darvocet on me. Case in point: I had an ingrown toenail that was infected. It was painful, but I really only wanted antibiotics. The doc asked me 3 times if I wanted a narcotic pain killer.

I also have given birth twice vaginally without an epidural. I have only taken ibuprofen 800mg post partum. I am shocked at the number of Percocet scripts that get prescribed for someone who hasn't had a c-section. And I was shocked that my doctor offered it to me when I was getting discharged even though I never took one pill of it during my hospital stay. CRAZINESS.

Anonymous said...

This is a good point to bring up.

The medicine chest when I was growing up only had only aspirin for oral use, Sloan's liniment, and come to think of it, a little pot of Sayman Salve. As a teen-ager, menstrual cramps might require staying home from school with a heating pad, but no medicine.

Prior to an outcome that required cranial surgery in the 70's I remember taking so much aspirin that the even the thought of it made my stomach hurt. In the hospital post-op a nurse asked me at bedtime if I was experiencing pain, and I found when I turned my head there was a little discomfort, so she gave me something narcotic-- which resulted in no sleep for the next 4-6 hrs; I was playing the trumpet on par with Louis Armstrong, and racing up and down trees with the hot breath of a large bear on my neck. Needless to say, I had no more need for pain relief medication after that, Still I was sent home with a prescription for Tylenol #3 and bisacodyl suppositories which were kept in the medicine cabinet and then thrown out at an annual cleaning. Since then I've always figured I'd been too sensitive to narcotics, and didn't have anything with childbirth (short labor).

My husband came to this country as a poor student and when he needed dental work, he prevailed on the only dentist of his particular heritage in his town to pull his tooth for a very small charge without Novocaine. When he broke a bone in his hand, he had to take something to reduce the swelling, but he only took 3 Lortab altogether before all of his physical therapy sessions.

I wouldn't say that we experience pain any less than anyone else, but that we deal with it and carry on. Occasionally migraines required Tylenol and a dark quiet room. Sinus headaches are remedied with hot tea, one Tylenol 500 mg, a couple sniffs of Flonase, and Afrin and going back to bed, Once, lugging a heavy suitcase in a hurry, I herniated something, and ever after found a support item would help avoid excessive strain, but I'd have to say that taking anything for pain is not on radar, Imagery helps in alleviating pain. For example when waiting for a tooth to die before crown, the intensity of pain was alleviated with a picture of what the darn dentist was allowing my raw nerve to experience. I do have to mention that waking after an endoscopy for which I'd been sedated with midazolam and a very potent selective narcotic was like recalling the restfulness of youth, but I don't think that it was a matter of pain relief, more of restful sedation. And, it is my understanding that a considerable component of pain is anxiety, and whether or not something will be done to help with anticipatory pain.

So, yes, last Monday after the bulk of a very busy morning had turned into the endless busyness of early afternoon at one of my Wal-mart assignments, I felt a sense of incredulity at filling many scripts for hundreds of Lortab of all strengths. (I had already turned the thought in my mind that many of them might be resold, not even thinking that one person would be taking so many tablets!)

Anonymous said...

http://www.nytimes.com/2009/02/10/health/policy/10fda.html?partner=rss&emc=rss

Thought you would be happy to see the FDA is thinking about doing something about this issue.

Spankie said...

i have been on percocet for 9 months now due to several cervical spine surgeries.

I take 3 -4 per day just to be able to work. every couple of weeks i stop them for a few days to a week just to make sure im OK.

yes, the retail pharmacist always gives me a look.

when i stop at the retail pharmacy (two towns over)near the hospital my wife works at to fill a script, the pharmacist always asks, "a little far from home huh?" im like, its not your business but my wife is the charge nurse next door in the ER and i brought her lunch.

another good one is, "let me see if we have these in stock.."

or they call my dr...

No, most times you wont see me in pain, because im on pain meds. but if you asked me to reach for the top shelf and get the box, i could not. If i dropped my change you would see me struggle to bend down and pick it up.

Growing up, i respected the pharmacist in my neighborhood. The same as i respected the DR, Cop, banker, or any other professional. I am slowly starting to loose that respect because of the way i get treated.

I am an addictions counselor. I understand that there are many who abuse and sell. Still, that does not give you the right to suspect me of being a drug seeker or treat me disrespectfully.

Its like a cop profiling a black man because some sell crack..

I have the spine of a 95 year old man. My bone density is Moosh. i have several bad discs as well as plates and screws in me. I still try to work to support my family even though i am in pain. I help addicts get free from their addictions. I take in foster kids. But at the pharmacy, i am treated like scum.

Brother Frankie

Pharmacy Mike said...

No, it's nothing like a cop profiling a black man because some sell crack. White people, asians, hispanics, and every other race also sell crack. Therefore, choosing one race to be suspicious of (soley on the basis of race) is profiling.

However, you can't be a drug seeker without trying to get it from a pharmacy. Therefore, when you present a CII script at the pharmacy, we're going to look at it a little more closely.

I'm sorry if you get caught up in the middle of it. You obviously have a reason to be taking pain medication. However, you have to understand that we get a ton of people who are just looking for drugs. We get very suspicious of people coming to the pharmacy for the first time from several towns away with a script for Percocet. We get very suspicious when they make it a point to pay cash. We get very suspicious when they come in requesting either the brand name or a certain generic manufacturer.

The point of the post wasn't really to bash drug seekers though. The point of the post was that these pain meds are overprescribed. If you sprain an ankle, you don't need Percocet. If you get in a car accident that results in only minor bruises, you don't need Dilaudid. However, prescribers seem to just give these narcotic pain meds away. Their poor prescribing habits enable drug seekers to get the prescriptions they need to present to pharmacists in order to get their drugs.

The poor prescribing habits mess things up for the people who legitimately need the drugs. Because so many people are so easiliy able to get Percocet and Vicodin prescriptions, we spend more time trying to make sure we're not enabling drug seekers than we do focusing on helping the person with the real pain problem.

It's sad, but the law has put us in the position where we have to be the narcotics police. On top of checking for interactions, verifying horrendously written prescriptions, counseling patients, and dealing with insurance problems, we have to make sure we're not feeding the addiction of drug abusers.

I'm sorry if you get wrapped up in the middle of it. If you were in our position, you'd understand.

sickofstupidpeople said...

Maybe if you had been given a few Vicodin for that severe ankle injury, you wouldn't continue to experience tingling in your foot. It has been shown that undertreated acute pain can turn into chronic pain. Under electron microscope, you can see that the pain receptors actually multiply when undertreated.
Dilaudid for bumps and bruises? yeah, that's a bit much. But, I'd say that the vast majority of docs writing for narcs have good cause. Sure, there are a few bad ones out there, as there are a few bad patients (and the two almost always go hand in hand). The docs have to walk a fine line. For many years, they were fearful that patients would get addicted (studies showed that they don't), so they underprescribed. Then the docs took the heat for undertreating pain, so they leaned the other direction, and some went too far.
Pain is a very complicated issue, and I try not to let my experience with the bad ones get in the way of how I treat the real pain management patients.

Pharmacy Mike said...

Ankle sprains do not require opioid pain relievers. You will never convince me otherwise.

That tingling in my foot is not from undertreated pain. It's from a severe injury to the foot that left me with permanent damage.

I've sprained my ankles so much that the ligaments are stretched out and the joint isn't very stable. I'm always one small misstep away from rolling it.

Again, it has nothing to do with undertreating pain. It has to do with a reoccurring injury... And I'm sure it has a lot to do with me not giving my ankles enough time to heal before trying to play basketball again.

Unless you nearly ripped your foot off your leg, you do not need opioid pain relievers for sprains.

lorena said...

Ankle sprains sometimes do require more than iboprofen. I had a sprain were they sent me away with just ibprofen. For months I could not walk on it without tearing up. Went back was told to ice it, rest, elvate etc and sent away. Went back again sent away. Finally someone took an X-ray and MRI saw I had tons of bone chips floating around and stress fractures. I had TWO ankle surgerys, after which the surgen said he was amazed I had walked on it at all. That I had pretty much destoryed most of the ligements holding my foot together. They put metals pins in it and 2 yrs later It still hurts, I still limp, I walk with a cane and I lost my gymnastics schlorship in school. Perhaps if someone had taken me seriously, instead of brushing me off as a drug seeker or "it's just a sprain" I wouldn't be in constent pain and have had to give up the sport I love.

I'm soorry there are a few bad seeds, but the rest of us in true pain, should not be punished. and btw it has been showed in several studies that minorties, women, and the poor (of which I am all 3) are often underprescribed narcotics even when reporting much higher lvls of pain. so all you ppl complaing that dr's hand out medication like candy should be grateful. not all of us are so lucky. some of us have to be in pain every day because ppl like you think we should suck it up or we are just druggies.

Pharmacy Mike said...

You obviously had more than an ankle sprain. You injured your ankle so badly that it required multiple surgeries.

That's basically a catastrophic injury. Your run of the mill sprained ankle does not need opioid pain relievers.

lorena said...

btw to spankie who complined that the pharmacy ask "wait let me make sure we have this in stock" the reason the pharmacy ask that is because as you should know C11's require a hard copy and if the pharmacy doesn't have it, you'll have to come back and bring the script to another pharmacy. so really we are just trying to help YOU. Save you a trip. and btw its not like if we have even two we can give them to you because that voids the rest of the script. and also for a while it was very hard to get oxycodone 5mg in stock and now oxycondone 20's because the manufactures are having a fight with brand because of lawsuits. so it really probally is not in stock. The pharmacy is trying to help you and they get tired of being yelled at when you come back because they didn't check. or they didn't give you a personal call even though they had to deal with the 300-500 other people coming in trying to get the prescriptions.

btw I know this is not relevent to the current topic, but a lot of the time the prescription is not ready because your doctor wrote it wrong, unreadable, makes no sense, the math is wrong, or didn't follow the law when writting it. so people should really stop and see if they are yelling at the right person. This goes with the charge too. Insurance often times sends back the price, we don't control that, nor is it are job to figure out what insurance you have. ppl really should be more proactive when it come to there own health. if you want to know why something is not covered give them a call. That is why there is a customer service number on the back of your card. Speaking of cards they don't just give them out for fun. they have a purpose. so bring you insurance card with you. it's not like if you say you have blue cross we can magicaly pull up you file it take a lot more information then that.

Anonymous said...

Pain is subjective and different for everyone. Good thing doctors are the ones prescribing and not pharmacists... they actually go to school for stuff like this.

Pharmacy Mike said...

Actually... I'm pretty sure I've been MUCH more educated in pain management than your run of the mill physician. I actually had courses devoted to it, and had years of pharmacology on pain medication instead of 1 semester like those that prescribe.

Therefore, I'm much more qualified to speak about this than the majority of doctors.

Pain IS subjective and different for everyone. However, there are some standards that are roughly similar. For example, you wouldn't put someone on a morphine drip because of a paper cut, would you? Just like you wouldn't prescribe Dilaudid for what was basically a very minor case of whiplash.

Anonymous said...

Mike,
Shut up and just dispense the drugs that people have legit prescriptions for. You are not a doctor(maybe a wanna-be)you are not a cop.
Get a life and butt out. Who cares if you don't take anything for pain? That is your choice.
People like you make me sick. You are as pathetic as they come.So are all the rest of you that agree with this communist wanna-be. Mind your own business and get a life. Loser.