DEA/PDMP


I’m going to post this as an appendum to my last offering. Two states in the U.S. (Washington and Colorado) have legalized marijuana, and it’s on the ballot here in Oregon. Federal law prohibits the sale of marijuana, so even in states where it’s legal, the DEA (Drug Enforcement Administration) could raid suppliers. I loathe, detest, and despise the DEA because, for one thing, based upon my experience—and the experiences of voters in Washington and Colorado—they spend millions and millions of dollars persecuting marijuana users for no reason other than that they receive millions and millions of dollars for persecuting marijuana users. Since they’re losing their grip on pot, they’ve now turned to narcotics as public enemy number one, and to this end, they’ve upgraded hydrocodone (the narcotic in Vicodin) to the same level as the stronger drug oxycodone (the narcotic in Percocet), and they’ve made it harder for people who use the drugs legally to obtain them.

Here’s what I—and everyone else who uses long-term narcotics legally—have to go through to get them. Every month, I have to go to my doctor’s office and put the date, time, my driver’s license number, and my signature, on a form in order get a new prescription for a thirty-day supply of oxycodone. Before I started using a mail order pharmacy, I would then have to take the prescription to a walk-in pharmacy, show the clerk my driver’s license and sign for the drug. Now that I’m on Medicare, I use a mail order pharmacy, so I have to mail the prescription (I, as in me, because my doctor can’t do it, and no one can fax it) to a special address in Pennsylvania. For some reason, it takes them two to three weeks longer to ship oxycodone than other prescriptions.

They send it by UPS (United Parcel Service), and I have to receive it at my house and sign for it. It can’t be left with a neighbor, and I can’t pick it up at a UPS facility. It has to come here, and it has to be signed for here, only I never know what time of day it’s coming, and I have literally stayed home all day trying not to make noise so I wouldn’t miss the delivery. One day, I waited ten hours, finally had to go somewhere, and, of course, that’s when the truck came, and I had to start the wait all over again the next day—three misses, and they ship it back. I have to do this every month, which means everything else has to be scheduled around the delivery, only I never know more than three days in advance when it’s coming, which makes it hard to plan my frequent doctor visits, not to mention little holidays with Peggy.

All of this bullshit is the work of the DEA, but they don’t stop there. They also require that I sign a yearly contract with my doctor promising that I won’t get narcotics from any other doctor—as I might do if I were if I were an addict, or having surgery. I also have to promise to always get my narcotics from the same pharmacy. A record of all this—along with every narcotic prescription I have filled—is put into a database so the DEA can be sure I’m being a good boy. Of course, they don’t say that this is the purpose of the database:

“The Oregon Prescription Drug Monitoring Program (PDMP) is a tool to help healthcare providers and pharmacists provide patients better care in managing their prescriptions.”

Bullshit! Bullshit! Bullshit! The sons of bitches! How dare they claim that they’re forcing every doctor and pharmacist in Oregon to spy on people for their own good! As might be expected, the news media is only too happy to handle PR for the narcs by running story after story about the evils of narcotics—how they are over-prescribed, how many people die of them (it’s an “epidemic!”), and how we need to use “other methods of pain control,” all this without a single, solitary mention of the fact that narcotics have a legitimate place in medicine, or that other “methods of pain control” might be inadequate, either in whole or in part. Heavens no! At the behest of the DEA, narcotics in and of themselves are coming to be regarded as the enemy, and let the patient tremble who, for whatever reason, gets them from two doctors or two pharmacies, even once, and woe be to the doctor who prescribes more of them than the DEA thinks appropriate because he or she will be raided (we might not have money for road repair and social services, but the military and the narcs need never go begging). Bear in mind that such raids never happen before patients arrive or after they have left, but always when the clinic is filled with patients, the goal of the DEA being the same as Bush’s goal when he bombed Baghdad—SHOCK AND AWE. It’s their way of saying to doctors, Put the image of being led away in handcuffs in front of a waiting room full of patients into your pipe and smoke it every time you write a prescription for Vicodin.

On the bright side, I only have one thing to report: the ACLU (American Civil Liberties Union) is suing to put an end to the narcotic monitoring program because they are so radical as to think that what transpires between a doctor and his patient—or a pharmacist and his customer—should be private, but, of course, as every real American knows, the ACLU is nothing more than a left-wing nut group.

19 comments:

Elephant's Child said...

How incredibly frustrating. And time wasting. And demoralising. And I suspect very, very expensive to administer.
I have also heard of an additional hoop which it seems that you at least don't have to jump through. One of my blogging friends has to have a blood test every month - to ensure that he is taking rather than selling his pain medication.
Hiss and spit.
There are some murmurs here about allowing access to marijuana for some limited medical conditions - but I don't expect it to happen any time soon.

Snowbrush said...

"I have also heard of an additional hoop which it seems that you at least don't have to jump through. One of my blogging friends has to have a blood test every month - to ensure that he is taking rather than selling his pain medication."

Or taking too much or taking unauthorized drugs in addition. This is a typical degrading requirement by pain specialists, which is done at the patient's expense. It is why I don't go to pain specialists.

lotta joy said...


Florida wants to legalize marijuana, but not the resources to acquire it.

I have the added burden of dealing with doctors who are all Hindu. They believe I have been reincarnated and have earned my suffering. If they help in relieving my pain, they are interfering with god's plan for my redemption.

My Hindu doctor demeans me, degrades me, and denies me while accepting my payment. At least Shanequa in the alley would allow me "some" dignity, but with my luck she'd be an undercover cop.

Stephen Hayes said...

The momentum for legalizing marijuana is building. Smoking dope is my only link to bad boy status. When it's legal I'll probably give it up.

Snowbrush said...

"My Hindu doctor demeans me, degrades me, and denies me while accepting my payment."

I've had doctors like that and as sexually rewarding as the experience was, they didn't do much for my problem (at least the problem I went to them for), and, as with you, they charged me dearly. I just want you to know that your secret is safe here, or does Joe get into that kind of thing? Also, will you be posting any photos?

"Smoking dope is my only link to bad boy status."

I guess you'll have to brainstorm. If you don't want to do it from your blog, you can do it anonymously from mine because, god knows, I'll post any damn thing, and I think I have some readers who are just sick enough to come through for you with some good ideas. BTW, have you bought any legal pot in WA, or do you have to have to be a resident?

David W said...

Hey Snow,

I work am just finishing my Physician Assistant degree.(PAs are similar to Nurse practitioners, we see patients, order tests, interpret results, diagnose conditions and prescribe medicine, including opiates.)

I do not personally understand your frustration, as I do not live with debilitating chronic pain, however, during my training, I have had many patients who deal with chronic pain.
I do not believe that what you are experiencing is a good response to the problem of over prescription of opioids, and I do not mean in any way to invalidate your experience and your frustration, I only mean to say that there is indeed a problem with over-prescription of opioid medication in the USA, and this over-prescription can lead to addiction, which often has life-shattering consequences.

In the USA, we consume something like 80% of the worlds opioids, this alone should show that we are doing something wrong.
I just finished my time in my Chemical dependency rotation, and sadly, the second most frequent addiction while I was there was to opioids.

I also agree that legalization of many drugs is probably preferable to keeping them illegal, but I think there is something different about a practitioner prescribing an opioid; many people seem to think that simply because it was prescribed, it is safe, and that more is better for you. Generally, such an attitude does not exist in regard to recreational drugs.

Anyhow, I do not have a solution to offer, I simply wanted to offer a perspective from the other side of the patient-practitioner relationship.

The problem for me, in regard to prescribing opioids is multi-faceted:
-I don't want to under-prescribe as this would leave someone with needless pain.
-I don't want to over-prescribe as this can lead to death in some cases, and addiction in some cases.
-I also don't want to over-prescribe as this could lead to me losing my DEA license, which could place my career in jeopardy.
-I also don't want to prescribe opioids to an addict who is lying to me and trying to scam me, because, well to be honest **** them, they are lying to me and trying to scam me and I don't like being lied to.

So what do I want to do? I want to prescribe *just enough* to make the pain tolerable, and *just* enough to last until the pain decreases to where it is tolerable without opioids. I do not want to prescribe enough to completely resolve the pain; why is this? Because if we prescribe enough of an opiate to completely resolve the pain, 0/10, the body will just adapt, increase the pain signal, develop a tolerance to the medication, and we ended up getting nowhere.

The real kicker here is that some people have chronic pain, and they are better-off being addicted to pain medication than they are living with chronic pain; I understand this point, but it's hard to remember when the opioid addicted person comes into the ER and tries to scam or lie to me. I will usually give them a small prescription unless I can prove they are lying, and they just move on to the next ER, all the while, costing the system more money. Also, they are usually on unemployment or disability due to their addiction, costing the system even MORE money.

-I just want to emphasize that I know that I do not personally understand your situation.
-I do think that legalization of most drugs is probably better than keeping them illegal.
-I do NOT want to keep pain medications from people with debilitating chronic pain.
-I do want to make sure that I do not create an addict by prescribing too much of an opioid.
-This one only applies to acute pain, and to chronic pain which is not severe and debilitating: I do want to make sure that people develop positive coping skills and positive pain management skills rather than taking LOTS of opioids, which just by the way, have the side effects of euphoria and addiction.

Anyhow, I am curious to hear your thoughts on this and to hear any recommendations that you may have for me.

PhilipH said...

America, the land of the FREE !

Ha - And Big Brother is watching over you all, just to see you do not break your 'promises' to be good and honest citizens.

And your lack of a decent health service is the personification of Fascism.

Charles Gramlich said...

Having to stay home every moment waiting for a delivery is the worst. I can't even take a nap on such days because they always come about 15 minutes after I lay down and am just nodding off.

Snowbrush said...

David, thank you so much for your well-considered and detailed comment.

"In the USA, we consume something like 80% of the worlds opioids, this alone should show that we are doing something wrong."

I have no doubt that there's a problem based upon what I hear from my live-in nurse (meaning my wife, Peggy), and upon hearing of people in my own town robbing pharmacies at gunpoint for narcotics. Even so, I'm suspicious of any and all statistics unless I know where they come from because the people who make money from drug enforcement have a vested interest in lying. I hate narcs with a passion because they incoveniece me, have terrorized my friends at times, and for all the money they've spent over the course of my lifetime, they've done nothing to solve the problem, which, if anything has only gotten worse. We're about drugs in this country like we are about all our stupid little wars in that if what we're already doing is a dismal failure, our answer to the problem is to do more of the same.

But I stray from the subject. I know that over-prescription is said to be a problem, but the experience of pretty much everyone I know is that their doctors are stingy with narcotics for the reasons you've given. So, they end up going to a pain specialist who treats them like druggies by making them have a blood test every time they come in. I went two of these guys just long to get their recommendations (two visits), and then I didn't go back because I found the blood tests too degrading, so I never took one, but I knew I would eventually have to if I kept seeing them, so there was no point in continuing to see them. My thought about doctors who demand these tests is, if they don't trust me, why should I trust them? Fortunately, I have a caring internist and a good orthopedist. Instead of them telling me what's going to happen, we share our thoughts and make a plan together, and that extends to prescriptions. I would say that a major failing of most modern medicine is that the patient is left to feel unempowered, yet what is more conducive to healing than a feeling of empowerment? PAs are different. A good doctor should behave like the few PAa that I've seen, and mine do.

Snowbrush said...

(cont.) I'll give you a tip here. When my internist comes into the room, I'll be sitting up on the exam table, and he will sit on a stool at my feet. Just that posture tells me that here is a man who isn't going to try to "lord it over me" or treat me like an object to be dispensed with as quickly as possible. He also tells me dirty jokes, and I respond well to that earthiness even though I'm sure it's at least partly a ploy. However, something that no PA and no doctor ever seems to do is to call me by my name except, perhaps, when they first enter the room and call me by my last name. Clearly, they don't care about names because there are too many names for them to care about. This tells me that even the good ones are lacking in terms of making a personal connection with me, and that it's probably too hard for them to do so. I heard a radio doctor say that doctors (and PAs, of course) can't let themselves care (emotionally as opposed to professionally), and that it wouldn't be in the patient's best interest if they did care, but that the good ones learn to fake caring. That made sense to me because I recognize the importance of objectivity. I don't pour out my emotions to doctors and PAs because I don't want to distract them--or me--from being objective. I tell them what's going on as completely as possible, but I don't get emotional about it in their presence--I have a wife for that.

"I also don't want to over-prescribe as this could lead to me losing my DEA license, which could place my career in jeopardy."

I don't think you should have to even think about that kind of thing because you're going to be tilted away from doing what's best for your patients through fear of the consequences to yourself even though I'm sure you'll try not to be. It's the reverse of when drug companies wine-and-dine doctors. Although the doctors might try to avoid bias is prescribing, statistics show that they favor the companies that wine-and-dine them. But I stray again... The DEA claim that it only raids (and delicenses) clear abusers, but, again, I don't believe them because I've never seen anything about the DEA that makes me think that they have a smidgen of either integrity or compassion, and I have heard the sob stories of doctors who had been raided.

"if we prescribe enough of an opiate to completely resolve the pain, 0/10, the body will just adapt"

I know, and I also know that they can quit working. That's why I rely on oxycodone as well as Neurontin, Cymbalta, and Ambien. In case this might be of benefit to you, I've had three shoulder surgeries, and they were hellacious in terms of a long and painful recovery, so I suggested to the surgeon that I might be able to reduce the narcotics (which for some reason, weren't working that well anyway) if I had sleeping pills, and I was right. The sleeping pills helped more than the narcotics (and ice helped more than any drug). I tried all of the new ones plus Dalmane and Restoril. These last two worked the best, but, as with narcotics, the longer you use them, the less well they work. I'll throw in another tidbit that I recently heard: narcotics taken prior to surgery delay recovery from surgery. Of course, being in howling pain probably prior to surgery probably doesn't help much either.

(to be cont.)

Snowbrush said...

This is taking too long, but I have one more thought. My wife became a nurse in 1983, and at that time, doctors were so stingy with narcotics that they commonly wouldn't prescribe adequate amounts for dying patients. The reason they gave was fear of addiction, which, of course, make no sense with someone who was down to his or her last days or weeks, leading some to speculate that maybe the real reason they wouldn't prescribe adequate pain relief was that they were influenced by the Christian notion that suffering is God's will and that it ennobles. Be that as it may, it was seen as a good thing when doctors started prescribing more narcotics. Now, the pendulum is swinging the other way, but no matter which extreme it goes to, it's the patient who gets screwed. I agree completely that narcotics have many serious limitations. I have a prescription for 20 mgs of oxycodone a day, but since that's not enough, I skip days and then take 30 mgs at a time. I took 40 a couple of times, and then said: screw this, if I keep going, there will be no end to how much I'll be taking, but there will most certainly be an end to how much I can get. So, I take my 30 mgs, and it dulls the pain, and it gives me a cheery little energy boost, and I go on with my day with the ability to do some things that would otherwise hurt so much that I wouldn't do them. I also worry a lot about how much all these drugs are going to shorten my life. One thing I don't understand is how so many people manage to accidentally overdose. All I can think is that they go off the drug, and then go back to the amount that were taking, and it kills them. Otherwise, how could these deaths be accidental? Surely, not one would increase their intake so substantially all at once as to stop their breathing.

Sir Marshall Stacks said...

maybe those deaths are not accidental. I am very close to someone who has no desire at all to wake up again tomorrow in 'level 9.5' pain from neck to feet. Their only relief is Cymbalta and a NSAID, both of which are a joke.
On the other hand, where is it specified that we are all supposed to be in perfect running order?
One of my friends therapists responded to some whining with "just be glad you don't have bowel cancer".
This old hippies hates the narcs too. I'm sure Texas jails still hold some once-gentle soul who got 50 years for possession of one joint.

possum said...

"...the narcotic monitoring program because they are so radical as to think that what transpires between a doctor and his patient—or a pharmacist and his customer—should be private"
In THIS country? Nothing is private.

Snowbrush said...

"And your lack of a decent health service is the personification of Fascism."

I hadn't thought of that. I've heard that leftists tend to favor government control of business but freedom for the individual, and that rightists tend to favor government control of the individual but freedom for business. I don't think of Communism as allowing individual freedom, but the definition does seem to hold with America's two dominant political parties, or at least it has traditonally. Now, I can't tell that either side is in favor of freedom for the individual, at least in regard to privacy, although with morality, it's another story with the left acting as if morals don't matter, and the right trying to whip everyone in line according their own religious beliefs.

"Having to stay home every moment waiting for a delivery is the worst."

UPS wil give you a two hour window, but you have to pay them for it. In other words, lousy service is free, but good service costs.

"maybe those deaths are not accidental."

This is often true, but there are other factors. For example, Bruce Lee died of an allergic reaction to a narcotic. Others have surely died of reactions between narcotics and other medicines, or else they had a few too many drinks while on narcotics. I suppose it's even possible that people might become so addled that they wouldn't remember how much they had already taken, or because they were in so much pain they couldn't think straight. I think it might also be possible that some deaths are not quite suicide, but not quite accidental either.

"One of my friends therapists responded to some whining with "just be glad you don't have bowel cancer'".

That's pretty lame, wouldn't you say? If I were paying someone two hundred dollars or more an hour, I should hope he or she could come up with something more original than what I had already heard a hundred times. The "count your blessings approach" sounds more like an accusation than a stratagem when someone is overwhelmed. It's not that it's worthless, but that it only goes so far, and it's also insultingly obvious.

"In THIS country? Nothing is private."

That's why I belong to the ACLU. The FFRF fights admirably for freedom from religion, but the ACLU has a broader scope. I hate a lot of their stands, but still...

Snowbrush said...

"Their only relief is Cymbalta and a NSAID, both of which are a joke."

I don't what the problem is, but it sounds nerve-related, so I'm surprised they aren't taking Neurontin. As for Cymbalta, it has helped me, but if I had that much pain and no promise of relief, I would either kill myself or go insane before the day was out, because that's screaming level pain.

"-I also don't want to prescribe opioids to an addict who is lying to me and trying to scam me, because, well to be honest **** them, they are lying to me and trying to scam me and I don't like being lied to..."

I think it likely that everyone who depends upon narcotics whether for reasons of addiction or pain-control alone comes to think and behave similarly because no one in either category can be assured of an ongoing supply. Thankfully, I haven't needed to do it, but can a person to do or say whatever is necessary to keep the supply coming. This threat of not having adequate pain control is part of why the recent DEA restrictions scares me. By pressuring doctors to prescribe less, my own doctor might decide to prescribe less, and then where will I be? What I'm saying is, don't be so sure you can always tell an addict from someone who really is in pain because both are motivated to be manipulative. Also, there's no gauge you can use to know how much pain someone is in. For example, everything else being equal, women tend to report more pain, and men less because men seek to avoid the vulnerability that comes with openness.

David W said...

Hi Snow,

" I'll give you a tip here. When my internist comes into the room, I'll be sitting up on the exam table, and he will sit on a stool at my feet. Just that posture tells me that here is a man who isn't going to try to "lord it over me" or treat me like an object to be dispensed with as quickly as possible. He also tells me dirty jokes, and I respond well to that earthiness even though I'm sure it's at least partly a ploy. However, something that no PA and no doctor ever seems to do is to call me by my name except, perhaps, when they first enter the room and call me by my last name. Clearly, they don't care about names because there are too many names for them to care about. This tells me that even the good ones are lacking in terms of making a personal connection with me, and that it's probably too hard for them to do so."

Thanks for the insight, I will try to incorporate that.

" Although the doctors might try to avoid bias is prescribing, statistics show that they favor the companies that wine-and-dine them"

True, good luck fighting ur unconscious biases.

" My wife became a nurse in 1983, and at that time, doctors were so stingy with narcotics that they commonly wouldn't prescribe adequate amounts for dying patients. The reason they gave was fear of addiction, "

We learned about this travesty during our pharmacology courses, how utterly disgraceful.

". I have a prescription for 20 mgs of oxycodone a day, but since that's not enough, I skip days and then take 30 mgs at a time. I took 40 a couple of times, and then said: screw this, if I keep going, there will be no end to how much I'll be taking, but there will most certainly be an end to how much I can get. So, I take my 30 mgs, and it dulls the pain, and it gives me a cheery little energy boost, and I go on with my day with the ability to do some things that would otherwise hurt so much that I wouldn't do them. I also worry a lot about how much all these drugs are going to shorten my life. One thing I don't understand is how so many people manage to accidentally overdose."

In my experience, many patients have a very limited capacity for critical thinking. The patients I have come across, who are focused on getting as large a dose of opiates as possible, have very little insight into their medical condition, very little foresight, and very little ability to think critically. The patients who overdose, in my anecdotal experience, never think "screw this, if I keep going, there will be no end to how much I'll be taking, but there will most certainly be an end to how much I can get"
Instead, they think, this is good medicine, more is better, and I am in pain, also this medicine is fun, so I will take more, period.
I think the thought process ends there for them.

Anyhow, thanks for the insight, and I will incorporate ur advice as best I can.

Snowbrush said...

"the patients I have come across, who are focused on getting as large a dose of opiates as possible, have very little insight into their medical condition, very little foresight, and very little ability to think critically."

I worry that I will insult you by telling you something that's all too obvious, but narcotics can mess up your thinking 24/7 without you knowing it. I noticed this when I was on Fentanyl last winter. Unlike oxycodone, I found that the drug left me with a less-pronounced high, but that it kicked my ass nonetheless, a fact that didn't become obvious until I stopped the 75 mcg patches and my mood and pain level both went right into the toilet. The drug also made me more emotionally reactive, and, while on it, I stopped even trying to make decisions that were of any importance, yet I gave no obvious appearance of being in an altered state.

I have often wondered what separates addicts from non-addicts, and my best information is that it's genetics What I have found with anything that I do in excess is that how much I consume is eventually limited by how the drug makes me feel. This gives me a certain sympathy for drug users because, just by looking at them, one can tell that they're ill, yet they still can't stop abusing. Still, I'm puzzled because, aside from the drug making me feel bad when I'm not actually on it, it also makes me feel bad when I am under its influence because a person can most certainly be high and still feel awful, yet even this doesn't stop addicts. There's a book I want to refer you to. It's by March Lewis and is entitled: Memoirs of an Addicted Brain: A Neuroscientist Examines His FormerLife on Drugs
by Marc Lewis.

BTW, when I went in today for my monthly prescription, I was required to take a urine screening. In my six years of taking narcotics regularly, I've never been screened, so when I asked the lab tech what was going on, he said the tests are random and, he thought, required by the DEA. I Googled the matter briefly without finding anything conclusive. Since I've never been screened before, I assume that at the very least, the DEA is turning up the heat on doctors to do screenings.

Joe Todd said...

That is a PAIN

CreekHiker / HollysFolly said...

Wow! I don't always agree with the ACLU...but I do on this!