Pain Management, Part I


In the first of a 3-part series on pain management, Sochoka laments the drift toward ever greater opiate dosages.

“I refuse to let it rule me ... and I don't want to become a druggie.”

Those were the words spoken by my beloved wife when I asked her how she deals with the very real, and excruciating, pain of fibromyalgia, which she has been bravely battling for the past 11 years. She basically looks at it as a test from God. It sounds right to me. Saints are made to suffer, after all. She gets chiropractic adjustments, a reiki massage here and there, and endures it. That's it.

Other patients I have encountered with various pain syndromes, although certainly not all, gulp down opiates by the pail full. I'd like to say that they are entirely responsible for their lot, but that would be a lie. Doctors and pharmacists have a dirty hand in this, and there is no ignoring it.

When I was a naive rookie pharmacist, I was out to save the world and to keep the junkies from getting the good stuff. I scrutinized every prescription looking for a reason to tell someone to get lost. I questioned the doses from doctors and repeatedly heard in response: “New research has shown the dose to be appropriate.”

Apparently, they were right. Sustained-release oxycodone tablets were released in 1996, and the doses were absolutely staggering. Prescriptions for 160 mg per day were being handed out to everybody with “intractable pain.” Fentanyl patches were being slapped on patients left and right. There was even some hack from central New Jersey writing scripts for meperidine injection for home administration. Things that were previously used only in end-stage cancer treatments, due to their toxicity to the liver, were becoming everyday, for-the-rest-of-your-life medication regimens. They didn't teach us about THAT in pharmacy school. Actually, in 1994 no one was “practicing medicine” that way.

In 2012, things are worse, with the exception that no one is prescribing meperidine for home injection anymore. Still, there is more than one Dr. Feelgood in the area where I practice, and, if they won't see you, someone within 40 miles will. We have professional narcotic ingesters whacking down oxycodone and methadone at doses that would kill someone taking them for the first time. The prescriptions are “legitimate,” so a pharmacist can make a call to the doctor and suggest a heart-to-heart with a patient about their problem only when confronted with a ridiculous drug regimen or a patient who is forging scripts or trying to get early refills. In a society that dispenses insulin syringes (and rightly so) to heroin addicts, we have become immune to addiction.

As I mentioned, we get to sit back and sadly watch patients drastically shorten their life spans and spend the rest of their lives in a chemically altered state. I foresee a liver transplants down the road for too many of our patients. These people are destroying themselves.

I have even seen heavy-hitting narcotics docs with buprenorphine/naloxone sublingual licenses. They can get the gorilla off your back and replace it with a chimpanzee. The level of unethical behavior is simply staggering. We'll talk about that branch of “medicine” in the next installment. Peace.

Jay Sochoka, RPh, wonders what went wrong.

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