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      03-25-2016, 08:50 AM   #89
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Agree to disagree on that. I had real pain from a car accident with real injuries and was refused pain meds from multiple docs because they said it probably wasn't that bad. I have 3 herniated discs in my neck from breaking a windshield with my head as a passenger in a taxi during an accident. Concussion, 6 months physical therapy, and had to endure nagging neck pain for a year without meds as a result.
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      03-25-2016, 08:54 AM   #90
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And there lies the problem doctors don't really know what they are doing. I agree you needed meds. Most don't especially for the rest of their lives for minor injuries. But I see it every day. I've been offered pain meds for the most mundaine of stuff. I wouldn't even think of asking because it's laughable.
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      03-25-2016, 08:56 AM   #91
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DEA didn't do this to my neighbor. It was the state of NY. DEA is federal.

Rich people buying stuff is not a drain on society. The stuff they buy creates jobs. Takes hundreds to build a boat, helicopter, etc. They get paid and buy more stuff. Money has something called velocity. It's really how fast it's earned and used. If you have high velocity and still have people saving a decent portion the economy is humming. If you slow velocity down, everyone is hurt. Taxes slow velocity, and the government also only produces 40 cents of output for every dollar they collect. This is 60% loss on waste. That hurts the economy too.

I get the rebellion thing you say. But if legal many more who have restrained using will try. A good percentage of those will become addicted. More than become addicted from trying rebelling.

Big pharma contributes mainly to guess who, the Democrats. Especially now with Obama care.

Drug abuse is not only in the absence of legal access. Some people have addictive personalities and physiologies. They are the ones who become addicts far more easily and frequently. Legalizing drugs will make many more addicts as they will now try them for the first time.
that's speculation at best no definitive proof to support your idea but just because its legal doesn't mean they sell it at a dispensary, it would be a govt building where you would have to sit through a lecture first about the consequences before they handed it out and offer treatment at anytime. There would be no first time users and drugs would still be illegal but a program where an addict can get their fix with out nefarious deeds. harm reduction on a much larger scale and all the money would be diverted from the dea and enforcement. dea budget is over 2 billion, I could accomplish alot with 1 billion.
whats the consequence because the system is a disaster now?

I consider myself a republican but i could never vote for ted cruz, they need a candidate that's young and who rides the middle. I feel trump or cruz gives the election to hillary by a landslide and i rather have bernie if i had to choose
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      03-25-2016, 09:11 AM   #92
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Originally Posted by 1MOREMOD View Post
You are naive. Half any doctors business is giving pain pills to people who if they weren't pussies wouldn't even be going to the doctor. We live in an immediate gratification society that didn't exist in the past. People have been led to believe doctors can fix anything wrong with them by taking a pill, we treat everything whether it helps or not. It keeps money flowing onto a relatively new big buisness. Medicine used to be about pt care now not so much.
Did you know the over 95% of people prescribed opiates for pain become dependent or have any lasting effects. Times are changing, doctors are running scared to write opiates in fear of govt action. That's why heroin is huge now, no more access to pills.

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Prescriptions drugs are so regulated, that the majority of the people you see abusing them are getting them illegally anyway. Either through the black market, through robbing pharmacies, or stealing from friends and family.

It is easier to find illegal drugs than it is to get prescriptions for the Opioid Painkillers; and the majority of the prescriptions you can get are tylenol w/ codeine or Vicodin, which are barely painkillers imo. My grandma has been on painkillers for about 20yrs due to some serioius back injuries and to get her prescriptions filled is a nightmare. I cant even go with her anymore, cause it seems everytime i do, they take her aside and question her about who I am, if she gives/sells the pills to me...

My parents own a pharmacy, sister-in-law a dr, wife works in the hospitals, and youd be amazed at the steps taken to regulate painkillers. My dad has to log each prescription he fills (amount, person, type, Dr., Etc) for every painkiller. If they are off on quantities at the end of the day (Maybe week, havent worked with him in awhile), then an investigation is launched. Also, if he is filling an above average amount of prescriptions, an investigation is launched. Over the 15yrs they have owned the pharmacy, they've had inquiries by the governing body probably 50+ times.

I am all for development of a new type of painkiller that is less addictive, but the fact is, these work wonders for the people that actually use them, so they arent going away.
because of this CVS will soon have a very limited supply of narcotic pain meds. people who are in actually pain will a hard time finding relief in the upcoming years from providers and pharmacies.
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      03-25-2016, 09:13 AM   #93
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Originally Posted by Fundguy1 View Post
Agree to disagree on that. I had real pain from a car accident with real injuries and was refused pain meds from multiple docs because they said it probably wasn't that bad. I have 3 herniated discs in my neck from breaking a windshield with my head as a passenger in a taxi during an accident. Concussion, 6 months physical therapy, and had to endure nagging neck pain for a year without meds as a result.
I heard florida has change drastically and went from the mecca of prescribing to undeserving those is real pain because of fear from the state and dea.
My wife is in pain MGMT and i could tell you more but I honestly fear the state or dea will find this thread and use it to hurt my family even though she does everything by the book and is a conservative prescriber. the world we live in
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      03-25-2016, 09:15 AM   #94
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      03-25-2016, 09:17 AM   #95
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There is still tons of access. Certain states or chains may be decreasing finally but not out west. The majority of people I counsel about meds report they have been on pain meds 5,10,20 years. Uncalled for in any circumstances. You should bee dead if you needed pain meds for that long and problem solved.
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      03-25-2016, 09:55 AM   #96
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Quote:
Originally Posted by 1MOREMOD View Post
There is still tons of access. Certain states or chains may be decreasing finally but not out west. The majority of people I counsel about meds report they have been on pain meds 5,10,20 years. Uncalled for in any circumstances. You should bee dead if you needed pain meds for that long and problem solved.
not true. I cant count on my hands and feet how many people i konw that have had chronic pain for 20 years or more. Most from back injuries that never healed properly or have progressed worse and worse over the years. Most these people also would not be able to function if they did not have the pain meds, but not from the withdraws, but because their pain is so bad. I havent made it to that point myself, but I do have chronic pain from several fractured vertabrae 10 years ago, and i can imagine once i get into my 40s/50s, i will no longer want to deal with the pain and get some painkillers for it (only 28 currently). As it is now, there are days i cant get out of bed, but i do have left over painkillers from past surgeries that help me function throughout the day when that happens.

Sure, maybe 100yrs + ago, these people would have died because there was nothing that would work for the pain and they would eventually waste away, but with todays medicine, they can actually live.
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      03-25-2016, 11:12 AM   #97
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I meant the conditions those drugs were prescribed for in the past were terminal. Now people take them for all sorts of lesser maladies. Once the medication is being taken routinely not in relation to pain level but because of perceived need it's an addiction problem not a pain problem. Same goes for sleep meds, ulcer meds allergies and so on. The industry want yout to take a pill for everything and are succeeding.
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      03-25-2016, 11:14 AM   #98
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No problem for terminal patients. But others are and should be carefully scrutinized.
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      03-25-2016, 12:15 PM   #99
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Quote:
Originally Posted by 1MOREMOD
I meant the conditions those drugs were prescribed for in the past were terminal. Now people take them for all sorts of lesser maladies. Once the medication is being taken routinely not in relation to pain level but because of perceived need it's an addiction problem not a pain problem. Same goes for sleep meds, ulcer meds allergies and so on. The industry want yout to take a pill for everything and are succeeding.
I agree with that statement and pain killers should be short term measure for relief for acute pain, but pain is subjective And if you talk to anyone in real pain they need their meds to get out of bed and lead a productive life with their medication. Pain mgmt is a real field and the last step in the treatment plan is an narcotic based ( should be anyhow, there are bad apples in every profession)
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      03-25-2016, 12:23 PM   #100
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Again, I'm not talking about bad apples. Same thing applies for antibiotics. When a pt comes to see a doctor they want to feel they got something out of it. Easiest is a pill. Antibiotics have been known to be used needlessly causing resistance but it still happens with almost every doctor. They give it anyways to appease the client just like pain killers. It's a much harder conversation to explain and withhold, most don't.
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      03-26-2016, 10:11 AM   #101
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Quote:
Originally Posted by 1MOREMOD
Again, I'm not talking about bad apples. Same thing applies for antibiotics. When a pt comes to see a doctor they want to feel they got something out of it. Easiest is a pill. Antibiotics have been known to be used needlessly causing resistance but it still happens with almost every doctor. They give it anyways to appease the client just like pain killers. It's a much harder conversation to explain and withhold, most don't.
Speaking of that... I was talking to a guy a few months back who thought he was getting the flu. He was headed to his local Hispanic supermarket to get a few antibiotic capsules to help him feel better. When I asked if he had seen a doc and gotten a prescription, he said you don't need that - they all sell antibiotics under the table. In Mexico you don't need any prescriptions, and the grocers being them back over the border and sell them here.

So all this "germ immunity/antibiotic reduction" the US healthcare community is pursuing is pretty much in vain. No wonder we are seeing drug-resistant TB, gonorrhea, etc. coming up from Mexico and Latin America.
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      03-28-2016, 07:13 AM   #102
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I work in the pain space and most of the problems with opiate based medications are only caused by about 5%-7% of the physicians and a similar percentage of patients. Numerically, most of the opiate based pain medications are prescribed by about 3000 physicians in the entire US.

The actual facts are that almost no GPs and very few IMs will prescribe opiates on a regular basis. As Fundguy1 said, it is actually not the DEA that causes problems for the prescribers, it is the state medical boards. The DEA cooperates with the state medical boards but mostly it works on the pharmacy side. This is where the big fish are. They look for variance in the number of prescriptions filled based on the pharmacies own data as well as by balancing that data relative to pharmacies located in similar demographic areas. If pharmacy A has a core population of 25,000 users and goes through 1,000 opiate pills per month but pharmacy B which also has a core population of 25,000 patients goes through 14,000 opiate pills per month, pharmacy B will have some explaining to do.

In the last 6 months in my part of the country over 20 pharmacies and about 16 physicians were rung-up for opiate abuse. In one instance of which I have direct knowledge, the physician was charged because an FNP went nuts with the script pad.

Another tactic employed by the users is to seek a physician near a state border and have the script filled as many as 8-10 times by crossing the borders and targeting mom-and-pop pharmacies for filling.

I won't address the illegal drug component of this conversation because the restriction of opiates HAS increased the number of heroin and meth seekers and this is only the tip of the iceberg. It will only get worse.

Cheers-mk

Here is a quick read on the problem.

https://www.drugabuse.gov/about-nida...ion-drug-abuse

Last edited by MKSixer; 03-28-2016 at 07:19 AM..
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      03-28-2016, 08:41 AM   #103
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Problem with that plan for pharmacies is it doesn't look at the demographics for the area each pharmacy is in. Different types of people have different needs. What if there is a pain clinic right by a pharmacy? This is a real problem for some pharmacies who get put on watch list without reason.
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      03-28-2016, 09:12 AM   #104
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Quote:
Originally Posted by 1MOREMOD View Post
Problem with that plan for pharmacies is it doesn't look at the demographics for the area each pharmacy is in. Different types of people have different needs. What if there is a pain clinic right by a pharmacy? This is a real problem for some pharmacies who get put on watch list without reason.
There just needs to be more active investigation of docs and pharmacies. That's a simple task next to illegal smuggling of hard drugs. There's records, licenses, signatures. I don't see cartels having any of those.
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      03-28-2016, 05:07 PM   #105
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Quote:
Originally Posted by 1MOREMOD View Post
Problem with that plan for pharmacies is it doesn't look at the demographics for the area each pharmacy is in. Different types of people have different needs. What if there is a pain clinic right by a pharmacy? This is a real problem for some pharmacies who get put on watch list without reason.
I'm not defending the policy, just stating what happens. Physicians have been placed in a nearly untenable position needing to balance the needs of the patients with the regulations, and now...fear of enforcement action.

And just to be clear, I'm not advocating for law enforcement or regulatory bodies...I'm industry.

Cheers-mk
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      03-28-2016, 05:08 PM   #106
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Pharmacists also
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      03-28-2016, 05:40 PM   #107
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Some of my best friends are pharmacists.

Retail, Managed Care, or Managed Markets (pharma industry)?
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      03-28-2016, 06:44 PM   #108
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Mostly retail, I do contract work. So you're saying you have weird friends?
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      03-28-2016, 07:07 PM   #109
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Is the Pope Catholic?
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      03-28-2016, 07:15 PM   #110
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Quote:
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There just needs to be more active investigation of docs and pharmacies. That's a simple task next to illegal smuggling of hard drugs. There's records, licenses, signatures. I don't see cartels having any of those.
Legitimate investigations, yes. Witch hunts, no. Again, physicians and pharmacists should not be subjected to a, 'shoot first then ask questions'...'guilty until proven innocent' mindset by state regulatory bodies.
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