they are at it again.. FDA

[Pharmacist.steve]

http://money.cnn.com/news/newsfeeds/articles/djf500/200902091424DOWJONESDJONLINE000480_FORTUNE5.htm

IMO... they are targeting mod/severe chronic pain patients.. since short acting opiates are EXEMPT

Maybe they figure that since all/most of the short acting have Tylenol/APAP in them.. that if people abuse them .. they will do their liver in from huge dose of APAP and won't have to arrest them... jail them... or deal with in after a while... Pretty inexpensive solution???

[Mark N]

Steve, although I hate to see their nose under the tent, I have seen cases reported where dentist and doctors are using our meds for inappropriate reasons. It is disappointing to see that some of our doctors and dentist are so uneducated and causing so much problems with our meds.

[hoops2u]

Steve,
I haven't written to you for so long. I was doing really good since I took myself completely off Neurontin. I felt like a new person.

I have started a new thread regarding these enormous "hot flashes" that are not menopause. I had the same problem when on neurontin plus a huge miriad of other side effects.

Now however I have been having the hot/sweaty moments again and it is exceedingly uncomfortable. Have to keep heat set at 62, so most people freeze at my place.

I was wondering if you would mail me at my email so that I can reply with a list of my meds, doses etc. to ascertain if there is something in that mixture contributing to this severe discomfort?

I have requested the same of my pharmacist well over a month ago. She said to give her a couple of weeks to get everything together and she would be more than happy to help. She claims to have done this for others and is quite comfortable with the request, but is very busy, so I must bear or bare with her. She hasn't had the time yet, but says she is working on it.

Would you care to take a stab at it off the record? That is, I certainly wouldn't hold YOU to anything, but it might give me an insight into the cause. Especially since I had gotten rid of the abberant reaction a long time ago and was free of it for a good while.

Thank you so much. I do VALUE your opinion.....
hoops

[Boxerlover]

What bothers me is what is NOT being said. It sounds all and good, like are there really docs out there giving patches to sprained ankles or did this person have some chronic ankle issue that caused pain?

Melissa

[puppybreath]

What more can they do to make it more challenging than it already is to get pain relief? Maybe they feel threatened now that Obama is in office. His stance is more relaxed than past presidents.(*peace IMHO it's about time)
Isn't the DEA already doing that job?

[Nana4&cntn]

It seems that if someone is in the news for illegally using a prescribed med the DEA jumps way too high in trying to fix the problem.

Any PM worth his salt isn't going to prescribe meds to someone they consider a risk of abuse.

We as Chronic pain parients seem to take it in the shorts (so to say)because some PM's get nervous because the FED's are playing Doctor again. I wish they could live a week or so in our shoes and see if they feel the same way. Every situation is different, and yes no doc should be prescribing Fentanyl Patches for sprained ankles, that is poor judgement on the doc's part.

This is me throwing my hands up and praying someone has some sense with this issue.

This is the rantings of a person with a temp of 102.4, please disregard if it makes no sense.

[Boxerlover]

Hey Dr. Steve I was thinking about all this and I got curious about something. At my appointment the other day when my husband asked what they do about prescribing pain meds he said that none of the docs there do anymore and refer to pain management. What I was wondering about has the number of scheduled meds gone up, down or stayed about the same since most docs are now refering to pain management? Is there a way to find this out? It would be interesting to know.

Thanks
Melissa

[lobelsteve]

Hey Dr. Steve I was thinking about all this and I got curious about something. At my appointment the other day when my husband asked what they do about prescribing pain meds he said that none of the docs there do anymore and refer to pain management. What I was wondering about has the number of scheduled meds gone up, down or stayed about the same since most docs are now refering to pain management? Is there a way to find this out? It would be interesting to know.

Thanks
Melissa

No real changes. The problem with the current schedules is that the science was not there in 1973 (I think it was 73) when the DEA made up the scheduling. So drugs like hydrocodone, oxycodone, and morphine which are all roughly equi-analgesic on a mg per mg basis- are not in the same schedule. This has led to rampant abuse of hydrocodone becuase it could get called in and no hard copy Rx is needed. Til this day I have never seen any data to suggest certain meds are more likely to promote abuse or addiction. I think all opioids should be Schedule II with codeine as the sole exception due to its clear lack of potency. I do not consider tramadol an opioid because its binding affinity to the mu opioid receptor is 1/6000 that of morphine. Darvocet will hopefully be off the market and should not be included. Methadone and Demerol can stay on the market but be restricted (owing to their risk profiles for bad things happening outside of abuse/addiction issues).

Most docs would rather not Rx opioids for a few reasons. The evidence supporting their use is present, but weak. The medications while excellent for acute pain, become much less effective for chronic pain- most chonic pain patients should expect 20% relief of their pain from opioids- no matter what dose. Most of the folks on more than 100mg of opioid per day have a psychological overlay and are between getting good relief from the opioid and being "chemical copers". This is another reason the PCP should not have to deal with opioids. It may take a little old lady 240mg Oxycontin and 120mg oxycodone every day, just to get to her 3 meals and bingo at the nursing home. Abuse issues are non-existent as the meds are administered by nursing. The PCP should not have to fear the legal and regulatory hassles of this while the pain doc is adequately trained to monitor the medications for these patients. It's akin to Oncology and chemo, or Rheumatology and immune suppressants. Certain meds should have certain doctors keeping track of things.

[Boxerlover]

Thanks Dr. Steve

Pharmacist Steve, OOPS!! Sorry, got my steves mixed up and thought Dr. Steve started the thread:o:o:o. I should have asked my question with a new thread!:o

Melissa