By nature, I am prone to the use of hyperbole. When I am asked to discuss something that matters to me, such as the treatment of persistent unrelenting pain, I can certainly resort to extreme passion and rhetoric. And as I lament that anti-opioid zealots, certain lawmakers, and even some healthcare providers continue to criminalize patients with chronic pain syndromes, I thought it was just me being me. I thought I was being hyperbolic (well at least a little). I no longer believe this to be the case. We are there. We have arrived!
If you doubt my view on this, check out www.protectpaincare.org.
HIPAA, SCHMIPPA. You want opioids? Talk to our narcotics auditor. Or perhaps our field auditors equipped with handcuffs can help you out. Why didn’t I think of that? Handcuffs can help people stop overusing their meds. If you think I am being hyperbolic about handcuffs check out their website. And, all the while, anti-opioid fringe and the drug warriors have been attempting to handcuff the prescribers.
For 2 decades of expanded opioid use we have been unable to raise the standard of care to the level suggested by Dr. Douglas Gourlay – that those who prescribe controlled substances could qualify, as he calls them, as “talented amateurs” in addiction medicine. Forget about amateurs, we have full on professionals available now. Oh wait, perhaps those folks are now law enforcement professionals; maybe retired police officers; and perhaps joined by some non-medical folks looking to make a buck. Don’t worry though, they’re using an “internet based, biometric enabled” technologically advanced platform, so I’m feeling better already.
Don’t get me wrong though. I have tremendous respect for folks like John Coleman, PhD. He’s not a retired police officer or anti-opioid wannabe, or downtrodden opioid soccermom. Dr. Coleman served over three decades as a Special Agent of the DEA as one of its top management officials. He knows the real story because he was an undercover drug agent on the streets. I think he’d agree that people on the street that sell and abuse drugs will find another way with or without prescription drugs – but hopefully he’ll chime in here.
This is as foul an indignity as people with chronic pain have yet suffered. And all because we have failed to change our healthcare system to accommodate the use of controlled substances for pain, with training, time, reimbursement and all the things that are needed to make opioids safer. Physicians don’t have the time to assess and monitor people with pain but profiteers and others do. I can tell you this from experience day in and day out. In fact, pain management is one of the few areas that I see a drastic need for help from clinical pharmacists that specialize in pain, to collaborate with their physician counterparts – there are just too few Pharm.D.’s trained in the specialty area to collaborate with physicians. One thing seems certain; while many pharmacists that are board certified in specialty areas like cardiology, heme/onc, psychology, infectious disease, and other domains are scrambling to find direct patient care jobs right out of their intense residency programs, physicians are begging clinical pharmacists for help in the primary care and the pain space. “Help us interpret urine screens; help us obtain consent for long-term opioid use from patients; help us educate patients, providers, and families; help us understand serum analysis; help us mitigate against dangerous drug interactions; help us dose-convert opioids; help us to understand pharmacogenetics; help us to understand pharmacokinetics; help us help our patients; and help us keep them alive and treat their pain while doing it.” Oh, and by the way, “help us figure out who’s a legitimate patient; who’s taking their drugs; who is not; who are taking half; who are selling them; and who flies under the radar because they are using illicit street drugs undetectable by urine screens.” You see my friends, this is an area where physicians need help and must collaborate with others who largely unavailable BECAUSE OF THE SYSTEM! And if there were enough trained pharmacists to go around, Congress has still not sanctioned them as “providers”, so what’s their incentive? They can’t be paid for the highly desirable help that is so desperately needed and sought unless they work in a government facility or very large academic setting that is willing to eat the cost to offer better collaborative drug monitoring.
If I had chronic pain and was desperate, would I be willing to sacrifice my privacy and further sacrifice my dignity? Up to now I would only have had to do that at the pharmacy. Now my doctor, the person I hope to trust and have trust me back, is going to farm out the job of assessment and monitoring of me to law enforcement – are you kidding me!?!? And if I don’t want to participate, what choice do I have?
Perhaps instead of all of this, we could have state run opioid distributors for pain. The inside would look a lot like a liquor store in a troubled neighborhood, everything behind plexiglass. We could handle opioids for pain like methadone maintenance. Everyone shows up every day for a one day dose of opioid. It would be like the “Stepford Painers”. At least then, everyone would be equally stigmatized. Rich or poor if you need pain control, go to the pain maintenance clinic. Absurd? You bet it is! But who do we think will be more hassled when the po-po are part of the treatment team?