They don't call them "seekers" for nothing.

Costs zero to beg.

Payoff is positive.

Yeah go into the ER for kidney stones in roofers clothes they will treat you like shit.  Once the DR strapped on the blood pressure cuff he figured out I wasn't faking like the condescending cunt triage nurse said I was.  Pushed a dilaudid and I woke up three hours later to my kidney stone diagnosis.  Sad part was my wife who was with me at the time was an DR in the hospital during her residency.  She was pissed at the way that nurse was talking out the side of her mouth, I told her to let it go the junkies have ruined everything for regular folks.  That was 15 years ago I cant imagine it has gotten better.

Yup. I don't really understand all of the statements about how easy it is for seekers to get pain meds. The two care providers in my locale are very strict on that stuff. As someone who's had five surgeries in the past three years (four of them spinal), I know a little bit about living with pain (and pain meds). But I've given explicit instructions to my wife about never taking me to an ER, unless I'm on a gurney. I had to break my policy when I impaled my calf and needed two layers of stiches, and when I had a bad gallstone attack. Other than that, I'd better be passed-out if I'm in an ER. Even my primary care doc and his nurse have said to stay far away from those places.

After hernia surgery and taking most of the first bottle of oxy the pharmacy called and had refilled it. Called the surgeon and asked WTF ?? Don't know where the wires got crossed but he called them and straightened that shit out PDQ.  Took the remaining 5 pills from original bottle to his office and was told to take them over to hospital for disposal.

I don't usually go to the doc's office unless I'm pretty fucked up. My bloodwork comes back clean always so I don't have too much trouble with getting meds if actually needed.

Yes that is a reason, also the introduction of the medication also brings the possibility someone would be allergic to it, and also brings on possible worse things like cornea melts.

The drops aren't even considered narcotics, but they are controlled. But lets do a hypothetical. You come in with a cornea abrasion. Extremely painful, but will heal unless infected.

The first day or so, OW.

But over time you will heal.

Should the doc give you something that you don't need (and isn't standard of care) and possibly create an allergy? an allergy that the doc would then have to treat with potentially steroids? steroids that you cannot utilize if there is a epithelial defect (which by definition you have in a corneal abrasion)?

Or the doc gives you the drops and you use them as directed and you feel great, never to return. Until that secondary bacterial or viral infection starts to create a central ulcer that perforates the cornea, or best case scenario you run out of drops and the pain sets in.

Or even if the doc says use this only once every 3 hours (ignoring the standard of care), and you use it ever 15 minutes and create a corneal melt, thereby setting yourself up for a corneal transplant and permanently reduced your vision.

Why risk introducing something that can stunt healing, create an allergic reaction, or a corneal melt, when if you do nothing, unless there's a secondary infection, will heal without intervention?

If doctors practice outside the standard of care, they should be prepared to defend their license quite often. The standard of care is what doctors are expected to abide by, and if they stray there better be a good reason. Standard of care generally isn't just a theory, it's backed by actual evidence and studies.

We've gotten so far away from allowing the body to naturally heal in some instances. People demand instant relief, and sometimes that instant relief doesn't allow the body to heal naturally, and sets up a dependency.

You should, emergency departments, especially in large cities, are the ultimate bad neighborhood.

there is probably more danger with antibiotic over prescribing than opiods long term. there is at least one bacteria now i think for which there is no treatment. if this trend continues, you get a serious cut or injury and it gets infected, you might as well be back in the middle ages for all the good medical science can do.

Happened to my buddy this past Christmas. Had really bad back pain and hurt to move. Went to the ER and they just treated him like he was trying to get dope. Even after dropping a WTF I'm not here for a script. They still treated him like he wanted pills.

If there was a real danger, one that posed severe "middle ages" consequences from antibiotics then we'd see it run rampant in India first. While a few have become resistant, it's no fucking plague and we have new antibiotics and tech available to fight bacteria.

Meanwhile my physiatrist cut me off Tramadol for a herniated and torn disc. I didn't want the opiates or the high dose ibuprofen and naproxen. I was taking it PRN at 50mg doses, mostly once daily maybe twice if the pain was bad. I would sometimes go weeks without taking it, I wasn't abusing it. The pain management doctor was even more strict. Fuck it, now I live with the pain.

There's one ER doc at work who will give it out to pretty much anyone. The other doctors are much more likely to throw you out.

LOL... yup. You NEVER ask for pain meds, no matter how much pain you're in. Seeing a doc for pain relief in these times is like a visit to the Soup Nazi. You quietly shuffle along, only speak when spoken to, etc. It's true.

I was talking to my NP about the sad state of current affairs with this whole "opioid crisis" recently and she said that there has been some clarification going on between the CDC, MDs, insurance companies, etc... because of the backlash in all of this shit meaning that legitimate patients have been UNDER-medicated in many cases, whether because of an over-reacting care provider, or because of an insurance company looking for any reason to deny coverage. It sounds like the CDC is now saying that their intention was NOT to impact the care that legitimate patients receive from providers by all of these edicts, and that they would be providing more clarification in the coming months. When you jam government entities and insurance companies between a patient and their doctor... this is the SHITE you get. She knows that if things were to get to the point for many hardcore (REAL) chronic pain sufferers that they cannot get relief, they'll either break the law by seeking medication from nefarious entities, attempt to dull the pain by becoming alcoholics, or commit suicide.

I had a very large tumor removed from my sciatic nerve three years ago. It was the most painful four weeks I've ever endured. Just BRUTAL. The surgeon is well-known as a chronic under-medicator. He's also known as one of the best surgeons around (which is why my primary care doc sent me to him). After that experience, I told my doc to NEVER send me to him again. His reply was "tell you what... next time (if there is one) I'll send you to him, but I'll take care of you after the surgery". I would have a bit of anxiety if I ever had to rely on that guy for surgical care again. He was a cold asshole who just said "I don't do pain meds". Really? You geek out about how this tumor was the largest one you'd ever removed in 20+ years of surgery, and you took it from being snuggled up to my sciatic nerve for years... but you DON'T treat the post-surgical pain??? Bizarre detachment from empathy.

Evidently, they don't care about the alcoholism and suicide crisis they're transferring the problem to.

My wife shattered her foot a few years ago (Lisfranc injury - broke like 8 bones).  Doctor said "woah! I'm going to prescribe you the hard stuff."  Wife said she wanted to try something that wouldn't make her woozy first.  Doctor said ok and prescribed her something like Tramadol, but told her to call back when the real pain kicked in, because it was coming.  She didn't like the Tramadol, because it made her feel weird - so she tried calling in to ask for something else that might work the same without the side effect.  She still didn't want Oxy or anything too strong, just an alternative to Tramadol. The RNs/NPs on duty freaked out, said that she was now marked down as a "Drug Seeker" and that in no event could she talk to the doctor again about the matter.  We explained that the doctor was trying to give her Oxy, and told us to call if the Tramadol didn't work out . . and that we didn't want anything too strong.  They still freaked out and said it was drug seeking behavior.  Freaking weird.

Wait... what? Not true (unless I read your statement wrong). NPs and PAs can (and do) prescribe schedule 2 substances in my state.

I fucking *HATE* pill chasers. They've made it sooo f'ing hard to get actual pain killers when you need them now for surgeries and other stuff.

you could kill all of them and I'd just giggle about it.

There ya go... Soup Nazi stuff. Courtesy of your friendly fed gov pencil pushing bureaucrats. Eggsalent 1st world medical care...

As someone who's been dealing with all of BS created by the seekers for years now, I understand your sentiment.

But there's a FAR better plan for [real] pill-chasers, meth-heads, chronic DUIers, etc... it's a plan where EVERYONE "wins". Make them sign a liability release form. Invite them into a secure room that's locked from the outside. Inside, there's a table. On that table will be a large quantity of whatever their chemical of choice is. Check on 'em a few days later, remove the body, hose off the floor, and invite the next guest in. I've been proposing this to the local PD for a couple of years. Of course, it will NEVER happen... because someone would actually have to be responsible for their actions in the end. But I can't think of a more "fair", "just" and "fitting" solution to the problem. Society gets what it wants/needs, and the seeker gets what they want. Everybody profits! (sort of)

when my brother damn near chopped his finger off, I took him to the hospital.

while waiting in the waiting room, there was a woman who was just hysterical about how much "pain" she was in.

The hospital staff all looked at her like they recognized her. they rolled her over into the corner, where she was yelling louder and louder, shortly later she was joined by her daughter who was crying "can't you please do anything for her, for the pain"

they repaired my brothers finger and sent us on our way and she was still there in the corner... yelling about the pain she couldn't describe.

based on what I'd seen, it was pretty obvious she was just looking for pills and they knew it.. I guess this is how they deal with it

Nope. They don't, and they'll tell you so.

I asked about patients turning to illegal drugs to treat pain.
Overdoses, alcoholism and all that goes with illicit drugs.

To the man the response was, " well my name isn't on what they OD'ed on".

Yup. It's all about liability. In an overall picture with regulation, costs, liability, and patient care being components... guess which part of medical CARE equation comes in last? Irony... it's what's for dinner.

Btw... my doc says "ten years ago, we were told to make our patients comfortable... now the pendulum has swung the other way". I know a two decade pain clinic patient (legitimate guy who's spine is far more messed-up than mine even)… who's been cut to 1/4 of the dose he's been on for years. He was talking about drinking himself to death when he told me that (he's not an alcoholic). He said that the long time head of the pain clinic is worried about losing his career. Not because of systemic abuse or overmedication... just because of the FUBAR times we live in. I've met that doc and he's a well-respected doc. I honestly dunno where things go from here. Fortunately, I live on the bare minimum I can get by on. My NP asked me how I was doing last time I saw her and I just said "I'm getting by". And that's it. I do my PT, I try to stay as active as I am able, and I deal with a daily grind of pain that some days fades into the background, and other days it's damned hard to thing about ANYTHING but how bad it hurts. But I'll be damned if I'm going to ask for any higher of a dose, because in this day and age, I'm damned lucky that I haven't had to resort to trashing my liver with alcohol (which doesn't work anyways) or move to a pro-cannibus state (doesn't seem to work for me either). It's all wacked. And yet you turn on the TV and all you hear these days is "Trump this" and "opioid crisis that".

They start winey threads in GD

Well, to be fair my limited medical knowledge suggest giving opioids to someone with a bowel obstruction makes the underlining condition worse.

drug seekers see doctors, and if they don't get what they want, they give bad reviews or complain to the state licensing board.

get a lot of complaints, and you're dinged on performance by insurance, or your hospital. get a bunch of complaints, and you might get investigated by the licensing board.

don't  give pain meds, and people with real pain suffer.

give out pain meds freely, and you get on a list somewhere and drug seekers start flocking to you.

give out enough pain meds, and you trigger an investgiation into whether you're running a pill mill.

doctors and prescribers can't win either way

Last time I was in the ER for a pain related type thing (probably 2012-2013 timeframe) was when I had my first kidney stone.  The pain was so severe I had to shuffle to the bathroom and puke right in the middle of doing my intake paperwork.  After that, they took me straight back to a bed and pumped me up with Dilaudid.

Guess things have probably changed since then.

Last year I took my GF to the ER with severe abdominal pain. They originally treated her like a seeker until her BP dropped to 80/60 and an ultrasound prompted emergency surgery to remove her gall bladder.

One of the first things they asked was what she wanted for pain.

As they were discharging her the next day they gave her a scrip for Percocet without being asked.

They're the same as the idiots who smoke cigarattes or weed and think they're hiding/covering it up and no one knows.

We all know.

It varies state to state.  Texas NPs cannot prescribe schedule 2s.

Yup, I agree, when I said 'drugs', I didn't have antibiotics in mind.  Give them whatever opiates they want.  No skin off of societies nose.

Yes, I know, they are a danger, sigh.  So let's make drug rooms available, it has got to be cheaper than incarceration.

It's odd for years doctors (and dentist) for that matter shoveled prescripts to me for everything from tramadol, hydrocodene, oxycodene for nothing and I never took them. Now that I have a serious diagnoses everyone seems afraid to prescribe anything. I guess it's just the changing of the times. My dentist used to prescribe a few months of hydrocodene for a teeth cleaning...

At least if you go in with a visible injury you're in better shape. When it only shows on a MRI and basically your immune system trying to kill you they avoid that entirely.

9.9/10

You forgot about [real] patients not "winning" either. Government wins and insurance companies win. Hmmm... makes me wonder just how many insurance company moles have infiltrated D.C. these days and what the connection might be... hmmm… I wonder.

The people going through withdrawal are hurting just as bad.  Sure, it's self inflicted, but that pain is jsut as real.

Are we a compassionate society, or do we punish people in pain becasue someone might be able to escape their miserable lives for a few moments a day?

Gall bladder attacks were "eye-opening" to this long time sufferer of pain. I was getting them every six weeks, and kept telling myself that I should really get that checked-out (didn't know what it was). After about six months of that, they got more intense and started happening every other day. That got my attention! I went to a walk-in clinic. They sent me to an ER (they do that with abdominal and head pain). The ER ran a bunch of tests and told me to check in with my doc a few days later (didn't give me anything for pain, and I didn't ask). I went to see me doc and he started touching my stomach area and I about jumped off the table when he got to my upper right-hand side. He said "your gallbladder's shot" and ordered an untrasound. Sure enough, it was full of rocks and needed to come out. The next week and a half were pretty hardcore. I remember drinking apple cider vinegar and living on Cheerios and hard boiled eggs. Anything else would send me into full attack mode. After they took it out, the surgeon said that most people have either acute OR chronic something or other, but I had both. That was the most successful out of all six of my surgeries. NO question it did the job. One night I had four hours of pain that wouldn't allow me to lay down OR stand upright. I finally passed-out and slept. The next night is when I went to see a doc. Gallbladder and kidney stone attacks are NO joke and should never be blown off by medical people.

It's a "f#ck everyone else who's not exactly like me" society... at least in GD.

I love coming into the ER when I’m passing another kidney stone. They look at me like I am a drug seeker. When the CT Scan report shows a 6-9mm stone is passing through the ureter and I’m pissing straight blood, I gets all the dilaudid I can take.

The are not in pain.
That’s why every non-narcotic pain medicine they are offered “doesn’t work.”

They work just fine for pain.
But they don’t work for making them have the feeling they want from taking a narcotic.

What is pain?  How do you know they are not experiencing it?

for years, it has been taught that pain is what the patient describes it to be, and to treat it appropriately.

and you know what? it appears that for patients with real pain, they don't get hooked on pain meds, like other do.

but for some people, there is some addictive potential that is triggered by opioids, and the increase in opioid use caused an explosion of drug seeking, and opioid usage.

with the added attention, there came the public impression that doctors are the cause of the opioid epidemic, because they were to freely giving out narcotics. this has led to the calls for increased  regulations from the federal, and state regulatory agencies to do something about it, and so prescribers are now running scared that they may have to justify every narcotic prescription they give out, or be penalized.

so, there goes the easy ability to treat real pain patients anymore. and, the headache of handling all the paperwork and such for chronic pain patients means it is easier to send them to a specialized pain management doctor, rather than try to keep treating them yourself.

it is a mess now.

people like you, who want to be freely given pain meds if you ask for them, have ruined treating pain for real chronic pain sufferers, who could tell you what real pain feels like.

Ah, ok. Thanks for that.

A couple of doctors I've been to (50+ in 5 years as they "look") have suggested it's a drug problem and want to do a test. I have no problem for it. Before I got sick the "incident" I was one of the most drug test people in the state. Every chemical plant or refinery I entered wanted a test. I went to 3/4 of the 100 of them between Baton Rouge and New Orleans. Sometimes 3 test a week. Pretty sure that wasn't the issue. Go there for 5 minutes to look at something, gotta have a test. To be a significant portion of stuff I was there to look at for a fix the person involved failed their after accident test.

Gay

This is how the medical industry signals virtue.

So you're saying that non-narcotic NSAIDS and acetaminophen are equal to opiates for relief of intense pain?

Yeah... your newsletter... it's a clusterf#ck.

P.S. My kidneys and liver aren't real happy about 8.5 years of the NSAIDS and Tylenol I've shoveled at them. There is NO comparison about the effectiveness of those drugs compared to opiates in treating the pain of a messed-up spine. The biggest problem with opiates for me is that the relief from pain is only short-lived. It is what it is.

Um, no. It's how we avoid getting nailed for being a pill mill or for prescribing to a known addict (both against the law) while still trying to not get too many complaints to the medical board from drug seeking lowlifes. Because even though the medical board knows it's a worthless complaint, they investigate it fully, suck up time and effort from the doctor to refute this, all while the druggie continues his quest for more dilaudid (which a lot of GD seems to really like)

Not really, 2 ? Years ago I went to the er with my blown acl and meniscus. I didn't scream or yell, just quietly waited my turn. When they brought me back the dr saw how swollen my knee was and asked me how it felt, I told her its in the top 2 of most painful things I've felt, and I was up to 9 orthopedic surgeries by then. Within 5 minutes they had me on morphine.

Wrong.

I was in Wednesday for kidney stones. Guy next to me had swollen feet but after 2 hours of waiting got up and started walking around. Said he was bored.